Going Beyond the Walls: Psychoanalysis in the Community

Maria Pia Costa
 

Community psychoanalysis focuses on problems derived from social exclusion that affect the constitution of subjectivity and intersubjectivity. Changes in the psychoanalytic frame are needed.

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Community psychoanalysis is based on the need to integrate the social and the cultural realms, but it goes beyond its mere presence in individual lives and the transferential exchange; it incorporates the external world as a constitutive element of the psyche. This is a response to classical practice’s relative confinement to offices and it demands a reassessment of theoretical and technical aspects that deal specifically with social problematics and their participation in the psychic construction.

Vulnerability is distinctive of the human being; we are born unfinished and can only guarantee our own survival thanks to another being who attends to our biological needs and ensures the subjectivation processes that take place within the relationship with the other. From the moment in which a caveman understood that he needed to ally with his neighbors in order to hunt bigger animals until nowadays, solidarity has been a priority for the community. It is not a philanthropic concept, but rather a practical necessity. In a highly socialized and globalized world, solidarity becomes indispensable to the maintenance of the common wellbeing.

Not few were the critics who accused psychoanalysis of being an elitist discipline that does not reach wider, less privileged groups. Although this critique is oblivious of the method’s principle, something in this sense did take place in the development of psychoanalysis. For instance, psychoanalysts’ attitude during the Third Reich did not help, since the ‘IPA and its affiliated societies, under increasing oppression and dissidence, had become sadly rigid and more conservative’ (Danto, 2005). This happened even if Otto Fenichel’s Rundbriefe [1] movement, despite fighting dispersion and exile, managed to maintain a community-directed practice. They launched the debate about the relation between internal and external lives, as well as the one about the culture’s impact onto the psyche (ibid). We must also emphasize the proposals from Balint followers who recognized culture as having a stronger impact than the instinctive life, as well as ‘culturalists’ in general, mostly in North America and especially Karen Horney.

It is necessary to say that, since psychoanalysis’s origins, this theme had been among Freud’s concerns. During the 5th International Psychoanalysis Congress in Budapest, 1918, he proposed the creation of a system of free psychoanalytical care: ‘It may be a long time before the State comes to see these duties as urgent… Probably these institutions will first be started by private charity’ [2]. As put by Danto (2005), this position is in line with the prevailing social-democrat discourse in interwar Vienna. A chain of cooperative mental health institutions started to emerge. Max Eitington was a pioneer by founding Berlin’s Poliklinik in 1920, where it was possible to discuss and propose directives regarding the extension of the treatment, limited-time analysis, and free care. Two years later, Eduard Hitschmann opened Vienna’s Ambulatorium. In 1926, we saw the creation of a clinic in London – under the leadership of Ernest Jones – and the Schloss Hegel Sanatorium near Berlin. In 1929, Sandor Ferenzi founded a clinic in Budapest, and Wilhelm Reich created Sex-Pol, a chain of clinics with a libertarian, radical leaning that expanded all the way to Zagreb, Moscow, Frankfurt, New York, Trieste, and Paris (ibid).

Danto emphasizes that renowned psychoanalysts took part in this movement: Erikson, Fromm, Horney, Bettelheim, Adler, Klein, Anna Freud, Alexander, Annie and Wilhelm Reich, Jacobson, Fenichel, Deutsch, Balint, Fromm-Reichmann, Nunberg, Loewenstein, and Grothahn. Most of them revised, at their own time, Freud’s theoretical principles. This is worth noting, since the theory’s innovative spirit explains, to a certain extent, Freud’s intentions to expand psychoanalysis’s clinical field, as well as his opening to different focuses within the discipline itself.

Community psychoanalysis derives from this initial collective impulse. Since then, a great number of initiatives have germinated from individuals’ proposals; today, a larger and more structured work, supported by psychoanalytical institutions, is necessary. Work in the community inserts the analyst in their own reality, motivating them and putting them in a place of abandonment and impotency that demands support and indispensable institutional backing.

The institution enables the access to State-run bodies, which amplifies the programs’ reach and facilitates the contact with local authorities. Moreover, institutional involvement promotes rich exchanges between members, as well as an awareness that has become progressively more urgent.

In this sense, it is important to praise the effort currently made by Latin America’s psychoanalytical societies – in line with IPA’s and FEPAL’s current board’s aspirations – to stimulate work beyond the consultation rooms. In 2018, during FEPAL’s Congress in Lima, a network was formed among colleagues from Argentina, Brazil, Mexico, Peru, Colombia, and Uruguay. The network has been recognized by FEPAL as a study group that we named Psychoanalysts in the community. This collective intends to share experiences, benefit from the work that takes place in the region, determine theoretical and technical standards, hone management strategies and project interventions, and stimulate investigation.

It is imperative to highlight the span that Latin America’s community psychoanalysis has reached, particularly as a continent where the majority of the population is subjected to circumstances that expose the urgency of facing issues that the State has not been able to tackle. This characteristic makes the work in the region even more valuable, since it faces an even bigger challenge, different from that encountered in Europe and North America [3].

Be it the pandemic, family violence, sexual exploitation, the lack of services for mental health care, or discrimination, marginality, and poverty in their most diverse manifestations, these are all emergencies that need to be incorporated into the psychoanalytical reflection and the therapeutical action.

The specificity of psychoanalytical community work resides in the focus on problems derived from processes of social exclusion, which are characteristic of the fragmentation of social links that influence the constitution of subjectivity and intersubjectivity. Therefore, this discipline presupposes a special look onto the ‘mismatch of expectations, the weakening of the authority, and the presence of parallel legal principles, unrecognized demands, damage without reparation, occultations… All that produces a type of suffering that cannot generally express itself as such, unless it counts on devices’ [4] especially designed for the detection of such problematics.

The in/out dialectic is in the core of that which is susceptible of consideration and revision. Mariam Alizade (Tanis and Khouri, 2009) proposes a new series to complement the classic ones proposed by Freud: a series that includes culture and its incidence onto the psyche not as a mere circumstantial factor, but rather interweaved within the psychic intimacy. I would like to refer to Winnicott’s concept of transitionality – which allows us to understand the interplay between environment and internal world – and Green’s concept of thirdness, which creates the space for a third axis within early life’s dynamic. Also, I would like to add two more concepts to this discussion: extimacy and factic

Lacan’s concept of extimacy explains that which, by being profoundly internal, is circumstantial to the external realm, since it is articulated with the other. It is a paradoxical formulation in which interiority and exteriority are in continuous flux – like a Möbius strip. Therefore, extimacy, while discretely assessing the very familiar internal/external dichotomy, also allows us to conceptualize a connection between the two poles, an imposed articulation – rather than a differentiation – between internal and external realms. It is somewhat a territory of conjunction of spaces that would have, at the same time, the values of interiority and exteriority. It is the privileged space in which happen the subjectivation processes; a space not solely interior and particular, but rather dual and mutual – although perceived as personal and unique.

The concept of factic, in turn, is defined by Benyakar as that which is external to the psyche. It is a dual concept that includes the internal factic (the corporeal, the somatic) and the external factic (the external world). The factic is articulated with the internal experience without neglecting the space for drive and desire. These elements are conjugated and differentiated, proposing a distance from the Freudian paradigm: ‘the drive and the object are linked by a causal dynamic that goes from the internal realm to the external’ (Benyakar, 2016).

What Benyakar proposes is truly innovative as it includes, within the factic and alongside the somatic – the source of the drive – the external stimuli: ‘We reach, then, a new proposal in order to conceptualize the drive: a way of organizing the factic. This proposal translates an interest that we consider fundamental: to promote to the highest level of our considerations the factic/psychic dialectic, including the external realm and, especially, the disruptive’ (ibid).

A revision of the technical aspects is also indispensable. Psychoanalytical work in the community often begs the psychoanalyst to get involved with environments that are not habitual to them; to encounter realities that are not necessarily close to their own experience. It demands the psychoanalyst to get closer to these realities with the same free and floating quality of listening that allows one to detach from preconceptions on poverty and vulnerability. In this sense, the risk rests fundamentally in the temptation for the ‘supposed knowledge,’ which, it must be said, easily projects the person who is in a state of vulnerability – a position that sometimes tempts the psychoanalyst and prostrate the other in powerlessness. This can also be combined with the danger of transforming the demand into a performance.

Changing the psychoanalytical framework becomes imperative. It will still be the central space in which the process is developed, but this will not necessarily happen exactly as we are used to. The framework will have to be especially well outlined in the psychoanalyst’s mind in order for it to allow the intimate exchange within a privileged continent. The function ‘analyst’s mind’ will be the one sustaining the process, while the analyst, in turn, will have to feel sustained by their own work in appropriate spaces; in this sense, the institutional support is fundamental. The work in the community is, thus, up to the analyst: they too will be part of a community network.

In these spaces, the neurosis of transference typical to the couch will certainly not occur. But one will need to be attentive to the diverse manifestations of neurosis are generally intense and must be accounted for.
Although there are some long-term experiences, they tend to be brief processes and, thus, very intense; processes in which manifest contents related to emergency situations are poured. It is necessary to work the disruptive experience while stressing its sensorial aspects in order to reach, in the case of group work, a collective narrative of the disruptive event. This is why techniques that include the body, movement, and artistic expressions are greatly useful.

Group projects are highly indicated because the disruptive events that demand them affect the whole community. Within them, some backwash of mistrust is expressed, since the bonding mesh tends to be damaged by endemic frustrations. In such cases, suspicion dominates trust, and envy reigns over the possibility of empathy. It will be necessary to facilitate the working through of these feelings.

We need to go beyond the walls of the consultation room, the walls of theory and technique, and the walls of the institutions. We must generate a reflection that can develop and systematize the clinical experience beyond its current borders; and generate, on these new zones, spaces of transformation and inventiveness.
 

[1] The Rundbriefe (newsletters) was a movement organized between 1934 and 1945 around Otto Fenichel and his epistolary capacity to tell the history of the evolution of psychoanalysis and its ideological disputes. The letters had a humanist spirit with a social-democrat inspiration, although a Marxist element was very present.
[2] Freud, S. (1918) ‘Lines of Advance in Psychoanalytic Psychotherapy’. In E.A. Danto (2005). Psicoanálisis y Justicia Social. Digital edition: RBA Libros, S.A., 2018. *English version: Freud, S. (1919), ‘Lines of advance in psycho-analytic therapy,’ in Smith, I. (2000, 2007, 2010), Freud – Complete Works, p. 3635. https://www.valas.fr/IMG/pdf/Freud_Complete_Works.pdf
[3 I abstain from commenting on Asia, whose reality I am not familiar with.
[4] Communication from Psychoanalysts in the community, 2019.
 
References
Benyakar, M. (2016). Lo disruptivo y lo traumático: Abordajes posibles frente a situaciones de crisis individuales y colectivas. San Luis: Nueva Editorial Universitaria - U.N.S.L. 
Danto, E.A. (2005). Psicoanálisis y justicia social, edición digital: RBA Libros, 2018.
Tanis, B. y Khouri, M.G. (Ed.) (2009). A psicanálise nas tramas da cidade. Sao Paulo: Casa do Psicólogo.

Translation: Gabriel Hirschhorn
 

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