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The good story

Truth, fiction and psychotherapy

CoverOctober 2014Medium length read
 

JMC

“The stories we tell about ourselves may not be true, but they are all we have.”

I am interested in our relations with these stories we tell about ourselves, stories that may or may not be true. Let me select three cases.

(a) I have a story about myself which I sincerely believe to be true, in fact which I believe to be the story of me, but which some ideal, omniscient, God-like observer who is entirely independent of me and to whose mind I have no access knows not to be true, or at least not to be the whole truth.

(b) I have a story I tell about myself, one in which I wholeheartedly believe but which certain well-placed observers (my parents, my spouse, my children) know to be flawed, probably self-serving, perhaps even to a degree delusional. (This is a not uncommon state of affairs.)

(c) I have a story about myself in the way that we all have stories about ourselves: I concede that it may not be true by the standards of (a) or even (b); nevertheless, it is “mine”, it is all I have, and therefore I give it my allegiance. “It’s all I have, it’s the best I can do.”

I take (c) to describe a common postmodern situation: there is no type (a) ideal observer who holds in his/her mind the true story of me, therefore let me negotiate some kind of life-narration for myself, one that is prudently enough worked out to take type (b) observers into account, yet that feels honest and sincere, even though I know at the back of my mind that there are interests at work – interests to which I am blind – which have almost certainly dictated that certain parts of “the” story – the full story, the type (a) story – should be occluded. I will not be able to put my finger on these occluded parts because “I” am engaged in hiding them from “myself”.

From my limited acquaintance with the consulting room, I get the feeling that as a discipline psychoanalysis does not take the distinctive features of (c) very seriously. The hyperconscious aspect of (c) is more or less brushed aside as secondary elaboration. Yet my sense is that the type (c) sensibility is more and more common today. It is an expression of the age we live in, and we ought to be cautious about downplaying it.

I may at this point seem to be about to make a plea for a new variety of analysis adjusted to a new personality type, but this is not in fact the direction I want to take. What I wish to focus on is the longing or nostalgia for the one and only truth, a longing that I myself happen to feel strongly, but that I don’t see in the kind of contract between therapist and patient which takes it as a premise that all transactions will be on an as-if basis: “I will tell my story as if it were true, and you will deal with me as if I were not just making it up, and we will see where we can go from there.”

My first question would be: Starting as-if from the truth, where can one expect to arrive, through therapy, save at an as-if destination? My second question would be: Are we truly so changed (so advanced) that we can be satisfied not only by as-if stories but by as-if destinations, by as-if solutions to as-if human plights? Do therapist and patient nowadays agree to trade only in fictions, fictions that both of them know – with a tacitly suspended knowledge – to be fictions; and is that enough to satisfy them? Or am I in error when I postulate a them who are not complexes of fictions but are “real” human beings whose hunger cannot be satisfied by such ghostly fare?

As you can see, I am as divided, undecided and confused as can be. By profession I have been a trader in fictions. From what I write it must be evident to you that I don’t have much respect for reality. I think of myself as using rather than reflecting reality in my fiction. If the world of my fictions is a recognisable world, that is because (I say to myself) it is easier to use the world at hand than to make up a new one. Gustave Flaubert wrote (in a letter to Louise Colet) of aspiring to write a book about nothing, a book that would be held together by the mutual tensions of its component parts rather than by its correspondence to any real world. He never wrote such a book: it was much too hard, and anyhow no one would have read it. But it is telling that a writer who is thought of as an arch realist should have had such a low opinion of reality.

What ties one to the real world is, finally, death. One can make up stories about oneself to one’s heart’s content, but one is not free to make up the ending. The ending has to be death: it is the only ending one can seriously believe in. What an irony then that to anchor oneself in a sea of fictions one should have to rely on death!


AK

It seems to me that we are talking about two very different kinds of truth. You write about an objective or a transcendent truth, a truth outside or above the realm of human understanding. I am working on the basis of a subjective and an intersubjective truth, a truth to experience, which is what I believe to be at issue when one is trying to help a patient who is suffering. People come for psychotherapy because they feel dreadful and are in subjective distress, not because they do not know if God exists or how to read the weather.

This is not to say that reality – whatever we mean by reality – goes out the window. But in psychotherapy one is not trying to establish objective truth. Instead it is the way the patient represents reality, the way in which the external world exists in the mind of the patient, with its distortions, its inconsistencies, its lapses, which one explores in order to understand the way their mind works and to help deepen their sense of subjective truth.

I would like to present a brief clinical vignette in order to think through this issue in the context of the therapeutic work I am engaged in with patients at the moment.1

A male patient started psychoanalytic psychotherapy with me a year and a half ago. He comes three times weekly. This material is drawn from the first session after a long holiday break.

The patient talked about collapsing in the last few days of the break. He also spoke of missing his sessions very much, particularly at a time when he was fighting with his partner. This patient has always found weekends and holiday breaks difficult. Early on in the therapy he dealt with this by forgetting about what happened in sessions and not thinking about me or the therapy when he was not in the consulting room. I understood this as a defensive manoeuvre, whereby he would do to me what he felt I was doing to him – that is, dropping him from my mind. This made sense to the patient and he called his strategy “turning the tables”.

At the present point in therapy, things have changed. The patient is more accepting of anxiety he feels about being dependent, which has had a positive impact on relationships in his life, most particularly with his son.

Today he complains bitterly to me about his partner. He has been horrible to her, he says. He does not know why he gets overcome by such rage towards her. The problem on the face of it is a strange one because his partner seems to be very concerned to do all she can to help him, but this only seems to enrage him. At one point he says to me: “Her love and concern are the problem.”

After a while I talk with him about how he feels vulnerable and needs my help, he needs the help of both his partner and me, but he hates feeling this way. It makes him feel small. He feels this particularly when he can’t come to see me in the break, and therefore feels shut out and rejected. I think when he is horrible to his partner he is getting rid of the feelings of being small and shut out by making his partner feel that way – he is making her feel how he feels. This makes sense to the patient. It draws on many conversations we have had in recent weeks, and has the effect of calming him.

Here I am trying to help the patient develop his tolerance of particular feelings – of needing help and being vulnerable, of feeling anxious about being hurt and rejected – so he does not have to get rid of them by making someone close to him feel them on his behalf.

The vignette describes a fairly standard piece of psychoanalytic work, one in which there is an exploration of feelings that a patient is struggling with inside of himself and the defensive ways he has developed of dealing with them. I hope it also shows the emotional nature of the therapeutic relationship, its significance for the patient, and the way in which one learns about the patient’s mind through the direct, lived experience of a relationship with them. It is difficult to get this across when one talks in abstract terms about the transference. The patient’s story is not something that takes place outside the consulting room and is reported back; it is enacted in a very real way in the relationship with the therapist. The therapist comes to adopt the curious position of being both inside the patient’s story and commenting upon it as it unfolds.

In narrative terms we could say that the story changes in the course of the session from something like “I feel rage towards my partner who patronises me” to something like “I hate feeling reliant on my partner and my therapist, it makes me feel small and wretched, and when it gets too much I can end up dealing with it by taking it out on them”.

In the terms of your letter one could characterise what is going on as a swap of one fiction (the patient’s) for another (the patient’s and mine). But this does not ring true for me. I believe that, like most patients, this patient brought his lived experience to me in good faith. It did not have an “as if” quality about it. It was the truth as he experienced it, although he had enough insight to know that there were aspects to what was going on in his life which he did not understand and which made him and those around him suffer. For my part, I believed in my experience of the relationship with the patient and in what I said to him about what I understood of what was going on in his mind.

The aim in psychotherapy is to help the patient fill in parts of a puzzle, which is their puzzle – the puzzle that is their mind. As the situation is considered more fully and one develops, through a shared, lived experience with the patient, an understanding of the impact of the patient’s unconscious mind on their conscious experience, one’s view of the situation changes – as inevitably as one’s view of a small part of a scene alters, sometimes dramatically, when a larger vista is revealed.

I would like to think that, on a good day, the trajectory of a therapeutic session is from a partial subjective truth to a greater subjective truth. I do not think the complete truth can ever be reached.


JMC

Although, like most well-brought-up people nowadays, I am careful to avoid the impolite locution “transcendent truth”, I confess that privately I continue to distinguish between things that really happened in the past and things that did not really happen. Don Quixote did not couch his lance and charge a giant: he charged a windmill, and if he says he charged a giant then he is lying, or, to put it more usefully, is delusional – is making up a fiction without being aware it is a fiction. The fiction he makes up may be more interesting than the reality, and (as you say) we may be better able to help people like Quixote back to sanity by going along with their stories for a while, pretending to believe they are true, which is what Sancho (who is fond of Quixote) does. Nevertheless, I would resist classing Quixote’s story of the giant as truth of any variety, for example, poetic truth or higher truth or transcendent truth or subjective truth. I would prefer to find some other term, one that doesn’t lead us into confusion.

Of course, patients, when they talk about their past, talk about events only a small part of the time. Mostly they talk about how they thought or felt in the past, how they think or feel in the present about how they thought or felt in the past, how they thought other people were thinking or feeling about them, how they now feel or think about how they thought other people were thinking or feeling about them, and so forth.

Thoughts and memories and feelings are more difficult to conceive as events than is charging a windmill. Is there any hope of recovering what the patient’s mother actually said the day she lost her temper with him, when he was six, for putting the cat in the tumble dryer, as distinct from what the patient heard her (when he was six) to be saying and remembers her today as saying, namely, “You are a cruel and cold-hearted child who is going to grow up to be a cruel and cold-hearted man”? Her utterance was certainly an event, but in practice it is impossible to disentangle it from the interpretation the patient has put upon it many years later. So, I concede, much of the time it would be futile for the therapist to try to distinguish between what actually happened and what the patient thinks happened, and therefore to distinguish between events on the one hand and interpretations of events on the other. In therapy, as you say, the real event, the event that counts, is the event that occurs in the consulting room between the patient and the therapist.

Yet I continue to feel that one takes a step too far if one says to a patient, in effect: “You have constructed a version of the past which is making you miserable (dysfunctional), so let us work together to construct an alternative version of the past with which you will be happier and which will help you get on with your life.”

The past, individual or collective, is always messier and more complicated than any account we can give of it. We make up an account of the past so that we can pack the past away and not be bothered by its messiness any more. Yet it seems to me a source of hope that historians take it as their calling to, every so many years, lift the accepted account off the shelf and scrutinise it again, checking it against the facts to see whether it still reads like a true account.

Historians are not simple-minded people. Many of them are able to hold two conflicting beliefs in balance: that every account we produce of the past will eventually be revealed to be a story, the kind of story that a man or woman of our times could, in retrospect, have been expected to produce; but that, despite the above, we nevertheless do not have a free hand to make up the past as we wish (or as our times wish us to wish).

It seems to me that the same sort of double awareness ought to colour therapeutic practice.

What is it that holds the historian – or the therapist – to his/her task? I suppose it is sincere belief in the value of what one is doing. One can’t devote oneself heart and soul to a task if one doesn’t believe in its value. That is why I would call the double awareness I tried to describe tragic: one believes sincerely in the truth of what one is writing at the same time that one knows it is not the truth.

There is a moment in the second part of Don Quixote when Quixote issues a challenge to us. He seems to step outside the reigning delusion that he is a real knight errant and says, in effect: I believe (believe sincerely) in the code of knight-errantry, I act in accord with my beliefs, and I become a better person by so doing. Would you prefer me as I was before – an impoverished member of the Spanish gentry, scraping a living on my run-down estate, waiting for death to come – or as I am now (as I seem to be now) – a protector of the poor and downtrodden, a rescuer of maidens in distress? If you concede that my beliefs transform me for the better, why are you trying to destroy my beliefs?

By the end of the book, many of the people around Quixote, particularly Sancho, have given their response to his question: We do indeed prefer the ideal, transformed, better version of you; it may be self-constructed, it may not be “real”, but we are prepared to ignore that detail.

Of course, Quixote’s companions are not themselves converts to Quixotic idealism, or at least not sincere converts. They are not saying: We vow, all of us, to live out our ideals as you do. Rather, they are saying: The world turns out to be a more lively, more entertaining place when at least some of us live out our ideals (while the rest of us are content to watch).

I am sure that my dogged concentration, here and in earlier exchanges between us, on the ethical dimension of truth versus fiction comes out of my experience of being a white South African who late in life became a white Australian and, in between, lived for years as a white in the United States, where whiteness as a social reality is more masked than in South Africa or Australia but is still there. That is to say, I have lived as a member of a conquering group which for a long while thought of itself in explicitly racial terms and believed that what it was achieving in settling (“civilising”) a foreign land was something to be proud of, but which then, during my lifetime, for reasons of a world-historical nature, had to sharply revise its way of thinking about itself and its achievements, and therefore to revise the story it told itself about itself, that is, its history.

Australia is particularly interesting in this regard. Crudely summarised, the story reigning in Australia today is that previous generations of white settlers acted under the sway of the pernicious illusion that because their ancestry was European they were better than indigenous Australians and were therefore justified in subjugating them and taking over their land. However (the story continues), the generations of white Australians who came to maturity after World War Two underwent some kind of evolution of consciousness as a result of which they have a better and truer understanding of what has really happened in Australia since 1788, that is, have developed a better and truer history of themselves.

In this better and truer history, white Australians today remain the heirs and beneficiaries of a great crime committed by their forebears, the sort of crime which enlightened people like themselves would never themselves commit but which their forebears, slaves to a false conception of themselves and their role in world history, could commit without crippling moral qualms.

If you tell the story of late-20th-century historical revisionism in these terms, an ambivalence becomes visible which at the level of the individual psyche ought to split people apart and make any kind of easy, happy life impossible. My great-grandparents were criminals (the revised story goes), complicit in an evil project whose fruits I am at present enjoying. Yet at the same time my great-grandparents were courageous, upstanding people who suffered hardship so that their descendants could have a good life.

The story of historical revisionism in Australia is different in scale but not in kind from the story of post-1945 historical revisionism in Germany. Our not so remote ancestors were fine people – so the story goes – but were slaves to an illusion. We ourselves have seen through that illusion. Thus we can see our ancestors as they really were, and our past as it really was. In that very specific sense we are better people than they, or at least freer people, and can set ourselves apart from them.

I am speaking at a level of generality which makes for the crudest of arguments. Nevertheless, let me state my crude point: that the settler societies in question, the settler societies of today, ought to be riven with self-doubt but are not. They – or their more articulate members – say the following: (a) Our forebears did bad things but they are not to be blamed because they were in the grip of false beliefs and a false understanding of their role in history. (b) We have more enlightened beliefs and a more enlightened understanding of our historical role. And (c), if, as history unfolds, we ourselves are revealed to have mistaken ourselves as deeply as our ancestors mistook themselves, there is nothing we can do about that, that is the nature of history, which is just one story overtaking and supplanting another; therefore the best we can do is to get on with our lives without more fretting.

I don’t want to push the therapeutic analogy recklessly, so let me simply ask the question: When a society (but for a few dissident members) decides that it does not feel troubled, how can healing even begin?


AK

I agree, it is hard to imagine healing occurring at a social or an individual level when the prevailing discourse is one that cannot admit to disturbance. I would also suggest that the more determinedly a society feels the need to look upon itself as having risen above the past and as being free and distinct from it, the more likely it is that it will be in its unconscious sway.

The split awareness you describe in Australia, in which two largely unintegrated pictures of the early settlers co-exist, sounds to me like a recipe for collective insecurity. (We have something similar in England, of course, in attitudes towards our colonial past.) In your account, Australia’s idea of itself as a civilised society seems to rest upon an idealised version of its past, a version in which cruelty and conflict are edited out. This does not sound like the basis for a happy, secure collective life, but an anxious one, in which any experience of wellbeing is fragile and can easily flip into a more troubled state when it comes up against memories and stories which do not fit with the idealised picture.

Perhaps you are right to say that use of the word “truth” is confusing in the context of our discussion about psychotherapy because of the implication that truth is a thing that exists out there, like a fact, something which can be possessed or fully understood at any one point in time. I have wondered whether it might be more helpful to invoke the notion of authenticity and of the aspiration to the authentic life, terms from existentialist philosophy which describe the ideal of a life lived through an open response to the experience of being-an-individual-in-the-world. And yet I am reluctant to give up on the idea of subjective or psychic truth. Firstly, I do think people understand what it means: the common instruction “be true to yourself” gets the message across nicely. But secondly, if it does confuse, I think there may be meaning in the confusion.

To my mind there is something strange and startling about Truth, which exactly captures my experience of discovery in psychoanalysis. Subjective truth in psychoanalysis is not the same as external truth at all, and yet it is something one bumps up against, sometimes quite violently and sometimes more gradually, almost in the manner of an external object or fact. By comparison, authenticity sounds like something you can buy or choose for yourself. It sounds like a lifestyle choice, a serious and not a trivial lifestyle choice, but a choice, something self-willed, nevertheless.

The psychoanalyst Hanna Segal wrote that psychoanalytic truth is a process and not a fact.2 She was describing the nature of the psychoanalytic endeavour, which is to help the patient understand themselves better by becoming more open to experience, and particularly to unconscious experience, however difficult or painful; and this in the knowledge that complete openness can never be achieved, because psychic life is in its essence dynamic and changing, and defensive processes will always be in operation to a greater or lesser extent. Along with this goes a commitment to a certain way of thinking and being rather than a particular predefined endpoint, although of course the strong hope and expectation is that the process will produce general benefits for the patient as well as a reduction in symptoms. A paradox lies in the fact that while the patient maintains too much of a focus on an endpoint, on, for example, getting rid of a particular symptom, it is much more difficult for them to give themselves to the task of exploring their own mind in a free and open way, and thereby to get to the point where the symptom can be given up.

But I think it is very difficult to properly describe any sort of real encounter with unconscious experience, of the type which occurs at significant moments in psychotherapy, without using the metaphor of an encounter with an aspect of external truth, an object or fact, a Thing. When a patient reaches the point of recognition of something meaningful which was previously not known or known about, it is as if they are saying to themselves: Ah now I see, this aspect of things was always there, I can see it now where I couldn’t before. I have lived with it for so long but I have found ways of getting round it, or of simply not seeing it, or of pretending it was something else. But now I do see it, as clearly as that chair or table. It is as if there is some aspect of the internal situation, of which the conscious self was not previously aware that the psychotherapeutic process brings the patient against, and is then present within the mind where before it was not. 

An encounter with something that has previously been unconscious is very like coming up against something outside of oneself, even though it is something that happens inside one’s own mind, because this thing or aspect of experience has not been a part of the self before. The situation will not of course remain that way; the find does not have the status of a fact or an object, and will be subject to reshaping and reinterpreting as life continues. But the metaphor still serves to convey the manner in which something important is discovered, uncovered or recovered within the mind.

1 Details in this clinical example have been changed to protect the anonymity of the patient.
2 Hanna Segal, ‘Reflections on Truth, Tradition and the Psychoanalytic Tradition of Truth’, American Imago 63/3 (2006): 283-292.

Extract from The Good Story: Exchanges on truth, fiction and psychoanalytic psychotherapy, by JM Coetzee and Arabella Kurtz, to be published by Harvill Secker in May 2015. Copyright © JM Coetzee and Arabella Kurtz 2014

 

About the author JM Coetzee & Arabella Kurtz

JM Coetzee was awarded the Nobel Prize for Literature in 2003. His books include Disgrace and The Childhood of Jesus.

Arabella Kurtz is a senior clinical tutor and an honorary senior lecturer in clinical psychology at Leicester University.

 
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