ACADEMY FORUM - The American Academy of Psychoanalysis and Dynamic ...

ACADEMY FORUM
Spring 2013
The American Academy of Psychoanalysis and Dynamic Psychiatry

Table of Contents
Vol. 57, No. 1
President’s Message: My Introduction to Telemedicine . ..................................................... 3
Michael Blumenfield, M.D.
57th Annual Meeting Update ........................................................................... 6
Mary Ann Cohen, M.D.
The AAPDP: Our Mission in a Changing World . ........................................................... 7
Joanna Chambers, M.D.
The Globalization of Psychodynamic Psychiatry . ........................................................... 8
César Alfonso, M.D.
Drug Ads vs. Psychotherapy . .......................................................................... 10
E. James Lieberman, M.D.
Letter to the Editor .................................................................................. 11
Ronald Turco, M.D.
Obituary – Sheila Klebanow, M.D. . ..................................................................... 11
Eugene L. Lowenkopf, M.D.
Articles
Reactions and Overreactions to Children in Foster Care: Underlying Psychodynamics . ............................... 12
Paul Fine, M.D.
Ideology and Psychoanalysis: The Excommunication of Ferenczi . ............................................. 14
Marco Bacciagaluppi, M.D.
Mothers-in-Law and Daughters-in-Law: A Dyad or a Triad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Cassandra M. Klyman, M.D.
Submission and Subjectivity: An Abbreviated History of Masochism in Psychodynamic Thought . ................... 18
Kyle Arnold, Ph.D.
Working in Translation: Chinese Student, American Analyst . ................................................. 21
Lynn Sommerstein, Ph.D.
A Tin of Snuff . ..................................................................................... 23
Leah Davidson, M.D.
The Secret Seven . ................................................................................... 24
William Moore, M.D.
Opinion
A Psychiatrist/Psychoanalyst Asks Barack Obama Six Personal Mental Health Questions .......................... 25
Peter A. Olsson, M.D.
Book and Film Reviews
Becoming Whole: Jung’s Equation for Realizing God by Leslie Stein . ......................................... 28
Reviewed by Crittenden E. Brookes, M.D.
The Maternal Lineage: Identification, Desire, and Transgenerational Issues Edited by Paola Mariotti . ............... 30
Reviewed by Joanne A. Byers, M.D.
Slots: Praying to the God of Chance by David Forrest, M.D. . ................................................ 32
Reviewed by Eve Leeman, M.D.
Relational Child, Relational Brain: Development and Therapy in Childhood and Adolescence,
Edited by Robert G. Lee and Neil Harris . ............................................................... 33
Reviewed by Shaneel Shah, M.D.
Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case by Debbie Nathan ............ 33
Reviewed by Gerald P. Perman, M.D.
New Members . ..................................................................................... 36
Front Cover
The artwork entitled “Close and Detached” is related to the Winnicott’s theme on the role of the “Emotional
Environment” in The Maturational Process. The scene has been painted in “expressionism style” in order to
emphasize feelings and emotions by using intense colors and unstable stretches. Costanza Palmitessa, Ph.D.
2

President’s Message: My Introduction to
Telemedicine/Telepsychiatry
by Michael Blumenfield, M.D.
There are many psychiatrists
and other therapists who have
been involved for at least several
years with using computers and
video cameras through the Internet
to see patients and teach. From
time to time over the years I
have attended presentations that
described the pros and cons of
this activity. I recall some of my
skeptical colleagues saying until
you can smell the patient they
were not getting involved. I always thought that was extreme
but recall another statement bandied around that you have to be
able to get a very good look into the patient’s eyes in order for
this technique to be useful. Still others likened this approach to
therapy on the telephone which some favored in rural areas with
circumstances where there was no access to in-person therapists.
My interest in this subject was
renewed about 3 years ago when
I left New York Medical College.
I established a practice in Los
Angeles and began to explore
some new venues. Dr. Elise
Snyder asked me if would like
to teach and do other activities
with the Chinese American Psychoanalytic Alliance program
(CAPAChina.org) that used SKYPE and ooVoo to teach classes,
supervise therapists, and treat therapists who were in their
training program. By this time I had experience using SKYPE
communicating with family members and sharing some travel
experience live online from far away countries.
CAPA is an extremely well organized program that continues
to grow and offers eager Chinese therapists a chance to receive
a high-quality two year training program in psychoanalytic
therapy. Within a short time after connecting with them I could
not believe that I was sitting in my office talking and interacting
with 10-12 Chinese students in three different cities. Needless to
say, I do not speak Chinese and to be accepted into the program
the Chinese students must be fluent in English.
I was re-reading and discussing some classical psychoanalytic
paper which I hadn’t read in many years. I was also learning
about some subtle cross cultural concepts. For example, the
concept of shame in China is a very important one and is
quite different than the concept of guilt which is so important
in western culture. I recall one homework exercise I gave the
students which was to discuss clinical examples of shame
in their therapy work or alternatively from their own life
experience. One bright student told how he as a young boy
would make up stories of things he said that he did wrong order
to show shame which pleased his grandparents and made them
very happy.
The opportunity to do one to one supervision and also some
individual psychotherapy also revealed new issues reflecting the
Chinese experience. For example, a patient after several months
3
in treatment began to mention that when
she was five years old, she and her family
had to move to the countryside. Her
memories about that time seemed to be
very benign. Doing some calculations in
my mind about the little Chinese history
that I did know I inquired if that wasn’t
a difficult time when many people were
being punished and treated badly as part
of “re-education” measures. This inquiry
led her to begin to rock back and forth
and cry as she recalled that that was a terrible time in the history
of her family.
In other ways the issues of trust, speaking freely and the
resistances to doing so are important in therapy but are colored
by the Chinese culture and the prevailing changing atmosphere
in China. All this was very enlightening to me and emerged from
my limited work with CAPA and telepsychiatry. My work with
CAPA led to me to going on a CAPA study tour where I was
ACADEMY FORUM
Editor: Gerald P. Perman, MD
Past Editor: Mariam Cohen, MD, PsyD
Editor Emerita: Ann Ruth Turkel, MD
Book and Film Review Editor: Sarah C. Noble, DO
Associate Editors: Abby Altman, MD; David V. Forrest, MD;
Harvey R. Greenberg, MD; Jeffrey M. Koffler, MD; Peter J. Stein, MD;
Edward M. Stephens, MD
Corresponding Editors: Roman Anshin, MD; Crittenden E. Brookes, MD;
Richard D. Chessick, MD, PhD
The American Academy of Psychoanalysis and Dynamic Psychiatry
Officers: Michael Blumenfield, MD, President; César A. Alfonso, MD,
Past President; Gerald P. Perman, MD, Secretary; Ann L. Price, MD,
Treasurer
Trustees: Abby I. Altman, MD; Crittenden E. Brookes, MD, PhD;
Mariam C. Cohen, MD, PsyD; Juan R. Condemarin, MD; Eugene
L. Lowenkopf, MD; Eugenio M. Rothe, MD; Scott C. Schwartz,
MD; Joseph R. Silvio, MD; Jane Simon, MD
Executive Director: Jacquelyn T. Coleman, CAE
Executive Assistant: Jacquilyn A. Davis
The Academy Forum is a journal of news and opinion published by the
American Academy of Psychoanalysis and Dynamic Psychiatry. Opinions
expressed in the Academy Forum are not necessarily those of the Executive
Council and do not represent the official policy of the Academy. The
Academy Forum welcomes contributions from readers. All manuscripts must
be submitted in computer-readable format. All manuscripts are subject to editing
for style, clarity, and length. All communications, including manuscripts,
queries, letters to the Editor and changes of address should be addressed to:
Gerald P. Perman, M.D. at gpperman@gmail.com.
Subscriptions: $20.00 per year (U.S. and Canada only). Order from the
Academy.
Email: info@aapdp.org
Website: www.aapdp.org
continued on page 4

President’s Message (continued from page 3)
CAPA Graduation Ceremony in Beijing
able to lecture in China, meet some the students in person and
attend the student graduation program in Beijing.
Our experience with CAPA led my colleague Dr. Jim Strain
and I to set up a non-profit teaching program in Psychosomatic
Medicine for third world countries (PSMWW.com). We had
decided to do this rather than write a second edition for a
large textbook we edited in the above field. We thus far have
taught two 8-session courses in South America and in Rwanda
via teleconferencing. One of the systems we use allows us
to share our computer screen and that makes the projection
of PowerPoint sides particularly useful. However the most
meaningful part of the teaching is the direct interaction with the
students. This exposure, and the nature of the teaching material
we have chosen that is greatly influenced by psychodynamic
experience, is also proving to be interesting from a cross cultural
point of view.
I had a completely different experience when I signed
up to work one half-day a week with the California
Telepsychiatry Group (caltelepsych.com/) that is part of
American Telepsychiatrists led by Dr. John Schaffer. This group
has a contract to provide psychiatric care via video conferencing
for several mental health clinics in central California. They
use a system called Web-Ex which seems to be even better
than SKYPE and ooVoo. They also have a sophisticated online
electronic medical record that I can easily access as well as an
online prescribing system called Infoscriber where I can directly
prescribe to any pharmacy in California.
American Telepsychiatrists has many other sophisticated
features. The sessions take place in a private room in a clinic
where I am comfortably in my office and where I can have a
psychiatric nurse present with the patient and/or a translator
when needed. While I am doing mainly psychopharmacology, I
can refer the patient to individual and group therapy, to primary
care physicians, and to substance abuse programs, and I can
order lab work, communicate with other health care workers,
and send patients directly to the hospital or do anything that I
might do from my private office. The psychiatric nurse with
whom I work, and the staff, are helpful and supportive. Patients
adjust easily to this form of communication and most of them
are extremely appreciative of the care that they are receiving.
Only recently have I considered using telepsychiatry in my
private office practice. There were two instances where college
students with whom I was working were going back to college
and they wanted to continue their sessions while they were
away at school. They were very comfortable with SKYPE and
one of them used it on his i-phone. The therapy didn’t miss a
beat. One session took me zooming from room to room as the
student’s roommate had unexpectedly appeared and the patient
was trying to keep his therapy confidential.
Only recently have I started using SKYPE to treat a new
patient who was from another city and expected to be traveling
to Los Angeles from time to time for occasional face-to-face
sessions. Of course resistance and transference issues have to
be considered when there is the lack of an in-person presence.
Recently a patient being seen through SKYPE asked if I would
mind if he lit up a cigarette. That issue hasn’t come up in over
20 years since I removed the ash trays from my office. So while
the smoke wouldn’t bother me, of course I had to explore the
patient’s state of mind for wanting to light up at that time.
We are becoming more of a global society. AAPDP is having
an increasing number of international members. We comfortably
travel in airplanes and through the Internet. It seems only
logical that we should take our professional lives with us on
these journeys.
4

57th Annual Meeting Update
Psychodynamics: Essential to the Issue of Suicide and Other
Challenges to Modern Day Psychiatry
San Francisco, California, May 16-18, 2013
by Mary Ann Cohen, M.,D., FAAPDP, FAPM, FACP, DLFAPA
Chair, 2013 Annual Meeting Program Committee
The 2013 Annual Meeting program
is both exciting and relevant
to your practice of psychodynamic
psychotherapy. This year’s theme
emphasizes the significance of
psychodynamic psychiatry in
meeting the some of today’s
most complex challenges. With
suicide as paradigm, the program
will cover topics that include the
nature of psychodynamics, analytic
psychology, psychodynamics of suicide and its aftermath,
physician-assisted suicide, and combat-related trauma and its
consequences. We will explore these challenges from biopsychosocial
and cultural perspectives consistent with the mission
of the Academy. We invite you to join us at the 2013 AAPDP
Annual Meeting in the beautiful city of San Francisco.
Modern day psychiatry and medicine are under siege from
disturbing internal and external pressures for productivity, efficiency,
and cost containment. Some of these pressures result in
less time for patients, defensive medicine, fragmentation of care,
and dissatisfaction on the part of both physician and patient.
Psychiatrists, psychodynamic psychiatrists, and their patients
may be most exquisitely vulnerable to these pressures. Clinical
challenges are magnified and care of patients compromised as
productivity pressures mount. Suicide and other self-destructive
behaviors are among the greatest challenges we face. In this
meeting we will describe the nature of psychodynamic psychiatry
using suicide as a paradigm. Our program is relevant
for psychoanalysts, psychodynamic psychiatrists, child and
adolescent psychiatrists, psychosomatic medicine psychiatrists
as well as general psychiatrists, and trainees.
Our goal is to demonstrate the salience of psychodynamic
psychiatry in the evaluation and care of patients, in maximizing
life potentials, and in the prevention of suicide and other selfdestructive
behaviors. We explore the impact of pressures for
productivity on countertransference and clinician satisfaction as
well as patient satisfaction. Through film, symposia, workshops,
and an emphasis on interactive participation of attendees we
provide a reference frame for understanding psychodynamics as
an essential component of modern day education and practice
of psychiatry and medicine.
Our program is filled with innovative and exciting psychodynamic
approaches to suicide and other challenges. Some
of these include unique presentations such as Military Sexual
Trauma, a Form of High Betrayal Trauma, Leads to Depression
and Suicidality in Women as well as an Increased Risk of Cardiovascular
Disease. Dr. Nancy Lutwak will present this work
based on her experience as director of a special emergency room
program for women only in the NYU Veterans’ Administration
Medical Center. Dr. Lewis Cohen will chair a symposium on The
6
Psychodynamics of Physician-Assisted Suicide: A Humanistic
Approach to Death with Dignity. Dr. Thomas B. Kirsch will
chair a symposium on Jungian Approaches to Depression and
Suicide. Dr. Mark J. Goldblatt will chair a symposium on The
Psychodynamic Treatment of the Suicidal Adolescent.
From suicide in adolescence to predicting suicide from the
manifest content of dreams, and the impact of maternal suicide
we will explore psychodynamic aspects of prevention,
understanding, and treatment. With the rising rate of suicide
in the military, an entire symposium is devoted to this important
topic. Dr. Michael Blumenfield chairs a symposium that
includes military psychiatrists. Dr. John Bradley MD presents
Veterans Administration and Department of Defense Clinical
Practice Guideline for Prevention of Suicide. Dr. George Brandt
presents on Building the System of Care to Bring Them Home.
Dr. Christopher Perry presents Alcohol Use in the Military and
the Relationship to Suicide. Dr. Judith Broder presents Profound
Effect of Combat and Multiple Deployment on Character Structure
and Predisposition to Suicide.
This year, thanks to the work of our 2013 Annual Meeting
Program Committee and in conjunction with AAPDP President,
Dr. Michael Blumenfield, CME Committee Chair, Dr. Silvia
Olarte, and Scientific Program Committee Chair, Dr. Eugenio
Rothe our topic is an exciting one and our three plenary speakers
are internationally known award-winning psychiatrists. Our
Opening Night Speaker, Mardi Horowitz, M.D., is Distinguished
Professor of Psychiatry at University of California San Francisco,
has written 20 professional books and over 280 scientific
articles in the fields of PTSD, stress, personality, and psychodynamic
psychotherapy. His outstanding presentation, Grieving
as well as Possible, will begin our program.
Our Keynote Speaker, Dilip Jeste, M.D., is President of the
American Psychiatric Association. Dr. Jeste is the Estelle and
Edgar Levi Chair in Aging, Director of the Sam and Rose Stein
Institute for Research on Aging, and Distinguished Professor of
Psychiatry and Neurosciences at the University of California,
San Diego, and at the Department of Veterans Affairs San Diego
Healthcare System. Dr. Jeste will present some of his ideas on
the unique relationship between wisdom and aging in his keynote
address on Wisdom: From Psychology to Neuroscience.
The Presidential Address will be presented by Herbert Pardes,
M.D., former President of the American Psychiatric Association.
He is Executive Vice Chairman of the Board of New York-
Presbyterian Hospital and New York-Presbyterian Healthcare
System and served as Director of the National Institute of
Mental Health (NIMH) and U.S. Assistant Surgeon General
during the Carter and Reagan administrations. Dr. Pardes was
also appointed to serve on commissions related to health policy
by Presidents George W. Bush and Bill Clinton, including the
Presidential Advisory Commission on Consumer Protection
and Quality in the Healthcare Industry and the Commission on

Systemic Interoperability. Dr. Pardes will present his thoughtful
work on health care policy in his address on Psychodynamics
in a Turbulent World of Health Reform.
The meeting theme and program are consistent with the mission
of the Academy “To provide a forum for the expression of
ideas, concepts, and research in psychodynamic psychiatry and
psychoanalysis” and “To constitute a forum for expression of
and inquiry into the phenomena of individual motivation and
social behavior.” It is also a great opportunity to network and
collaborate with our colleagues, to reunite with old friends, and
to meet new ones. To that end, we are planning to bring back the
traditions of a cocktail party on Thursday night and a welcome
reception on Friday night of the meeting as well as other chances
to get together in the warm and welcoming atmosphere of our
meeting. We will continue the tradition of the Award Dinner on
Saturday night.
Our 2013 Annual Meeting promises to be a wonderful educational
experience, a chance to share your ideas and network
with colleagues in a beautiful setting. I hope to see you in San
Francisco in May!
For additional information on the 2013 Annual Meeting go
to www.AAPDP.org.
The AAPDP: Our Mission in a Changing World
by Joanna Chambers, M.D.
7
The field of psychiatry is evolving
and we are not the same field
we were even 15 years ago, when
I was a resident. In so many ways,
we, along with all of medicine,
are in the midst of an identity crisis.
In psychiatry, our work force
is aging. Though this is a serious
problem, it is only part of our
crisis. Medicine, by and large, is
becoming a money-making conglomerate
of corporations led by non-physicians. Our inability to
contribute directly to generating significant amounts of income
for hospital corporations contributes further to the stigma that
psychiatry carries.
Patients no longer belong to the physicians who treat them,
but belong to the hospital system where they are seen. This will
only worsen with the current generation of residents who are
training with the newly incurred “Duty Hours,” further instilling
the shift-work mentality of our future physicians. Increasingly,
other specialties are seeing our patients, pressing the need
for psychiatry to demonstrate our value in the larger field of
medicine and in society at large. Psychiatry has attempted to
deal with some of these changes by focusing on the biological
aspects of mental illness, as if by demonstrating that if mental
illness is biological, we are a ‘real’ medical field. In spite of
the many groundbreaking findings in biological psychiatry, we
do not seem to be any more valued by our patients, our peers
or society than we were 30 years ago, before the “decade of the
brain.” However, what is different now is that all of medicine
is changing and physicians of all specialties are questioning the
future. We are living in a changing world and we, the AAPDP,
must figure out how to adapt.
Across the board, we are seeing an aging population in the
psychiatric work force. We are having trouble recruiting the
young not only into psychodynamics or whatever subspecialty,
but into psychiatry. Other organizations within psychiatry are
dealing with similar issues and discussing ways to recruit the
younger generation of psychiatrists into their organizations. One
of the missions of the AAPDP is to reach out to psychiatrists
who have a vested interest in psychodynamics and psychoanalysis,
but may not have a lot of support in their immediate
surroundings. We should include psychodynamic and psychoanalytic
psychiatrists who have plenty of support around them
too, but are likely to join because their supervisors/mentors/colleagues
have joined and will not need as much reaching out to.
It is clear that in the US, there is a geographical correlation
with psychodynamics in general. There is plenty of support and
acceptance of psychodynamic thinking on each of the coast lines
while the middle of the country suffers more from a lack of this
type of thinking. I was trained in the Northeast, but now living
in Indiana, I find myself very isolated in my psychodynamic
interests. The AAPDP is extremely important to me as a place
where I can find support for my interests and endeavors.
Since joining the AAPDP in 2011, I have been touched by the
warmth and the encouragement to get involved that I have received.
This is unlike any other organization that I have been
a part of and, in my opinion, what makes the AAPDP so very
special. I knew nothing about the AAPDP before joining and, a
little more than a year later, I find myself involved in the organization
in many wonderful ways. Even though I have not met
most of you, I see you as important colleagues. I would guess
that there are other psychiatrists like me, who could benefit
from the support, intellectual curiosity, and the collegiality of
the AAPDP.
However, I believe that our mission goes beyond reaching
out and recruiting. Psychiatry is at an important juncture in time
where we are quickly evolving and changing, even if we do not
wish to. There are simply not enough of us to treat the population
that needs our help. This means that treating the mentally
ill is increasingly being taken over by Primary Care Physicians,
Nurse Practitioners, prescribing Psychologists, and the Criminal
Justice System. Psychiatrists are increasingly serving the role
as expert consultants to these other specialties. Psychiatry will
quickly need to figure out how to make itself invaluable to the
rest of medicine and society by providing capabilities that are
unique to us. I believe that the only way to do this is by embracing
the Bio-Psycho-Social (BPS) approach to diagnosis and
treatment. This is something that none of the other specialties do.
To be sure, the BPS approach is not new, but it has been
watered down over the years with the biological approach being
understanding which medications to use with which DSM
diagnosis; the psychological approach being acknowledging that
psychological factors are at play; and the social approach being
an awareness that the patient has someone who cares about them
or needs assistance with their activities of daily living. This is

not what I am referring to. Rather, I am referring to a thorough
understanding of the neurobiology of a patient’s presentation,
their psychology from various analytic schools of thought, the
various social factors that impacts each of these and, most importantly,
the integration of all three areas. Ultimately, this is
what makes us different from Primary Care Physicians, Nurse
Practitioners, prescribing Psychologists, etc.
This BPS approach is what drove so many of us to choose
psychiatry as a specialty and what continues to make our field
the intellectually stimulating frontier that it is. However, we may
need to help our field adapt to the idea that these three areas: the
biology, the psychology, and the social aspects are not separate
entities, but rather integrated systems. The AAPDP, more than
any organization, represents the integrated Bio-Psycho-Social
approach. This puts the AAPDP in the unique position to be
a very important leader in our field for the foreseeable future.
It is exciting and a bit intimidating to think that our ability to
reach out, to include, to educate, and to lead, may ultimately
determine the future of our field.
The Globalization of Psychodynamic Psychiatry
by César A. Alfonso, M.D.
Immediate Past President, AAPDP
The first International Conference I attended took place in
Madrid 16 years ago when I was an early career psychiatrist
(ECP). Silvia Olarte asked me to participate in a wonderful panel
on transcultural psychiatry at a meeting of the World Psychiatric
Association (WPA). Olarte’s 1996 World Congress of Psychiatry
symposium featured luminaries who would later become presidents
of the American Psychiatric Association (APA), AAPDP,
and WPA. It was a valuable lesson to be selected by a former
clinical supervisor to participate side by side with senior and
established academics. Although my contribution to this panel
was marginal, Olarte was able to see potential in an ECP, and
was collaborative, supportive and inclusive, propelling my
enthusiasm, building self-esteem, and planting the seed in my
mind of the importance of mentoring in academic medicine. I
had lived in Madrid as a young child after migrating from Cuba
and being able to return to Spain under these circumstances
cemented my professional identity. Soon after that I presented
at a WPA meeting in Rome, mentored by Mary Ann Cohen, and
attended the first OPIFER meeting in Venice, brilliantly organized
by Joan Tolchin and Jules Bemporad. But my fascination
with European adventures and Western academic exchanges
became dormant for a decade (only to be recently awakened), as
I began to travel and teach in Asia instead, almost exclusively,
for the following decade.
I have a Chinese great grandmother and feel a kinship with
fellow Asians. My first trip to China was in 1988, the fall before
the unfortunate Tiananmen Square incident. I was lucky
to be able to accompany my father to the land of his ancestors
in what was a memorable family trip. Having lived through
political tension and being the child of a revolutionary helped
me enjoy every moment of a trip at such a tenuous moment in
Chinese history.
Once I was relatively established in my psychiatric career I
returned to China, not only as a tourist but also to teach. Membership
in our sister organization since its inception, the China
American Psychoanalytic Alliance (CAPA), gave me an opportunity
to meet students every week in Chengdu, Hong Kong,
Shanghai, Beijing, and Shenzhen, using videoconferencing to
dissolve geographical boundaries. CAPA sponsored study tours
to these cities plus Wuhan and X’ian allowed me to meet many
of my students and colleagues in person. Through other personal
connections I began traveling and networking in Southeast Asia.
Carl Castore, an American expat psychologist who is a family
friend invited me to become a visiting lecturer at the Department
8
of Psychology at Assumption University in Bangkok. One of
my supervisees at Columbia, a Thai American psychiatrist and
AAPDP member, Christina Kitt Garza, paved the way through
her family connections to organize a study tour to Chulalongkorn
University Medical School, ranked as one of the top Asian
medical schools. I mentored Christina to put together a team
of psychiatrists, three from Hawaii (Christopher Perry, Megan
Marumoto, Wendi Waits) and five from New York (Elise Snyder,
Silvia Olarte, Christina Kitt, Luis Garza and myself), joining a
similar number of senior and junior faculty members conducting
lectures and workshops in a collaborative co-sponsored
one-day conference at Chulalongkorn Medical School. My
investment of effort in academic endeavors in Asia resulted
in being asked to be the keynote speaker at the 2012 meeting
of the Royal College of Psychiatrists of Thailand (RCP-T). I
delivered a lecture called “Improving Treatment Adherence-
Contributions of Attachment and Psychodynamic Theories”.
This RCP-T conference was attended by over 500 of Thailand’s
approximately 800 psychiatrists. Since then I have been invited
to lecture in Changi General Hospital in Eastern Singapore and
to give a plenary address at the 2013 World Asian Congress of
Psychiatry. Over one thousand psychiatrists from Korea, Japan,
China, Taiwan, Thailand, Philippines, India, Singapore, Malaysia
and Indonesia are expected to attend the 2013 World Asian
Congress of Psychiatry. It would not surprise the readership of
the Academy Forum that psychodynamic psychiatry is alive and
well in Europe. I have found even greater enthusiasm in China

and Southeast Asia among psychiatric colleagues interested in
advancing knowledge by applying psychoanalytic principles to
clinical practice.
The history of psychoanalysis in Asia is peculiar. I highly
recommend Akhtar’s books Freud and the Far East (2010) and
Freud Along the Ganges (2005). One of the oldest psychoanalytic
organizations in the World is the Indian Psychoanalytic
Society, founded in 1922. Psychoanalysis and psychoanalytic
practice are well established in the Indian sub-continent. China,
however, with the largest population in the world, has only a
handful of certified psychoanalysts practicing in cities that are
larger than most countries. As a matter of fact, all of China
has less than half the number of psychiatrists as the USA. The
city of Shanghai (pop. est. 24 million) has a population more
than half of the entire country of Argentina. Argentina, with a
population of slightly over 40 million, has the same number
of psychoanalysts as the USA. In a recent AAPDP sponsored
symposium that I chaired in Buenos Aires, facilitated by our
esteemed colleague Sergio Rotenberg, Academy members John
Goethe, Silvia Olarte, Eugenio Rothe and Joseph Silvio spoke to
an audience of over 300. There were 12 other symposia simultaneously
scheduled, and close to 15,000 psychiatrists attended
this 2011 WPA congress.
While these transcontinental numbers may be surprising, they
do not necessarily correlate with enthusiasm about psychodynamic
psychiatry, and ultimately, quality of training. Enthusiasm
about psychoanalysis has been persistent in Asia for the last 100
years, but only few were able to travel to Europe or the USA
to become certified psychoanalysts. Maybe precisely because of
this, have our fellow psychiatrists in Asian countries been receptive
to learning about all psychotherapy treatment modalities
without oppressive scholastic competition or dogmatism. While
it may sound irritating to an American or European medical psychoanalyst
to entertain the notion of combining psychotherapy
modalities, our Asian counterparts are receptive to the idea and
train residents to do so. In a workshop at the 2012 RCP-T meeting,
Dr. Rasamon comfortably spoke about the psychoanalytic
principles guiding the practice of motivational interviewing,
and Dr. Puchong talked about combining dialectical behavioral
therapy group treatments with individual psychodynamic psychotherapy
for persons with borderline personality structure. It
is precisely this flexibility of thinking that helps position our
Asian colleagues potentially at the forefront of developing the
field of psychodynamic psychiatry.
With great anticipation I participated in an RCP-T clinical
workshop, alongside with AAPDP members Christopher
Perry from Hawaii and Ren Zhengjia from Chengdu and Hong
Kong, where we presented the USA experience with treatment
of borderline personality disorder and Puchong Lau presented
the Thai experience. Workshop participants (and co-leaders)
were surprised about the preponderance of similarities and lack
of cultural specificity. Is it that we are becoming a globalized
community and individual countries no longer need their own
diagnostic manuals (compare, for example, similarities between
the Chinese Classification of Mental Disorders –CCMD-3 and
the DSM-IV) or that the psychoanalytic model, metapsychologies
and contemporary theoretical constructs provide us with a
framework that allows clinicians to understand behavior across
cultures Elise Snyder speaks every year to our Chinese colleagues
about cultural differences often presenting as resistance
in psychoanalytic treatment. Her American colleagues have a
harder time accepting a notion that on the surface may seem
irreverent and dismissive of the entire field of transcultural
psychiatry, but upon further reflection most agree with what
she so elegantly describes as countertransferential overinvestment
in the exotic and how too much emphasis on intellectual
pursuits to understand the nuances of other cultures may distract
clinicians from more relevant dyadic and interpersonal psychodynamics.
I look forward to the CAPA workshops at AAPDP
and AAPsA meetings and I highly recommend that you consider
a cyber-adventure and join the ever-expanding international
CAPA faculty. My return to Southeast Asia for the World Asian
Congress in the fall of 2013 will be an opportunity to continue
to meet colleagues and cultivate relationships in prestigious
medical schools such as Chulalongkorn and Mahidol universities,
which are ranked among the top academic institutions in
the world. This brings me, a decade or so later, full circle and
back to Europe.
While in South America in 2012 I discovered that the WPA
has an active Psychoanalysis in Psychiatry section. WPA sections
function as the APA committees used to. The WPA being
such a large organization (over 200,000 members in almost 120
countries), the sections, of which there are close to 30, have
their own set of elected officers and active members. The first
time I looked at the WPA Psychoanalysis in Psychiatry Section
(WPA-PIP) roster I was surprised to find how the majority of
members were European, South American and North American,
in that order, and noticed that there were no Asians in the roster.
Invited by AAPDP member Debbie Katz to give a Grand Rounds
at the University of Kentucky in January of 2012, I met Daniel
Nahum, one of the chosen North American WPA-PIP members,
and Secretary of the section.
Daniel approached me after the Grand Rounds and without
really knowing me took a chance and asked me if I would like
to join him at the WPA-PIP symposium he was organizing for
the October 2012 Prague meeting. He was short one speaker
with an impending deadline. I was so thrilled that even without
checking my schedule I agreed to do so, and realized I had less
than a week to put together an abstract, which later became
part of the symposium. Returning to Europe after a decade of
traveling exclusively in America and Asia, to the enchanting
city of Prague, to yet another vibrant WPA meeting attended
by over a thousand psychiatrists, crystallized the realization
that the world is round and that I must put in equitable effort
with transcontinental academic pursuits. Soon thereafter I was
able to land a coveted spot as a member of the WPA-PIP section.
In my letter of introduction I took a chance and pointed
out how alarmed I was that there were no Asian members in
the section, and given my connections in Asia I suggested that
perhaps we could make the section have a positive impact in
the psychiatric community that serves the largest segment of
the world’s population.
I have now committed to attend WPA meetings in Vienna in
2013, Madrid in 2014 and Hong Kong in 2014. As a WPA-PIP
active member I am expected to present in workshops and symposia.
For the Vienna meeting I have enlisted AAPDP member
John Goethe to join Michel Botbol from France and Florence
Quartier from Geneva to participate in a symposium. Michel and
Florence are co-chairs of he WPA-PIP section. The Madrid 2014
World Congress of the WPA is expected to be one of the best
attended psychiatric meetings ever, with over 15,000 registrants
anticipated. Pedro Ruiz, WPA President and AAPDP member
9

is doing a phenomenal job putting together a stellar program
committee. I encourage all AAPDP members to contact me if interested
in attending or presenting in WPA meetings worldwide.
Although I am a relatively newcomer to the WPA community,
we can bond in exploration of rich academic exchanges.
I am honored that Richard Friedman asked me to step up
and join Jennifer Downey as Deputy Editor of Psychodynamic
Psychiatry. Part of my mandate and Rick’s vision of the journal
is to increase international exposure and participation. I look
forward to this challenge with humility and great enthusiasm.
AAPDP President Michael Blumenfield has made it clear that
international exposure and development is an important part of
his platform. I will assist him with energy and scholarly effort.
The AAPDP will continue to be my academic home base. All
of my mentors are AAPDP members and I am committed to
preserve the Academy’s legacy through mentoring and scientific
pursuits.
My father got his M.D. in
1930; I got mine in 1958. Insulin
and penicillin came into
being during his early years of
practice. In my first years as a
psychiatrist, tranquilizers and antidepressants
changed the landscape
of mental health. As doctors, Dad
and I both welcomed Medicare in
1965; later on as patients we became
grateful beneficiaries.
I remember him explaining “ethical pharmaceuticals” - a term
that distinguished companies like Merck from hucksters of “patent
medicines.” The scandal at Merck about the arthritis drug Vioxx
came after his time - he would have been appalled.
Recently the line between ethical drug companies and hucksters
was blurred by GlaxoSmithKline, which paid a record fine for its
bad acts. Until this Glaxo case, drug firms took fines and some
bad publicity in stride as a cost of business; now the companies
and Wall Street are getting a new message.
Medicine is a profession - a calling, not a business. In Dad’s
lifetime it was unethical for doctors, hospitals and pharmaceutical
companies to advertise. Now it is legal, and presumably ethical,
to peddle prescription drugs to patients who get doctors to swing
at the advertiser’s pitch. Doctors earn much more for prescribing,
testing and treating than for explaining. Insurance pays for the
expensive drug. How many doctors will take the time to suggest
a cheaper generic drug with an excellent track record
Direct-to-consumer (DTC) advertising is legal in only two
countries, the U.S. and New Zealand. It’s a very profitable exercise
of free speech for commercial broadcasters that lease our
public airwaves.
Although most doctors oppose DTC advertising, medical associations
are no match for the combined force of Big Pharma and
the TV networks. Drug companies spend far more on marketing
than on research. Profits come mainly from new drugs under
patent, only some of which have been proved better than less
expensive, well-tested generic drugs.
The Food and Drug Administration has been a muffled watchdog,
where political pressure for new drugs could trump research.
Enormous quantities of psychiatric drugs - chiefly antidepressants
and antipsychotics - flow through the blood streams of Americans;
the residues are measurable in municipal effluent waterways. Psychiatrists
are only four percent of physicians, so most psychiatric
drugs are prescribed by nonspecialists. The “depression hurts” ads
that say “ask your doctor” do not mean your psychiatrist!
Medicare, a huge benefit to older Americans, has been effective
Drug Ads vs. Psychotherapy
by E. James Lieberman, M.D.
10
partly because of its nonprofit single-payer system. Unfortunately,
the program suffers from too little government regulation. Prescriptions
are paid for with little or no attention to comparative
efficacy, safety, and cost. Unlike the Veterans Administration,
Medicare cannot negotiate lower drug prices. Elderly patients are
routinely overmedicated, and too often hospitalized when home
care is preferable.
Private health insurance is stricter than Medicare in some
ways, but not with pharmaceuticals. Despite cautionary teaching
in medical schools, rampant overprescription of antibiotics has
created monsters - resistant bacteria that threaten us in everything
from hospitals to handshakes. With its airwaves full of prescription
drug ads, our government must protect citizens against halftruths
masquerading as health education.
The new ED, formerly “impotence,” was created by corporate
greed, not medical need. Most of the over 20 million men (according
to ads) who’ve asked their doctors about sexual insufficiency
have a psychological or relationship problem. The vast
majority of doctors prescribing ED drugs are neither psychiatrists
nor urologists: they have little time, interest - even training - for
a good sexual history. They should, but won’t, interview the
patient with his partner - a basic diagnostic step. For a few patients
with organic disease the drug is a worthwhile treatment;
for most it’s a permanent crutch, a costly and possibly unhealthy
drug dependence.
The American Psychiatric Association (APA) has done little to
help. Psychiatrists don’t want to criticize other physicians, and
the APA itself depends on drug ads for its periodicals. Clinical
psychologists and marital therapists who do not prescribe drugs
are better equipped for couples work than psychiatrists, who earn
much more for three medication sessions an hour than for one
session of talk therapy. Of course, there are no ads for psychotherapy
or marriage counseling.
Americans have a weakness for the pill, the quick fix. Patent
medicine makers are happy to habituate them. The obligatory
list of awful side effects seems to be no deterrent. ED is a special
case, at a time when Internet porn has become increasingly
obscene in order to produce the excitement that readers once got
from a D. H. Lawrence novel.
These days a curious child can only wonder about an erection
that lasts more than four hours, and concerned adolescents might
wonder about how long they have before ED sets in. Pharmaceutical
and network executives are parents and grandparents, too.
How would they answer these questions
E. James Lieberman, M.D., M.P.H. is a Clinical Professor of
Psychiatry, Emeritus, at the George Washington University School
of Medicine. His email address is ejl@gwu.edu

Dear Editor: I read with interest the movie review of “A
Dangerous Method” by Michael Blumenfield, M.D. and Susan
Blumenfield, D.S.W. with questions and answers by Thomas
Kirsch, M.D. (Academy Forum, Vol. 56, No. 2, Fall 2012).
I strongly suggest that your readers view the documentary
“My Name was Sabina Spielrein” (German with English subtitles).
This movie can be rented thru Netflix and is readily
available in video stores. The film highlights the contributions
Dr. Spielrein made to child psychoanalysis (the first of their
Letter to the Academy Forum
kind) and has many accurate and direct quotes from the diaries
and letters she left behind before going back to Russia. Anyone
interested in this subject will find the film both fascinating and
important to a continued understanding of Dr. Spielrein, Freud,
Jung and the interrelationships of these pioneer psychoanalysts.
Ronald Turco, M.D.
AAPDP Past President
Dr. Sheila Klebanow, a long-standing and
staunch Fellow of the Academy passed away
on Friday, October 19, 2012. She had been in
failing health for more than a year.
Sheila and her younger sister, Diana, were
born to a struggling, middle class, immigrant,
Russian-Jewish family in Crown Heights,
Brooklyn. Sheila’s precocious intelligence
was appreciated by her family and teachers at
an early age, and she was known throughout
her school as the girl who had not only read
all of Shakespeare before the age of 12 but
understood what she had read. She went to
Erasmus Hall High School where her intellect
was also appreciated and then to Brooklyn
College. At this point, she was interested in
history and anthropology as two possible
future careers but, while attending Harvard
in pursuit of a master’s degree in history, she
discovered psychoanalysis and, from then on,
that was her professional goal. She went to
NYU School of Medicine after completing the necessary premedical
courses and, after graduation, went on to Maimonides
Hospital in Brooklyn for her internship and then to Bellevue
Hospital for her psychiatry residency.
As soon as she could do so, she entered the New York Medical
College Course in Psychoanalysis. I came to know her during
her medical school days, and then we met again at Bellevue
and then again in psychoanalytic school. Her enthusiasm for
psychoanalysis was so great that organized the student body
at the school into the Silverberg Society, an undergraduate discussion
group focusing on case material and current literature.
Obituary – Sheila Klebanow, M.D.
by Eugene L. Lowenkopf, M.D.
After receiving her psychoanalytic certificate,
she joined the school’s post-graduate organization,
the Society of Medical Psychoanalysts,
of which she later became President,
and the Academy where she was an active
Fellow.
She became a faculty member of the New
York Medical College School of Psychoanalysis
where she taught classes, and supervised
and analyzed students. At the Academy, she
co-chaired two meetings, the winter meeting
in Cancun, in 1992, and a weekend symposium
in New York of Money and Mind.
I was fortunate enough to be her co-chair
at both meetings and was impressed by her
wisdom, her judgment and her commitment.
We subsequently expanded the Money and
Mind meeting into a book of the same title.
Throughout my friendship with Sheila, I was
aware of her high standards and strong ethical
sense, she being one of the most ethical
people I have ever met. She remained a committed and enthusiastic
Fellow of the Academy until her illness slowed her
down. I would be remiss if I did not mention her many cultural
interests: music, especially opera, the graphic arts, theater,
literature and museum and gallery showings. Most recently, on
her many trips to the Southwest, she became expert on Navajo
and other Indian arts.
She leaves behind her devoted sister, Diana, her beloved
son, David, and his marvelous wife, Linda, and their three
adored and remarkable children as well as a host of friends
who admired and loved her.
11

ARTICLES
Reactions and Overreactions to Children in Foster Care:
Underlying Psychodynamics
by Paul Fine, M.D.
Presented at the 56th Annual Meeting of the AAPDP, Philadelphia 2012
Children who have experienced
overwhelming neglect, abuse,
abandonment and lovelessness,
and who may have lost any sense
of childhood innocence, represent
a painful challenge to civilization.
Typically they need special care.
Yet paradoxically, many seem
to elicit less support from adult
society rather than more.
This paper presents examples
of inexplicably callous and irrational decisions affecting children
in the welfare system. The paper suggests an underlying
psychodynamic that contributes to societal neglect and may be
a key to improvement. Specifically, it is that adults harbor a
deeply unconscious horror of motherlessness and that emotional
encounters with traumatized children can evoke primitive feelings,
with grandiose ideals of perfect mothering on one extreme
and perceptions of witch-like evil on the other (Grimm, Jacob
and Wilhelm. “Hansel and Gretel.” Kinder‐ und Hausmärchen.
1812). The underlying dynamic, a primitive duality or split, is
thought to be universal, with potentially profound effects on
society (Mohacsy, I. “The Medieval Unicorn: Historical applications
of psychoanalysis.” J. American Academy Psychoanalysis,16(1),
83-106, 1998). Conscious perception of disturbing
feelings about motherlessness typically invoke primitive defenses
of denial, projection, suppression, avoidance and acting out.
Much that occurs in welfare systems, in fact, fits the paradigm
of primitive splitting. Adults at every level of policy in
the welfare system, otherwise caring people, are liable to act out
dehumanizing approaches to children in substitute placements
and to project blame onto others including those who actually
provide care.
It is interesting to be back here in Philadelphia now almost
45 years since I worked at a community psychiatry program
sponsored by the old Philadelphia Child Guidance Clinic. One
aspect of that program was to provide integrated family therapy
at a pediatric clinic located in the basement of the neighborhood
school (Fine, P. “Family Networks and Child Psychiatry in a
Community Health Project.” Journal of the American Academy
of Child Psychiatry, 12:675-689, 1973). Most of the children
were poverty-stricken and many had been removed into foster
care for reasons of neglect or abuse. But there was an unexpected
positive side also. Some families from the neighborhood
took in other people’s children and a minority was recognized
locally for common sense skills at reparenting. These uniquely
gifted foster parents worked with us in a professional manner
on their children’s behalf.
Reactions and overreactions, positive and negative, are intrinsic
to foster care. My work with therapeutic foster parents
12
has continued over the years in a variety of settings (Fine, P.
A Developmental Network Approach to Therapeutic Foster
Care, Washington, D.C.: Child Welfare League of America,
1994), (Fine, P. and Pape, M.S. On the Demands and Rewards
of Being a Foster Mother. In Rabinowitz, C.B., and Spurlock,
J., Eds. Women in Context: Development and Stresses, New
York: Plenum Publishing, 1990), (Fine, P. Clinical Aspects of
Foster Care. In Cox, M. and Cox, R., Eds. Foster Care: Current
issues, policies and practice. Norwood: Ablex Publishing,
206-23, 1985). Therapeutic foster parents, at their best, are
altruistic, realistic and self-disciplined, yet their skills often go
unrecognized by the courts and social service systems. Incredibly,
some even become suspect, as if altruism constitutes a
mental disorder rather than a moral gift.
Consider a recent session with “Charles”*. Eight years old,
he was removed from his mother’s custody because of repeated
abuse and neglect. Charles is now in a well-supported foster
home. He has vivid dreams and recollections about beatings
from his father, blames his father for all his problems and hopes
to return to his mother, at least to visit. But visits with his mother
are impossible since her legal rights were terminated. Charles is
considered “pre-adoptive” but no one can be found to adopt him.
Last week Charles was suspended from school because he
threatened to “shoot” a classmate with a crayon. There was
something about the way he did it that terrified her. Charles’
foster parents, “Penny and John Smith,” are firm and tolerant
but frustrated by their inability to modify Charles’ obsession
with guns and Nazi insignia. Penny Smith feels Charles’ hostility
goes so deep that he may do them harm. Play with guns is
forbidden for him in their home. Nevertheless during sessions
with me he manages to create gun facsimiles from Legos. He
promises to behave better at school, but then pleasantly discusses
how he looks forward to using a submachine gun when he is old
enough, “to shoot bad people.” Charles professes attachment to
his foster parents but the Smiths are unconvinced and not sure
it is safe to keep him. Much support will continue to be needed,
and developmental continuity will be hard to maintain.
Decisions affecting foster children in actual practice often
appear irrational and in defiance of accepted principles for child
development. The problem holds true in a variety of circumstances,
geographic settings and social welfare systems. Consider
“Alisa” who against all odds became attached to a good
foster home, only to be removed when agency policies changed.
Alisa was taken into protective custody and placed at the age of
five because her mother was unable to provide a home. “Marlys
Grey,” Alisa’s mother, suffered from periodic depression with
loss of reality sense. She herself had been raised in a series of
foster homes and other impermanent situations. Marlys’s two
other children, Alisa’s siblings, were placed separately.
Alisa was ambivalently attached to her mother. Typically, she

fought each foster placement until it disrupted. Then she would
temporarily be returned to a family member, hospital or group
home until another foster home could be found. Fears and anxiety
were prevalent, leaving little energy for normal experiences.
Alisa fell behind at school.
By the time she was nine, Alisa found herself in the “Gordon’s”
foster parent - group home where the routine was well
structured. She had regular visits with her birth mother and
sessions with the psychiatrist. She grew to trust the Gordons
and acquired more normal social skills. Two years later, the
placement came to an abrupt end when public attitudes toward
welfare hardened and politics changed. “Mary and John Gordon”
came under scrutiny because of their independent streak and
faulty bookkeeping. Then a parent of one of their children filed
a complaint and despite years of dedicated service to many families,
the Gordons’ license was suspended and all five children
in their home precipitously moved to other homes.
I hastily arranged a last session with Alisa. She was anxious
and fearful, pulled the rubber head of Yogi Bear off the top of
her pencil and asked me to keep it until we would meet again.
She is an adult now, probably living a life as disconnected as
was her mother’s. It seemed to me that Alisa’s expressed needs
were ignored, her foster parents vilified and helpful connections
lost. All was done by adults with the best of intentions. That
was 25 years ago. I have wondered what became of Alisa and
how she could have been treated so coldly.
Another even more horrific case was encountered in another
part of the country ten years later. “Marilyn” was only four
months old when placed directly from the pediatric intensive
care unit into an emergency foster home. The baby’s injuries
included broken ribs, a collapsed lung, fractured femur and
general debilitation. The “Grob” family was chosen to foster
this difficult child because they were adjudged to possess stability,
cooperativeness and success with numerous other children,
biological and adopted as well as foster.
Marilyn’s placement became protracted while her birth parents
were investigated for neglect and abuse. The investigation
revealed that a baby had died previously in their home with
injuries similar to Marilyn’s. Marilyn’s mother, “Gladys,” had
not been charged with abuse or neglect despite suspicious circumstances
that were never completely explained. Marilyn’s
father was convicted of child abuse, based on Gladys’s plea
bargain and testimony, and he was sentenced to the penitentiary.
Pending resolution of legal custody, the Grobs were told “not
to get attached.”
Marilyn was a difficult infant. She slept fitfully, ate poorly,
cried easily and was hard to pacify. She was hyperalert, could be
promiscuously charming with adults, sometimes attacked other
children and, at age three, continued to resist toilet training.
Physically, Marilyn eventually appeared to thrive at the Grob’s
home, but behavior problems persisted. Repeated evaluations
by child psychiatrists and a clinical psychologist pointed toward
reactive attachment and post-traumatic stress disorder.
“Lynne Grob” brought Marilyn to our clinic for help with
toilet training when the child was four. Lynne had always
been successful with training, but in this instance felt stymied.
Resolution of Marilyn’s custody and secure permanency was
suggested as a solution. Ms. Grob was encouraged to enable
Marilyn’s attachment. The caseworker and guardian concurred
and regular sessions were held. All concerned worked hard
13
toward developmental goals. Marilyn gradually settled down.
Training progressed. Behavior improved. The girl began to
identify with the Grob family, and they with her.
About six months later Marilyn’s birth mother, “Gladys,”
reappeared unexpectedly with an attorney who demanded “family
reunification.” Court-ordered psychological testing found
Gladys “not unfit” for parenting. Civil proceedings commenced
to determine a permanency plan for Marilyn’s future. Marilyn’s
now beloved foster parents were again cautioned not to become
“too attached.” Four attorneys including Marilyn’s guardian
ad litem, her mother’s attorney and a lawyer for each set of
grandparents participated in hearings but the foster parents were
not represented. Subsequently, the judge ordered reunification
with the birth mother, to begin with supervised visits. Marilyn
became upset after each visit, clearly stating that she loved the
Grobs, wanted to stay with them and was afraid her birth mother
might hurt her. Marilyn’s trusted caseworker was removed from
the case. A special “tough” caseworker was assigned by the
court to facilitate Marilyn’s return to Gladys. Gladys then had
sporadic sessions with a psychotherapist but was thought to
remain insensitive to her child’s needs. The judge set a date for
Marilyn to join her birth mother. Marilyn became confused and
distraught. Her behavior regressed. Mrs. Grob offered to support
contacts for continuity, but her offer was declined. In fact, she
was reprimanded for becoming too attached. Marilyn was sent
to live with her maternal grandparents. We learned later that her
father had been paroled, the parents reunited and they moved
with Marilyn to another state.
The court allowed me one last session to “say goodbye.”
Marilyn’s affect during the session was dissociated and
mechanical. There was a look of frozen desperation. Clearly,
something tragically unreasonable had occurred. Marilyn’s
expressed needs had been ignored, her loving connection
at the foster home sundered, the foster parents blamed and
further contact forbidden. Most alarming was the fact that she
was litigiously returned to an abusive, unfamiliar, potentially
murderous situation. It is hard to find any rational basis for
the pain and confusion brought upon an innocent child by well
meaning adults in this case.
Common sense suggests better attention to the children’s
developmental needs, self-pride and supportive relationships.
Yet most attempts to improve foster care remain focused on
economies, quotas, deadlines and litigation. The strong body
of knowledge concerning child development (attachment, selfesteem
and social competence) is not well applied (Belfer, M.L.,
and Fine, P. Foster Care. In Noshpitz, J., and Alessi, N.E., eds.
The Handbook of Child and Adolescent Psychiatry, New York:
Basic Books, 111-124, 1997). Research by Barth in 1994 indicated
a persistent imbalance nationally between high levels of
support for child protection (rescue from abuse and neglect) and
low levels of support for child care following rescue (foster care)
(Barth, R.; Beruch, J.; Gilbert, N., eds. Child Welfare Research
Review, New York: Columbia University Press, 1994). Clinical
experience indicates that the imbalance has not been corrected.
Placements for children in state-sponsored foster homes remain
relatively consistent over the years at half a million.
Nothing less than a change in societal mores related to foster
children may be needed to improve their predicament. They
should include more humane approaches on every level of social
organization with respect, insight, and an understanding of

child development applied to all decisions that affect motherless
children. Emotional competence for the task, in addition, should
be expected of attorneys, judges and case workers as well as for
therapists and families, and is a logical topic for training in each
discipline. A unique resource for improvement, in addition is
presented by effective foster parents. They are in fact closest to
the children and represent a portion of the general population
with a gift for child rearing. Yet to the best of my knowledge
there has been little or no organized research to identify excellent
foster parents, support their work and apply their insights.
Not all foster parents, of course, are gifted. Some possess
only marginal skills or less than perfect motivation. No matter. It
should remain possible to mitigate conditions when professionals
work together with self-understanding. It also seems practical
in the long run to expect some degree of insight along the entire
spectrum of caregiving professionals. Change is never easy yet
there has to be a beginning. Hope, after all, in the final analysis,
really does spring eternal from the proverbial human breast.
Paul Fine, M.D., is a psychiatrist in practice in Omaha, NE. He
can be reached by email at spfine@cox.net.
In the title of this paper I chose
the term “excommunication”
because its etymology of
“exclusion from the community
of the faithful” clearly gives
the idea of the essence of this
procedure, which is the expulsion
from the group of reference as a
sanction for having broken the
group’s rules. In the Catholic
Church, a well-known example is
the excommunication of the Emperor Frederick the Second on
the part of Pope Gregory the Ninth. The Catholic Church did
not only apply excommunication in matters of faith, but also in
scientific matters, as in the equally well-known case of Galileo.
This is a means of social control universally applied. It is
found in all ages and at all levels, from the ostracism in ancient
Athens to the excommunication, in the proper sense, in the
various churches, to the informal expulsion from a family. The
effectiveness of this procedure is due to the fact that man is
a social animal, and that to belong to a group of reference is
an innate need. Among the pre-colonial Australian aborigenes
expulsion from the tribe could lead to death.
At the beginning of life, the equivalent of the need for
belonging to a group is the need for a primary relationship,
as distinct from the need for nourishment. In hospitalism,
described by René Spitz, hospitalized babies, although regularly
fed, would waste away, and sometimes die, due to the lack of
a relationship.
In what follows I examine the excommunication of Sandor
Ferenczi on the part of orthodox psychoanalysis. I then examine
four other authors, Erich Fromm, Jeffrey Masson, Alice Miller
and John Bowlby, following the thread of excommunication and
of the various reactions to it.
Ferenczi
This paper is concerned in the first place with the punitive
expulsion of Sàndor Ferenczi on the part of his group of
reference, Freudian psychoanalysis, for having broken a rule of
that group, consisting of the denial of the reality of childhood
sexual abuse.
This rule may be a particular case of a more general rule in
medicine, consisting, at least in the past, of the denial of the
Ideology and Psychoanalysis:
The Excommunication of Ferenczi
by Marco Bacciagaluppi, M.D.
14
reality of childhood traumas of any kind, physical as well as
sexual, if inflicted by the parents. Gianni Guasto, the coordinator
of a group of Ferenczian readings in Genoa, tells me that
the radiologist Caffey described in 1946 a neonatal syndrome
characterized by subdural hematoma accompanied by multiple
fractures of the long bones, but did not dare to suggest that
the cause was physical abuse on the part of the parents, as
was indeed the case. Things have changed since then. In 1968,
The Battered Child, by Helfer and Kempe, is full of horrifying
radiographs of fractured skulls and broken bones of infants.
Before denying the reality of child sexual abuse, Freud had
upheld it. He had a first experience of child abuse in 1885-
86, during his stay in Paris in which he attended Charcot’s
lectures. On that occasion he also visited the Morgue, where he
witnessed the autopsy of children who had been raped and killed.
In 1895-96, his patients reported sexual abuse in childhood.
Freud presented these results in a paper on The Aetiology of
Hysteria, given in April 1896 at the Society for Psychiatry and
Neurology in Vienna. The paper was met by a stony silence.
Subsequently, as he revealed in a September 21, 1897 letter
to his friend Fliess, Freud changed his mind. He decided that
he had been wrong to have believed his patients, and that the
recollections of the alleged abuse were actually fantasies. In
its subsequent development, psychoanalysis was based on the
theoretical premise of infantile sexual impulses expressed in
fantasy and was carried out in a position of neutrality on the
part of the analyst.
In the last years of his life, Ferenczi, Freud’s favorite pupil,
developed a series of concepts at variance with the orthodox
psychoanalytic ideology: in normal development, the importance
of parental love; in psychopathology, the reality of physical
and sexual traumas, to which the infantile psyche reacts with
dissociation; and finally, in therapy, the intense involvement of
the therapist, that included experiments in “mutual analysis.”
In September 1932 Ferenczi presented a paper at the 12th
International Psycho-Analytic Congress in Wiesbaden with the
title Confusion of Tongues between Adults and the Child, in
which he talked once more of the sexual seduction of children.
This was met with the strongest disapproval, just as Freud’s
1896 paper. Before the Congress, Ferenczi went to Vienna to
meet Freud who was too ill to attend and Freud asked him not
to publish the paper. This disapproval left Ferenczi isolated and

probably contributed to his premature death, which took place
soon after, in May 1933. His colleagues considered him paranoid
and did not publish the English translation of the paper. The
publication only took place in 1949, on the initiative of Michael
Balint, Ferenczi’s pupil.
To sum up, Ferenczi was alone in confronting orthodoxy.
He confronted it with courage and consistency, but he suffered
greatly from the excommunication, that entailed the loss of the
personal relationship with Freud that had meant a lot to him,
and of the membership in his group of reference, where he had
been very influential and highly regarded.
Fromm
Erich Fromm rose twice in defense of Ferenczi. The first time
was in 1935, soon after Ferenczi’s death, in a paper titled The
Social Determinants of Psychoanalytic Theory. In this paper,
Fromm viewed the disapproval of dissident followers such as
Ferenczi as indirect evidence of Freud’s basic identification
with social norms.
Fromm defended Ferenczi again after the publication in 1953
of Jones’ biography of Freud. He was indignant at the allegation
that Ferenczi had become insane at the end of his life. In order
to refute these accusations, in 1957-58 he carried on an intense
correspondence with many people who had known Ferenczi,
among whom were Clara Thompson and Izette de Forest, both
analyzed by Ferenczi. Fromm published the result of this work
in 1958.
I have reported this defense of Ferenczi on Fromm’s part
to stress some fundamental differences between these two
authors, and between them and Freud. In 1896, Freud, without
another group of reference and confronted by the hostility of
his colleagues, lost courage and changed his mind. Ferenczi, in
1932, confronted by the same disapproval, remained faithful to
his ideas but, being isolated, suffered from the excommunication
to the point of dying. Fromm succeeded twice in firmly
defending Ferenczi and in proclaiming the truth because he was
backed by alternative groups of reference. In 1935 he belonged
to the Frankfurt Institute of Sociology, which had a critical
position towards society. He published his defense of Ferenczi
in the Zeitschrift fuer Sozialforschung, the journal of the Institute
that at the time, after the advent of Nazism, was being printed
in Paris. In 1957-58 he belonged to the William Alanson White
Institute of New York, an alternative school of psychoanalysis,
following the interpersonal-cultural approach, that he himself
had founded in 1946 together with Sullivan. Whereas Ferenczi
was alone and died of his excommunication, Fromm was backed
by strong alternative and critical groups of reference.
Fromm in turn underwent excommunication. Paul
Roazen, psychoanalytic historian, spoke of his “de facto
excommunication” on the part of the psychoanalytic community.
In common with Bowlby, whom I shall examine below, Fromm
was very independent and had the capacity of creating new
groups of reference. At one point he also estranged himself
to some degree from the Neofreudian school he himself had
founded and reached out to a wider public of readers. After
having in vain tried to be accepted by the IPA, in 1962 he
contributed to the foundation of an alternative international
association, the IFPS (International Federation of Psychoanalytic
Societies).
Masson
In 1984 Jeoffrey Masson published a book, Assault on Truth,
on Freud’s abandonment of the seduction theory. Masson
15
was director of the Freud Archives in London, after having
completed a classical psychoanalytic training. In this capacity he
had access to Freud’s unpublished correspondence and realized
that the orthodox Freudian establishment (Anna Freud, Kurt
Eissler and others), in publishing Freud’s letters to Fliess, had
made selective omissions. He was also enabled to view the later
correspondence of Freud on the case of Ferenczi. When Masson
started to make public the results of his research, he elicited the
typical reaction of excommunication and lost his post as director
of the Freud Archives. He was a highly qualified scholar and,
like Fromm, he turned to a wider readership. In his book, in
addition to reestablishing the first phase of Freud’s work, he also
gives a detailed account of the case of Ferenczi, toward whom,
again like Fromm, he showed strong fellowship.
Miller
Alice Miller, the Swiss author, like Masson, had a classical
Freudian training. Ever since her 1979 first book, The Drama
of the Gifted Child, she dealt with deep compassion about
childhood traumas. The usual reaction of disapproval on the
part of the orthodox led to her resignation from the IPA in
1988. In her later books she radically challenged psychoanalysis
and included in her critique also the alternative psychoanalytic
approaches. Since then she did not want to be defined as a
psychoanalyst. Predictably, a circular process was set in motion.
If she ignored the psychoanalysts, both the orthodox and the
non-orthodox, they in turn ignored her. As in the case of Fromm,
her excommunication took the form of a wall of silence. Miller
reacted by proceeding along her solitary road with a series
of other books, relying on a loyal readership, with which
she was also in contact through her website. In one of these
books, Banished Knowledge (pp. 140 and 187 of the British
paperback edition), she twice mentioned Galileo, presumably
because of the obvious similarity to her own case. She also (p.
187) established a link between the case of Galileo and that of
Sigmund Freud. Both exhibited a severe somatic pathology.
Galileo went blind and Freud developed cancer of the jaw. She
viewed these pathologies as a reaction of the body to the denial
of important truths. This denial in turn is the consequence of
the subjection to an external authority.
Bowlby
The experience of John Bowlby, the initiator of attachment
theory, is similar in a way to Ferenczi’s, but with a vastly
different outcome. In a chapter of A Secure Base, his last book
of 1988, he describes the origins of attachment theory. On behalf
of WHO (the World Health Organization), he carried out a study
of the effects of inadequate maternal care that was published in
1950. Also in this case was the question of traumatic childhood
experience due to external factors, although it was not described
in these terms. Bowlby then turned to the direct observation
of the effect on children of separation from the mother due
to hospitalization. At this point Bowlby speaks of “the sharp
controversy aroused” by this research. In particular, “many
psychoanalysts…, especially those whose theory focused on the
role of fantasy in psychopathology…remained unconvinced and
sometimes very critical.”
What allowed Bowlby to proceed with his research and
theoretical development Again, as with Fromm, an institution,
the Tavistock, and, in addition, a wide network of friends and
collaborators in various scientific disciplines (Mary Ainsworth,
Mary Main, the ethologist Robert Hinde, the specialist in grief
and mourning Colin Murray Parkes, and many others). In a

word, he had a reference group that was an alternative to the
British Psycho-Analytical Society where Bowlby came from. In
common with Fromm, Bowlby had original views and he was
indifferent to hostile reactions. Unlike Fromm, Bowlby chose
to avoid controversy and continue his research. In common
with Masson he had scientific exactness, which Masson applied
to historical research and Bowlby to empirical research and
theoretical development. The outcome was a theory firmly
rooted in the theory of evolution and now widely accepted in
the scientific community.
Discussion
These remarks may be included in a macro-structural
paradigm. The analogy between the excommunication inflicted
on Ferenczi by orthodox psychoanalysis and those inflicted by
the Catholic Church is not only formal but also substantial.
These two excommunicating groups are social institutions, even
if of different dimensions. They both belong to the patriarchal
culture, which, as Bachofen (rediscovered by Fromm in 1934)
stated in 1861, was superimposed on the original matriarchal
culture only 4-5 thousand years ago. The matriarchal culture
dates from an immeasurably longer time, it is therefore still
present in our genes, even if, since the advent of patriarchy, it
is submerged and forbidden.
Every time the matriarchal culture resurfaces, it elicits punitive
reactions. Ferenczi may be viewed as a great representative of
matriarchal culture, severely punished by his patriarchal group
of reference.
Conclusion
The five cases examined, of Ferenczi, Fromm, Masson, Miller
and Bowlby, suggest that, in order to challenge an ideology in
the scientific domain, an individual effort is not sufficient, but
a strong alternative group of reference is required.
Marco Bacciagaluppi, M.D., Milano, Italy, Fellow, AAPDP,
Founding President, OPIFER. His email address is
m.bacciagaluppi@marcobacciagaluppi.com and his website
address is www.marcobacciagaluppi.com.
Mothers-in-law and Daughters-in-law: A Dad or a Triad
by Cassandra M. Klyman, M.D.
There is an old joke about asking why grandparents and
children love each other so much and so readily. The answer is
they hate the same people. So you would think that wives and
mothers-in-laws would get along well because they love the
same person. Why shouldn’t these two be friends - loving the
same man, wanting him to be happy Well there are 57 different
varieties of love and some are not easily compatible. Also there
are factors that complicate any sort of relationship between two
humans of the same sex - envy, jealousy and rivalry. Remember
the saying “two’s a couple and three’s a crowd”
We start out as a couple in the womb. In the act of nursing,
as we edge out of toddlerhood we soon find out there is a third
party out there that has real significance for our mothers. Either
mother + baby + father or someone else significant, e.g. sibling,
grandparent, mother’s work, baby-sitter etc. We then create
our own triangular relationship when we get married and have
children. We still carry inside our longing for it to be “just the
two of us.”
All new brides bring along baggage: the prototypes of the
original inevitable less-than-perfect relationship they had with
their parents. If they have not shaken off some of the negative
feelings they had with their mothers, those can get projected
onto any other older woman with authority - such as their husband’s
mother. Ironically the bride may over-react with “loyalty”
and won’t let herself have positive feelings for “another mother”
to deny her ambivalence for her biological mother. Or she may
be protective and caring for her own loved, vulnerable mother
who dreads “losing” her. So she may “protest too much:” “No,
you can’t tell me what to do - you’re not my mother!” and “I
can’t even call you Mom, what about Sally” And it may remain
Sally or “no name” until you become “Grandma.”
If this sounds childish and hurtful - it is. But unfortunately
a new marriage may bring out, not always the adult in us, but
the child too, for both the daughter-in-law and the mother-inlaw.
And assuming neither of these women are not mad or bad,
16
what goes wrong between them This brings us to revived
dual oedipal complex issues. Children, around the ages of 3-6,
may hesitate to make their claim too openly for an exclusive
closeness for the opposite-sex parent because that would mean
eliminating the same sex parent upon whom they depend upon
and also for whom they have affection.. They also worry that the
same-sex parent might hurt them if he or she knew their wish.
So little boys grow up singing “I want a girl, just like the girl,
that married dear old Dad.” And little girls want to marry men
that remind them of the best of their fathers.
Once they are married they can, and want to, lay exclusive
claim on their husbands. “Forsake all others! - including you,
mother - you’re mine, mine, mine.” Yet, in a healthy family, the
erotically-desired parent helps the child postpone his or her wish
and to recognize its unreality for gratification in the present.
Within the family, parents talk about how good and nice it is
that they all can love each other in different ways. Mom loves
Dad in a different physical way - mouth kisses, getting naked in
front of each other and sleeping together - and Mom loves her
son and she knows he loves her in their special, unique, tender
way, and when he grows up he will love his wife in a Dad-like
way. Then he will have his turn.
The Father correspondingly lets his daughter know he loves
her deeply but he will not let her touch his penis, will not
shower with her, and does not get into her bed. He loves her
with the same quantity but different quality. These assertions and
explanations may not be explicit but repeatedly get conveyed
through action.
So, too, the bride and bridegroom must convey new “rules of
engagement” with each other, and toward their parents, in the
new triangles of relationships that their marriage has created.
The parents may look with unconscious envy at the strong erotic
bond - they may regress to feeling “left out” of this as they
once had as children vis-a-vis their own parents. So they may
want to “get in” - in between the newly-weds’ embrace instead

of just beaming on it. They may insist on Friday or Sunday
night dinners together. In the spirit of generosity they will make
home decorating and entertaining suggestions. Later, pressures
for conception or suggestions about child-rearing are ways of
trying to get control and create that desired baby that long ago
they wished for with their Mom or Dad.
These unconscious underpinnings are for all of us to resolve.
If we don’t do it before we hit middle-age, we get a second
chance when our children marry. Our sons become an echo of
our fathers and their brides a reincarnation of our mothers who
we are happy to find fault with and vice versa.
Example 1
Mrs. A, recently widowed, presented bereft that her son and
daughter-in-law who lived close by had less to do with her now
than when her husband was still alive. She felt that she had
hinted plenty about her dismay but could not speak out directly
because she believed her grandchildren would then be kept more
distant from her. As it was, there were always excuses for her
not to have them overnight. She would be told of school plays
and talent shows only at the last minute so often she would have
to disappoint her bridge group which was becoming annoyed
with her. “How,” she lamented, “how could this happen Larry
had been so close to me, the closest of my three kids - why he
even made me this scrapbook on Mother’s day when he was 22.”
She showed me this thick scrapbook. It could have been a
Valentine’s memoir between sweethearts with page after page
of mother and son cuddling and kissing, with his declarations
of “I’ll never love anyone more than you.” It was so saccharine
that I thought maybe it was a satire although Mrs. A believed it
quite sincere and she had of course shown it to his finance as
evidence of what a loving man she was about to marry. Could
this have made the new Mrs. A keep her distance Or might it
have been the quite small amount of money that Mrs. A had
been willing to contribute to the wedding And was it Larry’s
initial failure to tell his fiancé that her engagement ring was
made from the 3 carat diamond his mother gave him from her
own mother that made his bride bristle at her mother-in-law and
assert: “I will never call you mother, I have a mother of my own,
and you’ll never take her place.” Mrs. A was taken aback. She
had previously felt so loving towards this vivacious, otherwise
charming girl who she was welcoming as a daughter.
It seemed to me that Larry was the pivotal actor in this drama.
He had loved his mother so intensely and had transferred his
love so completely to his wife that he had nothing left for his
mother and no awareness that he might facilitate the relationship
between the two women. He needed to explain to the “inner
child” of each of them that he had enough love for both and
that his love for his mother had changed from when he was a
little boy. Now it was filial and the love towards his wife was
romantic and there was no need for jealousy or rivalry between
the two of them. He needed to talk them up to one another rather
than maintain a wall of silence like a referee putting them into
their corners until the next round.
Interpreting this to Mrs. A gave her slight comfort. She did
not want to give up the illusion that Larry no longer loved her
the way he once did. She preferred to believe that it was her
evil daughter-in-law who kept him from her. She rejected my
suggestion that she ask Larry to come to a session with her. She
had left her previous therapist when they had come to a similar
understanding. Maybe the third therapist would be the charm!
Example 2
Mrs. B, mother of four boys, has three daughter-in-laws and
none says more to her than “hello and goodbye.” They complain
that she has done nothing for them even though she has been a
willing babysitter and encourages her husband to give generous
gifts from Mom and Dad. But the sons’ wives only thank their
father-in law, plan special birthday parties for him and send her
“belated” wishes for her significant occasions.
Why is she so ignored She has been sickly and she is a
wrinkled, stooped over and greying red-headed woman. Does
she embarrass them dressed in her sweats and walking with a
cane Do they blame her for her previous eating disorder that
helped to destroy her health Do the sons only tell their wives
stories about how their mother threw dishes down the cellar
steps when their father came home late for dinner, or not at all
Mrs. B has kept her husband’s infidelities secret. She promotes
the boys’ idealization of her husband at her own expense. And
the cost has been high. Her sons fail to tell their wives of the
ways in which their Mom had been a good Mom. They never
mention that their Mom welcomed all their friends, was the one
taking them for necessary medical/surgical attention, encouraged
their going to college, supported their sister’s rehab from alcoholism
and towards a successful buy-out of the family business.
So how can the three daughters-in-law appreciate her
One son moved to California, became wealthy and bought
his parents, primarily for his mother, a lovely home. He has
remarried and has spoken kindly about her to his second wife.
His wife now wants to be close and yet Mrs. B has become gunshy.
She states, “I’ve given up wanting to be loved - I’d just be
happy for respect!” The remainder of her children identify with
her husband and his treatment of her - with scorn and derision
under the guise of “just kidding, can’t you take a joke”
So the problem with her daughters-in-law stems from the
triangular system in which their husbands/her sons grew up: A
workaholic, philandering father and a mother probably short on
TLC while she nurtured five children in a tiny house, without
a car, and with an absent husband. The unknowing children
only remember her distress and none of her dutiful attention.
Her anorexia resulted from a biological diathesis and her determined
need to control something in her life no matter what the
ramifications. No doubt it was also an attempt to maintain her
figure and get her husband’s roving attention to settle back on
her. It backfired and she is still dealing with the repercussions.
Mrs. B still wants to protect her pride and so she cannot speak
to each of her sons individually, or collectively, to empower
them to bring about reconciliation between her and their wives.
She needs them to say: “I love you and my Mom in different
ways and I want to be able to show it to our sons. That way I
will be a model for our boys to love you and to have their wives
love you when they get married themselves.”
Example 3.
In conclusion: an example of things going right, the son
steps-up. Mr. and Mrs. C. go to Chicago to visit their son and
his family - and that’s how they identify it. They acknowledge
to me they are disappointed at how this family is evolving.
The daughter-in-law’s career is much more successful than
their gifted son’s. She is always working her high-powered job
and at home is always, when they visit, having a “melt-down.”
This particular visit was no different. The morning after they
arrived, Mary got upset that Mrs. C. had sneezed so loud she
17

woke up one baby who then cried, awakening her twin, and
then Mary. Besides, was Mom C’s sneeze going to make the
whole family sick
Mrs. C. replied she would try to stifle the next sneeze, wash
her hands thoroughly and believed it was only her allergy (she
kept it to herself that the guest room was very dusty). It was
about the same rational response she would make to an apprehensive
friend. Later that day her son pulled her aside, thanked
her for being so calm about the fuss over the sneeze and said:
“Please ignore the condition of the refrigerator and don’t mention
the pile of boxes from Mary’s on-line shopping. She will
get to them but last week was very busy for her. Cut her some
slack Mom. I love you both!”
At the end of the visit on Sunday night Mrs. C. the elder and
Mrs. C. the younger both declared the visit a great success and
made plans to get together soon to select baby-furniture together.
She could note that although her daughter-in-law doesn’t keep
the house the way she does, and just because she doesn’t cook
dinner every night, and doesn’t put a fresh piece of fruit into
the lunch box, doesn’t mean she’s a bad wife, mother or person.
It’s just that she’s different - that you’re an orchid and she’s a
rose or vice versa - both are wonderful to their son/husband.
Summary
The problem is in the triangle - it is not just between the two
wives. Yes, they may each have had issues with their mothers;
they may have clashing personalities; and they may have
cultural or traditional values that differ. Daughters-in-law may
feel entitled to be disdainful or greedy but their attitude is best
altered by their own husbands. A content mother-in-law in the
making can advise her son that it is his role to do the explaining
and set the boundaries, empowering him as the man; shifting
her regard from him as son or her own past father.
Judeo-Christian Bible
The Judeo-Christian Bible weighs in on this matter. In Genesis
we read that a “Man shall leave his family and cleave unto
his wife and they will become one flesh that no one shall rent
asunder” and we have the idealized mother-in-law/daughter-inlaw
pairing in Ruth and Naomi (Ruth 1:1-4:22). There the two
widows return to Naomi’s homeland with Ruth asserting “wither
thou goest so go I. Let me go with you. Your people will be
my people. And your God will be my God.” Ruth supported her
seduction of Boaz and rejoiced in their marriage. And Ruth thus
became the great-grandmother of the great King David. What
mother-in-law wouldn’t want that reward!
Cassandra M. Klyman, M.D. is Assistant Clinical Professor
of Psychiatry at Wayne State University School of Medicine,
Detroit, MI. She is in the private practice of Psychodynamic
Psychiatry and Forensic Consulting in Bloomfield Hills, MI.
Her email address is cklyman@sbcglobal.net.
Submission and Subjectivity: An Abbreviated History of
Masochism in Psychodynamic Thought
by Kyle Arnold, Ph.D.
To Freud, masochism was a conceptual anomaly and a clinical
enigma. The self-defeating behavior of the masochist seems
to challenge one of the most fundamental axioms of Freudian
theory: the pleasure principle, which has it that human beings
are driven to maximize pleasure and to minimize unpleasure.
Masochists, on the other hand, seek out suffering, giving the
impression that they experience pleasure in pain (Freud, S.,
1924, The economic problem in masochism, Standard Edition,
19, 159-170). Freud saw this paradox as a profound conceptual
problem. If human beings are biologically wired to seek pleasure
and avoid pain, how can psychoanalytic theory account for the
behavior of the masochist Why would someone want to seek
suffering
Freud thought that masochism presented one of psychoanalysis’
most vexing puzzles, and he spent years trying to solve it. In
his struggle to explain pain-seeking behavior, Freud ultimately
felt forced to fall back on the notion of an innate masochistic
drive. Yet he also, in a more generally accepted formulation,
suggested that masochistic patterns can be attributed to selfdirected
aggression (Freud, S., 1920, A child is being beaten,
Standard Edition, 17, 175-204) This self-directed aggression,
Freud claimed, can be conceived of as a defensive reversal of
object-directed aggression, which in turn can be interpreted as
a transformation of passive love for the Oedipal object. Guiltridden
by her desire for the parent, the masochist defensively
regresses to the anal stage, exchanging passive genital love for
anal sadism. Rendered once again guilty by her anal aggression
towards the object, the masochist turns this aggression against
18
the self. What begins as a loving impulse toward the object
becomes a sadistic urge directed at the self. Self-destructive
behavior represents both a gratification of and punishment for
this urge.
Freud’s pupil Theodor Reik (1941), in his seminal work Joy
from Suffering (re-titled in the English version Masochism in
Modern Man, New York: Farrar, Straus), drew upon this account
of masochism to make the case that although masochism may
appear to contradict the pleasure principle, this contradiction
is more apparent than real. He expanded and modified Freud’s
formulation, arguing that for the guilt- and shame-ridden
masochist, unpleasure is a condition for pleasure. The masochist
doesn’t seek pain. Rather, the masochist seeks the pleasure
that she feels she will deserve only after a period of suffering,
like the religious martyr who believes that great sacrifice will
be rewarded by a place in heaven. Pleasure, for the Reikian
masochist, is the light at the end of the tunnel.
Still, Reik’s close attention to the phenomenology of
masochism forced him to recognize that masochistic experience
rarely consists of a clear pain-pleasure sequence. Even when
the masochist is able to bear her suffering by looking forward
to a future reward, she frequently enjoys significant pleasure
during the suffering itself. Reik attributed this phenomenon
to the mechanisms of displacement and condensation. The
masochist’s anticipated pleasure, Reik suggested, is displaced
from the future to the present, where it is condensed with the
experience of displeasure. Accordingly, during suffering the
masochist experiences an amalgam of pleasure and pain. It isn’t

that pain is pleasurable to the masochist, Reik says, but that the
masochist can’t allow herself to feel pleasure without throwing
some pain into the mix. As he would put it, masochistic pleasure
is not pleasure in suffering, but pleasure from out of suffering.
Reik also placed some emphasis on the relational aspects of
masochism. He stressed the importance of superego pathology
in masochism and also offered a detailed analysis of the
narcissistic-exhibitionistic functions of masochistic behavior,
claiming that the masochist achieves narcissistic gratification
by demonstrating her fortitude and endurance through suffering.
Reik also noted that masochism can often serve the function of
guilt-tripping others, thus indirectly gratifying aggressive wishes
toward objects. Nevertheless, Reik was careful to locate his
ideas within the intrapsychic framework of Freudian theory, and
despite his assertion of the social nature of masochism, his own
writings are strongly focused on the dynamics of intrapsychic
conflict.
Bad love: The object-relational turn
Following Reik’s seminal work, a number of authors tried
to handle the problem of masochism by emphasizing a more
object-relational standpoint. Although operating within a loosely
classical framework, Bernhard Berliner and Esther Menaker
(Menaker, E, 1953, Masochism: A defensive reaction of the ego,
Psychoanalytic Quarterly, 22, 205-225; Berliner, B, 1947, On
some psychodynamics of masochism, Psychoanalytic Quarterly,
16, 457-471; Berliner, B, 1958, The role of object relations in
moral masochism, Psychoanalytic Quarterly, 27, 38-56) stressed
the internalization of sadistic parental figures. These authors
suggested that most masochists have been raised by sadistic
caregivers. In an effort to feel loved by and connected to these
caregivers, the masochist abjectly submits to their sadism,
while tricking herself into believing that it is a form of love.
In Berliner’s terms, suffering is both denied and libidinized. At
the same time, the other is falsely idealized and all badness is
attributed to the self. As the sadistic parent is internalized, the
child comes to feel that any loving relationship must involve
libidinized suffering in the service of an idealized other, and that
a failure to stoically accept this suffering will lead to loss of love
and abandonment. To feel safe and loved, then, the masochist
must remain in destructive relationships.
From this angle, the pleasure principle (and thus the
paradoxical urge to seek pleasure in pain), loses its clinical
importance. For masochism isn’t about pleasure and pain,
these authors essentially believed. It’s about relationships,
about surviving and maintaining them. Because Berliner
and Menaker were struggling to work within a traditional
framework, though, they were not able to fully articulate this
notion. Despite their clinical emphasis on relatedness, these
authors still metapsychologically adhered to the pleasure
principle. Therefore, although they could make clinical sense
of masochism, on a conceptual level it remained a problem.
For Ronald Fairbairn (Fairbairn, R, 1943/1952, The
repression and return of bad objects, In Psychoanalytic studies
of personality. London: Routledge), on the other hand, who
independently developed a theory of masochism closely
resembling Berliner’s, this new view of masochism was easily
housed within a new metapsychology. Like Berliner, Fairbairn
claimed that masochistic dynamics - that for him underlie all
psychopathology - arise because the child takes the parents’
sadism upon herself in order to maintain the comforting illusion
that her parents are good. As Fairbairn famously wrote, it is
better to feel like “a sinner in a world ruled by God” than like
a good person living “in a world ruled by the Devil” (Fairbairn,
1943, pp.66-67). This process sets up a bad internal object,
to which the child comes to feel she must remain linked. To
Fairbairn, this view required that the pleasure principle be
jettisoned from psychodynamic theory. In the final analysis,
Fairbairn argued, what we are driven to seek is not pleasure,
but relatedness. As he puts it, libido is not pleasure-seeking
but object-seeking. If we assume that people are motivated
by the urge for pleasure, masochism can seem baffling. But if
we instead suppose human beings to be driven by the need for
relatedness, masochism is clearly intelligible. The masochist
needs to suffer to maintain ties to punitive internal parental
figures. If the price for relatedness is suffering, relatedness is
well worth it.
As similar object-relational views became increasingly
prominent, masochism came to be seen as much less of
a theoretical conundrum than it had been for Freud. Few
if any recent authors regard masochism as theoretically
problematic. Partly through the influence of Fairbairn’s work,
masochistic dynamics have assumed a central place in several
contemporary accounts of psychopathology. Discussing relational
psychoanalysis’ theory of psychopathology, Stephen Mitchell
(Mitchell, S., 1988, Relational concepts in psychoanalysis,
Cambridge, MA: Harvard University Press) listed the tie to
the bad internal object, which is now more commonly referred
to as the bad introject, as one of three central reasons for the
fixedness of pathological patterns, the other two being the
need to maintain organization of self and the fear of unfamiliar
experience. Although the terms introject and internal object are
not always used to refer to the same theoretical construct, I use
them interchangeably in this paper.
On the face of it, it doesn’t seem particularly problematic
to say that masochists seek out suffering to maintain a sense
of connection to bad internal objects. Yet what is this sense
of connection, this tie that Fairbairn felt to be of critical
importance For both Fairbairn and Berliner, the relationship
to the inner parent is needed primarily because it is just that:
a relationship. Although both theorists told sophisticated and
detailed stories about the genesis and functions of the sadistic
superego (Berliner) or depriving internal object (Fairbairn),
these destructive psychological presences are mainly clung to
because the masochist simply needs to feel related. People crave
connection so much that they’ll take it however they feel they
can get it, even if how they can get it isn’t particularly agreeable.
Recognition and surrender: Intersubjectivity and masochism
Later theories tried to be more precise about exactly what it
is that is sought after in a masochistic relationship, and have
focused on how masochism relates to the sense of self. One
of the most comprehensive of these theories was presented by
Jessica Benjamin in The Bonds of Love (Benjamin, J, 1988,
The bonds of love: Psychoanalysis, feminism, and the problem
of domination. New York: Pantheon). Benjamin stresses
the connections between sadomasochism and the relational
dynamics involved in being recognized as a human subject or,
alternatively, objectified. For Benjamin and theorists sharing
her views, recognition is not about pride. Rather, it is a basic
formative building block of having any sense of self at all. It
is about being simply accurately registered as feeling what one
19

actually feels, thinking what one actually thinks, and being
who one actually is. Benjamin argues that recognition can only
occur in the context of mutual recognition, for I can only feel
recognized from the other’s point of view if I can recognize that
the other has a point of view. I can’t feel like I’m being seen,
one might say, unless I see that the other has eyes.
For Benjamin, mutual recognition is a favorable yet precarious
position. For it is difficult to recognize both self and other at the
same time. On the one hand, in my quest for absolute recognition
I can feel compelled to force the other to submit to my point of
view. The more I do so, however, the more the other ceases to
be an independent subject who is capable of recognizing me.
This variant of the search for recognition, then, ultimately makes
it impossible for me to feel recognized. On the other hand, I
may also desire to submit to the other’s viewpoint, hoping that
in doing so I will be discovered by her. This strategy, too, ends
in failure. In submitting to the other’s perspective, I negate
my own, leaving me without a subjectivity to be recognized.
The former method of trying to achieve recognition, Benjamin
says, leads to domination, while the latter results in submission
(cf. Sartre, 1943, First attitude toward others: Love, language,
masochism and Second attitude toward others: Indifference,
desire, hate, sadism. In Being and nothingness. New York:
Washington Square).
Like Benjamin, Emmanuel Ghent (1990, Masochism,
submission, and surrender, Contemporary Psychoanalysis, 26,
211-242) proposes that masochism is linked to a basic human
longing for recognition, which he believes requires one to let go
of false self so that true self can emerge and be seen. He calls
this process surrender. Surrender, for Ghent, means a relaxing
of defenses, a letting-go of resistances, in the service of growth.
Despite the connotations of the word, Ghent states that surrender
never occurs to another, but only in the presence of another. In a
moment of surrender, there is relaxation rather than domination,
and the self is uncovered rather than submerged. Ghent warns,
however, that the longing for surrender can be perverted into a
desire for submission, leading to masochistic acting out. When
submitting instead of surrendering, Ghent writes, the self feels
like a resigned “puppet in the power of another” instead of a
joyously emerging wholeness. Masochism is a warped need for
recognition.
A closely related view of masochism can be found in the
writings of Robert Stolorow, George Atwood, and Bernard
Brandchaft (1994, Masochism and its treatment, In Stolorow,
R., Atwood, G., & Brandchaft, B., The intersubjective
perspective Northvale, NJ: Jason Aronson). These authors are
chiefly known for having developed a comprehensive theoretical
framework they call intersubjective systems theory, which
incorporates aspects of Kohutian self psychology, existentialphenomenological
philosophy, and nonlinear systems theory.
These authors write of patients whose basic emotional states
were ignored or rejected by self-absorbed primary caregivers,
and accordingly were forced to sacrifice basic aspects of their
self-experience to maintain needed relationships. As adults,
these patients often feel swept up and lost in the perspectives of
other people. To understand this experience, readers might think
of a time when they were persuaded by a charismatic speaker,
only to decide in a more sober moment that they disagreed
with the speaker’s views. According to Stolorow, Atwood, and
Brandchaft, masochistic patients repeatedly go through that
unsettling experience, as they are swept away in the subjectivity
of one person after another. These authors understand masochistic
urges to be hit as concrete symbolizations of a need for a latent
inner self to be contacted. They propose that masochistic
suffering can serve as an antidote to feelings of deadness while
establishing a primitive contact with the other person. Stolorow,
Atwood, and Brandchaft note that their formulation has a crucial
practical implication: Using interpretation with the masochistic
patient can be countertherapeutic, because interpretation is felt
to represent yet one more dictatorial point of view to which the
masochist must sacrifice his or her own core experience in order
to preserve the relationship.
In a more recent paper that further develops intersubjective
thinking about masochism, Shaw (Shaw, D, 2010, Enter ghosts:
The loss of intersubjectivity in clinical work with adult children
of pathological narcissists, Psychoanalytic Dialogues, 20, 46-59)
contends that masochistic submissiveness emerges in childhood
as a complementary response to pathological narcissism on the
part of primary caregivers. Children of narcissistic caregivers
are treated in such a way that any assertion of their own feelings
is met with contempt. Revisiting Fairbairn’s work, Shaw points
out that the children of narcissistic parents are coerced to accept
all badness into themselves to preserve the parent’s feeling of
perfection. Children do not merely internalize the sadism of the
parent of their own accord. Rather, the parent actively pressures
them into internalizing it. Shaw contends that adult masochism
is a testimony to the defeat of the child when trying to assert
his or her subjectivity with the parent.
To sum up, masochism in psychodynamic thought has
passed through three phases: the classical libidinal-hedonistic,
the object-relational, and the intersubjective. The libidinalhedonistic
theory was problematic because masochism appeared
to contradict the pleasure principle. This problem could be
solved with a more object-relational approach, but the latter was
somewhat vague about the motivational purpose of masochistic
behavior. Intersubjective theories more precisely delineate what
the payoff is for masochists, while placing masochistic behavior
in the broader context of human existence.
That said, current views of masochism do not require that
therapists discard the contributions of the great traditional
theorists of masochism. Within the context of more recent
contributions, the masochistic dynamics that Reik, Berliner,
and Fairbairn illuminate can be reconceptualized as specific
variants of the paradoxical quest for recognition described by
Benjamin. From this perspective, the exhibitionistic functions
of masochism identified by Reik are aimed at giving the
masochist’s subjectivity a voice by demonstrating her sense of
annihilating abjection. Masochistic guilt tripping, accordingly,
has less to do with a drive for pleasure than with a need for
recognition from those who are felt to impose their subjective
viewpoints on the masochist.
Berliner’s ideas about the role of so-called libidinized
suffering and abandonment fears in masochism take on a
different significance as well. The deeper meaning of the
masochist’s conflation of sadism and love lies in his or her
ironic belief that it is only through abjection to the other’s
seemingly infallible perspective that s/he will discover the gleam
of recognition in the other’s eye (Benjamin, 1988; Ghent, 1990;
Stolorow, Atwood, & Brandchaft, 1994; Shaw, 2010). Given this
emotional conviction, the prospect of abandonment is doubly
20

threatening. For if the other’s subjectivity is felt to be the source
of absolute truth, then abandonment by the other is abandonment
by reality itself. To be abandoned, for the masochist, is to fall
off the edge of the earth.
As Shaw suggests, the Fairbairnian construct of the bad
internal object can also be rethought. Submission to another’s
subjective viewpoint entails the introjection of that viewpoint.
Introjects are dominating, totalitarian points of view that have
overrun the masochist’s mind, fundamentally usurping his or her
sense of being a person in his or her own right. Although the role
of the sadist is more glaringly evident in this dynamic than that
of the masochist, introjection requires the participation of both
parties. The introject is an invited guest, even if the invitation
is coerced. The submissive permits the other’s absolutist
viewpoint to enter in the hope that s/he will be discovered by
this viewpoint. For implicit in the dominant partner’s dogmatism
is the promise that since his or her perspective is the absolute
truth, it will, if accepted, reveal the masochist as who he or she
truly is (Ghent, 1990). A tempting offer indeed.
Kyle Arnold is a Psychologist at Kings County Hospital and a
Clinical Instructor at SUNY Downstate Medical Center. He can
be reached by email at kyle.arnold@nychhc.org
Working in Translation: Chinese Student, American Analyst
by Lynn Somerstein, Ph.D.
“Music is Love in Search of a Word.”
Sydney Lanier, from his poem, “The Symphony,”
published 1875.
In October 2011, I gave a talk about anxiety at the University
of Beijing with the help of a wonderful translator who is also
a psychologist. I had trepidations about filtering my meanings
through another person but we hit it off and we were playful
with each other and the audience. We were in the groove, people
asked questions and laughed at the right times, and everything
was perfect, until it wasn’t.
At the end of my presentation I taught a slow breathing technique
that alleviates anxiety. With the translator’s help I asked
members of the audience to sit up straight and feel their feet
on the ground. Instead, the entire audience of over a hundred
people stood up as one. I panicked: I had become my own
subject, anxiety personified and I began to breathe slowly to
calm down. Since this breath technique works whether you are
sitting down or standing up, I let the error pass and continued
the demonstration with volunteers from the audience.
Later on I wondered what else had gone wrong that I hadn’t
noticed. I was upset, but, I reminded myself, the students in
the audience related to the case presentation, their comments
showed that they understood, and they clearly had a good time.
Even if they didn’t always get my works exactly, they certainly
got the music; we were tuned to one another.
When you’re learning a foreign language you learn how to
coast inside the conversation, to “get it” even when you don’t
know all the words. You’re watching body language and you
are listening, body-to-body to the music and the rhythm of the
unconscious. When you meet someone new, you learn their
language, slowly picking up hidden meanings and metaphors, as
they learn yours. My Chinese students and I had met and were
in love, searching for the words to put to our songs.
When I first joined the Chinese American Psychoanalytic Alliance
(CAPA), I had the choice to teach, supervise or do treatment.
I wasn’t in the mood to add to my teaching load, which
was pretty heavy already. I was curious about treatment, but felt
that there were too many cultural and linguistic handicaps to
make treatment effective. Of course, I could stumble on culture
and language doing supervision too, but I felt that it would be
easier to ask questions without breaking the frame. Since then,
21
I’ve supervised two students.
Sal, the student I worked with the longest, met with me via
SKYPE once a week, finding each other somewhere in the ether,
Tuesday mornings in New York where I live, and Tuesday nights
in Shanghai, where Sal lives, to discuss her latest experiences
with her clients. She had several people to talk about, usually
students in the University where she is a counselor.
I intended to work as directly as possible with unconscious
process. My supervisory style combines a Socratic mentorship
and the metatherapeutic model.
The metatherapeutic model, unlike Freudian models,
uses the supervisor’s and the supervisee’s countertransference
both to each other and to the patient as relevant
information. Supervision thus becomes an adjunct to
the trainee’s personal analysis, which must then be integrated
into the work with him or herself and the patient.
(Leah Davidson, M.D. “Supervision and Mentorship:
the Use of the Real in Teaching.” 2006, Journal of the
American Academy of Psychoanalysis, 34:189-195).
The appearance of the transference/countertransference, even
mediated and disguised by cultural, linguistic and technical differences,
is powerful. Zaslavsky defines this approach as “comprehensive,
relational, experiential, and centered on the analytic
pair.” (J., Numes, M.L., Eizirik, C.L. 2005, “Approaching Countertransference
in Psychoanalytical Supervision: a Qualitative
Investigation,” Int. J. Psycho-Anal., 86:1099-1131). My hope
was that the emphasis on the transference/countertransference
process would work especially well for us since it includes the
nonverbal communication. Of course, there are other ways to
supervise: it depends on the teacher-student pair and what works
for them. There was little need for didactic explanation of theory
since Sal was already an expert but she needed to learn to recognize
and trust her feelings and develop the use of her intuition.
I encouraged her to begin her own psychoanalysis. She agreed
but did nothing about my suggestion – both transferentially and
culturally it was difficult for her to disagree with me directly
and tell me that she did not want to be in treatment.
Using SKYPE was new. I worried at first if it would be
possible to connect emotionally using what I had assumed was
a cold medium, but I quickly learned through personal experi-

ence that it is not cold at all. Facial expressions and nuance are
emphasized by the SKYPE screen close-up, so Sal and I were
able to track each other minutely. SKYPE is currently used by
the military and APA PsychNet predicts this use will increase
in other areas as well (The Face of 2010: A Delphi poll on the
Future of Psychotherapy, by Norcross, John C.; Hedges, Melissa;
Prochaska, Prochaska, James O., Professional Psychology: Research
and Practice, Vol. 33 (3), June 2002, 316-322.)
Meanwhile, Sal and I often responded to different references
and metaphors, and some of our conversation was about understanding
where we converged and where we didn’t, especially as
we got to know each other. We asked questions about what life is
like for each of us, what has special meaning and what doesn’t.
I felt comfortable asking and answering situational questions
about daily living, holidays, family relationships, child rearing
practices, sexuality and religion. We struggled with language,
and sometimes used SKYPE’s instant messaging program to
make sure we had made ourselves clear. Sal referred to her
dictionary when necessary, and I would hear a male computer
voice repeating the word I had just said, like a bilingual HAL
from the movies. I thought of it as Sal’s Hal.
Mothers, daughters, sons, husbands, separation, attachment
and loneliness were repeated themes. Most of the clients Sal
worked with had been separated from their parents for much
of their childhood. In China it is common for children to live
away from their parents, who often have to travel to another
town to work, and so they are raised by their grandparents as
had also been the case for Sal. As it happens, I too had been
partly raised by my grandmother, so we had important common
history. When you travel to China you see more young children
with their grandparents than with their parents.
Reality is usually easier to deal with than transference, a
complex frightening symphony of the real and the not real,
unwelcome or welcome ideas and fantasies. An idealizing transference/countertransference
protected the supervisory alliance,
and distanced and protected Sal from some of her patients too.
We developed a positive maternal transference-countertransference,
and Sal often told me that she felt as if I were her
mother. I told her that I, too, had strong feelings toward my
analyst and my supervisor when I first began my studies, almost
as though they were my real parents, or should have been, and
that these feelings were examples of transference. Mentioning
my own idealizations provided Sal with a context and helped
open our discussions about countertransference.
…some suggestions may be useful in the task of approaching
countertransference in supervision, as emphasized
by Blomfield (1985), Eizirik and Azalavsky
(1989), Eisirik (1991),Grinberg (1995, 1997b), Vollmer
and Bernardi (1996), Eizirik and Araujo (1997),
Zaslavsky et al. (2003): (a) observing the emotional atmosphere
of the supervisee-supervisor relationship; (b)
observing the personality traits of both; (c) waiting for
the countertransference to be brought up by the supervisee;
(e) whenever possible, using a personal example
from the supervisor, in which something similar has
occurred; (f) possibly, indicating some bibliographical
reference; (g) having a notion of the objectives and
limits of supervision and personal analysis, and the
boundaries between them. (Zaslavsky, 2005, p. 1122)
After a time, Sal asked me to be her analyst – a temptation
I resisted, although I was happy to see that she was now
thinking of analysis as a resource for herself. One of the most
controversial questions with respect to supervision concerns
the boundaries between supervision and analytical treatment
(De Bell, Grinberg, 1995, 1997b; Zaslavsky, 1999). (Zaslavsky,
2005, p. 1102).
I encouraged Sal to find a Chinese speaking psychoanalyst,
not an easy task but she did a few months before our supervision
was over. The ongoing psychoanalytic treatment was very
effective and Sal became more comfortable in the transference.
Working in translation is a challenge that I like. As Harry
Stack Sullivan said, “We are all much more simply human than
otherwise, be we happy and successful, contented and detached,
miserable and mentally disordered, or whatever.”
Lynn Somerstein is Director of the Institute for Expressive
Analysis and practices in New York City. She can be reached
at dr.lynnsomerstein@gmail.com.
22

Introduction
I grew up and lived in South Africa
between the ages of nine and
a half and thirty-one. It was a time
of punitive and strict apartheid. As
an immigrant Jew from an anti-Semitic
country I identified strongly
with the plight of our household
help, and other black workers. At
that time the laws did not permit
migrant workers from segregated
areas to be present in their areas of work and after dark unless
they could prove that they owned a special pass signed by their
employers. This story, written when I was 29 years old and
living in a suburb of Cape Town, is based on a real incident. It
mirrors many of the issues in the movie “The Help.” And also
some of the legislation imposed in Arizona two years ago.
From the curve of the bay an eiderdown blanket of mist is
rolled back by the morning across the flat land below Table
Mountain. Over the lagoon the water ripples gently and a few
seagulls perched on an island in the center greet the morning
with piercing calls. Pink, flushed houses waken to the rhythm
of the waves. Behind the dunes on the left the mist is thicker,
mixing with the smoke of coal-fires and the steam of boiling
water, which rises every morning from the shacks of Freeground.
Johanna, the charwoman, comes past the cemetery with a tin
of snuff, whose contents she will sell on her way to work in the
clean white town. Now and again she stops, as working men on
bicycles hail her. She pulls out a teaspoon from her shopping
bag, measures out, carefully collects the three-pence, and with
a joke or two goes on her way. Sometimes she has as much as
five pounds by the time she starts work. Often less. Dispensing
the snuff and good cheer, she bustles to her job at ten shillings
a day. Her shrewd, black eyes glint in the morning light under
the black beret pushed to the back of her head.
At the corner of the beach where the road turns into town
she stops petrified. A police van is parked at the curb. Around
it, a few men have gathered. Two policemen are checking their
passes. From behind the narrow grill of the van shrill women’s
voices rise in wails. Some of the men move off on their bicycles,
casting malignant glances at the policemen. Johanna shouts as
they leave, demanding details. Sly jokes are poked at the policemen
in a subtle language they do not understand. She notices
the grill of the van, which is now in full view. The dazed face
of her neighbor, Christina, stares unseeingly past her. Two tears
roll down the prisoner’s cheeks and tribal beauty scars, as the
van moves off.
“Christina! Don’t worry! I’ll get help. I’ll get you out!”
She hurries to work and sells no more snuff that day. Not
even to Henry, the fishmonger’s delivery boy, who is her best
customer. In the kitchen of her mistress, the daily servant has
breakfast ready. Over tea and bread they discuss the misfortune
of Christina and plan a course of action.
“It was her pass. I’m sure it was,” sighs Johanna. “She is
stupid. She does not understand the white man’s laws. She does
not know how to talk to policemen in their language.”
A Tin of Snuff
by Leah Davidson, M.D.
23
“What will happen to her children today” asks Esther the
servant.
“I don’t know, we must make a plan. You tell madam I have
gone to the shop to buy spirit for the windows. I’ll see if I can
send a message with one of the vegetable or flower girls to my
eldest daughter. She will take the children and feed them with
her own.”
Johanna’s mistress is elderly. She does not like to bother with
a change of servants, or to fend for herself, and therefore ignores
the minor offenses of her domestic staff. Johanna knows this,
and uses it to her advantage. She strides off towards the corner
of the street telling the story of Christina to friends as she passes.
“Where are you running to so early in the morning, Johanna”
“A terrible thing has happened to Christina. The police have
got her. I must find a place for the children.”
“Has she money for bail”
“I do not know. I don’t think so.”
“Does her husband know”
“No. He left early for the morning shift at the factory.”
On the corner she meets Cissie, the one they call “Vygie”
(the sour fig). Vygie carries a big basket of vegetables to hawk
from door to door.
“Good morning, Vygie. Christina is in trouble again.”
“Her man beating her again” trills Vygie in her high-pitched
voice.
“No, the police have got her.”
“And who will pay the bail Don’t ask me. I haven’t any
money.”
“I don’t want your money. Is Marie with you”
“Yes, she’s selling some lettuce to the upstairs madam at
No. 4.”
Vygie nods with her head in the direction of the house.
“Can you send her with a message to my Annie to look after
Christina’s children”
Vygie’s face cracks open in a smile. “Is that all, you old snuffbag
I will send Marie. Don’t worry, the children won’t starve.”
Vygie lifts up her basket and waddles off across the road. Johanna,
as she turns back to work, hears her advertise her wares.
“Morning, madam. Luffly carrots, madam. Luffly spinach.”
As she turns out and polishes furniture in the room, Johanna
mutters under her breath. She is thinking of a way out. From
the corner of her eye she watches the madam come out of the
bedroom and go to her bath. She gauges her mood and decides
that it is favorable.
“Now,” whispers Esther, carrying in the breakfast tray a little
later. Gingerly, she knocks on the open door of the dining room,
where madam is seated at the table.
“Madam,” she begins diffidently.
“What is it, Johanna”
“Madam remembers the girl who used to char for madam
before me”
“What” That lazy good for nothing What about her”
“She’s in trouble, madam. Madam did not sign her pass
properly when she left. Today the police come. They take her.”
“Well, it’s her own fault for not coming to tell me her pass
wasn’t in order.”
Johanna can sense that madam is irritated. She thinks fast.

“Please, madam. Please to phone the police station and tell them
madam was away and could not sign pass. Please, madam. They
will send her away. She got children, madam.” She appeals with
her brown eyes to the distant grey ones.
“Oh, very well. I’ll do it. But not for her. Because you ask
me.”
“Thanks, madam.” She slinks jubilant, but unobtrusively
from the room, and with a lighter heart continues her polishing.
Things are looking up. The children will be cared for. The bail
will be decreased in amount. A little smile plays about her lips,
and she sings softly as she works.
At lunch time, she goes over the situation with Esther. “All is
right now, except for the person to go and get her out.”
“I’m off today,” volunteers Esther. “I’ll go. You give me the
money and I’ll go.”
“No,” sighs Johanna. “It will spoil your day if you have to
bring her back to Freeground. By that time the whole day will
have gone for you.”
“It doesn’t matter.”
“And what will George, your boyfriend say You know he’s
jealous. He’ll beat you! No, we have to find someone else.”
“Selina next door goes off today too.”
“Can she be trusted with money”
“These days you can trust no one. But I think she’s alright,
at least as far as I know.”
“We have to take a chance. By tomorrow they might have
sent Christina away if no one comes to get her. Call Selina.”
It is half-past four. Johanna has washed the polishing brushes,
and taken tea to the madam. She relaxes over her own steaming
mug in the kitchen, and fingers the ten shillings she has earned
lovingly. Then she opens a knot in her handkerchief and adds
to it the money from the snuff. She counts the total. She has
exactly one pound left. The two-pounds-ten she has given Selina
for the bail should have been just enough. Content, she ties up
the money, washes the mug, and leaves quietly by the back
door so as not to waken madam, who is having her afternoon
rest. She hurries to the shops. She has much to buy before they
close. Tea, sugar, condensed milk and candles, sardines, some
mutton, and borrie (a curry mixture). She counts the articles and
estimates the cost as she goes.
The little shopping bag full to capacity, she goes across the
bridge over the vlei (lagoon), past the cemetery, to Freeground
where the fires have already been lit and the steam and smoke
rise again into the purpling evening sky. The road is thick with
bicycles carrying returning men and walking women, laden,
like her, with parcels of food. Periodically someone stops her
for snuff, and she puts her bag carefully by the roadside, and
ladles out the spoonfuls, collecting another coin to be placed
into the knot in her handkerchief. As she reaches her house, the
neighbors greet her and joke over the day’s events. Christina
breaks from a little group of women and runs towards her. Her
gratitude chokes her and she ends in tears.
“Eh, Christina,” mumbles Johanna in embarrassment, fingering
her beret. “So you are home. I didn’t trust that Selina, but
it seems she’s a good girl after all. And you’d better come and
thank madam tomorrow. You never know when you might need
her again!” Both women burst into laughter at the last words.
“Everyone!” Johanna shouts. “Coffee and drinks in my house
tonight. We must celebrate!”
The beat of a guitar starts up a favorite song. Johanna slumps
her bag onto the ground, and to the clapping of a circle of hands,
she dances her triumph. She stamps, she agitates her body, she
splays her arms, she grunts, and finally she doubles up with
laughter. From her pocket she pulls out her handkerchief with
the snuff money and holds it on high.
“Ach, the snuff, the snuff,” she chokes out in English. God
bless the snuff!”
Leah Davidson is a Life Fellow of The American Academy of
Pyschoanalysis and Dynamic Psychiatry and a distinguished
Life Fellow of the American Psychiatric Association. She is an
assistant associate professor at St. Luke’s Roosevelt Hospital
and is in private practice in Manhattan and Riverdale (Bronx),
New York. She can be reached at leahzd@gmail.com.
An Academy “Secret Seven” child psychiatry study group
has been meeting monthly for over forty years. What did we
do How did we do it Why did we do it Out of our shared
interests (plural) we became friends in some transcendent sort
of way. We were the next generation of child psychiatrists in
Houston and about the same age. I am eldest at 84.
Jim Duffy and I were partners with four general psychiatrists
in a group in private practice which became known as the
“Maroneal Mafia” because of our leadership influence. The
Presidency of the Houston Psychiatric Society was dominated
by us. Jim and I invited Doug Hansen, recently directing the
Child Psychiatry Program at Baylor, to have lunch with us at the
Shamrock Hotel Terrace. We hatched a plan to invite the other
four child psychiatrists to a home dinner to get better acquainted.
Barbara Ewing, Mae MacMillan, Jim Heald and Jim Robinson
and we three liked the idea of a monthly dinner with rotating
host. Maybe a topic of interest, problems, maybe a presentation,
children, families, development. It seemed to go well for about a
The Secret Seven
by William Moore, M.D.
24
year. Mae was the first to depart for other interests that included
a year at Tavistock in London with Anna Freud. Barbara left
about a year later because of romantic interests. She married an
analyst, George Taylor. Doug, Jim Heald and Jim Robinson were
commuting to New Orleans to complete their analytic training.
Jim Robinson would also continue to complete child analytic
training with Othilde Krug in Cincinnati. I was being supervised
by Hilde Bruch. Psychoanalysis was dominant in our lives. Hal
Boylston came to town from Menninger’s Topeka and a bit later
Roy Aruffo came from Pittsburgh, a trained child analyst. Jim
Duffy moved out of town.
We all were connected with Baylor Psychiatry and particularly
the child program. The Academy tagged Doug for the Review
in Child Psychiatry. We were the faculty. That gave us a lot to
talk about at our dinner meetings. We probably ate too much.
At times we drank too much.
Our wives were doing all the work to provide the dinners.
They were friends too and began to revolt after many wonderful

years. So we moved to commercial restaurants still with rotating
hosts. We drank less and eventually stopped smoking cigars.
The Aruffo’s, Nancy and Roy, graciously invite us as couples
at Christmas and other times the Fourth of July.
So, what did we discuss We were approved for Category
I, CME. We kept our focus on kids. Peer supervision became
important. Once Roy and I each had a 3 year old little girl
patient. We each presented our process notes for comparison.
The critiques were always helpful. We planned to build a child
psychiatry hospital. It fell through. I wish we had done it then.
Later Doug and Hal were part of a partnership in a hospital.
Besides children, we entered a phase of investment talk with
mixed success. One of us invested in a Canadian gold mine,
which proved to be a fraud. Sailing was another shared interest.
Jim Robinson and I crewed on Doug’s Ensign class boat at the
Houston Yacht Club races. He later had a cruising class yacht
which he raced Galveston to Vera Cruz. All of us with spouses
flew to Vera Cruz for the party. The Mexican selection of Miss
Mexico was part of it. Roy and I crewed on this boat too. Later
Doug and I, with Grace and Helen Hansen, chartered a yacht off
Cairns Australia to sail and scuba dive the Great Barrier Reef.
Our Yucatan Mexico time share was in the extension northward
of the “Lesser Barrier Reef” of Belize where we enjoyed scuba
and snorkeling for 20 years.
Jim Heald and I were active in Houston Group Psychotherapy
Society. Doug was the first of us to attend an A.K. Rice Residential
Institute. Mexico City was our first trip. Travel together
is a significant evidence of our friendship and compatibility. Jim
Heald’s wife, Mary Lee owned a major travel agency which
facilitated our travel. Mexico next door did too. In Mexico City
we spent several days with Luis Feder, M.D. discussing group
analysis. We spent the day with Peter Blos in New York City.
We regularly commemorated 5 year mile posts with a trip with
spouses including Costa Rica, Ecuador, Galapagos, Italy. Most
recently, after the 2012 Academy meeting in Philadelphia, Doug
and Helen joined Jim and Mary Lee Heald with Grace and I
in Rome for a cruise to Galveston. The Healds’ celebrated 25
years and the Moores’ 55 years married.
It’s been a good ride together. Jim Duffy and Jim Robinson
are dead. Doug retired from Baylor many years ago. Roy and
I supervised the school rotation for Baylor Child Fellows for
14 years. He retired over a year ago. Hal retired and moved
to Maine. Jim Heald is partly retired. I am semi-retired. Roy
hosted June, I hosted July, Doug hosts August 2013, and we go
on. Now we are the “Final Four.” All four of us are Clinical
Professors at Baylor. Roy is Emeritus.
How come the name “Secret Seven” There is nothing really
secret about it. When we had been meeting for over a year,
another generation of child psychiatrists had come to Houston.
We wanted to be hospitable to them and invited them to dinner.
It was at Doug’s home. We had no thought of adding to our
group. There developed a misunderstanding. Hal had a younger
associate in his practice partnership who asked if he could join.
Hal explained, “No, you’re not invited to join us.” The young
associate said, “So you’re the Secret Seven.” The name stuck.
William Moore, M.D., is a semi-retired psychiatrist. He is a
Clinical Professor at Menninger Dept. of Psychiatry of Baylor
College of Medicine in Houston, TX. He can be reached by
email at voodoodad@sbcglobal.net.
OPINION
A Psychiatrist/Psychoanalyst Asks Barack Obama
Six Personal Mental Health Questions
by Peter A. Olsson, M.D.
Editor’s Note: The opinions of the
author do not necessarily reflect
those of the AAPDP.
Dear President Obama:
In clinical, social, political
and academic situations, people
often take astute observations
about themselves as accusations
rather than potentially constructive
observations. A rare individual
relishes, values, and makes cogent, effective, growth-promoting
use of insightful observations about their personality and
behavior. I hope you can take up the challenge of such a mature
approach to governing and reflect upon my six personal mental
health questions for you.
Mr. Obama, you seem reluctant to make creative use of
criticism. You repeatedly project blame via speechifying
and verbally attacking your critics. This is so even when the
criticisms and disagreements seem cogent and respectful. Your
defensive responses and personalizing criticism seems brittle
25
even fragile at times. This seems incompatible with your abilities
and talents as reflected in your memoir.
The Wonder and Magic Charm of Words
We psychoanalysts view speech acquisition as a decisive
step in the foundation of the executive domain of the human
mind. In this our earliest childhood, speech is a magic charm.
It is directed toward forcing the external world and fate to do
those things that have been conjured up in our words. Our childhood
words will continue to be important later, even when the
early omnipotent magic is gradually tempered by reality. Your
speeches at home and abroad seem to ring with a magic charm
and charisma. They allude to majestic collective ideals, even
utopianism.
Mr. Obama, this essay will use your 1995 book, Dreams
From My Father: A Story of Race and Inheritance, and your
media comments and behavior, as a basis for asking you six
key personal mental health questions. From a psychodynamic
perspective, several pivotal questions are anchored around the
nature of your identification** with your father, and, or, your
introjections***of his image… and its psychological implications.
These introjections*** are likely complex in light of the

minimal actual time your father spent with you, and the separations,
abandonments, neglect, and loss you experienced as a
result of his behavior.
Sally Jacob’s carefully documented book, The Other Barack:
The Bold and Reckless,” helpfully provides further information
about your father… Barak Obama, Sr.
Question #1 - How do you understand your identification
with your father and the implications this has for the stability
of your narcissism and self-confidence What are the implications
of this question for your leadership and ability to govern
We all have internal representation of our parents’ personalities,
their authority, and their love of us… or lack of it. For better
or worse, we embrace or rebel against our inner parents. Denial
of our parents’ influence, or, blind idealizing or devaluing of
them, has profoundly negative consequences for our emotional
life and the trajectory of our maturation. You sometimes scold
congress like a testy parent.
Mr. Obama, your book Dreams From My Father, has a lyrical,
searching style. Your writing is bold and courageous in its
self-disclosure and creative curiosity. You and your Kenyan
relatives frequently call your father “The Old Man.” The candor
and eloquence of your memoir seems to reflect an intertwining
of your genuine search for your father, and simultaneously for
your true self. Your poignant words about the “island of your
grandfather Onyango’s shame,” and Barak Obama, Sr.’s quest
for power and recognition, leap from the pages of your memoir
when you say:
“He (Barak Sr.) had almost succeeded, in a way his own
father (Onyango) could never have hoped for. And then,
after seeming to travel so far, to discover that he had not
escaped at all! To discover that he remained trapped on
his father’s island, with its fissures of anger and doubt and
defeat, the emotions still visible beneath the surface, hot
and molten and alive, like a wicked, yawning mouth, and
his mother gone, gone, away…” (pp 428-429).
Your vivid “yawning mouth” metaphor resounds with implications
of what we psychoanalysts understand about the concepts
of psychological introjection and incorporation… and the notion
of oral aggression.
Mr. Obama, your island metaphor seems to accurately fit Onyango,
Barak Sr., and yourself… and all three of your maternal/
parental introjects. (Many islands here…Hawaii… a huge one,
Kenya a metaphorical one, and the haunting inner “island of
silence” that best be overcome… because as you aptly imply…
no Obama man ultimately is an island.) After describing your
inner thoughts and emotions you seek further closure with these
powerful words:
“For a long time I sat between the two graves and wept.
When my tears were spent, I felt a calmness wash over me.
I felt the circle finally close. I realized that who I was, what
I cared about, was no longer just a matter of intellect or
obligation, no longer a construct of words. I saw that my
life in America - the black life, the white life, the sense of
abandonment I’d felt as a boy, the frustration and hope I’d
witnessed in Chicago - all of it was connected with this
small plot of earth an ocean away, connected by more than
the accident of a name or the color of my skin. The pain I
felt was my father’s pain. My questions were my brothers’
questions. Their struggle, my birthright.” (pp. 429-430).
This scene you describe is intense and poignant. The narrative
that emerges from your remarkable dialogue with your relatives
and your own intensely personal peregrinations, reminds me of
the narrative that emerges during my work as a psychotherapist
with highly intelligent and well-motivated patients. A key difference
between your search for your father-yourself via your
process of memoir writing and a depth psychotherapy experience,
however, is the absence of a therapist. A therapist would
confront you with your psychological blind-spots and support
you in applying and extending your insights about your father/
yourself. Such consolidating psychotherapeutic help would reduce
the propensity for grandiosity or excessive chameleon-like
trends in your personality.
Your father was clearly a highly intelligent man but had a
difficult and conflicted relationship with his own father, your
grandfather, Hussein Onyango. Your Granny told you:
“Even from the time he (Onyango) was a boy, your grandfather
was strange. It is said of him that he had ants up
his anus, because he could not sit still”. Granny goes on,
“He was very serious always—he never laughed or played
games with the other children, and never made jokes.”
(“Dreams From My Father” p 379).
You Mr. Obama, like your vice president, seem to have a
lively, aggressive sense of humor. You enjoy jokes, playing golf,
and being playful with your children. This indicates strength and
a transcendence of your father’s trait. In addition, Onyango, like
you and your father Barak Sr., seems to have a keen sense of
curiosity and eagerness to learn… even from “the white man.”
Question #2 - In your moving memoir you are candid about
the white vs. black struggle within yourself. You seem to entwine
this issue with your search for your roots of identity in
Kenya. You also show great empathy for blacks and minorities
who have been abused by white slave traders, white colonialists,
and white oppressors…even some within the American
political system.
However, are you able to accurately perceive, collaborate
with, and compromise with older, white, but not racist, Republican
politicians With colleagues who challenge and vigorously
oppose your policies and philosophy I think such white men
stir “transferences” within your mind. Your unresolved transferences
likely create unconscious re-enactments of your father and
grandfather/yourself, which in turn can result in blind spots.
When unconscious identifications, introjections and transferences
gain ascendancy in situations of strong emotion, then
destructive acting-out or rigidity is possible. Or inaction! During
crucial political decision-making and compromise, the greatest
freedom from unconscious conflict is the ideal. However, it is
easier said than done… as you well know. You seem to have
a healthy rapport with Joe Biden (positive transference) who
even shares your father’s trait of verbal aggressiveness, although
sometimes I find Biden to be inappropriate. It obviously could
be more difficult with white Republicans such as Graham,
O’Connell, Kyle, Ryan, Cantor or McCain. You often seem
26

defensive, curt, abrupt and dismissive with these white guys.
Question #3 - What are your ideas and intuitions about the
roots of your father’s relentless ambition, severe alcoholism,
pathological lying, obsessive philandering, and significant character
defects Mr. Obama, you said:
“My image of Onyango, faint as it was, had always been
of an autocratic man—a cruel man, perhaps. But I had also
imagined him an independent man, a man of his people,
opposed to white rule. There is no real basis for this image
I now realized—only the letter he had written to Gramps,
(Your maternal grandfather in Hawaii), saying that he didn’t
want his son marrying white.” (“Dreams From My Father”
p 406). According to Jacobs, Onyango was alienated from
his own father for most of the eighty years of his life.
From your reports from your Kenyan relatives and Sally Jacob’s
research, I conclude that Onyango, who was called “The
Terror” by many family members, was very accomplished but
harsh, domineering, and obsessively controlling. He seemed to
express perpetual disappointment toward your father, Barak Sr.
It is interesting to me that your father, Barak Sr., wrote books
he called OTIENO (“The Wise Man”).
Also profoundly significant is your father’s early loss of
his mother through abandonment. You experienced traumatic
separations from your mother whose troubled relationships with
your father and stepfather led to painful disruptions and dislocations
for you. Psychodynamic psychiatrists would connect your
father’s maternal loss as a causal factor in your father’s severe
addiction to alcohol, his obsessive philandering, and character
defects including many episodes of pathologic lying. Did your
father harbor unconscious anger toward his father, his mother,
and all authority figures His unconscious mind was not userfriendly
toward women although he charmed many. He eventually
demanded feeding, nurturing, and affection from all the
women he successfully seduced or romanced. If his white wife,
Ruth, did not feed him as he demanded, he verbally abused her
(oral aggression), and beat her and her children. Like father
Onyango… like son, Barak Sr.
Your father’s biographer Sally Jacobs states:
“When Obama (Sr.) headed to America he left behind a
pregnant wife and a young son, all of whom seemed to vanish
into the parched red dust of Kenya. He neither spoke of
them nor acknowledged them to school or immigration officials
until, that is, he deemed them an asset to his resume…
In America he would marry one white woman, propose to
another and seduce many more. Polygamy was surely an
aspect of his culture but in the Luo tradition a husband
makes his home with all his wives. Obama Sr. did just the
opposite: moving from one to the next and betraying each
woman and the children he didn’t father (psychologically).”
Question #4 - Do you think that your father’s relentless academic
and political ambition was related to his unconscious and
desperate wish to gain his father’s approval Did your father’s
narcissistic hurt and resulting rage cause rigid reflex anger at
all authority
As you learned from your family in Kenya, your father from
his early school years onward behaved like a know-it-all. He
would correct and defy his teachers in front of the class. You
report, “His teacher would scold Barak for his insolence, but
Barak would refuse to back down. “ (p. 415).
Jacobs reports that a friend of your father named Abercrombe
said, “He was a very daunting personality…He just couldn’t
contain his irritation with people who were not as facile as he.”
Even at Harvard your father so offended some professors and
administrators that it led to his Ph.D. never being completed.
In essence, your father’s relentless, impulsive and cocky
know-it-all attitude led to his downfall. He asserted himself as
if he were the perpetual and ultimate authority speaking truth to
power. When this combined with his ever progressive drinking,
pathological lying and defiance, he ended up in abject poverty
and showed suicidal behaviors while driving.
Question #5 - Do you note within yourself an identification
or introjection of your father’s verbal style…i.e. a stubborn,
impulsive, cocky urge to assert verbal power when feeling on
the extemporaneous spot Does this verbal impulsiveness seem
automatic and difficult to resist
For example, your part in the precipitation of the infamous
“Beer Summit” highlights your Ready-Fire-Aim verbal impulsiveness.
When asked about the alleged police misconduct in
Cambridge at the tail end of your press conference, you at first
said that we needed to await the results of the full investigation
of the event before reaching conclusions. Then suddenly in the
next impulsive breath you said that the white Cambridge police
were stupid, but not your verbally aggressive, black Harvard
professor friend!
On another occasion you impulsively defended Eric Holder’s
half-cocked idea of trying KSM and other Islamist killers
in downtown Manhattan. You said that Americans shouldn’t
worry, the 9/11 killers would be executed eventually anyway.
Your comments could have been used by a clever Jihadi or
U.S. lawyer to demand a mistrial because of your influence on
a jury pool.
A third example occurred at the very start of your presidency
when you starkly stated that GITMO would be closed within
one year. Then, you studied the situation and now after several
years GITMO has been expanded. The world clearly realizes that
though imperfect, GITMO is run humanely and the prisoners
are treated better and more justly than in their home countries.
Your charisma and powerfully effective oratorical skill is
impressive and serves the leadership of America best when it
is as free as possible of your unresolved unconscious conflicts
being acted-out.
Mr. Obama, your ego strengths are many. Clearly, you have
successfully triumphed over your earlier substance abuse…even
cigarettes. Your marital relationship seems to show a commitment
to intimacy, communication and loving approaches to
marriage and parenting of your beloved daughters. This clearly
represents transcendence of the insecure and pathetic lack of collaborative
intimacy exampled in your father’s life and behavior.
Your efforts to form a healthy identity in this regard, seems to
have been very successful. Early childhood separations, losses
and neglect have made this no mean task for you.
Question #6 - Finally Mr. Obama, if your father was one of
your top economic advisors today, what major directions would
27

he recommend for our US Economy How much does his thinking
impact on your preconscious and unconscious mind
In your father’s July 1965 paper in the East Africa Journal
entitled “Problems Facing Our Socialism,” his economic and
political philosophy is clear as your father speaks about land
reform. “Would it not seem, then, that the government could
bring more rapid consolidation through clan cooperatives
Individual initiative is not usually the best method of bringing
land reform.” (p 29.)
Barak Sr. goes on about “society” or the ultra-collective, “If
one were to suppose that the state is an instrument of society
and if the society regards growth as well as the correction of the
lopsided development…(the rich vs. poor majority)… which has
characterized this country as important, then the society, through
the government which is it’s instrument, should enforce means
by which this growth and change can be brought about.” (p 29)
In the next paragraph he says about “class problems:” “But
we also need to eliminate power structures that have been built
through excessive accumulation so that only a few individuals
shall control a vast magnitude of resources as is the case now.”
(p 29)
President Obama, this rigidly repetitive theme appears in
many of your speeches. Finally, Barak Sr. says about taxation:
“Certainly there is no limit to taxation if the benefits derived
from public services by society measure up to the cost in taxation
which they have to pay. It is a fallacy to say there is this
limit and it is a fallacy to rely mainly on individual free enterprise
to get the savings.” (p 30)
Three sentences later Barak Sr. says, “Yet one who has read
Marx cannot fail to see that corporations are not only what Marx
referred to as the advanced stage of capitalism but Marx even
called it finance capitalism by which a few would control the
finances of so many and through this have not only economic
power but political power as well.” (p 30)
Mr. Obama, you have dismissed criticism about your possible
Neo-Marxist views or “Socialism.” But, it seems important that
you have a clear conscious awareness of your father’s Neo-
Marxism. Conscious awareness of your thinking in contrast to
that of “The Other Barack,” is very important.
Mr. President, I admire the candor of your memoir and I attempt
the same with my questions.
BOOK AND FILM REVIEWS
Becoming Whole: Jung’s Equation for Realizing God by
Leslie Stein
Helios Press, New York 2012, 336 pp. $24.95 hard cover,
$14.95 e-books
Reviewed by Crittenden E. Brookes, M.D.
Becoming Whole is difficult to review for a psychotherapeutic
reading audience. This is because the material covered appears
at first glance to be far removed from the daily concerns of a
therapist working with his or her patients. The book is concerned
with the late and deep work of a psychiatrist/psychologist who,
although he had previously had much to say about working with
patients in psychotherapy, apparently has become more and
more esoteric in his investigation and explication, and therefore
farther and farther removed from the usual experiences of the
consulting room.
What, one might ask, does a rarefied, complex and subtle
topic seemingly far removed from the experiences of most
of us (including many of our patients) have to say that might
educate our work An analogy might be appropriate here. It
has become recently well known (from newspapers and other
media) that scientists at the CERN large hadron collider near
Geneva have recently discovered “the God particle” (so dubbed
by the media), otherwise known as the Higgs boson that, if it
continues to be verified, may bring a certain completion to what
is called “the standard theory” of cosmologists and theoretical
physicists concerning the wave/particle and energic nature of
the universe as currently conceived. However, explanations of
events and physical existences in terms of paradoxical energy/
wave states, complete with electrons, quarks, leptons, bosons
and other energic “particles,” though abstract, can provide
certain information for the “average person” as he or she goes
about trying to pay bills, explain depressions and anxieties that
arise, and bring sense to intimate relationships.
28
Not only is there practical and immediately relevant use for
such information - nuclear energy and the nuclear bomb come
immediately to mind - but this information can add to a sense
of the mystery that continues to surround the nature of reality
and of being alive at all, that can bring one closer to the search
for personal meaning in being alive. And clinical experience
shows that engagement with questions of meaning is a positive
exercise in the search for mental health.
The “coming together” of spirituality and science for example,
an attempt to resolve what is apparently opposite or paradoxical,
can involve change in the sense of one’s existence, closely
associated with a healthier apprehension of one’s identity. Such
a change can contribute to a “redo” of psychological pathologies
and one’s attitude towards them. In a similar vein, it can
become clear on perusing this book, even to those not initiated
in Jung’s theories, that what he had to say in Aion late in his
career, that he called a “research into the phenomenology of
the Self” (Jung, C.G., Collected Works Volume 9.ii., Aion, Researches
into the Phenomenology of the Self, Bollingen Series
XX, Pantheon Books 1959), makes reference to aspects of the
nature of the psyche i.e. the mind as it experiences itself, that
could contribute to issues arising in psychotherapy, especially
during the late stages when meaning/identity outweighs reductive
work.
It is important to understand that Jung considered himself a
scientist, whose object of study was the human psyche itself.
The idea of Jung as scientist involves an assumption that has
evoked much controversy in the philosophy of science, i.e.
whether material that is fundamentally phenomenological (subjective
report of experience rather than measureable processes
or substances) can be observed and studied, both rigorously and
without becoming “mystical,” an accusation that was frequently
hurled at Jung, particularly in the days of Newtonian and positivistic
science, before the uncertainty principle and subsequent

developments in scientific investigation. No wonder that Jung
found himself more consonant with new developments in theoretical
physics than he was with nineteenth century causal science!
In any case, Jung himself clearly became fascinated with
deep investigation of the psyche using historical and contemporary
phenomenological data, just as theoretical physicists and
cosmologists became fascinated with studies of the permutations
of energy at the base of physical reality.
In reviewing this book, I shall accept Jung’s assumption that
the world of internal experience, the human symbolic fantasy
life both historical and personal, provides a wealth of data that
can be given order and understanding as well as applied in the
consulting room. In point of fact, this is what we do every day
as psychodynamic psychotherapists.
Jung considered himself one of the first “wave/particle investigators
of the psyche,” and his theory of archetypes gives one
example of his exploration of deeper layers of the psyche. Aion
deals with even deeper layers, and Stein tries to explain Aion.
Jung was not apologetic about going to psychic depths, even
though the work became increasingly complex and difficult to
explicate in simple terms. Stein himself acknowledges this in
a quote from Edward Edinger, one of the major interpreters
of Jung’s work, in which Edinger describes how when Jung
wrote Aion “he was at a stage of his life where he had decided
that he would no longer offer detailed explanations of the concepts
or terms that he was using and instead would require that
readers ‘would have to meet him where he was.’ ’’ (p. xviii).
On the other hand, Jung was also capable of attempting to
simplify his ideas, such as in his contribution to the book Man
and his Symbols (Jung, C.G., Collected Works Volume 9.ii., Aion,
Researches into the Phenomenology of the Self, Bollingen Series
XX, Pantheon Books 1959). It is interesting to note however
that material at the level of Aion is not directly included in Man
and His Symbols, although it is certainly implied. Leslie Stein
has given us a précis and summary of ideas that even reinterpreted,
at times seem so abstract as to defy understanding, partially
because of the immense detail and ordering of historical
phenomenological data (symbolic material from the history of
mankind) that justify these ideas.
This book however is a major contribution to clarification of
Jung’s most advanced thoughts and findings.
One can read this book without much previous knowledge of
Jung’s work, although at least an introduction to it (as provided
by Man and His Symbols cited previously) acquaints one who
has not been introduced to Jung’s thought and manner of working
with some beginning knowledge of its nature and implication.
There are many other introductions to his thought. Books
by Aniela Jaffe (The Myth of Meaning, Daimon, Zurich 1986 ),
Edward Edinger (Ego and Archetype, Penguin Books, Baltimore,
1973) and June Singer (Boundaries of the Soul, Anchor Books,
New York 1973) come to mind. There are many more. Whereas
the first two deal very well with Jung’s ideas, Singer’s book also
does that and in addition takes us into the consulting room.
Remember that Jung considered himself a scientist, who
worked with the “data” of human experience as recorded in its
symbology and mythology, drawing conclusions about the nature
of the psyche. In doing so, he described an “ideal” vision of
human development. On the other hand, this ideal implies the
path of an individual in the direction of increased mental health,
greater awareness and greater removal from the trials of the ego
pathology with which psychotherapists struggle daily.
Jung identified and organized the metaphoric data of human
experience, just as Darwin identified and organized observations
of plant and animal nature and behavior. From such data (the one
phenomenological and internal, the other naturalistic observation
and description of external rather than internal events), both men
derived formulations of the nature of the natural laws underlying
them. As I indicated, this book is an attempt to understand
one of Jung’s late formulations about the nature of the psyche
as it manifests the Self, although that formulation is anticipated
in almost all of Jung’s earlier work. The equation has not been
given much attention in studies of Jung’s psychology. Stein’s
book is an attempt to rectify this lack of attention to what to
some might mark as Jung’s crowning scientific achievement.
The chapters of this book have to do with detail involving
the concepts identifying and elaborating the nature of the equation:
Chapter 1, the nature of the equation itself; Chapter 2,
an explanation of the process by which it was derived; Chapter
3, commentary by some of Jung’s associates on the equation;
followed by Chapters 4,5 and 6, which elaborate a major thesis
put forward by Stein, himself a highly trained Jungian analyst.
In order to be understood, Stein’s own thesis involves a conceptual
digression. As I indicated previously, Jung considered
himself a scientist and not a mystic. However, the subject
matter which he chose to study (human subjective experience
itself) opened him to many accusations of being mystical, a
dirty word in the science of the nineteenth and early twentieth
centuries. Stein faces this accusation directly by disagreeing
with Jung, as we shall see.
Jung’s scientific thesis is that a deep investigation of human
phenomenological material produced by the psyche over several
centuries shows that inherent to its nature is a tendency to
evolve towards a condition of wholeness or “bringing everything
together,” and that furthermore, this tendency can be expressed
in presently used formulaic/equational form. The close connection
to mystical vision in this thesis is quite apparent, and Stein
feels that Jung stepped into the mystical area as he developed
the idea, although Jung himself repeatedly denied that. Jung
asserted that the symbolic material revealed in the study of the
psyche organizes itself in such a direction, with Jung only being
the observer, collating and organizing such information in a
scientific fashion, much as Darwin did with his data.
Stein insists that Jung did indeed step into the mystical area,
more however in moving toward resolving the paradox between
religion/spirituality and science, rather than committing a “sin
of mysticism.” He cites extensively three historical mystics or
mystical positions: Ibn Al-‘ Arabi, a twelfth-century Sufi, the
Indian philosopher Sri Aurobindo, and the writings of Jewish
mysticism (Kabbalah). Indeed, Stein maintains that in the
twelfth century, the Sufi mystic “remarkably (set) out the exact
process described by (Jung’s) equation” (p. xx). He proceeds
to make an argument that implies that Jung could not avoid
becoming a mystic, because the very process of identifying
the psychic (“of the mind”) characteristic of a move towards
wholeness necessarily deals with also identifying an extrapsychic
(i.e. having do with matter or physical reality) equivalent
movement, that makes it a paradoxical event. In this argument,
mysticism involves a resolution of the spirit/matter paradox;
hence Jung could not avoid being a mystic whether he identified
himself as such or not. Stein marshals arguments from all three
29

30
of the mystical traditions to draw this conclusion. However Jung
himself stoutly denied it, maintaining that he was only confirming
the existence of the image of God (Jung’s term was Imago
Dei), as an intrinsic part of human experience, and as a symbol
of the Self or organizing principle of the psyche and potential
center of identity, instead of the human ego. Note that Self is
capitalized, which avoids confusion with the present use of the
term “self,” which is a concept associated with ego psychology.
The equation which is central in this book is a formal representation
of ideas that also can be expressed in words. The
equation itself then becomes a symbolic representation of these
ideas. Truly understandable translation of these ideas into the
terms of the equation requires massive understanding of the
phenomenological material that Jung relied on to back up the
ideas themselves, let alone of the process of transforming them
to equational symbology. Suffice it to say that Jung relied on
reference to diverse sources: documented historical as well as
contemporary Christian writings and early Gnosticism as well
as others from Buddhist psychology (it indeed is a psychology),
medieval alchemy (which Jung saw as work with the psyche
rather than with the physical materials of popular concept), and
the work and ideas of modern nuclear physics and cosmology
- together with many others. He collected and collated massive
amounts of analogies among these sources. Understanding these
sources of data and their analogies is a prerequisite to understanding
both the equation, Jung’s perseverance in developing
it and the ideas underlying it. A brief summary of those ideas
follows:
The nature of being human at all involves a built-in drive or
intrinsic movement or evolution towards an identity no longer
centered in the ego with its continual pathological wars, but in
an identity more central than and distinct from the ego, which
Jung called the Self. Jung called this process individuation. Note
the similarity to Maslow’s self-actualization, for example.
The equation (and the ideas that underlie it) is the result of
Jung’s investigation of how all of this comes about, i.e. the
internal or psychic dynamics that are involved in the process
of potential psychological evolution.
What Jung did not do is to enumerate and organize the processes
by which such a movement does not occur noticeably in
many people, that is, he did not describe the impediments to this
evolutionary process, although he certainly implies throughout
his work that mental pathology (usually a pathology of ego function)
plays a massive role in such impediment. Thus he leaves
to the psychotherapist the job of incorporating teleological
ideas such as the ones discussed into the mélange of defenses
and painful symptoms which mark the life experience of those
suffering from them, while at times attempting to utilize them
in building a healthier outlook through the ascription of meanings.
Note that although being teleological in the sense of the
universe being based on some kind of design, Jung definitely
does not move toward the anthropomorphic argument for the
existence of God.
The characteristics of the equation are as follows in oversimplified
form:
Four major terms are involved in the equation, and each
given a letter designation, and a name which refers to their
symbolic appearance in human phenomenological history. They
are (A) anthropos, more or less equivalent to the unconscious
mind, (B) shadow, a term Jung used for reference to the instinctual,
“lower” nature of man, which contains a reflexive
instinct leading to reflection or conscious mental content,
(C) physis, in which consciousness perceives its connection to
(initially extra-psychic) matter (a step towards resolving the
mind-matter paradox), and (D) lapis, the “potential” for full
wholeness, not as yet realized.
The entire equation is a “flat” representation of what is
actually a three-dimensional dynamic movement of psychic
energy in a clockwise direction to accomplish “return to A” to
complete a process of fundamental change a completion that
Jung called the rotundum. The equation in total is a picture of
the process by which the Self is made conscious in the minds
of individuals. One is reminded of the ox-herding pictures in
Zen Buddhism, in which the aspirant returns to the beginning,
but changed.
I would not expect many readers to want to go deeply into
this topic, any more as I have said than I would expect them to
want to go deeply into current application of string theory and
other complex and esoteric mathematical procedures leading to
the concept of multiverse -- the idea that our entire vast universe
is but one of an infinite number of other universes.
However I would expect and hope that the idea of a multiverse
might be a part of the knowledge base of a psychotherapist
working with a wide range of sensitive people, for some
of whom the idea might become an aspect for the search for
meaning and significance in one’s life - an area that is too often
left out in a reductive psychotherapy.
Similarly, I would hope and expect that the idea that human
nature is deeply imbued with an evolutionary move towards
increased awareness together with centering identity somewhere
other than the ego in the sense of “I” or personal “me,” would
be another part of the psychotherapeutic knowledge base, to be
called upon at meaningful times during the process of therapy.
The Maternal Lineage: Identification, Desire, and
Transgenerational Issues
Paola Mariotti (Ed.); Routledge, East Sussex and New York,
2012; 417 pp.; $39.95
Reviewed by Joanne A. Byars, M.D.
The psychoanalytic literature has long investigated the
effects of mothering on the child. However, how the process
of mothering affects the mother has generally received much
less attention. The Maternal Lineage: Identification, Desire,
and Transgenerational Issues, edited by Paola Mariotti, aims
to explore this relatively neglected topic by examining the
mothering experience in detail.
Pregnancy and motherhood represent significant developmental
transitions, which if successfully navigated can bring about
increased psychic integration and health, but when problematic
can produce personal suffering for the mother and perpetuate
negative patterns through generations to come. Psychoanalytically
informed work with women who are considering motherhood,
pregnant, or raising children can help the patient resolve current
conflicts, as well as rework past developmental issues, and may
even aid the patient’s children and grandchildren via the formation
of a stable, nurturing maternal image which provides a firm
foundation for their own psychic development.

The first section of The Maternal Lineage focuses on
general issues relating to pregnancy and motherhood, and how
psychoanalysis during these life experiences can improve their
outcomes. Exploring mothering can bring up themes that make
both the patient and the analyst very uncomfortable, such as
maternal ambivalence, anger, and destructive fantasies. No one
likes to contemplate the reality that a mother can simultaneously
love and also hate her child, but as all good therapists know,
whatever seems scariest to discuss is precisely what profits
most from discussion. These issues can engender strong
countertransference reactions, and the therapist must remain on
guard against unconsciously colluding with the patient to avoid
the difficult issues that would most benefit from being brought
into consciousness and dealt with openly.
Pregnancy presents a unique moment for psychodynamic
work. The fixed timeline of pregnancy and the powerful affects
it generates can intensify the work and make issues such as body
image and body boundaries, unresolved Oedipal conflicts, and
unconscious fantasies much more accessible than usual. Working
with pregnant patients poses technical and countertransference
challenges, but offers the opportunity to conduct important
and long-lasting therapy during an important life transition.
Similarly, mothers re-experience their own past developmental
stages as their children pass through them, providing a chance
for further growth at these stages not typically available in
adulthood.
Mothering gives rise to specific fantasies and conflicts,
which can lead to increased psychic growth and integration,
or to symptom formation and despair. The dichotomy between
the fanatasized perfect mother and the reality of maternal
ambivalence can become a reservoir of shame and depression,
and derail a healthy separation-individuation for the child,
or can increase the patient’s acceptance and integration of
“good” and “bad” in herself, her internal objects, and the real
individuals in her life. No woman can fulfill the role of the
idealized perfect mother, and anyone who did would harm rather
than help her children. The child watches the real, imperfect
mother cope with negative affects and challenging situations,
and by internalizing her methods, establishes his or her own
capacities to do the same. When the mother emerges from a
state of primary maternal preoccupation and renews her interests
outside the baby (e.g., her relationship with the baby’s father,
her work, etc.), she opens up a space in which the child can
start to separate and individuate. However, if shame engulfs
the mother when she (inevitably) fails to live up to society’s
ideals and her own internal maternal ideal, then ambivalance
can become unbearable and can lead to psychic fusion with the
baby in a desperate attempt to preserve the “good” mother and
prevent the “bad” mother from destroying her and the baby.
Psychotherapy can enhance the the mother’s ability to recognize
and talk about ambivalence, thus overcoming shame and keeping
ambivalence manageable.
The second section of the book concerns infertility and
reproductive technology. One chapter, “The ‘Medea Fantasy’:
an unconscious determinant of psychogenic sterility” by
Marianne Leuzinger-Bohleber, describes the case of a woman
who remained childless until, through psychoanalysis, she
became able to hold a positive image of her femininity and
mothering capacity, maintain stable body and ego boundaries,
and transcend primitive fears that the mothering relationship
necessarily destroys either the mother or the child. Additional
facts in the history of this patient suggest severe conflicts over
intimacy which markedly impeded her sexual relationship with
her husband; while these circumstances understandably led
to childlessness, it is not clear whether she actually had any
gynecologic problems which would prevent a pregnancy, and
therefore may not fit most people’s definition of infertility.
While this patient certainly gained much from her analysis, the
other authors in this section stress that most infertility (over 95%
in some studies) is not psychogenic. For instance, the patient
Joan Raphael-Leff describes in “The baby makers: conscious
and unconscious psychological reactions to infertility and ‘babymaking’
- an in-depth single case study” has scarred Fallopian
tubes and her husband has poor sperm mobility; believing that
psychoanalysis can repair these factors and cure this couple’s
infertility constitutes magical thinking.
In the actual work of therapy, the underlying etiology
of infertility matters less than its meaning for the patient.
Regardless of what other medical problems may exist, the
patient can benefit from addressing the affects surrounding
infertility and working through conflicts and fantasies
surrounding motherhood, so that whether she eventually gives
birth to a child, becomes a mother via surrogacy or adoption,
or opts to remain childless, she will enter this new chapter in
her life better-positioned to handle it - possibly more so than if
she had immediately experienced an uncomplicated pregnancy.
Even though psychoanalysis cannot promise any woman a baby,
it always offers the hope of increased growth and health.
The third section of the book addresses the darker side of
mothering, including postpartum depression, child abuse, neglect,
adolescent motherhood, and repeated elective termination of
pregnancy. The authors of these chapters point out that women
may become pregnant for many reasons, not all of which involve
the wish or the capacity to raise a child. Pregnancy can represent
an assertion that a woman’s body belongs to her and not to her
mother, or may constitute an attempt to create an object who
will love her unconditionally and fulfill all her needs. Once an
actual needy, demanding baby arrives, mothering can prove
overwhelming and, without intervention, may result in negative
outcomes for both mother and child. Psychodynamic work under
these circumstances entails many obstacles, but also offers the
chance to achieve significant benefits that can last a lifetime
and, by interrupting multigenerational maladaptive patterns of
mothering, perhaps even longer. Such work may take the form
of traditional psychoanalysis with the mother alone, or can
involve meeting with the mother-baby dyad (and possibly the
father as well) in order to directly model positive, responsive
mothering behavior for both the mother and the child. Flexibility
and willingness to engage the mother and the baby at various
levels can encourage a healthier dyadic relationship and growth
for both of its members.
Throughout the book, the various authors emphasize the
intergenerational transmission of mothering. Positive mothering
patterns can serve as a source of strength for women, by
promoting successful navigation of developmental stages early
in life as well as forming templates for mother-child interaction
that the woman can use with her own children. Similarly,
negative mothering experiences can impair a woman’s separation
and individuation from her own mother and prevent her from
developing a mature, loving internal maternal image, that sets
31

her up for difficult relationships with others, including her own
children, and also deprives her of the tools she needs to cope
with these stressors. Breaking the cycle requires examining
not only the relationship between the patient and her child, but
also the relationship between the patient and her mother, and
possibly back even further to the patient’s grandmother and
great-grandmother. The multigenerational nature of mothering
can prolong serious disturbances, but can also lead to great
healing. Successful mothering of her own child can allow the
patient to better understand her own mother (real and internal),
and repair and deepen their relationship. The opportunity for
growth through the mothering experience can thus resonate
forwards and backwards through three generations.
The Maternal Lineage presents a variety of viewpoints on
the mothering experience and how psychoanalytically-informed
therapy relates to it, and will help psychodynamically-oriented
therapists more effectively address these issues with their
patients. Clinicians who are not psychoanalysts, psychiatrists,
or therapists, such as obstetricians and pediatricians, may also
appreciate this perspective on the problems confronting their
patients, even if they do not provide therapy to them. The
well-written papers, free of excessive jargon, make the book
accessible even to those without an extensive background in
psychoanalysis and the vivid case material brings the theory
to life. Although generally comprehensive in scope, the papers
in the book deal exclusively with heterosexual women such
that including material on mothering in same-sex relationships
would strengthen future editions. The Maternal Lineage
provides a thorough overview of the profoundly important but
little-examined experience of mothering, and illuminates how
psychoanalysis can help women who are going through this
process.
Slots: Praying to the God of Chance
Publisher Delphinium Books, Inc., 2012, 224 pp., paperback
$13.95, hardcover $24.95, also in eBook by David Forrest, M.D.
Reviewed by Eve Leeman M.D.
“God does not play dice with the universe,” Einstein famously
stated. In Slot: Praying to the God of Chance, David Forrest
M.D., a psychiatrist and anthropologist of popular culture, leads
us into a world in which people assume a vigilant state of anticipation,
praying for good fortune to a God whom they believe
really does play dice. “To pray is to play” he suggests, likening
the trance-like, meditative state of slot playing to religious
worship. He correlates the architecture of casinos to cathedrals,
jarringly contrasted by banal secular images like cans of spam
that must line up to yield a payoff. He considers prayers directed
toward an electronically random machine to be a reflection of
our modern materialistic reality.
In a conversational tone, part philosophical musing, part
travelogue of his visits to many of the world’s gambling dens,
Dr. Forrest describes, without pejorative judgment, the shy,
meditative people who return regularly to quietly lose their
money in these pseudo-cathedrals of fortune, where no skill
is required and winnings are determined only by chance. He
entertains us with details of the menu he has enjoyed at top
casino restaurants while traveling with his wife, and presents
anecdotes of the gambling sprees of celebrities and regular folk.
32
He considers some of the available neuroscience of gambling,
and finishes with advice on suitable alternatives for those who
seek the thrill but can’t afford the bill.
While the religious analogy underlying the appeal of casinos
is intriguing, the centrality of greed is highlighted by ubiquitous
images of classical icons and Gods, like Neptune and Zeus,
promising wealth and riches. In fact, the seven capital sins are
all in play. In one example of pride and envy in the context of
sibling rivalry, Alice, who won over $34,000 in a slot machine,
asked that most of her winnings be given to her by check, but
requested $4,000 in hundred dollar bills so she could lord her
winnings over her less successful sister by throwing them at
her when she opened the door. Meanwhile, the growing slot
machine industry gluttonously employs computer-programmed
strategies to decrease the probability of a payout, or to increase
the frequency of “teasers,” where two winning 7s line up with
the third just off the pay-line, to tempt players to keep playing.
These human Gods of industry actively stack the dice, engendering
the adage “the only way to make money in a casino is
to own one.”
Currently an estimated 365 billion dollars are spent on slot
machines in the United States per year; approximately 90% is
funneled back to the players, yielding an annual profit of 35
billion dollars. Slot machines are by far the top money earners -
they generate 70-85 percent of a casino’s profits. Because there
is little personal interaction in slot playing - you don’t need to
see an agent unless you win - there are almost no labor costs.
The gaming tables, which attract a more aggressive clientele
who are willing to gamble more to win more and where skill
can improve success, earn far less. Glitzy hotels, fancy restaurants,
bars offering free drinks and lavish spas are loss leaders
intended to lure players to the machines. Slots are also a major
source of patents, as computer programmers vie to find new
ways to appeal to players, for example by adding video game
features and virtual reality extras, to increase revenue. In spite,
or perhaps because, of the recession, the industry continues
to grow as cash-strapped municipalities relax regulations and
increasingly turn to gambling as a way to raise tax money and
generate business; some 35 states are trying to balance their
budgets on the backs of slot-players.
Having rarely stepped foot in a casino, I enjoyed the voyeurism
of riding into these places on the shoulder of one so familiar
with the sights, sounds and tastes. As I read of the shift away
from actual coins to a newfangled paper ticket system, I identified
with those who mourned the change. Once, while driving
across country on a tight budget in the early 80’s, I stopped at a
Reno, Nevada gas station that housed a slot machine. I hesitantly
dropped in a quarter and expectantly pulled the handle. What
a thrill when out poured an avalanche of quarters! Not being a
pathological gambler, I quickly scooped up the money in a plastic
cup and moved on. As per research Dr. Forrest attributes to
Nobel laureate Daniel Kahneman, my anterior cingulate cortex
may have reacted less to a win than it would have to a loss,
explaining why people bet more desperately when they lose. I
revisited the thrill of my small win every time I touched one of
those cool metal coins to pay a toll or buy a snack.
Since reading this illuminating book, I have begun to register
the signs of gambling everywhere: in magazine ads, on billboards
advertising Atlantic City casinos that fill the wall space
of entire New York City subway cars, and even in the sky over

Boston where planes regularly leave vapor trails advertising
Connecticut’s Mohegan Sun. Apparently, even with the enormous
proliferation of slot machines, pathological gambling still
only occurs in 1% of the population. But when Dr. Forrest suggests
that people should consider patronizing expensive casino
restaurants because few meals cost more than the amount that
can be lost in the time it takes to eat, one has to wonder about a
society that wastes so much time and technological prowess on
a losing proposition. As Einstein again wisely noted, “perfection
of means and confusion of ends seem to characterize our age.”
Relational Child, Relational Brain: Development and Therapy
in Childhood and Adolescence, Edited by Robert G. Lee and
Neil Harris, Gestalt Press, 2011, 382 pp., $39.95 in paperback
Reviewed by Shaneel Shah, M.D.
When I first heard about this book, I did not know a great deal
about Gestalt approach to working with children and families.
I was initially intrigued by its title, that, to me, suggested that
the book might help me paint a picture of child development
from a relational perspective. As a beginner in the field of
child psychiatry, I was also looking for a read that could help
me explore ways of working with troubled and troublesome
children. With that expectation I read Relational Child,
Relational Brain and I am thrilled to say that it not only lived
up to the expectation but also in many ways exceeded it.
Written by Gestalt therapists, this book is a comprehensive
introduction to the inter-subjective relational understanding of
us - humans - with a focus on children and adolescents. It is
the second book in the Evolution of Gestalt Series, the result
of a study conference at Esalen Institute, California. It touches
upon myriad of topics that are relevant for the clinicians. Some
of the questions it alludes to include: what can be the use of
Gestalt understanding of childhood development for those who
work with children, adolescents and their families; how can
we support the theories with findings from neurobiological
and developmental research; what might be the interaction
between how children relate to their environment and their
neurobiological development
The book is organized into three interrelated parts – Theory,
Support and Applications. Most of the chapters come directly
from presentations given at the conference and some chapters
were inspired by the authors’ experiences attending the
conference. The first section focuses on child development and
talks about the importance of feeling connected with others
and developing a sense of belonging while growing up. The
evolution of humans as relational beings and its necessity for
survival is explained from an evolutionary perspective.
Gordon Wheeler, President of Esalen Institute, starts by
describing what drives us – “the selfish gene” or relationships.
He convincingly puts forward an argument that brain
development occurs to fulfill social demands and needs; that we
cannot develop in isolation. He also talks about within-group
altruism and its evolutionary advantages.
The book then focuses on mindfulness. Daniel Siegel, Co-
Director of the Mindful Awareness Research Center at UCLA,
gave an interesting talk at the conference explaining connections
between mindfulness, attachment and brain development.
Verbatim record of that talk is presented in the book as a chapter.
33
The second section, Support, includes four chapters that speak
to the importance of relational connections in child development.
The chapters are rich with clinical examples and help further
clarify the vital importance of understanding and addressing the
problems that a child may be having, in a larger relational field.
A chapter by Mark McConville talks about different modes of
parent-child contact and how a child development concurs with
a relational field development within the family.
The final section, Applications, presents Gestalt approaches
to working with children and families in various contexts.
Marlene Blumenthal talks about working with adolescent girls
with eating disorders. The section also illustrates the art of
engaging adolescents presenting with both internalizing and
externalizing behaviors.
With a clear and lucid style, the book is easy to read. Editorial
comments before each chapter give a clear direction on what
to expect. Despite the fact that each chapter is written by a
different author, the book maintains a cohesive theme and is
easy to follow. Clinicians and educators working with children
and, for that matter, anyone interested in child development will
find this book helpful.
Sybil Exposed: The Extraordinary Story Behind the Famous
Multiple Personality Case
Free Press, A Division of Simon and Shuster, New York,
2011, 297 pages, paperback, $16.00, EBook available by
Debbie Nathan
Reviewed by Gerald P. Perman, M.D.
As Medical Consultant to an “Abuse and Trauma Recovery
Unit” in a psychiatric hospital in the early 90’s, I evaluated
and treated scores of patients with Multiple Personality Disorder
(MPD), now Dissociative Identity Disorder (DID). Many
of these patients, almost all young women, had co-occurring
symptoms of Borderline Personality Disorder including selfmutilation,
suicide attempts, splitting as a prominent defense
mechanism, and impaired social, educational and occupational
functioning. The unverifiability of the abuse that many of these
patients’ reported had the effect of putting the science of psychiatry
on thin ice indeed. This situation was exacerbated by
the gullibility of many of these patients’ clinicians who blindly
accepted the truth of their patients’ allegations. This in no way
contradicts the reality of widespread severe child abuse, nor, to
my mind, negates the validity of the diagnosis of DID.
Sybil Exposed: The Extraordinary Story Behind the Famous
Multiple Personality Case is a cautionary tale for psychiatry and
is instructive on many levels. Freelance journalist Debbie Nathan
has written an impressively-referenced book that debunks
and heavily critiques the famous case of Sybil by examining
records of the treating psychiatrist, the background of the famous
patient, and the records of the collaborating journalist. The
latter became wealthy through the 1973 blockbuster book that
sold over 6 million copies, the 1976 two-part TV special with
Joanne Woodward and Sally Fields and watched by 40 million
Americans, live TV appearances, and two Hollywood movies.
Sybil Exposed is written as a story of self-deception, naiveté,
greed and the disregard of what most of us would consider
basic tenets of the practice of psychodynamic psychotherapy.
Just because we ask our patients to tell us “whatever comes to

mind” does not mean that all they tell us is true. And even less
so when they are pressed, under the influence of IV phenobarbital,
to corroborate events that the therapist imagines happened
to them in their past.
We are hopefully more aware now, as we pay attention to
the narrative as well as the historical truth (Spence, Donald P.,
Narrative Truth and Historical Truth: Meaning and Interpretation
in Psychoanalysis, W.W. Norton and Company, 1984), as
we realize that memories are ALWAYS an admixture of fantasy
and reality (and memories of memories), that memories may
serve a screen function, that memories are heavily influenced by
the transference (with the patient telling the therapist what she
thinks the therapist wants to hear) and that patients’ memories
influence the countertransference. These are some of the lessons
that we can relearn from reading Sybil Exposed.
The psychiatrist was Cornelia B. Wilbur, M.D., the patient
was Shirley A. Mason, and the journalist was Flora Rheta Schreiber,
now all deceased. According to Ms. Nathan, Wilbur and
Mason gave Schreiber thousands of pages of treatment notes,
patient diaries, and transcripts of tape-recorded sessions. Schreiber
made her own meticulous notes of this material that were
archived at the John Jay College of Criminal Justice in New
York City and became open to the public a few years ago, and
on which Nathan relied heavily for Sybil Exposed.
In brief, pre-med student Mason becomes a patient of Park
Avenue psychoanalyst Cornelia Wilbur who, using hypnosis
and IV phenobarbital on multiple occasions, obtains a sordid
confession of profound childhood physical and sexual trauma
beginning at age 3 that was inflicted on her by her delusional
and psychotic mother. At the same time, Mason is experiencing
fugue states and gradually presents with 16 alter personalities of
various ages and both sexes. Mason becomes habituated to the
phenobarbital and eventually undergoes a painful detoxification.
Numerous boundary violations occur during treatment, with
Mason living with, working for, and receiving gifts and money
from, Cornelia Wilbur. Wilbur collaborates with Schreiber to
write a hopefully best-selling book for the public about her
fascinating patient. The book’s publisher stipulates that the book
will not be accepted for publication until Sybil is cured so that
it can have a happy ending. As the deadline approaches, “She
[Wilbur] told Shirley she would simply have to get well….So
she did…Shirley never again dissociated into an alter personality.”
(p. 140-141)
Nathan interviewed numerous people in the course of writing
this book: Mason’s childhood playmates, family members,
friends and roommates, other researchers who had worked on
the story, and many psychiatrists (including some well-known
members of the Academy). Time and again, many of the events
presented as “fact” by Wilbur and Schreiber about Mason’s early
life were found to be false, either totally of sync with the remembered
dates or extremely implausible based on the recollection
of friends, relatives, a housekeeper, and grade school teachers.
Nathan does a masterful job weaving together the many
threads of Sybil – the fascinating biography of Mason, the
description of Wilbur’s treatment, the literary collaboration
between Schreiber and Wilbur, and the fabulously successful
“business” of Sybil. According to Nathan, the initially unconscious,
and later conscious, deceit by Wilbur in the face of
emerging contradictory evidence lies claim to a shameful chapter
in psychiatry that unleashed a movement that pulsated with life,
created a new DSM psychiatric diagnosis (MPD/DID), and that
appears to have now largely evaporated. Nathan covers many
other topics of interest: ECT (performed by Wilbur on Mason
and others without anesthesia – the state of the art at the time),
Wilbur helping with hundreds of frontal lobotomies, the evolution
of the Feminist movement in America, the now discredited
story of satanic ritual abuse, and how the wheels of the literary
world are greased by dollar signs. Schreiber became wealthy
and Wilbur, and to a lesser degree Mason, received thousands
of dollars in royalties. Wilbur was feted with the accolades of
her colleagues, especially among the devotees (myself included
at the time) of the International Association for the Study of
Multiple Personality and Dissociative States.
Intended to attract as large an audience as possible, Sybil
Exposed occasionally shades into sensationalist journalism, e.g.
“Soon Dr. Wilbur was injecting and shocking patients in a way
that had never been done before, then writing up her “scientific”
experiments for publication.” (p. 47) And “Now she was also
drilling holes in their skulls and turning their brains into pulp.”
(p. 49) I also think that Nathan put too much weight on Wilbur’s
suggestion that Mason had pernicious anemia (p. 219) causing
vitamin B12 deficiency and that this was the likely cause of
all of her symptoms. More likely, Mason had been a highlysuggestible
little girl who grew up in a strictly religious and
rigid family and who created imaginary playmates. Her capacity
for suggestion was later tapped into by an accommodating
and available psychiatrist. She also may have had pernicious
anemia (this was never confirmed) that may have had some
undetermined influence on her clinical course.
Sybil Exposed offers little advice to the practicing clinician
who may still encounter (but not create) patients with dissociative
disorders in his or her practice. For this, we need to turn to
the well-grounded principles of psychodynamic psychotherapy
in which we offer a safe holding environment, help our patients
explore his or her mind whatever the contents therein, offer them
a meaningful therapeutic relationship, and help them achieve an
improved adaptation to life.
34

New Member Profiles – Accepted
The Membership Committee is pleased to welcome the
following who are new members to the Academy.
Panagiota Korenis, M.D. Eastchester, NY
Sponsors: Scott Schwartz, M.D., and Douglas Ingram, M.D.
Psychiatric Associate Members
Arthur Thomas Carter, M.D. New York, NY
Sponsors: Scott Schwartz, M.D. and Michael Blumenfield,
M.D.
Dr. Carter is a first-year resident at Metropolitan Hospital in
NYC and will begin psychodynamic training next year at the
NY Medical College Institute. He received his B.S. from the
University of Northern British Columbia and his MD from Ross
University School of Medicine in the Caribbean. He speaks
conversational French.
Mark Hreish, M.D. Chino Hills, CA
Sponsors: Scott Schwartz, M.D. and Ronald Turco, M.D.
Dr. Hreish received his BS in general biology and his BA in
Ethnic Studies. He completed medical school at St. George’s
University School of Medicine and is currently in his first year
of residency at Metropolitan Hospital and is strongly interested
in pursuing studies at NY Medical College Psychoanalytic
Institute where he will begin next year. According to his
sponsors, he is empathic, skilled as a physician and has a long
term interest in psychiatry and psychoanalysis.
Robert Adam Jenkins, M.D. Bala Cynwyd, PA
Sponsors: Kimberly Best, M.D., and Eugene Della Badia, D.O.
Dr. Robert A Jenkins is a fourth year psychiatric resident
at the Einstein Healthcare Network in Philadelphia, PA. He
graduated Amherst College Magna cum Laude in 2000 with
a B.A. in neuroscience, attended U. Penn. for a Post-Bac in
Robotics and Automation the next year, and took extra-curricular
training at Temple U School of Medicine from 2005-2009
with extracurricular training in Advanced Medical Spanish
and Medical Ethics. He began a two year psychodynamic
psychotherapy program at the Psychoanalytic Center of
Philadelphia in September 2012. He has received strong
recommendations from his two sponsors.
Ilea Khan, M.D. Weymouth, MA
Sponsors: Scott Schwartz, M.D. and Gerald P. Perman, M.D.
Dr. Kahn received her B.S. from UConn, her MD from St.
George University, Grenada, and she is in her fourth year of
psychiatric residency training in the Harvard residency system
in Boston. She worked last year in the Veteran’s Administration
seeing both younger and older veterans, in both inpatient and
outpatient settings. Dr. Kahn feels that she has received excellent
psychodynamic supervision and training and that this has been
an important part of her formation. She is interviewing for a oneyear
fellowship in public psychiatry to begin after she finishes
her residency. She is idealistic and thinks she may choose to
follow a career in public psychiatry.
36
Dr. Panagiota Korensis received her BS from Queen’s University
in Kingston, Ontario, her MD from St. George’s University in
Grenada, West Indies, and trained in psychiatry for two years at
Mt. Sinai School of Medicine in NY, and for the last two years
at Albert Einstein College of Medicine in the Bronx, the last year
as Chief Resident. She is currently a Forensic Psychiatry Fellow
at New York University School of Medicine. She did hurricane
relief work in the West Indies in 2004, and has served on several
educational and hospital committees. She participates actively at
the New York Medical College Psychoanalytic Institute and will
be presenting at the upcoming San Francisco Academy meeting.
Joshua Ryan Leo, M.D., MPH Boston, MA
Sponsors: César Alfonso, M.D., and Abby Altman, M.D.
Dr. Leo received his B.A. from UVA in Charlottesville, VA,
his MD from Tulane University School of Medicine in New
Orleans, LA and, at the same time, his MPH in Health Systems
Management and Policy from Tulane. He is in his fourth year
of residency training in the Harvard Longwood Psychiatry
Residency Training Program in Boston, MA. He is currently
the chief resident on the CL service at Brigham and Women’s
Hospital in Boston. He has instructed and supervised the work
of medical students and residents. He “plans to enroll in studies
in psychoanalysis” and to attend the San Francisco Annual
Academy Meeting according to one of his sponsors.
Hammad Mohsin, M.D. Jamaica, NY
Sponsors: Scott Schwartz, M.D. and Mary Ann Cohen, M.D.
Dr. Hammad Mohsin received his M.D. in 2005 from Nishter
Medical College Multan, Pakistan. He did his internship at this
same medical college in Pakistan. He is a third year resident at
Albert Einstein College of Medicine at Bronx Lebanon Hospital
Medical Center. He received the Albert Einstein Student teacher
of the year award in 2012. He is fluent in five languages and
enjoys several hobbies. He has applied for admission to the NY
Medical College Dynamic Therapy course.
Raymond Raad, M.D. New York, NY
Sponsors: Elizabeth Auchincloss, M.D. and Alan Barasch, M.D.
Dr. Raad is a fourth year psychiatric resident in the NY
Presbyterian Hospital-Cornell U. residency training program.
He was born in Syria and grew up in Brooklyn. He received a
B.S. in mathematics from MIT in 2004. As an undergraduate
he studied stress response genes in schizophrenia. He graduated
as a member of Phi Beta Kappa and the Arista National Honor
Society. He earned an MD and MPH from Columbia U. College
of Physicians and Surgeons in 2009. He again worked in a
research lab on schizophrenia. He worked with Paul Appelbaum
assessing the capacity of mental health patients to vote and
assessing aspects of informed consent, both project resulting in
publications. He interned at the CATO Institute in Washington,
D.C. after his third year of medical school assessing the U.S.

healthcare system in comparison to others. He had continued
to excel in his residency training program, winning several
prestigious awards, working with nationally known psychiatrists,
and serving as co-chief resident in the 4 th year. He is interested
in a career in psychiatry, law and public health policy.
Reza Taghavi Ardakany, M.D. New York, NY
Sponsors: Cesar Alfonso, M.D. and Scott Schwartz, M.D.
Dr. Taghavi Ardakany received his MD from the U of Tehran
School of Medicine in 1998, completed his residency at the
Bronx Lebanon Hospital, NY, and is currently in his Child and
Adolescent Fellowship at Bronx Lebanon Hospital, NY. He has
taken the Psychoanalytic Institute Psychotherapy Certification
Course with Dr. Alfonso and is highly recommended by his
two sponsors.
Enrique Vargas, M.D. New York, NY
Sponsors: Scott Schwartz, M.D. and Erminia Scarcella, M.D.
Dr. Vargas is a first year psychiatry resident. He was raised
in Puerto Rico, received his MD from St. George’s School of
Medicine in Grenada, and is in residency training in psychiatry
at the Metropolitan Hospital Center – New York Medical
College. He is interested in psychodynamic psychiatry and is
considering formal psychoanalytic training. Next year he will
begin training at the Medical College Institute Dynamic Therapy
Course.
Dirk Winter, M.D., Ph.D. New York, NY
Sponsors: Michael Blumenfield, M.D. and David Lopez, M.D.
Dr. Winter originally came to medicine and psychiatry with
a research background having obtained a PhD in Cell and
Developmental Biology at Harvard before entering University
of Minnesota Medical School and completing the Columbia
residency in psychiatry. He currently is completing a Child &
Adolescent Fellowship. He has a strong interest in psychodynamic
psychiatry and may plan to obtain psychoanalytic training. His
interests evolved from basic research to understanding child
development and the importance of clinical work. He feels
strongly about educating the public. He has recently obtained
a grant to study new media in child psychiatry. Dr. Winter
is enthusiastic about joining AAPDP and contributing to our
organization in any way that he can.
Psychiatric Members
Kendall Brown, M.D. Woodway, TX
Sponsors: Samuel C. Klagsbrun, M.D., and Gerald P. Perman,
M.D.
Dr. Brown graduated from Princeton U in 1981, received his
MD from the U of Mississippi School of Medicine in 2000,
completed residency training at the Medical College of WI in
2004, and has been in a Geriatric Psychiatry Fellowship at U
WI Madison 2006-7. He was a consulting psychiatrist for the
Department of Corrections in Oshkosh, WI from 2004-6 and
worked for the Milwaukee Country Mental Health Complex
from 2001-7 and well as many other clinics and hospital wards
in WI. He was a staff psychiatrist at Waco VA Memorial Hospital
from 2007-9 and has continued to work in the public and private
sector in TX treating patients with developmental disabilities
and severe psychiatric illness.
Gregory Mahr, M.D. Novi, MI
Sponsors: Ann Price, M.D. and Scott Schwartz, M.D.
Dr. Mahr received his B.S. and MD degrees from Wayne State
U and completed his residency training in psychiatry at the
Detroit Psychiatric Institute in 1987. He has been the Program
Director in CL Psychiatry at the Henry Ford Hospital since 1998
and had other Medical Director positions prior. He has received
several teaching awards over the years. He has given almost 20
presentations mostly in psychosomatic medicine.
Michelle Merrill, M.D. New York, NY
Sponsors: Deborah Cabaniss, M.D. and Eve Leeman, M.D.
Dr. Merrill, Assistant Clinical Professor in Psychiatry at
Columbia U/NYSPI and in full-time psychiatric practice,
received her B.A. from U California at Berkeley obtaining
highest honors in neurobiology and her MD from Harvard
Medical School. She interned and did her residency at New York
State Psychiatric Institute and Columbia U Medical Center. She
consults to the Women’s Mental Health Program at Columbia
U and supervises third year medical students. She has won six
prestigious awards, is proficient in Spanish, and was selected as
a fellow in the American Psychoanalytic Association.
Sabina Singh, M.D. New York, NY
Sponsors: Scott Schwartz, M.D. and Joseph Merlino, M.D.
Dr. Singh received a B.S. (summa cum laude) and M.S. in
molecular biology from Long Island University in Brooklyn
(both on a full academic scholarship), and her M.D. from Mount
Sinai School of Medicine, NY. She did a residency that included
pediatrics, adult, and child and adolescent psychiatry at the
Albert Einstein College of Medicine/Montefiore Medical Center,
Bronx, NY, finishing in June 2002. She did a one year resident
fellowship at the NY Psychoanalytic Institute. She is board
certified in pediatrics, adult and adolescent psychiatry. Currently
an Assistant Clinical Professor at SUNY Downstate, she has had
multiple academic teaching and clinical appointments and is
currently the Assistant Medical Director of the Adult Outpatient
Behavioral Health Services, Kings County Hospital, Brooklyn,
NY. Dr. Singh is on the Medical School Admission Committee,
Grand Rounds Committee and Resident Education Planning
Committee of SUNY Downstate. She lectures on a variety of
psychiatric topics to medical students, residents and fellows.
Psychiatric Fellows
Jack Levy, M.D. New York, NY
Sponsors: Jane Simon, M.D. and Gerald P. Perman, M.D.
Dr. Levy graduated Columbia University and Albert Einstein
Medical School in NY. He did his residency in psychiatry at
Hillside and Manhattan Psychiatric Center, a state hospital. He
simultaneously enrolled in the William Alanson White Institute
37

where he went for two years. He completed his residency in
1970, got married and took a trip around the world. He entered
the Army reserves for six years. A few years later, he entered
the Post Graduate Center for Mental Health (a psychoanalytic
institute) and took more courses, entered analysis and received
supervision for two years although did not graduate. He moved
to Israel from 1980-82 where he practiced inpatient psychiatry
in Hebrew and English. This was exciting and stimulating and
he worked with soldiers, children and adolescents. He moved
back to Manhattan where he held many part-time psychiatric
jobs, did locum tenens work and had a part-time private practice.
He now has a half-time private psychotherapy practice only.
He has always done psychotherapy, sometimes employing
medication, but psychotherapy has been the essential part
of his work. He is Director of the Literature Program in the
Department of Psychiatry at Columbia in NY. His website is
www.newyorkcitypsychiatrist.net. He had been interested in
the Academy for over 50 years and has attended a number of
Academy meetings especially in the 70’s and 80’s. He feels the
members are “more in line with how I think” than other groups.
Psychoanalytic Fellows
A. Matt Fogarty, M.D. Anaheim Hills, CA
Sponsors: Michael Blumenfield, M.D. and Gerald P. Perman,
M.D.
Dr. Fogarty completed psychoanalytic training at the Tulane
Psychoanalytic Academy affiliated with the Tulane University
Medical Center in New Orleans in 1999. Prior to this he received
a BS in Engineering from Tufts, studied pre-med biology,
chemistry and biochemistry at Harvard, received his MD.from
LSU in New Orleans and trained in psychiatry at Tulane
University Medical Center in NO. After his psychoanalytic
fellowship from 1993 - 1999 (his psychoanalytic training), he
joined the Clinical Faculty at Tulane and became a Professor
of Psychoanalysis at the Tulane Academy. He has had many
interesting vocational activities over the years. He is Vice
President of Exploration Systems, Inc. providing IT solutions to
the oil and construction industries. He has provided psychiatric
treatment through the VA system, has been medical director
of several outpatient programs, director of inpatient programs,
and most recently has been doing locum tenens work and while
establishing his private practice. He also has had a long-standing
interest in sports medicine and has been the U.S. Badminton
National Champion nine times and a World Championship
badminton team member for many years. Dr. Fogarty has a
deep commitment to understanding individual emotional pain
and working with patients in psychoanalytic psychotherapy.
Mark Goldblatt, M.D. Cambridge, MA
Sponsors: Robert Eisendrath, M.D. and John Maltsberger, M.D.
Dr. Goldblatt is a distinguished psychoanalyst and academic
psychiatrist. He interned in Cape Town, South Africa, and did his
residency at West-Ros-Park Mental Health Center in Boston, a
Harvard affiliated program. He is a Clinical Associate at McLean
Hospital and an Associate Clinical Professor of Psychiatry at
Harvard Medical School. He was a candidate in psychoanalysis
from 1990-1995 and graduated from the Boston Psychoanalytic
Institute in 2002. Dr. Goldblatt is on the faculty of Advanced
Training in Psychotherapy and the Boston Psychoanalytic Society
and Institute. He has been in private practice in Cambridge for
22 years. He has held many positions of leadership in the
American Association of Suicidology and is a member of over
a dozen other psychiatric and psychoanalytic organizations. He
has taught, lectured (nationally and internationally), and written
extensively including publications in the Journal of the AAPDP.
Peter H. Keefe, M.D. Toronto, Canada
Sponsors: Michael Blumenfield, M.D. and Graeme Taylor, M.D.
Dr. Keefe did his residency training at the U of Toronto and
Stanford in CA and completed psychoanalytic training at the
Toronto Institute for Psychoanalysis where he has been on
the faculty since 1994. He is also board certified in internal
medicine. He has hospital appointment in psychiatry and
internal medicine in Toronto and is an Assistant Professor in
the Department of Psychiatry at the U of Toronto. He has been
a member of a number of learned societies and is currently on
the Lacanian Clinical Forum in Stockbridge, MA. He has been
significantly involved in hospital CL activities, the history
of psychiatry, research and the study of drama. He has had
extensive teaching experience at various post-graduate levels
and has written numerous scientific papers including several
on Edvard Mumch.
Aneil Shirke, M.D., Ph.D. New York, NY
Sponsors: Richard Friedman, M.D. and Mark Novick, M.D.
Dr. Shirke received a BA in Biophysics in 1988 from Johns
Hopkins University in Baltimore, MD, his MD and PhD in
Physiology and Biophysics in 1998 from the University of
Iowa, and completed his residency in Psychiatry in 2002 from
Columbia University Medical Center and New York State
Psychiatric Institute in NY. He completed psychoanalytic
training in 2007 at Columbia University for Research and
Training in Psychoanalysis in NY. Since 2003 he has been
in private practice while doing on-call work and being a
staff psychiatrist for a visiting nurse association. He teaches
extensively in several capacities and has received a number of
important grants and awards.
38

American Academy of Psychoanalysis
and Dynamic Psychiatry
One Regency Drive, P.O. Box 30
Bloomfield, CT 06002