Adolescent Psychoanalysis

The Deconstruction and Construction of Adolescents and Their Analysts

Chapter 13

Part 4

Many or most of us psycho-analysts, both in the past and the present, have often followed and follow similar social-educational pathways through school,  the large majority of it directed toward ‘left’ brain development.  Most academic/scientific learning is necessarily directed that way.

I am going to focus on the education and other experiences of those students who intend to attend medical school early on in their lives.  For those who wish to become psycho-analytic physicians, graduation from high school, college, medical school, internship, psychiatric residency and psycho-analytic training is the pathway.  (I do realize that these days many psycho-analysts are not physicians or psychiatrists and have had no medical or psychiatric training.  As I said before, I am intentionally focusing on the former group, not the latter.)

(As a side note, without belaboring this point, I wish to focus briefly on the following point since it is relevant to much of what follows. Many of us believe, probably with some correctness, that psycho-analysts without medical training to be fundamentally different in many ways, some good and some not good, than analysts who are not medically trained.  Of course, physician/analysts knowledge of medicine exceeds dramatically that of non-physicians.  That, of course, goes without saying. Elements of medical training and experience, of diagnosing, treating, dealing with death and dying, etc. are both unique and formative. Such experiences fundamentally change many physicians in positive ways that cannot be well described in words nor taught later in life. The experience of these and other similar incidents yield an indelible mark on most physicians. In the proper hands such training and experience can be a great asset in the field of psycho-analysis; in others, unfortunately, such training may be an extreme drawback.  Freud in his  “Five Lectures on Psycho-Analysis” Volume 12 page 10 said “It is not without satisfaction that I have learned that the majority of my audience are not members of the medical profession. You have no need to be afraid that any medical knowledge will be required for following what I have to say.  It is true that we shall go along with the doctors in the first stage of our journey, but we shall soon part company with them and Dr. Breuer, and shall pursue a quite different path.”

If we physician analysts bring to our psycho-analytic patients an awareness of them as an unknown and fundamentally unknowable ‘whole’ human being, to be assessed and understood, not seen by us as a list of theoretical pre-conceptions, we and they are much the better for it.  To grasp physical and physical/psychological symptoms can be of great use.  Contrariwise, if we physicians learn to see our patients, in this instance emphasizing adolescents, as a list of potential diagnoses, as is often the case in medicine, the correct ‘one’ waiting to be found, both we and our patients are far the worse for it.

‘Differential diagnosis’ in medicine means, roughly, a list of the possible causes of a particular symptom or symptoms.  Such a list is extremely important in physical medicine, usually guiding the investigation of symptoms. On the other hand, such a narrowing of possibilities or thinking of our analytic patients analogously as medical problems to be found and ‘cured’ is a crucial mistake, be such a list created by physicians or non-physicians.)

I will use as an excellent example of the education/social experience followed by many of us, a middle school in Brookline, Massachusetts. If one lives in Massachusetts, perhaps Brookline, and wishes to attend Harvard University, the ‘Harvard’ track begins in 7th grade. It is very difficult to be admitted to Harvard in any event, but harder yet if one lives in Massachusetts. To see 7th graders, dressed in coats and ties and carrying briefcases, all in the name of this track, is particularly sobering.  The level of studying and academic achievement expected of these 7-8th grade students is extraordinarily high.  Ordinary social development is often left aside for other children to experience.  These other students are playing basketball, football, Little League and have begun to chase girls (or boys).  Sexuality is beginning to be experienced and seen. These non Harvard-track students will often be dirty from playground dirt and occasionally in trouble with teachers, principals, etc. Many would say they are normal 7-8th graders.

Our hoping to be Harvard bound students, on the other hand, will be as clean at the start of the day as at the end.  The chasing of girls and boys, consciously and unconsciously, will be set aside—too much school work to do. Evenings and weekends are largely unavailable to this group for much of anything but studying or being carted around by parents to various ‘activities’. Meanwhile, the ‘miscreants’ will be playing sports, at the malls, etc.  They will do their work, perhaps successfully, but at times that allow for many other activities.  The splitting off of social experience for our ‘Harvard’ tract students will have well begun. And, per above, many would be medical students will genetically come from and be raised by primarily ‘left’ brain families, usually high achievers.  Studying and academic achievement will receive much more emphasis than other activities.  Letter grades will be much more important.  Group testing results will also achieve much more emphasis.

Many of us have faced the same problems as the young Brookline students, many of us following the ‘Harvard track’ whether Harvard be the goal or some other educational institution. Many of us began our ‘run’ for medical school either in middle school or high school, studying very hard, eschewing ordinary social life in favor of other activities, mostly academic, adding to our academic ‘portfolios’, so that we may matriculate to an excellent college. We often added ‘Extra-curricular’ activities which were usually confined to those that support college admission—–Math club, Science club, etc.

In the good old days, there used to be ‘honors’ classes, which seemed to make at least some sense.  In an ‘Honors’ class, one would be grouped with academically talented and usually extra-motivated students, hopefully to learn more and get an extra grade for their trouble. This ‘extra’ grade was useful in applying for college.  An extra grade would be a grade added on top of a grade.  For example, if one were to get a B, it would be counted as an A. This would increase one’s GPA and broaden the array of colleges to which one might be admitted.

Then came the Advanced Placement class (AP).  This was and is a new and extraordinarily insidious high school academic ‘improvement’ that has sadly continued to develop in high schools to this day.  If one takes and successfully negotiates an ‘AP’ course in high school (available in many subjects), one achieves ‘rewards’.  There are 3: 1) One may actually learn more, an excellent goal;  2) As in ‘honors’ classes,  letter grades are raised by one.  For example, a B becomes an A, an A becomes whatever is above an A and so forth, raising ones high school GPA, sometimes substantially.  The pressure of grade achievement and successfully passing both the AP classes in which one is enrolled and the examinations which follow the completion of these classes is immense; 3) most insidiously, students successfully completing an ‘AP’ class and the associated exams, are excused from taking a similar class in College.  For example, if one takes and passes AP History, one is not required to take the equivalent History class in many colleges.

Many students take a number of AP classes, eliminating the necessity of taking numerous classes in college.  If one thinks about this practice, it is ludicrous.  Firstly, students must study very hard, to the exclusion of other important types of learning in high school. Secondly, there is no reason not to expect that the vast majority of the Professors who teach in Colleges and Universities would not exceed the skills and knowledge and teaching skills of high school teachers? Although this is extreme and impossible, why not have the full complement of AP classes, covering all college courses and eliminate college altogether. Perhaps professors could be eliminated entirely.

One must also recognize that while this academic orgy is continuing, anything that passes for ordinary social maturation and experience is often ignored and usually discarded from the ordinary high school experience.  Adolescence, which nearly everyone agrees is the bedrock upon which so many later developments in life rest, not the least of which is the efflorescence of what will be adult sexuality, is ignored.  Ordinary social interactions between students, boys and girls, athletics, athletic events, etc., for many, simply don’t take place. One cannot study this hard and have time for much else.  No grades are given for ordinary social development.  Perhaps such grades wouldn’t be a bad idea.

At this point, theoretically at least, prospective medical students and many other students, part company.  That is deceptive, however.  I have been discussing only prospective medical students.  There are many other adolescents who follow this same pathway.  Not all AP students by any means are interested in medical school.  The large majority is not.  But, they suffer the same developmental consequences socially.

Then comes the next serious problem for many students for the most part students who are late in adolescence.  College. There are many life functions, independence, love, social interaction, experimentation of whatever type, which should be a large part of college. Once in college, however, for many, the necessity of academic achievement becomes even greater.  If one  wishes to go to medical school or graduate school, especially a ‘good’ one, one must do well or very well academically in college.  It is difficult to quantify what portion of college or high school is responsible for social development (as above) but that portion is undoubtedly very high.  However, to benefit from this aspect of higher education, that of social maturation, students need to be physically and emotionally available.  If the same pattern from Junior High School to High School as outlined above, is followed, these students will be unavailable for anything but academics and suffer the consequences of no real social development.

To complete this particular disaster comes Medical School, Residency, etc.  For us of the old days, less so in current times, the demands on medical students are extraordinary.  There was and is very little time for anything much other than study and active participation in patient care, both in medical school, residency and somewhat in analytic training.  Little time is available except for the rare student who is used to finding his/her way around socially.  They find a way to find extra time, for dates, etc.

This lack of ordinary experiences in our lives leaves many of us grossly unprepared for ordinary life with ordinary social graces. Many outsiders regard practitioners in our field as both ‘weird’ and ‘out of touch’ with reality.  Go to an analytic meeting to gather evidence.  Meet the families of some analysts and be prepared to meet some of the most bizarre families one can imagine.  Often these families seem completely detached, or nearly so, from ordinary social reality. These families, of course, are also most often intellectually superior and highly educated, and, sadly, most often unable to negotiate ordinary life situations.  Choices we make are often bizarre. Unusual and odd theories of child rearing abound.  Ordinary structure is often absent or present in the most bizarre ways.  Theories gained in analytic training and analytic experience are often applied to families as though there were a direct correlation between our psycho-analytic theories and family life.  And so forth.  How much these failures result from the pathway I have described are, of course, unknowable.  In my opinion, the percentage is very high.

Perhaps the biggest problem presented by this pathway is that those who follow it never have the chance to be or to experience being an ordinary adolescent.  We have all encountered children who are said to have never been a child, just skipped ahead.  This is similar, but vastly more important. Not that one needs to jump from a bridge to treat a person who has jumped from a bridge, but to treat an adolescent without ever being one is a virtually impossible task.  The ability to identify with the adolescent is absent.  Ability to compare experiences is absent. Etc. As a consequence, from many analyst’s points of view, adolescents appearance scene is that of a flying saucer complete with spacemen.  ‘It’ is a foreigner.  ‘It’ has values and behaviors never before seen. Freud had very little to say about adolescents.  Neither did Melanie Klein, unless one is to take her theories of early infantile life and transmute them to adolescents.  That is to say, unless their researches and teaching are arbitrarily applied, the practical analysis of adolescents was untouched.  If arbitrarily moved, infancy to adolescence, sadly, make the analysis of an adolescent impossible and usually lead to very early termination.

Some of us treat adolescents largely as ‘symptoms’ that should be expunged.  Analysts of adolescents often seeks to cleanse them of these ‘symptoms,’ some of which are not ‘symptoms’ at all, but which are in fact the building blocks of adulthood. The danger is tempting unless one is aware that during these formative years, valuable parts of emotional and characterological formations, which are extremely important components of ordinary life, develop.

Alternative pathways are not followed by most of us by any means.  Were they, dramatically different personalities amongst us would evolve. Perhaps we can imagine ourselves as adolescents who were socially skilled, socially experienced, sports playing, dating, sexually experimenting, occasionally manipulating, occasionally lying, perhaps drug and alcohol experimenting, etc.  In short, we would have been normal teenagers, who also may have done well in school.

A young Asian girl of my acquaintance who coincidentally attends the same high school attended by me back in the day, has been raised in a very strict fashion by her parents.  She studied and studies very hard, has gotten very good grades, takes piano lessons, attends church many evenings a week, etc.  She was not allowed to see any boys.  She also happens to be very attractive.  Her mother did her best to keep her away from boys, feeling that they would somehow ruin her and keep her from her studies.  This family had moved from China to this country specifically for the sake of their daughter’s education. For a variety of reasons, in spite of the mother’s advice to ‘look up’, the boys ‘got’ her.  She was just too cute to escape unnoticed. She now has three boys who ‘like’ her (innocently), is much happier and her grades, already very good, have gone up considerably. (In her group, she seriously and laughingly explained to me, an A- is an Asian C.)  Because of these recent experiences, she is much less controlled by her parents. And, furthermore, she wants to be a doctor. She has escaped the trap. And, her grades, already ‘Asian’ A’s, improved. If the High School and College experience were confined to what takes place in the classroom, studying, etc., were the sum total of what is ‘learned’ in high school and college, then, of course, the system would be grossly defective.

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