Plea for a Measure of Humanity (Book Review)

Book: First Do No Harm: The Paradoxical Encounters of Psychoanalysis, Warmaking, and Resistance (Volume 45, Relational Book Series)
:  Adrienne Harris and Steve Botticelli
Publisher: Routledge, 2010
Reviewed By: Karen Weisbard, Spring 2012, 393 pp.

If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when? Hillel, Avot 2:4

One might wonder what a book about war, militarism, the politics of the American Psychological Association, truth commissions in South Africa, and terror states in Latin America has to do with relational psychoanalysis. Yet, when one delves into the eighteen chapters of First Do No Harm, each written by a different analytic writer, the answer, “everything,” unfolds in a resounding chorus. Adrienne Harris and Steven Botticelli, the editors of this volume, have compiled a treatise on the nature and function of interconnectedness, mutual recognition, and multiplicity for subjectivity and our ability to relate to others. It is a compilation of how what are essentials to a full human life are attacked, destroyed, and rendered meaningless by acts of war and the discourses that surround it. In this volume, the authors remind us that time does not stand still in the face of trauma, and understanding, recovery, and memory cannot be disembedded from the cultures in which they take place.

I  shall  begin  with  the  title,  First Do No Harm, as it is the editors’ aim to situate this volume of essays in paradox. Where  is the  “first” in this  Hippocratic  Oath? Tom McGoldrick’s work with  soldiers returning to war Iraq and Afghanistan is the first chap- ter of the book. His clinical vignettes exem- plify what we already know when sufferers of trauma enter our offices. Just our being there is a reminder of their wounds. Our attempts to provide them with some new relational experiences heightens their attention to that which they never received enough of. Every entrance into our room is an act of heroism. Tom safely sits in his office patching  up, or not patching  up, these soldiers so that they can return, or not return, to war. What is the first thing he should do? And even more paradoxically, which  is more  harmful—helping them to return to war or helping them not to return, when every ounce of their identity and livelihood depends  on them  being actively enlisted?

In Nina Thomas’s chapter on individuals giving public testimony to truth commissions in South Africa, she asks us to think about who is helped and who is harmed in this effort at national recovery. Do the commissions help the nation and harm the individual? Are the individuals helped by the opportunity to give voice to that which was silenced, or are they harmed by being reduced to victims, thereby denying the multiplicity of their identities? Similarly, Ghislaine Boulanger questions the usefulness of a diagnosis of posttraumatic stress disorder. Certainly many soldiers have been afforded resources with the recognition of this diagnosis, and yet “the diagnosis…can compound the objectifying forces of violence” (p.34). Does the diagnosis help or harm? More likely it does both.

In the chapters by Stephen Soldz and Steven Reisner, we learn that the paternalistic protection the American Psychological Association (APA) declared for the American public was at the cost of torture to detainees at Guantanamo Bay. Psychologists’ presence at interrogations was only one violation of the public’s trust, made paler by the more grievous exposure of their/our role in using psychological concepts to design that torture. Furthermore, we must wonder what harm, in trying to do no harm, is afforded to psychologists and patients by a psychological organization that believes it knows what is in the best interest of others. The APA did not engage in dialogue with nonmilitary psychologists, and they did not engage in a public discourse in which they could have attempted to know what others wanted or needed. They did not sit with the complexities of fear, uncertainty, and vulnerability that the attacks on 9/11 caused all Americans to feel.

In thinking about “first, do no harm,” one is left to conclude its impossibility as a starting point. There is no first; there is only ongoingness. In every situation of possible healing, there is the possibility of harm. Just believing in healing may be an act of forgetting, as Jean-Max Gaudilliere’s chapter, entitled “Men Learn from History That Men Learn Nothing from History,” aptly conveys. War continues and the traumas suffered are forgotten. Or the experiences of intensive, intimate encounters with an other, to whom one reveals one’s deepest, darkest weaknesses and evils, can accompany healing but can also be components of brainwashing, as Ruth Stein elucidates in her chapter. Or how being a listener and participant in an other’s war stories can bring relief but also excitement and pleasure, harming both teller and witness. As Donald Moss writes, reflecting on his experiences with his father, “For a moment, then, the title of this book may seem like it could just as well have been ‘First, do no pleasure.’ This is hard won: the sense that the difference between the two is not fundamental, that it is the product of some activity. Knowing that, or thinking you know it, is itself both a marker of harm done and pleasure taken” (p.248).

Thus, left with the impossibility of the Hippocratic Oath, where is left for a psychoanalyst to turn? Hope emerges in this volume by directing our attention to the cultural discourse of our time. Most of the authors elaborate the failures of society to remember, contain, and care about the horrors that have been done and are being done to its civilians. The familiar defenses of disavowal, dissociation, and denial are employed at an individual and collective level to deal with the failures of relationship. Failures to treat other human beings as just that—other human beings. Failure to name with truth and accuracy the violence that is being perpetuated against each other. Failure to take responsibility for social and political discourses that shame and blame those who are suffering as weak, cowardly, and “girlie.” And most importantly, failure to recognize the other’s difference and pain, and failure to acknowledge our interdependence. Rather, a discourse of either/or thinking is perpetuated in the forms of us versus them, self-sufficiency or dependence, strength or weakness, war hero or villain, soldier or civilian, perpetrator or victim.

Relational psychoanalysis has a vital role to play in challenging the predominant discourse in a number of ways. Though she does not have a chapter in this book, Jessica Benjamin’s influence on these authors is often explicitly referenced and always implied. In order for intersubjectivity to develop, we must recognize each other as “equivalent centers of experience” (p.xxix). Through this recognition, the widening and deepening of one’s own subjectivity takes place. We have to see the other to restore our own selves. In his chapter on Israeli soldiers’ resistance to fight/occupy Palestine, Steven Botticelli quotes Diana Fuss (1995): “If psychoanalysis is right to claim that ‘I is an Other,’ then otherness constitutes the very entry into subjectivity…(O)bjecthood, substituting for true alterity, blocks the migration through the Other necessary for subjectivity to take place (p.143)” (p.336). If Israelis and Palestinians are denied access to know one another, then they “are deprived the very basis for personhood” (p.336).

Eli Zaretsky writes about how recognition of vulnerability as a shared affective state “connects individuals to one another, while also broadening the circle of those who feel solidarity with others through shared feelings of vulnerability” (p.179). Both Zaretsky and Botticelli cite Judith Butler’s work as an alternative discourse. Botticelli states:

Butler (2003) vests significant hope in the political possibilities of identification, construed in the very broadest terms, as she posits the fact of humans’ common bodily vulnerability as the basis for “a normative reorientation of politics” (p.17)…Butler writes movingly of how we are “implicate[d]…in lives not our own” (p.14)…If “part of what I am is the enigmatic traces of others” (p.32), I am enjoined to take responsibility and have concern for the welfare of these perhaps not fully identified people who have left their traces, which is to say everyone. (p.329)

In Botticelli’s chapter, Israeli soldiers who refuse to serve cite their identification with the Palestinians both in their oppression and in their resistance to such oppression. Zaretsky further writes:

In lieu of this presupposition [that we are separate subjects] Butler asks, “what form political reflection and deliberation [might] take if we take injurability and aggression as [our] points of departure for political life,” that is, if we began from “an understanding of how easily human life is annulled,” rather than from the idea of a delineated, rights-bearing, and autonomous subject per se (p.194).

Relational psychoanalysis forged ground when it introduced the notion of a two-person psychology. The authors in this book move that work forward by bringing in the community as a third pillar, and a “moral third” (Benjamin, 2011) to an individual psychology. As we move away from the notion that we are self-contained, delineated human beings toward a notion of connection with something greater than ourselves, we continue to widen the scope of what is subjectivity. Another reason Israeli soldiers gave in their refusal to serve was their identity as Jews. One soldier stated, “You cannot be a Jew, the son of a refugee people, and oppress other refugees” (p.342). Identification with a belief and community greater than oneself is also referenced by the women in Nancy Caro Hollander’s chapter, who are dealing with state-induced terror in Latin America. The women’s activist groups became a “new privileged object.” She writes, “The struggle for peace and justice means another type of relationship with the object…and the ego ideal system has been altered: to be a mother now means ‘to fight for all our children’ or ‘to fight for life’” (p.299). Hollander goes on to say that these women “achieve subjectivity through their identification with the political cause that permits them to actively assert their desire and to demand of society a response” (p.299).

The necessity of stepping out of the predominant discourse to achieve mutual recognition and subjectivity is made possible by these appeals to “a third.” We must find someplace to stand that allows us to see we are them, and they are we. Frank Summers offers how this might have worked for the nation after the 9/11 attacks. He writes, “A self-interested approach to the bombings of the World Trade Center would have been to build on the worldwide goodwill and the support for the United States it evoked by rallying the world around ideals of social justice and freedom while refusing to reduce ourselves to the violent methods of indiscriminate killers” (p.165). Eyal Rozmarin offers how the collective is a core part of subjectivity, even though that can bring enormous internal conflict, again illustrating how we cannot escape our cultural heritages—we can only find ways to wrestle with them. He writes, “It is the point where the subject can conceive himself only as one of many. Where identity is both consciously and unconsciously collective, and where being depends on belonging with others across time and territory” (p.321). We must question our culture as we must also live in it. Rozmarin continues, “For psychoanalysis, as for the family, the task is to raise an individual who is neither a helpless soldier of the common sickness nor a lonely prophet destined to living in a social wasteland, an individual who can be both critical and desiring” (p.325). Perhaps we have to say to our children, to our patients, and to ourselves, “There is no not harming. Better to recognize that harm is being done and will be done, and that we are here to try to make this intelligible in spite of its unintelligibility.” Better to have conflict than dissociation (Bromberg, 1998). Better for there to be a consciousness about what is happening than unconsciousness that offers no avenues for meaning-making.

Another dimension of hope that can be offered by relational psychoanalysis is poignantly illustrated in Sue Grand’s work with a war veteran, in which the multiplicity of positions both patient and therapist occupies shifts from moment to moment in their clinical work. Her patient could not be reduced to a category, though both Sue and her patient started with very strong reifications of the other. Each became a fuller, more dimensional person during the treatment, and Grand allowed us to see the analyst as person, with her own gendered, political, and historical context. Relational analysts know that they cannot hide from their patients. If concealment is attempted, the patient will search to find the therapist, to free himself of a gaze that is directed in only one direction. Grand writes, “When citizens (soldiers and civilians) have access to divergent images of combat, human responsiveness tends to appear. Soldiers and civilians start having complicated conversations” (p.224). We might add that the same holds true for patient and analyst. The differences might not be about combat per se, but about what is going on between them in their divergent and yet common identities as people. In commenting on psychoanalysis and transference, Francoise Davoine adds, “This pseudoneutrality [on the part of the analyst] fuels war, for the hypervigilance of patients is unforgiving…To allow them to deny their perceptions of us it to engage in mystification, another betrayal by ‘fictitious’ discourses, in the words of Hannah Arendt” (p.219). The need to pay attention to one’s own resistances to engaging and being known by the other is further illustrated in the chapters by Neil Altman and Lynne Layton. For both, their self-explorations of their feelings of anger, futility, and hopelessness lead to a way to “stand in the spaces” (Bromberg, 1998) of their uncertainty, vulnerability, and shame. Both are able to rescue themselves from self-blame for failures at resistance by attending to their internal discourse, and identifying how feelings of failure are part of a larger social discourse on individualism and self-sufficiency.

My journey into this realm of that which is greater than us was propelled when I decided to resign as a preferred provider with a major insurance company. I could no longer afford, financially and psychically, the limitations I had agreed to. This forced me to lose a security that was really not a security, and to think more about how I wanted to spend my time both in and out of the office. I had to face the possibility of failure as a private practioner, and my dependence on my patients and colleagues to support me (i.e., to continue to see me and refer to me). I was made more vulnerable by my decision to exit this regulatory regime, and I shared many aspects of why I was deciding to make a change with my patients and colleagues. In turn, many of my colleagues have decided to follow suit and some of my patients have begun to wonder about the oppressive contracts they are making in their lives. Through this process, I am more than ever engaged in hand-to-hand combat with my patients and desire more to step out of my office and see what other changes I can bring to the world.

Finally, a review of First Do No Harm would be incomplete without identifying how gender polarity at home and abroad continues to do harm to men and women alike. Throughout this book, what it means to be a man/soldier returns to stoicism, independence, self-sufficiency, nonemotionality, power over others, and action. Torture humiliates men by treating them like women. Their bodies are assaulted and their connections to others are debased, exploited, and destroyed. Nonaction, reflection, and containment are ridiculed as weak, inferior, and feminine. The desire to understand and know the other is ridiculed as “soft on terrorism or, as Karl Rove once put it, ‘giving therapy to the terrorists’” (p.165). The social discourse on what is masculine and what is feminine is still dominated by these splits, and mind/body is militarized and tyrannized by these tenacious descriptions. It is incumbent on us to reckon with the sobering recognition that the work begun by feminist psychoanalysts is still not done. Our job must continue to be to complicate gender, rupture the habituated assumptions of what it means to be a man or a woman, and direct our gaze toward what it means to be human. This volume of essays is a vital part of that endeavor.


Bromberg, P. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: The Analytic Press.

Benjamin, J. (2011). Facing reality together. In M. Dimen (Ed.), With culture in mind: Psychoanalytic stories. New York, NY: Taylor and Francis.


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