Elizabeth Thomas

Elizabeth Thomas organized this weekend’s conference. The theme was an exploration of an experience that is both utterly familiar and deeply unsettling – that of betrayal. Thomas described the weekend by saying that betrayal is something that therapists know “all too well, because we encounter it regularly in our work and because we live it – as the one who has been betrayed, or as the betrayer – every day. Betrayal is inescapable.”

Dr. NANCY SHERMAN  gave us the opportunity to consider betrayal in the lives of American military personnel. A distinguished University Professor and Professor of Philosophy at Georgetown University, this spring she published Afterwar: Healing the Moral Wounds of our Soldiers. Her other publications include The Untold War: Inside the Hearts, Minds, and Souls of our Soldiers (2010), as well as numerous books and papers related to topics of ethics, history of moral philosophy, ancient philosophy, military ethics, moral psychology, and the emotions. Sherman is a research graduate of the Washington Psychoanalytic Institute.

Nancy Sherman

Sherman described the feeling of troops returning from the wars in Iraq and Afghanistan of being betrayed by commanders and unit members, by civilians who have “been at the mall while we were at war”, and by politicians who have failed to take responsibility for the wars. Taking issue with the diagnosis of PTSD as too narrow to address what troubles many troops, Sherman described “moral injury” as a wound that is occasioned by injustice and contempt. She noted that it gives rise to an anguish and resentment that both demands a dignified response and that binds society by holding us to moral account.

Sherman explained moral injury as being perpetrated by others against the self, by the self against others, by others toward others, and by the self toward the self. She stated that the perpetrator, the victim and the witness are all players in moral conscience. If one experiences moral injury at the hands of another, it incurs moral anger. If we take it up on behalf of another, taking the role of the witness, it gives rise to moral indignation. When it is based in self-accusation, it is guilt. Sherman described the extreme guilt felt by many soldiers who have fallen short of their ego ideals, often organized by the military code. The fact that the code itself is idealized and often impossible to meet doesn’t always register and failing at it often leads to intense shame, including suicidal shame. Sherman illustrated this in stark terms, by citing 23 – 26 veteran suicides per day.

Drawing from case studies with two veterans, Sherman argued that while PTSD and its treatment assumes a fear-based response that can be treated through desensitization, moral injury involves guilt and shame and requires a different kind of response. One cannot become desensitized to moral injury; rather, it has to be worked through to build self-empathy, self-trust and self–hope. That is moral healing in which the patient rebuilds a sense of his/her own moral goodness and a clearer picture of the goodness and badness of others. This latter piece requires the opportunity to develop greater clarity about the moral injuries involved, including moral morass of war, the politics of war, and the ethical dilemmas and reality of impersonal good and bad luck.

A lot of this healing, Sherman argued, takes place for veterans inside the clinic with a therapist. But it also occurs outside the clinic, insofar as the veteran is able to build trusting and supportive relationships with others including loved ones, teachers and mentors who help the veteran grow intellectually, psychologically, and morally so they may flourish. Importantly, Sherman argues that veterans also need a nation to return to that holds itself accountable, that talks about why it goes to war and whether the war and its partners are just.

Linda Hopkins with Masud Khan

Another speaker for the weekend, LINDA HOPKINS, drew on her 13-year research into the life of Masud Khan and his relationship to D.W. Winnicott to describe a betrayal within the psychoanalytic community itself. Hopkins is a clinical psychologist and psychoanalyst in Washington DC.  Her book False Self: The Life of Masud Khan won the Gradiva Award in 2007 and the Goethe Award for Psychoanalytic Scholarship in 2008.

Announcing that her talk might be upsetting to those who idealize Winnicott, she described her talk as a story of how Winnicott consciously betrayed Khan and caused him great harm. Khan was an Indian-born psychoanalyst who had a training analysis with Winnicott and went on to became Winnicott’s editor and close collaborator. In fact, several informants including Charles Rycroft claim that Khan wrote much that is credited to Winnicott and that Khan’s love of Winnicott was so great that he did not ask for credit. However, upon his death, Winnicott’s will did not name Khan as his literary executor, a role that defaulted to Claire Britton Winnicott, who disliked Khan intensely. At this point, Khan’s precipitous decline began – alcoholism, sleeping with patients, committing acts of professional suicide, and ultimately, drinking himself to death.

Hopkins’ talk brought out the complicated, intertwined and often fraught realities of that era of psychoanalysis. I have been aware of Khan for some time, having interviewed Adam Philips several years ago for a project on the relationship among Donald Winnicott, Claire Britton Winnicott, and her brother, Jimmie Britton, who is an enormously important figure in my field of English and literacy education. I was glad to see Khan getting some recognition. He is a brilliant and tragic figure and his near obscurity, especially in the U.S., may be its own form of betrayal. As Harold Bourne, writing a review of the book for The British Journal of Psychiatry, suggests, Hopkins’ biography

…should be obligatory reading for psychiatrists under 50 and psychoanalysts of any age…. This is not just the story of one man but a work of scholarship concerning the psychoanalytic community in post-1945 Britain and France, and dominating North American psychiatry until the century ended, yet now outside the experience of most psychiatrists under 50. They are not only deprived of a fascinating epoch recently in their field but more limited in vision by that than they may realise.

One fascinating and troubling omission I experienced in our discussion of Khan was what role, if any, racial, religious and colonial/post-colonial politics might have played in Khan’s reception and subsequent demise. I’m looking forward to finishing Hopkins’ book (which I started last night) to see how she deals with these complicated and painful issues.