by etta Saxe, ph.D.
IN A WHITE COAT: A FALSE
SELF FOR PSYCHOANALYSIS
purpose of this panel was to build on Marvin Hyman’s
chapter, “Why Psychoanalysis Is Not a Health-Care
Profession” in Kaley, Eagle and Wolitzkey, Psychoanalytic
Therapy as Health Care and to extend to practice,
thinking about psychoanalysis as other than health care.
on our belief that the associational flow and context of
material is most critical in understanding psychoanalytic
process, two consecutive associational process hours and a
telephone call were presented. The panelists used this
material as a grounding and take-off point for their
of the more usual discussion of such material focusing on what
the analysand is communicating or trying to communicate from
the point of view of different listeners/theories and what
proper technique would be, the discussants elaborated on the
principles and guidelines each holds for herself about her
place in the psychoanalytic encounter, the essential nature of
the psychoanalytic enterprise, the aims of the encounter, the
context and details of how she listens and processes, the
ethical imperatives she experiences, and her self-assigned
tasks or activities, including those activities
which she abdicates and prohibits herself in the service of
space makes it impossible to include the associational process
material within this summary, those portions of the
panelists’ discussions specifically related to the presented
associational process will not be emphasized/summarized.
Rather, focus will be on the more general aspects of
the panelists’ perspectives on the psychoanalytic situation
as other than health-care and on the panelists’ definitions
of psychoanalysis as other than health-care.
Etta Gluckstein Saxe, panel chair, began her introductory
remarks with a review of Dr. Hyman’s article.
In reviewing many of the contrasts he elaborated
between psychoanalysis and health-care activities, she placed
her emphasis on those she considers to be current issues and
topics within psychoanalysis.
This review set the stage for the discussants to
elaborate their own contrasts between psychoanalysis and
Saxe offered the view that psychoanalysis is not now and never
has been a health-care profession, although the creator of the
discipline was a physician—a physician who, while earning
his living through the profession into which he was
credentialed, came to discover those processes he called
unconscious and develop a method of inquiry, called free
Saxe asserted that there is much in Freud’s writings to
suggest that he himself was of at least two minds as to where
to locate psychoanalysis and whether to locate it as part of
At times Freud describes psychoanalysis as a method of
inquiry/research into the psychical or, as Barnaby Barrett
describes it, a discipline of inquiry.
At other times Freud suggests psychoanalysis to be a
set of discovered facts about pathology, etiology, diagnosis
and treatment, in the codifying tradition that Fenichel
attempts to follow in The
Psychoanalytic Theory of Neurosis.
his book about the everyday manifestations of unconscious
processes and dynamics, Freud framed these processes as
psychopathology, raising the interesting dilemma that those
very processes which he and most psychoanalytic thinkers tend
to agree are ubiquitous and one critical essence of our
humanity are simultaneously defined as “sick” processes to
be eliminated, i.e.,
In holding fast to the view that psychoanalysis is a
we present ourselves with the dilemma of attempting to cure
and eliminate this essence of our humanity.
Johanna Krout Tabin began her presentation, “Psychoanalytic
Process and Freedom,” with the motto she indicated she often
quotes with analysands. “I am a person.
Nothing human is alien to me,” which comes from
Terence 100 b.c.,
from a translated play, “The Self-Tormentor” by Meander,
She elaborated later that, in her mind, “pathology is
a synonym for what is both not understood and disapproved
of,” suggesting that a model of pathology and cure reflects
a breach of this motto and reflects a way of thinking that
makes alien the experience of the other through objectifying
Tabin went on to consider the relationship between
psychoanalysis and inner freedom.
She prefers this perspective to using a medical model
of symptom and cure.
Regarding symptoms as behavior which is not understood
nor approved of, she reminded the audience that psychoanalysis
is about understanding, not making judgments of others.
goals of psychoanalysis in Dr. Tabin’s view, are to achieve
choice rather than to feel compelled or inhibited, as well as
to make sense to oneself.
To achieve these goals, the analytic relationship must
provide psychic safety for exploring what seems “wrong”
according to the analysand’s perspective.
Tabin’s model is a developmental one. Contrasting this
developmental model and medical models, Dr.Tabin noted that
the medical model is tempting because pain motivates people to
enter into analysis.
The trouble with the medical model is its focus on the
lacks in the other person, demeaning the position of the
The purpose in such models then becomes correcting the
person’s defects, automatically making the helpful analyst a
Tabin went on to explain that our capacity
to understand each other comes from our “shared
treasury of emotions,” as Isaac Bashevis Singer terms it,
and in our traversing similar developmental terrain in
organizing ourselves into unique individuals.
Analyst and analysand share a common humanity and
This serves as the basis for the analyst joining the
analysand on his/her voyage of discovery in a manner that is
not hierarchical and is always, first and foremost cognizant
of the analyst’s obligation to be respectful of the
individuality of the analysand and the analysand’s
Dr. Tabin, the purpose of analysis is to take a voyage of self
discovery for the analysand and the analyst’s purpose is to
join the analysand on this voyage by offering concentration,
with the analysand, on aspects of the analysand’s ways of
being that produce incoherence from the analysand’s point of
The analyst has no magical power for which the
analysand must pay.
The analysand pays for the time and energy of another
person who is willing to set aside personal interests as much
as possible and to be concerned with the analysand’s
purposes, thoughts and feelings in the analysand’s
voyage of self discovery. Psychoanalysis is the most
respectful possible of another’s
We assume we can learn together.
The analyst offers a sensitivity developed through
self-analysis and experience working with others while the
analysand brings unique experience and final authority about
Tabin finds that, offered this developmental model, most
people seem to understand that psychic pain results from inner
Often, they must nonetheless learn to trust that, in
the presence of the analyst, they can safely start to
understand themselves—and that they are capable of doing so.
They can become “psychologically minded,” i.e.,
reveal a self-observing part of the ego.
preamble to psychoanalysis, as it is often described,
need not and should not be an indication for the analyst to
take over the direction of the treatment. The analyst in
standing for the possibility of
inner coherence helps sustain, rather than directs, the
Tabin’s developmental model includes the unevenness of all
Early mental structure can cause as formidable an
imprisonment as windowless concrete walls.
To further the goal of the inner freedom,
psychoanalysis engages the ego in the sense of the person’s
freest energies at the time.
Dr. Tabin finds that inner harmony, outer competence,
self trust and permission for spontaneous joy occur naturally
as someone learns that the strictures of early patterning are
now a choice, not a destiny.
Dr. Tabin, as analyst, this is not a value-free situation.
When an analysand achieves significantly greater
self-coherence, sense of personal competence, and increased
ability to enjoy life, the analyst, as a feeling human being,
cannot help being pleased and
has the right to feel so; but that is not to say the
analyst should define an analysand’s progress. The analysand
is the one to determine when the unconscious elements are
disentangled enough for the analysand’s purposes.
Susan Gendein-Marshall presented a paper jointly written with
Dr. Marvin Hyman, “No White Coat: Joyfully Bearing the
Uncertain Truth of Psychoanalysis.”
They put forward the idea that it is the contractual
context in which the psychoanalytic work takes place that
makes possible a process of inquiry and discovery for analyst
context is introduced to the analysand in the early part of
the work, through the analyst’s communications about the
The two participants thus come to agree that the
analysand is not a victim of forces beyond the analysand’s
control, including illness to be cured.
The analysand is made aware that she/he is, rather,
pursuing hidden agendas alternative to those in awareness and
that these agendas are the motivational factors in the
discontinuities in his/her life which are the “problems”
for which consultation is sought. Given this
conceptualization, analyst and analysand agree that: it would
be most useful to know consciously these hidden agendas which
that, through the associative method, they will work as
collaborators in a process of inquiry and discovery;
that all thoughts that come to mind, including reports of
misery and distress, will be listened to as communicative
associations from the unconscious. Contrary to any
health-care perspective, the collaborators consider how the
analysand’s experiences of discomfort and distress,
including the manifest reasons for which consultation is
sought, represent a very clever unconscious
“solution” to the “problem” of how to
simultaneous objectives in living one’s psychic life.
the analyst, this means assuming a listening stance wherein
the analysand’s verbalizations are taken as associative
communications from the unconscious
with emphasis on process rather than outcome.
Psychoanalytic discourse is poetic language; it is dynamic and
multi-dimensional. Associative communications from the
unconscious are subject to different grammatical rules than
ordinary discourse since, as semiotic process, forms and
meanings are created out of the living matter of an
individual’s narrative or manifest associations.
What is expressed and ultimately understood by the
participants is substantially greater than some measurable
piece of information, whether about “etiology” or anything
else, and new and expanded ways of thinking and experiencing,
informing, forming and reforming the self are opened up
through the process of “talking” together. In this view
meaning, not cure, is the essence of the enterprise.
model of the analytic work requires that the analysand be
perceived as a fully functioning, capable and responsible
individual, a collaborator in the work and not a subject or
patient to be acted upon, directed, or in need of our care
rather than attention.
Such a person is seen as being free to do and act as
people do and to live with the consequences of such action,
including the choice of using the process to alter the agendas
that motivate life. While the analyst can and should analyze
the choices made in this regard, there is no way a choice can
be forced on the analysand and the process requires that the
analyst not do so.
the process itself, belief must be suspended by both
participants, especially the analyst, that the matters being
dealt with are matters of objective fact or truth. Belief must
rather be held that representational language, imagery,
ambience and evocations contain the psychic truths of any
moment and that only associations to be subjected to the
deciphering work are being considered.
For this work to proceed the analyst and analysand must
take a stance that no associations are privileged and none are
judged. What ensues is a quality of open-mindedness that
resists value judgments and foregone conclusions, as in
Fenichel’s encyclopedic compendium of symptom-dynamics
correspondence and welcomes with open arms all associational
material that might emerge.
This is the position of neutrality often mistaken in
the literature for chilly aloofness.
The analysand’s task of associating freely is
facilitated by this neutrality. The analyst’s abandonment of
the judgmental/diagnosing/etiological thinking of the
health-care model is necessary for maintaining this
neutrality, which privileges no association by judgments of
any kind, including healthy and sick.
position also requires a restraint on action and words as
actions that would violate the agreed upon deciphering
process, which is called abstinence.
Abstinence requires that the analyst be honest and
humble about herself and the objectives of the analysis and
not assume a stance of superior knowledge of the analysand’s
mind as occurs within the framework of a health-care model.
This position also implies things the analyst is to do which
differentiate the analyzing process from treatment and methods
within a health-care model.
order for more full and precise meanings to emerge, the
analyst must hold firmly to the positions of neutrality and
abstinence. When not acted upon, temptations to depart from
the way of thinking and working elaborated in this
paper/perspective, can and often do provide useful information
about forms and processes of communication and as
associations, add to the making of meaning and the
collaborative understandings emerging in the work.
is an emphasis on process rather than outcome within this
The outcome is left in the hands/mind of the analysand.
While accepting the limits of the analyst’s influence can be
humbling for the analyst, it also frees the analyst of
responsibilities that are impossible to fulfill and allows the
analyst to focus attention on the deciphering work, seeking
knowledge of unconscious beliefs/agendas. Acceptance
of limitations enhances the work and helps the analyst
to find satisfaction in the analyzing process itself, rather
than in outcome/cure, the focus of health-care models.
summary of the “White Coat” panel discussion, which was
first presented at the 2000 Spring Meeting of Division 39, was
jointly written by the panel participants, Susan
Marvin Hyman, Ph.D., Etta Gluckstein Saxe, Ph.D.,
and Johanna Krout Tabin, Ph.D.