What’s happened to good, old-fashioned psychoanalysis? No one talks about being “on the couch” anymore. Instead, they talk about SSRIs, CBT, EMDT or DBT. The couch has taken a back seat to more modern therapies — a development driven as much by managed-care dictates as by truly dramatic advances in the fields of neuropsychology, biopsychology and psychopharmacology.
But a visiting poet on a recent wintry night reminded his audience of at least one marvelous way in which psychoanalytic theory of yore is still doing its good work in the world.
Poet and writer Kim Stafford, the son of poet and writer William Stafford, was in town Jan. 27 to mark the 100th anniversary of his late, great father’s birth during an event at Plymouth Congregational Church in Minneapolis. About 150 well-bundled people arrived to hear Stafford read his father’s poems — and perhaps to catch an echo of the elder Stafford’s austerity, wittiness, and deeply transcendent vibe.
In coming to understand his father’s work, and even his own, Kim had taken a page from the work of Stuart C. Averill, M.D. (1924-1996), a Menninger Clinic psychiatrist who had applied “object relations theory” in the treatment of his severely traumatized patients. To put it simply, Dr. Averill had found success with patients through “recovery of the lost good object” – that is, through “recovering a preverbal experience of the ‘good mother.’ ” This meant helping patients reclaim a forgotten or lost positive experience, so that they could reinvest in the world through new “objects,” which could be anything from a particular person, a particular place or a meaningful relationship.
Kim saw that the act of writing (for himself and for his father) held the same promise.
“Writing a poem … is a way of distilling the best we have from the past and from present thought,” he said after the event. “Many things are taken from us, debased, destroyed. But by writing, by seeking to describe, evoke, bring to life the best we have, we find a way to survive loss by cherishing what remains.”
Robert Burns and bagpipes
Dr. Averill was a World War II veteran and the son of a World War I veteran. His father’s war trauma and post-war treatment for testicular cancer precipitated and/or exacerbated mental health issues, triggering episodes of violence, “dementia praecox,” depression and psychosis.
The family was shattered, and Averill’s mother, who once sang and recited Robert Burns’ poetry in celebration of her Scottish heritage, became silent and joyless. Averill was just 7 years old.
As he matured, he gravitated to the field of psychiatry to “fix the world as he wished he could fix his father,” said his son, Thomas Fox Averill, a writer and teacher at Washburn University in Topeka, Kan.
Dr. Averill’s family trauma and his own unexpressed war trauma might have truncated that dream but for the fact that, in order to become a psychoanalyst, he had to undergo psychoanalysis himself. It was through this process that he discovered an even more compelling motive to heal himself and others.
“He realized he had lost his ‘good mother,’ ” Thomas Averill said. “And he had to go back and find her if he was ever going to work out his relationship with her or be happy.”
The “good mother” sang and played “Tam o’Shanter” at the piano and spoke in the Scottish dialect of her parents, who were both from Burns’ country near Dumfries and Ayr. The “good mother” had been loving, present, generous and loyal. As he reclaimed these memories of her, Averill took up bagpipes and began reading Burns’ poems out loud in the Scots dialect to his wife and four children. “This was all very surprising to us kids,” Thomas Averill said. “We didn’t even realize we were Scottish.”
In an essay for the Bulletin of the Menninger Clinic, published posthumously in 1997, Stuart Averill wrote: “I could be in touch with my own warmth and good cheer once again, and I could mourn what I now know had been lost but not gone forever.”
Spaceship and a moo-cow
To illustrate the efficacy of “recovering the lost good object,” Stuart Averill tells of several patients in his 1997 essay. Perhaps the most compelling is the story of Sam, a 4½-year-old boy who “terrorized his mother, ate dirt, was encropetic at times, and appeared to be antisocial toward all his peers.”
Averill describes long hours of tornadic play, in which Sam literally climbed the walls, “with my standing by or catching him as he climbed from chair to doorknob or windowsill.” Little was known about the etiology of Sam’s behaviors, but Averill operated on a hunch: “I began by telling him that I thought he once had something good but had lost it, and [that] it made him so mad that he wanted to make everyone, including me and his mom, suffer for it.”
Over time, Sam and Averill began to engage in more imaginative play, constructing a spaceship with office furniture and available toys. “We took a journey to a planet far away and he was very hungry. I was to play moo-cow and he was able to get all the milk he wanted to drink. We played this game for several days. I said that maybe he had found what he was looking for.”
Sam’s play shifted, he became “more loving and polite,” and ultimately “able to feel loved again.”
The account is very touching, not only because of Sam’s apparent recovery but also because of the time and patience Averill invested (by today’s standards, not exactly “cost-effective”). Not to mention Averill’s intuitive sense that Sam had lost something good and that he needed to get it back.
“And that’s what my dad was writing about, really,” said Thomas Averill. “You have to rebuild from a strong point. Rather than seeing yourself as a set of problems, you see yourself as someone who once was connected and once was loved. And you can love other people again. And you can love yourself again.”
Fathers and sons
In 1997, Kim Stafford and Thomas Averill met in Oregon, where Stafford lives and where Averill was giving a reading. They shared stories about their deceased and renowned fathers. They spoke of the challenges of being fathers themselves.
They spoke of their fathers’ lost good objects, and their own lost good objects. And how important it is to recover one’s own story.
Said Averill: “You have to have a narrative, and you have to be part of that narrative — not just a minor character or lost out there or at the whim of others all the time. And I think that’s part of what my father was doing — building that narrative from a place where you could start again.”
Psychoanalysis old and current
Psychoanalysis continues, but rarely in the “classical” form practiced by early disciples of Freud. It has continued to develop in various ways, and in full-blown form: for example by Winnicott, Fairbairn and Sinclair in Britain (the “Object Relations” school) and by Heinz Kohut in America (“Self Psychology”). As Sarah Williams indicates, the development of various medications, behaviorist therapies, HMO’s, etc., and the reluctance of medical insurance plans to pay for extensive “talk therapy” (not cheap) has both broadened the field of treatment and restricted it. Psychiatry has become largely diagnostic and medicative, with talk therapy mostly conducted by clinical psychologists and social workers.
Various studies have shown the value of psycho-dynamic talk therapy, however, including when used along with medication, and the influence and tradition of psychoanalysis continues throughout much talk therapy. Brain research has tended to support a model of mental structure derived from Freud (though not about “Eros”, “Thanatos,” etc.), and Freud, himself a physician, would not have argued against a physical basis (“predisposition”) for patients’ ailments. It should be noted, however, that times have changed in another way: classical “neuroses” are a relative rarity now, and “personality disorders” are the rule of the day.
And for those who wish to change through understanding of personality, psychoanalysis remains the gold standard.
Psychotherapy worked for me right from the beginning
In 1991 I had a tumor removed from my right frontal lobe. This caused me to develop bi-polar illness. Within a week of my hospital release I developed severe depression. I ended up having 3 suicide attempts. The doctors couldn’t figure it out. They put me in the psych ward for 30 days and tried me on numerous medications. It wasn’t until they introduced lithium into my system that I snapped out of it. They immediately declared that I had developed bi-polar illness. I still felt depressed though. They introduced me to a great psychiatrist who saw me on a weekly basis. After a few months of not snapping out of my depression she said to me, “Mike, unless you stop treating yourself as a victim and see yourself as a victor there is nothing I can do or say to you that will help you.” From that point forward my depression lifted. I changed my outlook on my life and I haven’t suffered from depression since. In fact I later found out that I was allergic to anti-depressants. They made me manic to the point of being delusional. In fact, one morning I woke up & I could feel the ground shaking below my feet. I ended up phoning everyone in the family to announce that it was the end of the world and that we should all get together. My father brought me to the emergency ward of the hospital where I had been treated. They quickly gave me a shot of an anti-psychotic in the rear. The shaking stopped within minutes. They told me to tell my psychiatrist to put me on a regular dose of anti-psychotic medication. She then put two & two together and realized what the anti-depressants were doing to my system. I haven’t touched anti-depressants since. Instead I’m on Tegretol, a mood stabilizer as well as valproic acid, another mood stabilizer. BUT… I still suffer from the mania. I often stay up all night long on the computer. It ruins my next day’s activities. No solution to the mania yet! I’m very tempted to go off of medications slowly but surely and rely on some good old fashioned psychotherapy. I did say slowly. I’m looking for a good psychiatrist who will help me in that regard.