Occasions arise when it feels opportune to look back see where the psychoanalytic trail began and where it has led. I have been in the field for now 30 years and, like many others, have seen my share of the theoretical controversies that seemed at times to consume us. At the outset, it is unquestionably true that we have benefitted enormously from the transformations in theory and technique that, starting with Freud himself and moving through Klein, Winnicott, Jacobsen, Shaffer, Bion, Ogden and others, have shifted and re-centered the psychoanalytic enterprise. But I am of two minds about change: on the one hand it is inevitable and almost invariably represents an advance in our understanding, on the other it can equally serve the ever-present tendency in human beings to discard and ultimately forget/repress crucial ideas.
In the tradition of Charles Brenner, I want at the outset to lay out my central argument which is this: I suggest it is time that we enlarge on Freud’s concept of a complemental series, e.g. that any observable mental phenomenon is the result of not one or even two or three factors but rather always represents an amalgam of multiple influences. An optimal psychoanalytic understanding in my view encompasses contributions from these multiple perspectives: the experience of the body, the genetic complement, the vicissitudes of each individual’s instinctual expression, the nature of early object relations and attachment, the subsequent effects of trauma and life dislocation, not to mention specific historical and cultural settings all of which are additive and influence each other. Each of these elements can importantly bear on symptom expression, ego efficiency, capacities for growth and ultimately therapeutic success. One example I have in mind is from the Case of Little Hans. (Freud, 1964). Hans’s ability to overcome his castration anxiety and horse phobia can be appreciated in significant measure as due to a fundamental loving experience with his fantasied threatening and castrating father. Another kind of object relation, one more tinged with actual frustration fear or hate, might well have forestalled any such clinical gains.
Unfortunately, this composite rich psychoanalytic view remains largely an ideal and surprisingly controversial. Instead of adding to Rangel’s psychoanalytical ‘trunk’, a newer generation of analysts appear anxious to hew off key older psychoanalytic discoveries in favor of valuable but partial additions or solutions. This problem struck home with special clarity when, while teaching a dream course, we reviewed an article by Lewis Aron originally published in “Contemporary Psychoanalysis.” The article in 1989 entitled “Dreams, Narrative and the Psychoanalytic Method” advanced the premise that the manifesta dream could be used without recourse to associative work.
In this paper I will review that paper to underscore my premise. To reiterate how I began this paper: Aron’s central claim, that dream images can be richly useful in their manifest form, is undeniably true; however, his further questioning of the use of free associations and the related centrality of unconscious fantasy and memory are, to my mind, of great concern. My comments are not intended to criticize Dr. Aron, but his paper dramatically highlights a misguided shift away from traditional good dream work and the related potential theoretical pitfalls to which I allude.
So the paper begins:
I had a dream. You always write down dreams. This one is disgusting! I was in a restaurant and I ordered a certain dish made up of certain types of meats, delicacies, kidney, prosciutto sautéed in urine. I thought it was disgusting but they said try it and I did, and I liked it. I thought it was gruesome. I heard that dreams are wish fulfillments is that true? (Aron, 1989, p. 107)
The patient, Mrs. D, is described as an “attractive, married, woman in her early thirties” who, although described as “psychologically unsophisticated” had begun reading self-help books in the third year of her analysis. As an aside, one could wonder if such behavior represented a dissatisfaction with the ongoing analytic process.
I will for the moment skip the biographical information provided and jump to the main points of Dr. Aron’s article which I will briefly summarize. Dr. Aron points out the manifest content, like in many reported dreams, has a “clearly organized structure” in this case, one in which this woman is being told to “do something” or to “swallow something” and finding herself disgusted but enjoying it.
Then begins a long exposition of the role of dreams in psychoanalysis specifically challenging Freud’s insistence on the need for free association to grasp the dream’s “real” meaning as opposed to one suggested by its actual oneiric images. Dr. Aron goes through a brief history of psychoanalytic thinkers including Jung, Erickson, Kohut and Sullivan who saw meaning in the manifest dream and, to a varying degree, felt that free association was unhelpful. In Dr. Aron’s view Freud’s insistence on ignoring the manifest dream and extolling the use of free association sprang from his theoretical need to preserve the distinction between primary and secondary process thinking, between unconscious and conscious themes. As Dr. Aron puts it: “Thus manifest hides latent, conscious conceals unconscious, surface buries the depths, defense distorts wish, present reenacts the past.” (Aron p. 113)
Freud viewed the dream as key to unearthing the “buried, repressed, infantile, sexual” past which in his view was crucial in resolving neurotic conflict. Dr. Aron correctly points out that many contemporary analysts have challenged both this view of the dream’s value as well as this theoretical formulation. The dream is now appreciated by many analysts, not as a “royal road” to the unmasking of disguised satisfaction of infantile wishes but as a form of thinking which serves important adaptive, regulatory and organizing functions. He quotes Sullivan who saw the dream as “a relatively valid parataxic operation for the relief of insoluble problems of living.” (Aron 117). In this light, the manifest content can thus be appreciated as a mental creation by itself and the analyst can use it therapeutically without the need for a “translation” via the patient’s associations.
Dr. Aron goes on to rightly to demonstrate how a classical psychoanalytic approach to the dream seriously limits what can be gleaned from the manifest dream. These include a number of important themes other than the genetic pathologic past, namely the state of the self, the competence of the ego, the nature of central compromise formations, the current core life issues, the active transference valence and even the progress of treatment. I could not be more in agreement with such a stance and it rightly highlights how the rethinking of ideas can generate new lines of inquiry. Such information constitutes valuable “branches” of a psychoanalytic process and, depending on the clinical situation, each can and should be pursued with the anticipation of real clinical value.
While Dr. Aron stops short of endorsing the complete abandonment of free association and “the deemphasis of the role of psychic conflict that often accompanies this shift,” (Aron 119) he almost immediately he goes on to extol his own version of pars par toto. In his view what is therapeutic or mutagenic is not the discovery and emotional elaboration of a traumatic past but rather that what matters is the construction of a life-narrative. He argues that psychoanalysis is best understood as a hermeneutic discipline in which the analyst helps the patient construct a self-consistent, coherent and comprehensive story of his life. (Aron p.119)
I will reiterate my sentiment that there are many valuable points in Aron’s article. As already mentioned, I strongly concur that the manifest dream offers a wealth of information beyond the sexual and aggressive fantasies of the infantile past, especially a picture of the self-image and the transference. I would further agree that in any successful analysis an increasingly genuine life narrative does indeed emerge. But in my view at no point is a patient or an analyst, except maybe in the setting of termination, ever in the privileged position to grasp the whole truth of a person’s psychic life to construct such a narrative. It is just for that very reason, that psychoanalysis has relied on free association to help the dyad discover the patient’s genuine understanding of his or her world. That we might, at one point or another, know more than the patient, prompting a clarification or even an interpretation, has forever been the “bread and butter” of our work but to offer anything more to a patient is an overreach no matter how compelling or seamless the narrative might appear. But the danger in this new perspective is far more than a case of an over-imaginative analyst. In extolling the creation of a life-story, Dr. Aron runs the risk of dispensing with the effects of history, whether in fantasy or reality, as central to the development of conflict and mental distress. Here I would remind the reader that it was in the “chimney-sweeping” of a patient’s repressed past, it’s veritable “trunk,” that psychoanalysis was born and in my view, continues to thrive.
I want now to turn to the dream. The current situation was that his patient was looking for a job and “outraged” that interviewers were concerned about her possible pregnancy. She reported that she had trouble talking with her husband and spontaneously mentioned it was “similar to her communication with her mother.” Both these themes found significant reverberations in the transference and I will return to them later. Associations to the dream led to the frying pan being Teflon. My own fantasy to her association “Teflon,” in the setting of her having been referred by Dr. Aron to a marital therapist, suggested that perhaps Mrs. D. experienced her conflicts as “slid sideways” by the referral. The patient was experiencing difficulties in her marriage; her husband wanted children and refused to accede to birth control which Aron takes as the central explanation for their having had little sex. However, when asked about the organ meats in the dream, she indicates that she finds oral sex “distasteful and disgusting” but knows her husband secretly enjoys this, strongly implying that their sexual difficulties were grounded in a more intrapsychic realm. The patient concludes: “I’m not doing what everyone else does, I’m not a connoisseur.” (Aron p. 121)
Dr. Aron asks Mrs. D if he is the waiter in the “white coat” and internally he questions if he has secretly been pushing his own agenda that she should come to feel that “oral sex, men, babies, pregnancy are not so bad.” He wonders with her if she feels that he and the marital counselor are together trying to convince her to do “disgusting things,” and thus outraged, she could “feel justified in returning to her mother and her mother’s views of men.” All of this seems quite likely and clinically valuable, but very “here and now.” I would like to underscore that in Dr. Aron’s enthusiasm for the shiny new concept of “narrative,” he appears to have abrogated the role of Mrs. D’s actual life history as a central causation for her problems. In the paragraphs that remain there appears to be no effort exerted to consider how her actual history might have contributed to the development of her unconscious fantasies that would shed light on this woman’s disgust for sex, refusal to have a child and critical attitude towards her husband.
I will now circle back to autobiographical details which, as I alluded to at the beginning, I had deliberately omitted. Mother is described as a “strict puritanical rigid Catholic”; younger sister is reported to have dropped out of college “following a dramatic suicide attempt” and mother spends most of her time caring for this child at home. While her husband has wanted children, the patient has reportedly had three “accidental” [Dr. Aron’s quotes] pregnancies all terminated by abortion. (Aron, pgs 108-109) Just from these few details, one might wonder about the effect of an ambivalent maternal relationship, intense sibling envy, and even some unconscious murderous fantasies involving pregnancy and children. But to proceed: father is described as an alcoholic “prone to physically abuse her brothers and to sexually abuse her. While the specifics of the sexual abuse remain unclear there now seems little doubt that she was repeatedly abused between the ages of five and eight.” (Aron, p.108).
I will leave it to the reader to see potential links from the manifest reported dream to a host of potential latent dream thoughts but I would contend that the psychological significance of the Oedipal drama, intertwined with known ongoing sexual abuse, embedded in this particular life story, cannot be ignored if there is to be a comprehensive attempt to understand Mrs. D’s conflicts over sex, children, men and women. I say women because asI processed this material, although this needs investigation and confirmation, I would wonder if, despite her mother being portrayed as “strict and puritanical,” she likely was aware of, tolerated, and possibly even encouraged, her husband’s activity. As I read this paper, I wondered about unconscious repetition of the dyads of mother and father and Aron and his marital therapist colleague. Early in the article Dr Aron adds that the tension between pleasure and abhorrence apparent in the dream was something that he had noted from the transference-countertransference. To my ear, I wondered whether his well-intentioned efforts to urge her to have babies and enjoy sex could unconsciously have been experienced as manipulative and seductive, a reproduced piece of the known traumatic past.
Again, I want to reiterate that I do not mean to disparage Dr. Aron or his approach. In Aron’s defense, he may well have worked at length around the issues of Mrs. D’s childhood but simply chosen to leave references to that work out of the paper. But when Dr. Aron writes that “For Freudians things are never as they seem” and that “the surface is…a deception covering a deeper buried core truth” this is because we have ample evidence that this is frequently, if not universally, the case.
Speaking of an uncomfortable and overlooked “truth,” one final comment about Ms. D and her dream: some part of this woman’s difficulties lies in an unconscious murderousness manifested in the killing of three of her unborn children. Every woman is allowed “a Mulligan” not three. Whether this fetus represents her brothers, her hated and envied sister, the product of her fantasied incestuous union with her father is anyone’s guess but represents a deep reservoir of sado-masochism, is probably central in this woman’s reluctance to consider starting a family and unanalyzed, represents an ongoing risk to her marriage and personal happiness.
I certainly do not think our analytic “tree” is complete. Even the role of the recovery of pathogenic memories needs elucidation. It was Freud’s view that lifting of repression, by itself, constitutes the main therapeutic task; a view with which I do not concur. My thoughts are closer to those of Franz Alexander’s when he wrote that “whenever a patient is able to recollect a forgotten infantile situation this will always take place when he is able to face a repressed tendency directed towards a person who pays an important role in his actual life.” (Alexander, 1940, p. 12) This formulation, of course, highlights that the door to a conflicted and forgotten past is embedded in both free association and the transference-countertransference experience.
In conclusion: every psychoanalyst with ambition and curiosity like Aron, has the same dream. We are all potential psychoanalytic “mothers” eager to outdo the master and desirous of birthing an all-encompassing theory that, not unlike in physics, can “explain everything.” But unlike their effort, which is anchored in new and better data, we are always at risk of throwing the old psychoanalytic “baby” that we labored to bear out with the bath water in our thrall with the next arrival. This is a mistake that casts on us needless discredit. There is a place for instinct theory, a place for the effect of having a certain kind of body, a place for theories of mind grounded in a search for instinctual satisfaction which can comfortably complement one highlighting the effects of projective identification, “good-enough mothering,” or affective attunement, a place to consider the effects of a childhood marked by trauma or by security, or those of a larger culture that is affirming or condemning. No one theory encompasses what we see in the office; yet they all play a role in our total view of the patient and the commingling of these multiple psychoanalytic perspectives offers unparalleled opportunity to understand our patients and help them in growth and recovery. It remains for us as psychoanalysts to tackle the complex task to see where when how and with whom such differing perspectives “fit” or are seemingly “at odds.” This is how we learn and we must be welcoming to new perspectives that complement what we already know.
But at the core of our effort, the trunk of our psychoanalytic tree, there is I believe, a de facto assumption at work: people fall ill finally as part of what actually or, at least in fantasy, happened to them. To do psychoanalytic work, I believe we are first and foremost all historians and must eek the unadorned truth of our own lives and those of our patients. In that effort there is grace, beauty, hope and the possibility of psychic recovery.
Aron, L. (1989). Dreams, Narrative and the Psychoanalytic Method. Contemp. Psychoanal., 25, 108–126.
Freud, S. (1964). The Standard Edition of the Complete Psychological Works of Sigmund Freud: Vol. Vol 5. Hogarth Press and the Institute of Psycho-Analysis.