Mark B. Borg, Jr. PhD
Borg, Jr., M. B. (2010).
Developing a Model of Psychoanalytically-Informed
Community Crisis Intervention. In N. Lange and M.
Wagner (Eds.) Community Psychology: New Directions
Happague, NY: Nova Science Publishers.
IN THIS CHAPTER I DEFINE AND ILLUSTRATE key concepts, practices and intervention
strategies from the seemingly disparate fields of community psychology and
psychoanalysis (specifically, relational/interpersonal psychoanalysis). Through
a number of examples from my own work as both a clinical psychoanalyst and
community practitioner, I hope to illustrate how a useful intersection has
been, and can be, developed to cross-pollinate and enliven the practice of
community crisis intervention (as well as how such work can also be usefully
applied to clinical psychoanalysis itself). I present an overview of key
psychoanalytic and community psychology concepts, such as transference,
countertransference, enactment, empowerment and primary prevention, and show
through a number of examples how these undergird the development of a
psychoanalytic approach to community crisis intervention. I will present a
number of new concepts — community character, point of impact, and project group methodology — which I will then use in describing the development of a model
of psychoanalytically-informed community crisis intervention. I will also
reverse the lens and utilize the community psychoanalytic concepts to
illuminate clinical work with individual patients.
Reverberations between Community Psychology
purpose of this chapter is to ask a series of questions that challenge the
conventional wisdom that psychoanalysis and community psychology are necessarily divergent approaches to
psychological intervention. There are, of course, commonly held distinctions
between the activities of community practitioners and analysts. For instance,
psychoanalytic patients generally initiate their own engagement in the analytic
process, while governmental, academic, and social-philanthropic bodies are generally
the initiators of community interventions, not the communities themselves.
Community practitioners often participate in the daily lives of the community
they are treating, while psychoanalysts do not participate with their analysands in such a
way. Lastly, there is a component of didacticism to community treatment that
would be considered very undesirable — in fact, boundary breaches — in
psychoanalysis. How, therefore, can we consider community work psychoanalytic? In this chapter, I will propose a method
of community analysis that retains
a strong emphasis on the unconscious, on understanding group level coping and
defensive strategies, and on the analysis of transference-countertransference
2,500 years ago, Hippocrates suggested in Airs, Waters, Places that grasping the inherent
disorder in any subject requires careful study of the subject's environment
(cited in Potter, 1996). With this in mind, my colleagues and I have noted a
significant absence of psychoanalytic thinking in contemporary community
research and practice (Borg, 2002b, 2003a; Borg, Garrod & Dalla, 2001;
Borg, Garrod, Dalla & McCarroll, 2009). However, further exploration has
uncovered some significant contributions that psychoanalysts have made to
social and community theory and practice over the years since its inception
(e.g., Altman, 1995; Bion, 1959; Clarke,
Hoggett & Sideris, 2006; Fromm, 1955;
Jones, 1964; Hegeman, 1995; Miller, 1989; Miller & Gwynne, 1972; Milman
& Goldman, 1979; Pines, 1998; Smelser, 1998, Sullivan, 1964; Volkan, 1988,
2009, and White, 2002).
psychoanalysts have traditionally shied away from direct community
intervention, Freud (1921) himself acknowledged a clear link between individual
and community concerns and processes:
contrast between individual psychology and social or group psychology, which at
first glance may seem full of significance, loses a great deal of its sharpness
when it is examined more closely. It is true that individual psychology is
concerned with the individual man and explores the paths by which he seeks to
find satisfaction for his instinctual impulses; but only rarely and under
certain exceptional conditions is individual psychology in a position to
disregard the relations of this individual to others. In the individual's
mental life someone else is invariably involved, as a model, as an object, as a
helper, as an opponent; and so from the very first, individual psychology, in
this extended but entirely justified sense of the word, is at the same time
social psychology as well. (p. 69)
is equivocal here as he was on many other topics — in fact, he seems to
have been downright conflicted about where he stood on the issue. Just nine years later, he described the normally functioning ego as an isolated
atom of self-regarding consciousness that had no relational continuity with its
surrounding physical world. He wrote,
there is nothing of which we are more certain than the feeling of our self, of
our own ego. The ego appears as something autonomous and unitary, marked off
distinctly from everything else . . . One comes to learn a procedure by which, through a deliberate
direction of one's sensory activities and through suitable muscular action, one
can differentiate between what is internal — what belongs to the
ego — and what is external — what emanates from the outer world. In
this way one takes the first steps towards the introduction of the reality
principle, which dominates future development (Freud, 1930, p. 67; emphasis
phrase "one comes to learn a procedure" encouraged generations of
analysts to maintain a strict patrol of the boundary between the ego and the
outside world However,
just a page later in the same article, Freud made an important concession when
he suggested that "our present ego-feeling is only a shrunken residue of a
much more inclusive, indeed, an all-embracing, feeling which corresponds to a
more intimate bond between the ego and the world about it" (p. 68). This
could be viewed as one of several remote origins of community
psychology — a refusal to settle for the "shrunken residue" in
favor of building upon "more intimate bonds" between ourselves and
the world around us. Therefore, even on the heels of Freud's seemingly
straightforward statement regarding the personal-social connection in his Group
the issue remained conflicted for him — as it does for many of us today.
also recognized another important intersection between psychoanalysis and
community psychology: a common concern about the effects of trauma. During the
development of his drive model and the abandonment of his seduction theory,
Freud emphasized internal conflict over interpersonal trauma and hardship as an
immediate basis for psychopathological processes and symptomatology. According
to the drive model, it is the patient — motivated by the increasingly
ego-dystonic experience of his or her neurotic symptoms — who seeks
psychoanalytic treatment. Had Freud not abandoned his original seduction
theory, the notion of trauma as the progenitor of psychopathological processes
and symptoms would have remained more in the foreground of theory and practice.
effort of many contemporary theorists and practitioners (e.g., Bose, 1998;
Bromberg, 1998; Coates & Moore, 1997; Davies, 1996; Gartner, 1999;
Stolorow, 2009; Tubert-oklander, 2007) are informed by an emphasis on the role of
trauma in personality development and a shifting and more expanded view of
causality — that is, many of the symptoms presented in treatment have
etiologies that go beyond intrapsychic determinants solely representative of
personal family dynamics. Clinicians are encouraged to pay greater attention to real aspects of interpersonal
environments rather than attend solely to an individual's internalization and
elaboration of interpersonal (and especially traumatic) events (Dohrenwend, 1978; Moos, 1984; Stokols, Misra, Runnerstrom,
& Hipp, 2009; Tedeschi, Park, & Calhoun, 1998; van der Kolk, McFarlane, & Weisaeth, 1996; Wachtel, 2009). This enlarged attentional
focus in the analyst requires a perception and understanding of environmental
conditions that — due to their embedded and pervasive nature — often
impede individual or community recognition of a need for treatment. In contrast
to an individual's ability to acknowledge specific, ego-dystonic symptoms as
signals of a need for treatment, the presence of chronic or acute trauma within
targeted communities serves as a potent indicator of a need for intervention.
However, such situations are
rarely cut-and-dried — it is often unclear whether symptoms are due to
internal conflict, external trauma, or a mixture of both. This is especially
true when we consider that so many traumas are the result of “friendly
fire” — a military euphemism for the accidental killing or wounding of soldiers
by their own comrades. I believe that psychoanalysis and community intervention
can often be viewed as the treatment of friendly fire victims. Patients often
resist believing that the people responsible for their safety — their
family, their community — have let them down, and come to believe that
their wounds have been inflicted by an "enemy" who exists outside of
their nuclear families or circumscribed communities. This “let down,” on an
unconscious level, targets how our families and our communities have not been
able to sufficiently protect us from pain that we experience in the world
outside of the boundaries of our safe (at least in fantasy) environments. There is a powerful taboo in our society
against acknowledging these friendly-fire incidents within families and
communities as they indicate systemic failures that are best left unspoken (due
to their tendency to induce deep shame and anxiety in said systems, as well as
to the intergenerational nature of such failures in our U.S. society). This
taboo results in psychological wounds remaining hidden, battle dynamics
becoming enactments (unconsciously acted-out), while suffering is symbolically
expressed as physical and behavioral problems associated with mental distress
or a wide array of rampant social ills in our society (Borg, 2003a). But what
happens when those responsible for one's injuries consist of one's own family,
community, or government?
his interpersonal psychoanalytic perspective, Harry Stack Sullivan argued that
psychiatric illnesses are caused by the collective action of constitutional,
environmental, and cultural factors (Sullivan, 1953, 1956). He considered these
causes as indigenous — that is, resulting from interactions among one's
psyche, body, family, and society. He described how interactions with
significant individuals (especially during early development) can lead to
behaviors that appear to be medically rather than socially determined — for
instance, strategic behaviors and rituals (often compulsive) that are
unconsciously created to ward off anxiety. In such cases, emphasizing medical
over social determinations supports the friendly fire taboo — patients come
to believe that their conditions are the fault of their minds and their bodies,
and not of their parents, or environments, or analysts.
or otherwise, pain, misery, and suffering enroll us in particular communities
or societies. Perhaps this enrollment shows up most profoundly in our bodies as
they are transformed through self-destructive practices (smoking, drinking,
overeating) damaging conflict with others (e.g., wars, physical altercations),
and interactions with environmental toxins (e.g., pollution, poisons). Physical or psychological symptoms serve as expressions of personal life
patterns and represent individual responses, reactions, and adaptations to
interpersonal, familial, and cultural experiences. Psychiatric symptoms may
also be used to enjoin ourselves with sanctioned patterns that mark what I have
referred to as our palliative care system (Borg, 2005c), thus dissociating — and
therefore keeping intact — the "friendly fire" wounds inflicted
by our families and society at large. These patterns also play out in
communities, especially between those in the center and those in the margins,
and so many marginalized groups play the role of scapegoat for our social ills. Symptoms such as crime, poverty, and various forms of discrimination represent
this process on a larger scale. In many cases, psychoanalysts and community
practitioners participate in this taboo, despite their sense of responsibility
for challenging it.
The Self-System, Dissociation, and Selective Inattention
From its inception,
interpersonal psychoanalysis has maintained a focus upon problems in living, and upon the impact of coping mechanisms that, while
reducing anxiety, may become entrenched in ways that impede growth (Sullivan,
1940, 1953). Sullivan focused on how we use these coping mechanisms or security
operations in our interpersonal
exchanges. They protect us from anxiety at the cost of limiting our ability to
acquire information that might facilitate adjustment through what Sullivan
referred to as the self-system.
The self-system is a concept that Sullivan uses to describe the total set of security
operations. The self-system maintains
the agency and integrity of the self through monitoring and limiting one’s
awareness of experiences that increase anxiety and/or decrease satisfaction and
security. Brown (1995), following Sullivan (1954), describes the self-system as
While self-system processes work
to determine what is in and out of awareness, they are, nevertheless, always
interpersonal operations in that they are always organizing self-experiences in
the course of (real or imagined) interaction that (1) minimize disapproval and
maximize approval and (2) are organized and internally consistent” (p. 873).
Similarly, Chrzanowski (1977)
refers to the self-system as the master “anti-anxiety device” (p. 12).
Selective inattention is
highly associated with the self-system’s natural tendency to actively exclude
from awareness, not notice or inattend, certain obvious experiences that would cause us discomfort (i.e.,
anxiety) if we noticed them. Of course, we need a certain degree of selective
inattention so as not to be stimulated — and overwhelmed — by every
iota of experience that bomb blasts our perceptive system all day every day.
Can you imagine being tuned in to every sound, every color, each smell that you
encounter just, say, on the way to work this morning? Selective attention
allows us to maintain a certain degree of focal awareness or concentration on
the task at hand. However, Sullivan conceptualized this to be a security
operation that maintains self-esteem and limits anxiety by means of truncating
the scope of our conscious awareness of everyday life. Using selective
attention, according to Sullivan (1953), is not without a price:
Selective inattention is, more
than any other of the inappropriate and inadequate performances of life, the
classic means by which we do not profit from experience which falls within the
areas of our particular handicap. We don’t have the experience from which we
might profit — that is, although it occurs, we never notice what it must
mean; in fact we never notice that a good deal of it ever occurred at all (p.
Dissociation, the more
hardcore and close relative of selective inattention, has been a hot topic as
of late. In fact, dissociation is the cornerstone of the contemporary evolution
of Sullivan’s notion of me-you patterns (or personifications) — coined multiple
self experience (Bromberg, 1994,
1998, Davies, 1996; Harris, 1996, 1998, 2009; Mitchell, 1993; Pizer, 1996,
2009). Dissociation is a primary operation (or defense) of the self-system that
blocks from awareness any motives or sense of self that have been associated
with an intense experience of anxiety (Sullivan’s uncanny emotions). At its most extreme, dissociation obliterates the
integration of experience completely from a person’s ongoing sense of
self — creating splits in the self-system, or personality, wherein there
are as many selves as there are interactions, each self atomized and completely
separated from all other selves in the overall system. Brown (1995) states that
The result of the [dissociative]
process is that the experience of
anxiety is diminished and security is enhanced. Dissociative processes include
disturbances in awareness ranging from commonly occurring instances of selective
inattention, to the more gross
occurrences of automatisms. Since
the details of the dissociated experience are not available in awareness for
realistic perception and processing, dissociation interferes with the ability
to learn successfully and adapt from experience [emphasis in the original] (p.
Self-system processes, such
as selective inattention and dissociation, are at the core of my description
and use of the concept of character. I describe character as a primary defense
against the anxieties of living in a state of chronic crisis, as are so many
communities both in the U.S. and abroad.
Though in her book, Remembering
the Phallic Mother, Marcia Ian is
speaking of character from the perspective of characters in novels, I think
that her definition might serve as a provocative alternative definition of the
dynamic defense system that I, and many others, refer to as character. Ian
Novels may function as idealized
worlds. Characters function as fetishes, which are “accretions,” of
idealizations. Together they comprise an idealized psychological interiority
extended through a makeshift duration. Effective characters resist even the
most strenuous efforts to deconstruct them entirely because we cling more
stubbornly to characters than to our verbal constructs (p 105).
Do we use our character in
ways similar to the ways that an author might: To keep intact our own idealized
version of ourselves and the world? Do we then crystallize and catalyze these
ideal selves (representing character), worlds, and communities, and bring forth
our own interiority solely through our engagements with the world, rather than
through actual experience and reflection, and therefore simultaneously resist
entering our lives fully.
That said, let’s go back to
analysis. Like the interchangeability for Sullivan between personality and
self-system, there is quite a bit of overlap between character and
self-system — they both operate as defensive systems to minimize anxiety
and maximize security and satisfaction at the expense of taking in actual
experience with the world.
There have been a number of
contributors to the theory of character from the world of interpersonal
psychoanalysis. For instance, David Schecter (1978), influenced by Guntrip’s
(1968) work on schizoid processes, developed the concept of character
detachment, which he saw as “a
network of defenses and coping mechanisms that become relatively stable,
structuralized and chronic in the personality” (p. 81). Joseph Barnett (1980)
also developed a description of character; though his idea was that character
is not solely defensive and that it is an overarching entity “and central
structural phenomena in mental life” (p. 399), that organizes roles and
functions, and determines which experiences can be incorporated into one’s
overall sense of self.
Erich Fromm, however, is the
interpersonal psychoanalyst most highly associated with the concept of character. Fromm (1941) stated that “Character É is the
specific form in which human energy is shaped by the dynamic adaptation of
human needs to the particular mode of a given society” (p. 305). Fromm (1947)
based his, specifically social, definition of character on the assumption that
“in the process of living, man relates himself to the world (1) by acquiring
and assimilating things, and (2) by relating himself to people (and himself)”
(p. 58). In summarizing Fromm’s description and definition of character, Brown
One can acquire by receiving,
taking from someone, or producing through effort, but acquisition and
assimilation are necessary in order to satisfy needs. In so doing, a person
cannot live alone, unrelated to others. Thus, character is the relatively
permanent, particular form with which we relate ourselves to the world. The
child’s character is patterned by the parents and the society for which the
parents are “psychic agents” (p. 863).
Invoking the specter of
Fromm’s (1947) notion of social character (and viewing character itself as a kind of societal security system),
Hegeman (1995) suggests that, within particular character formations,
“successful adjustment to society could produce psychopathology” (p. 830). This
being a society where some (e.g., the homeless, the mentally ill, other
minority groups) suffer from an inability to adapt while others suffer from the
compromises they have made in order to adapt (Fromm, 1955).
Freud developed his
theory of character as a system of strivings that underlie, but are not
identical with, behavior. Freud recognized the dynamic nature of character
traits and that the character structure of a person represents a particular
form in which energy is channeled in the process of living. Freud believed that
the sexual drive was the source of energy of the character. He described
character traits as “sublimations” of, or “reaction formations” against, the
various forms of sexual drive — i.e., as defenses. Freud interpreted the
dynamic nature of character as an expression of their libidinal source. For
Freud the fundamental entity in one’s character is not the single character
trait but the total character organization from which a number of single
character traits follow, or represent. As such, Blos (1968) says,
Character structure renders the
psychic organism less vulnerable than it has ever been before, and the
maintenance of this structure is secured against any interference from any
quarter, internal or external. If must be, one dies for it before letting it
die (p. 190)
Fromm developed his
definition of character to stand in sharp contrast to the traditional
intrapsychic Freudian notion of character. For him, one’s character is an
interpersonal event that is impacted and shaped by forces in the larger
environment (i.e., politics, economics, and so forth). He analyzed specific
cultural forces impacting the individuals in the U.S. society and delineated a
number of character types specific to our culture; this includes the productive
character orientation and four major
types of nonproductive character orientations — receptive, exploitative, hoarding, and
marketing. Fromm’s character orientations relate to the ways that individual’s assimilate resources from their environment.
Ultimately Fromm (1941), perhaps not so different from Freud’s (1930) social
analysis in his Civilization and Its Discontents, believed that “character is the basis for [our]
adjustment to society” (p. 60)
Wilhelm Reich (1933)
elaborated Freud’s original conception of character and developed an elaborate
means of analyzing character for its defensive purposes — likening
character to “armor.” He believed that character was both a representation of
person’s specific mode of existence as well as an expression of his or her
entire past. Reich saw the character to be a “compact defense mechanism”
against any and all efforts to change (e.g., analysis). Character, accordingly,
serves as a defense against external stimuli, as well as a means of gaining
mastery over internal impulses — libidinal and sadistic energies.
Consistent with the contemporary notion of enactment, Reich believed that
character manifests less in what one says, and more in what one does. Also, character is revealed less in the uncovering
of dreams and fantasies, and more in how these are censored, distorted, and
condensed. In summary, Reich sets the stage for my assertion throughout this
chapter that character is made up of expressions of dissociated, inattended,
and repressed unconscious content in specific communities that are then played
out between practitioner and community participant. And that this, in turn,
sets up a means for analyzing transference patterns that reveal themselves
throughout the course of this work — through their dynamic interplay in
circumscribed community settings.
A more contemporary
interpersonal position regards character as multi-determined; with influences
from significant interactions occurring during all eras in life (Cooper, 1991).
The purpose of this character is primarily protection and defense. In the interpersonalized version of character, its function is specifically to
protect self-esteem and diminish the experience of interpersonal anxiety. In
essence, this means that all significant interactions experienced within the
social context — family, peers, the community — have the potential to
be influential in the development and maintenance of individual character
structure. The purpose of this character is to protect the individual’s self
esteem and diminish anxiety through maintaining an unconscious conformity with
the “rules and regulations” of whatever social context — or set of
interactions — we operate within. Within a contained context, these
interactions themselves interlock to establish an overriding sense of character
representing the mutually-developed, defined (and enacted), and protected
structure and perpetuated by the interlocking interactive patterns sanctioned
by community members (Cooper, 1987). Each facet of character must be understood
in its own right, and then in relation to the environment as a whole (Cooper,
1987, 1989, 1991).
Transference and Countertransference Enactment
A perfectly acceptable
definition of transference (and its enactment) comes from Freud’s description
of the free-floating
attention/free association technique (Freud, 1912, 1914, 1917). He states that
“the patient remembers nothing of
what is forgotten or repressed, but…he expresses it in action. He reproduces it
not in his memory but in his behavior; he repeats it, but without of course knowing that he is repeating
it” (Freud, 1914, p.150). Minus the fact that Freud considered this process
part of the “armory of weapons” that the analyst must “wrest from [the patient]
one by one” (ibid, p. 151), there
are similarities between transference resistance and the notion of transference
enactment. The main discrepancy, in fact, seems to regard how the
transference/enactment is used. And 100 years of breaking taboos about the
“appropriate” use of countertransference has opened the door for contemporary
analysts to make much more use of our contributions to the
enactment/repetition — that is, the contributions made through our own
(counter-) transferential baggage.
Transference and countertransference
in the broadest sense, refers to the unconscious transfer of experience from one interpersonal or environmental
context to another; it results in the experience of reliving past interpersonal
relations in current situations — for both patient and analyst (Blechner,
1992; Epstein & Feiner, 1979; Fiscalini, 1995; Gill, 1987; Ghent, 1990;
Searles, 1975, 1979; Stern, 1994; Wolstein, 1975). In synchrony with this
definition, Fromm-Reichman (1950) expressed the conviction that “the patterns
of our later interpersonal relationships are formed in our early lives,
repeated in our later lives, and can be understood through the medium of their
repetition” (p. 4). It is possible that a person’s attitudes toward his or her
environment inevitably represent transferential (or, in early interpersonal
psychoanalytic parlance, parataxic)
appraisals (Levenson, 1983 1991, 1996; Sullivan, 1953, 1964), and that familial
as well as cultural contexts contribute to processes of introjection,
internalization, and identification (Borg, 2003a, Borg et al., 2009; Freud,
1912, 1921, 1923; Fromm, 1955) underlying these appraisals.
There are important
intersections between my use of transference and Sullivan’s (1953, 1954) notion
of parataxic distortion. Brown
(1995) describes this as follows:
Whereas the concept of
transference refers specifically to the patient’s perception of the therapist,
Sullivan uses the concept of parataxic distortion in the framework of
interpersonal relations in general to indicate that an integrating tendency or mode of interpersonal relatedness is at play that
is inappropriate to the [current] interpersonal situation” (p. 870).
An integrating tendency is
Sullivan’s term for describing the dynamic that underlies a person’s seeking
satisfaction or tension reduction through interactions with others, and
involves the transfer of previous
modes of interacting into contemporary interactions. Therefore, parataxic
distortions are inclusive of a person’s history and methods of attempting to
“fit in” to specific interpersonal context across time (especially those that
were successful in a salient context). Janet Rioch, in support of Karen
Horney’s (1939) repudiation of the pure instinct theory of the time, described
transference in a way that captures the essence of parataxic distortion. She
writes, “The particular character structure of the person requires that he
integrate with any given situation according to the necessities of his
character structure” (Rioch, 1943, p. 149). As important as this concept may be
in expanding our understanding of transference, most interpersonal analysts
currently use the term transference to both convey Sullivan’s earlier
interpersonal meaning, as well as in ways similar to how transference is
perceived and used across schools of psychoanalysis.
believe that experience and behavior take on meaning from the continuous series
of interpersonal interactions that occur from the beginning to the end of our
lives (Stern, 1997; Sullivan, 1953). It is through transference-countertransference
interactions that a patient’s problematic intrapsychic and relational patterns
are brought into the here-and-now of psychoanalysis and exposed for
exploration, intervention, and understanding (Levenson, 1991; Pizer, 2009).
Enactment has become a hot
topic in contemporary psychoanalysis. It is a concept that now includes the
voices of analysts of various schools of thought, as it has been taken up by
relational and interpersonal analysts (Bromberg, 2003; Hirsch, 1987, 1998, 2002;
Levenson, 1991, 2009; Mitchell, 1997; Stern, 1997; Hoffman, 1983, 1998),
Freudians (Jacobs, 1986, 2001; Boesky, 1990; Chused, 1991, 2003), and Kleinians
(Feldman, 1997). Margaret Black (2003) states that “enactment suggests that the
analyst receives information through the medium of felt experience” (p. 634).
One exploratory approach to understanding transference-countertransference
interactions is, therefore, the analysis of patient-analyst enactments, which
Hirsch (1998) defines as
what happens when the analyst
unwittingly actualizes the patient’s transference and, together with the
patient, lives out [the] intrapsychic configurations . . . [enactment] is
viewed as the patient’s unconscious effort to persuade or force the analyst
into a reciprocal action: a two-party playing out of the patient’s most
fundamental internalized configurations. (p. 78)
In 1933, Wilhelm Reich also
offered a succinct definition of enactment, where he associated it with Freud’s
repetition compulsion. Enactment, he said, is where “[a patient] behaves as
they once did in analogous situations É [where] the conflict, which is no
longer an internal one but one between patient and analyst, is thus brought to
a head” (Reich, 1933, p. 19). This makes transference, in Adam Phillips (1993) description, dependent upon
“psychic mobility; by sitting still the analyst becomes a moving target” (p.
102) for the enactments that will inevitably blast their way into the
treatment. Ferenczi (1932) addressed the importance of enactment as well, especially
when working with traumatized patients, when he asserted that the analyst would
unavoidably “have to repeat with his own hands the act of murder previously
perpetrated against the patient” (p. 52).
Enactment can be used, in a
clinically useful sense, to refer to the mutual and bidirectional unconscious
influence of discrete and unique interactive events (Aron, 1996, 2003; Jacobs,
1986; Harris, 2009; McLaughlin, 1991; Pizer, 2009). However, the concept of
enactment in its broadest sense can also be used to describe and address how
all interactions — in analysis and in our daily lives — are tainted
with, and make manifest, the unconscious dynamics of the enactor(s). Are
enactments so ubiquitous in our daily lives so as to be made useless, as a special
case of unconscious material, in the
analytic setting? With this in mind, Lewis Aron (2002), therefore, states that
“we are correct to ask, ‘What is not an
enactment?” (p. 623). However, Aron goes on to state his impression that
Enactments may well be a central
means by which patients and analysts enter into each other’s inner world and
discover themselves as participants within each other’s psychic life, mutually
constructing the relational matrix that constitutes the medium of
psychoanalysis (ibid., p. 629).
That said, contemporary
interpersonal/relational theories focuses specifically on the
transference-countertransference relationship as a means of addressing
recurrent maladaptive ways of relating to others — unconsciously repeating
in interaction, i.e., enactment — and the areas of conflict, deficit, and
characterological problems in living that they engender (Bromberg, 1998;
Cooper, 1991; Ehernberg, 1992; Figlio, 2008; Fiscalini, 1994; Levenson, 1991;
Lionells, Fiscalini, Mann & Stern, 1995; Miller & Rice, 1967).
Transference and countertransference, as I am using these concepts, refer to
habitual, repetitive ways of perceiving and relating to others that are formed
throughout development in one’s family and specific culture — creating
patterns and routines that we simply follow (enact) as if by rote. A person’s
attitude toward his or her environment is, inevitably, made up of
transferential appraisals, initially formed and subsequently maintained in
familial as well as cultural contexts (Drescher, 1998; Freud, 1921, 1927;
Fromm, 1955; Layton, 1998). Sullivan (1953), in many ways, captures the
culturally context-dependent nature of transference and countertransference
that I am utilizing in this conceptualization of community intervention. He
states that individuals “gradually learn ‘consensually validated’
meanings…These meanings have been acquired from group activities, interpersonal
activities, and social experiences” (p. 28-29). These meanings, in other words,
are in a state of being perpetually transferred into more contemporary contexts as we attempt to
integrate ourselves into our surrounds by enacting our personal, familial, and
community histories in the here-and-now.
I believe that through the
transference-countertransference performances and empathic opportunities that
are played out in the ongoing process of patient-analyst enactment, we are
seeing through the eyes and experiences of others, while our experiences are
also, and sometimes embarrassingly, seen by those others. In fact, I believe that many individuals in our
society are highly invested in not seeing
through other people’s eyes. I also believe that we use extremely powerful
dissociative defenses to avoid empathizing with the suffering of others — a
kind of “necessary ruthlessness” (Borg, 2007). We implement our necessary
ruthlessness and so remain unaware of our part in, our collusion with, the
society-level enactment of processes that result in the ongoing
disenfranchisement and marginalization of others.
Working through, as generally
understood, implies the state of coming to terms with psychic hardship, anxiety
and trauma, for example the death of a loved one (Freud, 1914, 1937a). For
Freud, countering resistances was the task of working through. He states,
When the work of analysis has
opened up new paths for an instinctual impulse, we almost invariably observe
that the impulse does not enter upon them without marked hesitation É No
stronger impression arises from the resistances during the work of analysis
than of there being a force which is defending itself by every possible means
against recovery and which is absolutely resolved to hold onto illness and
suffering (Freud, 1937a, pp. 141-142).
One point that analysts of
all bents agree upon is that the tough work of working through counters the
resistances and resolutions of the forces which hold onto lost experiences and lost objects. The goal of these
resistances and resolutions is, therefore, maintaining the status quo. And, I would imagine that community practitioners,
should they peer through a psychoanalytic lens, might also agree that many of
the problems faced in community intervention, are similarly (or seemingly)
Anita Tenzer (1995), in her
chapter on “Working Through” in the Handbook of Interpersonal Psychoanalysis begins:
Working through in both classical
and Interpersonal psychoanalysis involves repetitive, progressive, and
elaborate exploration of resistance É and that the difference [in interpersonal
psychoanalysis] is that the focus has shifted from pathology to the opening
up of possibilities; the emphasis is
not only on what impedes and constricts but also on what can enhance and
mobilize É [in this process] there is a collaborative exchange in which both
patient and analyst have a part. Together they may help the patient (and,
coincidentally, the analyst) to develop new patterns of understanding and
experience (p. 729) [emphasis mine].
Therefore, working through,
from an interpersonal perspective, is the process of “countering the inertia of
the familiar — raising tolerance for uncertainty, anxiety, and apprehension,
and fostering the introduction and re-introduction of new experience within a
variety of contexts” (ibid, p.
Across all schools of
analysis, repetition is the sin qua non of what one confronts in the process of working through. Freud (1914)
believed that the repetition compulsion served as a mechanism for the active mastery of experience. However, he
characterized it by its conservative nature and he considered it an expression
of the inertia principle (i.e., the death drive). In contrast, the
interpersonal psychoanalyst, Ernest Schachtel (1959) stated that “repetition is
not due primarily to the inertia principle but, on the contrary, is essential
for the productive work of exploring and assimilating the objects of the
environment É objects of the cultural environment” (p. 259).
Repetition can take
place across modalities (dreams, fantasies, memories, affects, and behavior)
and in different contexts, both within and outside the analytic
relationship/situation. Fromm-Reichmann (1950) suggested that any new piece of
awareness, any new experience, if it is going to be taken in and made use of,
has to be tested, re-tested, and re-conquered many times over. New experiences
often cause anxiety (whether a new experience of self, other, or environment),
calling for characterological defense to kick in and preserve a consistent
sense of self across a changed/changing environment. Therefore, the working
through process is very much about challenging the need to turn, to return, and
to repeat the steps that lead the self back to the old and familiar processes.
We utilize selective inattention and dissociation as self-protection which
serves to thwart our experience of the new, the anxiety-provoking, or the
Levenson (1972) writes, “The
core of psychotherapy lies in the delineation of pattern” (p. 211). Therefore, of primary importance in the working through process is helping the analysand understand the ways that repetitive patterns (of defense
specifically) are enacted — rather than experienced, taken in, and used in
day-to-day life. Levenson (1983) later states that
Change does not come out of
understanding the truth É but by “working through,” which from this perspective
does not mean doing the same thing over and over, but, rather, recognizing a
widening series of patterns of interaction and configurations of
experience — always, I must emphasize, to some end point that is never
achieved. It is an examination in great detail of the part to expand the whole. The therapist does not explain content; he [or she] expands awareness of patterning (p. 116, emphasis in the original).
Tenzer (1983) hypothesizes
that in the course of working through, insight becomes elaborated, to a large
extent unconsciously. And that it consists of two interrelated processes. One
process assimilates an experience and registers it at a higher level of
abstraction and consciousness. The other process organizes the
experience — by means of differentiation and integration — so that it
can be used to generate new kinds of behavior, understanding, and interaction
with the world and others.
Therefore, working through
consists of expanding intrapsychic and interpersonal frames of reference by
witnessing and experiencing oneself and others in different ways in different
contexts (e.g., analysis, community intervention). Tenzer (1995) states that
this process “requires a tremendous amount of repetition, so that any new piece
of awareness can be consolidated” (p. 738) — and integrated into one’s
sense of self, or self-in-context.
John Fiscalini (1988) refers
to the working through process as “living through.” He stresses that
interpersonal psychoanalysts do not see the working through process in the
abstract — it is a process that occurs within the context of the analytic
relationship. This process is characterized firstly by the creation of a new
interpersonal relationship wherein the analysand repeats old neurotic patterns
and the analyst responds to them in new and different ways. Then, the analyst
and patient “live through” their new interpersonal interaction repeatedly,
consistently, and across a variety of different circumstances that arise in the
patient’s life as well as in the analysis itself, with the analyst playing a
vital role in validating the psychic re-patterning that takes place.
Finally, Donnell Stern (1983,
1997) has discussed how the repetitive experiences that go on unconsciously and
are enacted in the analytic context represent a kind of “familiar chaos” that
can be contrasted with “creative disorder,” where uncertainty can be accepted
and previously unformulated experience is encouraged to surface through
hitherto dissociated states of self. Stern’s conception of such creative
disorder lends itself well to a way of viewing the working through process that
encourages the expansion of self experience across all major
domains — thinking, feeling, behaving, relating, and so forth.
Community Psychology Concepts
Empowerment taps into — and
makes use of — a community’s inherent resilience (Borg et al., 2009;
McCormack, 2009). It has been suggested that when a community has undergone a
process of empowerment, it has become “revitalized” (Bright, 2001; Revenson
& Seidman, 2002; Seidman, 1983, 1988, 1991; Warren, 2001). Therefore, the
terms empowerment and revitalization are synonymous when it comes to describing
community interventions that are grounded in empowerment theory. Empowerment is
both a value orientation for working in the community and a theoretical model
for understanding the process and consequences of efforts to exert control and
influence over decisions that affect one’s life, organizational functioning,
and the quality of community life (Borg, 2002a; Perkins & Taylor, 1996; Perkins
& Zimmerman, 1995; Rappaport, 1981; Zimmerman & Warschausky, 1998;
Watzlawick, Weakland, & Fisch, 1974; Weick, 1984).
One could argue that there
are empowerment processes going on in analysis quite often — whether or not
we choose to refer to these processes as such. Working through the tyranny of
unconscious id impulses and superego indictments, or breaking through the
enacted traumas and the influence of the dissociated experience of the
repetition compulsion is certainly empowering — leading to greater freedom
to experience one’s life across domains of thinking, feeling, and relating to
others and the world. This process, like empowerment in community theory, then
results in a person’s ability to have more of a sense of conscious choice and
volition in his or her life — which is the sine qua non of empowerment.
Empowerment theory describes
the processes whereby communities develop their own self-defined, workable
collaborative solutions to problems in living that account for contextual
issues related to their specific environment (Bloom, 1996; Borg, 2002a, b,
2004a, b, 2006; Fawcett, Seekins, Whang, Muiu, & Suarez de Balcazar, 1984;
Perkins & Zimmerman, 1995; Rappaport, 1977; Rappaport & Hess, 1984;
Rappaport & Seidman, 2000). An empowerment-driven reading of social
context, as opposed to an individual or a public health perspective, sees
“disorder” less a function of specific disease processes, and more as the
result of a transaction between efforts to make sense of one’s immediate world
and the constraints of environmental factors, including responses to other
people (Felner, Felner, & Silverman, 2000).
Empowerment theorists have
traditionally focused on increasing the power and legitimacy of local
communities, often through what are called mediating structures (Berger & Neuhaus, 1977; Mistry, Jacobs &
Jacobs, 2009; Seeley, 1981). Mediating structures are small local agencies,
institutions, and organizations that serve the local community residents, and
provide a necessary function for them by helping to ensure that their needs and
concerns are heard and met by large and often impersonal governing structures
(Levins, 1995; Miller, 1993; Woodson, 1987). Mediating structures may include
churches, service agencies, and other groups made up of community residents,
and therefore sharing their concerns. Often groups (or project groups) that form in the context of community
interventions may themselves be transformed into mediating structures, grounded
on the collaboration between intervention team members and local residents
(Borg et al., 2009). Yet the long-term goals of such projects require that
groups or organizations formed between residents and practitioners belong
fundamentally to and reflect the needs and the perceptive legitimacy of the
indigenous population (Mattessich & Monsey, 2001;
Mondros & Wilson, 1994). They must be thought of as extensions of
local communities, reflecting their own indigenous customs, practices, and
tacit systems of accountability, rather than as rote instruments of distant
government authorities, obeying abstract bureaucratic rules (Seidman &
Empowerment theory suggests
that optimal functioning is a collaborative project between people and their environment. The experience of
empowerment enhances people’s capacity to manage their own lives (Rappaport
& Seidman, 2000). Accordingly, assessments of community functioning must
take into account the relationships, social structures, and resources in which
existing competencies operate (Townley & Kloos, 2009). Empowerment
processes encourage the establishment of community- (rather than
institutionally-) controlled solutions that can be responsive to the varying
needs of different individuals, neighborhoods, and communities. Likewise,
Mitchell (1993) has said that “Useful forms of meaning and hope do not lie
preformed in the patient; they are generated when the analyst has found a way
to inspire personally meaningful forms of growth and expansion from the inside
out” (p. 225). This is as true of communities as it is of individuals.
Treatment, intervention, and even social policy are empowering to the extent
that they enable people to develop their own solutions to their problems, from
the inside out — and that these are perceived as being legitimate solutions
even if not implemented (i.e., imposed) by so-called “experts.”
The ultimate goal of the
community practitioner is to promote community members’ ability to define their
community’s unmet needs and advocate for themselves and their community in the
world at large (Albee & Gullotta, 1997; Bright, 2000; Zimmerman, 2000). The
hallmark of empowerment is the functioning of collaborative processes.
Empowerment processes have a way of shifting,
multiplying, dissolving, and reappearing; most especially, they have a way of
looking different to different residents and practitioners at different times
throughout the course of the work. This is so because such processes reflect so
many different facets of community life.
Participation, control, and
critical awareness are essential aspects of empowerment. At the individual
level of analysis, these factors include a belief in one’s ability to exert
control (intrapersonal component), involvement in decision-making (behavioral
component) and an understanding of causal agents (interactional component). At
the organizational level of analysis, these factors refer to settings that
provide individuals with opportunities to exert control and organizational
effectiveness in service delivery and the policy process (Speer & Hughey,
1995). At the community level of analysis, these factors refer to the contexts
in which organizations and individuals interact to enhance community living,
and insure that their communities address local needs and concerns (Berger
& Neuhaus, 1977).
Empowerment theory connects
individual well-being with the larger social, economic, and political
environment, and suggests that people need opportunities to become active in
community decision-making in order to improve their lives, organizations, and
communities (Zimmerman, 2000). Individual participants may develop a sense of
empowerment even if wrong decisions are made because they may develop a greater
understanding of the decision-making process, develop confidence to influence
decisions that affect their lives, and work to make their concerns known.
Organizations may be empowering even if policy change is not achieved because
they provide setting in which individuals can attempt to take control of their
own lives (Israel, Schulz, Parker & Becker, 1998; Pistrang, Barker, &
Humphreys, 2008). Communities may enhance opportunities for residents to
participate in the policy process even if some battles are lost. A community
can be empowered because the citizens engage in activities that maintain or
improve their collective quality of life.
“Given the nature of social
problems,” Rappaport (1981) stresses, “there are no permanent solutions, no
single this-is-the-only-answer-possible solutions…Problems must have many
solutions that change with the currents” (p. 14). Both empowerment theory and
interpersonal psychoanalytic theory implement this philosophy. Both seek to
expand the options available for dealing with problems in living, and to
support the agency of individuals in their efforts to find creative,
health-promoting, collaborative, and sustainable approaches to the inevitable
complexities and anxieties of everyday life. Interpersonal psychoanalysis and
empowerment theory, at core, stress the importance of paradox: the need to
sustain, rather than foreclose, the tensions among opposing and conflicting
points of view (Mitchell, 2000; Rappaport, 1981).
Empowerment theory has been
challenged. While critics commend those who seek to increase their own efficacy
by gaining new skills (e.g., job training) or abstaining from self-defeating
behaviors (e.g., substance abuse and crime), they lament the ubiquitous
application of the much ballyhooed, yet often vaguely defined, empowerment
nostrum to every problem imaginable (Ellsworth, 1989; Fetterman, 1994). Such
critics claim that empowerment work at its worst may foster dependency by
training people how to coerce or cajole benefits from governing bodies
(Weissberg, 1999). Also, there is always a fine line between practitioners
facilitating community revitalization programs in a framework of collaboration,
and the possibility that these same “experts” might impose external or
infantilizing measures. Therefore, the pragmatic focus on problems in living,
mutuality, and pluralism that are highlighted in interpersonal psychoanalytic
theory may provide an additional and important framework for community
practitioners as they negotiate the potential pitfalls of empowerment
practices. It is possible, as critics suggest, that the term has been
expropriated beyond its intended use. It is the distinction between spontaneous
empowerment activities occurring everywhere and the pragmatic use in dealing
with real life problems that is fundamental (Riger, 1993).
Due partly to these problems
with community empowerment, I believe than an interpersonal psychoanalytic
perspective has something valuable to offer the theory and practice of
community intervention. While interpersonal psychoanalysis and empowerment
theory complement each other in their shared concentration on collaboration
among individuals, I believe that interpersonal psychoanalysis can inform and
improve upon how empowerment is conceptualized and implemented. From the
psychoanalytic perspective that I am arguing in this chapter, community
revitalization, like individual analysis, requires the working through of
historically entrenched feelings of hopelessness, depression, and powerlessness
(Borg, Garrod & Dalla, 2001). This is especially so in cases where chronic
trauma, intensified by the defenses against overwhelming anxiety that are called
up to deal with it, interferes with collaborative functioning. This community
level process of working through historically entrenched problems in living,
exacerbated by trauma, is enhanced by a working understanding of transference
and countertransference enactments, just as in individual analytic work.
Primary prevention has
historically been a philosophy and practice that attempts to see the acute in
what is generally perceived as a set of chronic and intractable social problems
(Morgan, 2008; Trickett, 1996). Prevention practitioners have used this
information to develop methods of analyzing and intervening in social problems
as early as possible, and prevention is considered primary if methods are developed to intervene in social problems
before they begin (Albee, Joffe & Dusenbury, 1988; Price,
Cowen, Lorion, & Ramos-McKay, 1988).
Yet there is an implicit
level of “acceptable casualties” that we, as a nation, seem willing to absorb
(Jencks & Petersen, 1991; Albee, 1996). Psychoanalysts are in a good
position to witness and assess these casualties on an individual basis as they
manifest in various patterns of behavior and sense of self (or selves) that our
patients present in the consulting room — though, in prevention theory, psychotherapy
is considered to be at the secondary level. That is, therapy and psychoanalysis
are interventions that are generally implemented after a problem has already
arisen. Nonetheless, I believe that there are potential incidents and problems
that loom on the horizon of some of our patient’s lives that do meet the
criteria for being “primary prevention,” the most dramatic examples may be when
patients discuss, instead of act on, suicidal or homicidal ideations and
impulses (Borg, 2004b; Goldston, Daniel, Erkanli,
Reboussin, Mayfield, Frazier, & Treadway, 2009; Gullotta &
Bloom, 2003a, b).
So back to “acceptable
casualties.” There are alarming levels of highway deaths, homicides, substance
abuse, infant deaths, child abuse, homelessness, school failure, preventable
illnesses, unemployment, and other social problems that currently do not have
crisis levels of resources allocated to them — these are among the “chronic
crises” that I will highlight throughout this chapter. As a society, we operate
from a core assumption that there is an acceptable or necessary level of
casualties (call it “friendly fire”). This assumption appears particularly
manifest when we view the levels of resources being directed (or, actually, not
directed) to persons who have racial, socioeconomic level, gender, or other
qualities that set them apart (Albee, 1982; Hage & Kenny, 2009; Mannarini & Fedi, 2009). This
“setting apart” also includes a scapegoating process wherein marginalized
individuals and groups, who the system can not or will not take care of
adequately, are blamed for the very scarcity of resources that have and have
not been made available to them (Albee, 1986; Britner, 2008; Goldston et al.,
2009; Reich, 1995; Schorr, 1988) — what William Ryan (1971) originally
referred to as a “victim blaming ideology” (p. 1).
Primary prevention has
developed in response to this state of affairs — the state wherein many of
our most multiply-marginalized have had to somehow adapt to the most horrid
social conditions — chronic crisis — as if these could be in any way
tolerated. It is this state of affairs, actually, that might help to make sense
of the absolute need for powerful dissociative defenses in certain (many
really) condition within which people in our country and around the world live.
There are two pertinent and
similar definitions that I will utilize to define primary prevention. The first
is offered by Felner and Lorion (1985):
[Primary] prevention applies to
the enhancement, disruption, or modification, as appropriate, of the unfolding
process [and conditions] that lead to well-being or to serious mental health or
social problems. A primary prevention intervention involves the systematic
alteration and modification of processes related to the development of
adaptation and well-being or disorder, with the goals of increasing or
decreasing, respectively, the rate or level with which these occur in the
[target] population (p. 93)
And, the second, more concise
definition comes from Gullotta and Bloom (2003b), the editors of the recent Encyclopedia
of Primary Prevention, who define
primary prevention as follows:
Primary prevention and health
promotion encompass those planned actions that help participants prevent
predictable problems, protect existing states of health and healthy
functioning, and promote desired goals for a specified population” (p. 9).
There are three levels of
- Primary Prevention: To take action before some untoward set of
events occurs so as to preclude, delay, or reduce its occurrence. For instance,
lowering the rate of new cases of mental disorder in a population over a
certain period of time by counteracting harmful circumstances before they have
a chance to produce illness.
- Secondary Prevention: The most succinct definition of
secondary prevention is early recognition and prompt treatment, or early
intervention. For instance, reducing the disability rate due to a disorder by
lowering the prevalence rate of the disorder in the community (lowering the
number of new cases, shortening the duration of existing cases).
- Tertiary prevention: This level of prevention is associated
with treatment of disorders or problems that have already been incurred by
individuals or groups. For instance, rehabilitation is a common form of
tertiary prevention — actions that assist people in regaining the highest
level of functioning possible after the onset of serious illness, disorder, or
disorganized community existence.
Studies of the adaptive
impact of a wide array of developmental circumstances have shown that there are
common developmental antecedents, such as family resources and interaction
patterns, economic and social deprivation, other life stresses, powerlessness,
and an array of non-specific protective resiliency factors (social support,
sense of self-efficacy, hope), that all relate to the probability that persons
in a population will develop an extraordinary assortment of mental and physical
disorders (Felner, Farber, & Primavera, 1983; Kellam & Brown, 1982;
Perkins, Larsen & Brown, 2009; Senge & Scharmer, 2001; Shure &
Spivack, 1982), and that certain communities themselves will be “disordered”
(Kellam, Brown, Rubin, & Ensminger, 1983; Sameroff & Fiese, 1989).
prevention models emphasize the dynamic, reciprocal interactions between the
individual and their context, with bi-directional influence being a fundamental
element (Henggeler, Schoenwald, Bourduin, Rowland, & Cunningham, 1998;
Mistry, Jacobs, & Jacobs, 2009; Sarason & Doris, 1979). Consistent with
such a dynamic perspective, primary prevention becomes an ecological model
which holds that developmental trajectories are shaped by “Progressive, mutual
accommodation between an active, growing human being and the changing
properties of the settings in which the developing person lives” (Bronfenbrenner,
1979, p. 21). Such an ecological framework also provides for the consideration
of critical additional elements of human contexts. It offers a comprehensive
and integrative means of viewing the interactions between the various parts of
total ecological and psychological systems, as well as between individuals and
their proximal environments (Baltes, 1987; Benard, 1991; Latkin,German, Hua, & Curry, 2009;
It is possible that intersections can be developed to account for
similarities between primary prevention and interpersonal psychoanalysis.
Through its implementation of security operations, the self-system tends to
perpetuate its isolation within the personality. Hence, the person tends to
seek means of maintaining safety, tending to develop solutions to problems in
living which serve this purpose, albeit often in an indirect and not always
understandable fashion. The “me-you” patterns, which become the basis for
habitual distortions in experience, are always, according to the interpersonal
perspective, derived from actual, if improperly understood, experiences with
real others, in which the self has experienced some security or control, and
which has become misapplied in the face of anxiety.
From the perspective of this
potential as a foundation for prevention, Sullivan’s (1953) self-system can be
viewed as a metaphor for the potential for personal, and interpersonal, primary
prevention. The self-system can be translated, through theories of empowerment
and primary prevention, to suggest the human capacity to protect oneself from
the debilitating impact of anxiety and insecurity. The existence of the
self-system (while traditionally viewed from the perspective of its
pathological implications), therefore, indicates the human potential for an
internalized primary prevention system in that a person is able to adapt to
environmental stressors, through psychological defense mechanisms. This is done
in such a way that the person is able to maintain security. Yet the sacrifices
and concessions that one makes to maintain this sense of security underlie
Sullivan’s (1956) notion of psychopathology. However, the system itself remains
indicative of the health-preserving potential inherent within the individual.
It is my assumption that this system can be expanded within the context of
interpersonal and community relationships. Interpersonal psychoanalytic theory
would hypothesize that it is anxiety that disrupts the continuity of experience
and, therefore growth.
On the other hand, if an
experience arouses curiosity, strengthens initiative, and sets up desires and
purposes that are sufficiently intense (along the gradient of anxiety), it can
be a motivating force. The value of an experience, therefore, can only be based
on what it moves us toward and into. Of course, the value in this is in
bringing experience into conscious awareness — to prevent repetition of
destructive patterns. Gill (1987) states that “making explicit what is seen is
inherent to the psychoanalytic praxis” (p. 232). This takes active listening in
the process of interpersonal collaboration, framed in the development of a safe
relationship that perhaps was preserved through the initial anxiety-reducing
machinations of the self-system — qua primary prevention mechanism. Combined, these validate a person’s sense
that his or her experience of the world is worth attending to, and that he or
she has something to contribute to interpersonal processes. Levenson (1996)
states that “there is no such thing as unbiased listening…Cure, then, is an emergent
and collaborative process of awareness” (p. 241). The breakdown of the
established order, the temporary chaos that is created when the traditional
rules of interaction are challenged, may be vital to a creative process, a
reorganization of experience into more complex and flexible patterns (Borg et
al., 2009), hence setting up on ongoing internal/interpersonal primary
Taken together, the previous
ideas insinuate that rigidified systems of psychological defense (i.e.,
self-system) can be manifest in the overall character structure of a community
(Borg, 2005b). Also insinuated, however, is the notion that a breakdown of
established order (perhaps at the level of trauma, disaster, crisis) in a
community, may be vital to the reorganization of experience — setting up
opportunities for more functional approaches to prevention and empowerment.
A Psychoanalytic Approach to Community Work
interventions challenge many accepted assumptions and practices of
contemporary — and more so traditional — psychoanalysis. For instance,
community practitioners often initiate the treatment (that is, the
intervention), expand the "frame" by working — and working
through — in
the context of the day-to-day life of the client, and by making use of the educational
opportunities of the work. Nevertheless, community work can retain a strong
psychoanalytic sensibility. Martin Bloom (1996), a major figure in the primary
prevention field, has argued that
now know that traumatic reenactment is a central dynamic in the development and
adjustment of traumatized individuals, we must consider the possibility that
traumatic reenactment is a strong possibility for traumatized groups as well .
. . Therefore, personal and group trauma must be converted into a community
asset, not just a personal asset or catastrophe. (pp. 180-181).
of the examples of crisis intervention that I will explore in this chapter,
trauma was the initiating factor; in retrospect, trauma could in fact be viewed
as a "community asset" — a point of impact, an acute spike in a state of
chronic crisis, which ultimately served as a cry for help. It was only in response to the
South Central Los Angeles riots, for example, that city officials began to
address manifestations of both acute and chronic trauma; the riots catalyzed
their search for a community-based mental health organization to work with old
issues of impoverishment, intra-racial violence, racism, unemployment,
drug/alcohol abuse, and academic failure, as well as the riot-associated issues
of looting, arson, and inter-racial violence (see Borg et al., 2009). The
trauma of the riots led, therefore, to unprecedented reparation in the
community. Unlike individual psychoanalytic work, which takes place at
carefully delineated times and places, community work requires the active
participation of practitioners in the daily lives of residents. This kind of
personal involvement surpasses even the most progressive psychoanalytic models.
While these dramatic departures from the traditional boundaries of analytic
work might seem radical, I believe that such intimate contact does fall within
the bounds of a contemporary, interactive view of psychoanalysis.
traditional psychoanalysis generally eschews the didactic approach as
"non-analytic" ("acting out"), community work often
involves teaching — and it absolutely requires the willingness to be
taught. For me, Freud's injunction that "Where id was, there shall ego
be" speaks directly to the educative process that underlies psychoanalytic
practice. Furthermore, interpersonal psychoanalysis takes directly into account
the ongoing educational component of psychoanalytic interaction wherein the
reduction of dissociative processes allows for greater learning from experience
(Bromberg, 1998; Eisold, 1994; Ehrenberg, 1992; Fiscalini, 1988, 1994; Stern,
1983, 1994, 1996, 1997; Sullivan, 1953, 1954). What distinguishes
psychoanalysis from other educational experiences is its use of transference to
bring unconscious aspects of experience into conscious awareness. A
psychoanalytic approach to community work uses the same approach for the same
reason — transference offers the best access to the unconscious material
whose potential can improve everyday conditions. Asking questions such as what
does a particular interaction between myself and a particular community member
or among community members themselves mean about the unconscious dynamics at
play in the community itself has been an imperative part of each of the
interventions that I have been involved in to date. Dealing with, and then
making use of, transference and countertransference enactments in the community
eventually allows decisions to be made with an increasing sense of support and
hope, as new access has developed to previously ignored community resources for
developing ideas, implementing action plans, and working them through them in a
collaborative — and more conscious — manner. I cannot emphasize enough
the degree to which chronic oppressive conditions in a community truncate the
capacities of individual members to simply experience day-to-day life. In fact, such
conditions interfere with what the educational philosopher John Dewey (1991)
described as the key factor in all types of learning:
experience influences in some degree the objective conditions under which
further experiences are had . . . when [a person] executes his intention he
thereby necessarily determines to some extent the environment in which he will
act in the future. He has rendered himself more sensitive and responsive to
certain conditions, and relatively immune to those things about him that would
have been stimuli if he [sic.] had made another choice. (p. 20).
The way that the issue of gay
marriage was taken up by one of my patients might highlight how when societal
conditions are felt to be oppressive it can, and does, make it difficult for
some of its members to fully experience their life and to take in (i.e., learn
from) experience. During the week in which the gay marriage issue hit the media
(the controversy over states like Massachusetts issuing marriage licenses to
gay couples, and the ensuing protest, including George W. Bush’s sacralization
of sanctity of male-female coupling), Jerry, one of my patients, who is a gay,
African American postal worker, attended his session in what seemed to be a
state of panic. He was confused and scared. He said, “I feel as if I am being
picked on. And I cannot figure out why.” He spoke in a highly pressurized
manner for the first twenty minutes of our session as he described being
pervasively preoccupied with this sense of being picked on — he could often
think of almost nothing else. In
reaction to this feeling, he had initiated a number of conflicts with his
co-workers and his supervisor. He knew he was being picked on and was determined to find out who was
During a very brief pause, I
questioned the timing of his feeling of being picked on. In a hostile tone he
said, “What do you know?” He then commented that I had no idea what I was
talking about. I could feel his rage and resentment in my gut as I recalled his
previous interest in the gay marriage issue. “Well,” I said, “I am interested
in what you meant when you said that you’d been thinking of ‘almost nothing
else’…I am wondering about the issue of gay marriage. You spent the last few
sessions discussing it, and now that it is getting so much media attention you
are silent on the issue and I myself am feeling a knot in my stomach” Jerry
then said that he had been thinking about this issue all week — that, in
fact, his “gut was in a knot” — but it did not occur to him to discuss his
feelings and thoughts about the issue in therapy or with anyone else (even
though he had been obsessively following the stories, and the outcome of what
he considered a Civil Rights issue
since it first arose). When I questioned this, he said, “It’s hopeless, a dead
issue, anyway.” He went on to discuss his experience of the gay marriage issue
for the rest of the session and said that he could see how this had been a
major component of his preoccupation with being picked on during the week.
In this example we can see
how when a social condition is experienced as being oppressive it can lead to a
preoccupation that truncates other ways of experiencing ourselves. Jerry’s
behavioral acting-out at work and his hostile attitude toward me formed his
unconscious protest against the ways in which he personally felt oppressed. His
usual interests and general ways of interacting with friends and colleagues
were not available to him during the preceding week, only one aspect of his
experience was felt by him to be sanctioned and therefore able to be expressed,
a hostility that he wielded against all who he encountered, including his
analyst. In fact, his “What do you know?” — and the subsequent emotional
gut-punch that landed in me — was his way of aligning me with the system of
oppression; only then could we feel what it was like from within our shared
experience and work our way out together.
have been discussing as truncated experience in this example relates to the
role of dissociation in oppressed communities. In my experience of working with
oppressed communities I have seen a very common dynamic at play. This dynamic
is so common, in fact, that I have developed a formula for approaching my interactions
in community work. The formula is thus: Intolerable oppressive conditions
create the need for individuals and groups living in these conditions to
dissociate certain aspects of their experience — the “dead” and “hopeless”
aspects. These aspects are then enacted in interactions within circumscribed
communities. In the above example, aspects of my patient’s truncated
experience — links between his feelings and the oppressive social condition
he associated with the gay marriage issue, as well as strong expectations that
others in his social environment (including his analyst) will reinforce this
oppression — are dissociated and enacted as we can see in the antagonistic
exchanges that he had with others during the week, and this often occurs in a
physical sense (the knot in our guts).
Arriving at a point at which
this patient and I could have this discussion, and were able and willing to
experience the fullness of our interaction and the ways that pertinent issues
played out between us related to the wider context of his life took time and
the development of a sense of safety and trust. The fact that we could learn
from it was based on a number of years of developing a relationship that could contain the expression and enactment of such experience.
Similarly, in my experience, community interventions that emphasize didactic
approaches to group interaction in their early stages often facilitate
later-stage opportunities for unconscious processes to become manifest through
the analysis of these dissociated and enacted experiences. Simply, such
analysis, which we can be thought of as analyzing the
transference-countertransference of community interaction, is also educational.
(1972) believed that change in a system is created through a practitioner's
"ability to be trapped, immersed, and participating in the system and then
work his [sic.] way out" (p. 174). This statement is to my mind the
definitive description of the constructive use of enactment. The experience of becoming
embedded in, and gradually emerging from, an enactment — as was the case
with Jerry in the previous example — allows a community practitioner to
articulate the nature and the depth of significant longstanding areas of
community conflict. For me, working through transference-countertransference
enactments has consistently been the most effective way to help community
members increase their awareness of, and thus their ability to address and
change, areas of community conflict and crisis; enactment, therefore, is a
powerful means of making a community aware of its patterns of previously
inattended or dissociated thinking, feeling, relating, and behaving.
In Creative Evolution Henri Bergson said, "Our intellect is intended
to secure the perfect fitting of our body to its environment, to represent the
relations of external things among themselves — in short, to think
matter" (Bergson, 1911, p. ix). Bergson suggests that our biological
heritage makes us kin to the world around us. Therefore, the tools, artifacts,
and social structures that we create to navigate our way through this world
become unconscious enactments of our interconnections with each other, our
history, and the world itself. Experience and conduct are shaped by a
continuous series of interactions with the social-cultural-economic-political-geographical
environment. In fact,
dynamic systems theory suggests that all living beings receive a vast array of
inputs from the physical environment and the numerous experiences, especially
inter-human experiences, that we encounter in daily living (Ghent, 2002;
Prigogine & Stengers, 1984; Thelen & Smith, 1994). In other words, the
same input that makes up our experience of ourselves and our world are always
immersed in dynamic interchange with the environment. Transference — the analyst's,
the patient’s, the community practitioner's, and the community
member’s — is the result of how one's sense of self and other has been
unconsciously shaped and molded by that environment. It is through the
exploration of transference and countertransference that the patterns of living
created through interactions with the environment are brought into the
here-and-now of analysis and made amenable to collaborative exploration and
now proceed to the section where I will be describing the actual process of developing
and implementing community psychoanalysis, I will be most primarily setting out to explore
the sense of self, other, and context. This exploration, of course, has to take
place somewhere, and that somewhere is most often imagined as the analyst's
consulting room. But much of the data that we consider significant — the
autobiographical self-experience, the biographical experience of others, and
the geographical experience of context — is brought into the consulting
room by the patient.
The community is where all of these experiences of self, self-other, and
self-context are developed and repeatedly played out. There are many ways and
places to approach and engage these aspects of experience — both as they
are enacted between patient and analyst in the consulting room, as well as what
they convey about the patient’s environment/community — so as to enhance
analytic and community intervention processes.
Developing and Implementing
Comunity can be conceptualized
as a defense against the overwhelming sense of isolation and alienation that is
increasingly part and parcel of modern life in most Western cultures. The
French philosopher Jean-Luc Nancy (1991) suggests that “community, far from
being what society has crushed or lost, is what happens to us…in the wake of society” (p. 11, original emphasis). Thomas Pynchon (1961), similarly,
stressed such a use of community
to combat our forlorn, and often objectified status when he wrote in V., “Community may have been the only solution possible
against such an assertion of the Inanimate” (p. 289). Accordingly, I believe
that communities, like individuals, develop unique characters that make use of
unique constellations of psychological defense systems (Borg, 2002a). Also like
individuals, community responses to trauma are frequently marked by rigid and
repetitive modes of interaction (Garland, 1998; Ursano, McCaughey &
Fullerton, 1994) For instance, in many communities that have been traumatized by oppressive conditions — and
unjust treatment — from the wider society, patterns of interaction are
marked by suspicion and hostility. As I use the term, community character describes group-level self-protective mechanisms (or
group-level self-system operations).
To sum up, community
character is a typical style of interaction that reflects the unconscious,
unwritten, unstated, but ever-present laws that decrease group anxiety by
governing and limiting the ways that people interact with each other within a
community (Borg, 2004, p. 155). These
implicit laws grow out of the actual historical events, circumstances, and
experiences to which the community has had to adjust. They give communities
their distinctive characters, similar to the ones found in individuals. Indeed,
there is a direct connection between community and individual character;
individuals are formed in part by the character of their communities, and
experiences and behaviors that are not consistent with the community character
must be dissociated and enacted. For example, gang violence can be seen as an
enactment of a prohibited protest against injustice (Borg, 2005b; Borg &
Dalla, 2005). The community may acknowledge the injustice, but the act of
protest is prohibited, out of fear that protest would mark the community for
more oppression. The gangs hold and enact the protest for the community, partly
due to their willingness to violate the standard rules and regulations of the
community, and partly as a displacement of repressed/dissociated community
In communities that have
experienced significant trauma, as in individuals, character tends to become
inflexible, impinging upon individual members in ways that are overt and often
intractable. Rigid patterns of relating within communities are partly the enactment of the community
character (Borg, 2004a).
Community character is
organized into patterns of social interaction, relations, and
connections — essentially the sum total of the unconscious enactments of a
particular community’s stakeholders (Borg, 2004b). Through repetition, these
enactments lead to the establishment of rules, regulations, taboos, and
stereotypes, implying that any character formation based on acclimation to a
pathological society can produce psychopathology (Fromm, 1941, 1955, 1956,
1968, 1976, 1998; Fromm & MacCoby, 1970; Hegeman, 1995; Mead, 1934;
Menzies, 1960; Revenson & Seidman, 2002; Richardson, Fowers, & Guignon,
1999; Schultheis, 2004). Taking Fromm’s position regarding what he facetiously
called our “Sane Society,” we can see that symptomatic compromises, borne of
this acclimation, are currently visible in the loss of corporate ethics, a
growing tolerance of cruelty, and the tendency to target and scapegoat
criminals without accounting for the criminogenic environments that sustain
them (Borg & Garrod, 2003). The ultimate pathological compromise is the
acceptance of such behaviors as the norm.
Community represents interaction patterns among individuals who
respond and react to each other and to the outside world according to their
sense of security within the context that they have inherited and that they
themselves sustain. This is what Kurt Lewin (1935) meant when he argued that a
natural relationship exists between “the character of a given situation and the
character of the group which dominates the behavior of the individual in the
situation” (p. 109). First and foremost, the rules and prohibitions of a
community and the repetitive interactions they shape protect a tentative sense
of security. This function encompasses all the feelings, thoughts, belief
systems, passions, longings and other facets of those embedded within a
particular community character. The developmental and interaction patterns of a
community are specific to it, making it essential for community practitioners
to collect a considerable amount of community-specific data so as to understand
as clearly as possible the assets and deficits of community life.
Although it is tempting to
make generalizations and to organize troubled or traumatized communities into
certain types, every community ultimately requires a unique intervention, just
as do individual patients in analysis. This recognition supports an empowerment philosophy that encourages community
members to “work from the inside” to develop new ways of interacting that
support a growing sense of security based on expanding interactional
options — hence creating opportunities for primary prevention as new crises arise in the community. Generalities
about “primary causes” and beliefs about “universal dynamics” are not helpful
in this regard; in fact, they can obscure the unique reality of a particular
community and often create powerful resistance to actual change.
This was particularly true in
a consultation that I was involved in with a research and treatment substance
abuse center in East Los Angeles. The center had a tendency to see their
clientele in very general terms — as “junkies.” They did not treat them as
collaborative partners in their own treatment. They treated them in an
authoritarian manner, as if by having a drug addiction they were children, and
this set up a powerful relational dependency in the clientele. This worked
fairly well so long as the state was uncritically funding the treatment of such
individuals; in fact, since a major component of the center’s business was
methadone maintenance, the “junky” was a highly valuable resource. In my work
with the center, its directors were attempting to develop a program to help
their clients who were on methadone maintenance recover from their addictions
to both heroin and methadone
itself. This program innovation, however, was born of mixed motives — and,
therefore, highly resistant to change. Recent changes in California’s Medi-Cal
insurance policies had resulted in a large number or people in the program
being unable to pay for the services. Since ethically the program could not
just drop these clients, they had begun to float (i.e., provide pro bono treatment) a large percentage
of their population. This set up a rather desperate financial crisis in the
center. The program innovations ultimately failed, because regardless of the
crisis, they were unable to change the ways that they perceived and interacted
with their clientele: as junkies receiving the mythical free lunch and not as individuals in need of recovery.
Unconsciously the center’s character was built upon general “universal
dynamics” of the junky (especially their chronic dependency in which the staff
colluded). This dependency cycle, in fact, became the primary cause for the
clinic’s existence. To shift that way of thinking and perceiving would destroy
this clinic’s identity — ultimately, it would rather perish than face that.
It is important to develop
inferences about themes underlying community psychopathology, but we must do so
without letting formulas obscure crucial community issues or entangle us in the medical model by which an “expert”
(in many cases, a representative of the dominant society) seeks to prescribe
and impose a treatment plan, as in the case above. Approaches of that kind may
undermine a community’s efforts to develop an empowering means of relating to
each other and to outsiders. Expanding the field of inquiry so that community
members and outside sources of support can examine together the various aspects
of character facilitates the likelihood that improvements in living experiences
will be created. A common alternative — a behavioral modification plan
imposed by some well-funded intervention program — often carries harsh iatrogenic consequences. For example, imposed community modification plans institute dependency on
external (and generally transitory) resources, and so can actually erode the
capacity for self-advocacy and reliance that they purport to be strengthening,
as in the case where the treatment of
heroin through methadone becomes the illness itself.
My view of community
character is similar to how Erich Fromm (1941) and Allan Cooper (1987, 1991)
view individual character. That is, character is multi-determined,
multi-faceted, and has the capacity to be altered for better and for worse by
interpersonal experience. For instance, one of my earliest consultations was at
an adolescent psychiatric hospital that served also as a long-term residential
treatment center. During the time of the consultation, the character of the
community was profoundly impacted by dramatic and sudden changes in financial
resources. This treatment center had once been a cohesive community founded on
attention to consistent and progressive treatment, good communication,
appropriate boundaries, and a strong sense of collaboration among staff,
patients, and the patient’s families. The hospital administration supported
this environment both philosophically and financially.
Drastic cutbacks in insurance
reimbursement radically altered the makeup of this community. The residential
treatment wing lost its independent status and instead had to share the same
living space as the acute psychiatric ward. The experienced and well-trained
clinical staff was drastically cut. That staff had run “community groups” that
met twice every day. These groups were the backbone of the community’s
functioning. These groups focused on and explored the ongoing group process [15a] among staff and patients. This dynamic information was then used to monitor the
goings-on on the unit, with follow-through where needed, to help the community
maintain and improve safety and trust on the unit. After the budget cuts, the
community groups were no longer as capable of facilitating group process or
containing the hectic emotions of day-to-day life on the unit. Psychiatric
nurses and direct care staff no longer had a sense of the overarching clinical
goals, and were expected to run the unit with only the pragmatic guidelines of
basic physical safety and bare-bones behavioral management. Staff-to-patient
ratios were not increased to accommodate the population of the combined wards
nor the increased acuteness of the patients who were now in the care of the
staff members. Even behavioral management became increasingly difficult as the
community character deteriorated into one of hostility, paranoia,
non-communication, and non-collaboration. The physical safety of patients and
staff members was increasingly at risk. The character of the community was
being transformed as the support — financial, clinical, emotional — was
being drained from the system, and as the administrators decreased their
investment in the hospital itself. When a decision to sell the hospital,
essentially to “give up” on the staff and the patients, was arrived at (and,
interestingly, no one told the staff or the patients), an eight-hour riot
erupted, during which time patients locked staff in their offices, barricaded
the outside doors to the facility, and proceeded to demolish the unit. The
situation was contained only when a fire broke out that required the
intervention of the fire department and the police.
Before the cutbacks, the
community character of this treatment center had been governed by the
preconscious expectation that self-destructive behavior would be a target of
intervention (a self-sustaining primary prevention model unconsciously sustained by many an adolescent;
see Borg & Dalla, 2005) — after all, almost every patient on the ward
had ended up there as a result of uncontrollable self-destructive behaviors
(cutting, substance abuse, gang affiliation, suicidal and homicidal
gestures/attempts, eating disorders, and so on). The unspoken law of the community rendered these destructive behaviors
intolerable, and no longer hidden and colluded with. When the resources were
available, this law was upheld with relative consistency and reliability.
Once resources became scarce,
the overtaxed staff could no longer be consistent and reliable, however much
they wished otherwise, and trust began to wear thin. As it did, the community
character devolved into one of hostility, paranoia, and non-communication. The
hostility reflected the patients' anger at having had a safe environment yanked
out from under them (again). The paranoia reflected a return to a previous
state of existence in their homes before coming to the treatment center: an
environment where their own behaviors could not be controlled and their
emotional life was neglected. After
having learned to communicate their needs in the established trust that they
would be responded to appropriately, the patients were in a sense forced to
give up on this hard-earned expectation and the reverted to previous styles of
self-destructive behavioral acting out — a familiar and desperate cry
for help. Community character was now
operating according to a new set of unnoticed or unformulated assumptions. This
character implicitly mandated that needs should no longer be communicated
because they would not be reliably responded to or adequately met. Since needs
do not disappear, though, they merely became dissociated and enacted. It seems
that many of the incidents of anarchic community functioning were similar to
those that were enacted in some of the individual patients’ families, and
resulted in behaviors similar to those had gotten these patients hospitalized
in the first place. All of this created enormous anxiety in both the staff and
the patients reflecting/enacting also the dread in the administrators who were
trying to keep — and then gave up on keeping — the hospital alive.
Furthermore, this community
was replete with trauma. All of the patients had come to the hospital with
histories of profound abuse and neglect, and the trauma of their own
self-destructive behaviors. Before the cutbacks, this treatment center, with
its ten-year history of dedicated staff and program development, had been able
to meet successfully the challenges of this traumatized population. But once
financial constraints made adequate intervention impossible, the patients'
traumatic histories only made the deteriorating community character more rigid
as the need to defend against disappointment and despair became more and more
pressing. Patients' enactments of their dissociated desires to have their needs
met became their only means of communication as the new community character
became less and less flexible. The hopelessness of the riot foreshadowed the
eventual collapse and closing of this facility.
Sick Societies, Facilitating Environments, and Community
Erich Fromm (1941) believed
that many contemporary — at least Western capitalistic — human
societies fail to facilitate the full development of individual lives; instead,
they are designed develop capacities and technologies for material production.
In his view, societal structures tend to breed a consumer mentality:
Societies become structured so
that individuals are drawn into a view of the world and their place in it which
enables them to want to do the work which their particular society at its
particular point of history requires. The subjective function of character for
the normal person is to lead him to act according to what is necessary for him
from a practical standpoint
Fromm thought that all
societies selected for some characteristics and obscured others. He thought
that humanity had a potential which was carved into particular shapes by
culture, and that sick societies
were the ones that prohibited (or derailed) the actualization of human
potential. Fromm thought that people are shaped in Western society to think of
themselves and other people as commodities, to be valued according to the conditions of the marketplace.
According to Fromm, our essential aloneness and helplessness predispose us to
accept whatever the price is for belonging, such as the roles offered to us by
society (e.g., our role as a marketplace commodity). This need for belonging in
a particular society also predispose parents (who operate out of social
necessity by virtue of their own character structures) to introduce socially
fashioned solutions to their children. Repression in this case derives its
power from the fear of ostracism, not merely from the fear of punishment.
In the same manner that
Winnicott (1958) believed that proper analytic holding environments do not exert social influences on patients beyond the
facilitation of maturational processes, Fromm believed that in an ideal society
the psyche is not damaged by social forces. Instead, he viewed such a society
as a facilitating environment for
achieving our inherent psychic maturational potential. Fromm (1941) introduced
awareness of an element in the human psyche that encourages individuals to
collude with or opt for social arrangements that inhibit their
development — namely, the anxiety that arises from the uncertainties of
existence, or existential anxiety. To avoid this anxiety, Fromm suggested, most people
are willing (or compelled) to escape from freedom — that is, to make life more certain even if it
means accepting limited or symptomatic self-reflections through the eyes of
authority. The payoff is the illusion of being taken care of by god-like
figures who serve as buffers between individuals and the hazards of daily
living. Fromm felt that we exist in conflict between existential anxiety and
the inherent tendency to grow emotionally and spiritually. This conflict is
manifested and enacted through what Fromm (1941, 1955) called social
There are some important
differences between the community and social character concepts. Fromm (1941)
thought that social character was “the essential nucleus of the character
structure of most members of a group which has developed as the result of the
basic experiences and mode of life common to that group” (p. 305). In contrast,
the community character concept provides a means for understanding and working
with group-level transference and
countertransference and for describing interactions between and among
individuals from different groups. Unlike social character, community character
is enacted and exists on a local scale, according to the laws and mores of a specific
local community. Two individuals may belong to several overlapping communities,
with the enactments that they participate in being dependent upon the dynamics
of the combined communities that each one belongs to (or which they perceive
each other belonging to).
The concept of community
character allows practitioners to view community intervention through an
interpersonally-oriented psychoanalytic lens, by which character is seen as a
series of repetitive ways or patterns of relating to self and others. At the
most basic level, these adaptive/defensive patterns form a stable personality
structure for addressing security needs in the face of anxiety. They are
reinforced according to the degree that such needs are threatened in a given
relationship (e.g., between parent and child), in a specific community (e.g.,
by local beliefs, prejudices, and taboos), or within society (e.g., by formal
laws, sanctioned rules of conduct, or cultural norms).
Point of Impact
A disaster or crisis that
shakes a community system can be viewed as a shared focus through which
individuals and groups can explore their chronic concerns (Borg, 2002a). To
describe such experiences I use the term point of impact, defined as the “emotional epicenter where pain and anxiety become manifest and where the immediate trauma
and longstanding difficulties and conflicts converge” (Borg, Garrod &
Dalla, 2001, p. 19).
The point of impact is the
place where defenses break down and the individual and/or community is flooded
with overwhelming anxiety. This often manifests as an experience of acute
crisis that is related to something going on in the real world — an
interpersonal event. Furthermore, such interpersonal events are always embedded
in a context of personal, cultural, economic, racial, and political meanings.
The community character is that which protects the community from experiencing
its own chronic crisis (i.e., anxiety stemming from chronic hardship and
trauma). The point of impact is a break down in the community character’s capacity
to defend against (dissociate/enact) such anxieties.
At times of crisis, a
community’s traditional defense patterns are jolted and sometimes loosened,
thus offering new opportunities for learning and change. There is also a
corresponding potential that defensive patterns of relating may gain strength,
and become more rigid, but the fact that they are in flux provides a window of
opportunity for intervention. Community character defenses that are transmitted
across generations — for instance, racism and other forms of prejudice,
xenophobia, and stereotyped communication — evolve to manage the pain and
anxiety of chronic trauma. Yet they create emotional and behavioral climates
that may congeal into perpetually repeating manifestations of the trauma. A community
system that is resistant to change is likely to enact a widespread
dissemination of emotional (including depression, alienation, and paranoia) and
behavioral (including violence, isolation, and crime) symptoms. For example, in traumatized communities a common way of relating is through
exaggerated stereotyping and scapegoating. This way of relating often results
in the mistreatment of virtually everyone in the community at one time or
another, thereby creating an environment in which people are repeatedly
traumatized — and effectively distracted from the underlying traumatic
A psychoanalytic patient’s
presenting problem often comes in the form of an acute crisis — the recent
dissolution of a long-term relationship, a relapse into substance abuse, or an
episode of extreme anxiety or psychosis. Another patient may be present with an
acute flare-up within what is otherwise a chronic state of crisis — a
history of relationships with abusive partners, long-term substance abuse, or
extended depressive symptomatology. In my experience, these flare-ups represent
threats to characterological defenses that protect against overwhelming chronic
and unrecognized anxiety. Such defenses are so entrenched that they have become
synonymous with how these people are experienced by others (as well as by
themselves) across time. As Siegal (1987) put it, symptoms are, after all,
“attempts at solutions” (p. 289).
I will use the term point
of impact to refer to crisis
flare-ups that exist within and manifest more entrenched, chronic states of
community crisis. As in psychoanalytic treatment, it is often the eruption of
an acute crisis within a well-defended state of chronic crisis that initiates a
request for community intervention. Because the point of impact is essential to
each of the examples in this chapter, whether community or clinical, I will in
this section, present four examples (two community and two clinical) to
exemplify this concept.
What is the Point of Kendra’s Law?
Usually a chronic crisis
remains hidden during an initial community assessment, with an acute crisis
serving as the point of impact indicating a more chronic condition.
For instance, in
January of 1999, Kendra Webdale was pushed in front of a Manhattan subway train
by Andrew Goldstein who suffers from schizophrenia and was later convicted of
second-degree murder. The subway killing raised a huge public outcry and
resulted in the passage of “Kendra’s Law” in New York, which calls for forced
treatment for the mentally ill (AOT: assisted outpatient treatment). The irony
is that prior to the killing, Mr. Goldstein repeatedly sought treatment, only
to be denied. Another irony is that the State, which considered Mr. Goldstein
mentally ill when it passed the Kendra’s Law, argued in court that he was
perfectly sane when he pushed Ms. Webdale in front of the train. A final irony
is that, as a murderer, Mr. Goldstein is getting the treatment he had begged
for. This tragedy (point of impact) ultimately served to highlight a state of
chronic crisis in the community mental health system and the need for ongoing
assessment of how well it does (and does not) serve its target population.
Initially, however, this killing just seemed to be yet another random tragedy
in a large contemporary city.
So let’s back up to describe
this process. What does this example — this point of impact — say about
our response to social problems in our contemporary Western society? In the
last century, the pace of urbanization and industrialization in the West has
outstripped the development of life-sustaining infrastructures in support of
urban residents. We in the United States are now witnessing a backlash wherein
deindustrialization, corporate downsizing, unemployment, and the dismantling of
the welfare state are adding to the already considerable pressure on our
support structures (Blackwell, 2003; Giroux, 2003; Zizek, 1989, 2006, 2008a),
and, in turn, on our legislation and social policies that address these
structures (Gilbert & Etzioni, 2002; Huber & Stephens, 2001; Swank,
2002). Epidemiological studies are showing that increasing numbers of physical
and mental health impairments are resulting from exponential growth in
urbanization and industrialization and their decompensatory effects
(Price-Smith, 2001). Researchers working on the Global Burden of Disease
Project (GBD) have projected future causes of deaths and impairments using a
measure they call disease burden — though
we might read this as a more ominous and extended version of what I am calling
the point of impact. They believe that by 2020, the leading causes will be
heart disease, depression, and traffic accidents (Murray and Lopez, 1996,
2004). Furthermore, these and other researchers are predicting that five of the
top ten leading causes of “disease burden” by 2020 will be associated with
“psychiatric conditions” (Duckett, 2004; Hacker, 2002; Haagsma, Haavela,
Janssen, & Bonsel, 2008; Lee, 1999). If true, it is imperative that we
evaluate our service provision infrastructure for these conditions, the social
policies that support this infrastructure, and the cultural and political
implications of such services, including oppression and social justice in the
institutions we are creating to address our growing psychiatric disease burden
(Mathers & Loncar, 2006; World Health Organization, 2008). The
Webdale/Goldstein tragedy may be the kind of point of impact that can draw our
attention to the insufficiency in the infrastructure that we use to address a
potential psychiatric apocalypse. This being the case, we need look to our
contemporary times to evaluate the point of impact(s) that are being enacted
now and setting up the very conditions that will result in psychiatric
disturbances on such a grand and overwhelming scale.
My four-year tenure on the
executive board of a community health center in New York City gave me the
opportunity to observe and participate in a group attempt to develop an
effective community mental health approach and supportive infrastructure to
address the Webdale/Goldstein tragedy as a point of impact. The group process
focused primarily on how this tragedy called the New York service-provision
community to address and implement needed changes in social policy that
addresses the needs of the population it serves. During that time I also worked
with an ongoing community development project managed by the Coalition of
Voluntary Mental Health Agencies, a social policy and advocacy organization
representing over 100 nonprofit community mental health agencies in New York
City. This group worked at what might be considered the intersection between
the civil rights and community mental health movements. It became apparent that
the philosophies underlying these movements both have and have not been enacted
in contemporary social policy in the U.S. specific to addressing the needs of
people with disabilities. Specifically, it became apparent that the ways in
which the system (specifically made manifest in social policy) alternately
resists, repeats, and colludes with power operations under the guise of
unexamined assumptions referred to as ableism or disability oppression (Casteneda & Peters, 2000; Fanon, 1967, 1968;
Foucault, 1978, 1980; Freire, 1970; McClintock & Rauscher, 2007). These
terms refer to the institutional discrimination that serves to exclude
individuals with physical and mental disabilities from full societal
The current policy of
deinstitutionalizing mentally ill individuals in the U.S. was 50 years in the
making. The combined population of residents in state and county mental
hospitals in this country has dropped from more than 500,000 in 1950 to
approximately 50,000 today (Monahan, Swartz, & Bonnie, 2003; Shelton,
Taylor, & van den Bree, 2009). However, the total population of mentally
disabled prison inmates has increased to the point that a person with a serious
mental illness is almost five times more likely to be incarcerated than
admitted to a psychiatric care facility.
juxtaposition of declining treatment and increasing incarceration rates
suggests a point of impact that has increasingly attracted considerable
attention from deinstitutionalization critics, who note that most governments
have consistently failed to establish promised community-based treatment
programs (Swanson, 2000; Tam & Law, 2007). However, there are signs that
the tide is turning in this area. Backed by research asserting that treatment
can reduce violence in people with major psychiatric disorders and fueled by
high-profile cases of violent crimes committed by people suffering from severe
mental illness, community-based treatment approaches are slowly gaining
attention in this drama (Bell, Adams & Griffin, 2007; Korn, 2004; Perlin,
2000; Swanson, 2003). The issue remains controversial, since it pits public
safety concerns against individual rights.
Researchers in the Global
Burden of Disease Project (GBD) have predicted that five of the top ten
“disease burdens” the world must address by 2020 will be related to mental
disabilities (Murray & Lopez, 1996; Newton, Lee,
Goodman, Fernández, & Yeung, 2009).
However, it seems that a point
of impact that has already been predicted is a point of impact that can, at
least potentially, be prevented. The tendency to reduce the complex
circumstances, multiple identities, various etiologies, and personal struggles
associated with people with mental illness make them easy targets for fearful
projections (e.g., breakdowns, violence, instability) within the general
population. Scapegoating such as this makes the very idea of developing
preventative strategies impossible because the very use of the scapegoating process serves a defensive process
wherein causes and conditions remain hidden. The tendency of GBD and similar
discourses to lump together mental disability categories that reduce them to a
societal burden underscores the similarities of the ableistic perspective and
other discriminatory practices — especially the way we use certain groups
as scapegoats for societal malfunctions. In its worst form, this process
represents a “victim-blaming ideology” (Ryan, 1971) that casts doubts on the
legitimate rights of oppressed groups and supports cutbacks in or the
elimination of institutions meant to provide services for them.
Henry Giroux (2000) argues
that “Domination is never total in its effects; contradictions arise within all
public spaces, even those that appear most oppressive” (69). It seems as though
the further we move from social investment, the closer we come to the politics
of domination or social containment, in which state services are reduced to the
repressive functions of discipline, control, and surveillance (Aronowitz, 1996;
Foucault, 1975; Price-Smith, 2001; Said, 1993). By addressing the circumstances
that erupt at the point of impact — a symptom of such oppressive and
reductive strategies for dealing with epidemic social problems — we can
create responsive communities and policies to address the unique circumstances
of those individuals in need of mental health services is an important focus
for challenging the effects of domination. This is especially true when we go
beyond the language of individual pathology to the more threatening issue of
how we treat our marginalized populations. Working at the point of impact, we
might be able to expose the degree to which marginalized individuals in our
society still lack the security and resources required for their safety,
well-being, and empowerment.
By working at the
point of impact — specifically, the Webdale/Goldstein tragedy — this
group was able to describe certain processes at play in the service-providing
system, changing the community character of this system, and the ways that mentally-ill people are treated in
New York. This has been the main task of the Coalition, and the ongoing
development and implementation of Assertive Community Treatment — a treatment modality consistent with empowerment
and prevention praxis, in that it includes a treatment team approach from
various community resources that encourages and requires the full participation
of the client in his/her own treatment — has increasingly been accepted as
a primary form of care for psychiatric patients at risk.
When Getting Well is Not, Actually, the Point
Intervening at the point of
impact always produces unexpected results. For instance, at the time that
protease inhibitors — the first effective treatment for HIV — were being
introduced into the national healthcare system, I was consulting to a Southern
California AIDS/HIV clinic developing, implementing, and evaluating programs to
serve people with HIV and their families. While the drugs signaled hope for
HIV/AIDS patients worldwide, it also created daunting challenges for the
patients who suddenly had a future again. Many of the patients I worked with
were middle class and well educated, but had not worked for several years.
Quite a few of them were supported by Social Security Disability Insurance
(SSDI) benefits that they could only obtain when they were symptomatic, could
no longer work, and had gone through every shred of personal savings that they
had once built up. Furthermore, many of these individuals had resigned themselves
to the fact that they were going to have a very early death. As the patients
got better in response to the new medications, their SSDI benefits were
halted — both the actual health insurance, which paid for extremely costly
prescriptions and frequent doctor’s appointments, and monthly cash benefits.
Though the prospect of having
a longer life was hopeful in many respects, many of these individuals
confronted the stark reality that they would not be stepping into their old
lives — and began to detect characterological behaviors and feelings that had been established in
them related to the ominous character of the very community they had, often for
years, been turning to for help.
They had not worked in several years which made them unattractive job candidates;
their skills were often outdated and noncompetitive. Instead, many realized
that they would have to adjust to the stresses of not only poverty, but of
working-class poverty (e.g., low wages, entry-level employment, lack of health
benefits, and so on), brought on by the withdrawal of their disability
benefits. This often propelled these individuals into new situations that taxed
their functioning to the utmost. In these situations, the clinic clients often
found themselves working in a context where they felt undervalued compared to
their previous middle class occupations: long hours for low wages in positions
incommensurate with their education. Therefore, adjusting to this circumstance
was nearly catastrophic for many of the clinic’s patients. The one advantage to
thinking that they were going to die was believing that they only had to deal
with the ways in which the disease had taken their lives away for a limited
time. Having their death sentences rescinded meant that they would have to
figure out how to both grieve a life lost while simultaneously developing a new
life of increased hardship. Thus the introduction and the effects of the
protease inhibitors became a point of impact in this community, ushering in the
trauma of a return to physical functioning and ability to work with restricted
access to the middle class lives they once enjoyed. Having HIV/AIDS for many of
these individuals had already brought with it a status of feeling like a
disenfranchised person, the acute crisis laid this bare by the very fact that
these individuals would now be bringing this sense with them into their renewed
engagement with the social world.
Ironically, it was the
disease itself that made this community (i.e., clinic) necessary. The HIV/AIDS
clinic had served as a defense against the chronic sense of anxiety,
loneliness, and dread of being HIV-infected, disenfranchised, and often
ostracized. The protease inhibitors, qua point of impact, would save (at least extend and make more productive)
many lives, but would ultimately kill the clinic itself. Over the years, many
of the patients at this clinic had grown much invested in the sense of
community and solidarity that they had formed at and through the clinic. Now
that an effective treatment had been introduced to combat the disease, the
community was quickly losing its reason for existing as such. At a time where
many of the patients would need the kind of support and care that they had been
receiving — and had learned to trust — over the years, the community
itself was being dismantled due to the fact that the patients were “getting
better. However, due to a consistent effort to restructure their reason for
existing (what psychoanalytic
organizational consultants refer to as primary task), we were able to work together to develop a holistic
treatment program focused prevention and health promotion — as opposed to
primarily medical care — that was ultimately funded, and the clinic and its
programs continue today.
In analytic work, it might be
possible to identify a point of impact for every patient. I will give two
striking examples that add to the community dynamics explored above from the
clinical setting. Although, the point of impact is primarily a community
concept, I am presenting these clinical examples because they address dynamics
that are similar to the processes that might be encountered when we are
addressing the point of impact in community work. In the first example, the
case of Tim, we can see that, given adequate time and resources, an
understanding of what the point of impact is, as well as the chronic crisis
that underlies it, can become manifest in the transference-countertransference
encounter. Within this framework, the chronic crisis underlying the point of
impact can then be worked through and integrated into the patient’s
understanding of him- or herself in the context of his or her history. This
work can then be used to improve the patient’s functioning and well being in
their daily life. Often, however, as in the second example, the case of Jolie,
the point of impact is so overwhelming that it manifests (as an acute symptom
or symptom constellation) only for a brief time period. Sometimes, during this
brief encounter with the point of impact, the minimal and incomplete
understanding of the chronic crisis that it taps into can backfire (i.e.,
trigger powerful defenses), leading to an abrupt termination of the treatment
or intervention. The end result in that case (as in the second example) is a
return to a status quo of functioning wherein the chronic state of crisis is
(once again) thoroughly dissociated.
Tim as Toxic Agent
I met “Tim” when I was
working at a community mental health center in New York’s West Village. He was
a forty-seven year old, Caucasian, gay man who was living with his elderly
mother, as he had been for most of his life. During his initial intake he
described an almost unbelievable history of psychiatric hospitalization. From
the time that he was in his early twenties, he said that he had been
hospitalized over 100 times. He had been diagnosed with paranoid schizophrenia,
was taking a wide array of anti-psychotic medications, and had been released
from his most recent hospitalization just that morning. And that, for him, was
the problem: he was going home. I asked him why he was afraid of going home. He
was afraid, he said, for the same reason that he had, a month previously, been
hospitalized: he was terrified that something about him, something inside him,
something dangerous though indescribable that he carried within him, was toxic.
So toxic, in fact, that he believed that it had the potential to either kill or
drive his mother or anyone else close to him insane. He was in a panic,
sweating and shaking, and had a hard time staying until the end of the intake
session. We scheduled an appointment for later that week, but he did not
attend. In fact, he went straight back to the hospital. Later that day I
received a strange phone call at the clinic’s front desk — an “emergency.”
I picked up the line, stating my name, and all Tim said was, “Good, you’re
still alive.” And thus began the sputterings of what would become a many-yeared
Over the next six months he
would exit the hospital, reinitiate treatment for up to a month, and return to
the hospital repeatedly. Tim referred to the hospital as his “Home Away from
Home,” but it felt more like home to him than his actual home. Despite the fact
that the hospital felt like home to him, Tim nonetheless felt that his numerous
stays there meant that he was an outcast of society and that these stays
interrupted the possibility of him “having a life.” I was, of course, extremely
skeptical about the possibility that our work would contain him. But something
about that first session, the intensity of what I would later consider the
manifestation of a point of impact in that session and his subsequent phone
call, held my curiosity and sustained my hope during that first phase of
treatment. While a point of impact represents an acute manifestation of a more
chronic crisis, it was difficult to tell what the chronic crisis in Tim’s life
was. That is, both his hospitalizations and his living situation with his
mother seemed equally problematic to Tim, and both resulted in him feeling as
if he “had no life.” Though my curiosity and concern was engaged by our
interaction in the first session, the subject of his toxicity never came up
again during the first six month phase of treatment, and he seemed to have no
ability or desire to engage with me on the topic. After six months I told him
that the current situation of repeated hospitalizations interrupting his
treatment was unmanageable and we terminated his treatment.
Two years later, Tim
resurfaced. He had called the center, found out that I was no longer employed
there, found my number, and gave me a call. I told Tim that I would be unable
to work with him under the previous conditions. He assured me that that would
not be the case. He told me that was terrified of returning to the hospital again, as his most recent stint lasted for six months
instead of the “usual” week to month. In fact, he said that this was the first
trip in a long time where the hospital staff were speaking of
“institutionalizing” him indefinitely. He told me that he felt certain that
things had changed. He said that he was willing to comply with his medication
regimen (and sign a consent so that I could talk to his psychiatrist), that he
had quit drinking, and that he was wholly invested in continuing our work. He
believed that he would be able to “refrain” from re-entering the hospital, and
that he would be able to attend analytic sessions regularly. And so he did!
Over the next six months, Tim
attended his three-times/week analysis without missing any sessions, surprising
even himself. During this time, he would begin to put together a history of
what seemed to be crisis after crisis beginning with the separation of his
parents when he was age three. He revealed how, at that age, when his parents
were both but twenty-two, and already had three children, a sixteen-year old
girl came to the door and revealed to Tim’s mother that she had been
impregnated by Tim’s father. The results of this incident were that Tim’s
parent’s divorced, his mother suffered a “psychotic break” and was
psychiatrically hospitalized for the next three years, and Tim and his brother
were sent to an orphanage (while his sister stayed with the mother’s parents).
Tim was never to see his father again.
This series of events was key
in setting up what Tim and I began to refer to as the “Tim as Toxic Agent”
scenario. That is, Tim had developed a deeply held belief that somehow it was
he who caused the total annihilation of his family: His parents divorce, his
mother’s breakdown, the banishing of himself and his brother to the orphanage,
and the disappearance of his father. One of the ongoing effects of Tim feeling
responsible for the breakdown of his family is that Tim has taken up the care
of his psychotic mother. Tim revealed that, as a result of his care for his
mother and his hospitalizations he essentially “has no life.” Even worse were
his perpetual wishes and dreams that he actually was toxic so as to be able to
kill his mother who had, in many ways, “stolen my life.”
However, this did not come
into our treatment relationship until Tim had begun to piece together the
circumstances of his first psychiatric hospitalization. When he was twenty
years old, he was at a bar with a group of his friends and a male friend of his
had stabbed and killed his own impregnated girlfriend. Tim had been standing
beside her when this event occurred and was unable to stop the murder. Soon
thereafter, Tim was subpoenaed to testify on the matter; instead he was
hospitalized psychiatrically — the first of many hospitalizations. Tim
believed that rather than being called in as a witness to the murder, he was
being indicted to stand trial for his own crimes. An important part of that
story is that at the time none of these friends knew that Tim was gay, and he
had been in love with the man who murdered his girlfriend. This caused Tim,
once again, to wonder if his desire to “get rid of her” might have compelled
this man to kill her under the influence of the “Toxic Agent.”
On the evening that
Tim revealed this incident, I received a series of frantic emergency messages
on my voice-mail. “Are you OK?” Tim cried, “Please call…” When I called Tim he
was in a state of panic and could not believe that I was still alive. “I was
absolutely certain that you were dead,” he said, “that you jumped out of your
(seventh story) window as soon as I left.” Similar to our very first session
three years earlier, once again, Tim brought a point of impact into the
transference, into our relationship. He had, in his fantasy, driven me crazy
and killed me — by inducing me to commit suicide under the influence of his
toxicity. The fear (and the wish) of driving his mother crazy (as he believed
he had done at an early age) and killing her came full force into our
Tim’s acute anxiety that he
had driven me out the window was the acute crisis of the point of impact. It
was present in our very first session too, but we did not have the data that we
needed to make sense of it. Tim’s belief that he had destroyed his family now
became one of his central transference concerns with me. On occasion, this
transference theme would become so overwhelming that it would erupt into an
acute crisis, a point of impact. However, these acute crises were always
shadowed by chronic, but less pressing, concerns that he would damage me in
ways similar to that which he believed he had damaged his family.
Tim’s chronic state of crisis
was quite pervasive — and had much to do with his sense of being an
outcast, and an orphan, in both his family (having poisoned them all) and his
community (being a closeted gay man in a very conservative Bronx neighborhood).
After the eruption of Tim’s fear that he had caused me to jump out the window,
he began to reveal the full scope of his delusional system. He had come to
believe and develop fantastic conceptualizations that he was culpable for
virtually all of the pain and suffering in the world — that it was not his
world, his community that was dangerous, it was he. His hospitalizations were
generally triggered by his belief that the only way to save the world, his
mother, and his family, was to lock himself, and the toxicity that he
The dynamics associated with
“Tim as Toxic Agent” continue to come up in his day to day life, as well as in
his analysis. Understanding certain events, such as his fantasied destruction
of me, as manifestations of his most salient point of impact has been essential
for the ongoing process of working through. This process, through addressing
the point of impact, has helped us understand the effects of the family traumas
in Tim’s life and the chronic state of crisis associated with his own
psychiatric history and his relationship with his psychotic mother. In the
repetition of the acute states of crisis in the transference, we have been
increasingly able to make sense of the chronic crisis that stultified Tim’s
sense of being alive. We have been able to use this information and experience
to consistently challenge the “Toxic Agent” identity that had been lurking in
and wreaking havoc upon Tim since early childhood. In fact, in the last four
years Tim has been hospitalized just twice, each time related to someone being
hurt near him and him feeling culpable, and both times for 72 hour periods, and
both times adding considerable insights to our ongoing work.
On the Periphery of the Point of Impact
Often a state of chronic
crisis is so deeply embedded that all we can glean from an analytic interaction
is a point of impact that triggers powerful defenses and leaves us with a
series of unanswerable questions. One afternoon the clinic secretary called to
tell me that there was a woman there who needed to see me right away. The woman, Jolie, was not one of
my patients. When I met with her she told me, between heaving sobs, that she
did not know why she was in my office, how she got there, or who had sent her.
However, from the story we eventually pieced together, Jolie recalled that she
had been waiting outside the emergency room of a local psychiatric hospital
when she met an ex-patient of mine who suggested that she leave the hospital
and see me instead. During the two-hour session in my office she repeatedly
stated that her appearance here at the clinic “made no sense,” that she had
always been “just fine,” and that whatever was going on with her “would pass.”
Jolie was a
thirty-seven-year-old woman who had immigrated from India with her parents when
she was eight; she told me that her family was “good” and “intact,” and that
she herself was single, an actress, a dancer, a poet, and a screenplay writer
who had misplaced a project about her life that she had been working on for
five years. Unable to find the manuscript over the course of a week, she had
become increasingly paranoid and angry. She told me that she had suddenly lost
track of time and had found herself in several strange places — including
my office — without knowing how she got there. After a while she regained
some of her bearings and sense of self. She asked me to escort her back to the
hospital for an evaluation, and requested an appointment with me. Later that
night she called to tell me that she had not been admitted to the hospital, and
that she wanted to see how things worked out before she scheduled an
appointment. I never heard from her again.
I have seen her, however, in
various public situations over the past five years — walking down the
street, talking with friends, holding hands with a lover, reading scripts in
coffee bars, and hailing cabs in what look like costume for an acting or
dancing gig. In fact I saw her on the street just before I began writing this
chapter. Although we have made eye contact on a few occasions, she has never
given the slightest hint that she recognizes me. From what I can see, she has
not seemed distressed. I wonder whether she is working, loving, and doing well.
Had she experienced an acute flare-up of a chronic crisis on the day we met?
Had her own point of impact had suddenly erupted into her awareness? Or had she
been living in a dissociated state of chronic crisis connected to some deep
sense of having been robbed of her identity, history, and bearings, with the
experience constantly lurking on her horizon? Had she lost some core of her
sense of self when she left India? Did her family and community support her
artist identity, not to mention her immigration to New York City? And like so
many of the acute crises that we face in day to day life, when left unexplored,
I will never know the answers to any of these questions.
The reason why I think that
these clinical examples are important is because, frequently in community
intervention, encountering a point of impact is an intense experience that can
be used to either legitimize the work (as in Tim’s case) or can lead to an
abrupt termination (as in the case of Jolie). Working at the point of impact is
a process that brings to light previously dissociated crises that are then
amenable to intervention. This is, however, a delicate situation in that a
person (or a community) is engaged in a process where they are confronted by
anxieties and experiences that may verge on breakdown. At the point of impact,
a whole history of dissociated anxiety and crisis is brought into awareness.
Therefore, the clinician or practitioner needs to understand how much is at
stake, and also that experience at the point of impact is a rare opportunity
that, depending on the strength of one’s defenses, may be inaccessible under
any other conditions. And even then, as in the second clinical case, such
opportunities are generally fleeting, and that such windows of opportunity are
I use the point of impact
concept to describe the emotional epicenter of any crisis (clinical and
community) where pain and anxiety are manifested and where immediate trauma
converges with longstanding issues and conflicts. In this manner, acute trauma
can unlock a community’s history of chronic trauma (Borg et al., 2009).
Intergenerationally transmitted character defenses (such as prejudice,
stereotypical communications, in-group insularity) and ritualized communicative
and behavioral taboos (such as implicit prohibitions against cross-ethnic or
interracial communication) are created to manage the anxiety and pain
associated with chronic trauma. These defenses can result in the perpetuation
of trauma by means of the emotional tone, behavioral symptoms, and the
interactive patterns they sustain. As the emotional and behavioral symptoms
mentioned at the end of the preceding section are repeatedly enacted in a
community, crisis or disaster may be required to disrupt them. The point of
impact is an acute crisis that serves as a focus through which groups and individuals
can explore chronic conflicts, differences, and dissatisfactions (Borg, Garrod
& Dalla, 2001).
A point of impact is an
emotional entrance through which many of the communities and analysands with
which I have worked have relaxed their borders to let the outside world in.
They may also serve as portals for community crisis interventions. This may be
what Freud was hinting at in Analysis Terminable and Interminable (1937b) when he suggested that the stronger the
trauma, the better the chances for a cure. On a community level, acute trauma can unearth histories of conflict, anxiety,
and pain experienced in relationships among residents and service providers
across generations. In the South Central Los Angeles intervention mentioned
previously, inquiries into the history of relationships between residents and
service providers (especially law enforcement authorities) led to a forum in
which longstanding patterns of stereotyping, prejudice, inter-group suspicion,
paranoia, hostility, aggression, and violence could finally be given voice and
not only enacted.
As practitioners, it is our
goal to develop community interventions that transform these fixed points into
expanding spaces of awareness. Such spaces can provide access to emotional
experiences that in turn allow for negotiable and collaborative solutions to
characteristic hardships and problematic interaction styles.
Creating a Psychoanalytic Community Context: Project Groups
In some of the interventions
I have been involved in, residents and community stakeholders worked with
community practitioners to develop project groups comprised of community residents and practitioners to
focus on and intervene in a specific community problem (Borg & Lynch,
2005). I pose that we can view such groups as a type of action research methodology. Following Stringer’s (1999) description of action research methods, these
groups formulated an agenda of defining community problems to be addressed,
exploring problem contexts and sustaining or initiating environmental factors,
analyzing the problems’ component parts, and developing strategies for
resolution. Project groups are forums in which residents make commitments to
work collaboratively with practitioners to identify problems to be addressed,
to develop inquiry processes, and to develop explanations leading to better
understandings of community problems (Borg & Magnetti, 2004).
Project groups develop means
for planning, implementing, and evaluating the projects and programs they
create in the context of each intervention. As such groups collect additional
data, they invite community leaders and other interested people involved in
their political and educational lives to participate. Eventually, residents and
practitioners become participant/observers (Sullivan, 1954) capable of
consulting with and training other community members regarding the action
research methods they themselves had created, practiced, and sustained.
What we have come to call “project group methodology” grew out of the post-riot
South Central Los Angeles intervention that we were involved in for some years,
where we learned that bringing community residents and service providers
together to address, explore, and intervene in the oppressive conditions that
fostered trauma was an essential element in community empowerment (Albee et
al., 1988; Borg et al., 2009; Nebbitt, Lombe,
& Williams, 2008; Rappaport & Seidman, 2000). Since
then, each time I have seen this methodology used I have also seen how rigid,
conditioned patterns of thinking and feeling are explored by project group
participants, and how members are able to experience en vivo how these processes serve to maintain biases,
prejudices, and negative assumptions about other community members. In most
cases, residents reported an increased capacity to communicate needs among
themselves as well as more respect and understanding on the part of community leaders and service providers (including outreach
workers, teachers, police officers, and rent collection staff). This resulted
in higher levels of trust and increased feelings of responsibility about
My observations persuade me
that this methodology can also be used in organizations and communities that
have clearly identified problem areas or areas requiring increased development.
For instance, a disaster intervention organization that I belong to formed what
might be called a “project group” to enhance its outreach efforts, increase
funding, develop progressive tracking methods, and create ways of becoming
“authorized” for crisis activation. While establishing a formal project group
is not considered a standard practice in all interventions or consultations,
less formal groups with different names are often created to serve similar
research" component of project groups is generally focused on exploring
community dynamics through examining enactments, and understanding them as
manifestations of dissociated experience in the community. My colleagues and I
have repeatedly noted that the relationships formed within project groups and the emergence of
naturally supportive group processes result in increased levels of community
empowerment as well (Borg, 2004a). I therefore believe that by understanding
and working our way out of the enactments engaged in within the project groups,
members are better able to address problems in living in their community. In
many ways, expanding on this process is the primary task of project groups.
Enactments within project
groups, especially those between community stakeholders and the practitioners,
are microcosms of the enactments that take place in the communities these
people come from (and between their communities and other communities, or
between their communities and outsiders). Project group enactments, therefore,
offer the same kind of therapeutic leverage in community work that
transference/countertransference enactments offer in individual work.
Transference/Countertransference Enactments in Community Interventions
I suggest that individuals
within the same community develop common transferences and transference-related
enactments based on their shared experiences. One common expectation of the
South Central LA residents, for example, was that interactions with outsiders
would ultimately become hostile and neglectful, whatever the stated intentions
(Borg, 2004a). The idea that communities collectively develop common
transferences has greatly helped me understand the community work in which I
have participated. Knowing that individuals in communities will develop similar
transferences may also be helpful to analysts working with individuals from
In community work,
transference is a phenomenon in which community members’ experience and play
out their community’s underlying and disavowed conflicts (Borg, 2003b). I
generally use the transference and countertransference concepts to refer to the transfer of internalized
relational patterns from personal, familial, historical, and cultural contexts
to an individual's current experience of self and other (Borg, 2005a). Along
these lines, then, enactment is
best described as the behavioral playing out of unconscious transference and
countertransference themes that represent the unconscious dynamics of community
character. From this perspective, enactment is a vehicle for experiencing,
expressing, and ultimately understanding transference themes and the
ramifications of repetitive relational and current functioning patterns within
A central premise of the
contemporary interpersonal psychoanalytic perspective is that both participants
(analyst and analysand) are involved in processes that invariably affect and
are affected by an interpersonal field (Bromberg, 1998; Levenson, 1991;
Mitchell, 2000; Stern, 1997, 2003). Transference shapes countertransferential
relationships and is revealed in them; reciprocally, one’s countertransference
shapes and is revealed in the transferences of the other. Sullivan (1940, 1953)
described the analyst’s role in this process as that of a participant-observer
who attends to and appraises his or her participation in the analytic process.
This is almost always the case for community practitioners, who participate in
the daily life of the community and then must take stock of that participation.
In communities, persistent
modes of thinking and feeling are often reinforced in important ways by daily
interactions that are established, sustained, and reinforced by its members. As
Bauer (1993) notes:
A person’s distrust for others .
. . may result in a manner of relating (e.g., guardedness, defensiveness) that
actually creates a malevolent or rejecting environment, leading to further
guarded, defensive behavior. By behaving in a particular fashion, a person may
actually create an environment that provides continued validation for the
behavioral stance that supports the original premise. (p. 176)
When member involvement
becomes crucial (e.g., when practitioners use project group methodology),
transference and countertransference issues can serve as the raw material out
of which community change is crafted. Interactions and confrontations between
members and practitioners almost always mirror community issues that require
attention. Formal and informal meetings in which problems are re-enacted in
front of and with practitioners are vivid demonstrations in microcosm of larger
community patterns. As in individual work, the concrete experience of
transference enactments carries a kind of conviction that exposition, or even
interpretation in the abstract, seldom do.
I will present a more
extended case study to exemplify these concepts in community work.
The Women’s Prison Council
Since 1980, the number of
incarcerated women in state and federal prisons has increased fourfold (Borg
& McCarroll, 2004; Women’s Prison Association, 2009). Much of the increase
has been attributed to the national trend in sentencing drug offenders to
prison instead of probation or treatment programs (Belknap, 2001; Gilliard
& Beck, 1998; Lochart & Scott, 2009; Van Wormer & Bartollas, 2000). During the 1980s, the number of women arrested for drug violations more than
tripled — twice the rate of increase for men (Bloom & Chesney-Lind,
2003; Greenfield & Minor-Harper, 1991; Women’s Prison Association, 2008).
Today, the typical incarcerated woman is young, single, non-white, has
children, has few job skills, has little (if any) work experience, and has a
significant substance abuse problem (Borg & Garrod, 2003; Dittman, 2003;
Moore, 1995; Women’s Prison Association, 2009; Young, 2000). Though there are
few community organizations designed specifically to address this crisis, the
Women’s Prison Council of New York City (WPC) is a nonprofit organization
established in 1844 that has a long-term history of working to create
opportunities for change in the lives of women prisoners, ex-prisoners, and
their families. The recent changes mentioned above in the criminal justice
system have had a direct impact on the WPC’s ability to perform its primary
task: to help women make the transition from prison back into their communities.
During an intervention with
the WPC, a female colleague and I noted how patriarchal societal dynamics
associated with the oppression of women — specifically, female
prisoners — were enacted in interactions between WPC staff and their
clients, as well as between WPC staff and us. We also saw that this dynamic
played out in subtle and overt ways both within the WPC and between WPC and the
numerous institutional settings that they were connected to (especially the
criminal justice system). While the mission of the organization is to help
women (especially women of color, lower-income women, and women with health and
mental health problems) integrate back into the community after a prison
sentence, we found that some of the more pernicious aspects of the ways in
which our society treats women were also at play between the staff and the
clients, as well as between the leaders of the organization and the field
Something odd had
been happening in the ways in which the WPC staff — especially the clinical
directors and their teams — were dealing with WPC’s clients. As many of the
changes in the criminal justice system had resulted in greatly increasing the
caseload of the individual staff members, the staff members had begun to change
their tactics in dealing with their clientele. We began to think that the WPC
had changed its organizational structure as a means of dissociating the
overwhelming environmental conditions and changes in policy that were effecting
their population. It seemed likely that some of the conflicts that were going
on among individual members of the staff could be translated into
organizational (system-level) conflicts as they faced the changes in the wider
It had always been a strict
policy at the WPC that actual police intervention would be the very last
measure taken in dealing with the women that it served. The only times, in
fact, that police were called to intervene had been in overt cases of child
abuse. However, recently it was becoming increasingly clear that individual staff
members had been turning to the police for minor infractions perpetrated by the
women they served. This set up an ironic situation wherein the very people who
were ostensibly working to help women transition back into their communities
from prison were actually helping them to return. For example, one woman client
was charged with a parole violation and sent back to prison because she did not
show up for a meeting with her WPC counselor. It turned out that the reason for
this absence was that the client could not find child care (it also turned out
that the client had called to inform her caseworker of the circumstance).
Though this had been noted in staff meetings, none of the actual staff members
had been confronted on this behavior. Instead of addressing this behavior
directly, the executive director had decided that she would set up a kind of
subtle surveillance system that would be enforced in the heavy-handed treatment
of the WPC clientele by the executive team. It would then be the executive
team’s task to confront this issue — on a one-to-one basis — with staff
members and decide how it should be dealt with. This task included vesting the
executive team members (only one of whom was involved in clinical matters) with
the authority to terminate staff members who did not desist from this behavior.
So, rather than address how
this behavior might represent a desperate attempt at dealing with the massive
and oppressive changes in the how the criminal justice system treats women, the
WPC authorized members of its staff to quash any and all symptoms of this (i.e., the acting-out of the anxiety that
system-level changes in the criminal justice system were creating in the
interaction patterns being enacted between WPC staff and its clients as well as
between WPC staff themselves) as they were made manifest in the WPC itself. And
the degree of secrecy that the program manager, Ms. Vick (who had initiated our
consultation), stressed regarding this issue was particularly disturbing to us
in our consulting role. In fact, it seemed as though the executive team had
been empowered to enact a role very similar to that of the criminal justice
system itself, to seek out the rule-breakers and to punish them — without
any consideration of the ways in which certain problematic behaviors might
be — both real and transferential — reactions to problems in wider social context.
We established a project
group consisting of the five members of the executive team and began an
analysis of the dynamics that were at play both in the organization and in the
larger criminal justice system within which the WPC operated. We found that by
addressing the most problematic circumstances that the executive team was
dealing with as if they were solely “in-house” issues, set up an impossible
(seemingly futile) task. Therefore, the theme of the consultation seemed to
revolve around the enactment of trying to do the impossible and to do so by
dissociating and losing track of the primary task of the organization itself.
This was so because some of the ways in which the WPC served women were
becoming impossible in the system of oppression that the criminal justice
system was increasingly becoming. So taking on societally-influenced problems
as if they were solely “in-house” issues was an enactment of the WPC’s inability
to deal with, develop, and integrate measures to address such hopeless issues
as recidivism and changes in the criminal justice system’s treatment of women
(especially zero tolerance laws that increasingly targeted the often minimal
roles of women in the more severe crimes of their male partners). As the
criminal justice system burgeoned under the pressure of increasing female
inmates (with needs that the system itself was not equipped to deal with), the
female inmates became increasingly overwhelmed (and oppressed). Simultaneously,
the WPC became increasingly overwhelmed by their sense of decreasing their
efficacy in performing their primary task. When the staff members of the WPC
lost their sense of efficacy (and their sense of certainty as to the nature of
their primary task) there was a breakdown of the boundary that existed between
the WPC and the wider hostile environment within which it operated.
While this was clearly a
desperate situation, we increasingly felt as if we were intruding into areas
where we were not welcome. In fact, we often felt as if we were involved in
some kind of struggle between the executive team’s need for more understanding
of the complex dilemmas that they were caught up in and what we perceived as
the executive director’s covert need to keep us out (she refused to meet with
us throughout the consultation). As we had already become quite invested in
doing a decent job ourselves, we were struck with a sense of humiliation at not
being clear about what it was that we were trying to accomplish at and for the
WPC. Perhaps we, like the members of the executive team, did not really want to
know what we were facing. When we asked what we could do for them, it seemed as if they perceived this as a
question of what we were going to do to them (i.e., what we planned on perpetrating against them). The
transferential message that we kept hearing was something like: You say you
want to help, but we know you want to indict and charge us with wrongdoing.
Perhaps the members of the
executive team, desperate to figure out a way to be effective in what felt like
(and was) a hostile and forbidding criminal justice system, did actually invite us in to do something. But we
increasingly felt as if the system itself — the WPC — would not allow
us to do our job. Was this how it felt to be on the executive team? Take care
of our problems for us, but do so by getting rid of them, and, whatever you do,
do not let us (or at least the executive director) know anything about it.
After the first six months of
our consultation, we decided to hold a meeting to address (i.e., confront) what
we were seeing as the more problematic aspects of the functioning of the WPC,
especially the enactment of mistreatment perpetrated upon their clientele that
resembled the criminal justice system’s increasing mistreatment (i.e., making
the accomplishment of the WPC’s primary task increasingly difficult if not
impossible) of the WPC itself. And in doing so, we stepped right into an
enactment wherein we brought to life their transference fears about being
charged with wrongdoing. We mentioned the criminal justice system’s increasing
oppression of women, and how the WPC staff were behaving, against their best
intentions, in very similar ways. In our countertransference stance, we had
taken up an authoritarian, as opposed to collaborative, position vis-a-vis the executive team. We found ourselves enacting the
same kind of role that their executive director had taken up with the staff. By
relegating the power to the clinical directors to terminate to the clinical
staff, the executive director was able to distance herself–dissociate the
hopelessness in the system — with a sense of righteous indignation. Like
the executive director, we felt thoroughly authorized and untainted in taking up
the authoritarian position where we could dissociate and enact our sense of
hopeless (regarding gaining actual entry into the inner workings of the organization — and, hence, being
able to accomplish our primary
task) and we began to feel justified in our rather harsh feedback — i.e.,
criticism — of the organization’s overall functioning. Perhaps this was
because we, like the executive director (and on down the line), were feeling
ineffective in our roles (still related to the trickle-down effect of the
increased harshness with which the criminal justice system was treating those
at the lowest end of the treatment totem pole: the female prisoners
After we completed the
presentation of our conceptualization, Ms. Vick became visibly upset, questioning
our authority to make such hurtful comments, especially in our doing so in a
way that allowed us to distance ourselves from this dilemma with such critical
and harsh judgment. After all, weren’t we there to help them work through these
dilemmas rather than solely pinpointing the problem and then leaving them to
fend for themselves? We believed that the very circumstance of making progress,
while ostensibly hopeful, had been underlining the resistance that we
experienced in the organization (especially regarding our sense that we were
not fully able to do our job) since the beginning. That to make such progress also meant that the WPC would have to acknowledge
how it had been colluding with a wider system of oppression, and that this was
extremely painful to its core staff. We realized that what we were enacting
with them was mirroring the community (character) issues that we were trying to
call attention to. We openly discussed how the community problems were being
played out between the staff and the clients as well as between ourselves and
the staff. We were then able to use this information to begin to help the
executive team re-strategize their approach to dealing with their field staff,
and to focus on helping them provide adequate service to their clientele. The
executive team was able to develop ways of engaging with their staff with an
increased understanding of how they were being affected by changes in the wider
system that had been impacting their work, and had, prior to this, been
dissociated and enacted throughout the WPC.
Working through in Community Crisis Intervention
Applied to community
interventions, working through is
the process of coming to terms with the loss of a familiar and predictable
environment, and the acceptance of a new state of affairs. Donnel Stern (1983,
1997) expressed the same idea as giving up “familiar chaos” for “creative
disorder.” Such exchanges generally entail new experiences of uncertainty,
ambivalence, and anxiety.
The working though process
takes into account interactive repetition and the role that repetition plays in
establishing familiar and predictable experiences in living. It also addresses
the tendency that we have to resist experiencing ourselves in novel ways, and
instead to repeat historical patterns in all of our current experiences (Fromm,
1955; Schachtel, 1959; Sullivan, 1953). The primary goal of the working through
process is to become more aware of how one’s history of embeddedness in social
contexts has shaped one’s current experiences, and then gradually to increase
one’s capacity to tolerate new experiences across the domains of thinking,
feeling, relating, and behaving. Successful working through permits increased
awareness of alternative ways of experiencing oneself in interactions with other
individuals and the wider environment; it is reflected in more flexible,
functional and communicative interactions.
The character concept is
intimately tied to the working through process. In work with individuals,
working through refers to resolving intrapsychic conflict, addressing anxiety
to allow for a fuller interpersonal experience, and the revelation and change
of character. When working with communities, working through is a collaborative
process of exploring and understanding the dynamics that underlie and reveal
the community character (Borg, 2003b, c, 2004b, 2005c, d). These dynamics are
brought to life through transference-countertransference enactments that
highlight their development and use (Levenson, 2009). Working through in
community intervention, most specifically, is a process wherein the rigidity of
the community character is confronted and intervened in — hence expanding
experiential and practical options in community members (Borg & Lynch,
Throughout the working
through process the primary focus of the practitioner is on how community
members experience themselves, others, and their everyday interactions in the
community. Despite countless examples of conflict, confusion, and
contradiction, members function at various levels of competence within their
respective community’s psychic organization. However, rather than causing undue
anxiety while working through, it is important to recognize the assets (not
solely the deficits) in a community’s functioning — such as how the operations
of the community character allows for their ability to sustain a sense of
cohesion. Regardless of how hostile or non-supportive an environment appears
(whether or not the environment is welcoming), practitioners must assess how
individuals maintain their sense of cohesion and how they have maintained
relationships in the past (averting the possible narcissistic injuries implicit
in solely focusing on pathological aspects of their functioning). Once a more
holistic picture of the community begins to cohere, accounting for both the
assets and the problems in the community character, the information can be
utilized to determine how security and esteem can be developed and maintained
in a more conscious manner, and be expanded to encompass the operations of the community
as a whole. Similar to their clinical counterparts, community working through
processes eventually bring up issues of mourning, loss, anxiety, and fear. But
as we know from clinical experience, these are best countered by a sense of
hope, and this sense of hope needs to be present in community work too, even
where it is considered a taboo experience because of the dread associated with
Kristeva, 1989; Mitchell, 1993).
Practitioners of the
interpersonal psychoanalytic position accept that change takes time, is
difficult, and requires strong motivation and collaboration, both to sustain
changes and to establish new ones. Community practitioners must focus on how
community members relate to significant people in their personal and public
lives. Whether in analysis or community intervention, change is difficult
because abandoning familiar patterns (which preserve a sense of security) will
often produce the very anxiety that stereotyped relational patterns have been
developed to evade. The new anxiety can manifest in a disruption in the general sense of community, and this may
persist until new ways of interacting are integrated into the community’s
character. Such a
shift requires sufficient flexibility to allow community members to experience
new feelings, maintain new perceptions, and learn new skills (Kretzmann, & McKnight, 1993). As inherent
security operations permit the expansion of personal and interpersonal
awareness, members will note an increased sense of flexibility in their own
characters as well as in their interactional capabilities which will then be
reflected in the community character.
In the interventions I have
been involved in, a guiding question has been, "How can we facilitate and
help community members sustain a wider array of options for relating to each
other?" The working through process in the community setting facilitates
members’ learning new ways of relating to each other, and experiencing
themselves and their environment.
Bringing It All Together/Apart
Alfred Bester (1957) begins
his classic science fiction novel, The Stars My Destination, as follows:
This was the Golden Age, a time
of high adventure, rich living, and hard dying — but nobody thought so. This
was a future of fortune and theft, pillage and devastation, culture and
vice É but nobody admitted it. This was an age of extremes, a fascinating
century of freaks — but nobody loved it (p. 7).
This Golden Age was sparked
by the invention of a process called jaunting — teleportation, the
transportation of oneself through space by an effort of the mind alone.
However, there were some limitations; the most severe of these being that one
could not just jaunt out into an unknown space. All who had tried had either died or disappeared.
And perhaps enactment is itself a kind of reciprocal jaunting into the private
and unknown space of the other’s experience.
Yes, jaunting into unknown
space has always been, and Bester suggests will always be,
treacherous — and sustained by a profound fantasy of what the future, our
next destination, the self and the community that awaits us there, will be. And
yet we do it every day. Many, if not all, of the interventions that I have been
involved in have been sparked and sustained by dreams of the future, the coming
community. And although each of the interventions that I have described might
represent this process, I would like to conclude with a brief story that I
think supports this notion — that all interventions begin and end on
fantasy and the degree to which we are capable of bringing (or not bringing: resisting) that to life.
A Brief South African Dream
Some years ago, my
group — the Community Consulting Group — was contracted to consult to
one of the technical educational institutions, known as Technikons, in South
Africa. We were sought because a colleague, Mr. Zunkel, then living in Durban,
had informed the Dean of the local Technikon that we had previously been
involved in a number of community revitalization consultation projects. The
Dean had sent a representative to New York who worked with our team to
establish a set of goals and strategies for addressing the upheavals and stormy
seas that his particular Technikon campus in Durban was attempting to navigate.
The representative, Dr. Narismulu, wanted us to help his institute become more
effective at accomplishing their primary task: developing, from the raw
materials of the student body, a viable professional work-force for a new South Africa. Little did we know at the time that Dr.
Narismulu was essentially attempting to do something quite grander than neither
what he had been mandated to accomplish by the Technikon system — nor, how
both myself and Mr. Zunkel would be drawn into the enactment of that experience
as we engaged with Dr. Narismulu and the Technikon system. It was also
interesting to note how by calling in two foreign consultants — myself and
Mr. Zunkel — this intervention reenacted the colonial position in which
valued knowledge is seen as belonging to powerful institutions on other shores,
while the indigenous peoples experience themselves as lacking in knowledge and
authority, voiceless and disenfranchized (Said, 1993; Sardar, 1997). By
consulting to Dr. Narismulu and inadvertently training him to consult to his own organization — and
later, other linked institutions — we may have been, like him,
unconsciously challenging this system from the start. After all, moving from a
colonial to a post-colonial position is not solely about having access to
previously thwarted knowledge and power, but is more related to the struggle to
make that knowledge and power useful in local contexts (Desai & Vahed,
During the initial
consultation in New York, in the ongoing e-mail and telephone communication
over the next six months, and with Mr. Zunkel providing one-to-one consultation
to Dr. Narismulu in South Africa, we collaborated with Dr. Narismulu to develop
an elaborate project that would help his institution reach out to, and
collaborate with, under-served communities and institutions, and service
agencies in the region. We developed internship and outreach programs that
would serve to recruit residents of the Zulu communities and members of the
numerous shanty-towns and we then collaboratively formulated a mediation
program that would link the Technikon institution with other service agencies
already operating in the area (including the South African Police Service).
Little did we know, at this
stage that Dr. Narismulu’s mandate had been, instead, to find ways of helping
this particular Technikon join forces with their historical competitors, the
other Technikons in the Kwa-Zulu Natal region and beyond. Nor did we know that
the consultation itself had begun to reach epic proportions in the mind of our
consultee (Dr. Narismulu, that is, not the Technikon system itself). The competition
among the Technikons had been hotly sustained by a deeply engrained — and
quite realistic — sense of scarcity that permeated the South African
society, and played out dramatically among the educational institutions (Desai,
1999). There was a major merger going on in the Technikon system, and Dr.
Narismulu, in many ways, represented a fierce resistance to forming such
“unholy alliances” with the historical rivals of his circumscribed academic
community. When we found out about the system-merger, we thought that the
project that had already been set in motion (the one that we had helped Dr.
Narismulu construct and implement) could be expanded to include the other
tertiary institutions. That was not, however, part of the initial plan — in
fact, we ascertained that the plan that we had been working to develop was
meant as a means of countering the need for the Natal Technikon to collaborate
on the more wide-scale project.
So, Dr. Narismulu was
mandated to take on a task, he rebuked the task and took up a maverick project
to counter the dreaded merger/alliance. We joined him on this task, unaware of
the actual situation and of his mandate from on high. Though I met with Dr.
Narismulu, visited South Africa, and maintained regular communication with him
throughout the project, it is Mr. Zunkel who, after thirty years as an
international banker, volunteered to help out in the South Central project,
moved to South Africa, and wound up being the point person in this project.
In some ways, both Dr.
Narismulu and Mr. Zunkel were being asked to mediate between and among certain key positions, stances,
solutions, and understandings within vast and complex systems — political,
educational, professional, institutional, and theoretical, to name but a few.
However, as the project had been appropriated to fit the structure of Dr.
Narismulu’s fantasy life, and not the primary task of the organization that he
represented, it was not authorized, and doomed to fail (at least in terms of
his own enacted desires).
Many in South Africa had
struggled through years of oppression to finally achieve a position in their
own community of status and a sense of being personally valuable in the context
of the ubiquitous sacrifices that had been made in the years of perpetual
struggle. In many ways our intervention served as a confrontation of the system
of scarcity that had been developed and sustained in order to support a means
of allowing people to navigate their way through the day to day riptides
associated with living within a system of massive — ubiquitous — oppression.
The idea of a merger among the Technikon institutes represented a dramatic
shift from scarcity to synergy — a shift that would have been unthinkable
under the apartheid system. In fact, a synergistic system was unthinkable in
regards to how the apartheid system had been, and remained, internalized in
many of those who had spent their entire lives embedded in it.
The first elections to be
held in a fully democratic South Africa took place in April 1994. This was made
possible by a new constitution, approved in 1993, which provided for universal
suffrage of the South African people. The new constitution was the
manifestation of a voluntary relinquishment of power (with internal violence
and outside economic pressures acting as potent incentives) by the white
minority (Faure & Lane, 1996; Turner, 2000). This then signified the end of
over forty years of apartheid. One commentator noted that, in this act, “South
Africa emerged from the shadow of apartheid badly injured, but alive” (Welsh,
1999, p. 509).
The results gave a
substantial majority — over 62 percent of the votes cast, in a high
turnout — to African National Council (ANC) candidates, of which Nelson
Mandela was a member, of all races. Over the next six years, the ANC, initially
headed by Mandela and then by Thabo Mbeke, would struggle with many issues
related to the revitalization of an economic, institutional, political, and
educational system that had suffered many harsh blows over the preceding years
(Elbadawi & Hertzenberg, 2000). This endeavor was complicated, as well, by
the need to help many people (blacks, Indians, colored) make the transition
from holding a “non-entity” status (Asmal, Asmal, & Roberts, 1997), to
attaining, for the first time ever, a sense of empowerment and of their own
value as the social capital of a
newly emerging government.
It must be noted that there
was some suspicion as to why the National Party (NP) had “voluntarily” acceded
to the vote of 1994, knowing that this would, most likely, result in the end of
their rule. Many have justifiably heralded this as a great victory over the
South African system of oppression (Braude, 2009; Welsh, 1999). Yet others
have, more pessimistically, noted how the NP government shrewdly abandoned the
franchise at a time when South Africa faced a national debt, impoverished
economy, and depleted work-force that were essentially insurmountable (Desai,
1999; Harris, 1994; Lodge, 2009). Thus leaving the newly established ANC
government “holding the bag” on an economic and political environment that had
developed seemingly intractable problems.
South African president Thabo
Mbeki (1998) said,
We must, by liberating ourselves,
make our own history. Such a process by its nature imposes on the activist the
necessity to plan and therefore requires the ability to measure cause and
effect; the necessity to strike in correct directions and hence the requirement
to distinguish between essence and phenomenon; the necessity to move millions
of people as one man to actual victory and consequently the development of the
skill of combining the necessary and the possible (p. 9)
But there is a sharp
counterpoint to this sentiment posed by sociologist Ashwin Desai, who targeted
the darker, and less effective, components of the new government’s struggle to
liberate South Africa. Regarding post-apartheid conditions, especially in the
Townships, Desai (2000) writes:
Echoes of the apartheid past were
heard in the neo-liberal present. Evictions, relocations and disconnections
vied with promises of housing, water and a culture of human rights É Against a
new democratic government, implicit and ineffective boundaries to struggle had
to be observed. As a style of struggle, counter-violence was out, lobbying was
in. The rhetoric of human rights hindered as much as it helped. There was a
constitution that enshrined a multitude of rights. But these were rights over
the multitude; facilitating governance, enshrining property, observing process,
and always subject to financial limitation É Liberation did battle with
emancipation, empowerment with equality É [We saw that] human rights
interventions could also be converted into defensive weapons and important
tactical adjuncts to mass mobilization. Victory [over the NP government]
demarginalized rather marginal subjectivities (the indigent, the consumer, the
unemployed, the illegal), forcing these half-hidden and degraded personalities
to be examined in context
These statements, in many
ways, set the pace for the contemporary South African situation. The South
African economy had survived the impact of sanctions, disturbances and
disinvestment; battered but essentially intact, there had been negligible
damage to the industrial infrastructure or the functioning of the markets
(Desai, 1999). But it was in the deformed labor force that forty years of
“Bantu education” and many years of school disruption had brought about the
worst results of job discrimination and apartheid were felt (James & Van De
Vijver, 2000; Williams, 2009)). Skilled labor was in short supply, exacerbated
as disenchanted whites emigrated, and a threateningly large number of
unemployed — and nearly unemployable in a modern economy — needed to be
trained and/or retrained. It would be the primary task of the tertiary
education system, the Technikons, to develop the means of educating and
re-educating the people, the country’s newly established social capital.
In essence, what this meant
was that the Technikon system had been placed in a position wherein they were
faced with the unprecedented task of mediating between an amalgam of systems
that had been, historically, not only disconnected, but also in opposition to
one another. Most importantly, the individual Technikons did not consider
themselves to be part of a “system.” Rather, these institutions considered
themselves to be relatively autonomous organizations whose history of
interaction with other Technikons had been characterized by fierce rivalry,
fueled by their struggles for scarce educational resources, financial support,
and student bodies that could be considered educable.
Suddenly, these institutions
were chartered with the daunting task of churning out a functioning work-force
comprised, for the most part, of peoples who had so recently been ineligible
participants of the (seemingly) same work-force. Education itself became
increasingly politicized. The institutions comprising the tertiary educational
system suddenly found themselves in need of establishing new identities, and
creating means of collaboration, not only with each other, but also with the
very governmental systems that had so recently discovered the value, the
necessity, of what it was that they were doing. And, it seemed that Dr.
Narismulu was “holding” (had internalized and taken up the task) this darker
part, this daunting task, that was ushered in by breaking the NP stronghold on
South Africa. A task for which it would, and will, take many years to work
Merging the institutions in
the Technikon system was an important first step in this process. In retrospect,
we can see that the deal was going down — the merger within the Technikon
system — with or without Dr. Narismulu’ acceptance, or even his
participation, in the process. Ultimately, the intervention that we were
involved in turned out to be far more personal than the community-oriented
program that we developed originally accounted for. We joined Dr. Narismulu in
his grand (and perhaps grandiose) fantasy of building systems, shoring up the
defenses of a community that had survived traumatic oppression, and real
scarcity. A huge burden had befallen Dr. Narismulu and his institution, and he
certainly did want to help. However, when push came to shove, the work that we
conducted — and especially the work that we did not — was based on a
dream that seemed so absolutely essential that Dr. Narismulu (perhaps as an
important representative of the system he wanted to support) did not feel that
he could stand allowing the process of recovery to develop endogenously; that,
in fact, he had to have an active hand in helping move it right along. This
problem of “fixing” rather than joining a process and allowing it to unfold in
its own creative ways has been a problem we have seen along the way as we, in
the Community Consulting Group, have been developing this model.
The Technikon system was,
after all, heading toward an uncertain future with or without our help. It
seems that in many ways we were there — for a brief while — to sustain
very powerful, at times seemingly omniscient, fantasies about the kind of resources
that this institution would need to acquire and sustain if it was going to make
the transition into its post-apartheid identity, to prevent, at this primary
level, a repetition of its oppressive history. Both we and Dr. Narismulu wanted
to believe that we could be at the central core of this grand process. But the
reality was that this process — this process of working through toward empowerment at a much larger level — had
already undertaken a life of its own, and that it would take years to work
through the crises and the trauma of South Africa’s history. And so, after a
brief intervention, perhaps a daydream that had us caught up in years of
national trauma, the dream that we had joined for a brief while, continues as
the Technikon system continues its task of helping South Africa recover from
its apartheid years.
No matter what our previous
training, experience, and expertise, each time we encounter a new patient (and
often those who have been coming in for years), a new consultation opportunity,
or a new community intervention we are inevitably being propelled into the
unknown space of the other — as well as a whole history of environmental
factors and influences that the person brings with him or herself. How much we
allow ourselves to actually experience this is, of course, quite another
question. For when we experience these dangerous places, we might realize that
these are also the worlds that each of us lives in, consciously and
unconsciously, privately and collectively. As we know from both analysis and
community work, not to mention daily life, these are worlds of living and
dying, fortune and theft, pillage, devastation, and, of course, extremes. And
when we travel into these worlds part of us does disappear, to be forever
transmogrified by the experience of being touched and impacted by the
other — treacherous business indeed. This is the case whether these
experiences are minutely explored and analyzed as in psychoanalytic treatment,
whether this happens more incrementally in community work, or when it occurs
simply by living out one’s life in our embeddedness in human culture. What we
choose to do with it, to what degree we experience vs. dissociate these processes, is of course a personal
matter. I, following the lead of others, have suggested that these processes
are enacted ubiquitously throughout each of our existences here.
Throughout this chapter I
hope that I have allowed the reader to experience the world of the
other — that a kind of enactment has occurred wherein the reader has been
able to enter these worlds and experience him or herself as a participant in
the process. After all, one of the most essential healing ingredients in the
recovery of trauma is the witness (Herman, 1992; Manzo, 2002; Poland,
2000) — and in your reading you have taken up that role vis-a-vis the examples I have presented, their protagonists,
and the one who is reporting them. My hope that the reader might take up the
participant-observer position with and in these stories is best captured by a
statement made by Sandra Buechler (1999) in her description of the analyst’s
position in psychoanalytic treatment, “Perhaps the analyst must find, with each
patient, an optimal balance between being neutral enough to serve as a
transference object and vividly new enough, as an object, to inspire sufficient
hope” (p. 219).
In each of the cases that I
have presented, both clinical and community, the results — whether success,
failure, or, more generally, somewhere in-between — have had repercussions
that go well beyond the scope of simply presenting a case study. In each case
that I have presented I was involved with an exchange of time, energy,
commitment, emotional investment, and much tough work — and for this I am
exceedingly grateful. I have traveled through, and been offered access to, some
extremely intimate experiences often (at least emotionally) right where the
people whom I have introduced live. Not only that. The experience of closeness
and mutuality created in the process of being involved in these projects and
treatments has left me with a sense of having been “on the front lines.” Each
of the crises that these communities, groups, and individuals either live with,
have lived with, or have lived/worked through has given me a deep respect for
the nature of crisis — both in its acute and chronic states — and great
hope in the possibility that community-building, even in individual analysis,
can be a major force in the working through process.
Through these examples I have
attempted to locate individual and collective human processes in the real world with its multiple levels of
influence, acknowledge that our world includes groups diverse both in resources
and culture, and suggest that learning about and being effective and validated
in that real world involves creating authentic relationships that are
inclusionary, negotiated, and involve the development of trust and reciprocal
commitments. In both community psychology and interpersonal psychoanalysis the
primary task is to create a way of working with groups, communities, and
individuals that is built on new ways of thinking, new targets for
intervention, new conceptualizations of our professional roles and of our
cherished concepts and tools for doing so, and most importantly, fostering and
sustaining new hopes for collaborating with people and communities.
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