That psychotherapy brings to the facts the philosophy it claims to derive from them is a charge that can be levelled against many interpretive enterprises, including the one I have undertaken here. And yet, the anthropologist could insist that far from approaching phenomena with a fixed set of questions in hand, as might the experimental or quantitative researcher, he or she must remain an open book, hesitant to affirm anything until the relevant range of details are in. If we accept this view then anthropologists are in a far less enviable position than most, since they rarely know beforehand the kinds of questions their observations will force upon them. Through sustained submersion in a distinct community they will encounter many facts not of their choosing. At once all manner of seeming peculiarities, perplexities, and unforeseen happenings will crowd their field of vision. And yet through the fog of these countless impressions they must still find their way to certain connections that the misty opaqueness conceals. Facts are considered in their total surroundings; regularities are sought for beneath veils of the arbitrary; subjectivities and structures, their conflicts and concordances, are traced for relations and interde-pendencies, while theoretical reductionism is simultaneously eschewed in the name of a more holistic and analogical enterprise.
In my ethnography of the psychotherapeutic community I have not escaped any of the obligations that this particular vision of anthropology demands. Confronted with a plethora of socio-culturalcuriosities, I could not generate questions until what had first perplexed me yielded its meaning; meaning only revealed by‘living the community’. From the many questions raised during my participant observation I then had to select a workable few. And this meant rejecting many. Consequently what has been written is in no measure a complete representation of the community. My selection has unveiled but a portion of the picture (indeed other stories could be told). To reveal what I did, however, and as partial as it may be, only after the facts were in and the questions selected did I turn to established anthropological knowledge to guide interpretation.
Before I summarise the conclusions this approach has generated, let me make explicit the two fundamental questions of anthropological importance that this book has addressed: What are the distinctive aims of the psychodynamic institute? How do these influence the professional socialisation of trainee practitioners?
The psychodynamic community, as we have seen in chapter one, is under siege by manifold external threats. Challenged from media and from academe, from psychiatry and from new therapeutic schools in the genealogical structure, the psychodynamic closes its ranks and affirms its value and vision. While the sociology of the professions teaches that such affirmation is a feature of most established professions (e.g. via various strategies they protect universal aims of wealth, status, and power acquisition), I have illustrated anthropologically that‘maximising’ and economic interests alone cannot account for why psychodynamic training proceeds as it does. Other factors are at play.
What is distinctive about psychodynamic institutes is that they inculcate a body of specialist knowledge that has an intimate bearing on‘self’. The mythic recommends to novice practitioners new possibilities of self-knowledge, identity, and belonging, along with the privilege of discerning both professionally and personally in what direction as persons they are to strive. Institutes are thus organs of transition in a particular sense, for not only do they pass on clinical expertise, but also membership to an established and self-healing tradition. Psychodynamic socialisation, while avowedly aiming to heal the patient, thus also promises personal sustenance and meaning to practitioners. It achieves this largely through imparting a circumscribed, totalising body of knowledge, and thus a frame of orientation by which self, society, and the other may be understood.
Throughout my chapters I described psychoanalytic socialisation as‘affirmative’ since it inculcates largely conservative dispositions. By the circumscription of the theoretical body (chapter four), by appeal to shared concepts of personhood that legitimate role asymmetries (chapter four), by devices of secondary elaboration, displacement, and doubt management (chapter five), by the circumscription of aetiology which renders candidates convinced that they have something vital to offer clinically (chapters six and seven), and by the creation of susceptibilities which dispose trainees to submit to the instruction of seniors (chapter seven), trainees are institutionally coaxed into embodying a professional habitus which builds upon the foundational dispositions of‘partiality’ and‘imagining psychodynamically’ instilled ritualistically in pre-training therapy and assured avowedly by candidate-selection procedures (chapters two and three).
If these affirmative devices promote a tacit‘social contract’ of conformity, peer-fellowship, and a union of aims between novices and the initiated, I have also shown that they may generate low tolerance for individual transgressions of institutionally defined norms and boundaries. Whenever transgressions occur, and when more rarely such mutinous visions are institutionalised, competitors and thus conflicts are born. And yet, as we have seen in previous chapters, such‘conflicts’ do not engender total community fragmentation. While conflict may dissolve friendly ties between psychotherapeutic fractions (as I have emphasised in chapters one, three and eight), it can bind individual members of each fraction together against a greater external foe. In an anthropological sense, shared sentiments of conformity and solidarity thus unite the single school as effectively as do shared antagonisms towards rivals. Far from being indifferent to the dissociated and antagonistic‘other’, then, from this other the‘disassociator’ gains its identity, affirms its principles, and solidifies its aims.
If the therapeutic myth when fragmented extends outward into what I have called the genealogical structure, I have also argued that the myth extends downward into the institute itself. Trainees are judged as persons as well as practitioners (chapter seven); and as the criterion of judgement is culled from the psychodynamic myth trainees are treated like patients. This treatment is legitimated by‘role asymmetry’ (between seniors and trainees) which is in turn legitimated by recourse to concepts of personhood (chapter three). Dissent is managed via the‘psychologisation’ of complaints (chapter four), and appreciated trainees, just like good and willing patients, are those who submit to the guidance of the learned. The therapeutic ethos is therefore not confined to the therapeutic frame, but spills out in every direction: it is applied to the patient (in healing), to the patient/trainee (in training), it is applied by the practitioner (in practice), and by the leader (in teaching). It thus refracts in manifold contrary directions—outwardly into community structure, and downwardly into training device.
If the myth as I have observed permeates these different domains of the psychodynamic enterprise (the person, the institute, the practitioner, the trainee), where exactly does the significance of this fact lie? In the first place, exposing such permeation I believe reveals why the reform many therapists keenly desire is slow in coming. This is to say, as the myth is a pillar propping both‘system’ and‘self’, to undermine the myth is to undermine much that legitimates the affirmative project along with the personal advantages such a project secures. This conclusion might explain why objectives such as the following are rarely taken up in traditional institutes:
Our aim then must be, not just‘therapy’, but a self-reflexive practice which examines its own prejudices, ideology and will to power, which is aware of the ironies and contradictions in its own formation, and which is prepared to challenge them. (Littlewood and Lipsedge 1997 [1982]: 309-10)
The fact that weakening the myth, via reflexivity, would destabilize all that the mythic supports, raises two important concerns. The first must be the psychotherapist’s: does affirmative socialisation (which protects the practitioner’s community) undermine what by any account must be the ultimate goal of training— namely, the creation of the most effective healers? As this question can only be answered by first defining what is meant by the‘effective healer’, rather than enter the normative ground that making such assertions would oblige, I shall instead clarify the central problem for those practitioners who desire reform and who therefore believe that affirmative socialisation compromises standards. Since conservative trainings establish the conditions for the maintenance of their conservatism (i.e. by instilling affirmative dispositions in trainees) how are they to be transformed? Might Sinclair’s suggestion (Sinclair 1997: 321) that medical training must be reformed by impositions from without also apply in this context?
In confronting this issue we might first recall that affirmative socialisation, despite its conservatism, also creates opposition. Secondly, we must remember that affirmation creates opponents who, once being expelled for their diverging visions, can later be reintegrated back into the fold (as in the BAP, chapter one). These two insights lead us to the paradoxical conclusion that affirmation itself can be reformative, albeit indirectly. In this sense the question shifts from Sinclair’s concern about who reforms training institutions (e.g. the outsider or insider) to that of how reform transpires and at what pace. When considering how it transpires we would look to the external pressures which force segmentary alliances and thus bring new proximities and integrations. When considering the pace of reform, we would ask whether indirect reform is as radical and swift as reformers desire, and thus whether from their standpoint it adversely affects patients by denying them the fruits of prompt reform. The moral dilemma for the dissatisfied, then, is whether relying on indirect reform alone is the fairest option for patients. This must be the therapist’s concern: shall the community be reformed by default, or shall it be reformed actively, purpos-ively with greater rapidity, reflexivity and awareness? And if the latter choice is made, in which direction must reform strive? Towards ever deeper conservatism and protectivism, or to greater openness, reflexivity and integration? If we choose reflexivity and integration then we might do well to further accept that the certain training devices identified in this book may well be factors blocking reform; a reform which many believe is needed if psychoanalysis is to exist as a viable and vital profession in the twenty-first century. This is the choice for the psychotherapist.
The next concern is the anthropologist’s: what does the reproduction of the myth via the institute teach us about this form of socialisation? As we have seen, in this book I have identified a species of professional socialisation which surreptitiously requests a robust ideological commitment. That it makes this request distinguishes it from other forms of vocational socialisation in which the ideological is less covertly or overtly insinuated. We might think here of trainings in industry, in the manual professions, in certain artistic, bureaucratic or scientific pursuits. Psychodynamic socialisation also distinguishes itself from medical training, for in the latter‘concepts of the person’ are less explicitly declared than mutely implied, and the content transmitted neither shores up socialisation devices nor an energetic self-redemptive project (Sinclair 1997; Luhrmann 2000; Becker et al 1976).
Furthermore, unlike trainings in more skill- than idea-based professions, where practical attainments can reach high levels of perfectibility, the kind of abilities garnered from psychodynamic socialisation are characterised by non-completion. Like in Kabyle rituals where material exchange binds people in unending cycles of reciprocity (Bourdieu 1979), the project of the institutes, as with the project of therapy, never reaches completion. The gift given in training obliges a return—a lasting commitment. The trainee has thus entered a story whose narrative extends infinitely—person-hood is never fully obtained, and the final aims of analysis are never achieved (chapter three). There is no denouement at graduations’ end, for the myth will pronounce on the person interminably. Thus as with religious adherence so with psychodynamic: the only way out of the unbroken commentary comes via the renunciation of belief, since that believed-in obliges perpetual self-analysis as a condition of belief. As the institutionalisation of this non-completion finds its source in the specifics of the myth, here again we observe the myth’s permeation of the institutional ground—and through the works of the institute, the ground of the person.
In view of these comments we might envisage a scale of professional socialisation from those most explicitly ideological (e.g. political, religious, psychotherapeutic) to those more practically driven (manual, technical, industrial, bureaucratic). Future research might work to identify the structural and often tacit devices used by each species of socialisation. For example, in what features and forms do, say, seminary trainings resemble military or psycho-therapeutic? What are the training conditions under which inflexibility or else flexibility in professionals is furthered? And do comparable forms of socialisation create similar community structures and fragmentations? Furthermore, for the ethicist, could a normative scale of socialising forms be contrived for the better regulation of professional affairs? And again, how do wider socio-historical conditions relate to how differing forms of socialisation evolve and operate? Indeed, as much power in the West over the long-term has moved from centralised civic and governmental institutions to professional communities, investigating the sites where the professions are maintained offers a critical way of unearthing the hidden and powerful machinations and aims of the professions themselves.
Through this work, in sum, I have laboured to show that psy-chodynamic training inculcates commitments which are not explicitly recognised by the institutes as such—and yet the power of these commitments is so palpable as to pattern institutional directives and aspects of practitioners’ lives. In this sense, the institute seeks to reproduce in individuals in the form of dispositions its norms, its underlying presuppositions, and its modes of organising experience. This is assisted as members of the institute,‘partial’,‘susceptible’ and dwelling in states of forced self-inspection (forced by the conditions and devices of the institute) are so engaged as to rarely think of challenging the structured roles and rules. These structured‘others’ thus become firm and constant standards against which‘the self’ can be orientated.
The reality of the institute is then a fixed entity into which people must fit and make their way. And as the objectives of training fashion dispositions that become such integral markers of‘self’ as to feel indispensable, the public (institutional) infiltration of the private (self) creates persons who can be relied upon to reproduce the community project. And as affirmation is a precondition for fragmentation, that community fragmentation has been constant throughout the history of the profession is testament to the affirmative project’s ability to reproduce itself over time—a reproduction that shows the power the psychodynamic myth holds for all those who use the training institutes as an initiatory route down which they may enter a new professional and moral home.