John Keene – Biographical details
On graduating in Philosophy and Psychology in 1971, John worked in child protection and mental health in Enfield in the newly created Social Services department. Post graduate studies introduced him to the Group Relations training programmes at the Tavistock Clinic and the Tavistock Institute of Human Relations, and in the second half of the decade he gained more specialized experience on the admission wards at Claybury Hospital, which were run on group based therapeutic community lines, with individual and family work as adjuncts.
He completed his psychoanalytic training and the adult psychotherapy training at the Tavistock Clinic in 1986, when he joined the senior staff. In private practice from 1990 he has continued his NHS work as a clinical supervisor in Hertfordshire and as external consultant to Simmonds House Adolescent Unit and the former Northgate Clinics.
He became a Training Analyst in 1996 and teaches and supervises across the UK and abroad.
He is a contributor to and co-editor of Independent Psychoanalysis Today (Williams, Keene and Dermen, Eds. Karnac 2012). His interest in group and institutional processes informed his paper Unconscious Obstacles to caring for the planet, given to the IOPA/Science Museum Conference in 2010, which can be found on the website and in the book of the conference: Engaging with Climate Change: psychoanalytic and multi- disciplinary perspectives Sally Weintrobe (Ed) 2012, London: Routledge.
John Keene August 2017.
Brief Outline of Lecture:
While Freud’s contrasting statements about the importance of trauma in psychopathology caused confusion and for many years contributed to a disbelief in stories of abuse of many kinds, one stream of psychoanalytic investigators, originating with Ferenczi kept a continuous focus on the impact of numerous varieties of impingement on the infant and traumas throughout life.
A large volume of recent research including neurobiological and neuroimaging studies has confirmed the relevance of these theorists and researchers, but not necessarily their centrality in mainstream psychiatry. Last year Kolk made a dramatic critique which he entitled ‘ The devastating effects of ignoring child maltreatment in psychiatry’. (emphases mine)
These findings from attachment research have not been well integrated into clinical teaching, diagnosis, and treatment intervention. Safe and protective early relationships are critical to protect children from long-term problems. If the parents themselves are the source of distress, the child has no one to turn to for comfort and restoration of biological homeostasis. Since infants are programmed to turn toward their care givers to deal with their fears and distress, when the parents themselves are the source of terror children are left to their own devices: they ‘can neither approach (the secure and ambivalent ‘strategies’), shift [their] attention (the avoidant ‘strategy’), or flee’. Disorganized attachment has been called ‘fright without solution’ (Main, 1996).
A mislabeled patient is likely to become a mistreated patient. If one pays selective attention to faulty biology and defective genes as the cause of mental problems, and ignores the role of abandonment, abuse and deprivation, one are likely to run into as many dead ends as previous generations did blaming it all on terrible mothers. Both the DSM5 and the RDoC framework conceptualize mental illnesses as brain disorders in the hope that the clarification of the brain circuits that underlie mental problems will lead to the sort of ‘precision medicine that has transformed cancer diagnosis and treatment’.
However, mental illness is not really like cancer: everything about us – our brains, our minds, and our bodies – is geared towards being integrated members of social groups, able to share, nurture, and collaborate. This is the key to our success as a species, and this is what breaks down in most forms of mental illness. Clarifying the neuronal connections associated with mental illness is vitally important, but it is equally critical to recognize that those neuronal connections are, in large part, the result of early caregiving interactions that shape our minds and brains when we are young, and that continue to underpin the fundamental substance and meaning of our lives.
People with histories of abuse, neglect, chronic mis-attunement, or severe deprivation will remain mysterious and largely untreated unless we heed the admonition of Minnesota attachment researcher Alan Sroufe: ‘To fully understand how we become the persons we are – the complex, step-by-step evolution of our orientations, capacities, and behavior over time – requires more than a list of ingredients, however, important any one of them might be. It requires an understanding of the process of development, how all of these factors work together in an ongoing way over time’.
These modern trends have precipitated a situation where a colleague of mine, who runs a re-feeding unit for dangerously ill anorexics, has observed that a significant number of people admitted to his unit come after years of interventions with no thorough developmental or psychiatric history.
One group of psychoanalysts remained consistent in their study of these events and the way they are incorporated into the psyche and appear in the transference/countertransference matrix. Ferenczi and Michael, Alice and Enid Balint in Budapesth influenced a number of British psychoanalysts, Fairbairn, Winnicott, King, Heimann, Stewart, Milner, Limentani, Parsons, Kohon, Bollas, Williams, Sklar.
In this talk I will outline Pearl King’s key paper from 1978 and then discuss the problems I encountered in working with a patient who illustrates Kolk’s points and many more.
Pearl’s paper emphasizes the problems caused by parents when they use their infants as part objects in which to evacuate unwanted parts of themselves and punish control, reject or ignore them as a result. Internal objects are not introjected singly but always as an object relationship in which the ego/self can identify with either the original self or the original object. Pearl notes how often the analyst is treated by the patient as the child experienced and represented to themselves, being treated by the parent. This can cause difficulty for the analyst (and other mental health practitioners) when s/he is persistently made to feel the useless, inadequate, unlovable. Obviously this is most challenging for beginners who may not be able to distinguish their own feelings of inadequacy from what is being projected into them.
I will illustrate this with examples, mainly from my paper ‘Boundary issues in the recovery from trauma and abuse’, which looks at the early stages of the analysis of a patient whose progress I have followed over a number of years.
As the analysis develops, her initial presentation as a simply cooperative patient with a conflict between approach and avoidance, opens up to reveal complex strategies for defending herself against external and internal threats, which leave her feeling that neither her body nor her mind are safely under her control. As her whole relation to reality is vulnerable, the idea of suicide remains a welcome possibility.
I summarize this in a paragraph from p 214.
There appeared to be three parts of her with an interest in the omnipotent control of perceptions including particularly the allocation of blame and causality. A desperate frightened child was driven by terror to comply with whatever seemed immediately necessary for survival, including taking the blame for things she had not done. To cope with this, she would become panicky and confused, not knowing or remembering anything; or she could zoom off, withdraw, anaesthetize herself, or be what the other required by appeasement or seduction.
The distortion of truth could be used in two contrasting ways. It could be readily adapted for triumph, expedience or trickery to feel powerful and independent in relation to others. Alternatively, as Fairbairn described in the ‘moral defence’, she could distort in the other direction by seeing herself as in the wrong to sustain hope that if she could learn to be good, she would find she had good parents.
This seemed to be behind her frequent failure to perceive cruelty in the outside world or else to make excuses for it.
The consequence for herself was cumulatively, to feel bad, cruel, stupid, and useless instead of other people. “Not knowing” and “not feeling” were essential to her survival but they left her vulnerable to the feeling that I could get into her mind and control it, in order to exploit her. Collectively these undermined her capacity to make any stable sense of her history or her relationships in the present.
All these features of the patient were revealed and deciphered through numerous enactments within the analysis, which showed her that she could safely take more control and responsibility for her body and her mind and begin a slow process of recovery.
Essential Reading:
Pearl King, (1978) ‘Affective Response of the Analyst to the Patient’s Communications’ Int. J. Psychoanal., 59:329-334
It is also in Time Present and time past - selected paper of Pearl King (2005) London: Karnac.
John Keene, ‘Boundary issues in the recovery from trauma and abuse.'
Chapter 12 (pp 205-231) in Williams, Keene and Dermen, (Eds.)(2012) Independent Psychoanalysis Today London: Karnac.
‘Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016 ‘
Bessel van der Kolk; Journal of Child Psychology and Psychiatry 57:3 (2016), pp 267–270
Further reading:
John Keene, ‘Reflections on the evolution of Independent psychoanalytic thought.’
Chapter 1 (pp 3-61) in Williams, Keene and Dermen, (Eds.)(2012) Independent Psychoanalysis Today London: Karnac.
Lyons-Ruth, K., Dutra, L., Schuder, M., and Bianchi, I, (2006) ‘From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences?’ Psychiatr Clin North Am. 2006 March ; 29(1): 63–viii; NIH Public Access: Author manuscript. Available in PMC 2009 January 13
Macfie,J., Brumariu, L.E., Lyons-Ruth, K., (2015) ‘Parent–child role-confusion: A critical review of an emerging concept’ Developmental Review 36 34–57
McCrory, E.J.,. Gerin, M.I , Viding E., (2017) ‘Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry – the contribution of functional brain imaging’ Journal of Child Psychology and Psychiatry 58:4 (2017), pp 338–357
Teicher, MH. and Samson, Jacqueline A. (2016) ‘Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect’
Journal of Child Psychology and Psychiatry, 57, 241-266