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THE ANALYST
IN THE
INNER CITY
Second Edition
The Relational Perspectives Book Series (RPBS) publishes books that grow
out of or contribute to the relational tradition in contemporary
psychoanalysis. The term “relational psychoanalysis” was first used by
Greenberg and Mitchell (1983) to bridge the traditions of interpersonal
relations, as developed within interpersonal psychoanalysis and object
relations, as developed within contemporary British theory. But, under the
seminal work of the late Stephen Mitchell (1988), the term ‘relational
psychoanalysis’ grew and began to accrue to itself many other influences
and developments. Various tributaries—interpersonal psychoanalysis, object
relations theory, self psychology, empirical infancy research, and elements of
contemporary Freudian and Kleinian thought—flow into this tradition,
which understands relational configurations between self and others, both
real and fantasied, as the primary subject of psychoanalytic investigation.
We refer to the relational tradition, rather than to a relational school, to
highlight that we are identifying a trend, a tendency within contemporary
psychoanalysis, not a more formally organized or coherent school or system
of beliefs. Our use of the term ‘relational’ signifies a dimension of theory and
practice that has become salient across the wide spectrum of contemporary
psychoanalysis. Now under the editorial supervision of Lewis Aron and
Adrienne Harris, the Relational Perspectives Book Series originated in 1990
under the editorial eye of the late Stephen A. Mitchell. Mitchell was the most
prolific and influential of the originators of the relational tradition. He was
committed to dialogue among psychoanalysts and he abhorred the
authoritarianism that dictated adherence to a rigid set of beliefs or technical
restrictions. He championed open discussion, comparative and integrative
approaches, and he promoted new voices across the generations.
Included in the Relational Perspectives Book Series are authors and works
that come from within the relational tradition, extend and develop the
tradition, as well as works that critique relational approaches or compare
and contrast them with alternative points of view. The series includes our
most distinguished senior psychoanalysts along with younger contributors
who bring fresh vision.
RELATIONAL PERSPECTIVES BOOK SERIES
LEWIS ARON & ADRIENNE HARRIS
Series Editors
Vol. 40
The Analyst in the Inner City,
Second Edition:
Race, Class, and Culture Through a
Psychoanalytic Lens
Neil Altman
Vol. 39
Dare to be Human:
A Contemporary Psychoanalytic Journey
Michael Shoshani Rosenbaum
Vol. 38
Repair of the Soul:
Metaphors of Transformation in Jewish
Mysticism and Psychoanalysis
Karen E. Starr
Vol. 37
Adolescent Identities:
A Collection of Readings
Deborah Browning (ed.)
Vol. 36
Bodies in Treatment:
The Unspoken Dimension
Frances Sommer Anderson (ed.)
Vol. 35
Comparative-Integrative Psychoanalysis:
A Relational Perspective for the
Discipline’s Second Century
Brent Willock
Vol. 34
Relational Psychoanalysis, V. III:
New Voices
Melanie Suchet, Adrienne Harris, &
Lewis Aron (eds.)
Vol. 33
Creating Bodies:
Eating Disorders as
Self-Destructive Survival
Katie Gentile
Vol. 32
Getting From Here to There:
Analytic Love, Analytic Process
Sheldon Bach
Vol. 31
Unconscious Fantasies and the
Relational World
Danielle Knafo & Kenneth Feiner
Vol. 30
The Healer’s Bent: Solitude and Dialogue in the
Clinical Encounter
James T. McLaughlin
Vol. 29
Child Therapy in the Great Outdoors:
A Relational View
Sebastiano Santostefano
Vol. 28
Relational Psychoanalysis, V. II:
Innovation and Expansion
Lewis Aron & Adrienne Harris (eds.)
Vol. 27
The Designed Self:
Psychoanalysis and
Contemporary Identities
Carlo Strenger
Vol. 26
Impossible Training:
A Relational View of
Psychoanalytic Education
Emanuel Berman
Vol. 25
Gender as Soft Assembly
Adrienne Harris
Vol. 24
Minding Spirituality
Randall Lehman Sorenson
Vol. 23
September 11: Trauma and Human Bonds
Susan W. Coates, Jane L. Rosenthal, &
Daniel S. Schechter (eds.)
Vol. 22
Sexuality, Intimacy, Power
Muriel Dimen
Vol. 21
Looking for Ground:
Countertransference and the Problem of
Value in Psychoanalysis
Peter G. M. Carnochan
Vol. 20
Relationality:
From Attachment to Intersubjectivity
Stephen A. Mitchell
Vol. 19
Who Is the Dreamer, Who Dreams the
Dream? A Study of Psychic Presences
James S. Grotstein
Vol. 18
Objects of Hope:
Exploring Possibility and Limit in
Psychoanalysis
Steven H. Cooper
Vol. 17
The Reproduction of Evil:
A Clinical and Cultural Perspective
Sue Grand
Vol. 16
Psychoanalytic Participation:
Action, Interaction, and Integration
Kenneth A. Frank
Vol. 15
The Collapse of the Self and Its
Therapeutic Restoration
Rochelle G. K. Kainer
Vol. 14
Relational Psychoanalysis:
The Emergence of a Tradition
Stephen A. Mitchell & Lewis Aron (eds.)
Vol. 13
Seduction, Surrender, and Transformation:
Emotional Engagement in the Analytic Process
Karen Maroda
Vol. 12
Relational Perspectives on the Body
Lewis Aron & Frances Sommer Anderson (eds.)
Vol. 11
Building Bridges:
Negotiation of Paradox in Psychoanalysis
Stuart A. Pizer
Vol. 10
Fairbairn, Then and Now
Neil J. Skolnick & David E. Scharff (eds.)
Vol. 9
Influence and Autonomy in Psychoanalysis
Stephen A. Mitchell
Vol. 8
Unformulated Experience:
From Dissociation to Imagination in
Psychoanalysis
Donnel B. Stern
Vol. 7
Soul on the Couch:
Spirituality, Religion, and Morality in
Contemporary Psychoanalysis
Charles Spezzano & Gerald J. Gargiulo (eds.)
Vol. 6
The Therapist as a Person:
Life Crises, Life Choices, Life Experiences,
and Their Effects on Treatment
Barbara Gerson (ed.)
Vol. 5
Holding and Psychoanalysis:
A Relational Perspective
Joyce A. Slochower
Vol. 4
A Meeting of Minds:
Mutuality in Psychoanalysis
Lewis Aron
Vol. 3
The Analyst in the Inner City:
Race, Class, and Culture through a
Psychoanalytic Lens
Neil Altman
Vol. 2
Affect in Psychoanalysis:
A Clinical Synthesis
Charles Spezzano
Vol. 1
Conversing With Uncertainty:
Practicing Psychotherapy in a
Hospital Setting
Rita Wiley McCleary
THE ANALYST
IN THE
INNER CITY
Second Edition
Neil Altman
Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 27 Church Road
New York, NY 10016 Hove, East Sussex BN3 2FA
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RC506.A48 2009
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Acknowledgments
Introduction
Part I
Background
1 Clinical experiences from a public clinic
2 Theoretical, historical, and sociological background
Part II
Race, class, and culture
3 Social class
4 Whiteness
5 Psychoanalysis in black and white
6 Culture, ethnicity, and psychoanalysis
Part III
Thinking systemically and psychoanalytically at the same time
7 A psychoanalytic look at the bifurcation of public and private
practice
8 Thinking systemically and psychoanalytically at the same time:
Psychoanalyzing the context
9 Toward overcoming the split between the psychic and the social:
Bringing psychoanalysis to community-based clinical work
10 A psychoanalytic-systemic perspective on psychotherapy with
children and adolescents
Part IV
Psychoanalysis and society
11 Manic society: Toward the depressive position
12 Psychoanalysis in the political world: The case of the American
Psychological Association and torture
13 Psychoanalysis in the political world: Suicide bombing
14 Psychoanalysis as a potential force for social change
References
Author Index
Subject Index
Acknowledgments
1995
For much of the time that I worked in inner-city public clinics, I was in
psychoanalytic training at the New York University postdoctoral program. In
order to attend my classes, I would often leave work in the middle of the
day, get on the subway in a poor section of the Bronx, and emerge 20
minutes later in an affluent section of Manhattan. After sitting for two hours
in the instructor’s well-appointed office, I would get back in the subway and
return to the Bronx. It felt like culture shock to go so quickly from one world
to another. Likewise, I felt I had a split professional life: on one side,
psychoanalysis and my private practice, and on the other, the Bronx and my
work there. I always suspected that my participation in each world informed
my work in the other, that my psychoanalytic training deeply influenced my
work in the Bronx, and that my experiences in the Bronx and the
commitments that led me to work there influenced the kind of
psychoanalyst I was. Only after I decided to leave the Bronx, in 1990, did I
begin to articulate the links between my psychoanalytic work and my work
in the Bronx. This linkage took the form of a paper I wrote, “Psychoanalysis
and the Urban Poor,” which appeared in Psychoanalytic Dialogues in 1993.
Writing this paper was a form of integration of my experiences in the inner
city, as I did the psychic work of preparing to leave behind that phase of my
professional life. Since leaving the Bronx, I have been writing virtually
nonstop on topics stimulated by my experiences there. This book is the
product of that writing and constitutes an extended period of mourning, of
processing those experiences.
I wish to acknowledge the contributions of those who have supported and
encouraged me on the long path that led to the writing of this book. I feel
extremely fortunate to have had more than one mentor in my life, people
who believed in me and encouraged me to develop and pursue my own
vision of a meaningful professional and personal life. In my graduate and
postdoctoral education, Bernard N. Kalinkowitz, to whose memory this book
is dedicated, was extremely supportive of my efforts to find ways to use my
training in underserved settings. My decision to take a placement in a
single-room-occupancy hotel during my first year in graduate school seemed
to please and worry Bernie. He was concerned that I was a young, naive
student from the Middle West who would have a rude awakening upon
encountering the reality of New York City; nonetheless, Bernie clearly loved
the choice I made, and I felt that it reflected some of his own deeply held
values. During some of the more lonely and beleaguered times I spent in the
Bronx, a phone call to Bernie unfailingly restored my spirits.
Stephen Mitchell has been my editor, and so much more. In his capacity as
editor, Steve has had a gift for offering a challenging critique of my work in
the context of appreciation and faith in me as a writer. Since I showed him
my first tentative efforts at psychoanalytic writing, his belief that I could
write has been an important factor in my ability and willingness to believe
in myself. Steve’s passion and love for ideas and for the process of thinking
and writing has inspired me. When we have disagreed, there is enjoyment in
the exchange, a sense that I have his support whether I see things his way or
not. I cannot imagine an editor who would more effectively have promoted
my development as a writer. Steve has also been most encouraging of my
interest in psychoanalytic writing that has social relevance.
I spent over 15 years doing clinical and supervisory work, as well as
teaching, in the Bronx. Many people supported me, taught me, and
stimulated me in my work there. Eli Leiter was my “boss”; he was always
available for intellectual stimulation, laughter, complaints, and the
ventilation of feelings that is vital in the preservation of sanity under
difficult conditions. Luz Towns-Miranda was a friend who, along with José
Sanchez, helped me navigate treacherous administrative waters so as to
accomplish what I wanted to do. I also want to acknowledge the following
people with whom I worked and who contributed to this book through
helping engender a creative and productive atmosphere in the clinics where
we worked: Naomi Adler, Richard Briggs, Bette Clark, Lisa Director, Carol
Eagle, Barbara Gochberg, Samuelle Klein-Von Reiche, Laura Neiman, Cecile
Ortiz-Rodriguez, and Carol Wachs.
I appreciate greatly the help of the following people, who took the time to
read all or part of the manuscript and to offer thoughtful, critical, and
helpful suggestions: Margaret Black, Muriel Dimen, Richard Fulmer,
Adrienne Harris, Anita Herron, Steven Lubin, Wendy Lubin, Cecile Ortiz-
Rodriguez, and Kirkland Vaughans. Lennard Davis offered valuable help in
finding a title that captured the complexity of my project in an evocative
way.
My wife, Roberta, has shared my social concerns for 26 years, since our
time together in the Peace Corps in India. I read almost everything in this
book to her as soon as I wrote it, in states ranging from doubt and
insecurity, to pride and excitement. She was patient enough to put up with
my doubts, despair, and excitement at all hours, late at night and early in the
morning. She made many crucial suggestions for improvements. I am lucky
to have had her intelligence and wide experience in the public sector
available to me “on site” as I wrote and revised the book.
Finally, I want to thank my daughters, Lisa and Amanda, for their
patience with my states of preoccupation and their interest in what I was
doing. Each, in her own way, has been part of the strength and inspiration
on which I have drawn in order to do this work.
*****
2009
Fourteen years after the appearance of the first edition of this book I was
moved to write a second edition by the ongoing interest shown in it by a
new generation of readers. I want to thank those who reached out to me
with their interest and creative use of the ideas and experiences I put
forward in the book. My conversations with Jamey Phillips, Deepti Sachdev,
Beth Kita, Usha Tumala Nara, Jane Hassinger, and Daniel Gaztambide have
stimulated most of what is new in this second edition. They are the ongoing
wellspring of my sense of inspiration and I thank my lucky stars to have met
them. I am very grateful to Stacey Katz, April Fernando, Carol Tanenbaum,
Salvatore Zito, Maria Luisa Tricoli, Hazel Ipp, Gianni Nebbiosi, Susi
Nebbiosi, Ashok and Rachana Nagpal, Honey Vahali Oberoi, Ricardo Ainslie,
Laurie Wagner, David Ramirez, Rachel McKay, Annie Lee Jones, Sarah Hill,
Cleonie White, Melanie Suchet, and many others who invited me into their
organizations and professional worlds to collaborate and learn from them
and their colleagues. Lewis Aron, in a number of roles, has sponsored and
facilitated my work, for which I am eternally grateful. I learned a great deal
from Adelbert Jenkins as we co-chaired a 2002 conference on race,
psychoanalysis, and social policy at NYU, and from Marsha Levy-Warren,
with whom I co-teach. Thank you to the candidates I have taught in the New
York University Postdoctoral Program in Psychotherapy and Psychoanalysis,
at the Psychoanalytic Institute of Northern California, and at the
Philadelphia Center for Psychoanalysis, as well as the members of my
reading groups, many of whom have made major contributions to the
evolution of this book. I am tremendously grateful to Adrienne Harris for
her encouragement, editing, and loving care for me and my ideas. And,
more than ever, to Roberta, my wife, and Lisa and Amanda, my daughters,
who inspire me with their work and their lives. Amanda has inspired and
taught me, raised my consciousness, with her impassioned and humane
commitment to social justice and sensitivity to human suffering. Lisa has
inspired me with her tireless commitment to the people, especially the
children, of New Orleans, before and after Hurricane Katrina. Roberta has
been a partner in consciousness raising, as her study and teaching of
American history, parallel to my study of the history of psychoanalysis, has
taken us along similar tracks of uncovering hidden and dissociated aspects of
our historical legacy.
In the years since this book was first published, we have lost Stephen
Mitchell. Without his inspiration, trust, and support, this book would never
have been written. His spirit abides with me. I rededicate this book to Steve,
in loving memory.
Introduction
1995
For psychoanalytically oriented clinicians working in the public sector, these
are times of crisis and opportunity. Historically, psychoanalysis has largely
eschewed concern with inner-city public clinic work. On one hand, with
their requirements for a particular educational background and a Calvinist
tolerance of frustration, classical and ego psychological versions of
psychoanalysis largely excluded people of lower socioeconomic status and
non-mainstream ethnicity. On the other hand, the classical ideal of analytic
anonymity could not be approximated in a public clinic, where therapists
had to perform multiple functions for their patients, including bureaucratic
and advocacy functions. Public clinic administrations, trying to serve large
numbers of people, often did not look kindly on intensive treatment. Public
clinics, especially in the inner city, have thus not seemed hospitable to
psychoanalytic work. Psychoanalysts concentrated on private practice,
where conditions more nearly fitted the classical ideal and where, not
incidentally, there was more money to be made. The exceptions to this
pattern were analysts who stayed in the public sector in order to train
interns and residents. Their focus on those few inner-city patients who were
bright, educated, or middle class only reinforced psychoanalysis’s reputation
for elitism.
In recent years, developments have been even more discouraging for
people who hope to bring a psychoanalytic approach to the inner city.
Funding agencies have increasingly emphasized cost-effectiveness in mental
health treatment. When efficiency in symptom relief is the criterion for
effective treatment, psychoanalytic treatment easily appears to be at a
disadvantage compared with psychopharmacology and behavioral
techniques (I believe that this is so only if one adopts concrete and short-
sighted standards of cost-effectiveness). Most recently, the emphasis in
public mental health has been on intensive case management, in which case
managers follow chronically mentally ill, or otherwise at risk, patients in
their communities to advocate for their needs and to encourage treatment
compliance. The goal is to avoid hospitalization, far and away the most
expensive treatment modality. When the locus of mental health work thus
moves out of the office, it becomes difficult to see the relevance of
psychoanalysis per se as a treatment. (I argue later that, nonetheless, the
psychoanalytic perspective is invaluable in such work.)
There are, at the same time, encouraging developments: recent revisions
of psychoanalytic theory and technique make public clinic work much more
compatible with a psychoanalytic approach. Relational and interpersonal
psychoanalytic criteria for analyzability emphasize how the patient can use
the analytic relationship, rather than particular forms of verbal intelligence
and the capacity to tolerate frustration per se. The analyst’s stance is not
calculated to produce frustration in the patient, as is the case with classical
technique, nor is there necessarily an attempt to minimize behavioral
interaction. The multiple roles that therapists must fill in relation to public
clinic patients pose less of a problem when psychoanalysis does not require
anonymity and abstention from action in relation to the patient.
Contemporary psychoanalytic theory and practice thus potentially bring
public clinic therapy into the psychoanalytic domain; however, just at the
moment when psychoanalysts have become better prepared to do therapy in
the inner city, psychotherapy has become de-emphasized in favor of
seemingly more cost-effective modalities. What role might there be for
psychoanalysis in a world of biological psychiatry, behavioral psychology,
and intensive case management? Have psychoanalysts become dinosaurs,
fighting a losing battle against extinction as their ecological niche
disappears?
I think not, but the survival of psychoanalysis depends on analysts
believing in what they have to offer in this brave new world and acting
resourcefully to expand the niches in which they make their contribution.
For example, an understanding of transference and countertransference is
clearly absolutely indispensable to an intensive case manager. Intensive case
managers make home visits, take a great deal of responsibility for their
patients, and get involved in many areas of their lives. The setup, to an
analytically trained eye, clearly pulls for reenactments of parent-child
interactions. Powerful emotional reactions on the part of patients and case
managers are inevitable. Case managers may appear to their patients as
omnipotent rescuers, controlling and punitive intruders, potential lovers,
rapists, friends, and on and on. Case managers, who are often on call 24
hours per day, may experience their patients as overwhelmingly demanding,
intrusive, frustrating, abusive, seductive, and so on. Case managers, at least
as much as office-based therapists, need analytic understanding of their
interactions with patients if they are to manage them appropriately. There is
a role, then, an indispensable role, for analysts in the training, supervision,
and support of case managers—assuming this role depends on analysts
expanding their sense of what they have to offer beyond the traditional
private practice, office-based role. Analysts need to be able to apply their
understanding of transference and countertransference and the ways in
which these phenomena can be worked with therapeutically in the complex,
goal-driven, community-based interactions that case managers have with
their clients. To a traditional psychoanalytic sensibility, the active, directive
stance of the case manager and the in-home site of the interaction make the
case manager’s work an implausible object of psychoanalytic consideration.
It takes a more contemporary, relational sensibility, accustomed to more
flexibility with respect to the kinds of interactions that fit within a
psychoanalytic frame, to see the potential for enriched understanding
generated by bringing a psychoanalytic eye and ear to this community work.
My project in this book is part of a larger contemporary project of
integrating the social with the psychological within psychoanalytic theory
and practice. Sullivan and his followers in the American interpersonal
tradition took the lead in the middle part of this century with their
reformulation of Freud’s theory in social terms. Relational theory has taken
the project a step further by integrating British object relations theory, with
its focus on the ways in which interpersonal experience becomes
internalized. We have moved from an “asocial” view of the psychoanalytic
interaction (Hoffman, 1983) to one that takes account of both the analyst’s
actions and his subjectivity (Hoffman, 1983; Aron, 1991, 1992). In France,
Lacan (1977) took another path toward the integration of the social and the
psychological by conceiving of the mind—the unconscious, as he put it—as
constituted and structured by language (Dimen, personal communication,
1994). The “postmodern impulse” (Barratt, 1993) in psychoanalysis leads one
to see the mind in the context of socially shared discursive practices, that is,
the ways of thinking available at a given time and place and the social
power arrangements reflected therein (Foucault, 1980). Along these lines,
feminist psychoanalysts have pointed out how patriarchal society structures
the ways we have available for conceiving of gender. Gender as it is
constructed on the social level constitutes gender as a psychological
phenomenon from this point of view.*
In a variety of ways, then, psychoanalysts have been struggling to “see the
social and the psychological at the same time” (Harris, personal
communication, 1994; for similar efforts see also Cushman, 1994; Samuels,
1993). In considering the role of psychoanalysis in the inner-city public
clinic, I am taking on another aspect of this project. I am attempting to take
account, psychoanalytically, of the social context of therapeutic work in the
inner city in a way that will be of relevance to clinical practitioners. This
effort entails taking account, psychoanalytically, of class, culture, and race
and the dynamics of a public clinic and of a larger community. In this effort,
I seek ways to conceive of these factors within a psychoanalytic perspective
and to find the ways in which they operate in the clinical situation.
Recent decades have seen a heightened interest in, and awareness of, the
ways in which foundational values and assumptions permeate theory and
practice across disciplines. Traditional concepts and technical practices in
psychoanalysis have come to be viewed as saturated with the mores specific
to a time and place. Viewing matters in this way opens up opportunities for
taking a critical attitude toward the status quo in psychoanalysis and in
society. The consequence of failing to place psychoanalysis in historical
context has been the enshrining of a set of concepts and practices.
Conservative currents in psychoanalysis have come to predominate, while
psychoanalysis has become a conservative force in society. Freud could
postulate an equation of femininity with passivity, masculinity with activity;
feminist writing shows us here the reflection of the preconceptions of a
particular historical period that are contingent and thus open to critique.*
Similarly, traditional analytic developmental theory has built a pejorative
attitude toward homosexuality into psychoanalytic theory (Mitchell, 1981;
Lewes, 1988; Blechner, 1993; Lesser, 1993; Schwartz, 1993; Frommer, 1994).
Part of what analysts thought was subsumed in their “neutral” analytic
stance is now thought of as an often highly prejudicial set of assumptions
about people—analyst and patient. Once we begin to view our categories
and practices as contingent, that is, constructed within a particular cultural
context, we can turn a critical eye onto the forces and factors leading us to
construct gender and sexual orientation, for example, in a particular way
within society at large, as well as within the analytic situation.
We have ignored class, culture, and race as powerful elements in the
psychoanalytic field only by being unreflectively embedded in our society’s
arrangements with regard to these categories. Postmodern theorists tend to
focus on those who are marginalized as a way of heightening awareness of
taken-for-granted aspects of mainstream culture. It is harder to take
heterosexuality for granted if one is homosexual or spends time thinking
about homosexuality. Marginalizing homosexuals serves to reinforce our
sense of heterosexuality as “natural,” God given. Similarly, culture, class, and
race can be quite invisible if one lives in many parts of America. We can fail
to reflect on the ways in which these categories are constructed and the
social and psychic consequences and purposes served thereby. In limiting
itself to affluent private practice, psychoanalysis traditionally has created an
environment for itself that is the functional equivalent of a homogeneous
American suburban environment with respect to culture, class, and race.
Psychoanalysis has its own value-laden and culturally embedded
framework, which can remain invisible so long as people whose frameworks
are different are excluded. Once one listens to African Americans, Latinos,
the lower social classes, and the culturally nonmainstream, differences are
highlighted. If these “others” are heard, one is faced with the challenge of
reflecting on the processes by which difference and hierarchy are
constructed. To focus on psychoanalysis in the inner city, then, is to move to
the margins of what has been traditionally encompassed by psychoanalysis.
My project is, thus, to contribute to bringing social class, culture, and race
into the psychoanalytic domain. I want to stimulate psychoanalytic thinking
about the construction of these factors on social and personal levels,
especially in the clinical psychoanalytic situation. If, as I suggest, defensive
psychic functions are served by constructing these categories as we do, to
think psychoanalytically about how we use social class, culture, and race, is
to expand the range of our consciousness.
I suggest, then, that psychoanalysis has developed as an exclusionary
discourse. Classism, racism, and ethnocentrism embedded in our theory are
manifest, at the level of practice, by the exclusion of nonmainstream
members of our society as “nonanalyzable.” The excluded other also
represents the psychically disowned. We have thus built psychic defense,
projection, and introjection into every psychoanalytic interaction via the
implicit acceptance of ground rules (e.g., “talk, don’t act”) that arise within
an exclusionary discourse. In this sense, classism, racism, and ethnocentrism
structure every psychoanalytic interaction, just as they must structure every
interaction in an exclusionary society. Simply to speak of psychoanalysis in
the inner city highlights, or renders conscious, the implicit biases of our
theory and practice, just as to speak of “heterosexuality as compromise
formation” (Chodorow, 1992) highlights the heterosexist biases in our
discourse. I do not set out here to transcend bias in psychoanalytic theory; I
believe bias of one sort or another is inevitable, just as psychic defense is
inevitable. Rather, the psychoanalytic project in this respect is to commit
ourselves to an endless process of seeking to highlight and reflect upon the
implicit assumptions that structure our work.
I further address the social context of psychoanalytic work by focusing on
the public clinic, its dynamics and interdisciplinary relationships, as a part
of the psychoanalytic field. With a systemic perspective, I highlight how the
dynamics of society with respect to race, culture, and class, the dynamics of
an inner-city public clinic, and the dynamics of a therapeutic dyad within
such a clinic reflect one another. In this way, I bring together, within an
overarching perspective, the social and the psychological, the individual and
society, bureaucracy and the clinical interaction.
This book, then, has two centers of gravity. I want this book to be of
practical significance to the clinician working in the inner city. At the same
time, I am concerned with what we can learn about psychoanalysis and its
theory by taking analytic work into the inner city. I intertwine the practical
with the theoretical in a way that highlights the inseparability of the two.
By linking these two projects in one book, I offer my own source of
inspiration, my own way of finding meaning in this stressful and often
frustrating work at the margins of our society, our theory, and our practice.
I begin in the first chapter with a series of vignettes intended to set the
stage for the discussions in later chapters. My intention is to give the reader
a feel for the inner-city public clinic, in the context of the community, the
intrastaff relationships within the clinic, and the clinical work that takes
place. These clinical vignettes also serve as illustrative material for the
discussions in later chapters.
In Chapter 2, I present multifaceted background material necessary for the
reader to be oriented to later discussions. This chapter begins with a history
of psychoanalysis in the public sector, along with factors that have led
analysts to avoid the public sector in general. Next, I present a theoretical
frame of reference that draws heavily on contemporary relational and neo-
Kleinian perspectives and that is well suited for the work of integrating
social and psychological factors in inner-city therapy. I argue that a two-
person social-psychoanalytic perspective is necessary to accommodate such
intrinsically social factors as race and social class within a psychoanalytic
frame of reference. Further, a projective-introjective framework provides a
model for conceptualizing the psychic functions served by categorizations
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vida me parece; su tañer y cantar
todo se ha convertido en lloros y
tristezas; sus placeres y regocijos
en suspiros y gemidos; su dulce
conversación en una soledad tan
triste que siempre anda huyendo
de aquellos que lo podrían hacer
compañía. En verdad te digo,
Grisaldo, que las veces que con
él me hallo, en verle cual le veo,
con gran lástima que le tengo, me
pesa de haberle encontrado,
viendo el poco remedio que á sus
males puedo darle.
Grisaldo.—Mal se puede
remediar el mal que no se
conoce; pero bien sería procurar
de saberlo dél, si como amigo
quisiesse manifestarnos lo que
siente.
Filonio.—Muchas veces se lo he
preguntado, y lo que entiendo es
que él no entiende su mal, ó si lo
conoce, no ha querido declararse
conmigo; pero lo que yo solo no
he podido, podría ser que
entrambos como amigos
podiésemos acabarlo. Y si su
dolencia es tal que por alguna
manera podiese ser curada, justo
será que á cualquiera trabajo nos
pongamos para que un zagal de
tanta estima y tan amigo y
compañero de todos no acabe tan
presto sus días, trayendo la vida
tan aborrida.
Grisaldo.—¿Pues sabes tú por
ventura dónde hallarlo
podiésemos? que assí goce yo de
mi amada Lidia, no procure con
menor cuidado su salud que la
mía propia.
Filonio.—No tiene estancia tan
cierta que no somos dudosos de
encontrarle, porque siempre se
aparta por los xarales más
espesos y algunas veces en los
valles sombríos, y en las cuevas
escuras se encierra, donde sus
gemidos, sus lamentaciones y
querellas no puedan ser oídas;
pero lo más cierto será hallarle á
la fuente del olivo, que está
enmedio de la espesura del
bosque de Diana, porque muchas
veces arrimado á aquel árbol lo
he visto tañer y cantar estando
puesto debaxo de la sombra y
oteando de allí su ganado, el cual
se puede decir que anda sin
dueño, según el descuido del que
lo apacienta.
Grisaldo.—Pues sigue, Filonio,
el camino, que cerca estamos del
lugar donde dices. Y para que
menos cansancio sintamos,
podremos ir cantando una
canción que pocos días ha
cantaba Lidia á la vuelta que
hacia del campo para la aldea
trayendo á sestear sus ovejas.
Filonio.—Comienza tú á decirla,
que yo te ayudaré lo mejor que
supiere.
GRISALDO
En el campo nacen flores
y en el alma los amores.
El alma siente el dolor
del zagal enamorado,
y en el alma está el amor
y el alma siente el cuidado;
assí como anda el ganado
en este campo de flores,
siente el alma los amores.
Filonio.—Calla, Grisaldo, no
cantemos: que á Torcato veo
adonde te dixe, y tendido en
aquella verde yerba, recostado
sobre el brazo derecho, la mano
puesta en su mexilla, mostrando
en el semblante la tristeza de que
continuamente anda
acompañado, y á lo que parece
hablando está entre sí. Por
ventura antes que nos vea
podremos oir alguna cosa por
donde podamos entender la
causa de su mal.
Grisaldo.—Muy bien dices; pues
no nos ha sentido, acerquémonos
más, porque mejor podamos oirle.
Torcato.—¡Oh, claro sol, que
con los resplandecientes rayos de
la imagen de tu memoria
alumbras los ojos de mi
entendimiento, para que en
ausencia te tenga presente,
contemplando la mucha razón
que tengo para lo poco que
padezco! ¿Por qué permites
eclipsar con la crueldad de tu
olvido la luz de que mi ánima
goza, poniéndola en medio de la
escuridad de las tinieblas
infernales, pues no tengo por
menores ni menos crueles mis
penas que las que en el infierno
se padecen? ¡Oh, ánima de
tantos tormentos rodeada! ¿cómo
con ser inmortal los recibes en ti
para que el cuerpo con el fuego
en que tú te abrasas se acabe de
convertir en ceniza? Si el uso de
alguna libertad en ti ha quedado,
sea para dexar recebir tanta parte
de tus fatigas al miserable cuerpo
que con ellas pueda acabar la
desventurada vida en que se vee.
¡Oh, desventurado Torcato, que tú
mesmo no sabes ni entiendes lo
que quieres, porque si con la
muerte das fin á los trabajos
corporales no confiesas que
quedarán en tu ánima inmortal
perpetuamente! Y si han de
quedar en ella, ¿no es mejor que
viviendo se los ayude á padecer
tu cuerpo en pago de la gloria que
con los favores pasados de tu
Belisia le fue en algún tiempo
comunicada? ¡Oh, cruel Belisia,
que ninguna cosa pido, ni desseo,
ni quiero, que no sea desatino,
sino es solamente quererte con
aquel verdadero amor y aficción
que tan mal galardonado me ha
sido! Ando huyendo de la vida por
contentarte y pienso que no te
hago servicio con procurar mi
muerte, porque mayor
contentamiento recibes con hacer
de mí sacrificio cada día y cada
hora que el que recebirías en
verme de una vez sacrificado del
todo, porque no te quedaría en
quién poder executar tu inhumana
crueldad, como agora en el tu sin
ventura Torcato lo haces; bien sé
que ninguna cosa ha de bastar á
moverte tu corazón duro para que
él de mí se compadezca; pero no
por esso te dexaré de manifestar
en mis versos parte de lo que
este siervo tuyo, Torcato, en el
alma y en el cuerpo padece.
Escuchadme, cruel Belisia, que
aunque de mí estés ausente, si
ante tus ojos me tienes presente,
como yo siempre te tengo, no
podrás dexar de oir mis dolorosas
voces, que enderezadas á ti
hendirán con mis sospiros el aire,
para que puedan venir á herir en
tus oídos sordos mis tristes
querellas.
Filonio.—Espantado me tienen
las palabras de Torcato, y no
puedo ser pequeño el mal que tan
sin sentir lo tiene que no nos haya
sentido; pero esperemos á ver si
con lo que dixere podremos
entender más particularmente su
dolencia, pues que de lo que ha
dicho se conoce ser los amores
de alguna zagala llamada Belisia.
Grisaldo.—Lo que yo entiendo
es que no he entendido nada,
porque van sus razones tan llenas
de philosofías que no dexan
entenderse; no sé yo cómo
Torcato las ha podido aprender
andando tras el ganado. Mas
escuchemos, porque habiendo
templado el rabel, comienza á
tañer y cantar con muy dulce
armonía.
TORCATO
¡Oh, triste vida de tristezas
llena,
vida sin esperanza de alegría,
vida que no tienes hora buena,
vida que morirás con tu porfía,
vida que no eres vida, sino
pena,
tal pena que sin ella moriría
quien sin penar algún tiempo
se viese,
si el bien que está en la pena
conociese!
Más aceda que el acebo al
gusto triste,
más amarga que el acíbar
desdeñosa,
ningún sabor jamás dulce me
diste
que no tornase en vida
trabajosa;
aquel bien que en un tiempo
me quesiste
se ha convertido en pena tan
rabiosa,
que de mí mismo huyo y de mí
he miedo
y de mí ando huyendo,
aunque no puedo.
Sabrosa la memoria que en
ausencia
te pone ante mis ojos tan
presente,
que cuando en mí conozco tu
presencia,
mi alma está en la gloria
estando ausente,
mas luego mis sentidos dan
sentencia
contra mi dulce agonía, que
consiente
tenerte puesta en mi
entendimiento
con gloria, pues tu gloria es
dar tormento.
¡Oh, quién no fuese el que
es, porque no siendo
no sentiría lo que el alma
siente!;
mi ánima está triste, y
padeciendo;
mi voluntad, ques tuya, lo
consiente;
si alguna vez de mí me estoy
doliendo
con gran dolor, es tal que se
arrepiente;
porque el dolor que causa tu
memoria
no se dexa sentir con tanta
gloria.
Mis voces lleva el viento, y
mis gemidos
rompen con mis clamores
l'aire tierno,
y en el alto cielo son más
presto oídos,
también en lo profundo del
infierno;
que tú quieres que se abran
tus oídos
á oir mi doloroso mal y eterno;
si llamo no respondes, y si
callo
ningún remedio á mis fatigas
hallo.
También llamo la muerte y
no responde,
que sorda está á mi llanto
doloroso;
si la quiero buscar, yo no sé á
dónde,
y ansí tengo el vivir siempre
forzoso;
si llamo á la alegría, se me
asconde;
respóndeme el trabajo sin
reposo,
y en todo cuanto busco algún
contento,
dolor, tristeza y llanto es lo que
siento.
COMIENZA TORCATO Á
CONTAR EL PROCESO DE
SUS AMORES CON LA
PASTORA BELISIA
En aquel apacible y sereno
tiempo, cuando los campos y
prados en medio del frescor de su
verdura están adornados con la
hermosura de las flores y rosas
de diversas colores, que la
naturaleza con perfectos y lindos
matices produce, brotando los
árboles y plantas las hojas y
sabrosas frutas, que con gran
alegría regocijan los corazones de
los que gozarlas después de
maduras esperan, estaba yo el
año passado con no menor
regocijo de ver el fruto que mis
ovejas y cabras habían brotado,
gozando de ver los mansos
corderos mamando la sabrosa
leche de las tetas de sus madres
y á los ligeros cabritos dando
saltos y retozando los unos con
los otros; los becerros y terneros
apacentándose con la verde y
abundante yerba que en todas
partes les sobraba, de manera
que todo lo que miraba me
causaba alegría, con todo lo que
veía me regocijaba, todo lo que
sentía me daba contento,
cantando y tañendo con mi rabel
y chirumbela passaba la más
sabrosa y alegre vida que contar
ni deciros puedo.
Muchas veces, cuando tañer me
sentían los zagales y pastores
que en los lugares cercanos sus
ganados apacentaban,
dexándolos con sola la guarda de
los mastines, se venían á bailar y
danzar con grandes desafíos y
apuestas, poniéndome á mí por
juez de todo lo que entre ellos
passaba; y después que á sus
majadas se volvían, gozaba yo
solo de quedar tendido sobre la
verde yerba, donde vencido del
sabroso sueño sin ningún cuidado
dormía, y cuando despierto me
hallaba, contemplando en la luz y
resplandor que la luna de sí daba,
en la claridad de los planetas y
estrellas, y en la hermosura de los
cielos y en otras cosas
semejantes passaba el tiempo, y
levantándome daba vuelta á la
redonda de mi ganado y más
cuando los perros ladraban, con
temor de los lobos, porque ningún
daño les hiciessen.
Y después de esto, pensando
entre mí, me reía de los
requiebros y de las palabras
amorosas que los pastores
enamorados á las pastoras
decían, gozando yo de aquella
libertad con que á todos los
escuchaba, y con esta sabrosa y
dulce vida, en que con tan gran
contentamiento vivía, pasé hasta
que la fuerza grande del sol y la
sequedad del verano fueron
causa que las yerbas de esta
tierra llana se marchitassen y
pusiesen al ganado en necesidad
de subirse á las altas sierras,
como en todos los años
acostumbraban hacerlo; y ansí,
juntos los pastores, llevando un
mayoral entre nosotros, que en la
sierra nos gobernase, nos fuimos
á ella. Y como de muchas partes
otros pastores y pastoras también
allí sus ganados apacentassen,
mi ventura, ó por mejor decir
desventura, traxo entre las otras á
esa inhumana y cruel pastora,
llamada Belisia, cuyas gracias y
hermosura así aplacieron á mis
ojos, que con atención la miraban,
que teniéndolos puestos en ella
tan firmes y tan constantes en su
obstinado mirar, como si cerrar, ni
abrir, ni mudar no los pudiera,
dieron lugar con su descuidado
embovescimiento que por ellos
entrase tan delicada y
sabrosamente la dulce ponzoña
de Amor, que cuando comencé á
sentirla ya mi corazón estaba tan
lleno della que, buscando mi
libertad, la vi tan lexos de mí ir
huyendo, con tan presurosa ligera
velocidad, que por mucha
diligencia que puse en alcanzarla,
sintiendo el daño que esperaba
por mi descuido, jamás pude
hacerlo, antes quedé del todo sin
esperanza de cobrarla, porque
volviendo á mirar á quien tan sin
sentido robádomela había, vi que
sus hermosos ojos, mirándome,
contra mí se mostraban algo
airados, y parecióme casi conocer
en ellos, por las señales que mi
mismo deseo interpretaba,
decirme: ¿De qué te dueles,
Torcato? ¿Por ventura has
empleado tan mal tus
pensamientos que no estén mejor
que merecen? Yo con grande
humildad, entre mí respondiendo,
le dije: Perdonadme, dulce ánima
mía, que yo conozco ser verdad
lo que dices, y en pago de ello
protesto servirte todos los días
que viviere con aquel verdadero
amor y affición que á tan gentil y
graciosa zagala se debe.
Y ansí, dándole á entender, con
mirarla todas las veces que podίa,
lo que era vedado á mi lengua,
por no poder manifestar en
presencia de los que entre
nosotros estaban el fuego que en
mis entrañas comenzaba á
engendrarse, para convertirlas
poco á poco en ceniza,
encontrándonos con la vista
(porque ella, casi conociendo lo
que yo sentίa, también me
miraba), le daba á conocer que,
dexando de ser mía, más
verdaderamente estaba cautivo
de su beldad y bien parecer. Y
mudando el semblante, que
siempre solίa estar acompañado
de alegrίa, en una dulce tristeza,
también comencé á trocar mi
condición, de manera que todos
conocían la novedad que en mí
había.
Y todo mi deseo y cuidado no era
otro sino poder hablar á la mi
Belisia, y que mi lengua le
pudiese manifestar lo que sentía
el corazón, para dar con esto
algún alivio á mi tormento; y
porque mejor se pudiese encubrir
mi pensamiento, determiné en lo
público mostrar otros amores, con
los cuales fengidos encubriese los
verdaderos, para que de ninguno
fuesen sentidos, y así me mostré
aficionado y con voluntad de
servir á una pastora llamada
Aurelia, que muchas veces
andaba en compañía de la mi
Belisia, y conversaba con mucha
familiaridad y grande amistad con
ella. Y andando buscando tiempo
y oportunidad para que mi deseo
se cumpliese, hallaba tantos
embarazos de por medio, que no
era pequeña la fatiga que mi
ánima con ellos sentía. Y
habiéndose juntado un día de
fiesta algunos pastores y pastoras
en la majada de sus padres de la
mi Belisia, después de haber
algún rato bailado al son que yo
con mi chirumbela les hacía, me
rogaron que cantase algunos
versos de los que solía decir otras
veces, y sin esperar á que más
me lo dixesen, puestos los ojos
con la mejor disimulación que
pude á donde la afición los
guiaba, dando primero un
pequeño sospiro, al cual la
vergüenza de los que presentes
estaban detuvo en mi pecho, para
que del todo salir no pudiese,
comencé á decir: