Website paper 7

Having a Psychic Home – Aspects of Identity Roger Kennedy The paper puts forward the notion of a psychic home as an organizing psychic structure central to the notion of personal identity. The psychic home consists of four elements – the internalization of a basic structure as a protected space for shelter, providing the core of the psychic home; the pre-established intersubjective symbolic space predating the setting up of the home; the contents of the psychic home consisting of identifications with family members; and the sense of a home a s a site of household activities. It is proposed that the notion of personal identity can be enriched by taking into account the notion of psychic home, based upon a detailed reading of a number of general and psychoanalytic contributions to the literature of identity. While contemporary accounts of identity in other disciplines repeatedly focus on the notion of identity as plural, multiple and subject to many influences ,the notion of a psychic home can provide a starting point for the complex and indeed life-long task, of forming an identity, whether as a psychoanalyst or Identity is a term used in many different ways and by a variety of disciplines. It has become a central issue of concern in contemporary debates about politics, ethics and culture, as can be seen for example in Appiah, K. (2005), Sen, A. (2006) and Woodward, K. ed. (1997). Identity is a term that is of great relevance to issues of race, ethnicity, nationality, gender and sexuality. Identity matters in very immediate ways, when it becomes a question of belonging, of inclusion, but also of exclusion. The issue of identity has become a focus for various kinds of radical feminist literature, much of it challenging traditional psychoanalytic thinking, though also deeply influenced by it, even if in opposition, as with the work of Judith Butler (1990). The phenomena of terrorism and fundamentalism mean also that we need to look at how identities are formed, sustained and can also be distorted. The existence of the internet and the place of globalization in addition mean that individual identities are becoming more and more eroded by larger forces. It has become increasingly difficult for people to assert their own local identities; there is a constant risk of people becoming Though identity has become a central issue of concern in the humanities, it seems to have become of less interest to psychoanalysts, even though it was a major topic of interest from the nineteen fifties to the seventies. Indeed, some of the ideas generated then, particularly of course by Erikson, have become central to current preoccupations in other disciplines. Part of the purpose of this paper is to re-examine some of these earlier psychoanalytic thinkers in the light of subsequent developments, in order to restore some of I will argue that identity is a vitally important but complex and at times elusive concept. There are various fixed or constant elements in the development of our identity, which can become the source of integration and of a sense of permanence, of achievement and coherence, whether that be as a person and/or as a psychoanalyst; and there are still issues about the nature of identity that challenge our thinking, such as its link with the processes of identification, the question of whether or not unity is an illusion or a real possibility. One of these constant elements I shall call a psychic home, as a psychic structure that provides a basis for a sense of identity, and I shall explore what I mean by this term, and to see how it may link with other aspects of identity. When considering what we mean by identity, questions such as ‘Who am I? Who do I look and act like? Which religion and nationality am I?’ are crucial ones, indicative of a search for a place in life, an identity which provides a psychic home, not just a physical home. It is this psychic home that provides the core of this elusive and precarious notion of identity, whatever its complex vicissitudes. The main thrust of my own contribution to this field is to put forward the notion of a psychic home, of having an internal sense of a secure home base, as a key feature of identity, which provides an organizing psychic structure for the sense of identity. Such a home base must be built up from a number of different elements, as with the physical home, which forms its substrate. There are intrapsychic elements but also intersubjective elements, 1.) There is the basic structure of a home as a protected and hopefully welcoming space for shelter, providing the core of the internalized psychic home. The physical space of the home has an important function in helping to shape the interior life, as can be seen, for example, in Diana Fuss’s book The Sense of an Interior (Fuss,2004). There she explores the link between the inner mind and the inner dwelling, through exploring the rooms of four writers, including Freud and his consulting room. Interiority is described her as ‘a mental structure constructed over time, with inner chambers and inner walls that exceed in strength and resistance the physical supports of any actual building,’ (Fuss 2004, p.7). There is an interaction between the subjectivity of the writer and the interior space where they write. In this notion of a psychic home, the physical structure of the home thus has an important part to play in providing an overall, containing structure which becomes internalized as an organizing configuration. Thus, the fireplace creates warmth. Usually the first thing one does coming back to a cold home from being away is to light the fire. The hearth, the seat of fire, the place resistant to heat and combustion, has always been a central part of the home. Interestingly in Latin the word for hearth is focus. Thus, referring to focal work with families, Alan Wilson pointed out that ‘In a psychological sense, the focus also represents an important functionally organized aspect of resistance, that is resistance to instinctual forces, resistance to processes which the focus makes possible to use,’ (Wilson. The physical structure also has an interior marked out by defining walls. The boundary between the interior and the exterior may be firm and stable or flimsy or permeable; the bricks and mortar of the family home may be loose or secure, with a clear focus or none. One may recall here the story of the three little pigs – only the house built of bricks could withstand the breath of the hungry wolf. Indeed, it was the third pig’s fireplace that eventually killed off the wolf as he climbed down the chimney. The boundaries of the house also have to be seen in context, within a community of other homes, and within a society. The home must be permeable to external influences, or else it will become the source of unreal relationships. This was brought home to me when doing an assessment of a very worrying family. The mother, after years of being bullied by her autocratic husband, had finally managed to escape the family home with a younger child. The mother was a bright but rather passive woman, who had allowed herself to be completely submerged by her husband, had lost her own sense of identity. She had difficulties coping with the child, which is why they eventually came to the attention of After extensive investigations, the full picture of family life was gradually revealed, in part thanks to the fact that the father had kept hours of videos, charting the details of their bizarre family life, which I was obliged to view as part of my assessment. This was a family who had somehow evaded the education and social work authorities. The children had never been to school. The father ruled over the family, hardly allowing any trips outside the family home. No locks were allowed anywhere in the house, so that the father could enter any space at will. Sexual talk led by the father was prevalent, with clear indications, fiercely denied by him but revealed by the younger child, of active sexual abuse. A rather quirky language was used by the family, and the younger child took some time to speak without sounding false. Luckily there was a good outcome for the mother and this child, but the older children were left severely damaged, with long-term mental health problems, and with little sense of having their own identity separate from the intrusive father. 2.) There is already a pre-established intersubjective symbolic space predating the building or setting up of the home. The home-to-be already has a place in the family history and narrative, already situated as an element in a complicated network of relationships. There is a lineage, reaching back generations. The individual in a family is already situated before birth in a complicated, mostly unconscious, network of symbols, or kinship structure. 3.) The contents of the psychic home, its mental furniture, consist essentially of identifications with family members making up the home’s interior. In the secure home, the parents provide continuity over time in their home-making, providing a supportive base for the children to eventually leave, and ultimately to build up, their own home. A stable psychic home involves individuals being recognized as being autonomous yet dependent, and receiving respect for their own individuality. One can perhaps see most clearly here how the psychic home is integral to the notion of identity with the adolescent, for whom identity formation is a crucial task. They need the home base from which to explore but also they need it to be there for their return. This is perhaps why it can be so traumatic for the adolescent when their parents split up at this crucial point in their development, supposedly as they are now ‘old enough’ to be able to cope. One can also see how, as with the disturbed family mentioned above, that a sense of individual identity depends upon the mutual relationships in the family being respectful of personal autonomy; that is, boundaries within the home need to be respectful, with individuality being respected and recognized. For any individual, alternative psychic homes will develop in time, particularly if their family of origin is unstable or rejecting. Work for many people can become one such place; the workaholic can be locked into a sense of only being at home at work, even though it can never really be an adequate substitute for an actual home. At the same time, for those with a core sense of a psychic home, it may be less conflictual to seek alternative psychic homes, to feel at home in a number of different places, cultures, overlapping and interpenetrating. Nonetheless leaving one’s home where one has lived for long periods can still be destabilizing, as vividly described by Akhtar (2007). He shows how the non-human elements of the home, such as the child’s toys, blanket and elements of the environment, contribute to the sense of security and are formative in our psychic development. He emphasizes how the analyst working with traumatically dislocated individuals must be prepared to ‘receive’ non-human, largely environmental transferences. The way that such a patient brings into the space of the consulting room their sense of dislocation needs to be One can see a particularly poignant dilemma concerning the psychic home with adoptions, particularly when the adoptee reaches adolescence, as Betty Lifton (1994, p. 65) has pointed out. When adoptees reach adolescence, especially with closed adoptions, and when the adoptee cannot find their birth parents, or when the adopted parents deny the reality of the past, particularly difficult issues around identity may arise. ‘If your personal narrative doesn’t grow and develop with you, with concrete facts and information, you run the danger of becoming emotionally frozen. You cannot make the necessary connections between the past and the future that everyone needs to grow into a cohesive self. You become stuck in the life cycle, beached like a whale on the shores of your own deficient narrative.’ If the adopted parents do not respect the reality of the child’s past, the adoptee can grow up with a divided self, walling off essential aspects of themselves, and emotionally frozen, not feeling sufficiently recognized for who and what they are. They may remain hungry for a psychic home, bereft of the links to such a home. There may be some overlap in conceptualization here with John Steiner’s notion of ‘psychic retreats’ (Steiner, 1993). These are pathological organizations in more disturbed patients, referring to when patients can withdraw or retreat into states of mind experienced as if they were places into which the patient could hide. Such states of mind may appear as literal spaces, such as a house or a cave. One could add here, that if the patient makes a retreat, then presumably they are retreating from something, from live contact with the other, 4. The ordinary home consists of activities; it is not a static or frozen entity. What could be called the ‘work of the day’ (Kennedy, 2007, p. 246-60) takes place within the home. This refers to significant events which require thought and/or action. The ordinary work of the day, structured around everyday activities, involves attention to all the significant, and at times deceptively indifferent, thoughts, feelings and experiences that occupy us during the day and provide the raw material for thinking and for dreaming. Much of this psychic work carries on automatically without us being particularly aware of its regular occurrence or of its everydayness. It is usually taken for granted, unless the family has major problems, of the kind where the family home has broken down, and where ordinary family life cannot be held together safely. Where home life has broken down, where it is, for example, chaotic or dangerous, one can clearly see how the basic conditions for secure attachments and identifications cannot take place; the internalized psychic home then becomes precarious or dangerous. From such pathology, one can perhaps see how the core of the psychic home is probably linked to early experiences where psyche and soma are beginning to be linked together, when the psyche begins to feel ‘at home’ in the soma, along the lines described by Winnicott Thus one can see how the notion of a psychic home consists of a number of different and interacting elements, including the physical interior of a home but internalized as a psychic interior. The notion of ‘personal identity’, refers to the development and then maintenance of a person’s character, how they put together in some way their various multiple identifications, as well as including wider issues concerning a person’s cultural and social influences. I am suggesting that the basic elements of the psychic home can be seen to provide a way of organizing the person’s identity, or can be seen as intrinsic to any notion of identity. The psychic home, to borrow from Winnicott (1986), (who was quoting from T.S. Eliot’s East Coker), is the place we start from. In psychoanalytic treatments, one can see the notion of a psychic home in a variety of ways. Just to take a few brief examples from my own practice: 1. Mrs X now has a good home, with a stable family, but she never feels secure in herself; she carries around inside some deep anxieties, linked to her early life, about which she still has few memories. Her parents split up when she was very young, her mother soon remarried and then the patient was sent to boarding school soon after. Until the analysis, she had never questioned what had led to the break-up of the family, nor why she was sent away from home. She carries around quite a fragile sense of a psychic home, afraid of expressing dependent feelings, and quite emotionally inhibited as a person. Luckily, the home she has created for herself is strong enough to sustain her. 2. For Mrs Y home is not a place she can easily identify with. Her own mother was exceedingly narcissistic, never having recognized the patient’s own individuality. The family was not one where emotions were easily expressed; they had to be buttoned up. She was also sent to boarding school, where she felt happier in some ways, at least able to find a way of relating which did not demand having to accept mother was always right. Though she married and had children, she has always felt it difficult to identify with a sense of home; home as always reminded her of being unacknowledged. The notion of a psychic home makes a lot of sense to her; indeed, she felt that in some ways she has spent her life moving away from a psychic home, and yet yearning for it. It seems to encapsulate her own problematic particularly cogently. 3. Ms Z has quite severe mental health problems, probably of the borderline kind. Though educated and intelligent, she has found it difficult to work and finds close relationships challenging. Her family is important for her; indeed a continuing and major influence. They want her to live near them, outside London, and continue to offer incentives for her to do so. However, the atmosphere at home is quite deadly. Independence is discouraged, the parents are very intrusive about personal matters, there is little sense of a differentiation between generations. One sibling is probably schizophrenic and lives at home, another has only managed independence by living far away and by not having much contact with the family. A psychic home for the patient is fraught with the danger of breakdown. Perhaps here there are clear links with Steiner’s psychic retreats. 4. For Mr W, work as a professional is the only place where he has relationships. From his description, his own flat is a complete tip. It is hardly ever cleaned, and is grossly neglected. He has never asked anyone back there, and outside of work events he has no social life. He has never had a close relationship, only friendships. Such an existence would probably surprise his colleagues, who respect him and his work. He has an intense and highly conflictual relationship with his mother, who is demanding of his attention. His father, to whom he felt very close and whom he resembles physically, died many years ago. Indeed, he describes feeling as if he stopped developing psychically at that point. It as if he lives in a dead world, in perpetual mourning, like Miss Haversham in Dickens’s Great Expectations. The psychic home for him has never moved on, it remains full of dead introjects. Everyone carries the psychic home with them; for Mr W the only escape from this dead weight is at work. In order to deepen the notion of a psychic home, I shall now turn to some general issues about identity and then how they relate to some of the psychoanalytic literature on identity, and how in turn this impacts on the psychoanalyst’s identity. Psychic Home and Identity – some general issues While in psychoanalytic thinking identity has come to have specific uses, particularly in understanding adolescent and earlier development, it has also come to be used as a general term for weighing up a psychoanalyst’s stage in their career development. The phrase ‘identity crisis’, first used in detail by Erikson (1959, p. 56), is now very much in the public domain while referring to adolescent turmoil and their search for themselves, but it is also now applied to other stages of the life cycle, including middle and old age. That is, identity is a life-long process, a matter of ‘becoming’ as well as of ‘being’. For psychoanalysts, there is the specific issue of what it means to have a psychoanalytic identity, how one becomes an analyst and maintains one’s analytic stance, and how past generations of analysts have contributed to contemporary analytic identity, a topic I shall come to later in more detail. Identity matters in immediate and indeed practical ways. For example, if you wish to renew your UK passport, you now have to apply to the ‘Identity and Passport service’, which will authenticate your personal details and confirm your identity as a UK citizen, or not. Having a home is vital to this. Without an address, you cannot really be a citizen. This dilemma was especially poignant after the Second World War. Tony Judt (2005) has charted in his ground-breaking book Postwar, how there took place then a massive movement of millions of people, due to the aftermath of the concentration camps and also the civil wars that soon took place in what became communist Europe. Not only had there been, as a result of Stalin and Hitler, the uprooting, transplanting and deportation of some 30 million people between 1939 and 1944, but after the war Europe had to deal with an unprecedented exercise in ethnic cleansing and population transfer. Untold millions were displaced or were refugees. The distinction between displaced persons, assumed to have somewhere, a home to go to, and refugees, who were classified as homeless, was one of the many nuances that were introduced by the authorities trying to deal with this trauma, whose legacy remains to this The impact of these post and indeed prewar migrations of course greatly impacted on the history of British psychoanalysis. The fact that the controversial discussions took place both at a time of war and with a number of those who had been displaced from their homes, must have had a considerable influence on both the form and content of the discussions, focused around half conscious notions of whose home was the most suitable to house psychoanalytic truths. Feelings of loss about lost homes, about lost German or Austrian identities, idealized hopes for the new home or inevitable disappointments about establishing a home in exile may have crept into the apparently scientific arguments, and indeed, I suspect, remain still around in current concerns about the functioning of the British Society. Identity has always mattered at least in Western society, certainly since the ancient Greeks, even before passports and the internet. There are a number of famous examples in Homer’s Odyssey which brings this to light, where one can also see the resonances of the place of home and homecoming in the appearance of identity issues. Odysseus has finally returned home to Ithaca after nearly twenty years away, disguised as a beggar but also of course greatly changed physically. As he approaches his home in order to confront the pack of suitors who have intruded disrespectfully into his palace and are vying for the attentions of his wife Penelope, he is accompanied by a friendly swineherd who is unaware of his royal identity. Nearing the palace they come across an old dog left abandoned on a pile of mule and cattle dung, hardly able to move. But as Odysseus passes, the dog pricks up his ears and raises his head, recognizing the master who trained him and went hunting with him. Odysseus is unable to reciprocate as he wishes to keep his identity secret but carefully wipes a tear away. As the master passes on, the dog finally gives Later in the palace and still disguised, Odysseus is offered hospitality by his wife who still does not recognize him. She asks his old nurse to wash his feet as a token of hospitality. This nurse at first finds him strangely familiar, very much like her old master. But he manages to fob her off. However as she prepares to wash him, he has to reveal his thigh on which is engraved an old scar he received from the tusk of a boar, while hunting. When the old woman passes her hand over the scar she at once recognizes who he is and lets the basin fall onto the floor. With tears in her eyes, she wishes to let her mistress know his identity, but Penelope is distracted and the moment passes. Indeed, it is only later, and after he has slaughtered the suitors, that Penelope is convinced of her husband’s identity, when he reveals the intimate secrets of the marital bed, which he himself had built out of a thick olive Thus we have here, in Homer’s homecoming scenes, so many of the basic issues surrounding that of identity and psychic home, for example, how much a person remains the same over time, how much they change beyond recognition, yet are still capable of being recognized, given the right conditions; what kind of evidence we require to confirm a person’s unique identity; what marks out the subject as having that unique identity, how the identity of the subject and recognition by the other are intimately linked; how one’s identity is marked forever by one’s home, the psychic home one carries around in exile, during various adventures in foreign climes, as well as when at last one returns to the family hearth. A further element in Homer’s recognition scene is the fact that before finally being fully recognized, Odysseus eliminates the disrespectful suitors. It is only Odysseus, the rightful ruler and spouse, who commands true respect. We are prepared for this by his son’s earlier awareness of his presence, his old dog’s response, then from the nurse and finally from his wife. Identity, respect and recognition, all factors linked in with the formation of personal identity are here intimately bound together in Odysseus’s homecoming. In contrast to Homer’s epic grandeur, if one were to capture the modern concern with identity artistically, one could do no better than consider the troubling pictures of Francis Bacon. He highlights in a disturbing way how our modern, or indeed post modern, notion of identity is precarious. There is a permanent sense of unease in his pictures, marking the fragile sense of human identity. Faces and whole bodies intermingle and merge, sometimes are transformed into animal forms; mouths scream, bending figures cry out or are threatened, sexual encounters are anxiety ridden, identities are uncertain. Home is no comforting place here, rather the site of terror, cruelty, perversion and crude sexuality. In David Sylvester’s book ‘Looking Back at Francis Bacon (Sylvester, 2000), he describes Bacon’s Study for self- portrait (1985-6), a brilliant triptych, depicting the artist from three viewpoints. Bacon here seems to alternate between masculine and feminine identities, in one panel with his legs tucked primly under the chair like a modest lady, and in another panel more macho, emphasizing his massive arms and broad shoulders. Sylvester quotes the critic Richard Dormant when he states that in our ‘struggle to achieve a separate and secure identity’ we have to learn ‘to distinguish between our own bodies and those of others, to work out that our bodies not only have weight and mass, but also boundaries, limits, perimeters’. If the figures in this triptych ‘are seen as embryonic shapes desperately trying – and failing – to form a single, secure identity, then they speak of a universal human condition, the aboriginal calamity with which we struggle all our lives – and this is the stuff of the greatest art,’ While Bacon’s triptych may reveal the struggle to form a single secure personal identity, contemporary politics reveals a real danger when people claim a single and overarching social and cultural identity rather than a looser sense of crossing a number of different identities. The fundamentalist dangerously owns a singular identity, excluding the rest of humanity, with potentially hateful and explosive results. They are no respecters of other peoples’ homes. Identity can be homicidal, when it becomes singular and disrespectful of differences. Much safer is to recognize that we belong to a variety of groupings, with a plurality of affiliations, including language, gender, profession, religion, class, interest groups, political associations and belief systems (Sen, 2006). Identity can then be humanizing when it respects otherness. Thus a ‘positive’ notion of identity, respect and recognition of difference go together, as do a ‘negative’ notion of identity, disrespect and Perhaps a psychoanalytic overview of this complex field can add something useful to current debates about identity, even though it is now often stated that psychoanalysis itself is in its own identity crisis, faced by the challenge of alternative therapies and the constant pressure to provide convincing evidence of its effectiveness. If it is any consolation, one could say that psychoanalysis is not alone in being in a crisis; it seems to have become a way of life at the moment; we are all in some kind of identity crisis, financial or otherwise. Mind you, identity is perhaps the kind of concept to which one only pays particular attention at moments of crisis, when fixed patterns of identity formation begin to break down, such as during war situations, institutional change or personal trauma. The dilemmas of personal identity were first put forward philosophically by John Locke, who remains the seminal influence in the field. He places his account of personal identity in the context of the general nature of identity. The identity of a physical object depend on the identity if its constituent parts; if one part is removed, the object is changed. But with a living thing, the parts may change as in growth but it remains the same, so that identity in a living thing consists in the organization of its parts, the capacity to remain the same in the midst of change. The identity of a human being consists in the organization of their body. Personal identity consists in the unified consciousness of the self’s present and past thoughts, it is consciousness and memory that grounds personal identity. However, Locke also highlighted certain dilemmas about such identity, such as there are periods when consciousness is disrupted and we lose a sense of continuity. He even raised the possibility that one body could house more than one consciousness. Recent studies of ‘split brains’ involving severely epileptic patients, as well as experimental monkeys and cats, who have had the connections cut across the corpus callosum uniting right and left cerebral hemispheres, provide further evidence of the complexity of how we view personal identity. In fact, each hemisphere has the capacity to process information separately from the other hemisphere, and conflict may arise between both sides of the brain. According to Nagel (1979, pp.163-4), these studies challenge the notion of a single subject of consciousness. Indeed, most recent studies on brain functioning highlight how much integration occurs both at the cellular level and in parallel pathways, challenging any notion of an overall single integrating mind. For example, individual neurones in the visual cortex respond to particular inputs, such as vertical or horizontal movement. The cells do not care if the stimulus has, say, different colours; it just responds to verticality or whatever orientation it is set to respond to. So already at the cellular level there is abstraction (See Zeki, 2008). Evidence from work with the visual cortex reveals that each different area of cortex is capable of considerable integration, such as areas involved with colour or movement (Zeki, 2004). Different aspects of visual perception are integrated separately and indeed at different time intervals. This has major implications for our understanding of consciousness and hence of personal identity. There is no single, integrated visual consciousness, but rather several different consciousnesses coexisting at the same time (Zeki, 2004, p.197). How then do we have any unity of experience if there is no single place where things come together, and when integration occurs in parallel at many local levels? There are of course multiple and reciprocal connections between areas of the brain; areas are not isolated from one another. But accounting for the functioning of the whole is a major puzzle. Perhaps identity and some sense of unity of the whole person consist in having the various areas available, not coming together as such. When the brain is damaged severely, then particular areas are no longer available and integration is diminished. Severe damage to the frontal lobes definitely alters identity; the individual, incapable of deep emotional responses, appears to be another person, not themselves. Does this kind of damage indicate that identity and the capacity for emotional responsiveness are intimately linked? Ricoeur (1990) distinguishes two basic forms of identity – identity as sameness, Latin idem, and identity as selfhood, Latin ipse. Selfhood is not sameness. This is illustrated in Shakespeare’s Comedy of Errors. The plot of the play, with the confusion between two sets of twins, master and servant, both sets coming together after a period of exile for one of the sets of twins, illustrates how human identity is an elusive and precarious entity, nothing about it can be taken for granted, and perhaps we rely too much on things being or looking the same for reassurance about who we are. The plot of the play emphasizes how having an identity and being identical is not the same thing. One twin looks like the other but has a different role and personality. We may rely on things being the same but identities can be easily transformed. It does not take much for despair to set in, and with a sense that one has lost the ground for being certain about one’s own identity. One subject can easily turn into another subject, while appearing to remain the same. The ‘plot’ of life, one might say, Appiah (2005) links identity with J.S. Mill’s notion of an individual ‘plan of life’. The life plan is an expression of individuality, who I am. As Sinatra put it – ‘I did it my way’. However, this needs to be complemented by the realization that the idea of identity is linked to that of recognition by others; that individuality and sociability are interlinked. Identity provides us with a source of value, one that helps us make our way among options. To adopt an identity is to make it mine, give it a home, and to see it as structuring my way through life, as well as allowing myself to feel solidarity with other like-minded people. For Taylor (1989) identity designates the ensemble of understandings of what it is like to be a human agent, including the sense of inwardness, freedom, individuality, and being embedded in nature. The term is also defined ‘by the commitments and identifications which provide the framework or horizon within which I can try to determine from case to case what is good, or variable, or what ought to be done, or what I endorse or oppose. In other words, it is the horizon within which I am capable of taking a stand,’ (Taylor, 1989, p. 27). Thus for him, identity is linked with making choices. His use of horizon here would seem to have similarities with that of a foundational psychic home. Woodward (1997) discusses the tension between essentialist and non-essentialist perspectives on identity. The essentialist account suggests that there is one clear, authentic set of characteristics which account for identity, such as where one belongs culturally or ethnically. Whereas a non-essentialist definition would focus on differences as well as common and shared characteristics. She emphasizes how identities are not unified, and yet we need to examine how people take up various fixed or flexible positions and identity with them, in order to see our way through tensions between people. This means having to explore the nature of difference, as well as psychoanalytic understanding of how our subjectivity is invested in various kinds of identity positions. Her overall view is that we need to have a broad and inclusive, fluid and flexible, generous and respectful, notion of identity, if we are to escape the dangers of sectarianism. This leads on to more detailed consideration of the psychoanalytic contribution to Psychoanalytic thinking around the issues of identity first flourished in the 1950’s and 60’s, beginning with the work of Erikson, who was well aware of ambiguities and dilemmas in the very notion of identity. Perhaps the fact that he himself was half adopted made him particularly sensitive to the identity issue - his mother did not reveal that he was adopted by her husband, having been abandoned by Erikson’s father when she was pregnant. Erikson (1956) pointed out that Freud used the term only once, when trying to formulate his link to Judaism (Freud, 1941[1926]); that he spoke of an ‘inner identity’ which links the individual with the unique values and history of his people. It also refers to something in the individual’s core which links up with the group’s inner coherence. ‘The term identity expresses… a mutual relation in that it connotes both a persistent sameness within oneself (self-sameness) and a persistent sharing of some kind of essential character with others,’ (Erikson, 1956, p. 56). In order to clarify the subject matter of identity, Erikson approached it from a variety of angles, predominantly with a developmental theoretical perspective, but also using literature, sociology and clinical work. Identity then appears to refer to a conscious sense of individual identity, an unconscious striving for continuity of personal character, or as maintenance of an inner solidarity with a group’s ideals and values. The adolescent is consciously striving for an identity, as one can see in their various fads and enthusiasms, ways of dressing, kinds of music etc. This compares with the emerging and more unconscious identity of the mature adult. Processes of identification and identity formation are intimately linked. But identity formation involves the selective repudiation and mutual assimilation of childhood identifications, and their absorption into a new configuration (Erikson, 1956, p.68), which also involves the processes by which a society recognizes the young individual as somebody who had to become the way he is, and who is accepted for being that person. Identity refers to knowing where one is going, feeling at home with oneself and in one’s body, gaining assuredness, respect and recognition from While at the end of adolescence there is an overt identity ‘crisis’, identity formation neither begins nor ends with adolescence, for it is a lifelong development, largely unconscious to the individual and to his society. Its ‘roots go back to the first self- recognition: in the baby’s earliest exchange of smiles there is something of a self-realization coupled with a mutual recognition,’ (Erikson, 1956, p.69). The process of identity formation ‘emerges as an evolving configuration – a configuration which is gradually established by successive ego syntheses and resyntheses throughout childhood; it is a configuration gradually integrating constitutional givens, idiosyncratic libidinal needs, favored capacities, significant identifications, effective defenses, successful sublimations, and consistent roles,’ (Erikson, 1956, p.71). Identity formation involves a gradual integration of self-images. The father has a role as guardian of the child’s autonomous existence, balancing his threatening and forbidding aspects with the Winnicott was obviously concerned with what constitutes the sense of self and how this comes into being. Identity seems to be linked to the capacity to be alone, a stage of development where the individual is established as a unit, the “I am”, so they can they say “I am alone” (Winnicott, 1965, p.33). This capacity to be alone is a sophisticated one, with many contributory factors, and is closely related to emotional maturity. The basis for this capacity is the experience of being alone in someone’s presence; that is there has been good enough reliable ego support from the early parent. For the establishment of unit status, the whole person has a sense of an inside and an outside, living in the body, more or less bounded by the skin; for this to happen there needs to have been a successful negotiation of the stages of dependence. A crucial aspect of the establishing of unit status, and hence identity, is the process of ‘Personalization’. This describes the process when the person of the baby starts to be linked with the body and the body functions (Winnicott, 1965, p.59), with the skin as the limiting membrane. The infant’s psyche begins to dwell in the soma, or, one might say, feels ‘at home’ in the soma, with a sense of being self centred inside his body, and this process depends upon the mother’s handling, her ability to join up her emotional and physical involvement. Here, then, one may see possible early roots of the sense of a psychic The core of the self emerges out of the early mother-child relationship and implies body-mind integration. One could say that the merging of the mother’s and infant’s identities is basic for subsequent differentiation. In addition, around the various identifications, one could envisage a kind of containing membrane, holding them together in some way, akin to the notion of the safeguarding structure of a psychic home. Subsequently, adult life for Winnicott begins when the individual, climbing out of dependency, has found a niche in society through work and is settled in some pattern; here there is a compromise between copying the parents and defiantly establishing a personal The work of Lacan (1966), influential for feminist thinkers on identity, deconstructs identity. The human subject for Lacan is not an entity with an identity as such, instead the subject is radically split, a fragmented subject with no sense of unity, almost no sense of a psychic home. Any sense of unity in the subject is an illusion. The subject could be grasped in language, but one cannot find from language any sense of a total unifying self; that is the ego’s role on giving an illusory sense of permanence and stability. Such a view can be seen to arise from Lacan’s notion of the mirror stage, where the young child sees s total reflection of themselves. This reflection, bringing with it the appearance of wholeness, brings with it a feeling of jubilation and fascination, but is the source of alienation, the illusion of wholeness, an imaginary relationship with the body. The subject moves from fragmentation and insufficiency to illusory unity; psychoanalysis challenges our identity as subjects. This view contrasts with Winnicott’s view of the mirror experience with the mother, or the mother’s face, which can provide a sense for the child of being recognized. The mother gives back to the baby the baby’s own self, allowing the baby to begin to feel real (Winnicott, 1971, p. 117). This is in complete contrast to Lacan, for whom there is no possibility of anything except an imaginary sense of wholeness, of a complete identity. Thus what is for Winnicott recognition is for Lacan misrecognition. For one the mirror is restorative, for the other it is alienating. Of recent analytic thinkers, Perelberg (1999) tackles the distinction between identity and identification. Identification is a process that takes place in the unconscious and is the source of fantasies. As with Freud, identificatory processes are fluid and shifting. Identity, in contrast, is, rather as in Lacan’s work, an attempt that each individual makes to organize these conflicting identifications in order to achieve an illusion of unity, which allows an individual to say they are ‘this’ and not ‘that’. The paper then concerns how some violent male patients, overwhelmed by the extreme fluidity between masculine and feminine identifications, try to repudiate their feminine identification in order to establish an identity. Overall, one can see with various thinkers that the issue of unity as an illusion or as something genuine becomes a crucial one. My own view is that is plainly absurd to rule out any notion of unity or integration. The issue is where and how the integration occurs and under what circumstances. I have mentioned the evidence from brain research for integration at the micro level; even neuronal cells are capable of generalization and abstraction. But how all the systems come together in an overall unity, and whether or not they do, is another and My own picture of the human subject is relevant here, (Kennedy, 1998, 2007). This is of a subject where multiple paths are possible, holding together in some ways and not in others. Being able to tolerate the shifting and multiple elements of the psyche, bearing degrees of fragmentation, is crucial to the individual’s subjectivity. I coined the notion of a ‘subjective organization’ (Kennedy, 2007, pp,83-108), as the psychic organization that structures the subject, involving individual and social elements. Such an organization can become pathological in the sense of being defensive and held together by perverse forces, as with the pathological organization. But under normal conditions, the subjective organization remains the organizing structure involved in one’s sense of ‘I-ness’, as well as that involved in the way that the subject is organized in the social field (Kennedy, 1998, p.193-4). One of the essential aspects of the subjective organization is that it involves subjects in interaction with other subjects. The subjective organization is a dual structure made up of individual and collective elements in a complex interrelationship. I suspect that becoming a subject must intimately involve having the stable sense of a psychic home as the basis for psychic shifts. This situation could be understood by borrowing a musical metaphor, that of the modulation between tonic and dominant in, say sonata form, or with the resolution of dissonance when music returns to a home key from various musical excursions in related keys. (Hinshelwood, 1997) emphasizes that the basic experience of having a mind and sustaining its constituents is difficult, and the person remains vulnerable throughout life to primitive mental mechanisms, such as splitting and projection. The traditional unitary notion of personal identity is too static, not taking into account the discontinuities as well as continuities within and between people. Identity for Hinshelwood is what he calls a ‘locus of belonging’, that place within which mental entities can be gathered as sets of possessions, as well as eliminated through splitting and projection, (Hinshelwood, 1997. p. 195). This does not prevent us searching for illusory completeness, coherence and permanence, or in perhaps a more realistic way for the ‘thread of life’ as Wollheim (1984) put it. Such a thread can be achieved by the individual creating narratives of their life. In this sense, identity is a description of a particular kind of unified narrative that the subject can create about themselves. The locus of belonging and the psychic home seem to have similar patterns. Klauber tackled the complex issue of the analyst’s identity in an IPA symposium dedicated to the topic in 1976. He comments on 2 other papers first, by Edward Joseph and Widlocher. For Joseph, the identity of the analyst is marked internally by the capacity to think, feel and react as an analyst. Years of training and practice allows the precarious analytic identity to become autonomous, through continuous efforts of self analysis and education throughout life in order to maintain its autonomy. The latter is buttressed by entry into a psychoanalytical society, where attacks and invasions from within the society and from the external world have to be withstood. For Widlocher, what lays the foundation for the analyst’s identity is the nature of the psychic work which is demanded from him, with the unique and difficult practice of handling the transference and counter transference. This identity is linked to a narcissistic doubt as our practice is constantly being threatened, taking us away from the essence of the Freudian experience. Widlocher discusses how analytical societies not only have the purpose of training and scientific communication, but also a function of reassuring the group about their analytic identity in the face of doubts. Klauber points to two strains which these papers underline. The first strain is the quest for a new experience of truth, and the location of the analyst’s position in this search. Klauber, like Widlocher, stresses the centrality of the human encounter in this search. ‘This is where the mystery takes place, in which one human being understands another, and the sense of wonder is engendered at the persistence of unconscious patterns without which no psychoanalyst can feel at home in his profession,’ (Klauber, 1981, p.170). Thus identity is linked here to ‘feeling at home’ in one’s professional role, as well as finding a professional The second strain is that which responds to the pressure for therapy and even cure, with all the pressure from the external world for results. These two strains play a part in the ‘crisis’ of identity that psychoanalysts often experience. For Klauber, the central problem of psychoanalytical identity formation seems to lie ‘in finding a balance between the years of training necessary for a student often approaching mid-life or past it to master a highly exacting conceptual system and technique and the stultification of originality by the weight of authority.’(p. 176). For him, the sense of identity of the analyst depends upon an intense experience of the analytical process, which involves the analyst having ‘fire in his belly’, and it is a very personal process, involving the analyst as a person, their being able to link up the personal with the technical aspects of psychoanalysis – something which may take years to accomplish. In this sense, it may take years to feel at ‘home’ with practising psychoanalysis. For Michael Parsons, the identity of the analyst has a double meaning – what it means to be an analyst cannot be isolated from how an individual analyst’s personal identity is achieved, through a process of becoming that is unique to that analyst,’ (Parsons, 2000, p. 69-70). What most distinguishes the identity of the analyst is the relationship that they develop with their own unconscious. A trust in the unconscious is central to the analyst’s identity, even if the route we have come to get where we are can be complex and through many different routes. The sense of authenticity, of being highly trained and yet able to use analytic concepts and technique with appropriate freedom and flexibility would seem to be ‘…between, on the one hand, spontaneity, the sense of mystery, openness to the unexpected and trust in the unconscious processes, and on the other, rationality, adherence to fundamental principles, conceptual rigour and consistent, disciplined technique. These two aspects of psychoanalysis pull in opposite directions and psychoanalysts become the analysts they are by the ways the find of sustaining a creative tension between them,’ (Parsons, 2000, Thus one could say that a psychoanalytic identity involves both feeling at home in one’s role, and, hopefully in one’s institution, but that there is a also a necessary pull away from feeling too settled in one’s position; it does not pay creatively to be too comfortable with one’s position. Indeed, it is not that uncommon for the most creative analysts to feel, at times at least, rather on the margins of their parent institution; they seem to have a need to pull away from a psychic home, though of course there is also the need for the home, however frustrating, to be there to pull away from. I think that what has come out of considering the various psychoanalytic contributions to identity is how identity as an issue is complex and potentially precarious, involving steering a path between different polarities, but that in addition, charting a course along this difficult path requires holding a creative tension between possible positions, not holding fast to just one single way. However, feeling at home with a flexible notion of identity does not appeal to everyone. People vary as to how much the psychic home remains for them the only true home, how much they need to pull away from it. What contemporary accounts of identity in other disciplines repeatedly focus on is the notion of identity as plural, multiple, merging one with another, rather than as it were facing each other from separate corners. In addition, though identity involves individuals, their identity is formed under multiple influences. Identities involve having a position within our society and in relation to a history, a lineage. Certain markers of identity may be visible or can appear through inquiry – whether that be from a country of origin, race, religion or One can see an identity as involving the taking up of a particular position, depending upon different social roles or different histories. But taking up a position requires a starting point, or a frame of reference, or at least some scaffolding. This is where I would suggest the notion of a psychic home comes in, as the starting point for the complex and indeed life-long task of forming an identity, whether as a psychoanalyst or outside one’s professional life. Akhtar,S. (2007), The trauma of geographical dislocation: leaving, arriving, mourning and becoming, in The Geography of Meanings, ed M. Hooke and S. Akhtar. London: International Association.nalytical Appiah, K.A. (2005), The Ethics of Identity, Princeton N.J.: Princeton University Caldwell, R.S. (1976), Primal identity, Int.Rev.Psychoanal. 3: 417-34. Erikson, E. (1956), The problem of ego identity, J. Amer. Psychoanal Assoc. 4:56- ____ (1959), Identity and the Life Cycle, New York and London: Norton. Freud, S. (1941 [1926]) Address to the Society of B’nai Brith, S.E. 20, pp.271-4. Fuss, D. (2004), The Sense of an Interior, London and New York: Routledge. Hinshelwood, R. (1997), Therapy or Coercion, London: Karnac Books. Judt, T. (2005), Postwar. A history of Europe since 1945. London: Heinemann Kennedy, R. (1998), The Elusive Human Subject, London: Free Association Books. _____ (2007), The Many Voices of Psychoanalysis, London and New York:
Klauber, J. (1981), Difficulties in the Analytic Encounter, New York: Jason Aronson. Lacan, J. (1966) Ecrits, Paris: Le Seuil. Lifton, B. (1994), Journey of the Adopted Self, New York: Basic Books. Locke, J. (1690), An Essay concerning Human Understanding, ed. P. Nidditch. Nagel, T. (1979)Mortal Questions, Cambridge: Cambridge University Press. Parsons, M. (2000), The Dove that returns; the dove that vanishes, London and New Perelberg, R. (1999), The interplay between identifications, and identity in the analysis of a violent young man, Int. J. psychoanal. 80: 31-45. Ricoeur, P. (1990), Oneself as Another, trans. K. Blaney, Chicago and London: Sen, A. (2006), Identity and Difference. The illusion of destiny, Harmondsworth: Steiner,J. (1993), Psychic Retreats. Pathological Organizations in Psychotic, Neurotic and Borderline Patients, London and New York: Routledge and Institute of Sylvester, D. (2000), Looking Back at Francis Bacon, London: Thames and Hudson. Taylor,C. (1989), Sources of the Self, Cambridge Mass and London: Harvard Wilson. A. (1986), An outline of work with families, in The Family as In-Patient, ed. Kennedy, R., Heymans, A. and Tischler,L. London: Free Association Books. Winnicott, D. (1965), The maturational Processes and the Facilitating Environment, London: Hogarth Press and Institute of Psychoanalysis. _____ (1986), Home is where we start from, Harmondsworth: Pengion Books. ____ (1971), Playing and Reality, London: Tavistock Wollheim, R. (1984), The Thread of Life, New Haven and London: Yale University Woodward, K. (ed.) (1997), Identity and Difference, London: Sage Publications. Zeki, S. (2004, The asynchrony of visual perception, Chapter 12 in Human Brain Function, ed. R. Frack et al. London and Chicago: Elsever. ____ (2009), The Splendors and Miseries of the Human Brain, Oxford: Wiley-


E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s O R I G I N A L XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients ARL S. TORGERSON, MD, PHD MARK N. BOLDRIN, MS with type 2 diabetes are either overweight ONATHAN HAUPTMAN,

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