Adolescent Psychoanalysis

(Revised 11/4/08)

 

Cogito ergo Cogito

I think therefore I think

Chapter 11

Part 2

 

 

In the case of analyzing adolescents, even if the error is made in considering Theory and Practice to be identical, the absence of any understanding of L (adolescent language) completely alters the psycho-analytic state of affairs.  Even if we, armed with theories in our consulting room, busily looking to ‘find’ S that ‘fits’ T, with adolescents, at least, if ‘adolescent speak’ is not spoken or attempted to be understood, the net result is this:

 

L_a=Adolescent  Language  S= Statement    T= Theory I= Interpretation

 L_a * S* T = I * L_a

If L_a = 0    Then the above equation is 0 = 0

 

 

We have anointed T with a variety of qualities that make it powerful. First and foremost, T (theory) in this model is not functioning as a theory should.  Theories are just that.  They are speculative and virtually always not empirically based. The ‘theories’ we use in terms of their justification cannot rise above the standard of a rationally justified true belief and virtually never even approach that standard of justification. (In a subsequent chapter, I will have a good deal more to say about epistemological justifications as they apply to our field). A rationally justified true belief is not necessarily a statement of fact.  It is still speculation.  Our theories about the functioning of the human mind are speculations, but often said to be facts.  When theories dictate practice, they cease to be theories and become facts, much as in an operating room, for example, where the administration of anesthesia is not a speculative theory, but a fact, a practice, born of scientific research, experimentation and use, and the results studied and evaluated.

 

In Physical Medicine there are methods for the evaluation of treatments, medications, etc. Attempts at validation of theories in physical medicine often include what are called ‘controlled double blind’ studies. So, for example, let us imagine that there is a theory that drug B will be beneficial to patients who suffer from disease F.  This theory could have been developed in many ways, but usually starts with what is called an individual or small group observation, otherwise known as a ‘case study’.  In our case, from these meager beginnings this, this individual case study seems to be corroborated by other practitioners who treat patients who suffer from F, and have used drug B.  We all know of the variables that can distort ‘corroboration’. For example, the desire to find something that really helps with disease F, a serious disease, can lead people to ‘find’ cures’ and people to corroborate these findings, even though the whole endeavor may be specious.

 

However, minor experience, theories, etc., may lead to an actual study to determine the usefulness or lack thereof or associated dangers of drug B.  At that point, a study is planned. One of the facets that is most important in such a study is to remove passions and desires of practitioners from the evaluation, as much as possible.  The purpose of this practice is not because people hate practitioners and want to cut them out of work. The purpose is, as much as possible, to make the study rely on ‘facts’, and not the passions and biases of the researchers. Adequate standards for investigation are the foundation of such a study.  Bad standards equal bad evaluations.  This harkens to the somewhat ribald saying regarding computers—-S… in, S… out.

 

However, once planned, procedures to evaluate drug B are first practiced on many forms of life other than humans.  If the drug passes those tests, many of which are often of dubious value, then testing is begun on humans.  People with and without disease F are randomly assigned to test groups.  People inside these groups, randomly divided in a ‘double blind’ fashion are give drugs or no drugs.  ‘Double Blind’ means that neither the evaluators, or patients, or controls know if the patient is given the drug or not, the amount given, etc.. The purpose of that process is another step designed to make evaluations as unbiased as possible. As a part of evaluation, humans are involved—often physicians.  They are expected to follow certain criteria in their evaluations. Once all this data are compiled, a ‘verdict’ regarding drug B is arrived at. Should the verdict be that this drug B, is useful in the treatment of disease F and doesn’t cause serious drug use ending side effects.  Based on all this, approval by the Federal Drug Administration is sought.

 

If approved by the FDA, drug B is put on the market.  It is at this time that the most information about drug B is brought to light.  Unfortunately, at this stage, to a large extent, the investigations are now back to individual practitioners doing ‘case studies’, with all the risks that go with such ‘studies’.  As before though, should there be ‘enough’ questions raised about drug B, a new round of testing as outlined above is undertaken.  And so forth.  Out of all of this what was a theory remains partially a theory, but is moved into the realm of ‘fact.’

 

Psycho-analytic theories should be a part of the experience and learning that rest in the ‘back’ of our minds.  Perhaps a reasonable analogy is that of the relationship of the skeleton to the body.  The role of our skeleton is obviously crucial.  Without the support of our skeleton there will be no person.  But, the skeleton is not the person. Our theories should be the supporting elements for us in Psycho-analysis.  There should be no confusion on this matter.  The skeleton is no more a person than a psycho-analytic theory is a fact.

 

A New Definition and Use of S

Let us return back to our equation and assume another alternative and define S differently.  This new definition of S is that S is a statement, the dimensions and meanings of which are not known either to the patient or the analyst.  Let us further assume, given the above, that the analyst has no theory that he wishes to promulgate. The technique used in analysis of adolescents follows Freud’s Fundamental Rule: “It will been seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate everything that occurs to him without criticism or selection.  If the doctor behaves other wise, he is throwing away most of the advantage which results from the patient’s obeying the ‘fundamental rule of psychoanalysis’.  The rule of the doctor may be expressed:  he should withhold all conscious influences from his capacity to attend and give himself over completely to his “unconscious memory”, or, to put it purely in terms of technique:, he should simply listen, and not bother about whether he is keeping any thing in his mind., (what is achieved in this manner will be sufficient for all requirements during the treatment….” (Freud, Standard Edition, Volume 12, pgs 111-112 Papers on Technique, Recommendations to Physicians Practicing Psycho-Analysis)

 

Put as an equation:

S_1-® S₂®_-S₃ ®_-…S_n    

Each S represents statements made by the adolescent. Each “®” represents a connection between statements.  These connections do not say anything about the quality or specificity of a ‘connection’.  That is to say, except temporally, statements may connect, may not, or may not be known to connect or not to connect.

At each S or ®, questioning, clarifying, gestures, commenting, remembering, connecting, listening quietly, etc., may occur.

 

None of these statements or connections or investigations are based on any theory or predisposition.

 

This is a brief portion of a session with a 16 yo boy illustrating these principles. 

1.     “I hate my father because he has my mother.” He said.

(Using our new definition of S, this statement actually, in and of itself, tells us nothing.  S = ?. However, the meaning of it may be found out, or not, by investigation.)

2.     “You say ‘has’?”  I asked.

3.      “Yeah, he is always keeping her away from things she usually does with me and my brother, like making dinner.”  He said.

4.      shrug’. (?) portrays the analyst.

5.      “He is the most self-centered person I have ever seen.  It’s all about him.” He said.

6.      “What’s with that?” I asked.

 7.     “He’s forever telling us that he had a hard childhood which makes him this way and that we just have to be understanding.” He said.

 8.     “Really.” I said.

 9.     “Yeah. What a crock of shit.  He is forever making up stories or just plain lying.  He won’t take           responsibility for anything”. He said.

10.    “I take it you’re not too fond of your father?” I asked.

11.    “You can say that again.” He said.

12.    “I take it you’re not particularly fond of your father.” I laughed.

13.    “That’s another thing.  He has no sense of humor. Everything with him is so serious and usually                 about one or another defect he has. Things at home are just dead serious” He said.

 

Were I to have used our initial model: S + T = I, the chances that we would have been completely diverted into our theory/facts would be very high. For example, this vignette fairly calls out Oedipal to the Freudian.  To the Kleinian, this vignette might well be a clear illustration of envy of the father, hatred of the mother, the desire to steal the mother for both personal gain and to deprive the father.  Intersubjectivist colleagues would be needed by me to fill in what Intersubjectivist theory/facts would be illustrated by this vignette.

 

Using our new equation/view, this vignette may be seen as follows:

1₁  “I hate my father because he has my mother” at least as investigated at this point in time, less any fact/rules, is quite different than any of us would expect.  “Has” does not have any sexual connotation. “Mother” is not a sexual being as one might expect, but someone who is stolen away by father, not for sex, but to serve him.  It is also clear that the mother is seen by my patient as a functionary.  It is not clear during this session if she is expected to function as a mother or as a servant.

2_i   “You say ‘has’?”  I asked.  I selected ‘has’ to ask for clarification.  Obviously, I could have selected other elements of the statement to seek to clarify.  ‘Has’ at that time and in subsequent thought seems correct.  “Has my mother”, if possible, is both a provocative and ‘meaningless’ statement, that requires clarification.

3_i “Yeah, he is always keeping her away from things she usually does with me and my brother, like making dinner.”  He said.  Probably in response to ‘has’. He goes on clarifying his views of his parents: He takes, she gives, both at the ‘seeming’ needs of the children

4_i    shrug’. (?) portrays the analyst. I find it particularly useful to keep my inquiries as open ended as possible.  My reason for this is that I don’t wish, if possible, to direct the patient to any statement by the nature of my inquiries. This action presents an interesting dilemma:  There is no doubt that this is a dyadic conversation, but one with a unique set of rules.  Further, there certainly are times when this is not the case.  For example, should there be a contradiction, I often specifically ask about that contradiction, in as non-directive way as possible.

5_i   “He is the most self-centered person I have ever seen.  It’s all about him.” He said.

6_l    “What’s with that?” I asked.  Again I’m curious what he means, but ask in as open-ended way as possible.

7_i    “He’s forever telling us that he had a hard childhood which makes him this way and that we just have to be understanding.” He said.  More about ‘father’.  I say ‘father’ because I really don’t know what he means.  He has told me a number of factors of the person he calls ‘father’, but is about all I can say.  What a ‘father’ or ‘mother’ is to him, I don’t know.

8   “Really.” I said.

9_i   “Yeah. What a crock of shit.  He is forever making up stories or just plain lying.  He won’t take responsibility for anything”. He said.  More elements of the personality of what he calls a ‘father’

10_i   “I take it you’re not too fond of your father?” I asked.  There are clearly times when a sense of humor is very useful with adolescents.  The best I can say as to why ‘then’ and why subsequently is that I don’t know.  Perhaps I could be let off the hook by saying that at that time it ‘felt’ right.  The patient obviously responded well

11_i  “You can say that again.” He said.  More humor.  Again a feeling.  No specific justification. 

12   “I take it you’re not particularly fond of your father.” I laughed.

13_i   “That’s another thing.  He has no sense of humor. Everything with him is so serious and usually about one or another defect he has. Things at home are just dead serious” He said.  Further response to humor and other material.

 

Summary:  my patient did not feel he was one of my theories; he knew that I took him seriously; interpretations that I made were not intrusive to him, but seemed to have the effect of furthering our analytic investigation; he discussed issues that are clearly important to him (although to me, at least, quite unclear); humorous interpretations seemed to facilitate psycho-analytic investigation; transference was clearly important, me apparently being an idealized version of whatever a ‘father’ is to him; and, finally, clearly he has a constructive and friendly relationship with me.