Psychoanalysis in Eastern Europe

John Kafka, Washington
Psychoanalytic Institute

What can an analyst contribute to this discussion? Analytical thinking can be brought into it on many levels, but the most immediate contribution analysts can make is to share the experience they have derived from clinical practice. Analysts spend a lot of time with one person.

I am struck by the phrase environmentally sustainable development because this concept is something analysts face continuously in individual psychoanalytic practice: not what is eventually the ideal outcome, but what is manageable. What can the sustainable development of the individual be in the environment in which he or she lives? Realistic appraisal of the limitations imposed by the environment helps determine the appropriate psychoanalytic treatment of individuals, just as realistic appraisal of the environment helps determine appropriate approaches to social and economic problems.

The situation in Eastern Europe in some ways differs significantly from the situations psychoanalysts have dealt with elsewhere. In Eastern Europe there is tremendous enthusiasm for the further development of psychoanalysis, and a great deal of time is being spent on it. As the world of psychoanalysis opens up, there is a tremendous hunger to learn more about the field. When I attended a conference on psychoanalysis in Romania, I reamed that some of the participants from Eastern European countries had traveled four days and nights on the train to be there. The practice of psychoanalysis also expanded significantly in Germany after World War II. It was one way of trying to deal with what had happened.

I would like to link psychoanalysis in Eastern Europe with the concept of environmentally sustainable development. In Eastern Europe individuals who have not had access to full psychoanalytic training have managed to obtain partial training. They use their skills in a very creative way to adapt the approaches they use in psychoanalytic treatment to the emotional climate in which their patients have lived. In several Eastern European countries analysts cannot talk to patients about certain aspects of family relations because these patients are still too frightened and suspicious, and they do not yet have sufficient trust in the analysis. Analysts can, however, talk to individuals about their dreams. Things are changing rapidly. In much of Eastern Europe we see a recapitulation of the way psychoanalysis developed in other parts of the world. In the West, too, psychoanalytic dream interpretation arguably had earlier and broader acceptance than the idea that the relationship between patient and analyst mirrors important aspects of the patient's early relationship to parental figures.

Lying has become a significant part of the culture in Eastern Europe. I would like to summarize a case history from a count try that reveals among other things to what extent lying was accepted and was not problematic or in conflict with the individual's self-image. In psychoanalytic language this lying was egosyntonic.

A child was referred to treatment at the age of eight because her behavior was nearly psychotic. Among other things she bit other children. Her adoptive parents were opposed to sending the child to any kind of treatment, but she convinced them to do so by eating a rat. The child's biological parents had been killed in an automobile accident while she was nursing at her mother's breast. She was found starving many hours later, still at her mother's breast, and was sent to an orphanage in which there was one person who was friendly to the child; the conditions otherwise were horrible. The friendly person became pregnant and left the orphanage. The child was adopted at the age of five.

The couple wanted to adopt a child because their fifteen-year-old son had just died of leukemia. Their house was full of pictures of the son. This is where the lie comes in, and it is something that is hard to imagine. The parents told their adopted daughter that they were her biological parents and that she had been sent to the orphanage because they had to take care of their sick son. This is the environment into which the child came.

One of the major problems that arose during treatment of the child was convincing the parents that living with this lie was not in the best interests of the family nor of the troubled child. Under totalitarian regimes there are families in which honesty exists within the family and is clearly differentiated from the lying outside the family that may be necessary for survival. More commonly, however, the pervasiveness of lying contaminates most, if not all, relationships. In the case of this child the psychoanalytic therapist's understanding of the parents' socially influenced "egosyntonicity" of lying facilitated the achievement of a crucial change.

The child told the therapist that the reason she had eaten the rat was "to feed the dog inside her," and she wanted help getting rid of the dog. After that disclosure the therapist insisted that the parents tell the child the truth. Doing so resulted in a remarkable change in the child, who went through a period of severe depression and then gradually learned to trust not only her therapist but also, to some extent, her adoptive parents. I have not described many aspects of the child's treatment that were literally lifesaving.

Under totalitarian regimes there are families in which honesty exists within the family and is c/early differentiated from the lying outside the family that may tee necessary for survival - John Kafka

Even after liberation we saw ourselves in the mirror of the West. In fact when we talk about the self, we are actually talking about otherness. We are the other; and we continue to define ourselves as the other - Hoda El-Sadda