Becoming Alive: Psychoanalysis and Vitality (Book Review)

Author:  LaMothe, Ryan
Publisher:  Routledge, 2005, Vol. 26 (2), pp. 49-51
Reviewed By:  Marilyn Newman Metzl, PhD

The Search for Authenticity in the Analytic Relationship

When asked to review Becoming Alive by Ryan LaMothe, I was unprepared for the journey that would ensue from the opening quotes to the final conclusion 165 pages later. The book was an exciting, enlivening and thought-provoking journey through the excellent and thoughtful eyes of LaMothe, a man of obvious integrity and intelligence. The many pages of references provided at the end of the book attest to LaMothe’s scholarship and curiosity in writing this treatise.

While reading the book I frequently envisioned Martin Dysart, the psychiatrist in Equus (1973), when he spoke eloquently of his realization that mental illness had energy, and debated the question of when and how to puncture psychotic fantasy. Peter Shaffer expressed envy at the ability of some people, termed psychotics, to fully engage in their delusional universe. In my psychoanalytic practice I treat a compulsive gambler who lost everything material that he owned in the world as the result of a single bet. While helping him learn to modify his impulsive behavior, I became aware of my own inner struggle and touches of envy—what would it be like to risk everything, even though risking everything would lead to potential disaster?

The question could be formulated as a struggle between Eros and Thanatos; between life and death, but which route is life and which death is open to question and interpretation. In my own life I chose to complete school, to seek psychoanalytic training, to raise a family, to develop a practice, and to participate in my professional associations, a life certainly filled with excitement, but different excitement compared to my patient’s crash and burn philosophy. In my heart, I know there is some awe of the patient’s ability to get to the edge of his quest and jump over. While not advocating sex, drugs, and rock and roll as a solution to life’s existential boredom, I understand the allure of “the apple.”

A common thread running throughout psychoanalysis has been the study of human suffering (p. 4). In Freud’s view, the instinct for survival, which is manifested by the formation of symptoms, takes precedence over the motivation for the pleasure of freedom (p. 8). LaMothe views this eclipse of potential space and the hyper-attention on survival, which accompanies a draining of aliveness from the self and relationships, to be a consequence of massive distrust, betrayal, and hopelessness (p. 142). The author proposes that trauma manifests as a wound in the psyche and finds that the most devastating and long-lasting traumas are not necessarily natural disasters (unless the natural disaster is followed by the failure of other human beings to care), but disasters of profound human betrayal. Since it is not possible to live in a world of distrust and betrayal, the victim finds little hope for repair, and evades life because this avoidance becomes a way of avoiding surrendering to death.

Becoming Alive celebrates the experience of being alive and questions the entire practice of diagnosing mental illness as a convenient illusion. The book can be considered a companion piece to the newly released guidebook, the Psychodynamic Diagnostic Manual (2006), which emphasizes the importance of understanding the individual personality patterns found in many people, and reserving diagnosis of full-blown disorders only to these natural variations when they become extreme. In the manual, the dimensions of human motivation, emotional pain, and the stories behind the symptoms are available for exploration, as opposed to the simplistic DSM view of persons as “symptoms” that require only diagnosis and medication or less intensive, behaviorally oriented talk therapy.

LaMothe, as well, feels that DSM categories and case reports are deadening when compared with the liveliness of a patient and the patient’s symptoms. In this book, he challenges everyone: cognitive behavioral treatments, DSM, the practice of psychiatry, postmodernism, and pharmacology, all of which come under the rapier vision of his commitment to being alive. However, LaMothe warns of the difficult journey that will follow the course of challenging conventional wisdom. The book offers a theory about varying experiences of being alive and their organization in human life. It is comprehensive and integrates data from psychoanalytic theory, infant-parent research and recent neurological perspectives of the brain (p.16). LaMothe hypothesizes that experiences of being alive link the mind, the body, and the other, with culture in an intricate dance. His stated intent was to utilize a variety of examples from clinical settings, culture, literature, and religion to illustrate his observation that couch and culture are inextricably connected, and that the patient and therapist’s aliveness or deadness, while shaped by the peculiarities of past family romances, are formed by the narratives and rituals of their respective cultures (p. 129). This book should be of interest to psychoanalysts, to all clinicians interested in theory, and to all teachers, philosophers, scholars, and people in related disciplines who are interested in pondering the question of why we are here and what difference it should make.

Chapter I addresses the question of vitality in psychoanalysis. The author claims that topics of passion and aliveness have been present since the beginning of psychoanalysis, provides an overview of psychoanalytic thinking, and identifies various attributes required for the celebration of being alive. LaMothe proposes that experiences of being alive during each phase of development depend upon maintaining a dialectical tension between generating and surrendering to experience (p. 19). LaMothe cautions that tragedy follows when individuals mistake theories and rituals for life itself, as substitutes for the experience of being alive (p. 28). He lays the groundwork for subsequent writings and discusses significant features of human development and potential, which he divides into four modes of organizing experience, which are embodied vitality, living objects, vital subjects, and enlivening stories.

The subsequent four chapters discuss those four modes and express varying modes of organizing experience: corporeal, taxonomic, symbolic, and narrative. The second portion of the book addresses the varying types of relationships that are part of the experience of relating, which he describes as contiguous, objective, subjective, and communal. Modes of organizing experience and the dynamic characteristics of potential space are presented as they pertain to the experience of being alive. The author states that in writing these chapters he has attempted to show both the developmental continuity and discontinuity of life by holding to the idea that the ingredients that make up experiences of vitality are present in each mode. In other words, when investigating varying theories of development, it becomes apparent that each theory is related to a progressive stage of development, and each stage is portrayed as possessing particular crises, obstacles, and achievements, yielding continuity in the space of cognitive and relational transformation.

An example cited in this work is Erikson’s first stage of trust vs. mistrust as a developmental challenge that parent and child must handle. The author proceeds to discuss the issue of trust and mistrust as continuous hurdles to be negotiated throughout one’s life. LaMothe feels that Erikson was attempting to demonstrate continuity even as new capacities, challenges, and virtues were emerging. He disagrees with Erikson’s formulation and argues that the necessary, interrelated ingredients for a sense of aliveness, which he characterizes as agency, emotional regulation, continuity, cohesion, and validation, are part of each phase of development, even though the manner in which we experience and understand each phase may be different. The argument is made that agency must be joined to a sense of freedom and spontaneity in order to experience the feeling of being alive, with the caution that agency is frequently defined in pop culture as a one-person theory indicating what “I” must do. LaMothe’s definition is broader and is taken from infant development: he argues that an infant has a rudimentary somatic agency, which becomes dynamically part of consciousness, rather than the more traditional depiction of agency that is subjective and inter-subjective. He concludes that agency, emotional regulation, continuity, cohesion, and validation have significantly different meanings given the mode of organizing experience.

The final chapter contains concluding thoughts on how this model of human experience alters traditional psychoanalytic views of trauma, which has a relationship to the repetition compulsion and regression. LaMothe proposes that a sense of deadness in human life is not simply the result of trauma but may be culturally dictated as well. To LaMothe, vitality is inextricably a part of life from birth to death (p. 185), and the slow and insidious foreclosure of potential space and draining away of vitality that the culture foments by the unrelenting pressure in contemporary society to conform to economic, political, religious, scientific and social pressures are agents for creating trauma and deadness in people and in society. La Mothe feels that psychoanalysis and conscious awareness have the power to challenge these pressures. He further explores how culture plays a role in the diminution of experiences of being alive, and concludes with thoughts on how theory shapes ones understanding of psychoanalytic goals and process. With the promise of more excellent writing, LaMothe informs us that he is thinking about a new book on the implications of his theory for understanding the unconscious through semiotics, and will explore the important ideas of transference and countertransference.

LaMothe’s interest in how we become alive, how we create ways to experience being alive together and how we find ways to avoid being alive together are provocative, thought provoking, and would be a wonderful tool for analytic groups to utilize in generating discussions of how to proceed in therapy. The vision of the patient coming for treatment and sharing life narratives with the analyst is examined in depth in this work. LaMothe sends forth the idea that he has learned as much from his patients as his patients have learned from him. His experience in interacting with people who “bravely survive” incredibly difficult and painful experiences and yet have the courage to give voice to their longing to be alive challenges us to look upon a patient, not as an anemic artifact in the DSM characterizations, but as a person yearning for a voice and a relationship in the larger drama and mystery of being alive.

References

American Psychiatric Association. (June 2000). DSM-IV-TR. Washington D.C.: American Psychiatric Publishing, 4th edition.
LaMothe, R. (2006). Becoming Alive: Psychoanalysis and Vitality. East Sussex, Great Britain: Routledge.
Alliance of Psychoanalytic Organizations. (2005). Psychodynamic Diagnostic Manual. Silver Spring, Maryland: Independent Publishing Group.
Shaffer, P. (1973). Equus. New York: Penguin Group

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