by Amber Trotter, Psy.D.

DISSOCIATION AND DESIRE

There may be some bedrock properly described as “human nature,” but it seems the field of psychology perpetually discovers a greater role for socialization.

Part of Freud’s genius lay in capturing the impact of the society in which he lived on his patients’ suffering. As society changes, the trick, for analytic thinkers, is to persist in Freud’s technique, rather than in dogmatic adherence to his particular discoveries. In their recent book, Here I’m Alive: The Spirit of Music in Psychoanalysis (Blum et al., 2023) elucidate our psychosocial age of dissociation in a way I found helpful. They note, “There exists such widespread and pervasive alienation from the libidinal body and such hegemony over the life of the unconscious that the center of gravity of what ails us has moved, to some degree, from neurosis to dissociation,” with patients more in need of an experience of bodily and psychic aliveness than help to manage internal conflicts or other ways of defending against desire. They squarely implicate our present manic, hyper-stimulated, at once excessively regimented, and distracted society in contemporary psychopathology, managing sociological and clinical astuteness simultaneously. 

Their depiction of patients who build “discrete alter worlds in which they live in trancelike states of consciousness” as a way of defending against experience, period, resonates with my experience of many patients, conventionally successful largely through an existence so tightly controlled it shuts out life. Rhythm can become so mechanized that it’s no longer rhythm, no longer a place for the body to live, a gathering of libidinal energy, the foundation of a dance, but a straitjacket with no room for bodily disruption.

How can we work effectively with this kind of patient? While surely there are many answers, this book argues that the person of the therapist is a primary instrument through which music can begin to play again. This involves holding the analytic frame—and ourselves as a living frame—firmly, rhythmically, but also flexibly, and creatively responsive to our patients. The authors prescribe a “rediscovery of the psychology of the body and the revitalization of the unconscious,” not only for patients but for therapists, bringing our bodily, mysterious libidinal vitality into our work in a way that can be felt beyond words. 

This reminds me of one of my favorite quotes by Howard Thurman: “Don’t ask yourself what the world needs. Ask yourself what makes you come alive. Because what the world needs are people who have come alive.” It's a beautiful sentiment. And a real feat. Coming alive, staying alive, riffing on the melodies of the living world, surfing the waves of the libido is an accomplishment in this world. It makes me think about how I spend my time, what I do outside my work, and how that shapes what happens inside. The onslaught of brutality and pervasive sense of stuckness in our world can readily deaden. Perhaps staying alive, in full and free ways, is the best clinical provision we can offer.