1. Art and Diseño

Psychoanalytic Dialogues, 15(3):367–378, 2005
S YMPOSIUM ON M ANIC SOCIETY
From the Consulting Room to
Social Critique
Commentary on Papers by Neil Altman
and Rachael Peltz

Michael Rustin
Neil Altman and Rachael Peltz suggest the relevance of psychoanalytic
ideas drawn from the object relations tradition to understanding
contemporary American social life. They see the denial of suffering and
the projection of hostility in an increasingly individualistic culture as a
“manic defense.” While sympathetic to this critique, this commentary
raises questions about it. It argues that the object relations perspective
is only one of several versions of psychoanalytic thinking. Psychoanalysis
is neither value free nor committed to one set of values, but is rather a
plural discourse within which moral and social differences can be
explored. The paper suggests three ways for advancing the critical
program set out by the authors. It recommends that clinical work be
used as a valuable source of evidence of the consequences of social
organization for personal lives, that arguments based on case descriptions
of individual experience can be effective forms of public communication,
and that the value of the “containment model” presented by Altman
and Peltz needs to be demonstrated in practice as well as in theory,
through psychoanalytic work both in and beyond the consulting room.
T
HESE VALUABLE AND CLOSELY LINKED PAPERS SEEK TO REOPEN AN
engagement between psychoanalytic ideas that have normally
been focused on individuals and their personal experience, and
larger issues of social and political well-being on which psychoanalysis
has generally had much less to say. Their authors argue that

Michael Rustin is Professor of Sociology at the University of East London and a
visiting Professor at the Tavistock Clinic, London. He is author of many books, including Reason and Unreason: Psychoanalysis, Science and Politics (2001), and (with
Margaret Rustin) Mirror to Nature: Drama, Psychoanalysis, and Society (2002).
367
© 2005 The Analytic Press, Inc.
368
Michael Rustin

psychoanalytic ideas developed by Klein, Winnicott, and Bion, with
the importance they attach to containing relationships, provide a
resource for political and social thinking that is much needed in a
period of rampant individualism. Contemporary society is for them
dominated by manic defenses against guilt, which take the form of
the fear and dismissal of outsiders, addictive consumption, and
obsessional work. They thus call modern America “the manic society.”1
Neil Altman’s paper proposes that the distinction in Melanie Klein’s
work between the paranoid-schizoid and the depressive position has
great value in discriminating between different kinds of social
relationships, and indeed social order. Paranoid-schizoid states require
the denial of intense guilt brought about by the perceived or imagined
damage done to others, and manic defenses arise from this. Peltz’s
paper gives a complementary emphasis to the possibilities of a more
“depressive” social order, which would give greater weight to social
inclusion and the recognition of need and would sustain institutions
that are accessible to all and that create a containing reflective space
in which imaginative development can take place. She cites her own
experience of the local public library and its staff’s enthusiastic help
to her daughter, and her experience of the great museums as examples
of what such a public space can be like. Both authors lament what
they see as the decline of American government as an institution
capable of recognizing different interests and of negotiating their claims
to the benefit of all. Although it is obvious that society is now
dominated by the rich and powerful, and by an ideology of self-interest,
more than it was in the 1960s, there is more continuity in American
political history than Altman and Peltz like to allow. However, in their
references to genocide and slavery as foundational aspects of the
United States, they also acknowledge the deep-rooted nature of these
manic defenses.
Rachael Peltz is able to show from clinical material these connections
between social pressures and individuals’ psychic lives. She reports
clients who feel that their lives are being emptied out by the demands
of work, and by a host of obligations in which they feel they are driven
to succeed. Others feel that they are driven to seek their main
satisfaction in buying and consuming, only to find that this does not

1
The title of Trollope’s 1875 novel with its theme of commercial profligacy and
imperialism.
Commentary on Papers by Neil Altman and Rachael Peltz
369

really bring them satisfaction. One client, knowing that she has a house
she likes, nevertheless finds herself dissatisfied that it is not bigger,
and is troubled by this. Peltz suggests that these individual clients
represent instances of much more general states of mind, since there
is much evidence that modern American society (and others like it
such as, increasingly, Britain) is increasingly organized around the
desire to consume, and by pressures to work ever-longer hours to make
this possible.
At the same time there are indications that the American dream—
the belief in the universal possibility of an improved life, which
historically in the United States usually sustained both a commitment
to hard work and a sense of justified satisfaction in the material benefits
won by this—is now proving hollow for many. Standards of living are
only being kept up by very long working hours and short holidays—
few of the benefits of American prosperity seem to be made available
in the form of increased leisure—and by sacrifice of the time formerly
devoted to parenting, especially by women workers. Material standards
of living for low-income and middle-income families have not been
growing at all, and the gap between the richest segments of society
and everyone else has grown to an extraordinary degree. The fact that
the Bush administration can, in this situation, propose tax cuts that
largely benefit the very rich, and that this is not a self-evident act of
political suicide, is a revealing phenomenon in contemporary American
political culture.
The primary question that Neil Altman and Rachael Peltz’s papers
raise is, how far is it possible for a psychoanalytic way of thinking to
throw light on the way we live now and, at the same time, provide
some fresh intellectual resources to support those who might wish to
change it? The answer to this question, for both Altman and Peltz,
depends on demonstrating the relevance of the object relations
tradition in psychoanalysis to a socially responsible way of thinking,
in contrast to the perceived individualism of hitherto dominant ego
psychology and now also of postmodern strains in American
psychoanalysis. Altman draws more on Melanie Klein’s ideas in his
paper, and Peltz more on Winnicott’s and Bion’s in hers. Altman focuses
more on defenses against anxiety—that is, on pathological states of
mind—while Peltz also sketches a more positive conception of what
“facilitating relationships” (to use Winnicott’s term) might be like both
for individuals and families, and society more generally. The idea of
containment and reflective space, developed from Bion’s work, are
370
Michael Rustin

important, since they enable the writers to connect the good
experiences that their patients are able to find in psychoanalysis with
the space for thought and feeling that they find continually squeezed
out of their daily lives by internal and external pressures. The writers
also make reference to writings by American analysts such as Ogden,
Mitchell, Resnik, Chodorow, and Benjamin, indicating that they are
not alone in looking for a “social turn” in psychoanalytic thinking.
I am generally very sympathetic to the project that Altman and
Peltz are outlining in their articles. To a degree, both writers see the
relationship between psychoanalytic practice and wider social norms
to be a more positive one in Britain than it is in the United States,
because of the continued embedding of some psychoanalytic practice
in the British National Health Service.2 Psychoanalytic conceptions
(including the ideas of John Bowlby that later became established as
“attachment theory”) had influenced the postwar formation of the
welfare state, through their conception of the fundamental importance
of parenting to human development and of the need for social policies
to support the family in this role. These links between psychoanalysis
and social policy have been sustained in Britain, though—as one might
expect—in uneven and contested ways. British systems of health and
social care are also now beset by pressures to “marketize,” to prefer
quick and shallow solutions to problems over deeper remedies that
demand time and thought, to impose coercive discipline on the
underprivileged rather than giving them real help, and to continually
inspect and measure the work of public sector professionals in ways
that undermine their professional capability and autonomy. Still, for
all this, commitment to good practice in public health and social
services continues (the present government is greatly increasing the
proportion of national income assigned to the NHS), and an NHS
institution like the Tavistock Clinic has continued to thrive and even
extend psychodynamic and systemic therapeutic provision in the public
health system.3

2
Incidentally, it is hardly accurate to describe Winnicott and Bion as “renegade
analysts,”as Peltz does. In the UK at least, they have become central figures. The
“Controversial Discussions” (King and Steiner 1993) in the British Psychoanalytic
Society in 1941–1945 led to the full incorporation of Kleinian and related ideas into
the psychoanalytic establishment.
3
See the symposium on child psychotherapy at the Tavistock Clinic, in Daws and
Loose (1999).
Commentary on Papers by Neil Altman and Rachael Peltz
371

What are the conditions that make possible the transfer of
understandings gained in psychoanalytic practice, to a wider field of
social concerns? Altman’s and Peltz’s articles raise these questions
with particular force in the context of the United States, but whatever
might help this situation in the United States is likely to help it in
Europe, too—after all, most of the movement of influential political
ideas has for many years flowed westward across the Atlantic, not in
the reverse direction. And on both sides of the Atlantic, one must
beware of undue splitting between an imagined healthy European
practice and a deficient American one. That has the risks of being
another manic defense on both sides.
Psychoanalytic practice makes its most important discoveries, and
produces its most reliable findings, in the clinical consulting room
(Rustin, 2002, 2003). Psychoanalytic ideas have of course traveled
widely outside that setting—John Forrester (1997) has pointed out
that Freud’s books have long been worldwide bestsellers. But it is
mainly Freud’s ideas about the role of the unconscious, and of
psychopathologies, in the experience of individuals, that have become
familiar and influential in this way, not their broader application to
social problems. Generally speaking, the robustness and fertility of
psychoanalytic ideas has been less, the further they have become
removed from their primary clinical context of discovery. Altman and
Peltz show how these theories have a legitimate purchase on social
issues, but there is a continuing problem of how to ground such
applications on convincing evidence.
We need to address the methodological problem, identified by
Altman, concerning the link between the individual focus of most
psychoanalytic research, and its social relevance. Peltz’s article suggests
one way forward. She reports the unhappiness of some of her
psychoanalytic patients in a way that does make connections between
their private pain and its public causes. She shows that what they feel
to be missing in their lives—space in which to think and feel, to give
time and attention to their primary relationships—has been made clear
to them through their experience of therapy. They also come to see
that some of the pressures that drive them to sacrifice themselves to
ambition or to the necessity of having more possessions, have become
internal ones, part of a persecuting superego. As they come to recognize
this, in part because of the contrast between the kind of conversation
that is possible in analysis, and the more superficial kinds of
conversation that dominate their working lives, so they can begin to
372
Michael Rustin

recover some autonomy and understanding that change may be
possible.
Two aspects of this clinical experience are significant. The first is
that the consulting room provides genuine testimony about what it is
like even for relatively successful citizens to live in a society like ours.
Such evidence is harder to come by than one might imagine. After
all, most of the time, most of us rely on our personal experience, and
the media, to form our understanding of the social world. Most
journalism is shallow, and most social scientific writing is insensitive
to individuals’ experience. The second is that the consulting room
can provide some microcosmic embodiment of a different way of being.
It creates a space in which thinking can be allowed, and where the
consequences of what one might do can be considered without blame,
but also without denial. The psychoanalytic consulting room thus
provides a context in which depressive states of mind can be
experienced through the containing role of the psychoanalyst.
Psychoanalytic critique is most valuable when it is grounded in
actual experiences, unique to psychoanalysis. It is also important that
psychoanalytic critique should have a dimension of practice—in other
words, to borrow a phrase, that it should try not only to understand
the world, but also to change it. The developing applications of the
idea of containment in psychoanalysis in Britain—to many different
social settings) are rooted in a variety of practices, clinical and
observational, and their fertility comes from this.
C. Wright Mills memorably said that one of the principal
responsibilities of the sociologist was to explain the public meaning of
private troubles.4 That is to say, the sociologist must explain how some
problems commonly experienced in the personal lives of individuals
have their origin and cause in social arrangements, and can only be
rectified through addressing their social causes. It is this relationship
between the private and the public that Altman and Peltz are
addressing. It is the understanding of individual pain that
psychoanalysts obtain from their clinical experience that makes
possible their distinctive contribution to social critique.

4
“Know that many personal troubles cannot be solved merely as troubles, but
must be understood in terms of public issues—and in terms of the problems of historymaking. Know that the human meaning of public issues must be revealed by relating
them to personal troubles—and to the problems of the individual life.” From
C. Wright Mills, (1970, p. 248).
Commentary on Papers by Neil Altman and Rachael Peltz
373

Peltz refers to Richard Sennett’s (1998) book in her discussion of
the hollowness of contemporary American society. Sennett’s
description of the unsatisfied life of his principal research subject,
conventionally successful though he is, is a resonant account
of weakening social bonds. However, Sennett’s book is also
methodologically interesting from a psychosocial point of view. His
argument is exemplified by a single case study, and from comparison
of the findings of this study with earlier interviews conducted by
Sennett with the main subject’s father, a janitor. (His experience was
recounted at length in Sennett and Cobb, 1972.) We see here how an
influential social critique can be based on the study of a single
individual, if its description is rich enough for readers to be able to
see its relevance to their own experience. A psychoanalytic social
critique needs a related approach, working from its strengths of deep
knowledge of individuals and of being able to convey the meaning of
their lives in their own words. It has been a weakness of psychoanalytic
social critiques hitherto—even some of the most influential, for
example, those by Marcuse or Lasch—that it has been undertaken at
some distance from clinical practice.
Neil Altman and Rachael Peltz recognize that psychoanalysis has
historically embodied somewhat different worldviews. Their reference
to Freud’s own ideas, to ego psychology, and to the object relations
tradition they are most interested in, makes this clear. They also note
the interdependency between psychoanalytic cultures and their
broader social contexts. The Klein-Winnicott-Bion tradition has
flourished in Britain because it has had some consonance with its norms
of social solidarity, even though it has also made its contribution to
these. It is probably as well to accept that psychoanalysis is pluralist
in this way, and that it provides a space for debating fundamental
issues of human nature and value, not a definitive answer to these
questions. It might be easier to win support for object relations
approaches, both clinically and in social applications, if it is accepted
that different positions may reasonably be held within psychoanalysis,
as well as outside it. Altman cites Isaiah Berlin’s view that competing
moral values have in the real world to be traded off against one another.
One cannot have all of everything. Psychoanalysis itself illuminates
these life choices, both for individuals and in its own doctrinal
differences.
There must be good reasons why object relations approaches in
psychoanalysis have not resonated with important components of
374
Michael Rustin

American national culture. An upwardly mobile society based on
continuous immigration supported from its origins a much more
individualist and sectionalist worldview and found this functional for
much of its history, though not for all of its citizens or noncitizens.
The hierarchy and paternalism of European societies, the collective
identifications of class that emerged in struggles for social justice, and
the legitimacy of states that took quasi-parental responsibilities for
their citizens’ well-being despite many political changes, are attributes
that Americans deliberately turned away from. After all, many of them
had fled from the more oppressive features of the Old World and had
no wish to recreate it on the other side of the Atlantic. New immigrants
from Asia or Latin America now replicate their experience.
Furthermore, in a society made up of strangers who began their lives
in America inhabiting very different cultures of origin but in which
there were found over time to be opportunities for at least a large
majority, narrow loyalties to family, neighborhood, and ethnic or
religious group made sense. More universal rights and claims seem to
function at a more abstract level of rhetoric and ideology, while
individual freedom is assigned most value. The continuous affirmation
of Americanness in the culture of the United States, as in the frequent
references to the “American people” by its politicians, seems to be a
symptom of the shallowness of underlying solidarity, not its strength.
Perhaps different psychic formations have affinities with different
social structures and cultures. Paranoid-schizoid formations may be
more functional in some environments, more depressive ones in others.
Altman and Peltz both clarify how psychoanalysis in the United States
has accommodated the dominant social climate, giving more
commitment to individuals’ advancement than to social
responsibilities. They also note the sacrifices that might be required
to do anything else.
But we must then ask, how may these depressive values, grounded
in one psychoanalytic view of human nature, gain a greater resonance
than they now have in American society? There are three dimensions
to this question, those of understanding, of communication, and of
practice. I will discuss these in turn.
So far as understanding is concerned, a crucial place to start is with
analysts’ clinical knowledge and experience of patients themselves.
Where there are aspirations to different kinds of experiences of self
and others latent in our society, one would expect to meet them in
Commentary on Papers by Neil Altman and Rachael Peltz
375

the consulting room. The vignettes5 from Peltz’s work with her patients
provide just this kind of evidence, for example, of one client’s wish to
be able to relate more deeply to her family and to find a way of coping
with internal and external demands that give everyone more space to
grow. Family is indeed one of the primary locations of commitment
and affection in American society, and distress about the damage to
family experience may be a point of resonance in a new social critique.
It is conflicts between shared aspirations and values, on one hand,
and actual experience and suffering on the other, that make change
possible. Clinical practice may provide some exemplary understanding
of such contradictions as they arise in everyday lives.
The second dimension is whether psychoanalysts can find a way of
writing about these issues that is meaningful both within and outside
the psychoanalytic profession. If this is possible, it is likely that case
descriptions will have a central place, as after all they have done in
most memorable psychoanalytic writing. It is where readers can
recognize themselves in the experience of a reported subject that new
ideas and representations of experience begin to travel. This is what
has happened in the social understanding of sexual repression (a major
social change brought about in part through psychoanalytic ideas).
There seems no reason why this could not also be true of the social
understanding of other kinds of psychosocial malaise. Different
sciences communicate their findings in different ways, using what the
sociologist of science Bruno Latour (1987) calls different “incription
devices.” Geographers use maps, statisticians use figures, and botanists
use diagrams and classificatory systems. Louis Pasteur (Latour, 1988)
staged public demonstrations of the power of bacilli to cause illness
and for immunization against bacilli to prevent it. Psychoanalysis
publishes case studies, with theoretical models that explain their typical
aspects (the Oedipus complex and its vicissitudes, for example), and
their relation to common human experience. There is no reason why
psychoanalytic case descriptions that are sensitive to broader social
and cultural conditions could not also achieve resonance.
A third dimension is of practice. It would help the influence of
psychoanalytic social critique if one could show that psychoanalytic
methods can make a difference in practice, and not offer merely a

5
The necessity to present case material in composite forms is a limitation in this
work, since it dilutes the quality of the evidence presented.
376
Michael Rustin

theoretical description of pain. The therapeutic relationship between
individual client and analyst is not sufficient in this respect. In working
with families, this relationship may be insufficient even for its clinical
purpose—one may need to work with a whole family to make a
difference, and this is hard for a single therapist. But psychosocial
approaches need to be practiced in the health, social care, and
education systems so that these networks become containers for
development. The strength of a broad-spectrum public health clinic
such as the Tavistock in London has been that it has been able to
develop interventions within many professions and client groups, and
to explore in practice the relevance of psychoanalytic methods.
Individual private practice does not facilitate these broader
developments.
If the work that Altman and Peltz propose is to develop, it follows
that psychoanalysts need to work cooperatively to find agencies that
are prepared to support this. One knows that the public context for
such developments is weak and has been further damaged by the shift
to the right in American politics over the past two decades. But, as
our authors say, public institutions do exist, and some of them (such
as the school system) have a central role in American life. Institutions
need to be found, or created, that are committed to relations of trust
and support, and to showing the good that follows when this available.
If they can’t be, it is a bleak outlook.
I will conclude with some observations on one contemporary manic
defense that neither Altman nor Peltz discusses. The main manic
defense now being employed in our societies is organized around fear
of enemies and the daily amplifications of threats from them. Projecting
hatred and fear onto enemies has always been a means of denying the
reality of differences, inequalities, and suffering in any society. The
cold war had this role on both sides of its frontier for 50 years—Altman
refers to the role of McCarthyism in having intimidated analysts who
had fled from Europe into not expressing their liberal political
commitments in their new situation. Hanna Segal (1987), in an
unusual psychoanalytic intervention into the nuclear arms debate,
argued that the cold war had provided a durable structure for paranoidschizoid anxieties—a perverse containment, we might call it. She
suggested that the end of the cold war would leave such unconscious
fear and hostility without an object, and suggested (Segal, 1995) that
the first Gulf War was motivated by the need to find some fresh location
for these projections. Segal’s interpretation of the first Gulf War may
Commentary on Papers by Neil Altman and Rachael Peltz
377

have been a little psychoreductionist, but there seems little doubt that
she has been proved right in the longer term. A new paranoid-schizoid
structure has replaced that of the cold war, organized as a state of
permanent war against a variety of disparate enemies, including drugs,
terrorism, “the axis of evil,” and various demonic figures such as Osama
Bin Laden and Saddam Hussein. Several wars have followed, and
indeed continue in a low-intensity mode, in Afghanistan and Iraq.
The state of mind that followed the events of September 11, 2001,
was seized on and amplified by the Bush administration to turn
attention away from the actual disappointment and frustration of many
Americans. It is not too much to say that this catastrophe has rescued
his then-vulnerable and unpopular presidency. There has in fact been
a sacrifice of a sense of proportion in characterising September 11 as a
global catastrophe around which the whole world must reorient itself,
considering the vastly greater scale of other disasters that beset the
world, from earthquakes to mass epidemics such as HIV-AIDS. The
element of manic defense lies in the exaggeration of likely damage
and danger, in omnipotent conceptions of how these can be prevented
or avenged, and in the refusal to take responsibility for much larger
sources of pain and suffering. Some of these then add to the danger
via states of resentment and desperation. In sum, the paranoid-schizoid
position is in the ascendancy and is bringing with it great damage.
It is no doubt easier to point this out in Britain and in many other
parts of Europe than in the United States. But the solidarity against
external enemies that was demanded during the cold war, and is again
being mobilized in the Islamic wars, is a prime example of the manic
defense that informs Altman’s and Peltz’s articles. Mobilization against
external enemies is a powerful political weapon, as Euripides long ago
pointed out in his dramatic polemics against the war party of ancient
Athens. This is true especially since such enemies do really exist, and
because they become drawn into self- sustaining dynamics of
antagonism, which on both sides is constructed as a state of holy war.
Psychoanalysts should be giving their attention to these states of
anxiety, too.
REFERENCES
Daws, D. & Loose, J. G., eds. (1999), Child psychotherapy: A report from the
Tavistock Clinic. Psychoanal. Inq., 19:119–278.
378
Michael Rustin

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