"One of the things that I find absolutely remarkable about psychedelic medicines is the access one can have into discovering different parts of  oneself, different ways in which we’re put together  Also, to see how we shape our worlds in a very interesting way, experientially. That has been shocking to me - to see and experience how our psychological frameworks have a coherence. They feel structural in a way that you can experience anxiety being removed and then it coming back and it being held somewhere in your body in a very distinct way. Even to be able to travel into an anxiety held in the body in a distinct way and understand its roots and origins as if it was a structure in and of itself. To say it is mind-blowing would be an understatement."         Episode Description: We begin by discussing the medical aspects of ketamine which includes its long history of use and safety. Gita shares with us her psychoanalytic background and how it has played a central role in her work utilizing psychedelic medicines. We discuss the similarities and differences between the regressions in both treatments and share thoughts about the differing modes of therapeutic action. She describes clinical situations demonstrating the impact that a therapeutically assisted psychedelic experience can have on long-standing character impediments. We close with a reminder of the long-standing interest that psychoanalysts have had in this promising modality.         Our Guest: Gita Vaid, MD is a board-certified psychiatrist and psychoanalyst practicing ketamine-assisted psychotherapy in New York City. She is a co-founder of the Center for Natural Intelligence, a multidisciplinary laboratory dedicated to psychedelic psychotherapy innovation and clinical practice. Dr. Vaid completed her residency training at NYU Medical Center and psychoanalytic training at the Psychoanalytic Association of New York. She trained as a fellow in clinical psychopharmacology and neurophysiology at New York Medical College and completed a research fellowship at NYU Medical Center. Dr. Vaid serves as the Director of Psychedelic Awareness at The Chopra Foundation and is on Faculty at The Ketamine Training Center.         Linked Episodes:         https://harveyschwartzmd.com/2022/01/28/ep-23-psychedelic-psychotherapy-for-ptsd-new-research-with-ingmar-gorman-phd/         https://harveyschwartzmd.com/2021/02/26/ep-2-psychedelic-medicines-therapeutic-context/         Recommended Readings:    Critical Period Plasticity as a Framework for Psychedelic-Assisted Psychotherapy Lauren Lepow, Hirofumi Morishita and Rachel Yehuda    Frontiers of Neuroscience Sept 2021         Pivotal Mental States Ari Brouwer and Robin Lester Carhart-Harris Journal of Psychopharmacology 1-34 2020         Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness H. Kettner, F. E. Rosas, C. Timmerman, L. Kartner, R.L.Carhart-Harris and L. Roseman    Frontiers of Pharmacology, March 2021         Notes on Memory and Desire, W.R. Bion 1967)    The Present Moment in Psychotherapy and Everyday Life. Daniel Stern 2004    Psychedelic Psychotherapy : Building Wholeness Through Connection    Gita Vaid, MD; Barry Walker, M.Ed 

A Psychoanalyst Administers Ketamine with Gita Vaid, MD

Psychoanalysis applied outside the office.

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“What is it like to be a clinician with a patient who either comes because they're going to be dying or it happens in the treatment -  what is it like for the clinician? It's lonely in a way because there is a lot of parallel with what the patient is going through. To me, and as a field, I would like to think we could talk about this and write about it. My peer group at the time was terribly important to me - colleagues, people that basically would be with me in this. But in the end I was the one that went alone to the service at the funeral home and I went to my patient's luncheon, not to have the lunch but to talk to the family, and then I left - I didn't stay for the lunch, I thought that might be a little intrusive. There's nothing really to read about, talk about, pick somebody's brain about how do they experience this in their work or I don't really understand why we've been so quiet about this in our work.” PW   “You mentioned about being alone in it, and there is a way in which it's very true. I think a large part is that not many of our colleagues have had this experience. But on the flip side, maybe because I’ve worked with so many patients and I’m beginning to notice a certain consistency, but I've also had such an experience of close intimacy with these patients. There's a closeness that is to be had particularly in analytic work and work over time - but it happens quite quickly in the work with dying patients, and in that regard, I felt less alone in my work. In some ways in the rest of our work, because we maintain a careful distance in a way, a boundary with the patient, a frame - I feel with the dying patients, I feel like both of us are more in the room together.” MM     Episode Description: We begin with acknowledging the tension that exists between the literal and metaphoric aspects of the analytic relationship and how that is highlighted in the face of physical illness in either party. We focus on patients' illnesses both as they present upon initial consultation and when they develop in the course of treatment. Mark describes his years of work with cancer patients, and Peggy shares her experience with an analysand who, in the 6th year of her treatment, developed a terminal illness. We consider the emotional challenges associated with making home visits, the meaning of 'boundaries', feelings associated with fees, and the shared experience of love between patient and analyst. We consider the ways that the analyst’s affective intensity may also be associated with earlier and feared illnesses in their own life. We close with considering the difficulties that our field has in honestly communicating this aspect of the heart and soul of psychoanalysis.   Linked Episodes:  Episode 23: A Psychoanalyst Encounters the Dying – Discovering ‘Existential Maturity’    Episode 40: How Psycho-Oncology Informs an Approach to the Covid-19 Crises with Norman Straker, MD   Our Guests: Mark Moore, PhD, is a clinical psychologist and psychoanalyst who works in private practice in Philadelphia. He was the Director of Psychological Services at the Abramson Cancer Center at Pennsylvania Hospital from 2004-2014 where he supervised psychology interns and post-doctoral fellows during their psycho-oncology rotation and provided psychological services to cancer patients and their families. He is also currently a co-leader for a weekly doctoring group for neurology residents at Penn Medicine. He was the Director of the Psychotherapy Training Program from 2014-2020 at the Psychoanalytic Center of Philadelphia, where he currently teaches courses on Writing, Assessment, Core Concepts, and a comparative course on Psychotherapy and Psychoanalysis. He was a recipient of the 2020 Edith Sabshin Teaching Award from the American Psychoanalytic Association, and he runs a monthly teaching forum for faculty at his institute. Dr. Moore’s clinical work focuses on health issues, notably chronic illness, losses, and life transitions associated with cancer, and the fear of dying. He has written several book chapters on topics including the concept of harmony in Japan, cultural perspectives on lying, conducting therapy outside the office, the experience of bodily betrayal in illness and aging, the experience of shame across the adult lifespan, and more recently about friendship.    Peggy Warren, MD, is a psychiatrist and psychoanalyst in Boston. Originally from Chicago, she danced professionally with Giordano Dance Chicago from ages 15 to 21, which created a lifelong interest in the effects of creativity and mentoring on human development. Fascinated by cell biology, she received a master’s degree in microbiology from Chicago Medical School and then an MD from Rush University. In medical school, she was chosen to be an Osler Honor Fellow in Pathology/Oncology, where she was first exposed to dying patients. Awarded the Nathan Freer prize for excellence in a medical student at graduation, she used the prize money to buy the Complete Works of Freud and began to learn about the power of the unconscious. After completing residency training in psychiatry at Massachusetts General Hospital, she pursued analytic training and graduated from the Boston Psychoanalytic Society and Institute. She was on the teaching and supervising faculty of the MGH/McLean psychiatry residency program for 30 years, the Boston Psychoanalytic faculty for 20 years, and won the teaching award from the Harvard Medical School MGH/McLean residency program in 2010. She has given talks on “Vaslav Nijinski: Creativity and Madness,” was a discussant with Doris Kearns Goodwin on Abraham Lincoln and depression, lectured on the effect of twinships on siblings, was a discussant in the “Off the Couch Film Series,” (Boston Coolidge Corner theater), a case presenter “On the Dying Patient” at the 2017 American Psychoanalytic meetings, and is a faculty member of the American Psychoanalytic Association’s annual Workshop on Psychoanalytic Writing. She has been in private practice in Boston as a psychoanalyst for 38 years.   Recommended Readings: Bergner, S. (2011).  Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology, 28,267-292.   Emanuel, L. (2021). Psychodynamic contributions to palliative care patients and their family members. In H. Schwartz (Ed.),  Applying Psychoanalysis to Medical Care. New York: Routledge.    Hitchen, C. (2012).  Mortality. New York: Hatchette Book Group.   Minerbo, V. (1998). The patient without a couch: An analysis of a patient with terminal cancer. Int. J. Psych-Anal., 79,83-93.   Norton, J. (1963).  Treatment of a Dying Patient. Psychoanalytic Study of the Child, 18, 541-560   Didion, Joan: The Year of Magical Thinking. Vintage/Random House, 2007   Jaouad, Suleika:  Between Two Kingdoms: A Memoir of a Life Interrupted; Random House, 2022.   Bloom, Amy: In Love: A Memoir of Love and Loss;Random House, 2023.  

The Dying Patient in Treatment with Mark Moore, PhD (Philadelphia) and Peggy Warren, MD (Boston)

"From such accounts [of Polish atrocities] we can see how incredibly emotional and how incredibly pleasurable it could be on the social level, not only for the people involved, but for the whole group, and we can really see how violence on others becomes the core of social identity, of the national identity. We tend to think about committing violence as anti-social, and that Eros  is the only force that brings us together.  We can’t see here how eroticized violence or sexualized violence might do it as well. After so many years of research, we don't really have to ask the question: how is it that people can do such things, or how can people become murderers on a social level, on a group level?  I'd say that the more interesting question we may ask is how did the murderers stay people and stay citizens? How could after committing such crimes in plain sight of the whole group, how could that group remain a stable group? How could a community of murderers and bystanders to the violence - what is the social glue that brings them all together? I would say that eroticized violence is one of the main aspects, one of the main elements of creating a closed identity based on denial of humanity of the other.”    Episode Description: We begin with acknowledging the phenomena of bystanding in the presence of extreme violence. The slaughter of neighbors by neighbors notoriously occurred in the Rwandan genocide and in the Polish Holocaust, which is the focus of Jan's research. He posits that the psychoanalytic concept of perversion best captures the denial and split-off excitement that characterizes bystanding - 'one eye open, one eye closed'. He challenges the possibility of observer's indifference, documents the ever-present knowledge that neighbors have of the history of their neighbors, and discusses the experience of 'ghosts' inhabiting the homes of forgotten/remembered neighbors. We distinguish between being a bystander and a witness, and the state of mind “We will not forgive you for what we did to you.” We close with our sharing the difficulty of listening to this material and how he managed this over the years of his research.   Our Guest: Jan Borowicz, PhD, is a certified psychotherapist and candidate in psychoanalytic training in Polish Psychoanalytic Society (IPA). He is a Member of Holocaust Remembrance Research Group in the Institute of Polish Culture, University of Warsaw, Poland.  He is interested in cultural memory, psychoanalytic theory, and Holocaust studies. He published two books in Polish on history and memory of the Holocaust. Recently, he published his first book in English, Perverse Memory and the Holocaust: A Psychoanalytic Understanding of Polish Bystanders (2024), in which he explores the deep implications of witnessing mass violence and extermination.    Recommended Readings: Jessica Benjamin, "A relational psychoanalysis perspective on the necessity of acknowledging failure in order to restore the facilitating and containing features of the intersubjective relationship (the shared third)", International Journal of Psychoanalysis, vol. 9, iss. 3, 2009.   Jan Borowicz, Perverse Memory and the Holocaust: A Psychoanalytic Understanding of Polish Bystanders, trans. Mikołaj Golubiewski, Routledge: London and New York, 2024.   Stanley Cohen, States of Denial: Knowing about Atrocities and Suffering, Cambridge: Polity Press, 2001.   Samuel Gerson, "When the Third is Dead: Memory, Mourning, and Witnessing in the Aftermath of the Holocaust", International Journal of Psychoanalysis, vol. 9, iss. 6, 2009.   Grzegorz Niziołek, Polish Theatre of the Holocaust, trans. Ursula Phillips, London: Bloomsbury Publishing and Instytut Teatralny im. Zbigniewa Raszewskiego, 2021.   Probing the Limits of Categorization: The Bystander in Holocaust History, eds. Christina Morina, Krijn Thijs, New York: Berghan Books, 2019.   Joel Whitebook, Perversion and Utopia: Studies in Psychoanalysis and Critical Theory, Cambridge, Massachusetts: MIT Press, 1996.

Bystanding as Perversion: "We need to forget about what we actually did not even see here." with Jan Borowicz, PhD (Warsaw)

My conversation with Sudhir Kakar took place five weeks before his untimely death on April 22nd.  “Freud obviously is very brave and courageous to accept that the world is inadequate and that my desires will never be sufficiently fulfilled. My question - is this in fact the case? I think that everyone has had some kind of spiritual experience, some more than others and in many different contexts, not just religious ones. Spiritual experiences contradict Freud’s notion of common unhappiness and the idea of the world as inadequate. What reason do we have to assume that all such common experiences are simply false, that they are based on some kind of false consciousness? Rather, I believe that the inadequacy lies in our own awareness rather than with the world. The world allows for many experiences that would be highly adequate yet we block them - what we call the mundane world is much more enchanted than we think it is."    Episode Description: We begin by considering the embodiment of one's cultural imagination - "one's mental representation of culture" - into one's unconscious mind. Sudhir describes different early child-rearing practices and invites the question about their influence on our later inner lives. He shares with us his early idealization of Freudian/Western ways of thinking and his later development, which returned to the enchanting aspects of his Hindu youth. We discuss the similarities and differences between a Judeo-Christian-based psychoanalysis and one founded on a Hindu imagination. We consider the different notions of God, ritual, and illusion. He distinguishes an 'autonomous person' from a 'communitarian person' and describes the pleasures and burdens of each. We close with his sharing his lovely psychoanalytic origin story connected to his meeting Erik Erikson and discovering "I want to be like him."   Our Guest: Sudhir Kakar was a psychoanalyst, scholar, and writer. He had been a Lecturer and Visiting Professor at Harvard University, Visiting Professor at the Universities of Chicago, McGill, Melbourne, Hawaii, and Vienna, Fellow at the Institutes of Advanced Study, Princeton, Berlin, and Cologne, and was on the board of Freud Archives. He had received the Kardiner Award of Columbia University, Boyer Prize for Psychological Anthropology of the American Anthropological Association, Germany’s Goethe Medal, Tagore-Merck Award, McArthur Research Fellowship, and Order of Merit of the Federal Republic of Germany. `As ‘the psychoanalyst of civilizations’, the French weekly Le Nouvel Observateur listed Kakar in 2005 as one of the world’s 25 major thinkers. Sudhir was the author/editor of 20 books of non-fiction and six novels. His books have been translated into 22 languages.   Recommended Readings: Kakar, Sudhir -  The Indian Jungle: Psychoanalysis and Non-Western Civilizations, Karnac. June 2024    The Capacious Freud, in F. Busch and N. Delgado eds.The Ego and the  Id 100 years Later. London: Routledge 2023   Re-reading Freud's The Future of an Illusion in Hindu India, in O'neill  &  S.Akhtar.eds.On Freud's the Future of an Illusion. London: Routledge, 2018    The  Analyst and the Mystic Chicago: University of Chicago Press, 1992   Psychoanalysis and Eastern Spiritual Healing Traditions, J. of Analytical Psychology,48(5).    Shamans, Mystics and Doctors: A Psychological inquiry into India  and its Healing Traditions. New York: A. Knopf, 1982.    Mad and Divine: Spirit and Psyche in the Modern World. Chicago: U. of Chicago Press, 2009

An Analyst's Hindu-Indian Imagination with Sudhir Kakar (Goa, India)

"Psychoanalysis landed in Finland in the 50s; before the Second World War there were one or two persons familiar with psychoanalysis. In the 50s, psychoanalysis got a lot of interest in Finland but then there was no possibility of training in Finland. The pioneers went abroad, some to Sweden and some to Switzerland. They picked up the theoretical preferences in the new countries and new institutes - the IPA Associations mainly were from people studying in Sweden and coming back to Finland and creating the IPA association. The Therapeia Institute consisted mainly of people studying in Switzerland and got a lot of influence from existential psychoanalysis and Jungian psychoanalysis… I tend to side with Lee Grossman [link below]; I guess the theoretical theories reflect more the character - when you listen to a case presentation of course people present them differently depending on their theoretical background, but in the consulting room I am not sure there is that much difference."    Episode Description: We begin with acknowledging the value of meeting and learning from analyst colleagues from around the world.  We discover both similarities and differences in both the challenges and pleasures of this work. In Finland there was a government-mandated change in the structure of training in psychotherapy and psychoanalysis starting in 2012.  The anticipatory anxieties were considerable. There was input from the university on issues of curricula, research opportunities, and improved pedagogy. The fears of loss of meaningful autonomy proved to be mostly fears - not realized. We also discuss the origins and current state of psychoanalysis in Finland. We close with a few words of the pervasive role of sauna in Finnish life and the ways it manifests in analyses.   Linked Episode:  Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.) – IPA Off the Couch   Our Guest: Jan Johansson is a psychologist and a training and supervising analyst at the Therapeia Institute in Helsinki, Finland. Currently, he’s working as a psychoanalyst in private practice in Helsinki. In addition, he supervises psychotherapists and psychoanalysts. He has been interested in issues concerning psychoanalytic training for the last decade and a half. Currently he is the chair of the board of the Institute, while also being a member of board of the Therapeia Society. He also was a member of the Executive Committee of the International Federation of Psychoanalytic Societies 2014 - 2022. He is interested in promoting the multitude of psychoanalytic voices; while being trained within an object-relational frame, he doesn’t identify exclusively with any particular theoretical frame of reference. He lives in Espoo, a neighbor city of Helsinki with his wife. After languishing in the darkness of the Finnish winter from October to mid-March, in the summer they enjoy the light and the white nights at their summer-house at the seaside, heating their sauna everyday and swimming in the Finnish Gulf.   Linked Episode:   Episode 135: Technique is Character Rationalized with Lee Grossman, MD (Oakland, Ca.)    Recommended Readings: Grossman, L. (2023):  The psychoanalytic encounter and the misuse of theory. New York: Routledge.   Kernberg, O.F. (2016).  Psychoanalytic education at the crossroads: Reformation, change and the future of psychoanalytic training. New York: Routledge   Reeder, J. (2004).  Hate and love in psychoanalytic institutions: The dilemmas of a profession. New York: Other Press.   Tuckett, D. (2005). Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence. Int J Psychoanal. 86: 31–49.   Tuckett, D., Amati Mehler, J., Collins, S., Diercks, M., Flynn, D., Franck, C., Millar, C., Skale, E., Wagtmann, A-M. (2020): Psychoanalytic education in the Eitingon model and its controversies: A way forward. Int J Psychoanal. 101: 1106 – 1135.  

'Does it Still Taste like Psychoanalysis’? - University Affiliation in Finland with Jan Johansson (Helsinki)

“My interest is to rather than continue with the psychoanalytic tilt which has tended to try to find the words - to find the areas of the analyst that has words to engage with these states and then help the patient transform these states into something thinkable and communicable. [In contrast] my interest has been to take the patient where they are; it’s kind of a radical way of saying ‘meeting the patient where they are’, and find our way and lend ourselves to engaging with them in their own idiom, using Bollas’s term, in their own way of being and to find ways to be with them that don’t necessarily rely on talking about things and making things known.”   Episode Description: We begin by considering patient's non-represented mental states and their manifestation in somatic and motoric registers. Robert describes his understanding and approach to clinically engage those who "barely experience continuity of the self or subjectivity in themselves or others." He recommends 'companioning' with them. This entails not trying to "move the patient out of these regressed areas into greater relatedness ...but to welcome these other dimensions and their full expression within the analytic space." We consider the role of enactive engagements, the non-verbal vs the pre-verbal and 'radical neutrality'. He presents a case where the patient and analyst shared music, food and not discussed emotional intimacy between them that he felt was vital to enable the patient to emerge as a 'real person'. We close with speaking of Robert's professional history of working early on with psychotic individuals and finding that his approach enabled them, often to their surprise, to feel heard. He also describes his attunement to the experience of being an 'other' that emerged from his growing up as an 'other' - a Jew in London.       Our Guest:  Robert Grossmark, Ph.D., ABPP, is a psychoanalyst in New York City. He works with individuals, groups, and couples. He is on the teaching and supervising faculty at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, The National Institute for the Psychotherapies Program in Adult Psychoanalysis, The National Training Program in Psychoanalysis, National Faculty Member, the Florida Psychoanalytic Center and lectures at other psychoanalytic institutes and clinical psychology training programs nationally and internationally. He is an Associate Editor for Psychoanalytic Dialogues. He is the author of The Unobtrusive Relational Analyst: Explorations in Psychoanalytic Companioning and co-edited The One and the Many: Relational Approaches to Group Psychotherapy and Heterosexual Masculinities: Contemporary Perspectives from Psychoanalytic Gender Theory.      Recommended Readings: Grossmark, R. (2024) The Untelling, Psychoanalytic Dialogues. In press.   Grossmark, R. (2019)  The anguish of fatherhood, Psychoanalytic Perspectives,  16 (3), 316-325. Grossmark, R. (2023) A child is being murdered: A contemporary psychoanalytic treatment of a compulsion to child pornography, Psychoanalytic Psychology, 40: 25-30   Bach, S. (2011) Chimeras: Immunity, interpenetration and t he true self. Psychoanalytic Review, 98(1): 39-56   Winnicott, D. W. (1974).  Fear of breakdown. International Review of Psycho-Analysis, 1(1-2), 103–107.   Bollas, C. (2011)  Character and interformality. In C. Bollas, The Christopher Bollas Reader (p. 238-248)   Ogden, T.O. (2017) Dreaming the analytic session: A clinical essay. Psychoanalytic Quarterly, 86: 1-20.   Stern, D.B. (2022)  On coming into possession of oneself: Witnessing and the formulation of experience. Psychoanalytic Quarterly, 91: 639-667   Symington, N. (2012)  The Essence of psychoanalysis as opposed to what is secondary. Psychoanalytic Dialogues. 22, 4, 395-409

A Psychoanalyst Administers Ketamine with Gita Vaid, MD

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