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Darren Haber, "Addiction, Accommodation, and Vulnerability in Psychoanalysis: Circles Without a Center" (Routledge, 2022)
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This episode is brought to you by Google Health. Stop chasing someone else's definition of health. What matters is what's healthy for you. Google Health offers a new kind of coach built with Gemini for effortless tracking, sleep insights and holistic coaching tailored to you. Visit googlestore.com to learn more and start a new relationship with your health. Requires Google Account, Google Health App, Internet and Google Health Premium Subscription. Features subject to change Availability and results vary. Not intended for medical purposes or works independently of Gemiini apps. Check responses for accuracy if we knew more about our sleep, what would we do differently? Would we go to bed at a consistent time or take steps to reduce interruptions to our sleep? With Sleepscore, Apple Watch measures your bedtime consistency, interruptions and sleep duration. Then every morning it combines these factors into an easy to understand score from 1 to 100 so you'll know how to take the quality of your sleep from okay to very high. Know your sleep score With Apple Watch iPhone 11 or later required welcome to
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the New Books Network welcome to New Books in Psychoanalysis. My name is Isaac DeVries, and today I am speaking with Darren Haber, who is a practicing psychoanalyst in West Los Angeles. Darren specializes in treating childhood trauma, addiction and anxiety and depression. He's published in the Los Angeles Review of Books through the American Psychoanalytic association, has numerous publications in the journal Psychoanalysis, Self in Context, and regularly blogs on Good Therapy, Psychology Today, and has a substack titled Hearing the World of Others. Today we're going to be speaking about his book Addiction, Accommodation and Vulnerability in Circles Without a Center, which was published by Rutledge. It is a book that explores the compulsions and traumas that underlie addiction. One of the unique aspects of this book is his use of intersubjective systems approaches in understanding the inspirations and challenges that arise in the psychoanalytic treatment of addiction, compulsivity, and related dissociative conditions. Which is to say that he draws on insights from his own analytic practice, his personal experience, as well as the work of Stallero, Atwood, Winnicott, and in particular Bradshaft in considering the complex ways in which addiction becomes woven into a person's life and how it interacts with other problems such as depression and anxiety, self fragmentation, and ambivalence about treatment. Another unique aspect of his book is how he creatively integrates the work of Camus, Kafka, and Beckett and other existentialists to further contemplate the dilemmas that can arise during the clinical process and in identifying his own and his patients vulnerabilities and contradictions. His book is an honest, humorous and sometimes painful account of what happens in our consulting rooms, particularly when we are working with substance abuse, with addiction and compulsions of all kinds. Addiction challenges psychoanalysts and it challenges our field of psychoanalysis with vaccine dilemmas. And so, Darren, I'm really glad to welcome you to the New Books in Psychoanalysis podcast.
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Thank you very much. Thank you for doing this and being here.
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You're welcome. So generally and historically, our specific podcast has always started with the question, to the extent that one can know one's own motivations, what motivated the writing of this book?
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Well, before I was a psychoanalyst, I had a previous semi career as a semi employed screenwriter and TV writer, especially in comedy. Part of that was caught up with my alcohol fueled fantasy life and world, which fit beautifully with Hollywood. And then in the year 2000, I stopped that, had a really good psychotherapist and kind of sobered up to the realization that I was not a good fit and ended up going back to grad school and one thing led to another and so on. But I've always loved writing and reading and the authors that I discuss in the book. And it just seemed to me that one of the things that appealed to me with intersubjective systems, those authors Donna Orange, Bob Stallero and George Atwood, is that they were also very attuned to existentialist and phenomenological literature. That whole period sort of between world wars and post war European sensibilities, philosophical and literary. And so that would, that was a big draw. And it just seemed that, you know, I kind of felt like I had found my, my people, so to speak, and it, it just seemed like a natural fit to bring in, you know, Beckett, especially Godot, and that, that sort of dry absurdist repetition seem like a good match with moments or passages of psychoanalytic treatment where everything seems both dead and hopeful in a very strange way that I think Beckett captured. I think all of these authors capture an absurdity in a very profound way. And there are other people I didn't write about the theater of the absurd. Some of those playwrights I really admire, Ionescoe and Pirandello and some of those where, you know, we seem compelled to repeat and play out drama, which for some reason or another is the reality we inhabit. Like it or not, often not. It just seemed like a good fit. So all of that kind of came together and I couldn't resist the sort of trying to bring these streams together and I guess that you could call that a sensibility. It's almost like these authors. And some of this found me in the consulting room during difficult moments where I would pause and privately reflect on moments in Kafka or Beckett or. I read those authors in. And after college, I was really into Kafka. In fact, I. I lived in Prague for a year in my 20s. And, you know, Kafka was sort of everywhere, both as a tourist in advertisements, which is kind of very crassly commercial, would have horrified him, probably, but also in just the whole living in Prague and all that. I can get into that another time. But. So, you know, and. And when you're talking about an addictive process, whether it be substances or sexual compulsivity, pornography especially, the more you talk about it, the more the minutiae emerges and the more lost and decentering the experience starts to feel and, you know, you're becoming slowly dissociated. But it's. It's all real and it's all lived experience. It's. It's a little hard to capture, which. Which again, is what draws me to some of these authors that they do capture, I think, sometimes more than our analytic literature does. So that wrote these pieces starting end of my doctoral program and then just after that, and then they were eventually collected into the book we have today.
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So you mentioned the doctoral work. It was written at the end of your doctoral work.
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It started there, yeah.
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Or started there. Sorry. And I was thinking about how deeply autobiographical this book is, in a way. It's also about your own journey and transformation, which, as I understand it, is a journey out of a family and a situation in which substance abuse had very grave consequences. Then you moved into recovery yourself and then worked in the recovery mental health field and then to some extent departed into psychoanalysis. And I'm wondering if you would say something about your own personal and professional transformation. That is, what's the story of you transforming into recovery and then into an analyst, and then into an analyst who specializes in addiction.
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That's a great question. I would just add today it's branched out from addiction, but that's always in the background because I often there is some. I'll answer your question, but just a quick footnote there. Even. Even with patients who aren't primarily where addiction isn't the. Isn't the foregrounded or, you know, issue, there is often some compulsive activity that. And I don't mean just relationally, although that's there too, quite obviously. But there might be a parent Or a sibling or an uncle or a grandparent that had a problem with gambling or drinking or whatnot. So it's. And I think a lot of modern life is very compulsive and we talk about social media and trying to get us hooked on, you know, and then sometimes in mainstream journalism people will talk about addiction in all kind of ways, positively also, like I'm addicted to this literature, this great new literature, whatever. So there's always, I don't know, there's something about the materialist world and our consumerist, you know, sensibility, late stage capitalist, whatever, combined with being human and our relationship to the, to the material. You know, there's always that tension between the psychic or the, you know, the experiential and the material and that interaction. And you know, I think a lot of, I think a lot of big tech knows this. So that's what I'm just writing about this now. You know, I find something very compulsive about working with AI. I start off with a search engine question and, you know, an hour goes by and I'm down some rabbit hole or another part of that's my personality. But to answer your question, yeah, I come from a deeply alcoholic background. And the autobiographical element I wrestle with in part because there's this rule or something in my head that, you know, this isn't about you, it's about working with patients. But one of the things that, which I think as a rule is absolutely true, of course we foreground the patient, but you know, we bring ourselves and our subjectivity into the, into the process directly, even when it's not in the foreground. And especially with something like addiction, which is so complicated and so often intense and contradictory and it's going to engage our consciousness in all kind of layered and contradictory ways. I don't see how some aspect of. I think in any analytic process. One of the things I like about intersubjective system is they talk about the inner subjective field. And again, even though the patient's experience and the exploration and understanding of that experience is in the foreground, we are bringing ourselves into the process. We are there and our subjectivity shapes. As one of my professors, teachers at ICP said, our fingerprints are everywhere. So anyway, so it just felt like addiction has influenced me in so many ways. And even if these are things I'm not talking about with patients, it's there, you know, it's shaped me and as has recovery and all of my experience, basically, I, over and over again, the addiction treatment world has kind of found Me, I really was, I've always been interested in psychology, even as a struggling film and TV writer. And when I got out of grad school, I wasn't sure what I wanted to do. I was thinking about working with maybe psychosis and people struggling with, you know, that, those, those challenges. And then I got a call from someone who worked at a fairly well known rehab center and said, hey, we need a on site residential therapist. Are you interested? And I went in and interviewed and I really liked the people. And there it was. And I think to try to keep it relatively brief, recovery gave me, I like the word disorder. I found alcoholism to be very disordering in all kinds of ways and it was chaotic. And I grew up in chaos and what I loved about recovery and I, you know, I started off in, in Al Anon. That was my first. And I've, I actually have participated in many different recovery fellowships, so all of which have been very useful. So I think the, the whole mentality or, or sensibility is very structured and very orderly, you know, and I kind of needed, when I first put the bottle away, it was very chaotic. You know, I was in a state of mental chaos and there was untreated depression and all kinds of things. And there were people I trusted who were very loving but very, you know, serious about the illness I had and that I had seen destroy lives around me growing up. And I needed someone to kind of say, okay, you're going to do this now and then you're going to do this and you're going to do A, B, C and D. And I resisted and, but eventually I tried it and it really helped. And there was a transformation. I think the recovery world gave me a container and a firm foundation to put my feet on where the earth wasn't always opening up to swallow me, you know, by, by my own doing, you know, and there's so much we're not, I, I was not conscious of contributing to my own self destruction. It's amazing. I mean that to me is one of the, the most powerful things about the, you know, I, I, I have full respect for the destructive power of addiction because, you know, it becomes so common and so ordinary. You don't even see it. You don't, you don't see that, that the house is on fire and that you're throwing matches into the, the corners. So, you know, and I just, I really like the people in the recovery treatment world when, you know, I went in for the interview and it worked out and it was a real mom and pop operation then Corporation ultimately bought it, and that's when I left. But, you know, these were people who were there to help others. And in the spirit of, you know, regardless of the, the 12 step or AA philosophy, which we can talk about later, you know, for all the pros and cons in terms of psychological suffering or that, that overlap with alcoholism, we should say they, they were loving and devoted and living. They were walking the walk themselves. And, you know, we were encouraged to not, not dump on vacations, but to be open and say, you know, we're, we're in, we're on the same boat here. You know, we, we, we, we don't pick up drugs or drink no matter what. You know, we're not here to lecture. We're here to share what has helped us. And, you know, we really tried not to be top down too much. I mean, there was some of that. We had to be in some, know, any institution or organization. There has to be somehow. But, you know, and I felt like it was part of a, a family, just like in the rooms of recovery, you know, there was a, there was a, it was this very bittersweet, you know, which I, I try to bring out in the writing as a bittersweetness because you've been through hell, but, but here you are with another chance, which I think is, is wonderful, you know, and that's not something we often hear about in the psychoanalytic. I don't know what to call it. Over sensibility. Well, I don't know what to call it, but I don't know if you want to. I mean, if, you know, you say the word spirituality and most analysts cringe, and I can understand the cringe. I have some of that too. But there is a sense that patients know when you or any analyst knows what they're saying and they've been through it. And it doesn't have to be explicit. It can be a lot of, you know, both in recovery and then in the, the treatment setting. I started in that, that openness of sharing our stories when appropriate, was encouraged. You know, a lot of the pa, we call them clients there, but would ask, you know, hey, Darren, what's your background? You know, how did you end up in all this? And, you know, I would tell them and, you know, I, I was, I was the one who was kind of too smart for his own good and, you know, brilliantly thought my way into impossible, you know, situations and, and, you know, a drink was a nice solution. You know, the solution becomes the problem. But, but in the analytic world, I guess in self psychology, there's some of that, but that it's very hard to put into words without sounding trite or corny, but just that sense of, I get it and there's hope, but it's an embodied, earned and lived hope or kind of openness. It's almost like if you've. I used to be involved in the Buddhist world just before I got sober and had a lot of great experiences there. And there was some teachers and not all of them, but there were some who had really devoted themselves and were open. And there was a kind of sort of cheerful, light but grounded openness. And some analysts have that we just don't always write about it as a. I mean, George Atwood talks about hope and the absolute importance and necessity of hope for some patients, which is a very interesting theme, but I don't know, let's give it some more thought. But anyway, so after a few years of the treatment center, I took a, you know, I was always really interested in Freud and Carl Jung and a little bit of Winnicott, whatever I could understand of him and others, and took a continuing adult continuing ed class at icp, the Institute for Contemporary Psychoanalysis, and, you know, learn more about intersubjective systems and relational theory and some of the east coast folks. Stephen Mitchell I really loved his writing. Lou Aaron Good just really opened up a whole new way of thinking about what I felt but couldn't say was happening that I was observing in the treatment. And by that point I had started a very small private practice. Some of the patients from the rehab would come to see me and others. But I felt like I was starting to hit walls in these various settings that I was working in, especially at the rehab. And I think it had to do with what I would call the systemic blocks or challenges or sort of limiting edges of our, our approach. You know, a 30 day program, you don't have a whole lot of time. You know, you really have to kind of get down to brass tacks and, you know, but in the system, as much as I like being there, there was something going on, especially with patients who came in, you know, families would kind of dump them off at the front door and say, hey, you know, do what you can in 30 days and we'll come pick them up. And what started to emerge for me is something very familiar in my own background. Again, always hard to escape is something systemic. You know, the, what we might call first the identified patient syndrome. You know, this is the problem. This, this. There were a lot, mostly young adults I Should say the patients or clients, they were mostly young adults, not all, but. But for the most part, who had had problems since adolescence. But as they shared with me, you know, I heard a much more complicated story than psychologically. I heard a very layered, complex story sometimes, which could be, you know, empathically put to the side until sobriety, some kind of sobriety was. Was established. Or sometimes that system was so intense or that, you know, my call enmeshed or whatnot, that. That sobriety was a challenge. You know, in a way, the. The person played a certain role where drinking became kind of part of that role. This is part of the absurdity of the writers. I'm just talking about where there's a kind of black absurdist comedy to it. I mean, it's very sad in a way, but the person almost has to be the problem 1. They draw the focus from other things that are going on. So it's complicated. I'm not, you know, I don't necessarily fault the treatment center. I, you know, we did good work. It's just maybe the whole model needs. Is. I don't know. There's limits to everything, isn't there? Even as one on one clinicians, we do the best we can. But addiction is such a complicated systemic problem. I came to see, and that's what really drew me into the psychoanalytic world with. With intersubjective authors because they talked about systems and inner subjectivity. And I noticed how patients who didn't always comply, quote, unquote, sometimes because they didn't want to be there, sometimes because they were scapegoated, sometimes because they had other problems that I don't think it was just misbehaving or, you know, I think there were other deeply psychological issues going on that sometimes we could address and sometimes we were. We couldn't. And I was sometimes seen as the. The pleasant, affable gadfly. We would say, wait a minute, you know, I think this might be a trauma response. I think this might be an enactment. Sometimes that was met with sympathy and okay. And sometimes it was met with too bad, you know, if they don't. If they continue to disrupt, they can't be here. And some of them couldn't. You know, some patients did need something a little more containing, which is a nicer way of saying they needed to be probably in a psychiatric unit first. And then some. Sometimes it would come back. Not always, but. And I think what I'm touching on too is what I'm seeing now in my practice and the reason I Don't consider myself solely an addiction therapist or analyst is because it's very rare that a person comes in. And that is the main issue. You know, there's usually a constellation. I hope I answered your question. I went. Going all kind of different directions, but.
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Well, there's so much. So many of the topics and themes that you were just discussing in your answer to my question really comprise the book as a whole. But I wanted to return to one of the. One of the comments you made about being in recovery programs. This. This statement you made. You're going to do this right? You're gonna. You're gonna follow suggestions. That's often in 12 step programs. One of the first questions that they ask somebody who shows up and asks for a sponsor. Are you willing to take suggestions? And when I was learning to read in college, which is really when I guess I learned to read, I had a professor who said, when you pick up a novel, I remember it was. I think it was Joyce, actually Portrait of the Artist. And she said, open to. Or maybe it was Melville. But she says, open up to the middle of the book. Like, count the pages. Go to the middle of the book and look at the middle of the book and see what the center page is and what's happening around the center page. And I have no idea if this is. Is actually good advice or if it works with all novels, but if I remember correctly, whichever novel we were reading, it worked with. And when I got your book in the mail, I opened up to the middle page in the middle chapter, and I looked to see what was going on there. And right there in the middle is. I think it's the second term in your book's title, which is Accommodation. It's a chapter on accommodation. It's chapter five, I believe. And this is the chapter where you really talk a lot about Branchaft, who seems to be the figure in the world of intersubjective psychoanalytic systems that you draw most on in understanding your own practice, but also in understanding addiction. He provides a model of thinking about addiction and compulsion. And. And so I wanted to ask you about Branshaft. You write about him in a way that feels deeply alive. He's not simply a theorist for you, but he's someone who has changed for you how suffering can be understood. And I'm wondering, how did his work point out what is missing in psychoanalysis, in your opinion? What kind of framework does he provide for you? What's it done for you in your own work, in your own understanding of working with Addiction maybe. Specifically, I could ask what is his idea of accommodation?
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Yeah, branchaft was the. The bridge for me from the. I guess psychodynamic slash recovery or CBT type modality. I know those two were always kind of coexisting to. Yeah. The psychoanalytic world. Bradshaw presented a. A way of seeing accommodation that just. It was this. It was. If he'd eavesdropped at some of my chaotic family dinners growing up, I felt like. I felt known and seen by, by Branch in a very interesting way. There was such compassion. And I think there's parallels with Winnicott, which is another author I feel very deeply connected to. But, but Bradshaw was inside the experience of accommodation as a. As a way of living and thinking and relating that is. Is as fundamental as oxygen. It's deeply unconscious. There's a phrase I return to often, you know, with. Within a system that is hostile to any fundamental differentiation. There's a great passage in his paper on accommodation, pathological accommodation, where he talks about. He has a phrase about there are whole zones of development that are cordoned off again unconsciously in order to stay in the. What did he call them? The peremptory adhesion in the system or the dictates of antiquity. These sort of unspoken commands. This hearkens back, by the way, to the systems I was starting to hear about from the patients, you know, the so called identified patients who had been airlifted into treatment usually in the middle of the night. Not literally, but kind of felt that way at times. But anyway, so, yeah, in, in the recovery world and even both. Both in the recovery rooms and also in the treatment. And there's obviously a lot of overlap there. There was talk about people pleasing or codependence or that kind of language which I never really found very satisfying. I thought there was an edge of glibness to it, not always intentional, but I thought it just skimmed the surface. And Branchaft is talking about something even more deeply rooted psychically and epistemically, where there is such a hijacking of the person's psyche that even. And by the way, Winnicott says something remarkably similar that even seasoned analysts might miss it for the first years of treatment. It is so smooth and so such a integrated part of the person's psyche. And obviously I have some of these tendencies. I don't think that's shocking to say, but I just remembered this constant tension growing up in an alcoholic family with just. Is this okay to say? Is that okay to say? What's going to get me in trouble? What's going to cause an explosion as I got older, into adolescence? What don't I give a shit about anymore? Um, and to go back to your point, because what, what came up, there were some other people who were sober in the doctoral training program, and we had a lot of discussion about accommodation. And is there such a thing as healing or good accommodation if you're trying to get off of, say, you know, shooting heroin or, you know, chronic alcoholism or, you know, is it, you know, does that go against analytic principles? I, I, you know, you're gonna do. This felt like a, a sunnier, healthier version of what I grew up with. So it was very familiar, but very different at the same time. It was pointing me, I wanted to be like the people I was getting to know who were successful and kind and good humored and very imperfect. But we're open about such imperfections, you know, that I think that was a real draw to that world, the openness, the sort of de. Shaming of what was so shameful growing up. And, you know, when I'm working with patients, there's often such deep shame about what they almost can't help, you know, that no win again, that darkly absurdist tension. And I'm going to go do the thing that gives me a little bit of relief, but then I end up feeling bad that I did that, that I looked at the porn or scored the drugs or got drunk and did something really dumb or, you know, got a dui, whatever it is. So it just seemed to me that the way Branshaft captured
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the
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systemic rootedness of the problem, that this is occurring in a deeply, that these principles of comply or die are in the wallpaper of the home that this is occurring in. And then more broadly, there's questions of do we accommodate our theories, do we accommodate our analysts, or are. I mean, in some ways we all have to accommodate time and, you know, capitalism and all kinds of, you know, in a relationship, you know, it's, we have to sort of be flexible. But where, where is the. I think there's a very, there's a lot of ambiguity. You know, there, there were some, there were some clients in the rehab who, first they were too rebellious and then they were too compliant. They're just trying to be pleasing. You know, these folks couldn't win. But I started to think, I don't think they know another way. And I think Branch understood just how fundamentally degenerative, you know, and rigid these systems are and how much that inhibits growth, often very painfully. And he writes about people who And I see this with patients all the time, even ones that aren't necessarily sober or have addiction. But just the challenge is when good things happen, there's a sort of very painful emergence of what I guess Staller would call the repetitive transference, where that critical. He would call it organizing principle. We could call it the inner critic or whatever arises to say, do you really deserve this? Are you sure you've earned this? Do you. You know, that that's how. That's how demanding and adherent. And, you know, we could even say effectively tyrannical those early systems can be, you know, and then you get into, well, is 12 step the same way, you know, And I. I've worked with people who dare not deviate, you know, one iota from every sentence of this or that literature. And, you know, that on the one hand it saved them and it's keeping them alive, which is wonderful, you know, would never. Would never. I mean, there's no. I think that's terrific. And they help people and so on. But then when it comes to relationships, to areas where it's not black and white, where it's not just about not drinking or it's about relating to another human being, it gets. It gets difficult because the rule book isn't as. Isn't as clear. And that's what also pulled me into psychoanalytic thought and study.
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Right. Because they're still living in a structure of accommodation.
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Right.
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Yeah. I mean, when I was reading your book and trying to understand this notion of accommodation, let me ask you if I've got this right. The way that I understood it was that there is, for addicts and alcoholics, a history of. It really is a kind of do or die sense that very early on the message is, I've got to put away all of my thoughts and feelings, my impulses, in order to accommodate the caregiver's thoughts, feelings, impulses and experiences. I have to put myself away. I have to set my life up and set my being up in a way that takes care of the feelings of the person who's supposed to be taking care of me. Is that the basic idea?
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That sounds right, Yeah. I wouldn't necessarily say every single one, but there's some.
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This is a deep structure, though, that you're finding in. Yeah, because when I thought about it that way, it made a lot of sense to me because then it's like, well, I've had a. I've had enough of this. I would like to find something that takes care of my feelings and certainly drugs and Alcohol do that? Not, not finally, not ultimately, but for the next hour or for the next six hours, you know, until I need to score another drink or another drug or another hit or another sex outing or whatever. Right. It's, it's, it's that deep system of accommodation. So it sounds to me like what you are doing in this book is really theorizing addiction as pathological accommodation. Does that sound right?
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That sounds right. And that, do you mean that the addictive pattern or the compulsive way of living is itself sort of a, it's a respite, but also has an accommodative flavor and accommodating the substance or the consumption, Is that what you mean? Or are you talking about that, that
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you get that that one begins to accommodate the substance also. But also that the. But, but that one finds a way of being accommodated by the substance. The substance takes care of my feelings. The alcohol takes care of my feelings. Because I never had anyone to take care of my feelings. No one even taught me how to take care of my feelings or my thoughts or my impulses or my experiences because I was so busy accommodating someone else's thoughts and feelings and experiences.
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That sounds right. Yes. And also there's the stigmatization, I think. What does it Stallaro say for some patients, you know, emotionality itself comes to be stigmatized.
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Yeah. It becomes a do or die situation for a lot of these people. Yeah. I mean, I, I, I think that there is something really there in addiction and alcoholism that is not quite there in other pathologies. That is like, I cannot give this up. I cannot give this up. To give this up is to risk multiple kinds of deaths. It's death of myself. It's death of my relationship. It's death of my, you know, I, I need this to continue living. If I give this up, I'm going to die. Which of course is like, not true. But it's like to, to keep doing this is to risk death. But, but I wanted to, I wanted to circle back then to something about, something around what you were saying about the cringe around spirituality. Here's how I would put it within the context of accommodation that we're talking about right now, that 12 step programs or recovery programs place an enormous amount of emphasis on surrender. There's this notion of surrender to a higher power. There's the surrender to the group. There's the surrender to the reality of addiction. And in your work, you've written extensively, in this book, you're writing extensively about accommodation and the ways that people adapt themselves to external demands. I'm wondering how you would distinguish between a surrender or an accommodation that's liberating versus a surrender that risks becoming another form of accommodation.
- [41:25]
A
That's a great question. I think in any substantive long term relationship that is sort of structurally lived, including in psychoanalysis, there is that question of when is this sort of surrender for them, but for me too, in a beneficial way, or when is it disproportionately for the other? And I would say in the beginning with patients who are, you know, like some people come in and say, well, let me back up. I think what you're talking about is one reason why the harm reduction movement, which a colleague of mine, Bradley Jones, knows a lot about, along with Andrew Tatarsky and Barbara Rothschild and other very seasoned clinicians. But I think that AA and other fellowships and 12 step programs can take a very black and white view. And you can argue about the utility of that view and the necessity in some cases warranted, but maybe not in all cases. You have a young person who's 18 or 19. There are emerging models of treatment where maybe let's experiment with pot a little bit or, or soft, you know, even, you know, what is less harmful and not totally immediately self destruct, you know, what, is there some manageable middle ground? Is there a gray area for some people? Is everybody is. Does it have to be total abstinence, total surrender, maybe even total compliance? And I really hope not. I mean, I don't, I've never met, even in the rooms or in the treatment where I've never met saints. So principles and lived experience are often quite different. I'm not a perfect 12 stepper. I've diverged. There are some times where when it came to relationships, I've had to change mentors because I was told, now you're going to do this not in terms of not drinking or using, but in terms of your family or with other situations that I felt were to do that, where to totally surrender would be exploitive to myself. So there had to be pushback and that was very difficult. And there was a lot of differentiation and a lot of tension between the sort of, you know, recovery, 12 step, you know, there's kind of a, you know, your feelings do these actions kind of thing that's a little harsh, but. Or your feelings don't matter, which could be sometimes true, again, especially in the earlier days. But that also felt very limiting and very constrictive, especially when you're talking about relating and developmental experience and expansiveness you know, I mean, we are feeling beings. I don't, you know, in what way does that principle or does that slogan, how can that be useful? How can it not become over a sustained period of time, a, you know, a set of handcuffs in a way, you know, and a lot of the patients I work with now are wrestling with that because they again, they have a well established track record and Persona and community in the recovery world, which again, which is great, but they're very isolated, haven't had a lot of success romantically or in intimate relationships or their career is stalled and, you know, some risks need to be taken, you know, and then there are other, there are other things happening. You know, I think there are some repetitions of systemic issues like the branch Aftian dictates that they might still be following. And where is it okay to differentiate from even recovery in a non destructive way? Right. What's an okay risk to take?
- [45:41]
B
Yeah, so I think that we're talking about this structure of accommodation or this dynamic of accommodation as a deep structure in addiction and compulsive processes. But I think also in your book you extend this in your own experience to the experience of training at a psychoanalytic institute. And also within this particular chapter, the fifth chapter, what struck me is that accommodation seems to happen not only in childhood, but also in analytic training. Candidates often learn implicitly what can and cannot be thought, said, felt. And I'm wondering if you would like to speak to that about the. Speak to the experience of accommodation in psychoanalysis and psychoanalytic training and accommodation to theoretical systems. And if you could address psychoanalytic candidates and psychoanalytic faculty on this issue of accommodation, what would you say? How did it play out in your experience?
- [47:00]
A
I think that's great. That's the constant evolution of the analyst. I think, I think about Bian, who told his students, you know, whatever you do, don't become a beonian, you know, find your own way.
- [47:17]
B
It's like Nietzsche, don't become a Nietzschean.
- [47:20]
A
Exactly. Yeah. So, you know, the phrase that keeps that I, that haunts me from branchaft is, you know, these systemic, these systemic ways of being and relating that imprison and protect. So I think our theories too, imprison and protect and guide. And you know, there were times where in a lot of the literature and case studies of working with patients, there were challenges. But overall the underlining attitude or assumption was that once the patient feels deeply understood, reflected, attuned to, you know, once the analyst becomes, you know, a sibling in the Same existential darkness, so to speak. Things open up, things settle. And with my very first patient, the one I talk about in that Branch chapter, at least the way I was doing it. And I was get. I was getting guidance from a supervisor and other teachers at the institute who were, I guess, more self. Psychologically oriented. A lot of it was helpful. But there were times where the patient, I think, was so entrenched in his ways of, oh, here's where I feel good. He talked about that a lot. Where can I feel good? I want to feel good. I always feel bad. You know, that approach seemed at times limited. You know, he had had a very. I think of fathers a lot. And I think the image of the benevolent versus sort of more malignant father is sort of another background theme through the book. You know, I talk about Kafka and his father in the Kafka chapter and all that. And I think I saw Branchaft as a. As a very benevolent, wise, almost Yoda like guide. But the understanding and exploration I was trying to engage with this patient. I kept hitting walls. There was a concreteness and okay, I'm suffering. What do I do about it? And I see this a lot with addiction or, you know, there's. There's maybe preverbal or deeply unconscious trauma that affects the ability to, you know, develop or engage a sustained relational field or field of inquiry or reflection. There's, you know, there's a kind of a stubborn. I mean, Branch talks about that too, in a way. There were times where this patient and others who wrestle with this kind of compulsivity want another blueprint, but then they immediately rebel against it. And Branch talks a lot about rebellion, which turns out to be kind of a superficial rebellion. You know, there's a love hate with the accommodating or the caregiver or transference caregiver who's. Who seems to be asking for accommodation. So I think my patient was deeply, deeply ambivalent to where there were times he was fighting against even being there. You know, when we got into a period where he was missing or late or wanted to stop and you know, there was a lot of chaos to work through. And then even when he was there. So, you know, there were times where he felt understood. There are times where that pull to, you know, what, what Freud talked about, that motor activity, you know, was. Was very powerful and very strong that I, you know, I actually found a little success briefly when I recommended he try Al Anon because he had a partner who was alcoholic, as I write about. And that helped for a bit, but then he. He didn't really care for that. He said it was too depressing, and that didn't really work. And that's okay. There were other things, but he. He needed more than. What, more of a structure or container because, you know, he was living so chaotically. But, you know, I found in the years since the book, and I don't want to get too much into it, but that, you know, one of the reasons I've been returning to classical theory or those that wrote about the classical theorists, you know, sort of more in the object relations school, Winnicott and others, Michael Eigen beyond and so on, is they talk about this breakdown of being able to. To think and reflect, that there's something semi. There's a semi psychosis in a chaotic psyche that has trouble putting thoughts and words together. You know, there's. There's. Do you know what I'm saying? Do you? Yeah.
- [52:34]
B
Yeah, I absolutely do. I know it in the experience of working with alcoholics, and I also know it from the experience of. Well, what's ironic about drinking to the extent that many alcoholics do is that they actually drink to such an extent that they break down their thinking when it's like a night out is successful. To the extent that you drink to such an extent that you have breakdown of thinking and you have a breakdown of body and you have a breakdown of speech. Right? It's like.
- [53:12]
A
Yeah, literally.
- [53:14]
B
Yeah, right. It's like. It's like. Actually, it's a defense against thinking and against speaking in. In a lot of ways. But in the treatment itself with alcoholics, it. It shows up in a profound way because it. The tran. My experience. And I. I want to ask you about this. If, If. If it's also your experience that there's something in the treatment of alcoholics and addicts that. That especially moves towards a deadness and a breakdown. And I. I want to. I want to return to that, but I. I want to note that we're like. We're at time, okay? And there's, like, so much in this book that we have. I mean, we've like, covered like, one tenth of it, and there's like, all this stuff about transference and countertransference and vulnerability and childhood and self. And. I mean, there's just so much in here that I want to recommend and that we're not going to be able to get to. So. But I want to. I want to ask one more question that is on the theme of what we were just talking about, this breakdown and this deadness when. So let me set the question up this way. When I had a patient recently who he was like, two months into treatment, and he says to me, I don't feel like we're getting anywhere. I don't know where we're going. How long is this going to take? And I said, well, think of it this way. Would you like a metaphor or analogy? And he says, yeah, give me a metaphor and analogy. And I said, think of it this way. Can you imagine, like, taking a long boat trip across the ocean? And he says, yeah. And I said, imagine getting on a boat and you leave New York harbor, and as you're sailing out into the Atlantic, you. You look back and you see the coastline. And. And then, you know, 10 hours later, you wake up and all you see around you is just water, sky, and some wind. And for the next six hours, the next 12 hours, it's just water, sky and wind. And for the next day, it's just water, sky and wind. And every once in a while you get a little bit of rain, but it's mostly water, sky and wind. Water, sky and wind. Water, sky and wind. And it seems like you're going absolutely nowhere. You're just. It all looks the same. There seems to be no movement. You can't tell where you are. And you just see the same thing over and over again, which is water, sky, and wind. And then one day, all of a sudden, you see land, and it looks just like the New York harbor. But as you get closer, you realize that actually you've arrived on a different continent, you've arrived in Spain, and there's a different language, there's different food, there's different customs, there's different buildings. All you've done is, like, sit on a ship. And it feels like it's just water, wind, and sky for weeks, months, years. And yet somehow you arrive at a different continent. And when I was reading chapter one is this chapter called Yearning for Godot, which is about this, you and the patient waiting for something, some fantasy of rescue or cure. It's about how psychoanalytic work with generally, but also with addicts and alcoholics moves through a kind of repetitive longing toward a more shared vulnerability in human relatedness. And the question I have that I'd like to close on is with addictions and alcoholism, which is so repetitive, and then the treatment breaks down into repetitive deadlocks, into deadness and non movement. How does circularity and repetition become movement? Because this is also, I think, what they say to a lot of addicts. That stop moving. Stop. Stop going into action. Stop moving. Hold on. Because if you can stop moving. If you can just stay put, that will turn into movement. And this first chapter feels deeply concerned with the tension between repetition and development. People are waiting for what never arrives. And yet something really meaningful still emerges in the waiting itself. So I want to ask you in closing, what transforms waiting from dead repetition into a living analytic process, both in psychoanalysis and in recovery?
- [58:09]
A
It's a great question and I love your metaphor of the New York harbor actually being a completely new country altogether. That's great. I might have to borrow that. I'll give credit when appropriate.
- [58:23]
B
I think I might have gotten it from Paul Geltner or some version of it from Paul Geltner. I think he talks about driving across the country and it's just like, just cornfields throughout all of middle America.
- [58:34]
A
But holy smokes, here we are. Yeah, I'm going to tie your, the question to something you, you said, and I like the way you said it a little bit ago about, ah, here's the drink. You know, I can relax, I can feel. I'm allowed to, you know, I feel. And I can feel good. I think a lot of what happens is there's a seduction or what the philosopher Wittgenstein calls bewitchment, in that we start to have expectations of other things that can give us the ah. That's a clinical term, the ah, maybe related to the O and beyond. I have no idea. Probably not. Probably not. But I think what happened, and it's a very. There's a lot of ways to answer your question, but just to try to keep it all intact here, I think the patient starts to see the analyst as the quote, unquote, drink or drug. You know, what do I do? You know, how do I. I mean, I often have patients who come in who are in trouble with their partners because of pornography or other compulsive sexual behavior. And they're like, I feel so ashamed. And it's, it's like, how do I stop it? And how do I get rid of the shame? And just that language, right, how do I get rid of it? Is sort of the ideology of this whole branch aft in self canceling that we're talking about, you know, and end of addiction.
- [60:13]
B
And. Yeah, how do I.
- [60:15]
A
Here's how you get rid of it. Do this.
- [60:17]
B
Right? Drink this.
- [60:18]
A
And I love your water, sky and wind. Because actually, and some of this comes through analysis for me, and some of this comes through studying and reading, and some of it comes through recovery and Some of it comes through meditation. Each day is actually a little different. We just don't notice it and we don't notice the difference of the other right before us. And I think what happens is, for patients is there's a profound disappointment, you know, in that play, that classic play by Beckett. It's very funny, but there's a lot of sadness and rage and abandonment. I mean, these two guys are abandoned by Godot, essentially, and they're just kind of waiting. And in Beckett's life, I write about this, he longed for his father against the very critical mother, who's a lot like Pozzo, kind of a slave driver. And they beloved the dad, but the dad was an alcoholic. So anyway, there was tension there and he and his brother would hide under the table for mom waiting for dad to come home and lighten the mood. And dad a lot of times just wouldn't come because he was at the bar. So there's this sense of patient comes in and they're suffering and semi conscious or even unconscious of all that suffering. There's so much pain that has to be slowly, diligently permitted to emerge, you know, and I don't, I don't see my job as to fix or change anyone directly. I can't. That, that's like, that's, that's almost ludicrously egotistical. What I can do is try to facilitate an opportunity, an engagement, an invitation for the person to engage in a process where there's water, sky and wind for a long time and then something starts to emerge and it's them. And it's not a quick fix and it's not a, ah, within, you know, 10 or 15 minutes or, you know, it's, it's a presence. But in being present, we have to let go of the past. And there's a lot of grief in that. There's a lot of sadness in that. There's a lot of difficulty, expressions of self, experience and, and feeling that have never been permitted, you know, because there's that prohibition. And also there's a lot of anger at the analyst, a lot of transferential anger. You're not, oh, so you're not going to be what I thought you were. Even if we might see it as, you know, I don't have a magic wand and oh, you know, you want me to, you know, we can get defensive about that and some analysts will say, oh, I don't have a magic wand, I can't cure you. And maybe that's just the thing to say, or maybe there's a way of communicating it with certain patients. At times it becomes more empathically holding. But I think we, you know, we. We become the potential Godot in the. What George Atwood called the anti Godot. We're going to disappoint them again. And I think some of the deadness is a function of the patient's disavow or dissociation of these very intense feelings, including anger, rage at the analyst, and maybe our own discomfort with the fact that this is going to be long, slow, painful and very unsexy. You know, it's not. It's not going to be the sexy website where there's excitement and orgasm. You know, this is going to be water, sky and wind. And it might feel incredibly boring, but what can we do? This is. We're all siblings in the same existential, you know, rolling hills and flatness of life. Sometimes it is, you know, But I love that idea of what did they say in Alan? Don't just do something, sit there. You know, and that's so counterintuitive in so many ways. But.
- [64:10]
B
But I love what you said, that especially against the backdrop of accommodation, what emerges in sitting there is the self. You get yourself back, which is in a lot of ways, I think, really what recovery is. What does one recover? One recovers their self.
- [64:31]
A
Yeah. And a self that is valued in that Winnicottian caregiver's face is the first mirror an infant sees. They see a gleam of that developmental recognition, dare I say, affection, tenderness, love, and other cringy words, but just a full embodied presence of recognizing that that is a good thing, that. That that self is welcome, inherently worthy.
- [65:02]
B
Before we jump off the phone, what are you working on? What's next?
- [65:07]
A
I just turned in my manuscript for a book on Wittgenstein language and psychoanalytic process, especially around dissociation and compulsion and how language both facilitates and challenges our dialogues and words that we seem to have an agreement on, or phrases or concepts and so on, or beliefs that actually are very different that slowly emerge in the dialogue where there's much more of a difference than first meets the eye. And then how do we work our way out of beliefs that maybe undermine the process just in the ways you and I have been talking about? There's an accommodation to deadening, to the devaluing of sharing affect, experience, or privileging of concept, or you could almost call it a hierarchical belief structure that's monolithic or rigid and that words become very powerful, almost totemic. And I think the challenge for us can be a more subtle seduction of theory and language in ways that it all sounds very doable and smooth and understandable. And we got this and then we're with the patient and nothing's working.
- [66:33]
B
And when can we look forward to that?
- [66:35]
A
I think it's going to be later this year.
- [66:37]
B
Amazing.
- [66:38]
A
Yeah. But man, thank you so much. This has been so much fun. I've really enjoyed getting to know you and your time and attention and questions, and it's been a very rewarding dialogue.
- [66:50]
B
Well, it has been my pleasure and it was my pleasure to spend time with your book, and I highly recommend it. And so thank you very much also for making time to be on the channel and until next time, and we'll talk to you soon.
- [67:05]
A
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- [67:13]
B
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- [67:15]
A
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B
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- [67:19]
A
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