Sunday, 25 May 2008

A Meta-Perspective on Externalisation

Melanie Klein Michael White

A conference at the Tavistock about a year ago had psychologists from different therapeutic traditions formulating the same cases using these different perspectives. It became apparent to all that the term 'externalising' could stand for either a process which was indicative of emotional progress and recovery, or for a process which indicated just the reverse. Yet whilst this was noted, no meta-perspective was offered which allowed for a theoretical reconciliation of these two uses of the term. This is what I shall try to provide in this post.

So sometimes we think of externalising as a failure to own parts of the self, parts which instead become split off and located in the environment. Here the therapeutic work consists in undoing externalisation - promoting the integration and coherence of the self. When this is done the centre of gravity of the self returns, the patient recovers themselves, they can own their guilt or tolerate their mental pain, they can tolerate healthy depression (i.e. they can start to make movements from the paranoid-schizoid to the depressive position, and can tolerate residing in the latter for longer). This notion of 'externalising' is principally located in a broadly psychoanalytical tradition (and is akin to what Steiner calls 'attributive projective identification'). But we might also recall, more generally, talk of the 'externalising disorders' of childhood (i.e. conduct disorders versus the 'internalising' depressive disorders).

At other times however we think of externalising as a healthy manoeuvre. Here - especially in the narrative therapy tradition - we are thinking of cases where people are unable to make progress because they are so bound up in their identity with a powerful bad object. This entanglement prevents the development of secondary process thinking about their predicament, encourages acting out, and prolongs their stuckness with painful feelings of self-loathing. An example will help: A young child with encopresis is making no progress. In their own (largely unconscious) mind they are this shitty, hopeless, out of control child. They cannot bear to even think about their problem, to do anything about it, because to do so immediately activates self-representations which are too painful to bear. Instead they live in mindless thrall to it. The only two options seem to that mind to be subscribing to a view of the self as loathsome, or obliterating the self and thereby making impossible the process of self-development; typically they choose the latter.

In this latter case, externalising is the move the therapist encourages. Instead of a shitty child, we construct and encourage a view of the child as good and well-intentioned. This good child who has every right to feel good about her or himself is however in battle with a problem which (so to speak) is not of their own cloth. This problem is something which happens to them. Perhaps we call it 'sneaky poo'. Rather than she herself again engaging in shitty behaviour, showing her lack of control, actively partaking of the unbearably shameful, we have a healthy happy child who is having to fight an external monster: the 'sneaky poo' monster who sneaks up on them. How can they outwit it? How can they defeat it? How can they - the good child - along with their parents and their therapist - everyone who is on the same side together (not against the child but against this sneaky poo monster) - how can they tackle the non-child sneaky poo problem?(Psychoanalytically we might talk of the separation of a superego and an ego which had become fused.)

Through the healthy externalising procedure the possibility of recovering the self (recovering agency, recovering the secondary processes) is actualised. Yet then again it was precisely through undoing externalisation - promoting internalisation - that the psychodynamic therapist's patient was recovering. It was through owning rather than disowning their responsibilities - being enabled to do so through being 'held' whilst they allowed themselves to feel the depression which otherwise felt too unbearable - that the analytic patient recovered. How can these perspectives be reconciled?

There are different ways of resolving such apparent contradictions. An obvious one is to look for different meanings or senses of the key terms (i.e. different senses of 'externalise' within the two traditions). Yet tempting as this may be, I'm not convinced this is the right way forward here. What I want to suggest is that we instead hold onto a univocal sense of 'externalise' and think instead of the stage of development of (the relevant part of) the self and of the possibility and viability of taking responsibility for one's thoughts, feelings, and behaviours. (i.e. I shall look for different objects, rather than different intensions, of 'externalisation'.)

Externalising, I want to suggest, is healthy when what it undoes is someone's taking too much responsibility for their actions. The obsessive-compulsive person, for example, is prone to take responsibility for the (sacrilegious, erotic, violent) thoughts that come into their mind. The encopretic child imagines - to the extent that they even allow their mind to engage with the topic - that they are responsible for their soiling (or they are caught up in an angry emotional denial of this responsibility). It is this felt culpability that makes their action so shameful. What externalisation allows for here is the relinquishing of this responsibility, either permanently (in the case of the obsessive-compulsive) or until such a time as a perfectly meaningful and possible degree of agency has developed (in the case of the encopretic child). Now that the young child understands they are not responsible, they can work on developing their agency regarding their bowel movements. Once this agency is installed, then appropriate responsibility may follow. With the obsessive-compulsive person, the degree of agency they imagine themselves to require regarding their own thought is fantastical. What they need is to develop the faith and trust in a world and a mind and a body which is not totally (and at the last analysis, not at all) under their control, to tolerate the anxieties of living and in particular to be helped to put down the anxiety-increasing tendencies to try to take responsibility where none is either due or required.

Contrast the case of someone who cannot tolerate the depressive position and who has unhealthily externalised aspects of their selves - structures of intention and responsibility - for which they are actually culpable. Here, whilst some of their neurosis may spring from an exceptionally harsh superego which inflates the extent of their responsibility for their actions and feelings and thoughts, and which accordingly results in its own projective (externalising) impulses, other aspects of the neurosis may stem from an inability to tolerate genuine feelings of realistic guilt. We only have to think of the patient who comes, through analysis, to be able to own their own contribution to the interpersonal disputes they always find themselves in at work or at home, for which hitherto they had angrily ascribed responsibility to their colleagues or partners. In such cases - prior to their resolution - we often find a seemingly paradoxical structure consisting of both (say) worthlessness and omnipotence. On the one hand I (for example) suppose that others think badly of me; on the other I act as if I were always the bee's knees. By helping someone gain a more realistic appreciation of (for example) the perception of others, their need to deploy narcissistic defences against blame also lessens. I can tolerate my guilt better if I know that others will also tolerate or forgive me for the often practically unavoidable yet still culpable minor thoughtlessnesses which we, as all-too-human, are drawn to perpetrate every day.

I want to conclude by commenting on the ways in which these different (narrative and psychoanalytical) discourses often become totalising. Narrative therapy draws on postmodernist conceptions of the self - in particular on constructionist conceptions of self and agency. The self is seen as a function of the narratives which are installed about it. By contrast, the psychoanalytic tradition draws on a romantic conception of the self - as an inner domain to which our narratives must conform if they are to do justice to the psychological truths about our functioning. These two conceptions of narrative and of its relation to the self are often presented as doing justice to 'the human condition' per se, and theorists argue about which is correct.

What I want to insist on is the need for a meta-perspective which makes room both for description and construction - both for the idea of narrative as needing to be responsible to the self, and for the idea of narrative movements as constituting the self's auto-creation. These surely are the two poles between which we oscillate every day. On the one hand we are given - in virtue of being genuine agents - some degree of 'say-so' or 'constituting authority' regarding our own thoughts and feelings and desires. I need serious grounds to not take your word as definitive when it comes to what you yourself are thinking or feeling. Absent such grounds and my doubt becomes a demeaning failure to take you seriously as an agent or as a person. On the other hand we are also beholden - in virtue of our only being subjects to the extent that we are subject to social norms - to standards which are not simply of our own making. These exist both socially but also intrapsychically; this possibility makes room for infelicity when it comes to my avowal, and accordingly constitutes the condition of possibility of defensive disavowal. Achieving this balance - between what we could call doing and creating justice, or between owning and creating - is the task of all of us as subjects or agents striving to live up to these designations. At the same time, it is the duty of us psychologist students of human nature to achieve this balance in our theorisations. Achieving a theoretical distinction between the two different objects that 'externalisation' may take is but a small part of this project.