Beth Kalish-Weiss: Dr Rangell, you grew up in Brooklyn, New York, a long time ago. Can we begin by you telling me of your early childhood days and your family life?
Leo Rangell: Okay, that's a good place to start. I must say that my early life was extremely unintellectual. I was born into an immigrant family, father and mother refugees from Russia and Poland respectively. I was the oldest of four, two younger brothers and then my sister, 17 years younger than me. There was no literature, no books, no intellectual excitement in my home. I do remember my father quite routinely reading the daily newspaper, The Daily Forward. It was in Yiddish. I remember having a good feeling about that; it was sort of a window to something larger. My parents mainly wanted their children to be educated. That seemed to be taken for granted. That's what we were to do, go to school. My father worked hard to make a sufficient (skimpy) living, and my mother kept a clean and orderly house. She made simple, tasty food; I sometimes think of it nostalgically as I enjoy the more exotic and varied fare I eat today.
B.K.-W.: Could you say something about your siblings, how you interacted with them, and what their personalities were like, compared with yours?
L.R.: I guess the most important sibling relationship I had was with my two-years younger brother. He was very close, always near me, and there is much to be said about that. After him was my next brother, five years later, and when I was 17, my mother, who by that time had had three sons and had long wished for a daughter, finally had her little girl, when I was already a sophomore in college. She was adored by all. All of them went through school well; they all were intelligent, wonderful, decent human beings, with varying degrees of satisfaction, as well as frustrations and disappointments, in their (in all our) lives. The material level was not much above minimal, no luxuries or great ease. My two-years younger brother was closest to me, naturally wanted to do most of the things I did just ahead of him, and turned out be a stereotypical loved one and rival, a truly ambivalent tie, strong at both poles, that probably had a great deal to do with my relationships thereafter.
B.K.-W.: That's very interesting. I'm wondering how you decided to become a psychoanalyst. Was this in your mind when you were a college student at Columbia?
L.R.: No, not yet. I was certainly contemplating what I was going to be when I grew up, so to speak. I got into a good college, after going to a regular public school in Brooklyn, New York. I had high enough grades to make Columbia, which was a great plum, with a scholarship that made it possible to go there. I had no career direction as yet. As a matter of fact, I had studied Latin for four years in high school, and continued that in the first year in college. I was exposed there to a teacher who was, or became, a famous classicist, Dr Moses Hadas, and I remember that I thought briefly of becoming an academic as a college professor of Latin. I considered adding Greek, but did not get to it. I can see that that teacher was the first person I identified with, I mean in my early almost-adult years. After that, I sort of gravitated into a pre-law regime, mainly because that was what was talked about in my family and with some close relatives, that I was supposed to become a lawyer.
It was only after my third year, as I was nearing my last year in college, that I came to a kind of autonomous decision. I remember looking at the medical books of a slightly older and idealized cousin, who was in medical school at the time, when I almost declared to myself, “Gee, that is what I want to be.” Besides being aware of the exalted position of the physician in the minds of my parents, the anatomy diagrams fascinated and intrigued me. What could elicit more of a bang than seeing the insides of my body, muscles, bones, everything. I switched in my last year in college from pre-law to pre-med, and a year later applied to medical schools, and went from there.
B.K.-W.: You ended up at the University of Chicago Medical School, is that right?
L.R.: Yes, that was a period, when I graduated from college, of quite some antisemitism in the academic world. Getting into medical school was extremely competitive and difficult, and as the much-desired goal of a large Jewish population of bright young people at the time, most aspirants ended up going to European schools, in Basel, Switzerland, in Scotland, Italy and other places. I was lucky enough to be in a small wave of students admitted that year into the University of Chicago, under the liberal influence of a new, young, progressive University President, Robert Maynard Hutchins. I really knew little about the school, but it had a good aura for me, and a positive feeling and reputation. It was also important to me as the first time I left home, which I wanted to do with all my heart. I went from New York to Chicago, which for me at the time was like going to the other end of the world. I went there and pursued my medical training.
B.K.-W.: I understand that there you first became very interested in neurology and neurological surgery. What was the shift from that interest to psychoanalysis?
L.R.: We are moving fast now. In medical school, I became inspired by a neurosurgeon named Percival Bailey. He had been the right-hand man to Harvey Cushing at Harvard, who had started the new field of neurosurgery. As I look back, it seems to me to have been a bold and brazen concept for me to think of neurosurgery, which seemed to be the top of the profession, the most delicate, difficult, esoteric, and difficult-to-achieve specialty. Yet I also remember feeling, “Why should I hesitate to think of that?”
Associated with this path was my interest in neurology. I had a professor of neurology, Roy Grinker, incidentally a rare Jewish member of the faculty, and I quickly became interested in the central nervous system, which I came to regard as a central core – maybe that is where the idea of “core” first entered my intellectual conceptions. It seemed as if that was the core of human life, of human action and decision-making, which was to become an analytic interest of mine later on. It was from there that I started out, after medical school and internship, to think about specialization in neurosurgery, with the idea in mind of neurology first as a stepping-stone toward that goal.
B.K.-W.: And then psychoanalysis? How did that come to mind?
L.R.: History explains it. This was 1939, when I finished my internship and was ready to enter neurology. I next entered a residency in what was regarded as one of the best neurological hospitals perhaps in the world, Montefiore Hospital in New York City, filled with chronic (and rare) neurologic patients. My idea was to go on to study neurophysiology with Fulton at Yale, and then to neurosurgery, hopefully supported by Bailey, but I also now had in mind a new, young, highly thought-of Jewish neurosurgeon, Dr Leo Davidoff, whom I had known on the staff during my internship when I went back to Brooklyn. However, a crucial period was the neurological residency in Montefiore. Here a group of bright, young residents – perhaps the often-used phrase “the best and the brightest” applies her – were studying the organic nervous system, but at the same time, New York City was becoming a prominent place for a newly talked-about discipline, that of psychoanalysis
In the late 1930s, the influx of European émigrés was already well underway into psychoanalytic centers throughout the country, of which New York was becoming a most important one. I was becoming familiar with such names as Hartmann, Kris, and Loewenstein, all of whom were becoming prominent on the American scene. Most of my neurological teachers were students or young graduates of the New York Psychoanalytic Institute. It didn't take much for their enthusiasm and influence to compete with my previous goal of an organic path, especially because my life was now becoming more conventionally romantic. Marriage was in the air, and settling down to a normal married life, which easily competed with the idea of a prolonged and indefinite period of training and studentship (although little did I know then of what either path really entailed!). Added to these prosaic events was the growing intellectual knowledge that most of the “nervous” patients I would see would turn out to have little or no neurological disease.
B.K.-W.: You mentioned that this was happening in 1939. That was a very troubling year. Europe was already engaged in war, and it was beginning to affect people in the United States as well. How did World War II affect your life and especially your career?
L.R.: These questions are apical, contributory, and right on the mark. Accompanying my own personal development was the dramatic dark cloud that was beginning to envelop the world. It was toward the end of being in medical school that some classmates and other friends and colleagues left their activities in this country to go abroad to Spain as volunteers to fight against a new type of evil person and threatening ideology, Generalissimo Franco and rising Fascism. Most of my young generation were progressive and left-leaning in their political and social thinking. As the sky darkened over Europe and the world, when the Hitler movement took hold in Germany and began to spread – 1937/38/39 – this was exactly the period when I was an intern and resident, a time of increasing anxiety about the direction in which the world was fast moving.
At that historic moment, this knowledge and fear about external events played a great part in forming my idea of the central role of conflict in life. But while in that case the conflict was external, my educational development at that very same time was focusing on internal conflict as well. The two came together. Life was becoming seen as understanding, facing, and resolving conflict. I mentioned 1939. That is when hell broke loose.
B.K.-W.: Could you say more about what your role was during World War II? Where did it take you geographically?
L.R.: Things happened fast. The invasion of Czechoslovakiaoland that started the War took place during my internship in 1939, and the attack on Pearl Harbor during my psychiatric residency in 1941. After a year of practise in 1942, I joined the United States Air Force as a psychiatrist, leaving New York on New Year's Day, 1943. I was fortunate in having been trained sufficiently as a psychiatrist to be used in my specialty throughout the War, rather than at some other level.
I served in various psychiatric Air Force facilities until the end of the War and my discharge in 1946. While there, I met psychiatrists from all over, and benefited from exposure to many teachers from around the country. William Menninger was the Chief Psychiatrist in the Surgeon General's office, and a prominent analyst from Boston, John Murray, held that same function in the Air Surgeon's office. Both of these men had a psychoanalytic view, and sought out those with any analytic training to treat the casualties that were beginning to pour in to the psychiatric centers. In my positions, these were mainly airmen who had been shot down during their missions and were being treated under analytic principles by narcosynthesis. One of my last stations was in California, where I had thought I might re-settle after the War for personal reasons and influence. After my discharge from the service, I made the move to the West Coast in a large wave of analysts, and analytic hopefuls, migrating from east to west, arriving in Los Angeles in June 1946.
But there had been another interesting serendipitous encounter. By serendipity, I also had the good fortune of briefly meeting Otto Fenichel, who had recently settled in Los Angeles, when he visited my army post in Denver, Colorado, to observe analytic treatment via pharmacologic hypnotherapy. I had actually been inspired by his views in his masterful book that had come out in preliminary form while I was still a resident at Columbia in New York in 1941. He and Ernst Simmel had been sent to Los Angeles by Freud to start analytic activity in that region. After a brief visit, Fenichel put my name on a notepad to continue my training with him after the War. But fate was to intervene. Six months before I arrived in L.A., Otto Fenichel died, in January of that year, of a ruptured cerebral aneurysm, at the age of 49. This was while he was serving as an intern, to get his State medical license, in order to give psychoanalysis more legitimacy in California. And so I continued my analytic training without him.
B.K.-W.: How far did you get in your analytic training in New York before it was interrupted? And at what point did you pick it up and re-enter training on the West Coast?
L.R.: My analytic training began officially in February 1941. I had been accepted by the New York Psychoanalytic Institute, and began my analysis on February 1 of that year. The War started in 1939, Pearl Harbor on December 7, 1941. I was in my second year of candidacy when I left for the army. I had begun analytic courses in the fall of 1941. I remember being introduced to a galaxy of big names that were staggering to me. I have a memory of seeing Gregory Zilboorg, with a sweeping cape; he somehow brought to mind to us students an image of Rasputin. Edith Jacobson was another teacher, and Phyllis Greenacre, and Bertram Lewin and Leo Stone. When I left New York for the service, I was in my second year of analysis and my first year of courses; after that came my military experience with a psychoanalytic point of view. On the West Coast, I resumed my training at the Los Angeles Psychoanalytic Institute. There was no issue as to which group then. As with the New York Psychoanalytic Institute, the L.A. Institute was the undisputed Freudian leader in its respective city.
B.K.-W.: Would you describe, if you will, aspects of your analytic history from that point on?
L.R.: It had a very auspicious beginning. A big split was going on in the United States just at the time that I was graduating from the L.A. Institute, in 1950. In the late 1940s to 1950, four Institutes in the United States were subject to splits, essentially over the same theoretical issue – analytic neutrality versus the corrective emotional experience. Ironically, the leaders for these then-dichotomous positions were Fenichel and Franz Alexander, both of them in Los Angeles, with representatives of these positions in each respective city.
I gave the last paper, which happened to be my graduating thesis, to the still-single Institute in L.A. before the split into the Los Angeles and the Southern California Societies and Institutes. My paper was on a case I had treated as a candidate, “The analysis of a doll phobia.” By chance, I had seen an announcement in the International Journal of Psychoanalysis of a Clinical Essay Prize being given by the British Society for the best clinical paper of the year. I had the temerity to send in this graduation paper, which had a very interesting structure and course and was an exciting report, and I won that international prize, just as I was finishing my analytic training. The paper was then the lead article in the next issue of the International Journal of Psychoanalysis. It is possible that my international orientation may have begun at that time.
B.K.-W.: You have certainly been a major if not the major contributor to psychoanalysis in your writings over many years. And you have held many important positions in both the American and the International Psychoanalytic Associations, serving twice as President of both groups. Could you go back to the time, and set the stage of psychoanalysis in the world when you were first a young analyst?
L.R.: After the splits settled down, the various resulting memberships began to work – this was now the immediate post-War period – and the atmosphere in this country was one of optimism and success; returning to peaceful and fulfilling group living was in the air. Personally, what took place for me in the next few years following my graduation was a period of prolific writing of papers. In my day, leaders in the field were those who wrote, who made theoretical contributions that excited people. The main interest of psychoanalysis to me – and I believe to the masses who were supporting it – was the intellectual breakthrough that it represented.
From 1950 and 1951, for the next decade and more, there was scarcely a meeting of the American Psychoanalytic Association, as well as many local societies, at which I was not a prominent presenter of papers. I was asked to be a Reporter of some key panels of the Association in the early 1950s. One of the first was on “The theory of affects” – a very abstruse theoretical subject. The major contributors on the panel were David Rapaport and Edith Jacobson. I was the Reporter, but I managed to write a comprehensive yet succinct and pithy summary so that my name became connected with the subject, and I was very excited about the idea of understanding this difficult, abstract subject of affect, which to this day I don't believe has been clarified much more than it was at that early panel. I remember when I gave a summary of the panel at the Sunday morning plenary – I believe it was in Atlantic City. David Rapaport, who was then in the audience, came up to me and said – and this warmed my heart – “now I know vat I haf said.” I was of course thrilled.
It was only for a short time – maybe the next year – that I was both the Reporter for and a contributor to the panel on “Similarities and differences between psychoanalysis and dynamic psychotherapy.” This was the era of ego psychology, where ego functions, the functions of mastery, of the resolution of conflicts, were at the apex of our efforts to understand internal pschodynamics. I remember not being satisfied to be the Reporter at that panel, but again having the courage or brashness to present a paper. Both of the later-published papers, my own on the similarities and differences, and my report of the panel, became basic building blocks of what was then and remained afterwards a constant preoccupation of the field, about what was the same and what was different between regular psychoanalysis as a theory and technique, and the derivative activity of psychotherapy as contrasted to psychoanalysis itself. This subject and my participation in it started me on a long train of writing papers.
B.K.-W.: Could you elaborate on what you see as the primary differences in technique between the methods of psychoanalysis and of analytic psychotherapy?
L.R.: In looking back, one has to take into account the preoccupation of the times. The main concern of that time was to preserve psychoanalysis, because the tendency was to dilute it, and to use analytic principles in all directions. This was actually a laudable thing, but at the same time it was necessary to protect the core itself. Coming into prominence at that time was the ever-interesting subject of the transference neurosis. While there was always its proper and appropriate place, it was also frequently overdone or underdone; there was always a difficulty in knowing just where this stood.
At the same time that transference was the dominant concept, a parallel or perhaps sister theme was maintaining the objective analytic attitude, which in fact would permit the transference neurosis to develop and emerge, to become the central, and some people felt the only, factor in the psychoanalytic process. I remember – and I take some pride in this – that I never allowed transference to stand alone, but also kept in central view the original neurosis for which the patient came to treatment. In a definition of psychoanalysis I ventured in 1954, which can still be read with profit, psychoanalysis is a process in which both the transference neurosis and the neurosis from which the transference was derived are treated mainly by interpretation. A very important paper on that panel was that of Edward Bibring, which was read by his wife Grete Bibring since he was ill at the time. In this, he gave five theoretical principles and associated therapeutic techniques that were crucial to understanding the similarities and the borders between psychoanalysis and psychoanalytic psychotherapy. The dominance of interpretation is on the analytic side; explanation, reassurance and clarification veer to the psychotherapeutic.
B.K.-W.: It is very interesting that you haven't mentioned frequency as a factor between psychoanalysis and psychoanalytic psychotherapy. Do you feel that that is a primary factor today?
L.R.: That is a very good question because it leads to the principle of what the essentials are, and what are maneuvers to achieve the essentials. The extremists, who are criticised as being rigid and purists, elevated and held strictly to ideas that are usually merely accompanying characteristics of the psychoanalytic process, such as five times per week or lying on the couch, or not answering questions, psychoanalytic anonymity. To me, and it turned out this way more and more over the years, these were not the essential core elements. These were all methods of achieving the analytic attitude which would best permit the transference, as a derivative of the repressed past, to enter into the analytic room and relationship. They are actually loose. One can be flexible, and the more experienced one becomes, the more flexible one is about frequency, lying down, answering questions. In the dim past, if a patient came in and said, “How are you?,” the analyst could become tongue-tied, afraid to say “Okay,” or anything, or nothing. I remember a joke that went around about one of the senior analysts, that when a patient said “Hello,” the analyst is supposed to have thought, ”I wonder what he meant by that.” You can see that those artifices were not essentials, that one had to be human, and get over giving those accompanying arrangements too much of a definitive role.
B.K.-W.: Dr Rangell, you have written so much over all these years, more than 450 articles. Your writings began even when you were a candidate in training. Could you elaborate on what inspired you to write, and who were some of the most inspiring and exciting people that came into your writing?
L.R.: Well, the desire to write did come very early. As a matter of fact, I wrote a few papers in neurology and psychiatry before psychoanalysis. I remember that, during my internship, I developed the habit of volunteering to present clinical cases to the attending staff, from whom the interns would learn. I found every patient unique and interesting. I remember that this was especially so during my military work. I always felt that my patients’ histories were the equivalent of short stories. All of them were interesting and every one was different; none of them was alike. I told you how, during candidacy, my graduation paper described a phobia for dolls in an adult male that drew wide interest, no doubt stimulating me to continue writing.
Even prior to beginning analytic training, during my psychiatric residency in New York, I had met a young émigrée refugee analyst from Europe, Margaret Mahler. I was assigned a patient of hers whom she had hospitalized, a seven-year old boy with maladie des tics, or Gilles de la Tourette's disease. The two of us wrote this up in the literature – while she was the supervisor, Mahler did not speak English well at that time, so I did a major portion of the writing. This paper was, and is to this day, the only psychoanalytic treatise on Tourette's that I know of. It was also seen as a psychosomatic syndrome, which introduced me to writing combinations of psychoanalytic and somatic syndromes, neurological and other, on which I wrote a number of papers.
Shortly after my analytic graduation, having been a Reporter of panels of the American Psychoanalytic Association, I began to write independently of such invited roles, and my large output of papers began to take place. They were on many subjects. While some early papers were on psychoanalysis and dynamic psychotherapy, another subject that soon emerged was anxiety, the heart of neurosis. One noteworthy experience in that direction was a panel I shared with Elizabeth Zetzel. With anxiety, as later with broader subjects, I was always interested in unifying theory – in this instance Freud's two theories of anxiety.
Most people thought the two should be separate, feeling that Freud discarded his first theory of anxiety, along with “actual neurosis,” in favor of the second, the famous signal theory of anxiety. I felt and took the position that both theories had validity, clinical and scientific, and described an ongoing unconscious intrapsychic continuum in which the anxiety signal was one outcome. Expanding Freud's concept of signal anxiety into what I call “the intrapsychic process,” I consider this sequence of unconscious mentation “the psychic spine,” the mental core comparable to the organic spine in the body. Freud's signal theory of anxiety is expanded into an intrapsychic process composed of many microscopic phases that include “thought as experimental action.” This series became for me a source of a great deal of future writing. Within this area, I might add that I offered a change of Freud's puzzled “non liquet,” with which he ended his treatise on his second theory of anxiety, with the more positive “liquet.”
B.K.-W.: Very interesting. You also spent a year – you took off a whole year from your private practice in LA and went to the Center for Advanced Study in the Behavioral Sciences at Stanford. Would you describe what that year was like for you? And what came out of it, meaningfully, in your own thinking and creativity?
L.R.: That was a relative stopping point or pause in my usual activity, after a decade of very intense involvement. But it was a continued year of writing and further experience. I had the privilege being at that Center, where I was with distinguished representatives of the humanities and the social and behavioral sciences. There were 50 Fellows from around the world, and only two were psychoanalysts that particular year. It was my good fortune that the other analyst was Erik Erikson, who had just returned from India, and was writing his book on Gandhi – you can imagine how stimulating that was. There were all these personal contacts during that year, with behavioral scientists, mostly academicians, economists, professors of English literature, mathematicians, social scientists, philosophers, political scientists, a mélange of specialties.
What came out of that year for me creatively was not a book but a number of separate papers. One was an early Franz Alexander Lecture that stemmed directly from that year, since it had to do with the theoretical separation of psychoanalysis from other social sciences. What was the unique area of psychoanalysis relative to other social or behavioral sciences? I zeroed in to the specialization on the unconscious, specifically on unconscious psychoanalytic conflicts. It was from here that I later extended the term from “conflicts” to “process,” describing a wider intrapsychic series that included many other psychic functions. That is where the term “process” entered, describing the microscopy of intrapsychic events – a series of phases that included intrapsychic conflicts, but dealt with much more, before and after conflict is established.
During that year, I also wrote, or finished, a paper “On friendship.” I had previously delivered a plenary address at the American Psychoanalytic Institute on that subject, and during the year at the Center I expanded that paper, worked on the fine points and the bibliography, and wrote a much longer work than I had delivered orally. That also became a one-of-a-kind paper; I don't think there are any other papers in the literature, even since then, on the psychoanalysis of this most frequent object relationship of all human relations. It is so under-talked-about in the psychoanalytic literature.
B.K.-W.: You've written a number of books. Could you tell us a bit about how those books came about, and which books you might feel most proud of today?
L.R.: That depends on the times. Each book reflected the dominant issues of the era. Currently, I feel that my last two books belong together, My life in theory and The road to unity in psychoanalytic theory. The first describes the subjective aspects of splits, and the divergent theories that often went with them, and the second, my view toward a unified theory, which I have always advocated. While many changes brought progress, theoretical history has also resulted in the loss or decline of vital insights and discoveries.Actually, I was more in the habit of writing papers than books for many years. I think the first book was one that culminated another stream of interest of mine, in group psychology, more accurately in the psychology of the mass, of large groups. I always thought that Freud's title “group psychology” was incorrectly translated; he actually wrote about “Massenpsychologie,” or psychology of the masses. As President first of the American Psychoanalytic Association and then of the International Psychoanalytic Association (IPA), I became acutely aware of certain group phenomena that merged into the irrational. Any leader – and that included those of the American and International Psychoanalytic Associations – is a target of positive and negative transferences, of emotional idealization as well as an equally affectively motivated criticism based on diverse dynamics.
During the entire period I was President of the IPA, I was concurrently an observer of the same phenomena on the national political as on the personal level. During that time, Richard Nixon, a unique President with a very specific type of character disturbance, was the elected leader of the United States, and the notorious Watergate break-in had just taken place. As I watched that episode unfold, I became convinced I was seeing psychopathology as intense as and certainly more important than in any individual patient I had in treatment. On this basis, I began to analyse the situation that led to that epic event, and the emerging phenomena unfolding in the present tense.
Characteristically, I was less interested in the personality of Richard Nixon, whom I had no right to analyze from afar – I would regard that as wild analysis – than in what I regarded as equally important, even more so: the analysis of the base of the population pyramid. Specifically, that had to do with the psychology of the people who had elected Nixon by the second largest landslide in American history six months after the Watergate break-in, and after that criminal act had been traced as coming from the White House. It seemed to me that the American people – over 100 million then, now 300 million – were gullible or easily seduced, and susceptible to leaders of questionable character, corrupt and far less than ethically reliable.
That led to my first book, The Mind of Watergate, which, by the way, referred to the mind not of Richard Nixon, but of the electorate that had elected “Tricky Dick,” as he was known for a quarter of a century. That, in my opinion, was the most important message of that book, whose subtitle was “The syndrome of the compromise of integrity,” which can well stand to be brought up to modern times.
B.K.-W.: Would you say that today you still have the same passion about the connection between the political scene and psychoanalysis that you had in those early days when you wrote The mind of Watergate?
L.R.: Every bit as much. That was a continuous and endemic relationship. Also I don't think that group psychology within the psychoanalytic family is any different from relationships among social scientists, or for that matter in any political or socioeconomic group. People are people. Divisions between people are due to narcissistic involvements in the form of interpersonal frictions and conflicts. Psychoanalysis has set out to identify and treat these with specific expertise. But, as I pointed out time and again, I think that the subject matter of psychoanalysis has at times invaded the method of psychoanalysis, resulting in a blurring between what we are analysing and difficulties within the technique itself. There is a distinct link between them about which we have to be vigilant.
B.K.-W.: One of your major contributions has been on the subject of unconscious decision-making. Could you elaborate somewhat on those ideas?
L.R.: That is one of the several outputs of the unconscious intrapsychic process. Just as analysts are aware of the developmental process within their clinical method, so am I constantly aware of the intrapsychic process in the individual patient. This is not the same as the developmental process, but is a series of unconscious mental phases ongoing in every individual from childhood into adult life. In the early stages of development of theory, analysts were mostly interested in instinctual motivation, what drove people. This first led to the division by Freud into the two instincts of libido and aggression, love and hate. Then came the conflicts against these drives, by another agency, the ego, mainly with its defensive operations, and then, as equally necessary to round out the motivational systems, there came the very-much-needed super-ego, of rules, regulations, restraints, and conditions. All of these join in shaping human behavior. During the intrapsychic process, the presence or absence of anxiety is one of the chief motivational streams that determine psychic outcome, a person's moods, attitudes, and actions. What I did was to follow what goes on intrapsychically after the signal process has been completed and the signal of either anxiety or safety has been received and absorbed by the ego. What does the ego do next? – after it has received the warning signal or the safety signal as to whether or not it can go ahead. This led into the subject of action, but, in keeping with what was characteristically psychoanalytic, in the unconscious. We are dealing throughout with unconscious decision-making, leading to unconsciously decided actions, initiated within the unconscious, notwithstanding that they reach their final stages of fruition after a conscious polishing-up of what has taken place during this unconscious process. It is not unlike the dream, which undergoes secondary revision upon awakening.
B.K.-W.: What would you say is the primary paper that describes this phenomenon?
L.R.: This stream of ideas is in a series of papers. The definitive one is “The unconscious decision-making function of the ego,” published in The Psychoanalytic Study of the Child in 1971. A number of other works form the understructure of this line of thought, such as papers on intrapsychic conflict, one on the scope, the other on structural problems, another on the intrapsychic process, several on the theory of anxiety, and parallel or derivative writings, as on the compromise of integrity, another outcome of intrapsychic activity, all culminating in the psychoanalytic theory of action in 1989. These papers form a compact cluster of active unconscious mental functioning.
B.K.-W.: Are these papers published in your text The human core?
L.R.: They are in there, but unfortunately they don't stand out as a unit, because there are some 35 papers in that book, and they tend to get lost in the wider span of interest. I think it would be good to have another book just with the papers on intrapsychic conflict, the theory of anxiety, the theory of action, unconscious decision-making, the compromise of integrity, one possible outcome of intrapsychic action. All these together would be a work on abstract theory, strongly tied in to clinical theory. That might obviate what took place in the field when clinical and abstract theory were separated and abstract theory was given a negative connotation. While analysts consider the entire range of consciousness, as other psychologists, the unconscious remains its unique domain. It would be ironic and sad for analysts themselves to allow this to wither.
B.K.-W.: The compromise of integrity is such an interesting idea. Could you put that into a modern context?
L.R.: That type of pathology cannot be emphasised enough. Psychoanalysis has always paid attention to certain things, and neglected, or not yet come to, other equal points of interest. Ego–id conflicts lead to neuroses; that was the center of the stage at the beginning; it began in Vienna and spread over the world. My work on The mind of Watergate led to a syndrome, present in masses of people, that I believe added a great deal of understanding to the totality of human behavior.
Conflicts exist not only between the ego and id, but just as ubiquitously in everyday life between the ego and the super-ego. People ignore their own rules, or short-cut them; they about-face, act out of convenience, or for the satisfaction of personal needs. I came to the conclusion that the compromises of integrity emphasised in the national fiasco of the Watergate event were also present in the normal life of man in the marketplace, jostling with others in negotiating, loving, competing, in many of his routine activities. The ego is as much in conflict and tension with the super-ego as it is trying to deal with id impulses.
In the 21st century, I think eventually we will have a neutral position not just between the ego and the id, but on the plane of the ego seeking mastery in its dealings with the super-ego. So that to expand Anna Freud's idea of the equidistant attitude of the analyst, it should be equally distant between the id, the super-ego, and the external world – the ego being the arbitrator, the negotiator, the actor, the agent of action, the decider of what the individual will do next. The compromise of integrity, which I have come to abbreviate as C of I, is just as important clinically as neurosis or the more disturbed psychotic phenomena analysts relate to.
B.K.-W.: Don't you think this also exists in the larger political world, nationally and internationally?
L.R.: In everything human, and constantly. Scandals, C of I, occur in any field: business, academia, sports, science. And temporally. I think it existed in man when he was in caves, as well as in a CEO living in a skyscraper. Compromising the super-ego takes different forms at different times and in different cultures, but the principle and mechanism are always the same, a conflict between what you are supposed to do and what you feel you want to do strongly enough, whether to eat, procreate, get a mate, overcome some difficulty which is otherwise unsolvable, or achieve fame – where breaking or stretching the rules is the way.
B.K.-W.: I'd like to shift the focus a little bit back to you, Dr Rangell. What would you say has been the most satisfying aspect of your career, your clinical work with patients, your writing, or other aspects?
L.R.: All of my activities have been a combination of conflict and satisfaction, as I think all life is. I think I've developed a unique and fortunate way of overcoming the inevitable frictions and daily frustrations of being an analyst, especially at being an analyst at the helm of many extraclinical analytic activities, including heading its largest organisations. I try to adopt an analytic attitude toward the larger phenomena in the same way as I do to an individual patient. This can be overdone, and one can make Pollyanna-like pronouncements about everything – I think one's extra-analytic life and experiences, personal and professional, have to be met with appropriate affect, including affects that may be unpleasant, to oneself or to others. Yet containment by analytic understanding can sometimes lead one to live with the way things have to be. Much of our present political life is unacceptable in many ways, but as an analyst these can become as acceptable as disruptive behavior by our patients. We can't kill ourselves because patients want to kill themselves and the analyst. We have to become philosophical – a better word than that is analytic – or better still, analytically philosophical. That is the savior that I have found, or worked out, throughout a long analytic life that leads to a necessary equanimity in the face of forces that are often larger than we are.
B.K.-W.: What about psychoanalysis as a profession today? What do you think will be the future of psychoanalysis, as an international profession as well as a method of daily practise?
L.R.: Well, that follows from what I have said so far. It is not a question of geography. It is the same in the United States as in Europe, and will be the same in any part of Asia, as the analytic population spreads out over the world. The future is that there is a new profession, of people who understand the unconscious levels of human behavior. That is the permanent outcome of Freud's discovery around 1900.
B.K.-W.: This will be the last question I would like you to respond to, but on a much more personal basis than you have been speaking about in the last several questions. Looking ahead, what would you personally like to be remembered for?
L.R.: Looking back at the body of literature I represent, to pick one theme, there is a certain central core that I suggest has not been highlighted enough for what it is, and I would like to show why I think it is important, even though I feel it might lead to a puzzle rather than an easy solution. By examining microscopically what takes place unconsciously, we get to the core of what psychoanalysis can contribute to human understanding.
What came out of one group of my papers is that the mentation that takes place unconsciously is more than the instinctual motivation that was highlighted in the first century of psychoanalysis – which stressed the wishes behind our acts of which we are unaware. What I have emphasised beyond that is that I started from that point and went on to say that not only the motives for what people do, but also the choices they make after they examine the motives, are also unconscious, and that this has a very large meaning in human life. Beyond motives, I examine unconscious intention, purpose, and final action. My thesis is that people decide, and actually do things that remain as unconscious as the motives for which they do them. The reason I pick this out as extremely significant is that it touches upon the important issue of human responsibility.
One of the outcomes of psychoanalytic understanding in its first century was that people were less responsible for what they did than they thought, because they were unconscious of a large segment of their motivations. If we go on to think that they are also unconscious of the choices they make, they bear different degrees of responsibility for the choices that were started unconsciously and consummated in conscious life. This has ethical and even legal consequences. While the first half of psychoanalysis pointed out that man, to a great extent, was less responsible than he thought, it now devolves that he is more responsible for what he does than he thinks, since he set actions in motion more than he gave himself credit for. Since both are true simultaneously, it becomes a more subtle question as to how much a person is responsible for his actions when not only the motivations, but also the active choices, are unconscious. Volition can be unconscious as well as conscious.
Whether an action is illegal or adaptive, it may have been decided and even acted upon before the individual knows he has decided. Young people decide what to do when they grow up, not when they are 21, the legal age of responsibility, but often in the formative years long before, or at times long after. In a paper on “Seventeen,” I wrote that much decision-making is made at the portal to adult life rather than after crossing that threshold into adulthood and responsibility. Often before they go to college, it is already vaguely obvious as to whether a direction will be taken, unconsciously, to either betterment or defeat in one's life. I think a future development in psychoanalysis will be to balance some of the earlier thinking with new standards of responsibility and accountability, and make it more subtle and difficult to assess these in human life. That is where I think the future theoretical direction will go, although I frankly do not have much hope that this will be articulated sharply or taken seriously and lived by relative to the magnitude of the understanding that it promises.
Thank you very much Beth, for all the questions you have asked me.
B.K.-W.: It has been a great pleasure to listen to your answers, and especially to your elaboration of your particular point of view of the importance of psychoanalytic theory of the past, present, and future. It has been extraordinary to have this interview with you, Dr Rangell, and I hope that we have many more in the future.