Adolescent Psychoanalysis

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The Adolescent as Illness

Chapter 5

Part 2

Although a general examination of the thesis of this book would seem to suggest that this ‘dialog’ is based on a conscious exchange of conscious material, that is not the case.

Virtually all of us recognize the existence of the unconscious. Freud offered two pieces of evidence for the existence of the unconscious—-dreams and slips of the tongue. We all, but for a few, accept these as evidence for the existence of the unconscious. Our practice as analysts suggests that we all clearly know that communications from our patients are evidence of the existence of the unconscious. Our interpretations are statements of our belief that the unconscious exists. Therefore, all such communications from the adolescent are not exclusively conscious. We tend to look at communications from the patient as a conscious disguise of the un-conscious. We do often fall back on explaining to our adolescent and other patients, ‘what they really mean’ (what his/her unconscious is actually saying).

The fact that this is so should offer us hope in the treatment of adolescents. There is more to adolescents than their overt statements. We often, however, take their utterances as direct statements of the their absolute truths. Should an adolescent report that they have smoked marijuana, for example, this statement may often be taken by us as the set in stone report of their infinite, inalienable code of conduct. Period. We tend to forget that all of adolescent behaviors are multi-determined as are every ones. We forget and have tremendous difficulty standing the pain or anger, etc. to find our way to these factors.

If we are not limited to seeing adolescents as solely conscious beings who are sick, how one looks at material is considerably altered. If one were to assume that the adolescent is a whole person, not a diagnosis or condition, issues such as ‘what does the adolescent really mean’ take on a different light. If we accept that what they mean is what they mean, the work takes on a wholly different character. At that moment, for them at least, their statement is the truth. To argue with their ‘truth’ is both futile and illogical. We may see other connections than they in their statements, but at that moment they see only what they say. If, as shown throughout the body of this paper, however, this ‘truth’ is accepted and explored, other truths and other truths will emerge. Contradictions emerge, as with all patients, which need to be investigated, but carefully and respectfully with adolescents.

Perhaps, without our awareness, we often make the assumption that adolescents ‘free associations’ are conscious thoughts that are complete. That is, if these ‘free associations’, are assumed to be different from those of others and are assumed to be statements of fact, they are not ‘free’ but predetermined pronouncements. These statements to us are more reminiscent of the brain washed that bode no discussion. We rarely assume that adolescent ‘free associations’ are just that, associations that are ‘free’. ‘Free’, then, taken literally, would mean that such communications are free of an absolute connection to anything. Or at least, ‘free’ until a connection is or can be established

Freud’s often quoted statement that ‘sometimes a cigar is actually a cigar’, perhaps sheds light on this situation. If an adolescent is regarded as a ‘cigar’ in the Freudian sense, then understanding adolescents’ statements takes on a whole new light. In this instance, then, the adolescent, would be regarded as extrapolated from Freud’s statement, as a person. “Patients” looked at in that way, cease to be ‘patients’ but are people.

Most of us people do not spend much time contemplating what is the unconscious/disguised sick meaning of selecting answers in life. For example, what if an adolescent, while out to dinner, chose squid over sweet breads. One might ask why one over the other, but in asking that question, would not be expecting a psychological explanation on the part of the diner as to the sicknesses in his personality such a choice exposes. In fact, should this food aficionado make such a statement, we would all naturally wonder what’s wrong with him. On the other hand, should an adolescent/ person/patient, say, in a session, something like ‘There was a debate at dinner about sweet breads and squid, which is the better. I like them both, but squid sounded better last night’. Since we believe, per Dr. Grotstein, that adolescents bear an ‘unfathomable illness’, that statement would be regarded as disguising the ‘real meaning’ of these statements, even if unconsciously generated An ‘interpretation’ could, therefore, soon follow. What does ‘squid’ really mean? Perhaps what he really meant to say is that he is negatively identified with and in competition with his father (grasping, trapping, beak armed, squid) who fancied himself as a culinary expert. Such a choice by the patient, then, would be looked at as having little to do with food preference, but his desire to both humiliate and devour his father. The choice would not be looked at not as a food choice, but as disguised assault upon his father, an illness.

In the psycho-analysis of adolescents and others, Freud’s dictum, expanded on by others, particularly Bion, that ‘memory and desire’ are an anathema to our work, has profound implications. In the psycho-analysis of adolescents, this is particularly true. The desire for cure is great. This particular group of adolescent ‘patients’ tend to bring out the savior in many of us (desire). The ‘symptoms’, as defined by us and seen in adolescents, are seen as very severe (memory). Thus, we are treating a severely troubled adolescent, not an adolescent. There often is a very strong parental transference between the analyst and the adolescent. The identification of the adolescent’s dangerous behaviors, as well known to adults and analysts, is a necessity, and must be imparted to the adolescent (memory and desire). Further, there is a sense of urgency to correct these behaviors, usually much more so than with adult patients (desire and memory). There is often, unlike most adults, great pressure from parents to ‘cure’ Johnny, whom they often feel is just shy of death’s door. These parents often want ‘action’. They are also often faced with a complaining adolescent who would do just about anything to not have to go to analysis. This form of at home acting out is often seen even in adolescents who actually like their psycho-analysis.

With adult patients, their worry about the passage of time is not so great. Adolescents themselves, for entirely different reasons, do not worry at all about the passage of time since time to them is infinite. To parents of adolescents, the passage of time is critical. Most adults who come for analysis realize that analysis is a long process. Adults are almost always ‘voluntary’ patients. That is to say, for the most part, they come of their own volition. Adolescents, on the other hand, are often brought to analysis against their will. Outside pressure on the ‘progress’ of adults tends to be quite low, unlike the pressure brought often by parents on the analyst to get results with their off-spring much sooner than later. Further, most adults have come for ‘treatment’. They are willing, for the most part, to accept our interpretations, no matter how founded or unfounded, perhaps largely on the ground that they are present for ‘treatment’ and feel what analysts say must be part of our treatment of them. Perhaps they feel they have a broken mind much like a broken leg and are seeking a treatment analogous to broken leg treatment—the medical model. In neither instance (broken leg/broken mind) are they expert. Adolescents, on the other hand, often come unwillingly for no treatment since they have nothing to be treated.

The Medical model is an anathema to psycho-analysis. The Medical model implies sickness. From the Medical model point of view patients are sick and need to be cured. If patients are looked at as sick, there can be no analysis. To assume that an adolescent is ‘sick’ requiring treatment stands resolutely in the way of Psycho-analysis.

In one of Freud’s Introductory Lectures On Psychoanalysis, Standard Edition, Volume XV, pages 15-19, he speaks to group of physicians about psycho-analysis. He tells them, reluctantly, that they must forget all that they have learned in medicine, that psycho-analysis is not a medical treatment. He further said that he realizes that many in his audience might well get up and leave, never to return, because of that fact. In fact he advises many in his audience that they should leave lest their reputation in the medical community be irrevocably lost.

For us, especially with adolescents, to eschew the stance of the medical model, is extremely if not impossibly difficult. For most of us the ability to investigate statements of adolescents verges on the impossible. Should, for example, an adolescent be talking to us about issues of great, emotionally frightening impact on us, the temptation to leave our roll as analyst is overwhelming. Should these statements remind us of the pain and anxiety of our own adolescence or the unbearable awareness of ‘catastrophic dangers’ facing our own children, etc., regardless of their age, the temptation to depart from our function as psycho-analysts and be-come instructors in the ‘correct way’ to lead life may be inevitable.

This departure may be overtly concrete or subtle. We may resort to exortation or to slanted interpretations. By ‘slanted’ I mean interpretations that have secondary motives, as in ‘moral tales’. These ‘moral tales’ are often couched in psycho-analytic sounding terms, but are ‘moral tales’ nonetheless. As I have pointed out before, both exhortations and/or thinly veiled ‘interpretations’ are the undoing of the analysis of adolescents. Assumptions made by adolescents, which are often true, are that they are not being listened to and are the attempted victims of one more psychological theory into which they have been fit. Add to these problems ‘morality passion plays’, ‘cautionary tales’, and the problems become virtually insurmountable insofar as psycho-analysis of the adolescent goes. They have long been lectured, over and over, about their sick, destructive life styles at home, in school, etc. Yet, what they need is to be talked with, understood, rather than lectured. Ironically, what they need is psycho-analysis, the very thing they will not be getting.

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