Panel Reports
1205
level of the brain and neuroscience may combine profitably with that of the person and psychoanalysis are still unclear, but we should not lose sight of how it is only in recent times that detailed correlations across these levels have been possible at all. Before, such correlations were based even more on faith alone. Coincidentally, this presentation demonstrated one of the other values of research enterprises to psychoanalysis: an entry route for talented younger people with a feel for analysis to find places in which they can further their development. The Tavistock Adult Depression Study and its Treatment Manual was the topic of the third presentation. It began its project of assessing the value of 18 months of weekly psychoanalytic psychotherapy for patients with long-term, so-called treatment ‘resistant’ or ‘refractory’ depression in 2000 and it is now in its final stages. It has 129 participants. The final participant in the two-year follow-up period will be rated by December; by then a total of almost 600 years of trial patient data will have been collected. The primary outcome findings will be reported in the course of the next year. The Tavistock Study, like the LACS, has aimed to develop an in-depth understanding of these difficult-to-treat forms of depression. It has combined three methodologies: randomized control trial, qualitative research and clinical investigation, in order that each complements the findings of the others. This author describes how key to the co-operation between researchers and clinicians is the constant attention to maintaining a culture of mutual respect. The approach taken in the Treatment Manual is key to this; it does not set out to teach qualified, well-trained analysts how to do their job. It is permissive and not prescriptive. It does not impose a focus but authorizes the analyst to follow the patient. For Taylor, on the basis of clinical impression, at least some of the seriously ill patients receiving the treatment under test in this trial show themselves able to use and benefit from psychoanalytic therapy. However, the ending of the treatment is often a severe crisis. A brief but moving clinical case illustrated this. In conclusion, this rich, well-stocked Panel, ably time managed by its Chair, Heinz B€ oker, presented three very serious research enterprises. As is proper, the outcome findings are as yet unknown, including to those doing the study. Their attitude is best captured by Samuel Johnson in his letter to Bennet Langton: Let us endeavour to see things as they are, and then enquire whether we ought to complain. Whether to see life as it is, will give us much consolation, I know not; but the consolation which is drawn from truth if any there be, is solid and durable: that which may be derived from errour, must be, like its original, fallacious and fugitive. [Note: The IJP is planning a special issue on psychoanalytic research. We welcome submissions of quantitative and/or qualitative research that explore the grounds for psychoanalytic ideas and conclusions. Guidelines for Research Papers can be found online at: wileyonlinelibrary.com/journal/ijpa. All submissions should be sent in the usual way and will be peer reviewed. Deadline for submission: 1 July 2014.]
The world is looking east: Growth and development of psychoanalysis in the Asian region21
Frances Thomson-Salo, Reporter
This panel gave a glimpse of what the West might see on looking eastward, conveying an extraordinary vibrancy of developments in Asia, and it was perhaps somewhat surprising to learn how long there has been an acceptance of Freud in different cultures as well as interest in self-reflection, and in some cases long histories of trying to gain recognition by the IPA. The co-moderator, Peter Loewenberg, in introducing the panel, shared his hope that Asia might one day become a fourth region of the IPA, particularly now that the other co-moderator, Maria Teresa Hooke, is Chair of the IPA New Groups Committee. The five panellists, in reviewing the process of becoming recognized by the IPA and considering the interplay of specific socio-cultural factors relevant for each place and time, gave an indication of how different cultural systems are modulated when they meet. In outlining developments in their countries, the speakers often conveyed, subtly, the pain involved in this growth, thus illustrating the congress theme of facing the pain. Liu Chia-Chang described Taiwan, named beautiful island by Portuguese explorers 400 years ago, as having a high level of diversity of people, languages, cultures and politics, and making recent attempts to nurture diversity in local initiatives in order to develop psychoanalysis while working towards more formal IPA recognition. Liu Chia-Chang made a number of points about cultural aspects interacting with the development of psychoanalysis; for example, in Taiwan psychoanalysis and psychotherapy are 21 Moderators: Peter Loewenberg and Maria Teresa Hooke. Panellists: Liu Chia-Chang (Taiwan), Do-Un Jeong (Korea), Arup Ghosal (India), Kunihiro Matsuki (Japan), Yunping Yang (China).
Copyright © 2013 Institute of Psychoanalysis
Int J Psychoanal (2013) 94
1206
Panel Reports
seen as linked with medicine, as there is the expectation that only something tangible can be financially subsidized by the government. An implicitly religious attitude to life, one that has Buddhist and Taoist roots, may predispose people to enduring suffering in a difficult phase in an analysis. In a culture with a long tradition of paradoxical logic, the concept of the unconscious with the meaning both of “hidden and waiting to come back” and “no consciousness” may be well accepted and facilitate thinking about the infinite possibilities of one’s psyche. A diversity of psychoanalytic approaches has been absorbed from visiting psychoanalysts, such as Kleinian and Bionian concepts about primitive processes, which are deemed helpful in clinical practice, and French psychoanalysis, with its emphasis on infantile sexuality. This is counterpoised with a lack of meaningful words in traditional Chinese language for both sex and sexuality; the character, xing, which is used for both meanings without any corresponding affective emotionality, commonly has a number of other very disparate meanings, and Chang posed the question of why this seeming gap exists. Do-Un Jeong’s powerpoint presentation, Sustaining psychoanalysis in Korea and envisioning its future in Asia, began with an evocative poem, ‘The flower’ by Kim Chun-Soo, with the lines, ‘When I called her name she … became a flower’, seeming to symbolize the blossoming of the Study Group when they were recognized; it also functions as a metaphor for the whole panel and the role of IPA Committees in supporting the growth of psychoanalysis in the East. Jeong traced the history of the Study Group’s efforts to gain recognition throughout the considerable time from the 1957 Sigmund Freud Symposium in Seoul; he considered their long tradition of self-education in the face of the unavailability of psychoanalytic education, and the sense of moving from having no name to that of a “name of their own”. Jeong thought that the membership is strikingly future-oriented and he listed a number of current outreach activities important for the future of psychoanalysis in Korea. Concerning the contribution that Korea might make to the future of psychoanalysis in Asia, Jeong addressed co-operation between all the countries in the region, with detailed suggestions, such as ongoing regional meetings rather than large conferences, regional discussion forums to achieve accurate and culturally sensitive translation of psychoanalytic terms, and an Asian Journal of Psychoanalysis. In thinking about how to utilize 1000 years of Asian scholarly heritage, he said there is a need to reposition psychoanalysis in Asian cultural and scholarly contexts, and accept the responsibility for creating and sustaining opportunities and institutions and resolving local, regional and international constraints. Arup Ghosal’s paper, Psychoanalysis today in India from the perspective of the socio-cultural matrix, indicated some sociocultural factors in the way that psychoanalysis has been “translated” and accepted in India, particularly in the context of political changes in the last 30 years. He also referred to sociocultural changes in the patient population while psychoanalysis was being developed as a major profession, such as changes in the joint family system and in socioeconomic conditions, and the anxiety that these changes brought. Ghosal thought that societal pressures have both contributed to an increased number of female patients coming for psychoanalytic therapy, while increasing cultural and financial freedom may have contributed to a greater number of women seeking psychoanalytic training. Ghosal noted that the guru–sishya parampara (teacher–pupil) tradition may hinder expression of the negative transference, but he concluded that the influence of Hindu notions and culture-specific models of the patient–therapist relationship that might hinder the transfer of psychoanalysis had not in fact done so. Kunihiro Matsuki, in his paper entitled, Recent developments and difficulties faced by the Japan Psychoanalytic Society, described how the Society could trace its history back to 1955; and now with about 35 members, linked with an association of nearly 3000 psychoanalytic psychotherapists, the Society’s members exert a significant influence on the health professions and the wider society. Matsuki described the development of three Japanese concepts stemming from the mother–infant dyadic relationship, namely the concept of amae, the core loving emotion of the mother–infant relationship, the don’t look concept, referring to the pain of separation, and the Ajase concept of an infant’s guilt about hating his or her mother. In 1932 while studying in Vienna, Heisaku Kosowa, the founder of clinical psychoanalysis in Japan, had personally handed to Freud the essay he had written on the ‘Ajase’ concept. Matsuki commented that the extensive development of these three concepts places Japanese psychoanalytic thinking more within the object relations tradition and he suggested that many Japanese psychoanalysts who are writing about their practice experience the pain of creating a theory and technique of psychoanalysis that reflects Japanese culture and experience. Matsuki suggested co-operation between the different countries in the East would not only promote evidence-based practice but also publicize the significance of psychoanalysis. Yunping Yang presented a case rather than outlined psychoanalytic training in China. Her paper, The impact of poverty as a psychic trauma on individuation and self-identity in the context of family in China, provided a lengthy introduction about the impact of poverty as a cumulative trauma within Chinese culture, where it is especially important for children to bring fame and glory to the family and ancestors, with a resulting profound, even life-threatening sense of shame when this is not fulfilled. Yang illustrated these points by the only case material in this panel – of a depressed man whose mother had been very depressed throughout his lifetime, and whose sense of self was as ugly and lonely. In this way, Yang argued that the trauma of poverty can become a psychic organizer. Yang very movingly contrasted
Int J Psychoanal (2013) 94
Copyright © 2013 Institute of Psychoanalysis
Panel Reports
1207
this patient’s despair at his failure to provide well for his parents with the author and Nobel Prize winner for literature, Yan Mo, who was supported by a mother of enormous inner resources and was able, despite a strikingly more impoverished childhood than Yang’s patient, to develop great creative potential and output. There were many lively comments and questions from the audience. One analyst, noting the axiom that culture is like clothing, thought that the panel had indicated that psychoanalysis could be applied and adapted so that culture may not be as deep as was thought; this analyst wondered if perhaps our templates of psychoanalysis can be transferred everywhere. Vic Sedlak (UK) picked up a theme of developing psychoanalysis being like walking into the mist, not knowing what the future will bring, linking the panel contributions with his work in developing psychoanalytic training in the north of England. Another analyst questioned whether cultural factors were implicated in the references to the numbers of psychoanalysts with a medical background as opposed to other disciplines. Lastly, Alf Gerlach (Germany) suggested that it would be interesting for a conference in Asia to explore how psychoanalysis was embedded in the religious traditions of the East and how psychoanalysis could be embedded in society. The speakers conveyed striking differences in the trajectories of development of the different groups: some, such as India and Japan, had been developed for decades; some had struggled to gain recognition and feel accepted, while psychoanalysis is flourishing in newer groups, such as in China and Taiwan. While there was not time to draw out what might be learnt from this, an emerging theme, however, was that a co-operation could be envisaged that might transcend national boundaries.
Copyright © 2013 Institute of Psychoanalysis
Int J Psychoanal (2013) 94
1205
level of the brain and neuroscience may combine profitably with that of the person and psychoanalysis are still unclear, but we should not lose sight of how it is only in recent times that detailed correlations across these levels have been possible at all. Before, such correlations were based even more on faith alone. Coincidentally, this presentation demonstrated one of the other values of research enterprises to psychoanalysis: an entry route for talented younger people with a feel for analysis to find places in which they can further their development. The Tavistock Adult Depression Study and its Treatment Manual was the topic of the third presentation. It began its project of assessing the value of 18 months of weekly psychoanalytic psychotherapy for patients with long-term, so-called treatment ‘resistant’ or ‘refractory’ depression in 2000 and it is now in its final stages. It has 129 participants. The final participant in the two-year follow-up period will be rated by December; by then a total of almost 600 years of trial patient data will have been collected. The primary outcome findings will be reported in the course of the next year. The Tavistock Study, like the LACS, has aimed to develop an in-depth understanding of these difficult-to-treat forms of depression. It has combined three methodologies: randomized control trial, qualitative research and clinical investigation, in order that each complements the findings of the others. This author describes how key to the co-operation between researchers and clinicians is the constant attention to maintaining a culture of mutual respect. The approach taken in the Treatment Manual is key to this; it does not set out to teach qualified, well-trained analysts how to do their job. It is permissive and not prescriptive. It does not impose a focus but authorizes the analyst to follow the patient. For Taylor, on the basis of clinical impression, at least some of the seriously ill patients receiving the treatment under test in this trial show themselves able to use and benefit from psychoanalytic therapy. However, the ending of the treatment is often a severe crisis. A brief but moving clinical case illustrated this. In conclusion, this rich, well-stocked Panel, ably time managed by its Chair, Heinz B€ oker, presented three very serious research enterprises. As is proper, the outcome findings are as yet unknown, including to those doing the study. Their attitude is best captured by Samuel Johnson in his letter to Bennet Langton: Let us endeavour to see things as they are, and then enquire whether we ought to complain. Whether to see life as it is, will give us much consolation, I know not; but the consolation which is drawn from truth if any there be, is solid and durable: that which may be derived from errour, must be, like its original, fallacious and fugitive. [Note: The IJP is planning a special issue on psychoanalytic research. We welcome submissions of quantitative and/or qualitative research that explore the grounds for psychoanalytic ideas and conclusions. Guidelines for Research Papers can be found online at: wileyonlinelibrary.com/journal/ijpa. All submissions should be sent in the usual way and will be peer reviewed. Deadline for submission: 1 July 2014.]
The world is looking east: Growth and development of psychoanalysis in the Asian region21
Frances Thomson-Salo, Reporter
This panel gave a glimpse of what the West might see on looking eastward, conveying an extraordinary vibrancy of developments in Asia, and it was perhaps somewhat surprising to learn how long there has been an acceptance of Freud in different cultures as well as interest in self-reflection, and in some cases long histories of trying to gain recognition by the IPA. The co-moderator, Peter Loewenberg, in introducing the panel, shared his hope that Asia might one day become a fourth region of the IPA, particularly now that the other co-moderator, Maria Teresa Hooke, is Chair of the IPA New Groups Committee. The five panellists, in reviewing the process of becoming recognized by the IPA and considering the interplay of specific socio-cultural factors relevant for each place and time, gave an indication of how different cultural systems are modulated when they meet. In outlining developments in their countries, the speakers often conveyed, subtly, the pain involved in this growth, thus illustrating the congress theme of facing the pain. Liu Chia-Chang described Taiwan, named beautiful island by Portuguese explorers 400 years ago, as having a high level of diversity of people, languages, cultures and politics, and making recent attempts to nurture diversity in local initiatives in order to develop psychoanalysis while working towards more formal IPA recognition. Liu Chia-Chang made a number of points about cultural aspects interacting with the development of psychoanalysis; for example, in Taiwan psychoanalysis and psychotherapy are 21 Moderators: Peter Loewenberg and Maria Teresa Hooke. Panellists: Liu Chia-Chang (Taiwan), Do-Un Jeong (Korea), Arup Ghosal (India), Kunihiro Matsuki (Japan), Yunping Yang (China).
Copyright © 2013 Institute of Psychoanalysis
Int J Psychoanal (2013) 94
1206
Panel Reports
seen as linked with medicine, as there is the expectation that only something tangible can be financially subsidized by the government. An implicitly religious attitude to life, one that has Buddhist and Taoist roots, may predispose people to enduring suffering in a difficult phase in an analysis. In a culture with a long tradition of paradoxical logic, the concept of the unconscious with the meaning both of “hidden and waiting to come back” and “no consciousness” may be well accepted and facilitate thinking about the infinite possibilities of one’s psyche. A diversity of psychoanalytic approaches has been absorbed from visiting psychoanalysts, such as Kleinian and Bionian concepts about primitive processes, which are deemed helpful in clinical practice, and French psychoanalysis, with its emphasis on infantile sexuality. This is counterpoised with a lack of meaningful words in traditional Chinese language for both sex and sexuality; the character, xing, which is used for both meanings without any corresponding affective emotionality, commonly has a number of other very disparate meanings, and Chang posed the question of why this seeming gap exists. Do-Un Jeong’s powerpoint presentation, Sustaining psychoanalysis in Korea and envisioning its future in Asia, began with an evocative poem, ‘The flower’ by Kim Chun-Soo, with the lines, ‘When I called her name she … became a flower’, seeming to symbolize the blossoming of the Study Group when they were recognized; it also functions as a metaphor for the whole panel and the role of IPA Committees in supporting the growth of psychoanalysis in the East. Jeong traced the history of the Study Group’s efforts to gain recognition throughout the considerable time from the 1957 Sigmund Freud Symposium in Seoul; he considered their long tradition of self-education in the face of the unavailability of psychoanalytic education, and the sense of moving from having no name to that of a “name of their own”. Jeong thought that the membership is strikingly future-oriented and he listed a number of current outreach activities important for the future of psychoanalysis in Korea. Concerning the contribution that Korea might make to the future of psychoanalysis in Asia, Jeong addressed co-operation between all the countries in the region, with detailed suggestions, such as ongoing regional meetings rather than large conferences, regional discussion forums to achieve accurate and culturally sensitive translation of psychoanalytic terms, and an Asian Journal of Psychoanalysis. In thinking about how to utilize 1000 years of Asian scholarly heritage, he said there is a need to reposition psychoanalysis in Asian cultural and scholarly contexts, and accept the responsibility for creating and sustaining opportunities and institutions and resolving local, regional and international constraints. Arup Ghosal’s paper, Psychoanalysis today in India from the perspective of the socio-cultural matrix, indicated some sociocultural factors in the way that psychoanalysis has been “translated” and accepted in India, particularly in the context of political changes in the last 30 years. He also referred to sociocultural changes in the patient population while psychoanalysis was being developed as a major profession, such as changes in the joint family system and in socioeconomic conditions, and the anxiety that these changes brought. Ghosal thought that societal pressures have both contributed to an increased number of female patients coming for psychoanalytic therapy, while increasing cultural and financial freedom may have contributed to a greater number of women seeking psychoanalytic training. Ghosal noted that the guru–sishya parampara (teacher–pupil) tradition may hinder expression of the negative transference, but he concluded that the influence of Hindu notions and culture-specific models of the patient–therapist relationship that might hinder the transfer of psychoanalysis had not in fact done so. Kunihiro Matsuki, in his paper entitled, Recent developments and difficulties faced by the Japan Psychoanalytic Society, described how the Society could trace its history back to 1955; and now with about 35 members, linked with an association of nearly 3000 psychoanalytic psychotherapists, the Society’s members exert a significant influence on the health professions and the wider society. Matsuki described the development of three Japanese concepts stemming from the mother–infant dyadic relationship, namely the concept of amae, the core loving emotion of the mother–infant relationship, the don’t look concept, referring to the pain of separation, and the Ajase concept of an infant’s guilt about hating his or her mother. In 1932 while studying in Vienna, Heisaku Kosowa, the founder of clinical psychoanalysis in Japan, had personally handed to Freud the essay he had written on the ‘Ajase’ concept. Matsuki commented that the extensive development of these three concepts places Japanese psychoanalytic thinking more within the object relations tradition and he suggested that many Japanese psychoanalysts who are writing about their practice experience the pain of creating a theory and technique of psychoanalysis that reflects Japanese culture and experience. Matsuki suggested co-operation between the different countries in the East would not only promote evidence-based practice but also publicize the significance of psychoanalysis. Yunping Yang presented a case rather than outlined psychoanalytic training in China. Her paper, The impact of poverty as a psychic trauma on individuation and self-identity in the context of family in China, provided a lengthy introduction about the impact of poverty as a cumulative trauma within Chinese culture, where it is especially important for children to bring fame and glory to the family and ancestors, with a resulting profound, even life-threatening sense of shame when this is not fulfilled. Yang illustrated these points by the only case material in this panel – of a depressed man whose mother had been very depressed throughout his lifetime, and whose sense of self was as ugly and lonely. In this way, Yang argued that the trauma of poverty can become a psychic organizer. Yang very movingly contrasted
Int J Psychoanal (2013) 94
Copyright © 2013 Institute of Psychoanalysis
Panel Reports
1207
this patient’s despair at his failure to provide well for his parents with the author and Nobel Prize winner for literature, Yan Mo, who was supported by a mother of enormous inner resources and was able, despite a strikingly more impoverished childhood than Yang’s patient, to develop great creative potential and output. There were many lively comments and questions from the audience. One analyst, noting the axiom that culture is like clothing, thought that the panel had indicated that psychoanalysis could be applied and adapted so that culture may not be as deep as was thought; this analyst wondered if perhaps our templates of psychoanalysis can be transferred everywhere. Vic Sedlak (UK) picked up a theme of developing psychoanalysis being like walking into the mist, not knowing what the future will bring, linking the panel contributions with his work in developing psychoanalytic training in the north of England. Another analyst questioned whether cultural factors were implicated in the references to the numbers of psychoanalysts with a medical background as opposed to other disciplines. Lastly, Alf Gerlach (Germany) suggested that it would be interesting for a conference in Asia to explore how psychoanalysis was embedded in the religious traditions of the East and how psychoanalysis could be embedded in society. The speakers conveyed striking differences in the trajectories of development of the different groups: some, such as India and Japan, had been developed for decades; some had struggled to gain recognition and feel accepted, while psychoanalysis is flourishing in newer groups, such as in China and Taiwan. While there was not time to draw out what might be learnt from this, an emerging theme, however, was that a co-operation could be envisaged that might transcend national boundaries.
Copyright © 2013 Institute of Psychoanalysis
Int J Psychoanal (2013) 94
