David Morgan, psychoanalyst and author, reviews this vital book which explores class inequality in relation to psychoanalysis and what might make the latter more ‘accessible’. January 2021.
Review: Class and Psychoanalysis: Landscapes of Inequality, by Dr Joanna Ryan, Routledge, London & New York, 2017 ISBN 978-1-138- 885516
“ Its the same the whole world over its poor what gets the blame, it’s the rich that gets the pleasure*, ain’t it all a blooming shame’.
(anonymous victorian music hall song).
Fascinatingly, the very title of this book seems to me to highlight an important aspect of the class system. If we are British we begin to make preconscious assumptions about an individual’s social class from the moment they open their mouth. Is it ‘class’ to rhyme with ‘mass’ or is it ‘class’ to rhyme with ‘farce’? In such tiny details lie the icebergs of the North-South divide, and snap superficial decisions about poshness, status, and education.
Assumptions about status and class do appear, at least from an external perspective, to saturate psychoanalysis and psychotherapy. An ex-trainee I know from a cockney working class east London background was constantly referred to as ‘chippy’ by his more middle class teachers, seemingly oblivious to the social class fundamentalism that accompanied this judgment. For a different person from a more recognisably posh background it might just have been described as ambition.
Class and psychoanalysis have had a long and fluctuating history. This book is the first time that Class, however its pronounced, has been specifically explored from a psychoanalytic perspective in the UK. There are others in the field internationally, such as Lynne Layton et al.2006,2017) and
Joel Kovel (1970), both from the United States, (Kovel in his many books probably the first pioneer of issues of racism, classism and politics) who have explored these traditional blind spots of psychoanalysts and psychoanalytic theory.
As Layton (2017) states the relation between the psychic and the social must account for the ways that we internalise oppressive norms as well as the ways we resist them. We build our identities in relation to others circulating in our culture imbued with the inherent hierarchies of sexism, racism, classism. These “normative unconscious processes” replicate the unjust social norms that cause psychic pain in the first place.”
All of us who have worked in mental health surely recognise the role that poverty, opportunity and class always play in the development of psychological symptoms, and this is particularly relevant, now, with austerity playing a large part in maintaining the class system in the Western world. Surely we all recognise that a persons life should not be dictated by where they have had the luck to be born and to whom.
As Ryan shows, private psychoanalysis from Freud’s Vienna had relied mainly, with a few notable exceptions such as the low cost clinics of Wilhelm Reich, on the well off middle and upper class for their practices. Freud in actuality, felt psychoanalysis should be provided to rich and poor. He supported the development of free clinics in Berlin and Vienna.
He thought it was important to recognise that sexual repression in a society could cause neurosis, and as we know Fenichel (1953) wrote about the relation between capitalist culture and mental illness.
The Frankfurt School explored the role of problems that were due to the pressures of modern society, strong reverberations of which we can see today in our current neoliberal economy.
Freud argued in Totem and Taboo (1913,1955), Moses and Monotheism (1939), Group Psychology and the Analysis of the Ego (1922; 1959), he put forth his primal horde theory, in which the sons’ rage at the primal father’s freedom to exercise his sexual and aggressive instincts without restraint
leads them to murder the father. The ensuing sense of guilt ushers in a more egalitarian, but at the same time a far more repressed version of society, in which no one is allowed to enact the primal father’s instinctual freedom. In this d model, neurotic conflicts are primary in determining the form of a society, whereas in the model described earlier, society is the prime cause of neurotic conflicts. (Layton 2013).
A model was needed, and has been needed, “That allowed for not reducing the psychic to the social, nor reducing the social to the psychic that allows for both e.g. norms are internalised as well as for what makes psychic resistance and challenge to social norm possible.” (Layton 2013).
Trainings have also been expensive and therefore closed to many, other than those who are well off or determined, or who have as in my own case, a supportive NHS profession and a training analyst who could afford (I assume gratefully) not to charge high fees.
Thankfully, Joanna Ryan addresses these issues suggesting that there has unfortunately been a division between psychoanalysis and the other humanities, such as sociology, philosophy, politics and cultural studies as used to be represented by the Frankfurt school, whose work is often not taught in some psychoanalytic training. This is a complex issue as psychoanalysis does explore that peculiar realm called the unconscious which unexamined can come to govern so many of our actions and behaviours, while academic studies tend to concentrate on conscious manifestations of our existence. This has led to a split and this has led to problems within psychoanalytic practice.
A colleague of mine when applying to train as an analyst was told that she was trying to appear posher than her background suggested. The assumptions contained in this inter change were myriad and full of class references, which were clearly considered not open to analysis at the time. I have heard similar interchanges around race, disability and sexual orientation. This bias in analysis about these issues was never really referred to, as it was seen purely as transference material, so that certainty in the analytic process dominated. Ryan explores the mythological concept of analytic neutrality of the psychoanalyst in the consulting room, demonstrating how, as many of us must have experienced, how it is often more specific than our current theory acknowledges.
Think of how difficult it has been for analysands to train who are gay or from different cultures. I think this has changed considerably but I think class is still a silent issue and we must thank Joanna Ryan for making it conscious to us.
For instance in an assessment of a new patient for a second analysis, the patient told me how furious she was that their previous analysis had consisted of endless interpretations of the patient’s envious attacks on the analysis particularly differences around class status and wealth, either in phantasy.
This disparity may have been certainly relevant, the disparity of the relatively economically challenged patient, being seen in analysis, in a house that was worth several million pounds, that was never alluded to seemed significant. It seemed that the inequality and class divide between patient and analyst, the unlevel playing field, seemed to underpin the whole enterprise. This exploration would have suggested to me, albeit working from slightly more modest circumstances, an intervention that included an awareness of this disparity and unfairness, such as ‘I think its understandable for you to feel that my apparent privileged circumstances might make it difficult for me to understand the issues that you are bringing to me’. This is specifically addressing I feel the difference and how painful and unfair life is, rather than taking it up just as envy or just transference, which of course is also an important consideration.
Ryan’s starting point is that class does matter. It matters because it is a major source and consequence of inequality, often transmitted trans-generationally, that brings these generations of inequality in an embodied form in the patients material, right into the here and now of the consulting room. I saw for instance an Irish patient for whom the potato famine appeared in her dreams, including the inequity of the British government and the land owners who had exploited the Irish they were trans-generational grievances that had never been engaged with and were looking for symbolic expression in her analysis, and were highlighted by our perceived differences.
At times I feel psychoanalysis provides the first symbolic representation of these traumas of poverty, war and suffering. It has to be experienced by the analyst in a real way, in particular the privilege of the analyst actually having the equipment and the training to engage in such meaningful way with his patient.
Joanna Ryan explores, variously, the early history of free and low-cost clinics in Germany and Austria, set up in many cases by many of the early psychoanalysts, who were also she states often active politically espousing socialist and Left wing ideology, she cogently describes the intense theoretical debates that underpinned these early discussions. Since then class has been almost eliminated from psychoanalytic debate, in addition psychoanalysis has gradually been withdrawn from the public sectors clinics of many countries; there has been a divorce between psychoanalysis as practiced and class theory and sociology, important areas such as social mobility, class differences in the transference and the therapeutic relationship; and the crucial role of money and fees in analysis and therapy. These issues have often been taken up individually in the transference, but not in anyway that might change the analytic approach.
As Ryan states the role of neoliberalism and its symptom austerity and the at this moment widest gap between the haves, have nots and the have mores, create a background of inequality and it has been much easier for relatively wealthy clinicians to concentrate on their individual patients, rather than the increasing sickness of the society, in particular climate change and inequality, that analyst and their patients inhabit.
The privileging of what she describes as individualism over collective
narratives and solutions is a trend to which much contemporary psychoanalysis has arguably fallen prey. Due reference is also made throughout to the connection of class with other issues that have become neglected in this discourse such as race, gender and sexuality. Ryan describes British psychoanalytic culture as currently riven with inequalities, rivalries and snobberies, both in terms of access for clients and also trainees and therapists from working-class backgrounds.
As stated earlier, Ryan refers to a wide range of writers within the fields of sociology, psycho-social studies, psychoanalysis and demonstrating the need for psychoanalysis to get its house in order in relation to the setting and environment their patients live in, encouraging a more externally focused practice that recognises the role of socio-economics factors in assessment and treatment of people from a wide range of backgrounds. This might include snobbery, the corruption of privilege, and the humiliation of poverty and in the under privileged, the shame and guilt that arises from these positions.
I was always been curious how my Welsh grandfather after being traumatised in the trenches of the first world war, became speechless and unable to speak, in the face of the horrors he witnessed, where the more educated and middle class seemed to develop stammers, leaving me wondering are psychological symptoms class based?
This is an area that was beautifully explored in Pat Barkers Regeneration Trilogy (2013), through the exposure of the chief character, a psychiatrist, Dr W. Rivers, to his many war trauma patients from different stratas of society. Dr Rivers notes the detrimental presence of class distinctions within the ranks of the British military and the injustices of these class distinctions and the harm they produce on the war front, “the army structured itself around class” and “in many ways, recreating the British class system in miniature: aristocratic generals, middle-class officers, and a working class rank and file”. “long-standing prejudices of the British class system ensured that enlisted men were treated almost like children.” Some soldiers played the role of servant and waited on officers of high class who enjoyed luxuries unheard of to those existing in the grime of the trenches”.
A character in the book, Prior, a working class soldier, who has become an officer, due to shortages of live men, is asked about snobbery, he states “it’s made perfectly clear who is immediately accepted at the front and who is not, certain status enhancements such as having attended ‘the right school” or wearing shirts of ‘the right colour’ predominate. Prior notes that he comes nowhere close to possessing any of these high-class qualifications and suffers accordingly. “What you wear, what you eat. Where you sleep. What you carry‘ all contribute to the reinforcement of class distinctions.”
I am not suggesting here a direct comparison with the psychoanalytic army in the trenches of the unconscious, but there are some parallels, in that Dr Rivers struggles counter-transferentially with his prejudices, and his dawning recognition that his patient’s symptoms and treatment often reflected these origins, and this gradual dawning is beautifully described by Barker and one that I was reminded of by Ryan’s excellent timely book.
The concentration on the individual as a circumscribed unit, that currently exists, probably is the result of many analysts feeling that it is quite radical enough to help individuals change their own microcosm rather than their place in the macrocosm. But there is a pre-conceptual world that we enter before and after we are born, that is redolent with cultural and class distinctions, and this precedes the influence of the parental mind and its influence on the child. This is the parental role of the society that many of grew up in. In my case a caring society, that then became denigrated under Margaret Thatcher, from a caring society to a nanny state, “There is no such thing as society.”
The external world, if we are lucky can provide containment, as in Winnicott’s holding environment or as in Bion’s container contained. Clearly a society that has a welfare provision and an egalitarian
health system, creates this container or safety net for all, especially the economically disadvantaged, that must influence profoundly how that parent interacts with their child. Ryan quotes Lacan who describes ‘entry into the symbolic which involves entry into a language, culture, society, and politics, referencing Carl Jung’s emphasis on the collective Unconscious or I might also add S.H.Foulkes emphasis on the social unconscious, as a pre-existing container. Whether this culture or environment is driven by a caring societal approach or market forces is clearly crucial. We are all
seeing victims of the current economy in our consulting rooms as working practice turns them into units of production as predicted by Herbert Marcuse in book, The One Dimensional Man(1964).
Ryan explores the notion of a psychoanalytic technique that allows for different cultures and class experience. She reminded me of my working class trainee who had been described as ‘chippy’ throughout his training, and how Wilhelm Reich the doyen of low cost clinics in his writing highlighted how people from working class backgrounds could be easily pathologised by middle class analysts as anti-social, rebellious and only driven by their instincts. Rather than struggling in an unfair society to have a fair crack of the whip. It put me in mind of how quickly one may adapt to what feels an upper/middle class culture eschewing ones origins, developing a false self with one’s analyst or peer group. Disappearing into the relative retreat of the consulting room as the society we and our patients inhabit deteriorates.
I found myself reflecting like Dr Rivers on why I work from Hampstead, a leafy and wealthy part of north west London, and on early feelings of insecurity in my training where I was confronted by people who attended private schools and other privileged institutions and perhaps how quickly one can if not careful, or helped in ones analysis, tends to adapt to a stereotype, that might have its roots in 19th century Vienna or indeed 20th century Hampstead.
Were these issues ever a subject for one’s analysis, or did they just become part of the backdrop, that went unanalysed? Ryan does us an enormous service with this excellent book that challenges many cosy assumptions that we may have adopted and perhaps offers us a way back to the true radicalism that psychoanalysis offers.
Having read this book and being moved by Joanna Ryan’s thinking on class and psychoanalysis. I feel obliged to say however that my experience of the British Psychoanalytic Society forces me to say that psychoanalysis as a profession is actually a melting pot and its members are drawn through their analysis, to be almost classless. Just as we might give up religious conviction we might also give up classism. Many also experienced real difficulties when involved in such an intense training, but felt it was worth the effort and sacrifice.
Thus a phantasy that all analysts are from a particular social class or elite, which might have some validity, might also be, in fact be more a projection into our institution. What drew most of my colleagues and myself to do such an arduous training, on top of our day jobs, seems more due to intellectual capacity and curiosity than economics. I for instance saw two very impoverished depressed working class patients for five times a week analysis, for seven years and five years respectively, through the low cost clinic at the British Psychoanalytic Society. I also saw a young adolescent from the same source and for the same amount of sessions for three years. None of these patients had any money and their lives were infused with anxieties of being a have not, in an uncaring society.
“In leading his patients to understand that breakdown was nothing to be ashamed of, that horror and fear were inevitable responses to the trauma of *war and were better acknowledged than suppressed,
that feelings of tenderness for other men were natural and right, that tears were an acceptable and helpful part of grieving, he was setting himself against the whole tenor of their upbringing. They’d been trained to identify emotional repression as the essence of manliness.” (Barker 21013).
*I would add the trauma of poverty and class inequality to this passage.
Barker, P (2013) Regeneration Trilogy; Regeneration, The Eye in The Storm and The Ghost Road. Penguin.
Fanon, F. (1952), Black Skin, White Masks, trans Charles Lam Markmann, New York: Grove.
Kovel, J. (1970). White Racism.A Psychohistory.Columbia Press.
Lacan, J. 1988 (1978), The Seminar of Jacques Lacan, Book II: The Ego in Freud’s Theory and in the Technique of Psychoanalysis, ed. Miller, Cambridge: CUP.
Layton, L (2017), Toward a Social Psychoanalysis:A Conversation with Lynne Layton. Dialogues at the Edge of American Psychological Discourse. p245-278.Palgrave.
Layton, L., Hollander, N. and Gutwill, S. (eds) (2006) Psychoanalysis, Class and Politics NY: Routledge.
Robb, George. British Culture and the First World War. New York: Palgrave, 2002.
David Morgan is a consultant, psychotherapist and psychoanalyst at the NHS and in private practice. He is a training analyst/therapist and supervisor for the British Psychoanalytic Association and British Psychotherapy Foundation, and a Fellow of the British Psychoanalytical Society. David is Hon. Lecturer at City University, London, and a director of (PiP) Public Interest Psychology. He provides consultation to the public and private sector, including organisations of a political and social nature, and is a regular speaker at conferences. He was co-editor with Stan Ruszczynski of Lectures on Violence, Perversion, and Delinquency (Karnac, 2007).