Adolescent Psychoanalysis

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The Adolescent as Illness

Chapter 5

Part 1

The statements by the adolescent and the investigation thereof provide the fuel for ongoing discussion of the ‘ride’ of the patient. When asked appropriately, these inquiries rarely cause defensiveness or withdrawal on the part the adolescent.

I would like to briefly revisit my definition of ‘appropriately’ which is so crucial. There are many elements of the ‘ultimate truth’ expressed by the adolescent in each and every statement. Investigation of these utterances, in my experience, should be something like as follows. There are many elements in an utterance. The analyst will have to pick an element, based on experience, intuition, etc., to ask about. This ‘asking’ needs to be done in as non-specific way as possible. It should be as general as possible. It should be asked in such a way as to not demand a specific answer, but to call attention to an element of the ultimate truth of the adolescent.

For example, an adolescent, in a session, said to me, “last night my girlfriend, as usual, didn’t want to have sex”. There are many elements to this utterance. One must initially pick one. For example, I selected ‘girlfriend’. ‘Girlfriend’? I said. ‘yeah, she is supposedly my girlfriend, but you couldn’t prove it by me’. ‘Supposedly’? said I. ‘yeah, people say that, but I don’t think its true’. True? ‘If she were my girlfriend she would want to have sex”. Is that the way it goes, girlfriend equals sex? I asked. ‘it’s supposed to go that way. Not for me. I think I just pick wrong’. ‘Pick”? ‘yeah. Or maybe there is some thing is wrong with me’, and so forth.

Logically and understandably, most of us are glad to explain our beliefs to someone who welcomes such explanations. Should I make a statement such as “I hate my mother”, that is my utterance and is the statement of my truth. There is no rational basis for debating or arguing with my utterance. Our skills should not be used for arguing the unarguable. There is, however, a logical basis for requesting further information. The concept ‘Curiosity’ may be correct. In thinking that such utterances are the ultimate truth of the adolescent, and following the clarification of the utterance and of the content, we can logically discuss the product of the clarification with the adolescent. These elements of investigation may or may not lead to any of our theories of analytic treatment or their application. Our discussion must only be a discussion of the clarification of the utterance. It’s purpose is not to judge the elements of the clarification, but to attempt to further clarify the utterance or to lead to another ultimate truth, and so forth.

It seems to me, one might ask, what is the purpose to such a process. If one looks at psycho-analysis as not a treatment nor a tool to establish a diagnosis, but an analysis of the psyche, as it’s name indicates, such a process makes a great deal more sense. Psycho-analysis does lead to learning on the part of the adolescent and the analyst. Psycho-analysis of adolescents leads to reflection, usually thought of as a hall mark of adulthood, not adolescence. This often yields an especially attractive situation: a person who is an adolescent, but who reflects upon being an adolescent. Such a combination is especially attractive when one considers the MRI results of Dr Geidd: being a reflective adolescent during the time of ‘hard wiring’ may be an especially attractive situation.

I wish to add that this process, which looks somewhat more like a recipe for a cake, is not at all that concrete. The order in which elements may appear is unpredictable. That clarification of the utterance may lead to other “legitimate” memories or associations, as far as psycho-analysis is concerned, which require the same process. Where such a process will lead is, of course, unknown and infinite, as psycho-analysis is.

There can be no collusion, no insipid agreements (“that must be hard for you”), etc. Any such or similar activities on the part of the analyst absolutely derail the actual analysis. What is left when derailed is a mystery. One outcome is a certainty. What is left is not psycho-analysis. Curious clarification is a bedrock of psycho-analysis. Or alternatively put by a supervisee of mine, Eric Bergman, MFT, Los Angeles (intern) ‘patient curiosity’—which is and isn’t a pun.

An esteemed colleague, teacher, and mentor of mine, James Grotstein, M.D., a prominent and widely published Los Angeles Psycho-analyst, in a recent private discussion, offered what seemed to be both an intriguing and probably accurate view of this phenomenon. As he put it, “we are looking at the patient not as a disease or as a diagnosis. We are looking at the patient as a ‘human being’.” This should not be understood as an insipid ‘touchy feely’ comment, but one of great depth. His reasoning is as follows. ‘We tend to look at patients as ‘sick’ and because of that view tend to regard what adolescent patients say as signs of illness and hence to be ignored and re-interpreted. The actual meaning at that moment in time of the thoughts/feelings of the patient, are ignored. He went on to say that all this is especially relevant to adolescents. As we all know, adolescents are regarded by many as bearing an unfathomable illness. Looked at as sick, basically all hope of actually analyzing adolescents disappears.

There should be no debate (A formal contest of argumentation in which two opposing teams defend and attack a given proposition) except for rare circumstances, in the ‘dialogs’ I describe. People rarely argue with themselves. In my view, however, many analytic sessions are what they shouldn’t be - debates. Assertions of the patient are the subject. Knowledge held by the analyst is the counter-point. A debate then ensues. The patient is told ‘what they really mean’. The patient argues that what he means is what he said. If there is a debate, it should be between the patient and him/herself.

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