With Culture in Mind: Psychoanalytic Stories (Book Review)

Edited by:  Muriel Dimen
Publisher:  Routledge: New York and London
Reviewed By:  Vera Camden, Spring 2012, pp. 196

With Culture in Mind: Psychoanalytic Stories takes up the “constructed” nature of human identity through a series of “psychoanalytic stories,” culled from the practices of several analysts. Each essay is briefly introduced by editor Muriel Dimen and then discussed through general commentaries by Jessica Benjamin, Susie Orbach, and Andrew Samuels. Taken together, these essays and the reflections they generate draw much-needed attention to the place and power of culture within the psychoanalytic situation.

In her introduction, Dimen explains the origins of the volume in a psychoanalytic writing group whose one rule of interaction was to listen, empathize, and foster the voice and vision of each member. Emerging from this discipline, fortuitously, was a common intersection of interest. “From the members’ diversity grew a mutually agreeable form: essays locating the psychic and the social in a single clinical moment” (p.2). Indeed, this volume coherently and communally aims “to offer a new way of talking about the analyst’s struggle to grasp the patient’s internal life as voiced in relation to others in their political, social, and material contexts” (p.3). This triad of contexts comes alive through the riveting, sometimes radical, snapshots of analysts who work, precisely, with “culture in mind.”

As one would expect, Dimen and her contributors demonstrate facility with prominent cultural and psychoanalytic icons such as Jacques Lacan, Michel Foucault, and Louis Althusser, as well as contemporary theorists such as Jessica Benjamin and Judith Butler. What is unexpected, and most welcome, is how the contributors, by and large, demonstrate the clinical utility of these theorists. Concepts like “interpellation,” in which the individual is “called into being” through and into cultural discourse, become meaningful when put in terms of a patient’s efforts at “resignification,” whereby the “old enchainments” are endowed with “new meaning” in the course of psychoanalytic treatment. In the treatments represented by these pioneering analysts, the struggle for political and cultural liberation follows from an awareness of one’s “cultural unconscious.” These analysts who “keep culture in mind” rush in where so-called normative psychoanalysts have feared to tread; they show us a terrain that is rough and unmapped. The landscape they map is often as hidden from view as the world Freud paved with the “royal road” offered to him through dream work. If, that is, Freud opened up the unconscious of his patients by his odyssey through their dreams, and his own, so the analysts of this collection attempt to open up the “collective unconscious” of our cultural world. These writers admit that they often feel like strangers to this terrain, that they must learn to speak new languages, that they must turn back to find missed roadways, and that they might get lost, or need to ask for help. It is indeed this attitude of open exploration that makes the volume both useful and revelatory to the analyst reader: it allows for introspection into one’s own practice. The patterns and pressures depicted in these intimate, clinical narratives provide road maps to places one might have been, or might have wanted to be, in one’s own analytic practice and in one’s life.

Inevitably in such a collection, one will find in oneself a range of responses to the diversity of material generously offered in these intimate scenes from psychoanalysis. In what follows, I will offer my contrasting responses to two of the collected essays. The first essay, for me, exemplifies how powerful and filled with integrity clinical practice from within a cultural perspective can be. My second example, however, suggests that the analyst’s attempt to keep “culture in mind” may perhaps hamper her in keeping the patient in mind, potentially eclipsing the needs of the patient.

I. In the story of Li-An, who was “wounded by war,” Glenys Lobban, a New York psychoanalyst, narrates with admirable economy how her work with a Vietnamese immigrant to the United States impels, in countertransference, a confrontation with her personal memory. She illustrates how she must recognize the intergenerational transmission of trauma in her own family, mourning her own losses, before she can allow her Vietnamese-American patient a “resignification” of national and familial identity. Lobban’s attempt to discourage her young patient’s healing odyssey to Vietnam with her estranged father is, she realizes, mediated by a personal and cultural prejudice. She herself had accompanied her father, a World War II veteran, to the “scene of the crime” of his postwar amnesia: traumatic imprisonment in German camps in Egypt. Disappointed in this journey, Lobban remembers that hoped-for healing, the lifting of her father’s depression, did not occur. In a protective, overidentification with her patient, Lobban at first resists her patient’s pilgrimage to Vietnam, only to correct herself. She comes to recognize that Li-An and her family are rooted in a “non-Western philosophical model that emphasizes interdependent selves…community, forgiveness, and reparation. I was trying to impose the traditional psychoanalytic…notion…[of] the ‘normative independent self’”(p.28). I read this essay moved by this analyst’s honesty, by her capacity to reflect on and use her own countertransference to empathize with, yet differentiate from, her patient’s past, and thus ensure her hopeful future. I read this story cognizant of the ways the cultures of Vietnam and the United States are imbricated through the Vietnam War, and through the lens of my own childhood, spent, as it happens, in Southeast Asia. I felt anew that my cultural memory of these years has remained “unsignified” in myriad ways. Such recognitions may similarly emerge for other readers of Keeping Culture in Mind, reflecting how much we may have missed, as analysts and analysands, because of our repression of, and resistance to, our collective, cultural unconscious

II. If there is in Li-An’s story an inexorability to the cultural, historical, and mental convergence of analyst and patient, there is, in my estimation, a striking and disturbing contrast in how much divergence is perhaps left unspoken in Orna Guralnik’s account of her travels through “Reality” with her patient, Raven. For me, this essay reflects how holding culture “in mind” risks distorting an analyst’s vision, when efforts at cultural connection may foster a collusion with the patient’s externalizations. Guralnik courageously attempts to strike a balance between recognizing the symptomatic and troubled character of Raven’s acts while at the same time supporting their self-curative intent. The analyst’s attunement as a cultural clinician, however, creates a tension in her essay that may leave some readers despairing at the extent of the self-harm tolerated by both patient and analyst in this painful treatment. The necessary brevity of the piece precludes presentation of her young patient’s history, but what we do learn is that Raven’s parents despair for her future, and that her biracial background may foster a preoccupation with the skin and the body. As if in a dramatic search for interiority, Raven literally and increasingly deepens the wounds that she inflicts on her body in the course of her therapy—from forearm studs that cause weeks of blood infection to giant oozing scars from what her analyst calls a “beautiful” tree carved deep into her thigh and hip. As reported, her analyst sustains an admiring, muted sympathy for her patient’s suffering, while refraining from intervention and interpretation, for fear of being “possessive.” Yet, at the same time, the analyst reports that she is moved to “outrage” at what Raven’s brother has “been through” as a soldier in Iraq. She reports that his suffering and his silence about his trauma is “difficult for me to bear.” In my estimation, the outrage and unbearable sorrow for her patient’s slashing and burning of her own body is to some extent displaced onto Guralnik’s ideological critique of the “handcuffs of the state,” relative to her patient’s brother. Such a stance runs the risk of valorizing characteristically male suffering in war, while marshalling theories of the self-mutilating practices of “Generation X” as transcendent, Eastern mysticism on the one hand, and Western performance art on the other. The mayhem and murder of war can safely channel moral outrage, but therapeutic attempts to characterize her patient’s idealization of flesh-hooking as “derealization” and “dissociation” is chalked up to “psychiatric lingo” to be disparaged and dismissed by Guralnik. That such categories attempt to capture states of trauma and loss of being is not considered in this case. Thus Guralnik’s account of this treatment underemphasizes the struggle Raven is dramatizing around her “inside” when she brings to the treatment acts of penetrating and piercing her outside. Has Raven perhaps internalized forms of oppression (social, familial, gendered, racial), which operate as unique psychic elements, once internalized, only to be acted out on her body? Even her final dream of hugging her brother, and thereby extricating the shrapnel from his body, feels to me like a wish that she too could find a way to carve and dig out the foreign “objects” embedded in her flesh.

With Culture in Mind thus inspires my admiration but also, at times, my reservations. I have no doubt, however, that its stories need telling. They must and will stir up many mixed reactions in their readers, if their telling is going to fulfill the editor’s and contributors’ aim of revealing, revising, and reversing the cultural assumptions that have remained unexamined in traditional psychoanalysis. It is my hope and expectation that these psychoanalytic stories will generate many more.

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