Psychoanalysis On and Off the Couch

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From Reacting to Reflecting: "How Psychoanalysis Made Us Better Surgeons" with Mauro Vasella, MD and Flavio Vasella, MD, PhD (Zurich)
"I have had quite some reactions to the article [on their psychoanalyses]. I was also telling Mauro and my colleagues that out of quite a number of articles I've published on maybe more pressing issues in the field of cancer research, for example, brain tumor research that I've spent quite some time with, I think it's actually the article [on psychoanalysis] that probably prompted the most reactions, at least in my personal surroundings, and the reactions have been overwhelmingly positive. So colleagues are very interested. They often ask questions about psychoanalysis, quite specifically, how it works, how it contributed, and also complemented the article in the sense that it was something that was quite outside of the box, so outside of the typical surgical publication.” - FV "How can we reach surgeons? How can we make this interesting and attractive for them to even consider? I think most surgeons will be very performance-driven people, and I think that it goes hand in hand that that type of person will seek ways to improve themselves, but probably more in a technical way. Let's say they want to get faster in their operations. They want to get more skillful. They want to do more complicated surgeries. So there's a lot about self improvement in that you exercise until you master something. And I think that analogy with sports was our way of saying, hey, you know, this is actually pretty cool. You can compare yourself to professional athletes, in terms of self improvement, and this is actually one way you can get there, how you can improve. At the same time, it was also important for us to acknowledge that it's not for everyone so we also mentioned alternatives, of course." - MV Episode Description: Mauro and Flavio begin by describing the encouragement they received from their father to pursue personal analysis "to explore our unconscious minds for a lighter life and less emotional baggage." They share their psychoanalytic journeys and give examples of how their greater capacity to reflect instead of react has led to improved surgical patient outcomes. They also describe collegial tensions that were more clearly addressed through their ability to authentically know how they felt. They recommend that like elite athletes who have sports psychologists to address obstacles to their performances, so might surgeons appreciate the utility of psychoanalysis and other measures to improve their clinical attunement. Mauro concludes "Everyone has their baggage - don't be afraid to look at it and to understand what's going on. It's worth it." Our Guests: Flavio Vasella, MD PhD, is a junior attending neurosurgeon at the University Hospital Zurich, with a clinical and research focus on neurosurgical oncology. He earned his PhD in Molecular Life Sciences at the University of Zurich, where his research explored genome editing strategies in primary brain tumors. His primary academic interests include translational and clinical neuro-oncology as well as surgical education. Mauro Vasella, MD, is a board-certified plastic surgeon with multiple years of clinical experience specializing in reconstructive surgery. He is affiliated with the University Hospital Zurich in Switzerland and the Royal Melbourne Hospital in Australia and has held positions as a fellow and attending surgeon. His practice and research field focuses on regenerative-reconstructive surgery and burn injuries. Recommended Readings: FV - Paul Kalanithi – When Breath Becomes Air This memoir by a neurosurgeon-turned-patient is a poetic and piercing meditation on mortality, identity, and the transition from doctor to patient. It explores the tension between the analytical and emotional mind (somewhat paralleling the internal work of psychoanalysis) and offers profound insight into the humanity at the core of medical practice. Bill George – True North: Discover Your Authentic Leadership This book presents a leadership philosophy rooted in self-inquiry, values, and life stories. True North emphasizes that effective leadership comes from understanding your life narrative and using that insight to lead with integrity and resilience. True North challenges leaders to cultivate authenticity by exploring their internal landscape. While the book focuses on leadership in a business context, it offers a compelling, practical perspective for medical professionals as well. Atul Gawande – Complications: A Surgeon’s Notes on an Imperfect Science Gawande offers a candid look at the uncertainties, dilemmas, and emotional burdens of being a surgeon. His reflection on fallibility and decision-making underlines the importance of non-technical skills and the internal work required to become not just competent, but humanely attuned, in medicine. The impact of nontechnical skills on technical performance in surgery: a systematic review. Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. J Am Coll Surg.2012 This systematic review analyzed 28 studies linking surgeons’ non-technical skills—such as teamwork, situational awareness, and stress management to actual technical performance in the operating room. It found evidence that effective NTS positively affects outcomes, while fatigue and communication failures contribute to technical errors. MV - The Art of Loving – Erich Fromm Realizing the simple but somehow not always obvious fact that before being able to truly love someone, one must truly find themselves loveworthy. This implies and demands introspection, as well as forgiveness towards yourself and others. Outliers: The Story of Success – Malcolm Gladwell To master something, one must invest a substantial amount of time and dedication – this is not only true for technical skills, but also non-technical skills. Personal growth is only possible if you invest time, such as undergoing a psychoanalysis or similar. The Checklist Manifesto – Atul Gawande While the checklist itself is very technical, the way it was conceived and its effect was and still is rather non-technical. It is a question of putting your ego aside and truly focusing on areas which you can improve.
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'Why is This Happening in My Body'?: the meeting of/between patients' imaginings and analysts' theories with Sharone Bergner, PhD (New York)
“I really think that the purpose is to make space for the unknown, uncertainty, and for our kind of humility in the face of the complexity of our belonging to the physical world. So it's our animality, our physicality, all of that is so complicated and difficult to grapple with. The unknown is uncontrollable and is a huge abyss, as we know, for everybody. I do think that I'm trying to pivot here a little bit towards meeting the patient's attempts to grapple with that unknown.” Episode description: We begin by examining the assumptions of causality that we humans commonly invoke when faced with physical ailments. Childhood imaginings come forward during such times, and, despite being distressing, they offer comfort in the face of frightening uncertainty. Similarly, analytic theorizing has occasionally suggested certainties in the face of the unknown. This may limit the analytic space, thereby making vulnerability, fears, and new awarenesses less accessible. Sharone presents clinical material from patients with testicular cancer and lymphoma, where their psychogenic theories of etiology interfered with their medical care. We consider the distinction between patients with somatic symptoms and psychosomatic patients. We question the ability of the analytic method to uncover the origins of medical illnesses while emphasizing the importance of recognizing the "particular possibilities of our method." Our Guest: Sharone Bergner Ph.D. is a clinical psychologist and psychoanalyst in full time private practice of psychoanalysis, psychotherapy and clinical supervision in New York City. She is a member and former faculty at the Institute for Psychoanalytic Training and Research and is Adjunct Assistant Clinical Professor and a clinical supervisor at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, in the Contemporary Freudian track, where she teaches a course called The Body in Analytic Reverie. She is a member of the International Psychoanalytic Association and the editorial board of The Psychoanalytic Quarterly. She has a special interest in the body/mind in relation to maternal reverie in early development, vitality, embodiment, and medical issues, having worked early in her career in a cancer hospital, with the internal medicine, OBGYN, and dermatology clinics of a large urban teaching hospital, with political refugees and with parent-child pairs. Recommended Readings: 1. Bergner, S. (2011). Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology 28:267-292. 2. Gottlieb, R. (2003). Psychosomatic medicine: the divergent legacies of Freud and Janet. Journal of the American Psychoanalytic Association, 51:857-881. 3. Winnicott, D.W. (1966). Psycho-Somatic illness in its positive and negative aspects. International Journal of Psychoanalysis, 47:510-516. 4. Lombardi, R. (2017). Body-Mind Dissociation in Psychoanalysis: Developments After Bion. Routledge. 5. Lemma, A. (2015). Minding the Body: The Body in Psychoanalysis and Beyond. Routledge. 6. Miller, P. (2014). Driving Soma: A Transformational Process in the Analytic Encounter. London: Karnac. Not to be missed: case vignette: Recalling a Challenging Analytic Case, pp. xxvi-xxxviii
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Affairs: Exploring the Dynamic Mind with non-Clinical Readers with Juliet Rosenfeld(London)
“The subject of affairs, I think it's of interest to everybody. We have all had an Oedipal experience - we've all been babies who have at some point realized that we are not the only person. We're not perfectly fused with our mother, and she has other things to do, and there may be a father. We've all known what rejection feels like, and probably betrayal, and I think that affairs are in our unconscious. I think that's sort of evident in the way that most great novels, most great films, or at least many, have an affair at their heart. From Anna Karenina to Madame Bovary to Fatal Attraction, I think this is something that is just interesting. I wanted to write about affairs because I think they are a way of showing what psychoanalysis can do in a field in which everyone has an opinion on, and probably most people, in some way, have been indirectly or directly affected by. That was really the sort of the genesis for wanting to write about affairs.” Episode Description: We consider the challenge of writing about dynamic treatments in a manner that is accessible to the non-clinical reader. Juliet's book about affairs opens up this widely recognized experience and adds intrapsychic insights without using emotionally - distancing jargon. She introduces us to individuals who have been involved in affairs, with carefully protected confidentiality, who generally reveal the power of past experiences to influence adult choices. Some end happily, and some end in agony. Juliet demonstrates the usefulness of bringing a dynamic listening to both accepting and deepening each individual's lifelong search for love. Our Guest: Juliet Rosenfeld is a psychoanalyst and a member of the British Psychoanalytical Society, London. She studied at Oxford before a 15-year career in advertising and marketing, ending up in Government Communications. During this time, she began a Master's at the Tavistock and Portman Trust in Organizational Consultancy and started training as a psychotherapist a year later. She qualified as an integrative psychotherapist in 2012. Juliet was an elected trustee of the UK Council of Psychotherapy for four years, and is presently one of two clinician Trustees at the Freud Museum London, Sigmund Freud's final home. Juliet is the author of two books, The State of Disbelief ( 2020) and Affairs, True Stories of Love, Lies, Hope and Desire. Juliet's broader interest is in how psychoanalysis might be more accessible, and its ideas put into non-clinical language for audiences who may never be able to access psychotherapy themselves but are curious about what the unconscious means and what goes on in the consulting room. Recommended Readings: Creativity and Perversion by Janine Chasseguet-Smirgel (W. W. Norton & Co., Inc., 1984) Dreams of Love and Fateful Encounters by Ethel S. Person (American Psychiatric Association Publishing, 2006) Home Is Where We Start From by D. W. Winnicott (Penguin, 1990) Love in the Time of the Internet by Martina Burdet (underbau, 2020) Sex, Death and the Super Ego by Ronald Britton (Routledge, 2020) Sexual Attraction in Therapy edited by Maria Luca (Wiley-Blackwell, 2014) Sexuality and Attachment in Clinical Practice edited by Joseph Schwartz and Kate White (Routledge, 2019) The Bonds of Love by Jessica Benjamin (Knopf Doubleday Publishing Group, 1988) The New Sexual Landscape and Contemporary Psychoanalysis by Danielle Knafo and Rocco Lo Bosco (Confer Books, 2020) Novels about Affairs Anna Karenina by Leo Tolstoy (Penguin Classics, 2003) A Very English Scandal by John Preston (Penguin, 2017) Deception by Philip Roth (Vintage, 1991) Getting Lost by Annie Ernaux (Fitzcarraldo Editions, 2022) Madame Bovary by Gustave Flaubert (Wordsworth Editions, 1993) Middlemarch by George Eliot (Wordsworth Editions, 1993) The End of the Affair by Graeme Green (Vintage Classics, 2004)
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Affects, Curiosity, and Corporal Punishment with Paul Holinger, MD, MPH (Chicago)
“Now's the time to tell that wonderful story of the little boy. He was about two or three years old, and he went in the icebox to get some milk, and he managed to get this big carton and spill it all over the floor. Now, needless to say, there'd be a lot of parents that would react very negatively and frustrated - this mother happened to be a scientist. So she came in, she saw the bottle of milk, and what had happened. She went and got some paper towels, put them on the milk, and said, ‘Look at this. Look how the milk starts creeping up these fibers of the towel. Isn't that cool?’ And then she said, ‘Look, if you have something heavy you need to get out of the refrigerator, feel free to call me. But how neat is this that the milk is being absorbed by the towel?’ Well, she was a scientist, and he became a world-class scientist. She understood his interest and she didn’t bring a fear and shame-inducing reaction, and all the negative effects that could have resulted if she had handled it differently. Instead, she put a sense of joy and interest in being intrigued with his interests, and turned the whole thing around.” Episode Description: Paul starts our conversation about affects by referencing Tomkins’ work, which identified 6 negative and 2 positive affects/feeling states, all of which are represented by different facial expressions in infancy. He reports on clinical work that is enhanced by locating the patient's affective surface, which enables meaningful contact within the dyad. We focus on the affect of interest and how essential it is in establishing a sense of self in the world. He also shares the many ways that this interest can be undermined by the child's environment. He describes research on the capacities of 18-month-olds and how they differ from 14-month-olds regarding the awareness of self and other. Paul also emphasizes how destructive corporal punishment is in the lives of children and in society at large. We end with the final sentence from his book, a quote from Abraham Lincoln, "We can succeed only by concert. It is not 'Can any of us imagine better?' but 'Can we all do better?' Object whatsoever is possible, still the question recurs, 'Can we do better?' Our Guest: Paul Holinger, MD, MPH, is a psychiatrist and psychoanalyst, Faculty and Former Dean at the Chicago Psychoanalytic Institute, Training/Supervising and Child/Adolescent Supervising Analyst. He is Professor of Psychiatry (Retired) at Rush University Medical Center, Chicago. His most recent books include Affects, Cognition, and Language as Foundations of Human Development and What Babies Say Before They Can Talk: The Nine Signals Infants Use to Express Their Feelings. Recommended Readings: Holinger PC: Violent Deaths in the United States: An Epidemiologic Study of Suicide, Homicide, and Accidents. New York: The Guilford Press, 1987. Holinger PC: Offer D; Barter JT: Bell CC: Suicide and Homicide Among Adolescents. The Guilford Press, 1994. Holinger PC: What Babies Say Before They Can Talk: The Nine Signals Infants Use to Express Their Feelings. New York: Simon & Schuster, 2003. (Several Translations) Holinger PC: Affects, Cognition, and Language as Foundations of Human Development. New York/London: Routledge, 2024. Holinger PC: Violent deaths as a leading cause of mortality: An epidemiologic study of suicide, homicide, and accidents. Amer J Psychiatry 137: 472-476, 1980. Holinger PC: A developmental perspective on psychotherapy and psychoanalysis. Amer J Psychiatry 146: 1404-1412, 1989. Holinger PC: Noninterpretive interventions in psychoanalysis and psychotherapy: A developmental perspective. Psychoanalytic Psychology 16: 233-253, 1999. Holinger PC: Further issues in the psychology of affect and motivation: A developmental perspective. Psychoanalytic Psychology 25: 425-442, 2008. Holinger PC: Further considerations of theory, technique, and affect in child analysis: Two prelatency cases. International J Psychoanalysis 97: 1279-1297, 2016. Holinger PC: The problem of physical punishment and its persistence: The potential roles of psychoanalysis. The Psychoanalytic Study of the Child 73:1-9, 2020.
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The 'Necessary Foreignness' of Psychoanalysis with Mariano Horenstein, PhD (Cordoba, Argentina)
“In the analysis, the place where you face the experience of otherness, of foreignness, of the unconscious that goes through you, it doesn't appear as knowledge. Of course, in an analysis, you get a lot of knowledge, but it's not an important aspect of an analysis. I think that in the analysis, and that's the idea of using that word ‘transmission’ instead of ‘teaching’, what you receive is something that the analyst doesn't have. When you receive some knowledge from a teacher, you receive the knowledge the teacher has. When you transmit something, or when you receive something that has been transmitted by the analyst or by the psychoanalytical setting, is something that the other doesn't have. It's a kind of void. It's a kind of fire. It's like the baton that every runner passes to others in a relay race. It is something more difficult to be grasped with words, is something elusive to words, but it does exist.” Episode Description: We begin with describing the 'necessary foreignness' of psychoanalysis, "It is from both a foreign perspective and foreign listening that makes it possible to notice the concealed underpinnings, to discover the new, and to express the unexpressed." We consider the clinical asymmetry that allows for the patient's unbridled freedom to think and speak the unspeakable. Educationally, Mariano discusses the essential transmission of analytic experience as contrasted with the teaching of knowledge - a distinction between science and mystery. He shares his thoughts on eclectisism, hypothesis testing and risk. We close with recognizing that the "anachronistic method of psychoanalytic listening is the most authentic way of being contemporary." Our Guest: Mariano Horenstein, PhD is a training and supervising analyst who belongs to the IPA, FEPAL (Latin American Psychoanalytical Federation), and the international research group "Geographies of Psychoanalysis". He is an IPA Board member and a former chief editor of Calibán, the official Journal of FEPAL. Former Training Director of APC (Argentina). His articles have been translated into Portuguese, English, Farsi, French, Russian, Italian, Portuguese and German. Author of four books :Psychoanalysis in Minor Language, The Compass and the Couch. Psychoanalysis and its Necessary Foreignness, Funambulistas. Travesía adolescente y riesgo and Artists, Writers and Philosophers on Psychoanalysis. From the Couch. He has received international awards as M. Bergwerk (about the clinic forms of Evil), Lucien Freud (about Psychoanalysis and Culture); Elise Hayman Award for the study of Holocaust and Genocide (given by the IPA); A. Garma (given by the Spanish Association of Neuropsychiatry); the FEPAL Award and Carolina Zamora Award (given by Madrid Psychoanalytical Association). http://www.marianohorenstein.com/ Recommended Readings: Horenstein, Mariano, The compass and the couch. Psychoanalysis and its necessary foreignness, Mimesis, Milan, 2018. Horenstein, Mariano, Artists, writers and philosophers on Psychoanalysis. From the couch, Routledge, London, 2024. Horenstein, Mariano, Psicoanálisis en lengua menor, Viento de Fondo, Córdoba, 2015. Preta, Lorena (ed), Dislocated subject, Mimesis, Milan, 2018. Preta, Lorena (ed), Geographies of Psychoanalysis, Mimesis, Milan, 2015. Preta, Lorena, The brutality of things. Psychic transformations of reality, Mimesis, Milan, 2019. Wohlfarth, I., Hombres del extranjero. Walter Benjamin y el Parnaso judeoalemán, Taurus, CDMX, 2014.
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