Letters

The following letter has been sent to the Freud Society of Vienna.

The distinguished critic and Professor of English and Comparative Literature at Columbia University, Edward Said, was invited to deliver the annual Freud Memorial Lecture in Vienna on 6 May (the anniversary of Freud’s birthday).

The invitation, which Edward Said accepted, has been withdrawn ‘on account of the political development in the Middle East’. We wish to state that we deplore this move and consider it to be contrary to the spirit of psychoanalytic understanding and dialogue.

I read Wynne Godley's painful account of his analysis with the late Masud Khan (LRB, 22 February) with concern, anger and regret at the maltreatment of a patient by a psychoanalyst. In order to understand the reaction of the British Psycho-Analytical Society, of which Masud Khan was a member, I have talked to older colleagues. Although there were rumours of inappropriate professional behaviour by Masud Khan, a case of malpractice could not be brought on the basis of rumour. I believe that attempts were made to encourage patients and ex-patients to come forward with a complaint, but none did so. Colleagues who knew Masud Khan said that he was knowledgable and intelligent and could be sensitive and insightful. Some patients felt helped by him. Sadly, his behaviour towards other patients was totally unacceptable. When Khan himself provided evidence of his professional misconduct with patients, his contempt for colleagues and his anti-semitism in his last book, When Spring Comes: Awakenings in Clinical Psychoanalysis (1988), he was expelled within months from the British Psycho-Analytical Society.

Today, we endeavour to protect patients in a variety of ways. We now respond to third-party complaints (when there is more than one), rather than waiting for a patient to come forward, by interviewing the analyst concerned. We also have a designate analyst who is available to talk to family and friends who may be concerned about a patient and/or their treatment. We have developed a Code of Ethics and Guidelines, which has established standards of practice and a system of investigating alleged offences. If a patient wants to file a complaint they can come in confidence to our Ethical Committee. In sufficiently serious cases, legal counsel and non-analysts are welcome to represent complainants and respondents at ethical hearings.

The patient and selfless analyst Wynne Godley found to undo the consequences of his disturbing experience practised the kind of analysis we teach and practise in the British Psycho-Analytical Society.

Wynne Godley ends by saying: ‘What I have written is not an attack on psychoanalysis, for which, as a discipline, I have the utmost respect.’ It is unbelievable how every sad story about analysis is seen as exceptional and successful analyses are seen as the rule. Most of the problems Godley describes have some relation to the structure of psychoanalysis, which favours secret, uncontrolled, unequal relationships in which helpless and slightly disturbed people let themselves be manipulated by somewhat deranged self-declared geniuses. When will people realise that a ‘skilful, patient and selfless analyst’ is the exception, and that even these exceptions will in time lose touch with reality, because there is so much pure hype and make-believe in psychoanalytic theory?

It seems clear, as Wynne Godley points out, that the traumas of his childhood were repeated under Masud Khan's care and that Khan himself was too ill to be practising psychoanalysis. It is a tragic and disturbing story, especially since Khan was an exceptionally gifted clinician and a profound thinker, breaking new ground in psychoanalytic theory. Unfortunately, such instances of malpractice and abuse do occur. The British Confederation of Psychotherapists – an umbrella organisation representing psychoanalysts, analytical psychologists, psychoanalytic psychotherapists and child psychotherapists – was established in 1993 to maintain and encourage high standards of professional practice, training and selection. We have also ensured that in all our member societies codes of ethics and complaints procedures conform to the Human Rights Act.

The recent Psychotherapy Bill, introduced by Lord Alderdice, which has been going through the House of Lords, marks an important initiative to ensure better standards of care through strengthening the self-regulation of the profession.

On the face of it, Wynne Godley’s article provides sound ammunition for the increased regulation of psychoanalysis. There is no guarantee, however, that regulation and training will be a cure-all. As Andrew Samuels well knows (Letters, 8 March), a substantial number of those who practise psychoanalysis and its next-door neighbour, psychoanalytic psychotherapy, are already regulated by the UK Council for Psychotherapy. Regulation has not solved the problem of poor standards of education throughout the profession. How many psychoanalysts are aware that Winnicott’s formulation of the true and false self is highly problematic? To put the argument at its simplest: how can either the analyst or the analysand distinguish between what is true and what is false? Godley describes vividly and movingly the anguish caused by psychic conflict, yet all the states of mind he experiences are ‘true’ of and about him. This is not a new point of view – it is an obvious implication of the work of Lacan or Post-Modern theory.

Why did Winnicott, one of the most influential psychoanalysts since Freud, refer patients to Masud Khan even when he knew a great deal about Khan’s personal and professional problems? I have spent the last six years working on a biography of Masud Khan and, as a practising psychologist and lay analyst, I would like to add something to Wynne Godley’s account.

Masud Khan was Winnicott’s principal disciple and together they helped to evolve analytic technique at a time – the 1960s – when there was a general questioning of dogma. Analysts in France, the US and London were challenging the idea that change occurred only through insight, and looking at the importance of relationships and environment. This seems so obvious now that it may be hard to remember a time when it was new. It was a period of experimentation, which might make it easier to understand why Winnicott and others initially tolerated Khan’s unorthodox behaviour. In addition to his many problems, Khan was also an extremely talented psychoanalyst who had a reputation for saving patients who had been pronounced incurable by other analysts. This reputation is supported by a number of analysands I have interviewed, especially those from the period before Khan’s major deterioration after Winnicott’s death in 1971.

Khan often referred to himself as a paradox and people who knew him well tend to agree. He was a living example of Winnicott’s theory that when we get access to the deeper parts of a person’s self, we find multiple selves which are incompatible with each other. As Khan wrote, ‘one can explicate a paradox, but one cannot resolve it thereby.’

I, too, had an encounter with Masud Khan when, on a trustworthy recommendation, I approached him towards the end of his life, not as a patient but as a trainee psychotherapist looking for a supervisor. His behaviour at the meeting was, to say the least, eccentric; having some idea of what was appropriate in a training analyst, like Emma Tennant (Letters, 8 March) I took flight. However, my reasons for wanting to work with Khan were based on his undeniably brilliant writing on psychoanalytic matters and I still recommend these to trainee psychotherapists today.

Multinationals are a complex and troubling feature of modern society, but they will not go away and it is not remotely desirable that they should. They wield a lot of political influence, some bad and some good. They are the theatre for much of the comedy and tragedy of personal life at the turn of the millennium. They also transmit knowledge and skills across frontiers and generations. They value docility when it suits them, but since docility is not always conducive to innovation they sow the seeds of their own subversion. When producing in poor countries, they pay wages that are absurdly low by rich-country standards but usually high by local standards (that's how they make their money). A haemorrhage of their talent is often the way local production gets started. They produce many of the essential and many of the ridiculous features of modern life, from life-saving drugs to Spice Girls records to the aircraft that transport anti-capitalist partygoers to Davos and the mobile phones they use to organise their activities when they arrive. Executives of multinational corporations are as complicated and various as the readers and writers of the LRB (which, with a workforce spread across the world, is a multinational too). They are in it for themselves, certainly, but they also lecture us, often sincerely, on ethics and the future of the world, much as Paul Foot (LRB, 22 February) does. They pose a challenge to modern politics but they deserve a more subtle treatment than they have been receiving recently in the LRB.

The supreme irony of the organ-retention brouhaha discussed by Hugh Pennington (LRB, 8 March) is how difficult it is to donate one's whole body for medical use. Potential donors are warned in bold type by HM Inspector of Anatomy of the uncertainty that any given bequest will be accepted. An entire page of the guidance notes is devoted to listing the reasons for turning down a bequeathal, including post-mortem examination, bedsores, recent operations where the wound has not healed, amputation and dementia. It is not entirely clear whether dying of old age would be a disqualification, but the distinct impression is given that to be considered one should preferably not have died at all.

Because I know so little of current British cattle-raising practices, I found the letters of Messrs Scott, O’Leary and Urquhart (Letters, 8 March) very interesting indeed. David Scott worries for my bull calves and their testicles, implying that castration is unnecessary as well as cruel (though we use supposedly painless plastic clips). We find that, unless castrated, the males fight each other – and older bulls, with sometimes disastrous results – instead of putting on weight. I wonder if what makes the difference is our ‘wild’ Nelor breed, or is it just a matter of control? Our cattle of all sexes and none range freely within two fenced pastures of roughly twelve thousand acres each; we cannot possibly practise one-on-one animal husbandry to keep the animals separate. As for vermifuges, we use a Brazilian-made ‘ball’ that we try to feed to each animal twice a year. Perhaps our voracious tropical worms are unknown in Britain. I am puzzled by the non-use of vaccination against foot and mouth disease; even on our jungle-river border with Brazil, with neither passport control nor customs, there are animal inspectors paid by Brazilian ranchers, and we cannot sell our cattle unless they’ve been vaccinated. Yet I understand from Mike O’Leary as well that vaccination is not compulsory in the UK. I wonder why. Will that perhaps change now?

While acknowledging that ‘antibiotics are seriously overused’ by others, Mr O’Leary explained his own commendably organic methods, which I gather are very different from normal cattle-raising practices in the UK. Unfortunately I did not understand his ‘herd management system’, and would be most thankful for an explanation (gratefully received at edward.luttwak@gte.net or via the LRB).

As for my abysmal numbers compared to his 100 per cent fertility record, congratulations are certainly due to Mr O’Leary, and his bulls as well. But I had misrepresented our results, poor as they are: 60 per cent was a minimum, we usually achieve 70 per cent, and it is not that we have 60 or 70 live births per 100 cows, but rather that we obtain 60-70 per cent herd growth each year, net of predation. We do not even know how many live births actually occur because newborns are of course especially vulnerable to maned wolves as well as to jaguars, both locally abundant. It was our choice to stop all hunting, and we accept the consequences. I was impressed by Mr Urquhart’s encomium for Scottish beef. Is it really raised without grain or other proteinic feeds? If so, none of my strictures would apply, because then the use of antibiotics need not be habitual. But I wonder therefore why with very high fertility rates, and no ‘antibiotics, vermifuges, vaccinations, sonograms etc’ to pay for, beef production in the UK is not a highly profitable activity. Can winter hay be that expensive?

Adrian Woolfson (LRB, 8 March) is right if he believes that the relation between genes and organisms and indeed the nature of genes themselves are often grossly oversimplified in the popular press. The completion of DNA sequencing does not, as so often claimed, represent the ‘deciphering’ of the genome. What it reveals are the coded instructions, which are still in many ways highly cryptic. Only the organism as a whole ‘knows’ how to do all the deciphering, and a total detailed account of the living organism is very far from being achieved. Nevertheless, contrary to the impression that may be given by parts of Evelyn Fox Keller’s book, and Woolfson’s review of it, there is no good reason to devalue the ‘gene paradigm’. It is true that our view of genes is much less simple than it used to be. We now know that genes sometimes have variable starts and stops, and are commonly transcribed into products that have to be cut and spliced, sometimes in several different ways to yield different products. And genes are, of course, expressed in different ways and to different extents at different times and places during the development of the organism. But these complications do not detract from the ultimate authority of DNA. Variations in gene action are controlled by proteins, often in large aggregates and working in ways that are dauntingly complex and usually far from being fully understood. The crucial point is that all of these regulatory proteins are themselves encoded in the DNA of genes – the genome regulates itself. The basic reason why the developmental programme is reproduced so faithfully from one generation to the next is the high degree of accuracy of transmission of DNA sequence, monitored by correction mechanisms, themselves functions of gene-encoded proteins. Rare errors (mutations) do accumulate over long periods, and are essential for long-term evolution, but the most remarkable thing about biological reproduction is its accuracy, based on the rules of DNA base-pairing. The DNA paradigm is here to stay, and it emphatically does not imply simplicity.

David Guedes’s squib (Letters, 8 February) in response to my piece about Noam Chomsky charges that I am nasty about quite a lot of people, such as Geoffrey Sampson, and not a few cherished institutions, such as Nato and the Académie Française; that, like high-altitude bombing, this nastiness is indiscriminate, or nearly so; and, anyway, there’s no pleasing some people. His main worry seems to be that I ignore contradictions which ‘knaves and fools’ might spot. For example, how can anarchists such as Chomsky moan that the Kosovo operation was illegal? If torture’s bad, how can it be bad to bomb Milosevic to stop him torturing (or conversely)? The ‘Atlantic democracies’ – that is, we – are the good guys, right? So how can we be the bad guys? But these are contradictions only for those who swallow – or mouth – State Department propaganda. The real inconsistencies surface when politicians try to gloss Realpolitik with moralistic rhetoric. Anyone who takes this rhetoric at face value risks being embarrassed by some of the actions waged in its name (such as killing Serbs or Kosovars for charity, or high-altitude bombing). Guedes voices the view, which he implies I share, that ‘liberalism is a shoddy arrangement.’ I assume he has in mind a liberal version of the old Marxist distinction between the ideal and the sad imperfections of practice. The actually existing liberalism of the ethical foreign policy, making the world safe for democracy, the New World Order etc, now has a long history, and includes the killing of a million-odd Indochinese civilians in liberal attempts to stem the tide of ‘Communism’. Shoddy? I’m only an exiled Brit trying to make sense of the local folkways, but is that what Americans call ‘irony’?