Response to Discussants Lesley Caldwell and Van Dyke DeGolia

This response to commentary of Drs. Caldwell and DeGolia (this issue) looks at Winnicott’s language and a revealing case example (“String”) by way of making a place for the concept of the negative transitional object. Rather than a regression or a fixation at a presymbolic level, it views negative transitional objects such as addictions as a creative if problematic adaptation to a flawed relational surround. Winnicott’s case example suggests that he may well have been pondering similar extensions of his theory at the time of his death.     

Sandel on enhancement: A response to Van Niekerk

Michael Sandel has criticised recent developments in, and towards, the biomedical enhancement of human beings. His view is criticised by Anton A. van Niekerk in a recent issue of this journal. Van Niekerk takes Sandel to task for rejecting enhancement tout court, for advancing inconsistencies, and for regarding enhancement as a “drive for mastery”. In this paper I argue that Van Niekerk’s critique fails. After discussing what we should mean by “enhancement”, and presenting an overview of what I call “the Sandelian picture” (of enhancement), I go on to address Van Niekerk’s criticisms. The first, I argue, either begs the question or attacks a straw person. The second pays insufficient attention to things Sandel says which, once on the table, leave his “inconsistency” critique inadequately argued for. The third also rests on misunderstandings and, as such, attacks a straw person. While stopping short of defending Sandel’s position outright, and allowing that Van Niekerk makes some important critical points, I maintain the three central criticisms fall short as an argued-for critique of Sandel’s view.     

A Response to the Contributors

Abstract

In my “response to the contributors” I emphasize that I was moved to write my book in response to the question “Why are so many well-trained colleagues, young and old, having so much difficulty developing satisfying analytic practices?” To answer that question I proposed to explore my experience successfully developing and maintaining an analytic practice.

In attempting to answer the question I inadvertently stumbled upon a revolutionary (with a “small r”) answer to the problem. I discovered, in my attitudes and in my way of working in a consultation and the early phase of an analytic collaboration, a new “concrete puzzle solution” to the problem of how to help a prospective, often reluctant collaborator give analysis a “try.”

My book emphasizes my view that courses on “analyzability” and differential diagnosis are based on psychiatric rather than psychoanalytic diagnostic schema and may interfere with candidates' ability to learn how to create analytic patients.

Since I was a candidate, courses on analyzability have always seemed to me to resemble an exclusive club, deciding whom to exclude and whom to admit, rather than a procedure based on sound clinical experience. Analytic experience has demonstrated that it is not possible in a consultation to predict accurately the outcome of an analysis. To make matters worse, it is probable that an analyst whose mind is focused on the task of evaluating a prospective analysand contributes to creating an environment in which certain patients are experienced as sicker than they might otherwise be.

In spite of the fact that it is not possible in a consultation to predict accurately the outcome of an analysis, many experienced “senior” analysts believe an analyst can and should be evaluative and selective. In their discussions of the subject, they focus primarily on characteristics of the patient rather than the match.

In my book I emphasize that in a consultation there are advantages in focusing on the patient's responses to the idea of engaging in a trial of analysis. The issue of the match and the particular time in their lives are significant from my perspective. The analyst's gender, age, personality, and related state of mind may be as important in effecting the outcome of a trial as any feature of the patient's mind.

My book shifts the emphasis of the focus of inquiry in a consultation from the patient to the analytic couple. It offers a different way of teaching candidates to work with prospective collaborators.     

A Response to Monica Mookherjee

This response discusses Mookherjee’s views on plural autonomy and autonomy-promoting education, and her recognition that different cultural value systems can lead to varied responses and strategies across cultures. It considers mechanisms to counter forced marriage and argues from the standpoint of grassroots work within the Muslim community for the importance of the distinction between traditional culture and religion. It raises the issues of racism, islamophobia, and stereotyping in silencing Muslim women’s voices and reducing the space for them to argue for change within communities.