Working through Guilt and Regret: An Emergent Psychoanalytic Paradigm? (book review)

Review of Susan Kavaler-Adler’s The Anatomy of Regret: From Death Instinct to Reparation and Symbolization through Vivid Case Studies (London: Karnac Paper, 2013), ISBN 978-1-78049-117, 248 pages, paperback, £21.34.

Susan Kavaler-Adler is the founder and executive director of the Object Relations Institute (ORI) for Psychotherapy and Psychoanalysis in New York and the author of several books and many papers in the area of British and American Object Relations theory and therapy. (The unfortunate term “object” in psychoanalytic Object Relations theory refers to the loved and hated others with whom the self is in relation both in the external interpersonal and, more importantly, the internal intrapsychic worlds.)

In the book under review, the author presents in her introduction, chapter one, and conclusion the revised version of Kleinian theory, integrated with concepts of William Ronald Dodds Fairbairn, Donald Winnicott, and Margaret Mahler, which informs her view of the therapeutic process as one of “developmental mourning.” It is through facing up to and mourning one’s destructiveness (arising in Kavaler-Adler’s view not from innate aggression but from trauma broadly defined) and one’s consequent regrets, all in the context of a therapeutic holding environment, that one is able to liberate oneself from their defensive and maladaptive “false self” (Winnicott), one’s “antilibidinal ego” or “internal saboteur” (Fairbairn), and from Freud’s and Klein’s sadistic superego. Having clearly outlined her theoretical framework, the author illustrates it through a series of extensive, richly described case studies that, to my mind, succeed in demonstrating in clinical detail her theory in practice and its therapeutic power in work with patients suffering from diverse levels and types of psychopathology.

Kavaler-Adler’s perspective is, in many ways, parallel to my own, as outlined in The Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience (2013). Whereas I speak more about guilt than regret, I think the two are really inseparable as one cannot genuinely face and learn how to bear one’s guilt without at the same time experiencing regret about the damage one has done

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to others and to oneself. Kavaler-Adler and I agree with Melanie Klein that consciously integrating one’s guilt and regret, working through the depressive position, and moving toward reparation, is the path toward recovery.

Because I confine mourning to the process of working through losses, including those resulting from our destructiveness, I do not view working through the depressive position by genuinely facing guilt and regret as mourning per se. Though certainly sobering and humbling, accepting responsibility in this way at the same time relieves one from painful shame and superego torment and leads to reconciliation with conscience. I suspect some patients on the verge of the depressive position who intensely and extensively experience mournfulness and what Kavaler-Adler calls “the grief of regret” may be using these painful emotional states as a delaying tactic against getting on with the work of repentance and reparation.

I share Kavaler-Adler’s rejection of the concept of the “death instinct” (a concept defined so differently by different authors that it is only in context that one may hope to grasp what it might mean). In any case, the concept is redundant and can safely be ignored, for on virtually every page Klein mentions it she provides an alternate and, to me, far more acceptable explanation of the infant’s inevitable paranoia as arising not from projection of the death drive but from its cognitive limitations and interpretation of all frustration as an attack. The absent good breast is experienced as a bad attacking breast. Like many North American writers, Kavaler-Adler succumbs to the idea that Klein ignores the real parenting, letting the caretakers off the hook and blaming pathology on the child’s drives and fantasies. However, throughout her career Klein has stressed the importance of the real caretaker, whose goodness and love are crucial to offset the paranoia arising from projected aggression arising from both the existential and the surplus frustration due to parental failure.

While many deplore the fragmented state of contemporary psychoanalysis, I see the fragments as pieces of a wonderfully complex puzzle that we are gradually beginning to be able to piece together and which will constitute the higher dialectical synthesis of the existing partial perspectives. Analysts who have immersed themselves in Sigmund Freud, Klein, Fairbairn, Winnicott, Mahler, Heinz Kohut and others seem to be overcoming tunnel-vision and glimpsing and beginning to delineate an overarching framework for psychoanalysis. In this connection, a recent posting by Arnold

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Richards to the Clio’s Psyche listserv (June 23, 2014) is of interest: “A worldwide conceptual survey by the IPA [International Psychoanalytic Association] shows that the number one and number two concepts were transference/countertransference and projective identification,” a finding he feels “supports the view that there is a new conceptual consensus with a Kleinian take.” Kavaler-Adler is an important contributor to this emerging synthesis.

Although this book does not directly contribute to psychohistory insofar as the latter utilizes psychoanalytic theory as a basis for understanding the psychology of historical actors, an emerging new psychoanalytic paradigm should be of great interest to psychohistorians. This new paradigm emphasizes the role of unconscious guilt stemming from aggression reactive to frustration and trauma and turned back against the self by a persecutory superego, leading to varying degrees of self-punishment and self-sabotage often unrecognized as such. In the lives of individuals, groups, and nations, self-defeating repetitions result from, among other factors, repressed or split-off guilt and unconscious identifications with both the aggressor and the victim expressed through the destruction of the self and others. I agree with Kavaler-Adler that it is only through consciously experiencing and working through our guilt and regret that positive change through repentance and creative reparation can occur.

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