The Collapse of the Self and its Therapeutic Restoration (Book Review)

Author:  Kainer, Rochelle G. K.
Publisher: Hillsdale, NJ: The Analytic Press, 1999
Reviewed By: David L Downing, Winter 2004, pp. 60-62

This is a rare book of synthetic, integrative elegance; one that is bound to become an important touchstone for those interested in theory as well as clinical practice. It is, on one level, disarmingly accessible in its compositional style, phrasing, and tone. This, however, belies the clear need for the reader to be quite conversant with a multiplicity of psychoanalytic theories and perspectives. As such, it challenges the reader to step beyond and outside of one’s cherished sectors of comfort. Dr Rochelle Kainer has been able to find points of concordance among a variety of psychoanalytic schools of thought—and that is rare. In this respect, the reader necessarily becomes a learner. While this might sound like enough of a given for anyone purchasing a book—let alone as a unique strength—I am not at all convinced that this is so. I suspect that many times we select from a more limited array of authors or subject categories that may enable us to deepen our knowledge base within a particular domain, rather than experience the discomfiting sense of dislocation that accompanies the sojourner afoot in uncharted terrains.

Additionally, Dr. Kainer asserts/inserts her abiding regard for, and knowledge of, the arts and literature, as a leitmotif for the book. In particular, her connection with Dada and Surrealism resonates harmoniously with the psychoanalytic enterprise as she locates it, whether intrapsychically, intersubjectively, or within the culture-at-large; the latter consisting of the mythic elaborations that are literary, artistic, and filmic representations of intrapsychic dilemmas.

The book is well organized into three related, progressive dialogues. Part I: Creating the Self explicates Dr. Kainer’s abiding fascination with the building up of self-structures, and processes that may enfeeble this process. Here, as in other sections of the book, her appreciation for Freud, and the privileging of a dynamic unconscious, is evident. This is a singularly important corrective to a trend or movement within psychoanalysis away from latent processes and derivative communications to a concern with more manifest material. This has led to a more concretized psychoanalysis at times; a preoccupation with matters of technique; a curious focus on self-disclosure, often times asserted as a salutary emollient to the psychoanalytic endeavor and an exemplar of two-person democratization of an heretofore elitist and all-too-authoritarian form of psychotherapeutic discourse. Additionally, the political elements of psychoanalysis are often expressed, obliquely, through such pathways, to the detriment of furthering true engagement with the ostensible objects of psychoanalytic enquiry (for a rich and elaborated exposition on this and other more purely theoretical matters, see Christopher Bollas’s The Mystery of Things). Thus, in the first section of Dr Kainer’s book, we have an exceedingly perspicacious delineation of identificatory processes, and their vicissitudes as articulated by Freud, Klein, Fairbairn, and Kohut. Presaging things to come, pathological vicissitudes of identification are delineated, as is the transformation of love into hate.

Here, I think, Dr. Kainer might well have incorporated the work of Winnicott (1947, 1969) into her discussion, especially the importance of the survival of the object following the ruthless attacks upon it by the infant. The object’s survival as a consistent, dependable, unchanged, non-retaliatory entity despite such hating enables the infant to truly believe in his/her capacity to love and be loved for who and what he/she truly is. This also accords with such central themes of Klein’s work as the depressive and paranoid/schizoid positions, so well articulated by the author; as well as the tension arc/dialectic of hate/envy and love/guilt/reparation.

Dr. Kainer’s exposition of her fascination with the novel by the Japanese author, Junichero Tanazaki, The Makioka Sisters, splices her clear passion for applied psychoanalytic studies with the central theses of The Collapse of the Self in a not very straightforward manner. In fact, it is for this reason that I had to re-read this chapter more than once in order to try and understand the author’s potential rationale for including it. While efforts are clearly made to highlight themes of study that had been articulated earlier, such as The Ideal Self, Idealization, maternal and paternal registers, etc., I came to realize that these were offerings meant to keep the book on track. In reality, I suspect that this chapter is, in fact, the real crux of the biscuit. Using the artistic “found object” of Marcel Duchamp and the Dadaists as a metaphor of self-discovery, and the realization of one’s own idiomatic way of being, Dr. Kainer underscores, in a most politic manner, the truly idiosyncratic fashion in which each of us “finds” psychoanalysis—and ourselves as authored by it. It is in this respect that we idiomatically (re)construct this as a discourse of healing, identification, embodiment of Ideals, fulfill our own (un)conscious desires, and so forth. Here, Dr. Kainer reminds us of the self-analysis that Freud undertook, as well as such papers as Harry Guntrip’s commentary on his psychoanalyses with W.R.D. Fairbairn (1975), and Margaret Little’s psychoanalysis with D.W. Winnicott (1990).

At a time when we are inundated with articles and books that offer technique-based, programmed and manualized, reductive, industrialized, and commodified treatments, such playfulness with psychoanalytic concepts and their elusive applications to treatment is utterly refreshing–and necessary, if there is to be something called psychoanalysis in the culture. While not a Surrealist as such, the author correctly positions the artist, of various persuasions, as a kindred spirit. As such, this is a helpful reminder as to the position of the psychoanalyst: to the host culture, to the analysand, to the psychoanalytic situation, and to the very Self. Essentially, we occupy a liminal position in, but not of, whatever context we are in relation to. In this respect, immersing ourselves in literary, filmic, and other artistic domains can be a source of enrichment for our clinical selves/work—as well as intrinsically fulfilling for those of us choosing/finding a profession that holds such potential for the judicious, non-exploitative application of one’s creative processes. For us, there can be no sacred cows. This echoes John Friedman’s (1998) evocative declination regarding the psychoanalyst’s loving attitude toward one’s patients. Friedman notes that it was Freud’s devotion to understanding his patients and, especially, understanding the unconscious of his patients that epitomized his work and relation to the people that sought him out. To adopt other potential positions may well lead to (re)enacting something untoward with the patient, transferentially, and/or counter-transferentially.

The next sections of the book would likely fall on happier eyes. Part II: The Collapse of the Self, and Part III: The Therapeutic Restoration of the Self, in which Dr. Kainer articulates her at once integrative and unique perspective on understanding and treating primitive mental states. She also models for us the ethics of working with current and former patients around extremely sensitive clinical material meant for presentation at professional gatherings, as well as publication in the professional press. Her vignettes are carefully framed and contextualized with respect to her own efforts to understand each particular patient, and displays how each patient may create his/her own psychoanalysis, even though the psychoanalyst is ostensibly the same. We are privileged to gain some measure of admittance to Dr. Kaiser’s own idiom, and see an experienced, gifted, theoretician and clinician struggle with the multitudinous array of data and information that must be registered, and note her own indebtedness to historical and contemporary figures in psychoanalysis that enable her to keep her moorings, and not be swayed under pressure into some form of gratifying, seductive, or aggressive enactment—usually.
It is, once more, a noteworthy feature of this work that the author includes examples of her ruptures in empathy, and fairly detailed/explicit renderings of her often-times quite inadvertent slippage into the analysand’s own repetition compulsion.

Her self-analysis of these clinical moments (in some cases, fairly detailed expositions of the totalistic treatment) is, however, bounded within a frame of understanding the treatment context, and, ultimately and especially, the meanings for the treatment and for the patient. These explorations are quite honest, and being in print as they are, quite courageous. What is perhaps most laudable, however, is Dr. Kainer’s ability to avoid the more gratuitous, self-revelatory expression of her perspective and subjectivity. This hearkens back to Freud’s sage advisement that we do not make the patient privy to our own neurotic processes or need structures. The practice of psychoanalysis is difficult and, narcissistically, it can yield a peculiar form of emotional depletion. To desire to be known and to be seen for “who we really are” can potentially be a powerful allure, especially as it is our fate to remain as essentially Other for our patients—constructed and de-constructed within the transference without regard for the reality pressures that are increasingly impinging upon psychoanalytic treatment from without; and pressures to “be real” with the analysand that are emanating at times from within the psychoanalytic movement. Managing such a balance, as Dr. Kainer seems able to accomplish, requires what I would term “The psychoanalyst’s capacity to be alone” (Downing, 1998). Not only self-awareness, on-going self-analysis or consultation, etc., but self-care, enables one to metaphorically hold such characterologically enfeebled patients as Dr. Kainer treats across the time requisite to effect some modicum of psychotherapeutic change.

Working with more disturbed patients, however professionally successful many of them have evidently been, has become an increasing part of the everyday work of all psychoanalysts, if perusals of journals, and professional conference offerings are any indication. On this front too, Dr. Kainer’s book will be of immense value to any reader. Drawing upon the work of the British object relations schools, she notes that many of these patients have no moorings in the mind or mindfulness of the mothering one. Such a loss is nothing short of catastrophic, and she offers rich exposition on these fronts. Here, I believe that her discourse could have benefited from greater inclusion of the perspective of Lacan. In the sense of being lost to the mind of the Other, the question becomes one of the patient’s having perhaps failed to enter the register of the Symbolic. Furthering a linkage with constructs that are briefly touched upon such as maternal and paternal orders (e.g., The Law of the Father) would certainly fulfill the integrative quality of this remarkable study, and are “ready-made” (another artistic term!) for inclusion in the author’s detailed rendering of the etiology and treatment of her patients’ psychopathological self-structures. Many of the patients she describes seemed to have developed highly somatisized and possibly perverse solutions to their early traumas, not surprisingly. She brings her understanding of “mindfulness” to bear, as well as autistic phenomena.

Additionally, Dr. Kainer’s focus on the oft-cited, but problematically rendered, concept of projective identification, is exceptionally well wrought. Locating more psychotic elements in the personality organization of otherwise neurotic individuals is also most pertinent, as matters of conceptualizing and otherwise assessing (if not “diagnosing”) a patient is vital to understanding the totalistic personality makeup. In the ongoing nature of assessment, by necessity, across the entirety of a treatment, her lucid depictions again are helpful to consider in light of possibly “under-” or “over-pathologizing” someone. Of special import here, is the care given over to bringing the work of Victor Tausk to the fore, and placing him, rightfully, in the position of prominence that he so deserves. His brilliant paper, initially published in 1919, “On the Origin of the ‘Influencing Machine’ in Schizophrenia,” was first resurrected for a more contemporary psychoanalytic audience by Paul Roazen, with the publication of his book about Tausk, Brother Animal. Roazen later edited a book of other of Tausk’s writings, including the paper on “The ‘influencing machine’” in Sexuality, War, & Schizophrenia: Collected Psychoanalytic Papers (1991). Kainer, like Roazen, points out that Tausk really was the first to discern how the process of identification was related to projection, and, “was the forerunner of Klein’s actual naming of the phenomenon and her expansion of it to a fully developed theory of the mind” (p. 138).

Especially relevant to our technology-obsessed times, this prescient paper is used to good advantage in a return to several of Dr Kainer’s major themes: identification, psychotic process, sexuality, a focus on the body in general, and aggression. Regarding the former, she asserts that this “comes from a powerful need for a shared identity...albeit in this case it is of a non-human and persecutory kind” (p. 139). Furthermore, “[t]he machine is also a metaphor for how a person who lacks sexual vitality gradually comes to feel: mechanical, robotic, and non-human. These catastrophic feelings are disavowed by being attributed to (projected onto) the external machine, but they are clearly also an attempt to make sense of one’s experience as well. The defensive function of evacuation exists together with a struggle to understand the incomprehensible” (p. 139).

As Dr. Kainer offers her reader a deep, abiding rendering of the complex nuances of psychoanalysis in a highly lucid manner, inviting us all the while to re-examine what we purport to “know,” it appears that she also is the rare scholar–theoretician who is able to offer such a rich, contained, therapeutic frame wherein the analysand may be afforded the space to access the mind that thinks them, or had thought them, and put words to inchoate murmurings. The author’s own clear regard for the teachings of her predecessors has an important and vital function in the parallels of the psychotherapeutic domain –connecting the past with the contemporary, and background with foreground. Her artistic sensibilities permit an openness to the influx of the nonlinear and a receptivity to the stuff of ostensible nonsense. This renders “what was” a place in the realm of the “is,” perhaps in creative, new, reconfigurations.

References

Bollas, C. (1999). The mystery of things. London: Routledge.
Downing, D.L. (1998). The psychoanalyst’s capacity to be alone: Working psychoanalytically in anti-psychoanalytical spaces. Paper presentation at the American Psychological Association, Division of Psychoanalysis (39). Boston, Massachusetts.
Friedman, J. (1998). The origins of self and identity: Living and dying in Freud’s psychoanalysis. Northvale, New Jersey: Jason Aronson Press.
Tausk, V. (1991). Sexuality, war, and schizophrenia: Collected psychoanalytic papers. Paul Roazen (Editor). New Brunswick, New Jersey: Transaction Publishers.
Winnicott, D.W. (1947). Hate in the counter-transference. In Through paediatrics to psychoanalysis, New York: Basic Books, pp. 194-203.
Winnicott, D.W. (1969). The use of an object and relating through identifications. In Playing and reality, New York: Routledge, pp. 65-85.

Reviewer Note

David L Downing is Director of Graduate Programs in Psychology and Associate Professor at the University of Indianapolis. He is the Treasurer of the International Federation for Psychoanalytic Education, and is the President of Section IV. He has written and presented on the treatment of primitive mental states, applied psychoanalysis, and psychoanalysis and the arts. He maintains a private practice in psychoanalysis and psychoanalytical psychotherapy in Chicago and Indianapolis.

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