FORMAS DE DIFUSIÓN DE LOS PROCEDIMIENTOS Y DISPOSICIONES

Both psychoanalysis and psychotherapy have had a problematic relationship with culture and clinical practice with black patients is still less than adequate. Arguably, Freud’s anthropological works show the influence of, and are consistent with, the then current anthropological view (quoted at some length in Totem and Taboo (Freud 1913). However, Freud believed that his theories provided an understanding o f man, a universal theory o f man’s psychology predicated on some questionable assertions about a certain hierarchy o f races. These notions have now largely disappeared from the literature (but see Rushton 1990). This was, in essence, racist (Dalai 1988). Tribal peoples were viewed as primitive (or savages - Freud 1913). There are different “levels” o f man. He clearly delineates a continuum between the primitives and savages

and the so-called civilised (Tor civilised read white, middle-class western European)

man, the former being represented in both children and neurotics in the civilised

societies. Male adult Europeans unsurprisingly were at the top end o f “civilisation”^'*, although admittedly struggling with “civilised” sexual morality (1908).

It was not only in anthropology, and the developing arena o f psychoanalysis, that such “layering” o f societies was apparent. Sue et al (1998) refer to this as “scientifie racism” where others are seen as inferior because o f their biology^^.

Most o f the clinical disciplines were, in some way, trying to justify “empire building” if not slavery. Psychiatry was providing diagnoses for slaves (e.g. Cartwright’s

In se v e r a l p a p ers (m ost notably Civilised Sexu al M orality 1908) Freud n o te s that civilisation in volves a relinquishing or constraining of instinctual n e e d s . In this he is c o n sisten t, with the then, current notion of th e “s a v ag e " living with nature being content and free o f illn ess (of c o u r se th e corollary of this is that “civilisation” lea d s to illness).

But s e e Freud’s definition o f culture pg. 21

T h ey a ls o cite th e alternative explanation - “ the cultural deficit model" - which s u g g e s t s that ethnic m inorities c o m e from im poverished en viron m en ts com pared to w h ites ( s e e Kardiner and O v e s e y later).

drapetomania “the irresistible urge to run away from plantations” (Thomas and Sillen 1991), elsewhere described as the “flight from home madness” (Carter 1995), i.e. pathologising what can be understood as normal behaviour in an abnormal situation. However, importantly (notwithstanding the racism), Freud was putting “social effects” (Abel and Metraux 1978) and “cultural effects” (cf. Turkic 1992), on the psychoanalytical agenda. How and where you were raised affected your worldview and your psyche. Freud wrote at length about the role o f perception and its influence on our unconscious and our thinking. Freud’s influence can be still be seen in modem psychology which has accepted the role o f culture (in part by developing the field of cross-cultural psychology), looking at the dynamic interplay between the internal world o f the mind and its perception o f the social world.

It is clear from many scientific disciplines that the way a child is brought up by their family, in a given society (remembering that the body, the psyche and the community do not possess fixed, immutable meanings across cultures - Kakar 1982, quoted 1995), have profound effects on the individual and their view o f the world. People will also assimilate and choose to follow some (if not all) aspects o f their culture, and in some ways these are selected through individual life experiences (see Kakar 1995).

If one re-evaluates Freud’s thoughts (discarding his inherent layering o f societies) he is recognising the need for understanding cultural norms and values. Paradoxically in none o f his case studies, nor in his theoretical works, does he show whether psychotherapy would work in other cultures where child rearing practices and family constellations are different. Nor does he convincingly show how his theory could be applied to patients from other cultures.

Early psychoanalytical writings, by other analysts, approached “culture” with the bias o f looking at whether Freud’s assertions about m an’s more primitive drives {Triebf^

could be shown in primitive cultures - his “anthropological approach”. However, in anthropology the ideas have moved on, as Krause (1998) notes

other cultures could now be seen as living concerns rather than as museum pieces or exotic, malfunctioning survivals o f the past....more importantly customs, ideas and ways o f living which had before seemed irrational and exceptional now came to be understood as well functioning and sensible alternatives, at least by the anthropologists who had studied them (pg. 9).

Conversely for psychoanalysis we find that for European and (North and South) American peoples the emphasis has been on clinical studies, while the emphasis o f psychoanalysts working with Non-European or Non - Euro-American peoples has been anthropological. Is this yet another reflection o f the “inherent” layering o f societies - a form o f scientific racism?

Psychoanalytical/psychotherapeutic researchers have concentrated their cultural research on therapy with either preliterate, isolated societies trying to fit western psychoanalytical conceptualisations to such groups (e.g. Roheim (1932) working in Somaliland, Western Australia and New Guinea, or with indigenous peoples in Western society (e.g. the Native American Indian - Devereux 1951, Erikson 1995). Others have looked at indigenous psychotherapy, e.g. “Religious Psychotherapy o f the Iroquois” (Wallace 1959), and “Ute Dream Analysis (Opler 1959a,b). Such research tends to concentrate on internal processes to the exclusion o f the external world. This

S trach ey in the Standard Edition o f Freud’s w orks tra n sla tes “Trieb” a s “instinct” how ever, m o st m odern authorities would translate th e word a s “drive” - s e e L aP lan ch e and P on talis (1 9 8 8 ) for a fuller d isc u s sio n o f this.

has lead, on the one hand, to a misunderstanding o f the cultural processes, and on the other, to viewing other groups as “exotic”. This has had the effect o f forcing an homogeneity onto “other groups”, an approach similar to that o f early anthropology. Even excluding such ethnocentrism, such anthropological/psychoanalytical work should have delivered some coherent ideas on whether psychoanalysis really is pancultural, and therefore whether Freud’s “universal” theory needs amendment.

However these approaches have emphasised the essentially primitive and dijferent

nature o f the tribal peoples. There are, o f course, theoretical (as well as ethical) difficulties with this. Looking beyond the racism, if as Freud postulates, the savage is seen in the neurotics and children o f the civilised societies^^ then the argument that black people will not understand therapy, put forward by therapists, is untenable. Therapists work with both neurotics and children and therefore should be able to treat all patients with equal success. Therefore they must feel that culture has a role, in which case the tautology is that “external” reality has a place in therapy.

In psychotherapy the view o f the ethnic minority patient is that they are incomprehensibly different (and therefore unanalysable) rather than explaining symptoms as comprehensible in terms o f a different understanding o f the world, or for others (especially those bom in the UK) a similar understanding o f the world expressed in a different way due to different life experiences and upbringing.

In a similar way to other disciplines, such work is then generalised to ethnic minorities in American and European countries. The net effect o f this has been to encapsulate the individual “black experience” into a “primitive society experience” relieving the

T his is not an argum ent to which I would su b scrib e. In a sim ilar w ay to my view that black p atients do not p r e se n t with “e x o tic ” problem s, I include it to e m p h a s is e that th e argu m en ts put forward to ex clu d e black p atien ts from therapy d o not hold up to c lo s e scrutiny.

burden o f having to understand the complex transitions that have happened within the different cultural communities in Britain today (with similar effects in other European and American Countries), the strengths o f different cultural groups, and has lead to a generalisation o f the group experience to an individual one. This, may show the discomfort o f psychoanalysis in working with difference, and therapists’ inability to react to and reflect upon difference, especially cultural difference. They seem unable to adapt their technique to accomodate such differences.

Psychotherapy has been unable to think about different family frameworks and different religious practices, but also itseems unwilling to contemplate working with single people living outside the expected social organisation, and situations where such family organisation is not protective.

The role o f “culture” has not been discussed in the therapeutic literature to a great extent so it has not been translated into a coherent psychoanalytical/ psychotherapeutic theory to produce a truly “universal” theory. Nor has it been reflected in therapeutic practice. However, in the modem world, where patients may not be culturally similar to their therapist this neglect seems inappropriate. The reason for this “neglect” seems to be predicated on the psychoanalytic focus on the internal world and psychic reality. Psychoanalysis is, according to (Oliner 1996),

insensitive^^ to conditions in external reality such as abuse, poverty, oppression, or the analyst’s contribution to the transference.

I would add to this the difficulty o f understanding patients who present different life experiences and who are from different cultures^^. Therefore, contrary to current

psychoanalytical thinking, culture and the experiences o f minorities in Britain should be an implicit part o f the understanding o f the person and their presenting problems and thus o f the therapy. Culture is fundamental to the person (for majority as well as minority cultures). Individual development from the infant to the grown adult is in a specific familial context^”, and such contexts may be different from, in this case, those o f the white British culture or as Kakar (1995) says:

In a fundam ental sense, psychoanalysis does not have a cross-cultural context but takes place in the same culture across different societies; it works in the established (and expanding) enclaves o f psychological modernity around the world....the clientele fo r psychoanalysis....are involved in modem professions....in the sociological profile, at least, this client does not significantly differ from one who seeks psychoanalytic therapy in Europe and America.

Hence one can argue that changes in traditional family structure and cultural support structures (e.g. religion), allow psychotherapy to take on a more important role.

The idea that the psychotherapeutic worldview was culture free, encouraged a predominantly white European/American profession to believe that their values, attitudes and beliefs and the predominantly verbal, non-physical therapy was in some way inherently “correct”, not merely an artifact o f their upbringing, the class into which they were bom and the societies into which they were bom and were raised. But in this they are also conforming to the original anthropological view that the European/American worldview is in some way inherently superior {more civilised) to

W e can return to th e idea that w h en Freud w orked with real trauma, his th eo r ie s reflected this. Therefore a s m ost th erap ists are w hite and m id d lecla ss, and s e e p atien ts from a sim ilar d em ograp h y, then their th eories are com patible with this group. By this argum ent, if they worked inter-culturally their th e o ries and practice would d e v e lo p accordingly, and p erh a p s provide insigh ts into their work with their w hite p atients too.

those o f other races, and hence cultures who did not subscribe to these “ideals” were in some way “lacking” {more primitive)

This notion o f primitive has lead to a rather paternalistic view o f different cultures by therapists and analysts alike. It should be remembered that psychoanalytical views on other cultures seems to be limited to those “black cultures”, where society is not generally structured in a hierarchical way. Hence we find Freud in 1935 (in his Postscript to “An Autobiographical Study”) talking about thriving psychoanalytical societies in non- European/American situations:

In addition to the older local groups (in Vienna, Berlin, Budapest, London, Holland, Switzerland and Russia), societies have since been fo rm ed in Paris and Calcutta, two in Japan, several in the United States, and quite recently one each in Jerusalem and South Africa and two in Scandinavia, (pg. 258).

This is an important distinction, for psychoanalysts (including Freud) the emphasis is on how closely your society is structured. Most societies that have a hierarchical structure based on class or caste systems have embraced psychoanalysis (including, more recently. South American countries including Brazil)^^. This can be viewed in a cultural perspective. For many therapists, psychoanalysis is viewed as a universal understanding o f man. In fact, psychoanalysis can be seen not only as predicated on Freud’s Jewish upbringing (see Roith 1987) but also on his middle -class life and the structured society he lived and grew up in (initially Moravia in Czechoslovakia, which was at that time was part o f Austro-Hungarian Empire, and after he was three years old, in Vienna), as well as the era in which he lived and worked (see Kakar 1995).

T hu s all therapy is (in a s e n s e ) intercultural, a s no two individuals will e x p e r ien ce their cultures identically (following from the notion o f a p sy ch o lo g ica l culture I p ro p o sed earlier).

Freud was not only part o f an oppressed minority (by virtue o f his Jewish origins), but also a migrant. This man who wrote extensively about the human psyche, who might have been expected to write extensively on the experience o f being culturally “different” does not show this in his writings.

However, many o f Freud’s early writings, particularly the early ones and specifically his understanding o f “real trauma” and his notion o f nachtraglichkei^^ which he developed in the time prior to his renunciation o f the seduction theory, can be seen to be reflections o f his own family history and the effect on him. There were limitations put on his career development because o f his Jewish origins and he identifies some o f the conflicts with his identity and his biculturalism in The Interpretation o f Dreams (1900), perhaps most notably in his description o f the hat incident (pg. 286).

For Freud’s patients (at the end o f the 18th and early part o f the 19th centuries), the theory and practice are emic (they reflect a similar worldview); for patients at the start o f the new millennium there is a vast array o f therapies open to them, and often the therapies reflect a particular worldview (e.g. the Lacanians in France and South America, the ego psychologists in America). Therapies have developed to keep in touch with the culture within which they are applied, so that the theory and therapy remain emic. For ethnic minority groups in Europe and America the theory and therapies may seem to be etic to them (they do not reflect their worldview, depending on the level o f assimilation/integration/ cultural pluralism o f the individual).

P er h a p s paradoxically, Freud b elieved o n e o f the problem s of civilisation w a s that it lead to n e u r o s e s (1 9 0 8 ).

It is largely the m iddle c la s s e s w ho h ave a d op ted p sy ch o a n a ly sis.

T his is th e notion of "deferred action”. T his is w here an incident h a p p e n s which is th en rep resse d . If a sim ilar s e t o f circu m sta n ces reoccu rs then th e p erson rea cts to it a s if it w a s th e original trauma. H en ce in th e “Project for Scientific P sy ch o lo g y ” (1 9 5 0 ) w e find the e x a m p le o f Emma.

The question remains as to whether a therapy that was developed within a particular cultural framework has any relevance to patients whose cultural backgrounds are different to those o f the majority culture.