INTERVIEW WITH DR. MELVIN LANSKY
INTERVIEWER: Marcia Meldrum
DATE: November 15, 2012
MARCIA MELDRUM: Good afternoon, Dr. Lansky.
MELVIN LANSKY: Good afternoon to you.
MM: Could you introduce yourself for the camera, please?
ML: Yes. I am Dr. Melvin Lansky. I am a physician, a psychiatrist, a psychoanalyst and a teacher of psychiatry, but especially of psychoanalysis, here in Los Angeles.
MM: Excellent. So tell us a little bit about your own background. Where did you go to school? Where did you get your training? And, in particular, why did you make the choice to get into psychiatry and then into psychoanalysis specifically?
ML: [During] my undergraduate days at Berkeley, I was pre-med, but I became very enamored of the study of philosophy, which I took as a freshman, and then majored in philosophy, although I still was pre-med. I really went back and forth about, “Do I want to be a philosophy professor, or do I want to be a physician?” I hung on to both. I graduated, went to graduate school at Berkeley, but I had also applied to medical school, across the Bay at the University of California San Francisco. I was accepted there, and I decided to go to medical school. I really was very interested in, yes, the mind, but also the brain, and thought about all kinds of things, as young students do. I mean, I wasn't on a beeline toward psychoanalysis, although I was really quite fascinated with psychoanalysis.
I put a lot of emphasis [on the mind] in medical school. Took all my electives in neurology, and took one of them in England, [where] I heard in one of the lectures that Freud, as a medical student, studied at the Salpêtrière in Paris. Within an hour or so, I fired off a letter in my finest college French to the Salpêtrière. I received a letter shortly thereafter which said in French, "Oh, we're so sorry. We just can't." OK, they refused me. But actually, the letter went on to say, "Alas, all we can offer you is a position without pay." I never asked for pay in the first place. That was their elaborate way of accepting me. So I went to the Salpêtrière, where Freud went to [attend] the lectures, the leçons du mardi, of [Jean Martin] Charcot, and that was quite an experience.
As things evolved, it became more and more clear, and especially [when], as a resident at Yale, two or three of us, [in] the philosophy department [and] me in psychiatry, got up a study group on philosophy and psychoanalysis, and that was quite fascinating. Like almost every male physician in my vintage, I had a stint to do in the military, and I was lucky getting an assignment to a teaching hospital where, lo and behold, the residents in psychiatry asked for a course in psychoanalysis and wanted me to teach it, so I did that.
Then I came here [to Los Angeles], and for an elective at the [Los Angeles Psychoanalytic] Institute, I asked for permission to take a special elective with a very famous analyst, Dr. Rudolf Eckstein, whose doctorate was in philosophy. We did that group for seven or eight years, so it’s been parallel tracks. More and more, I got into clinical psychoanalysis, which is what I like doing best, but things are still tinged by my background in philosophy and my other interests as well.
MM: That's fascinating. So why do you think you like clinical psychoanalysis best?
ML: Well, I like helping people. That sounds sort of cliché, but you can't be a clinical philosopher. You can be a philosophical clinician, but you can't be a clinical philosopher. I find the work – medicine in general is very satisfying because you help people. Psychiatry is very satisfying, and with psychoanalysis, I find that to be the most satisfying of all. I mean, that's a more selective sample of people who can do the procedure, commit to it, participate in it, with some help. But I’ve found it to be one of the most satisfying things I can imagine doing.
I'm still excited about my work; I love it. I'm in study groups. One is a continuation of the Leo Rangell Study Group that is still called the Leo Rangell Study Group and still continues to meet a number of times a year.
MM: Tell me just a little bit about the study group.
ML: I can't remember how long ago, probably in the early 80s, I would guess, Leo Rangell and the late and much lamented Dr. Adrienne Applegarth of San Francisco, kind of lamenting the way residencies have gone, and even institutes – I'll get to what's lamentable about that – decided to form a group of analysts who could think like Leo, meaning, “Add anything that's of value, but don't drop the rest of it.” The big problem is not adding; it's that people sometimes get swept away by exciting new discoveries, and they are exciting. Things don't end then, and they're not ended now, and there are exciting things all the time.
The problem comes when people get so excited they drop the rest. What Leo was so famous for was [his insistence that we] add anything that's of value, but don't drop anything that's of value. It sounds trivial, but it isn't. It's a minority that can really hold onto that.
MM: So you want to give an example? I'm particularly interested in Dr. Rangell. We're sort of getting ahead of things, but that's all right. We'll come back.
ML: One very famous paper, and a book, that is very misunderstood, is a book called The Mind of Watergate [Norton 1980] that Rangell wrote. This was not a matter of Rangell versus Nixon. Most of us in this business are politically liberal, but that's quite beside the point. What Leo was pointing out is that the Watergate hearings brought to his consciousness, [though] not to very many other people’s, here was a man on trial for condoning this break-in and actually fairly petty burglary at the Watergate Hotel. OK. That's a crime; it needs to be dealt with. But that's not what interested Leo.
What Leo brought up is [that] millions, maybe billions, of people looked at the Watergate hearings [and the events that] culminated in [President Richard] Nixon's resigning, and focused on what Nixon was like. Leo's take was much different. What he wrote about in the paper, which was a presidential address for the International Psychoanalytical [Association], (of which he was president twice and later honorary president), this is not about Nixon. It's about a public who had referred to this man for at least thirty years as “Tricky Dick”, that was surprised at this basically illegal prank, and [felt that] the president of the United States shouldn't be doing that.
But [Rangell’s] focus was on the public's attention to this. First of all, voting for him, and then voting him in again, knowing that he had been known as “Tricky Dick” and with absolutely convincing evidence. It's not hearsay, with the Helen Gahagan Douglas and the Voorhees scandals in the forties. Leo [felt that] he was putting forward a syndrome [that] is on a par with the neuroses in significance. [He called it] “the syndrome of compromise and integrity.” One gets corrupted.
It got a lot of press. The book sold a lot. Most people don't [quite get what Leo meant]. It hasn't been followed up, like so many of Leo's great papers. It would be great if they were followed up, but after the fanfare is over, people tend to forget. He's using this not as an opportunity to bash Nixon. Leo didn't do that kind of thing. But [he meant it] as [a demonstration of] something that's part of the psyche that is every bit as important as a neurosis, and that's that compromise of integrity.” [The book is less about] Nixon [than about] the public who voted him in now getting enraged at the trial and not seeing the contradiction in their own opinions.
[pause] Where are we? I have so much to say.
MM: I asked you for an example of one of Dr. Rangell's fresh ideas, and I think you told me, so let's go back in time just a little bit. So tell me about when you first met and got to know Dr. Rangell.
ML: I met him in passing because he was such a prominent figure that there was always some huge event. When I really met him, and it was a shocker to me, the local society, not the analytic group, the psychiatric group, which is the largest in the country, the Southern California Psychiatric Society, gave a big event in honor of Leo's seventieth birthday in 1983, and invited speakers to discuss varying aspects of his work. To my very pleasant surprise, I was asked to be one of the speakers. At that time, I still very much had a foot in the academic camp and a foot in the psychoanalytic camp, and I wondered, “My God, why me?” I mean, there are certainly more accomplished, more senior, more productive folks than I.
Leo actually knew about my work, which surprised me, and knew especially about my work on post-traumatic nightmares. I ran a family treatment unit for UCLA, where I worked part-time.
At the Institute, I was the guy who taught the dream course for several decades, I mean, the whole Interpretation of Dreams, which I still think is a neglected text. I mean, to read the whole book, not selections. And I had started talking to combat victims, rape victims, auto accident victims. When I taught the dream course, [I became interested in] nightmares. Now, it's easy to assume that a post-traumatic nightmare is a picture of what happened. It's an intrusive thought. It's basically a nighttime memory. It occurred to me, when I asked [the trauma victims] a couple of very simple questions, “Tell me the dream. Was this about something that actually happened? What was that?” Simple questions. What was so striking, in virtually every case, and I mean well over a hundred patients studied in detail, there was a gross discrepancy, more discrepant if the trauma had to do with human malignity. That is, if you got in a car accident, that's less traumatic than if you're raped. Or there you are on the battlefield and your buddy's head gets blown off. Those are traumatic, so you think of those dreams, OK, they're dealing with the trauma. That's how Freud, in 1920, got to the idea of the repetition compulsion.
My studies, based on very simple questions, convinced me that there actually is a huge discrepancy between the patient's description of the dream and that same person's description, less than ten minutes later, of what actually happened. “Do you ever have nightmares relating to combat?” “Yes.” “Was this about something that actually happened?” “Yes.” “Could you tell me about the dream?” “Yeah, there I was in Vietnam, and this is something that happened. We were in combat, and I was facing ahead trying to shoot at the enemy, and I turned around for some reason, and I saw the enemy soldier, and I turned around and shot quickly and I got him. He fell off the roof, landed face down, dead. I walked up to the corpse, and I turned him over, and that face was my brother's face.”
Now, that's not the trauma. I mean, being in Vietnam and being in combat and feeling you’ve just missed death by seconds, and you happened to take a shot and it was right on the mark, and you got the enemy. OK, that happened. But that [the dead man’s face] was my brother's face does suggest sibling rivalry of a very serious sort. So I started asking – this is very simple methodology – “Do you have nightmares?” There's almost no work done on nightmares from a psychoanalytic point of view. “And were they related to things that happened? Tell me the nightmare, the story, and tell me what happened.” They didn't line up. Almost never did they line up. They line up a lot, but not completely, as with this – there was a [nightmare] scenario, but then, “It was my brother's face.”
So I began studying these things. I had a very, very cooperative staff, who just asked, “Do you have nightmares?” And then I would interview, of course with permission. They were disguised, but the actual data are there, and I had a huge sample, over a hundred. In the analytic literature, none of the [other published] studies have more than two or three, that we're talking about.
I decided to present this at the then Los Angeles Psychoanalytic Institute. We got remarried to the Southern California [Psychoanalytic Society and Institute]. We never should have divorced in the first place. I presented it, and it was called “The screening function of post-traumatic nightmares,” which really means they aren't just photos, they've got a function. They screen, as with this man's deadly rage within his family of origin. It had a legitimate outlet on the battlefield, but that doesn't mean he doesn't have [those lifelong] dynamics. And the actual product, the bit of ideation, this little smidge of consciousness while we're unconscious, as Freud called it – it has a lot of meaning and has to be analyzed, and with great profit.
I presented that, and Leo, who was so busy, very hard to book for anything, was intrigued by this. He showed up sort of spontaneously and discussed the paper. Said some very nice things about it. He had asked me a little bit later to be a presenter. That's why he had suggested that I could think about screening and about trauma and not drop one [of the two phenomena]. And that's the center of Rangell's [philosophy, which] sounds simple: total composite theory, add without subtracting. Trauma has tended to be neglected. It was for a while. Freud started out thinking everything was post-traumatic, with the early seduction hypothesis, studies on hysteria, and then, in 1905, he discovered the internal world much more.
A lot of people tended [to think], OK, so we don't have to study trauma, we just look at what the mind does. But that's an error, too, because trauma is very important.
MM: I know I interrupted you right in the middle of a sentence. Do you remember where you were?
ML: I was saying trauma is very important. But the idea of incorporating a totally external event, the trauma, [with] the internal workings of the mind, [is] not easy to work out. That requires major, major consideration of, for example, the topic of anxiety, and in that area, I think Leo Rangell is second only to Freud, and in a lot of ways surpassed Freud.
Things don't stop with Freud. [Hysteria] got him into his studies of anxiety. This advance was very important. Freud started out originally [thinking that] anxiety is all organic, dammed up libido, having to do with suppression that gets internalized as repression. That's trickier than one thinks because, I guess, as the French have pointed out, you not only have to repress, you have to repress the idea that you've repressed. Who made the decision to repress this? I mean, you keep going and get an infinite regress there.
The first theory [in Studies on Hysteria, by Breuer and Freud, 1893-95]* was a post-traumatic theory, [which] often [sees] males as the abusers and females as the abused. That is not always [the case with abuse]. Anxiety [was] understood, after 1905, [to come not simply from blocked libido but] also from [conflicts involving] internal workings. [Psychoanalysts have had to face the problem: How does one add to psychoanalytic theory, yet retain what is of value?] The topic of signal anxiety doesn't really get fully developed till 1926, in The Problem of Anxiety, sometimes translated [as] Inhibition Symptoms and Anxiety.
[Regarding this problem with the theory of anxiety,] Freud himself concluded, in two Latin words, “Non liquet.” It doesn't work. Rangell, opposing Freud this time, said, after his really masterful studies in anxiety, “Liquet.” It does work. You can reconcile them.” And [the theory of anxiety is a large component] of his opus, four hundred papers and many books. It's not simply one or the other. [Rangell’s major contribution] later in life [was with the prevalence of] pars pro toto,” part for all thinking. So many [psychoanalysts become swept up] with excitement over the new view that they drop the older [tenets that remain of value].
Leo wanted it [all] integrated. The phrase “total composite theory” is a very serious [agenda, not simply a slogan]. We have to re-examine what's new, and we have to seriously examine the [existing] body of knowledge, though we're always ready to add, and if there's a good reason, we will replace. If you had one epigram for Leo that people should carry away, my personal nomination would be that. Watch out for pars pro toto errors, because there are, we hope, always going to be exciting new developments in our field, [which we should use to integrate, not replace].
MM: Could you maybe give a specific example? I mean, looking at your own career, what new things have come up, and are there specific things that have sort of taken over some parts of the field? People have said, “Well, this is the answer;” and [they’ve] sort of gone off in one direction, abandoning other significant – Can you give an example?
ML: I will give lots of examples and name no people.
MM: OK. That's good, too.
ML: I am what I would consider a mainstream psychoanalyst. I have learned – I am blessed in my education in that the then Los Angeles Psychoanalytic Institute had a Kleinian component. A lot of that group has broken off and formed a newer Institute, although the members retain dual membership. Wilfred Bion was a member of our Institute for years. I got a chance to work with him and write [several papers] about [his ideas].
The point is, if one says, I want to add Melanie Klein – In fact, I want to add object relations people, not Klein, but the Middle School – [Donald] Winnicott, [Ronald] Fairbairn, Max Eitingon – all these people. And then, I guess it was 1971, [Heinz] Kohut's The Analysis of the Self came out, and like so many people, I read it and I thought it was a blockbuster. It was just an amazing book. This went beyond anything Freud thought of.
OK, there's separation anxiety, which Freud talked about in 1920, [and] castration anxiety, which needs a lot of explanation. But Kohut said there's a third kind of basic danger that hasn't been taken into account, and that everybody knows about but we haven't [explicated] – fragmentation anxiety. “His girlfriend dumped him last night, and he's falling apart – everybody knows what that means.” It's not that we don't know what that means. But exactly what is fragmentation anxiety? Well, that's for scientific discourse, but it's not like people don't understand. You know, there was this huge rejection and this person is falling apart. Kohut took this very seriously. I rank him in the pantheon of great thinkers, along with Melanie Klein and a few other people.
And, again, Leo – there was a personal [element] – Heinz Kohut and Leo Rangell ran for president of the International [Psychoanalytic Association] at the same time. Leo won, and it was right before The Analysis of the Self came out. I am not saying one has to do with the other. Kohut was a genius, and he was a wonderful, lasting contributor. But sadly, he left us [Kohut died in 1981]. I wish he hadn't. I had an opportunity to hear him, to meet him and to talk to him. He came to Los Angeles, where he was much more welcome than he was in other big psychoanalytic centers.
The danger is to dismiss Kohut, or dismiss the rest of the body of knowledge. You might think everybody would know that. But somehow it's [only] Leo saying, "No, don't dismiss what's of value." That means you've really got to look at what's new, and that doesn't mean push everything else off the table. It sounds simple, but it isn't.
MM: Actually, I imagine it would be very difficult to integrate some of these complex types of thinking.
ML: Yes. I mean, you don't have to have a [written down] theory, because that would be a very elaborate theory. Leo could do that; not very many people could really do that. But to think, when I add, it doesn't mean I replace. It does mean I have to look and really scrutinize, “Does this add? In what way? Am I going to take this on board without pushing off [some other concept]?” You don't want to take on board fragmentation anxiety. “His girlfriend dumped him and he was falling apart.” Everybody knows what that means. But it's not integrated into theory. You don't want to push aside separation [or castration anxieties, just because you’ve added fragmentation anxiety].
Freud made a very apt comment on Otto Rank's The Trauma of Birth [1924; English edition 1929]. The reason I mention it is, it's very telling. What Freud criticized was not the addition of birth trauma basically, [but that] the primacy of separation anxiety [was] a bit overdone, by saying, "Look. It's as though somebody tips over an oil lamp, the house caught on fire, the fire department shows up and rights the lamp and then leaves." Well, not so simple. It's an interesting example. I mean, theoretically we can't just pick up the lamp and right it, and we can't ignore the fact that the house is on fire. We've got work to do, every time there's a big exciting [new idea], like separation or fragmentation.
There's been very little effort to clarify the notion of castration. Castration anxiety is a big word, misused by Freud and everybody else. I can elaborate for a moment. It doesn't mean just fear of mutilation, or of losing testicles or ovaries. Freud is actually talking about anxieties of the anatomic differences between the sexes, which is upsetting to either sex, [especially] because [Freud’s interpretation was] rather phallocentric. You have [a penis] or you don't. Well, women have plenty, but it's not dangling out there; and if you've seen young children, you'll see they're very perplexed about, “Why don't I have one?” – and [it’s] a source of perplexity to anxiety. Why he chose the word "castration," which is not [about] having a penis or not having a penis, or having it and it was cut off, or being cheated out of one; that's an endocrinologic event, the removal of testes or ovaries. But let's not get too pedantic about that now.
[The very topic of castration] upsets people. Leo gave a plenary address at the American [Psychoanalytic Association], of which he had been president twice, and just in his last few months was named Honorary Life President of the American. He was already Honorary Life President of the International. He gave a lecture on castration. That was his choice. He said he did this not because it was the only thing on his mind, [but] because it hadn't been properly done, and told me in private conversation, although I think he said this publically, it was very difficult to write. Very, very difficult, and yet he's not willing to abandon the term, and the term needs some clarification.
We had some talks on that topic. It's so interesting that he chose that word because it really polarizes people. People who are Kleinians or Kohutians or Inter subjectivists or Self-psychologists don't tend to use the word castration anxiety, nor do they say, "Well, we won't use that [term], we'll use ‘upset about the anatomic difference between the sexes’." But I don't hear them saying that [either]. I obviously haven't read everything. [Genital mutilation] tends to be upsetting. It's upsetting in development, and it's upsetting to look back on. With the exception of the French, and mainstream psychoanalysis, it's so interesting how that topic drops off; people tend to run away from that issue.
MM: This is fascinating. OK. But we want to talk just a little bit, because we started talking about how you got to know Dr. Rangell and how you were asked to give this talk. If you could just talk a little bit then about your relationship and how it developed over the years and how you sort of got to be one of his friends.
ML: I'd be happy to. I had met him [long ago]. He was a quite a luminary. “Hi, I’m Mel Lansky, I don’t know that you would know me.” But he did know about me and my work. Interestingly, this was work in family systems theory.
Now, this is a long story that I won't make too long. It started out [that] every single proponent of family therapy was a psychoanalyst, and [almost] every single one left psychoanalysis, often with a bang. Helm Stierlin, who's probably forgotten and shouldn't be, a wonderful German analyst. And Don Jackson, [who introduced] the double bind theory, a psychoanalyst. Murray Bowen, a psychoanalyst. I couldn't go back and get all the names, but just about every single one.
As soon as you get the ego – I always tell my students, "Would you like a brief summary of ego psychology?" "Yeah, we'd love one." "How about a very brief one, a very, very brief one? One word. Adaptation." If you have all biologic forces, how do you understand that the mind has to integrate your lusts with your conscience or your fear of punishment? Then you have to, if you want to conceptualize the mind, have something that's innate. I don't want to say impulses or drives or the id, because that's terminology. Not that there's anything wrong with it, as long as one understands its limits. And then there's restraints, either external ones – get your hands off Mommy or I'll punish you, little Hans is told, and then he becomes very afraid of horses in the street.
MM: You were talking about family systems theory, how all the family systems theorists were at one time psychoanalysts.
ML: Yes, they were analysts, but then they became kind of rebels. They didn't have much of a psychoanalytic identity, except for a probably forgotten man, who shouldn't be, Helm Stierlin of Germany; [this is] thirty or forty years ago. So there tended to be, and I think still is, a sort of anti-analytic bias in family therapy. I'm not current enough in the literature to know whether this still is the case.
Leo has written some incredible papers. As of at least a few years ago, in the psychoanalytic literature, there is only one paper written on friendship. Leo's paper on friendship was another one of these plenaries. It's not like people didn't know about it. Here is the most famous psychoanalyst in the world being inaugurated, and he gives this as an address. You really have to understand that friendship, if you assume it's a biologic bond, has to be aim-inhibited, I mean, not headed toward consummation, orgasm, sexual satisfaction. Now, if that doesn’t bother you – I just mean “a friend”. I don't mean a roll in the hay. In conversation, that's no problem, but if you want to look at the biology of all of this, friendship becomes a very interesting – I mean, how do you account for just friendship? And Leo addressed this in his paper on friendship. It's a neglected paper.
Leo drew attention, in part [to] my own researches, which were always about my own clinical problem. I keep stumbling over this, and I always look at my material. This is me, Lansky. When I came to realize – because I review my clinical stuff a lot – know what I’ve missed in all of these things? There's a dimension of shame that I hadn't taken into account. As I think I mentioned, three of us founded a Psychoanalytic Association discussion group. Myself, Dr. Benjamin Kilborne, who is now in Massachusetts, [and] my dear friend Andrew Morrison, sadly now deceased. We started the Shame Dynamics Discussion Group.
The American Psychoanalytic has over a hundred of these little groups that get together, and would meet for – it used to be three hours. Now we only get two hours because there's so many of them. The group was very well attended. I think I mentioned we invited Leo, who was the first major psychoanalyst in the world to talk about shame.
It was in one of these presidential papers called “On Poise”, an absolutely brilliant paper where he starts out with a comment from a woman in analysis, [who told him,] "I go to a party, and I just can't keep myself together unless I have a drink in my hand. I don't mean the alcohol. I mean holding a glass, whether it has alcohol in it or not, and a cigarette, whether I'm smoking it or not, so I can feel together. It's not about tobacco or alcohol, it's about engaging my hands, and only then do I not worry I'm going to fall apart and experience shame."
So Leo goes in to [the problem of] shame. Now, the interesting thing about that is that, [at the time he wrote his paper on poise,] nobody else [considered shame, including] the late Charles Brenner, [a man] whom I greatly admired, but who I think was not on a par with Leo. [Brenner first wrote of sexual and aggressive drives, but later, close to the end of his life, refined his language to refer to sexual and aggressive wishes. That is an important refinement, but Brenner still doesn’t mention anything about shame dynamics – his thinking certainly allows for shame dynamics, but he doesn’t mention them specifically the way Rangell did in his early paper, “On Poise,” in which he describes a woman analysand who declared that she was so frightened at a party unless she was holding a drink or a cigarette in her hands. Then Rangell explored what the conditions were for poise and the conditions for freedom from anxiety about losing composure and subsequent experience of shame.]
And the danger of, as Leo called it, “un-poise,” is if you have a shame attack. This is decades before anybody got into it. Not only that, [but] people haven't returned to it. There are people who really recognize shame – I'll just diverge for a minute because it's very important. Kohut's first book [was] The Analysis of the Self, is a magnificent book. ‘71. To study shame in 1971 is where you date the calendar. Then, in the ‘77 book [The Restoration of the Self], he doesn't talk about fragmentation anxiety. He now moves to completely psychological rendition, and that's of value, except it pushed fragmentation anxiety off the table.
I haven't heard – now, this is my limited [acquaintance with] self-psychological [writings recently], and I've done a lot of reviewing, I have friends who are self-psychologists and even prominent in the movement. They don't talk about fragmentation anxiety anymore. They will talk about shame, but it's an affect. Theoretically, that's pale, compared to [the feeling that] “I'm really seized with the fear that I'm going to fall apart.” That's not just shame, it's the danger, imminently, of debilitating shame, but, [in Rangell’s words,] it's offset if I have that drink and that could be just club soda, and it could be a cigarette that isn't even lit, or no cigarette, but something [else in my hand]. And the nuance to that really requires a total composite theory.
MM: OK. It's all sort of coming together. It's quite interesting. I just want to get sort of a handle on this, and I'm not sure if I have it. In terms of where psychoanalysis is at the present day, do you see it sort of drifting in all these different directions? I mean, this seems to be something that Dr. Rangell was very concerned about. Do people who say, "I am a psychoanalyst," does that still have a strong identification with either a Freudian theory or something that's fairly well established on the same lines? Adler, or Jung or some people I would have heard of. Or Kohut, for that matter. Does this create a fragmentation in the field, or what would you say?
ML: A fragmentation – there should be different points of view. There shouldn't be a Politburo kind of dictating who thinks what. But the failure of integration is to be lamented. That's what Leo was worried about, not that he wanted self-psychologists to talk about castration all the time, or people who talk about castration to talk about fragmentation. It would – in a turn of phrase – drift away. It's almost like global warming. I saw something – this wonderful, lovely polar bear on a little piece of ice, and everything was drifting away, and that bear's going to be dead, and I'm afraid that's a good metaphor. I mean, there's not enough solid ice to hold that huge gorgeous creature.
I have a similar worry. I tremble to think that [the polar bear] might be an apt icon for the dangers to psychoanalysis. When you stop to realize, worldwide, psychoanalysis doesn't get external support. Go to the psychiatric meetings, and the drug companies will fund stuff, sometimes with great integrity, even stuff they don't agree with, sometimes less so. But the couch companies don't underwrite psychoanalysts. It's not like Sealy and Simmons [mattress companies] giving us grants. (chuckles) We don't use that many couches when push comes to shove. A few thousand.
MM: Yes, there are a lot of forces working the other way, towards more biological psychiatry.
ML: I'm not simply talking about self-serving corrupt people. That's not my interest. But just that when you stop to think about world psychoanalysis, as one of my great teachers at our Institute said, "This isn't really a faculty per se. We're a bunch of tired old men doing this at night for nothing." I mean, there are very dedicated people, but there's no undergirding, there's no support. Not due to the workings of evil. It's just people are so passionate about psychoanalysis, they will make the sacrifice, they will cut into [their working hours]. I teach a two-hour seminar; that means I have to take three to four hours out of my Wednesday midday, morning, [or] early afternoon. I'm glad to do that, I'm honored to do that, but it's also prime time.
MM: Right. Not doing something to earn some money. OK. Do you want to look at the questions and see what we haven't covered, perhaps? I know I asked about Dr. Rangell's contributions. If you could sort of summarize them? You might want to do that, but I want to make sure you get to say everything you want to say.
ML: I actually had a list. Maybe this is a little bit of a review.
MM: That's OK.
ML: Anxiety. Anxiety basically is a taking in of external prohibition and fear of punishment, in the form of bodily mutilation. How do you have a theory of anxiety that's not just the way – I imagine a lot of academic psychologists, and I have a lot of respect for them, but they're not that worried about integrating in the way that we clinicians are. There tends to be research, and then there's the practical stuff. They might be analytic; they might not. But the whole business of, “Is it opposed to biologic nature? Or is anxiety itself to be looked at as an alarm system, a signal of danger, of internal or external? Internal from my conscience, or just from my awareness that my capacities won't support – What about my aspirations? What about prohibitions? What about punishment?”
So the whole theory of anxiety as it unfolds, starting with Freud, and nobody's more important than Rangell, nobody in the world, in building on that, even when Freud said, “Non liquet,” it doesn't work. Leo Rangell [responded], “Liquet,” [with] papers on anxiety that are luminously written. What's so interesting about looking at Leo's work, and I don't think this is because of a bias toward my very dear friend Leo, they last. The composite theory. Add what's of value; don't drop what's [still] of value. The third point on shame dynamics, not just the affect, the dynamics, your relationship with yourself. I'm going to be exposed as one who – [like] the woman with the drink and the cigarette – as one who falls apart at a public gathering for no apparent reason and is just disgraced.
That plenary, I think in 1990, [on] castration. Let me read – "Enduring anxieties, not always conscious, on the anatomic difference between the sexes." Now, I don't think there's a comic living who doesn't turn a coin on the battle of the sexes. That is about the richest field to mine I can imagine. They can always lampoon people in public office, but that gets dreary. It's the anatomic difference or the battle of the sexes, not always anatomic.
Many more [contributions]. I've mentioned dreams, and [that] happened to be some of my own research. Anything that I would regard as an original contribution of mine, that would be it. And Leo getting it, adding to it. The [observations on] the public and the inferences from [the Watergate hearings]. The idea that this is not just – Are most of us in this business politically liberal? Yes. Am I? Yes. Is that what The Mind of Watergate is about? No. He's describing something that he tells us is a kind of conflict hitherto completely ignored, that has to do with the compromise of integrity, that should be fully on a par with neurosis. The paper wasn't neglected. I mean, it was a plenary address. It's been reprinted so many times I can't even count them.
It should be that which unites self-psychology and inner subjectivity with mainstream analysis and concerns about bodily integrity and the anatomic differences between the sexes. That would take another Leo Rangell to do. So those of us who get it with Leo really appreciate that. It’s very, very hard to integrate. There's a lot of work. You've got to be doing your homework all the time.
I think I’ve covered the major points. There [are many more] minor littler points, and certainly personal reflections on a wonderful, loving, generous man.
MM: Do you want to give us any personal comments on your interactions with him?
ML: Yes. I was, and still am, very fond of Leo's family. His beloved wife Anita died a long time ago. We had the Rangells over many times. He was fond of my family. He liked my wife very much, very close to her, very close to my kids. My daughter, in fact is an advanced psychoanalytic candidate. If you're familiar with the word "kvell," [it’s] a Yiddish word meaning the kind of joy you get from your offspring. He took the liberty, which he was well entitled to kvell from my daughter; he was very close to her. A very warm, loving person, and less appreciated for that. Generous. So you can tell I miss him a great deal.
On a personal level, the timing – I mean, there's not a good time to die. Leo was coming up on ninety-eight, and one would say that's a rich life. But I was out of the country, on a long trip to Spain, and I got word of Leo's death, and I was sad to lose him, but was sorry that I wasn't able to be on the scene. We did have some memorials for him, with all kinds of things to do with people who cared about his work.
MM: OK. Thank you very much.
ML: Thank you very much. I appreciate this opportunity.
MM: It's a pleasure.
ML: And for me, too.
MM: I think that was fine.
ML: Thank you for being a really good and compassionate interviewer.
MM: Oh, that was fascinating. I'm learning so much. My knowledge of psychoanalysis, after the early days – I'm an historian by trade. I don't know if I told you that.
ML: I didn't know that.
MM: I'm not a professional video camera person.
ML: I suspected that. From your erudition, not from your –
MM: Well, I could have been. In any case, I'm certainly learning a lot about psychoanalysis and its development, particularly since the Second World War, I guess. It does seem to be – maybe I'm wrong about this. I mean, certainly not neglected. I think it's a field which many people find rich and fascinating, but it's somehow kind of out of the mainstream of the psychiatric world. Do you think that's a correct statement?
MM: And why do you think that is?
ML: This is just on a personal level. I've always been interested in psychiatric medication. Much less so now because I just don't have time to keep up, so I have people that I refer to sometimes. If I kept up to date with general psychiatry, I would be just overwhelmed to the point where I wouldn't do any reading psychoanalytically. And that's not because somebody's to blame. Happily we know so much [more] now. There are people who know thises and thats about medications, and they could really be of help to people. Why not have people get consultations? And I have my cadre of people who are very respectful of psychotherapy or analysis. It works great, but I couldn't do both at this point. I couldn't really be up to date or spend the time.
I know a pharmacologist in town, whom I greatly respect, who has people who had a tough time with a medication, and he said, "Okay, here's what I want you to do. Take the capsule, open it up, do it grain by grain." I mean, we're talking a few hundred grains in that capsule, and it built up to [too much, but] somehow this person can get by adverse effects (not allergies; you can't get by an allergy). But then it overwhelms people, and if you go super slowly with tiny doses, it really can make a difference.
If I did that, I wouldn't have time to do the analytic work, be in analytic groups, talk about cases and theorize like that.
MM: No. There's only so much you can do and do well.
ML: Well, that and be married and have a family, and once in a while go outside and play. (chuckles)
MM: You said your daughter is going into psychoanalysis.
ML: Well, she's an advanced candidate up in San Francisco. She's finished with all the years of seminars.
MM: [[Psychoanalysis is] not for everybody, I wouldn't think. I mean, it must require extraordinary patience. I've always thought that. Yes?
ML: Yes, patience, but it's not just enduring. I mean, you have to be fascinated by the way the mind works and be able to deliver that so that what one wants is that people have choices where they never thought they did. That's sort of one of the major linchpins of psychoanalysis.
MM: This is really probably a really, really stupid question.
ML: I notice that self-styled stupid questions are almost never stupid questions. (laughs)
MM: Well, I'm not so sure about this one. OK. Again, this is the historian's viewpoint; I'm not a psychoanalyst. But you're talking to people who have a good deal of internal conflict, and isn't the goal to help them understand what their own difficulties are? You don't tell them, right?
ML: Right. There's a reason for that. That is, if you do something like tell them – if so, the likelihood is not that they're going to fall apart, but that you'll become [a person who advises and then new material associatively connected with prior material won’t get into focus]. I hope I said that clearly.
MM: Yes, I think that's very clear.
ML: It's a hazard of suggestion. I use suggestion when it's appropriate.
END OF INTERVIEW
 Jean-Martin Charcot (1825-93), French neurologist, was famous for his “Tuesday lectures” at the Salpêtrière, where he served as professor of anatomical pathology for 33 years. He is considered “the founder of modern neurology” for his work in differentiating and delineating many specific neurological disorders.
 Rudolf Eckstein (1912-2005), Austrian-American psychoanalyst, was noted for his work with autistic children and children with borderline personality disorders at the Reiss-Davis Child Study Clinic in Los Angeles from 1957-76.
 Adrienne Applegarth (1926-2003) was a San Francisco physiologist, psychiatrist and practicing psychoanalyst; she was also a member of the Center for Advanced Psychoanalytic Studies at Princeton.
 The International Psychoanalytical Association grew out of a small group of four men who met regularly with Sigmund Freud starting in 1902. By 1908, the group had grown to 14 and decided to sponsor an international meeting in Salzburg, at which the plan to form an international association was agreed. The IPA was founded in Vienna in 1910 and today has 12,000 members on four continents.
 Nixon’s attacks on Douglas, his 1950 opponent in the California race for the US Senate, accused her of being a Communist sympathizer and fellow traveler, accusations that are generally considered to be unfounded; the smear campaign not only cost her the election but ended her political career. Four years earlier, Nixon had successfully used similar tactics in his 1946 Congressional campaign against Jerry Voorhees, a member of the House Un-American Activities Committee.
 Freud’s classic work of 1910.
 Repetition compulsion is the compulsive repeating of a traumatic event or reaction to it, even when the original circumstances have been repressed or forgotten.
 Anxiety’s signaling function, alerting the psyche to the threat of distressing feelings and triggering defense mechanisms; the concept was introduced by Anna Freud.
 Freud’s original title in German was Hemmung, Symptom und Angst. The essay was translated into English by Henry Alden Bunker in 1936 and published as The Problem of Anxiety.
 Melanie Klein (1992-1960) was an Austrian-born British psychoanalyst and co-founder of object relations theory, in which the child psyche develops in relation to other individuals in its environment. She postulated psychic oscillations between life-sustaining and life-destroying states and pioneered play therapy in child psychology.
 Wilfred Bion (1897-1979) was a British psychoanalyst who spent many of his later years in Los Angeles. An object relations theorist, he offered many original ideas about group dynamics and about emotional experience as the foundation of mental development.
 Donald Winnicott (1896-1971) was a British psychoanalyst and object relations theorist who introduced important concepts such as the true and false selves, the antisocial tendency, and the transitional object. He belonged to the Middle Group (see note 12).
 Ronald Fairbairn (1889-1964) was a Scottish psychoanalyst and object relations theorist. Fairbairn was a theorist for the British Middle Group, or Independent Group, of analysts whose theories diverged from those of Klein and Anna Freud. They focused on interpersonal relationships rather than on inner drives.
 Max Eitingon (1881-1943) was a Russian-German psychoanalyst who worked with Freud in the 1920s and helped to establish guidelines for psychoanalytic training. He emigrated to Palestine in 1933.
 Heinz Kohut (1913-1981) was an Austrian-American psychoanalyst who rejected Freud’s division of the psyche into id, ego, and superego, and proposed instead the tripartite self, which has specific “self-states,” each with needs which must be met through interpersonal relationships for the self to fully develop. This theory of self-psychology became very influential after Kohut’s publication of The Analysis of the Self in 1971. After he emigrated to the US in 1940, Kohut spent most of his career at the University of Chicago.
 See note 3.
 Otto Rank (1884-1939) was an Austrian psychoanalyst and close colleague of Freud. The Trauma of Birth discussed the psychological significance of this pre-Oedipal event and the development of separation anxiety, prompting a break with his mentor.
 Founded in 1911.
 Helm Stierlin (1926-) is a German psychoanalyst and family systems therapist who served as Director of the Department of Psychoanalytic Research and Family Therapy at the University of Heidelberg from 1974 to 1991. He founded and co-edited the German journal Familiendynamik.
 Don D. Jackson (1920-1968) was an American psychiatrist and family therapist. He co-introduced the idea of the double bind, the emotionally stressful situation in which an individual receives two or more messages that are in conflict so that s/he cannot respond to any one without rejecting the others. Jackson founded the Mental Research Institute in Palo Alto, California, in 1958 and served as its first director.
 Murray Bowen (1913-1990) was an American psychiatrist who pioneered in the development of family systems theory and the understanding of the problem of differentiation of self. He spent most of his career at the Georgetown University Medical School in Washington, DC, where he founded a Family Center.
 Rangell L. On friendship. J Am Psychoanal Assoc 1963 Jan; 11: 3-54.
 Benjamin Kilborne (1943-) earned his PhD from the Southern California Psychoanalytic Institute in 1990.
 Andrew Morrison (1935-2010), an American psychoanalyst based in Cambridge, Massachusetts, wrote extensively on shame and narcissism.
 Rangell L. The psychology of poise; with a special elaboration on the psychic significance of the snout or perioral region. Int J Psychoanal 1954; 35 (3): 313-332.