Wednesday, August 15, 2012

UpToDate has added a new specialty, psychiatry

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UpToDate has added a new specialty, psychiatry

UpToDate has added psychiatry to its list of specialties. Here is a blurb from UpToDate’s email announcement about this.
“Our Co-Editor-in-Chiefs of UpToDate in Psychiatry, Dr. Peter P. Roy-Byrne and Dr. Murray B. Stein, worked with a team of leading psychiatrists to build and expand our psychiatry content. Testing with psychiatrists showed that UpToDate answered their clinical questions 90% of the time.*
Content covers all the major areas of psychiatry — including psychotic disorders, depressive disorders, bipolar disorders, anxiety disorders, somatoform disorders, eating disorders, impulse control disorders, substance-use disorders and personality disorders.”

The Tangled Links Between Psychiatric Disorders and Creativity

The Tangled Links Between Psychiatric Disorders and Creativity:
The potential association of creativity with mental illness has generated both scientific interest and controversy since such a relationship was first posited by the ancient Greeks.

The two might...

Psychiatry’s Legitimacy Crisis

Wednesday, August 15, 2012

Psychiatry’s Legitimacy Crisis

All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders
by Allan V. Horwitz and Jerome C. Wakefield

Book Review by Andrew Scull
The Los Angeles Book Review
Originally published on August 8, 2012

ABOUT 40 YEARS AGO, American psychiatry faced an escalating crisis of legitimacy. All sorts of evidence suggested that, when confronted with a particular patient, psychiatrists could not reliably agree as to what, if anything, was wrong. To be sure, the diagnostic process in all areas of medicine is far more murky and prone to error than we like to think, but in psychiatry the situation was — and indeed still is — a great deal more fraught, and the murkiness more visible. It didn’t help that psychiatry’s most prominent members purported to treat illness with talk therapy and stressed the central importance of early childhood sexuality for adult psychopathology. In this already less-than-tidy context, the basic uncertainty regarding how to diagnose what was wrong with a patient was potentially explosively destabilizing.

The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.

The entire story is here.

Perversion: A Lacanian Psychoanalytic ... - Routledge Mental Health

Perversion: A Lacanian Psychoanalytic ... - Routledge Mental Health: In Perversion, Stephanie Swales provides a close reading (a qualitative hermeneutic reading) of what Lacan said about perversion and its substructures (i.e., fetishism, voyeurism, exhibitionism, sadism, and masochism). ... allegedly less pejorative term 'paraphilia' in the psychiatric textbooks, most psychoanalysts continue to employ the term, and much in the same way as their fellow clinicians, notably as a synonym for transgressive and eccentric sexual behaviors.

The Suffering Stranger - Hermeneutics for Everyday Clinical Practice - By Donna M. Orange

The Suffering Stranger

Hermeneutics for Everyday Clinical Practice

By Donna M. Orange

Published April 21st 2011 by Routledge – 279 pages

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Utilizing the hermeneutics of Hans-Georg Gadamer and the ethics of Emmanuel Lévinas, The Suffering Stranger invigorates the conversation between psychoanalysis and philosophy, demonstrating how each is informed by the other and how both are strengthened in unison. Orange turns her critical (and clinical) eye toward five major psychoanalytic thinkers – Sándor Ferenczi, Frieda Fromm-Reichmann, D. W. Winnicott, Heinz Kohut, and Bernard Brandchaft – investigating the hermeneutic approach of each and engaging these innovative thinkers precisely as interpreters, as those who have seen the face and heard the voice of the other in an ethical manner. In doing so, she provides the practicing clinician with insight into the methodology of interpretation that underpins the day-to-day activity of analysis, and broadens the scope of possibility for philosophical extensions of psychoanalytic theory.
Name: The Suffering Stranger: Hermeneutics for Everyday Clinical Practice (Paperback)Routledge
Description: By Donna M. Orange. Utilizing the hermeneutics of Hans-Georg Gadamer and the ethics of Emmanuel Lévinas, The Suffering Stranger invigorates the conversation between psychoanalysis and philosophy, demonstrating how each is informed by the other and how both are...
Categories: Psychoanalysis, Hermeneutics, Philosophy of Psychology

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  1. The Suffering Stranger

    Hermeneutics for Everyday Clinical Practice

    Utilizing the hermeneutics of Hans-Georg Gadamer and the ethics of Emmanuel Lévinas, The Suffering Stranger invigorates the conversation between psychoanalysis and philosophy, demonstrating how each is informed by the other and how both are strengthened in unison. Orange turns her critical (and...
    Published April 20th 2011 by Routledge
  2. Strong Hermeneutics

    Contingency and Moral Identity

    Recent years have seen a resurgence of interest in ethics, particularly in the approaches of deconstruction and hermeneutics. At the same time, questions of identity have risen to prominence in philosophy and beyond into cultural studies and literature. Strong Hermeneutics is a clear and accessible...
    Published August 27th 1997 by Routledge
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Forthcoming Books

  1. Hans-Georg Gadamer
    By Karl Simms
    To Be Published February 28th 2013
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New York London
Hermeneutics for Everyday
Clinical Practice
Donna M. Orange
Taylor & Francis Group
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Library of Congress Cataloging‑in‑Publication Data
Orange, Donna M., 1944- author.
The suffering stranger : hermeneutics for everyday clinical practice / Donna
M. Orange.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-415-87403-8 (hardcover : alk. paper) -- ISBN 978-0-415-87404-5
(softcover : alk. paper) -- ISBN 978-0-203-86363-3 (e-book)
1. Psychoanalysis--Philosophy. 2. Hermeneutics. I. Title.
[DNLM: 1. Psychoanalytic Theory. 2. Humanism. 3. Philosophy. 4.
Psychoanalysis--history. WM 460]
BF175.4.P45O753 2011
150.19’5--dc22 2010046619
Visit the Taylor & Francis Web site at
and the Routledge Web site at
Preface ix
Chapter 1 What Is Hermeneutics? 1
Chapter 2 The Suffering Stranger and the Hermeneutics
of Trust 37
Chapter 3 Sándor Ferenczi: The Analyst of Last Resort
and the Hermeneutics of Trauma 73
Chapter 4 Frieda Fromm-Reichmann: Incommunicable
Loneliness 111
Chapter 5 D. W. Winnicott: Humanitarian Without
Sentimentality 137
Chapter 6 Heinz Kohut: Glimpsing the Hidden Suffering 175
Chapter 7 Bernard Brandchaft: Liberating the
Incarcerated Spirit 205
Afterword: The Next Step 237
References 239
Index 259
The Suffering Stranger and the
Hermeneutics of Trust
One must lose oneself in order to find oneself.
Who am I, so inconstant, that notwithstanding you count on me?
Trust transforms the pregiven into a ground.
Our journey through the history of hermeneutics has brought
us to a crossroads. At this point we will pick up what some
might call an ethical path for clinical work. It appears first in the
hermeneutics of trust only vaguely suggested by Ricoeur, as we
have seen, but later more clearly explained in his encounter with
Lévinas. Second, we discern this trail in the gentle and generous,
though always questioning, dialogic hermeneutics of Gadamer,
in his attentiveness to the specific and characteristic voice of
the other. Finally, in a very different tonality, and above all, the
Lévinasian “face” commands me to respond, or at least not to kill;
the face holds me hostage. These three come together, if not seamlessly
then at least adequately, to form a clinical philosophy quite
alternative to that originally taught to most of us in our training
38 • The Suffering Stranger
but well illustrated by the five extraordinary clinician hermeneuts
we will study later in this book.
Here we need only to resummarize the idea of the hermeneutics of
trust. This approach to clinical practice interprets from a point of
view that assumes a common world, in which both people live, suffer,
play, and search for meaning together. It assumes the goodwill
of both partners in the search for meaning and truth. It assumes
not that everything is obvious, explicit, and transparent but that
what is unhidden also contains important truth. The hermeneutics
of trust works from what both partners hold in common to find
understanding where differences exist. It assumes, in a word, truthfulness
and good intentions, in both or all partners to a conversation
or interpretive process. Without this assumption, there can be
no real dialogue.
As a clinical philosophy, this hermeneutic keeps us closer to
our patient’s perspective and permits an emotional availability
(Orange, 1995) that heavy reliance on the hermeneutics of
suspicion (see Chapter 1) precludes.* It gives us some chance to
mitigate both the shame built into the psychotherapeutic situation
(Orange, 2008b) and that particular to this patient, for we
too may seem to have human frailties and vulnerabilities that we
too are placing at risk (Jaenicke, 2008). The hermeneutics of trust
invites less defensiveness, as it understands resistance and defense
as absolutely needed modes of coping with unbearable traumatic
terrors and lonely anxieties. Gradually such a hermeneutics makes
a relational home (Stolorow, 2007) for previously unwitnessed
traumatic experience.
Critics of a more compassionate psychoanalysis have
always feared the loss of the detailed questioning so beloved in
* When I use Ricoeur’s expression “school of suspicion,” I will be referring to a preponderant
reliance on the methods of unmasking of defenses and disguises.
The Suffering Stranger and the Hermeneutics of Trust • 39
interpersonal psychoanalysis and with it a needed critique and
challenge to the patient. Mitchell (1986), for example, expressing
concern about Kohutian and Winnicottian views, cautioned
that “a receptive, unquestioning approach misses the function of
the narcissistic integrations in perpetuating old object ties, and
runs the risk of consolidating them” (p. 125). Note that Mitchell
assumed that “receptive” and “unquestioning” attitudes go
together. It seems to me, instead, that a receptive attitude, one that
establishes the secure holding environment that a hermeneutics
of trust creates, makes room gradually for all the questions that
Mitchell would have wanted to ask.
Within the hermeneutics of trust, then, the questions beloved
in the school of suspicion can find their secondary place. Once
the patient realizes that the therapist or analyst refuses the investigator/
prosecutor role, new questions often emerge: What am I
doing to make this happen over and over again? A shared world
of meaning and trust more or less established, it no longer matters
much who raises these inquiries, and they often come from
the patient. Depending on the particular situation, the clinician
may also be able to ask, Do you have some mixed feelings about
this person? But if these inquiries are too disturbing to trust, we
leave them for the moment and attend first to the “one thing necessary,”
the state of the connection between us. The hermeneutics
of trust does not mean that we can take the patient’s trust in
us for granted; as clinicians, we understand that trust is a fragile
treasure—if not a completely impossible thought—for most of our
patients, sometimes found only after many years of treatment.*
* From Hans-Georg Gadamer (1996): “On the other hand [versus scientific medical techniques],
there remains what we call treatment. The German term Behandlung is a rich and
significant word for ‘treating’ people and ‘handling’ them with care. Within it one hears
literally the word ‘hand,’ the skilled and practiced hand that can recognize problems
simply through feeling and touching the affected parts of the patient’s body. ‘Treatment’
in this sense is something which goes far beyond mere progress in modern techniques.
Here it is not only a question of the skilled hand but of the sensitive ear which is attentive
to the significance of what the patient says, and of the doctor’s observant and unobtrusive
eye which knows how to protect the patient from unnecessary distress” (p. 99).
40 • The Suffering Stranger
The hermeneutics of trust principally concerns our attitude
toward our patients: trusting that they are trying to communicate
their truth to us, by whatever they are saying or doing, and
that it is up to us to try to understand. Until the patient actually
attacks me physically, or until the relentless contempt becomes
more than I can bear (Orange, 2009b), I give my patient the benefit
of the doubt, on the assumption that he or she is trying to tell
me something.
Although Ricoeur would have none of Gadamer’s conversational
hermeneutics (Gonzalez, 2006), we will see that a hermeneutics
of trust weaves easily into Gadamer’s dialogic hermeneutics and
even more easily into Lévinasian ethics.
Gadamer’s hermeneutics, though extensively developed in relation
to the literary and visual arts, contains a running auditory
reference to the voice. He had a special love for Augustine’s “inner
word” or verbum interius (Grondin, 1994; Grondin & Weinsheimer,
2003). Gadamer’s lifelong immersion in Platonic studies prepared
him to understand this internal voice not as a solitary univocal
subjectivity but as dialogically constituted. This hermeneutics of
the voice, therefore, shows up preeminently in Gadamer, throughout
his work, as a hermeneutics of the voice of the other (Risser,
1997). This emphasis distinguishes his work clearly from that of
Heidegger, in whom the other disappears into Being, and brings
him closer to Ricoeur, for whom his more trusting hermeneutic
concerns the restoration of the meaning of what we seek to understand.
Gadamer (1979b), in fact, actually described hermeneutics,
To let what seems to be far and alienated speak again. But in all
the effort to bring the far near … we should never forget that the
ultimate justification or end is to bring it near so that it speaks in
a new voice. Moreover, it should speak not only in a new voice but
in a clearer voice. (p. 83)
The Suffering Stranger and the Hermeneutics of Trust • 41
Immediately we notice that hearing the voice of the other does
not mean assimilating or appropriating it to my own. Dialogue,
in Gadamer’s sense, makes clearer just what belongs to the other’s
voice. His fusion of horizons (Horizontsverschmelzung) does not
threaten the uniqueness and individuality of the other; instead, it
seeks to clarify the other’s voice in the process of inclusion.
Gadamerian hermeneutics invites the other to conversation
(Gespräch), perhaps his favorite word and favorite activity in the
end of his very long life. His version of Socratic “recollection”—for
Plato, knowing meant remembering—was “not only that of the
individual soul but always that of the ‘spirit who would like to
unite us’—we who are a conversation” (Michelfelder & Palmer,
1989, p. 110).
Whether we encounter a text or a person—in Gadamer’s hermeneutics,
the process of understanding is dialogic in either case—
we meet the other precisely as other:
A person trying to understand something will not resign himself
from the start to relying on his own accidental fore-meanings,
ignoring as consistently and stubbornly as possible the actual
meaning of the text until the latter becomes so persistently audible
that it breaks through what the interpreter imagines it to be.
Rather, a person trying to understand a text is rather prepared for
it to tell him something. That is why a hermeneutically trained
consciousness must be sensitive to the other of the text from the
beginning. (Gadamer, Weinsheimer, & Marshall, 2004, p. 271)
This passage could serve as an introduction to clinical practice.
Every hour of our day we try to resist fitting our patient into
our preconceived ideas and to listen to the person who struggles
to give voice to his or her confusion, suffering, hopes, and despair.
Unfortunately Gadamer himself agreed with Ricoeur that psychoanalytic
work exemplified the hermeneutics of suspicion (Gadamer,
1982; Gadamer et al., 2004). In Risser’s (1997) words, “The therapeutic
model is assumed to be hierarchical and non-dialogical as
in psychoanalysis where the therapist/analyst is not a true partner
in conversation. There are of course other therapeutic models”
42 • The Suffering Stranger
(p. 252, n. 48). Fortunately we can say to both Gadamer and Risser
that—thanks in part to the courageous people discussed later in
this book—forms of psychoanalysis, as well as other humanistic
psychotherapies, have now emerged that are truly dialogical and
asymmetrical only in inescapable ways that relate to ethical responsibility.
Many of us now share with Gadamer a passion to make the
voice of the other audible and as clear as possible, so that we can
render it back to the speaker as his or her own.
But Gadamer knew well that the project of hearing the other’s
voice would often mean hearing what we might not want to hear.
He wrote that we must be ready to hear the claim of the other
against us, against the one who seeks to understand:
Every encounter with others … means the “suspension” of one’s
own prejudices, whether this involves another person through
whom one learns one’s own nature and limits, or an encounter
with a work of art … or a text: always something more is
demanded than to “understand the other,” that is to seek and
acknowledge the immanent coherence contained within the
meaning-claim of the other. A further invitation is always
implied. Like an infinite idea, what is also implied is a transcendental
demand for coherence in which the ideal of truth is
located. But this requires a readiness to recognize the other as
potentially right and to let him or it prevail against me. (1979a,
p. 108)
What my patient is suffering, for example, may challenge
cherished beliefs and emotional convictions (Orange, 1995) that
organize my experience and keep me intact. My antidogmatism,
hard-won and very precious to me, may be challenged by the pain
of a young patient torn apart between a fundamentalist family
and her studies in philosophy or science. I will be tempted quickly
to dismiss the dogmatic religion and thus refuse to suffer and
understand and undergo the situation with my patient.
In addition, patients’ sources of suffering may evoke our own
and threaten to retraumatize us. If there was bigotry, or sarcasm,
or cruelty in our own families, it may be very difficult for us to
work with patients we find bigoted, sarcastic, or cruel toward us.
The Suffering Stranger and the Hermeneutics of Trust • 43
Unless, however, I can receive and engage with such a patient,
there is no chance for a healing understanding to emerge. Feeling
that I already “know” this person, I cannot hear the underlying
distress or its sources. An involved hermeneutic requires me to
give up this knowing.
We can also think of this politically, as we hear the voices of
people whom Europeans and North Americans have exploited.
We may hear the silenced voices of the trauma of slavery in our
African American sisters and brothers (Gump, 2010), for example.
We will often hear it clinically, if, with Ferenczi, Kohut, and
Brandchaft (see later chapters), we listen to our patients accuse
us of misunderstanding and hypocrisy. We will need at the very
least, in a dialogical spirit, to suspend our attachment to our desire
to be right, our assumptions about patients’ pathologies, our presuppositions
about ourselves, many concepts taught to us in our
training, or even the latest popular jargon in the journals of our
professional communities if we are to hear the voice of the other,
to “recognize the other as potentially right,” and to let him or her
prevail against us.
Working dialogically risks, as Winnicott quoted from T. S.
Eliot, “not less than everything” (Rodman, 2003).
What, we may ask, makes it reasonable to relegate the hermeneutics
of suspicion to a secondary place and to trust the emergence
of emotional truthfulness in therapeutic dialogue (including the
nonverbal)? Gadamer relied on Dilthey’s concept of Wirkung
(effect), incorporated into his own idea of Wirkungsgeschichte
(history of effects) to explain that we depend on our involvement
in ongoing tradition. By this he meant not just thinking
and doing what has always been thought and done but something
more like what today we call “transgenerational transmission”
of experience. As phenomenologist Rüdiger Bubner (1994) put
it, for a hermeneut—and clearly here we see that every clinician
44 • The Suffering Stranger
functions hermeneutically, consciously or not—“it is important to
school the ear for this phenomenon” (p. 77). In contrast to those
who see tradition as imprisoning us, Bubner, like psychoanalytic
developmentalists, saw it as giving us ground for understanding
and expanding horizons:
Being involved in tradition does not mean just being bound
to the particular determination of a situation, but also means
being confronted by an inexhaustible richness of possibilities.
The hermeneutical activity of expanding horizons and stepping
beyond limits, which makes up our true existence, unfolds itself
by proceeding from a particular point of concrete involvement
in tradition. We are ourselves when we find ourselves at work
trying to determine our reality in argument with the cosmos of
hermeneutical understanding. The possibility to do this, however,
is given through tradition that engages us. (p. 78, emphasis
Gadamerian hermeneutics does not depend on cleverness, or on
deconstructive reversals, or on unmasking pretensions, but on an
original trust in the realizability of the hermeneutical task …
nothing besides trust remains in the face of that emergence of
effects, which in every historical moment has long since taken
hold of us, before we could carefully consider whether we should
have dealings with it or not. (Bubner, p. 79)
Let us pause to consider this stunning statement, written by a
philosopher about the hermeneutics of Gadamer, by a man who
evidently had nothing to do with psychoanalysis, about Gadamer
who considered psychoanalysis insufficiently dialogical. Our only
possibility, both men tell us, in the face of our thrownness* that
includes what happened to us before we could carefully consider
whether to have dealings with it, is to trust in a dialogic process
of our emergent understanding of the effects of history. Bubner
(1994) went on, “Trust transforms the pregiven into a ground”
(p. 79, emphasis in original). He went on to speak of the risk-filled
* Heidegger’s word for the unchosen aspects of our existence: our family, culture, genetics,
social and economic class, and so on.
The Suffering Stranger and the Hermeneutics of Trust • 45
“advance on trust” that affirms our implications in traditions,
“which relativizes our own being, knowing, and capability in light
of that which it is not … the ground of understanding, which is
pregiven in history, proves itself to be a possession, which in truth
belonged to us already” (p. 80).
This language of knowing, possession, and trust in a common
world, however, gets seriously disrupted in the ethical philosophy
of Emmanuel Lévinas.
On first look, it might seem strange to find Emmanuel Lévinas* in
a book on hermeneutics. But his rejection of Heideggerian understanding
as reducing the other to “the Same” (to categories, to
the known and objectified) did not mean that he rejected every
kind of understanding and interpretation. As a Talmudist he saw
interpretation, as he would have said, “otherwise,” as blowing on
the coals of the traditional text or as offering a drink to the thirsty
“widow, orphan, and stranger.” He too had learned to distrust
psychoanalysis,† especially for relying on explanation and on theories
of unconscious motivation. Still, his work offers a striking
contrast to our ordinary clinical ideas of understanding and interpretation
and challenges us to an ethics of response and responsibility
to the face of the destitute other. This “face”—not something
one can touch but something that speaks: “You shall not commit
murder” (Lévinas, 1969, p. 199)‡—unsettles any complacency or
* For an introduction to his life (1906–1995), work, and clinical relevance, see Orange
† Hutchens (2007) would also dispute his relevance for psychoanalysis or for psychotherapy
generally, but notably he lacks sympathy for the entire Lévinasian project and
seems acquainted only with those forms of psychoanalysis that Ricoeur characterized
as belonging to the “school of suspicion.” To the contrary, however, important voices in
American relational psychoanalysis (e.g., Harris, 2009; Rozmarin, 2007, 2010; Suchet,
2010) are now seriously engaging with the work of Lévinas.
‡ It is “the face of the other who asks me not to let him die alone as if to do so were to
become an accomplice in his death. Thus the face says to me: You shall not kill” (Cohen,
1986, p. 24).
46 • The Suffering Stranger
knowing sufficiency by which we may be tempted. Thus, although
respecting Lévinas’s own sense of standing against psychoanalysis
(Fryer, 2007), we can consider what his challenging philosophy
might mean for clinical work that leans toward a hermeneutics of
Lévinas, student of Heidegger and Lithuanian survivor of 5
years in Nazi labor camps, lived and worked in France until he
died in 1995. He propounded one big philosophical idea, namely,
that ethics is first philosophy* where ethics is understood as a radically
asymmetrical “relation of infinite responsibility to the other
person” (Critchley, 2002, p. 6). Lévinas became convinced that
something “otherwise” than being or knowledge must be fundamental.
In his first great work Totality and Infinity, he contrasted
what he called “totalizing”—reducing others to objects to be studied,
categorized, or comprehended—with responding to the face
of the other.
This other, no alter ego that resembles me, bursts the bounds of
the phenomenology Lévinas had learned from Edmund Husserl
and from Heidegger. As David Ross Fryer (2007) put it, “Husserl
discovered the other ego as an other ego like myself, but Lévinas
discovered the other person as also a radical other beyond my
capability and capacity to know” (p. 582). This irreducible “face”
always transcends our concepts, representations, and ideas:† “The
way in which other presents himself, exceeding the idea of the
other in me, we here name face” (Lévinas, 1969, p. 50). The other
(Autrui, the human other) presents me with an infinite demand
for protection and care. The face says, You shall not kill (tu ne
tueras point). You shall not allow me to die alone. Each face, in
Ricoeur’s (1992) paraphrase, is “a Sinai that prohibits murder. …
* The expression “first philosophy” comes from Aristotle, who used it to refer to his metaphysics,
the study of those principles that underlie and transcend the contents of the
particular sciences. Lévinas’s point was that ethics is even more fundamental.
† Knowing and categorizing (in our field, diagnosing) reduce the other to “the same,” to
just another member of a class. For Lévinas, as his dedication to Otherwise Than Being
made clear, classifying was tantamount to “the same hatred, the same anti-Semitism,”
whether Jews were involved or not.
The Suffering Stranger and the Hermeneutics of Trust • 47
Whereas Kant placed respect for the law above respect for persons,
with Lévinas the face singularizes the commandment: It is
in each case for the first time that the Other, a particular Other,
says to me: Thou shalt not kill” (p. 336).
Lévinas (1981) contrasted his sense of the “height” or transcendence
of the other with description or classification or civic agreements:
The neighbor concerns me before all assumption, all commitment
consented to or refused. I am bound to him, him who is, however,
the first one on the scene, not signaled, unparalleled; I am
bound to him before any liaison contracted. … It is not because
the neighbor would be recognized as belonging to the same genus
as me that he concerns me. He is precisely other. The community
with him begins in my obligation to him. The neighbor is a
brother. (p. 87)*
Every reduction—by systematizing, classifying, pointing, even
describing—is, for Lévinas, a violence, a violation, a form of murder.
The neighbor, instead, exposes me “to the summons of this
responsibility as though placed under a blazing sun that eradicates
every residue of mystery, every ulterior motive, every loosening of
the thread that would allow evasion” (Lévinas, 1996, p. 104). The
response must be “Me voici” (me here): I am indeed my brother’s
keeper, and there is no escape.
In Lévinas’s emphasis on belonging, though perhaps controversial
among those who might accuse him of speciesism, we can hear
resonances with Gadamer’s emphases on belonging to a common
world and on conversation, and also with the insistence we will
find among our psychoanalytic hermeneuts that we are all more
simply human than otherwise (Harry Stack Sullivan’s maxim).
Belonging in community creates obligation to the neighbor, to the
brother, to the sister.
The relation to the other (Autrui) creates what Lévinas called
a “curvature of intersubjective space” (Lévinas & Nemo, 1985,
* Lévinas used autre, Autre, autrui, and Autrui for other, without discernable pattern. I
follow his translators when quoting and use other in my own text. I also include, when
quoting, his own frequent use of italics.
48 • The Suffering Stranger
p. 291). What can this mean? The ethical relation is not between
equals but radically asymmetrical, that is, from “inside that relation,
as it takes place, at this very moment, you place an obligation
on me that makes you more than me, more than my equal”
(Critchley, 2002, p. 14). Although we need law and justice and
equal treatment ethics—as a kind of support system for the ethical
relation—the fundamental ethical relation of proximity to the
neighbor is so radically tilted and irreversible as not to seem equal
in any phenomenologically describable way.
By “proximity,” an important concept in his last major work,
Otherwise Than Being (1981), Lévinas tried to explain what he
called “incarnate subjectivity” (p. 86). Subjectivity, an “irreplaceable
oneself … is set up as it were in the accusative* form, from the
first [moment] responsible and not being able to slip away” (p. 85).
Proximity means that the other, right next to me, remains both
other and separate but never allows me to evade responsibility. I
am I only insofar as I am affected, accused by the need of the naked
and vulnerable face of the suffering stranger. “In contact itself the
touching and the touched separate, as though the touched moved
off, was always already other, did not have anything in common
with me. As though its singularity, thus non-anticipatable and
consequently not representable, responded only to designation”
(p. 86). Lévinas’s language confounds, as he perhaps meant it to
do, evoking the traumatic circumstances in which his philosophy
took form.† He seems to have meant here that contact‡ with the
other means meeting the radically valuable, someone beyond and
above my attempts to predict and control and represent. In his less
* Lévinas plays with the “accusative”: He contrasts it with nominative “I” subjectivity, all
full of itself and also often repeated that the other’s need accuses me, makes me responsible,
even guilty in the Dostoyevkian sense that he frequently quoted: “Each of us is guilty
before everyone for everyone, and I more than the others” (quoted from The Brothers
Karamazov in Lévinas, 1981, p. 146).
† He wrote that his life was “dominated by the presentiment and the memory of the Nazi
horror” (Lévinas, 1990, p. 291).
‡ He listed five words that go together, that also form major and minor themes of this book:
“maternity, vulnerability, responsibility, proximity, contact” (Lévinas, 1981, p. 76).
The Suffering Stranger and the Hermeneutics of Trust • 49
strictly philosophical writings, Lévinas (1998b) would say that in
the face of the other is the “trace” of the infinite, that “God comes
to mind.”
My response to the face is simply “me voici” (hineni), not “Here
I am” as it is usually translated but rather, as Paul Ricoeur (1992)
pointed out, “it’s me here.” The face of the other calls me, demands
from me, takes me hostage, persecutes me. Response is my refusal
to be unmoved, or indifferent, to the face of the other, to the other’s
“useless suffering” (Bernasconi & Wood, 1988). Sometimes
Lévinas implied that I cannot be indifferent, that I am held hostage,
but he knew very well that many do not and did not respond.
This “cannot” must refer to the unavoidable ethical demand. What
I am or need, or how I feel toward the other, is, for Lévinasian ethics,
not in question.
Some aspects of Lévinasian ethics admittedly sound extreme,
for example, substitution. Sometimes he seems to require that I be
prepared to give my last ounce of bread so that the other may have
a chance to survive or to volunteer to face the firing squad in your
place. Working with severely traumatized patients, I sometimes
notice that a background working attitude of empathic resonance
or attunement, often playful in a Winnicottian sense, seems to
break down. I find myself impelled to wish, and sometimes even
to say that I wish, that I could take at least some of their torment
onto myself, make it lessen at least for a while, to let them be less
alone. What is this? Have I become a terminal masochist? Have
I become a grandiose messianic figure in my own imagination?
Should I quickly seek out another analysis? Or is there also something
to understand here about the nature of our work, about the
“therapeutic action of psychoanalysis”?
Let us listen to the formulation in his essay titled “Substitution”
(Lévinas, Peperzak, Critchley, & Bernasconi, 1996): “It is through
the condition of being a hostage that there can be pity, compassion,
pardon, and proximity in the world—even the little there is, even
the simple ‘after you sir’” (p. 91). Robert Bernasconi explained that
“this suggests that Lévinas is asking what underlies that behaviour
50 • The Suffering Stranger
which sometimes is called superogatory [commendable, but not
required], gratuitous or as he prefers to say, ethical. His answer
is that at the heart of subjectivity is not a [Sartrean] ‘for itself,’
but what he calls ‘the one-for-the-other’” (Critchley & Bernasconi,
2002, p. 235). Responsibility for the other, said Lévinas, “is the
essential structure of subjectivity” (Lévinas & Nemo, 1985, p. 95).
In other words, according to Bernasconi, he was not preaching
sacrifice but did want to account for its possibility. If we were as
essentially for-ourselves as Sartre (2001) and others have believed,
Lévinasian ethics would not be possible. Neither heroic behavior—
like that of those who had risked their lives to save Lévinas’s
wife and daughter—nor everyday “après vous, monsieur” courtesy
would be possible. We would live in the Hobbesian world of “all
against all” or at least in the familiar “What’s in it for me and my
family?” world.
Rationality—the rationality of conventional morality—and
Lévinasian ethics have nothing to do with each other. Clearly
Lévinas did not appeal to the “reasonable man” argument of
American jurisprudence; he never tried to reconcile rationality
and ethics. Rationality knows, objectifies, calculates, represents,
classifies, reduces, is always prepared to murder in the service of
its calculated aims; ethics, as Lévinas used the term, responds to
an absolute summons and command: Do not kill me.
Subjectivity almost disappears in Lévinas. Only in the suffering
of the other, and in my response, do I (a moi, not an ego) come
into being, “me voici,” called into being by the other’s naked and
vulnerable face. The sovereign self, with its “place in the sun,”
always trying to have more, would be indifferent to the plight
of the other. What minimal subjectivity remains to me, instead,
comes about via my response to the widow, the orphan, and the
stranger. Ricoeur (1992), in his encounter with Lévinas, spoke of
the “modesty of self-constancy,” so different from the “Stoic pride
of rigid self consistency” (p. 168). He went on to ask, “Who am I,
The Suffering Stranger and the Hermeneutics of Trust • 51
so inconstant, that notwithstanding you count on me?” (p. 168).*
In the instance of a gift, “the other can be said to dispossess me on
occasion so that giving is not an act, but an ethical event whereby
I lose my sense of mine in the face of the other” (Critchley &
Bernasconi, 2002, p. 240). Something happens to me in the face of
the other’s need so that my giving has the quality of participating.
My background role becomes habitual.
More than 20 years after his Freud book, we can hear Ricoeur’s
(1992) much clearer preference for what we are calling the hermeneutics
of trust, now framed in Lévinasian terms:
Credence is also trust … a trust in the power to say, in the power
to do, in the power to recognize oneself as a character in a narrative,
in the power, finally, to respond to accusation in the form of
accusative: “It’s me here” (me voici!), to borrow an expression dear
to Lévinas. (p. 22)
Now we can see how closely the older Ricoeur, the dialogic
Gadamer, and the ethical Lévinas actually fit together as a hermeneutic
for hearing and reading the more maternal,† and thus most
often contemptuously excluded, voices in psychoanalysis. Without
losing critique and questioning and concern for justice,‡ we have
a place for trust, welcome, and hospitable listening that places the
need and the voice of the other first.
Freedom, agency, and authenticity have little place in the
Lévinasian vocabulary, except to reject them (Lévinas, 1997).
* I am reminded of Bernanos, whose country priest without faith of his own speaks to the
dying congregant: “‘Be at peace,’ I told her. And she had knelt to receive this peace. May
she keep it for ever. It will be I that give it her. Oh, miracle—thus to be able to give what we
ourselves do not possess, sweet miracle of our empty hands! Hope which was shriveling
in my heart flowered again in hers” (Bernanos & Morris, 1937, p. 180).
† The complexity of issues and attitudes about gender—masculinity/feminity—and gender
roles in parenting and clinical work—paternity/maternity—far outstrip my knowledge
and the scope of my project. Nevertheless they have important bearing on the negative
attitudes toward the clinical attitudes excluded from official psychoanalysis. See, for
example, Vida (1997, 1999); Ellis and O’Connor (2010).
‡ Ricouer (1992): “The sense of justice takes nothing away from solicitude; the sense of
justice presupposes it, to the extent that it holds persons to be irreplaceable” (p. 202).
52 • The Suffering Stranger
Apparently speaking to Jean-Paul Sartre (2001), who proclaimed
that we are condemned to be free, he commented,
The “for itself” as a mode of existence designates an attachment to
oneself as radical as a naïve will to live. But if freedom situates me
effrontedly before the non-me in myself and outside of myself, if it
consists in negating or possessing the non-me, before the Other it
retreats. The relation with the Other does not move (as does cognition)
into enjoyment and possession, into freedom; the Other
imposes himself as an exigency that dominates this freedom, and
hence as more primordial than everything that takes place in me.
The Other, whose exceptional presence is inscribed in the ethical
impossibility of killing him in which I stand, marks the end of
powers. If I can no longer have power over him it is because he
overflows absolutely every idea I can have of him. (Lévinas, 1969,
p. 87)
In other words, the face of the other demands of me a subjection
(to Lévinas the only meaningful use of “subject” and “subjectivity”)
to the “dimension of height in which the Other is placed, is
as it were the primary curvature of being from which the privilege
of the Other results, the gradient of transcendence” (pp. 86–87).
Sartrean freedom makes no more sense to Lévinas than does
Heideggerian authenticity and resoluteness. “To welcome the
Other is to put in question my freedom” (p. 85).
This surrender—not to be confused with masochism, as Ghent
(1990) clearly understood—will clearly grate on a generation that
grew up with European existentialism and with American therapies
inspired by it. These words—freedom, agency, and authenticity—
became our core vocabulary. These words also resonate with
the emphasis on individual achievement, and independence from
others and their needs, that American culture generally idealizes.
Even for those of us inspired by the kinds of clinicians and
ideas we study in the following chapters, it seems that we want
to feel that we agentically take responsibility, not that we simply
are responsible. Lévinas did not see those who do not respond as
agentic, that is, as choosing not to respond; for him the subject is
subject only as subjection. Instead, he spoke of evasion.
The Suffering Stranger and the Hermeneutics of Trust • 53
It is, of course, no surprise that renouncing our robust Sartrean
freedom for solidarity with others will never leave us comfortable:
“At least it will be recognized that this freedom [of the Sartrean
for-itself, the I] has not time to assume this urgent weight and
that, consequently, it appears collapsed and defeated under its suffering”
(Lévinas et al., 1996, p. 95). At times, at least, bearing the
suffering of others, witnessing and accompanying their trauma so
that they may no longer be so completely abandoned, so that they
may recognize the wrong that has been perpetrated against them,
may give us the look of the overwhelmed. We are, according to
Lévinas, exposed to wounding and outrage and infinitely responsible
to the suffering stranger.
A gentler voice in Lévinas, more understandable and more
bearable for many clinicians, calls us to hospitality in the intimacy
of the home: “The interiority of the home is made of extraterritoriality
[nonpossessiveness] in the midst of the elements of
enjoyment with which life is nourished. This extraterritoriality
has a positive side” (1969, p. 150). What Lévinas seems to be saying
here is that to make a home welcoming, we have to be nonpossessive,
nonterritorial. Against possessiveness, he often quoted Blaise
Pascal, who wrote, “This is my place in the sun. The usurpation
of the whole earth begins here” (Lévinas & Robbins, 2001, p. 53).
Instead, hospitality
is produced in the gentleness or the warmth of intimacy, which
is not a subjective state of mind, but an event in the oecumenia
[universality, generality] of being—a delightful “lapse” of the
ontological order [of being, totalizing, objectifying] … gentleness
comes to the separated being from the Other. The Other precisely
reveals himself in his alterity negating the I, but as the primordial
phenomenon of gentleness. (Lévinas, 1969, p. 150, emphasis
in original)
Lévinas accepted from Heidegger that we find ourselves dwelling
in a nonpossessive, nonterritorial spirit in a home. Into this home,
we gently welcome the separated other (the widow, the orphan,
and the stranger) who reveals herself as other (this is alterity),
54 • The Suffering Stranger
negating me not as erasure—erasure means reducing the other to
the categories of the same—but as “the primordial phenomenon of
gentleness.” In gentle, unobtrusive hospitality, the ego or I of the
host largely disappears. Thus, he continued, “the idea of infinity,
revealed in the face does not only require a separated being; the
light of the face is necessary for separation. But in founding the
intimacy of the home the idea of infinity provokes separation not
by some force of opposition and dialectical evocation, but by the
feminine grace of its radiance” (Lévinas, 1969, p. 151).*
In many places Lévinas said that infinity alluded to Descartes’s
use of it in his ontological argument for the existence of God—
that which outstrips all our concepts. The title of his first major
book, Totality and Infinity (1969), refers to the contrast of the infinite
demand that the face of the other makes upon me with the
murderous objectifications that he called “totalizing” and that he
attributed to the entire Western philosophical tradition and to
every attempt to know and categorize. Instead, the face requires
of me both refraining from murder and the simple welcoming
response of hospitality that he associated with the feminine.† The
emphasis on separation points to his concern that the other not be
appropriated or subjugated to the knower as the “same”; instead,
the other remains truly a separate other to whom we respond.
We should perhaps note that there are differences between what
Lévinas, in his intentionally disruptive style, actually said and
what we can infer from his thinking. A colleague from Australia
* It strikes me as a similar intuition that in Mendelssohn’s oratorio, the Paulus, sopranos
embody the divine voice. (The musicality in the Lévinas family, however, seems to have
come from his wife, Raissa. Their son is a prominent French pianist and composer in the
tradition of Olivier Messiaen.)
† Feminists have been widely and deeply divided in response to this aspect of Lévinasian
thinking. See, for example, Chalier (2002), Chanter (2001), and Irigaray and Whitford
(1991). It may, however, be relevant to the more maternal aspects of psychoanalysis.
The Suffering Stranger and the Hermeneutics of Trust • 55
wrote to me after a recent workshop in which many found the ethics
of Emmanuel Lévinas disturbing:
Psychotherapeutic hospitality has an essential psychological
and emotional dimension. It is a welcoming openness of mind
to the presence of the other’s mind, in all its stranger-ness. We
offer the hospitality of our mind: a willingness to welcome into
our mind, and engage with, the full range of the other’s psychological
and emotional experiencing. It is with this hospitality of
mind that we greet our patients at the start of each session, again
and again … over time, what is also importantly healing is the
re-experiencing of this hospitality, and the sense of being psychologically
welcomed-in—much more than tolerated, or selectively
engaged with. It is a gateway to developing, perhaps, the capacity
for self-hospitality. (Carol-Ann Allen, personal communication,
July 10, 2010)
A Lévinasian therapeutics, thus, hospitably welcomes the
patients and engages them simply, humbly, and patiently (Kunz,
1998). An understated style, attuned to the other’s need and
responsive to it when possible, will minimize the unavoidable
shame our patients feel over needing our help at all or over needing
specific forms of help. Recently, a training analysand, in treatment
with me only for a few months, came to his session after
a full day’s work that had left him no chance to eat. After a few
minutes of talk, he confessed that he was so distracted by hunger
that he could not concentrate on what we were discussing and
wondered if I had anything in my office that he could eat. He was
quite aware that this was quite an unorthodox request to be making
and that he risked not only refusal but extensive interpretive
inquiry and humiliating disparagement. He also felt sure that I
would henceforth view him as a “bad patient.” Though he had
not heard about Ricoeur’s “school of suspicion,” he knew very
well the rules of classical psychoanalysis. But he was hungry, and
knew me a little, and decided to take the chance. Once munching
contentedly on the energy bar I quickly provided, he told me his
many fears of asking, a long catalog of potential humiliations. The
complex meanings of this request and response received extensive
56 • The Suffering Stranger
attention, though of course not possibly exhaustive. He told me
later that he felt sure that without the easy provision of the food,
we could not have explored the meanings.
Of course this simple story contains nothing heroic or esoteric,
but it illustrates clearly the ordinary, everyday character of what
Lévinas had in mind: that we respond to the other before we consider
concepts, rules, categories, and so on. It is easy to imagine
the discussion this example would evoke, even today, in many
supervision groups, under the hermeneutics of suspicion.
This leads us to a second aspect of a Lévinasian therapeutics:
its nonjudgmental character. It is not for me to judge whether
the suffering widow, orphan, or stranger deserves my hospitality.
Lévinas often spoke of the command coming from an “immemorial
past” that precedes all ordinary time: “Since the Other looks
at me, I am responsible for him, without even having taken on
responsibilities in his regard; his responsibility is incumbent on
me” (Lévinas & Nemo, 1985, p. 96). Incumbency means already
in place, unchosen by me. There is no time for judging whether
the other is worth my care. Furthermore, the other’s need transcends
me, is higher than me, so that I am never in a position to
judge, for example, whether my patient really needed something
to eat or not or should have packed lunch if he was going to have
such a busy day. For Lévinas, that would be like saying that the
other deserved to die for being Jewish, that someone deserved to
be raped because she is a woman, or that one deserves violence
or discrimination for being lesbian or gay. Just respond, and stop
categorizing and judging from your high horse, he would say. It is
simple to respond. Hineni. Take and eat. Take and drink.*
Nonviolence, third, would also characterize a Lévinasian therapeutics.
Subtle forms of violence, especially those involved in
* Here we hear his reference to Christian liturgical words. Lévinas often commented on the
resonances between the hesed (loving-kindness) of Judaism and the charity preached by
Jesus (Lévinas & Robbins, 2001). While remembering that the perpetrators of Auschwitz
“had done their catechism,” he welcomed the papal letters around Vatican II saying that
Christians had something to learn from their Jewish brothers and sisters, after all.
The Suffering Stranger and the Hermeneutics of Trust • 57
naming, would disappear from the practice of clinicians as they
absorb this spirit. Technical and theoretical language, whether
psychiatric, psychoanalytic, or from any tradition, tends to reduce
by knowing too much and to keep the clinician above and away
from the other’s suffering. We will see that the clinicians/dissidents
whose work we consider in later chapters, if they did not
eschew jargon completely, sought experience-near language for
their theorizing. Such experience-near language kept them closer
to their suffering patients and reminded them that knowing was
not so important as they had previously thought. It could even
harm people.
Finally, in a Lévinasian therapeutics, asymmetry outranks
mutuality. (Much as Lévinas admired Buber’s work, he thought
the emphasis on mutuality and equality missed the essential
ethical situation; see Atterton, Calarco, and Friedman, 2004.)
Friendship and mutuality, so greatly to be desired in ordinary
life and love, suffice neither in extreme situations, nor
in the doorway through which someone must go first, nor in
the therapeutic relationship. In therapy—here Buber too recognized
the indispensible asymmetry (Buber & Buber Agassi,
1999)—as in parenting, the asymmetry of originary (always
already, “immemorial”) responsibility often overwhelms the
also indispensible reciprocity and mutuality, as Ferenczi was
to learn (see Chapter 3). The needs of the suffering stranger
are the raison d’être of the therapeutic relationship, and if we
forget this, every kind of ethical failure can ensue (Celenza,
1998, 2010).
Three questions surface frequently when Lévinas comes into
conversation among psychotherapists. First is the concern about
the narcissistic and grandiose patient—so well described and
understood by Heinz Kohut—who does not at all appear to be suffering
and destitute in the Lévinasian sense. This objection generally
comes from analysts and other therapists who value a more
confrontational style and who do not really accept Kohut’s understanding
of the psychological fragility expressed in grandiosity
58 • The Suffering Stranger
and narcissistic rage. It seems to me that a Kohutian understanding
and spirit will lead us clinicians to exactly the attitudes that
Lévinas would advocate, a willingness to put ourselves on the
back burner for a long time while we make ourselves available to
respond to the suffering other. We will consider this kind of situation
in more detail in Chapter 6.
A second objection comes from those who worry about the parentified
child.* What about the patient, they ask, who has always
taken care of others at the expense of her own self-development?
Am I supposed to be telling such a patient to continue forever to
put the other first? No, of course not, Lévinas would say. The ethical
demand is addressed only to me. My readiness, my hospitality,
my care for the patient (the widow, the orphan, and the stranger)
changes the situation. This patient, little by little, remains no longer
the person who has never been put first. What he or she does
with this changed situation is not up to me. What is up to me is
my attitude toward the naked face of the suffering neighbor.
In addition, this objection contains a subtle but understandable
misunderstanding of Lévinas, who distinguished between
my enslavement and my immemorial responsibility. In a very difficult
passage, typical of his later work, he wrote,
The psyche [the moi, not really I] is the form of a peculiar dephasing,
a loosening up or unclamping of identity: the same [now the
result of reductionism has been shattered] prevented from coinciding
with itself, at odds, torn up from its rest, between sleep and
insomnia, panting, shivering. It is not an abdication of the same
[there is no organized I to abdicate], not alienated and slave to
the other, but an abnegation of oneself fully responsible for the
other. This identity is brought out by responsibility and is at the
service of the other. In the form of responsibility, the psyche in
the soul is other in me [no normal subjectivity this], a malady of
identity, both accused and self, the same for the other, the same by
the other. Qui pro quo, it is a substitution, extraordinary. (1981,
pp. 68–69, bracketed comments added)
* Often a clinician, as many of us can attest.
The Suffering Stranger and the Hermeneutics of Trust • 59
Not enslaved to the other, the me, the psyche is at the service
(reduced to “the same”)* of the suffering other to whom it finds
itself responsible.† The tiny homeless woman whom I meet in
the passageway between the bus terminal and the subway every
week on my way to work does not make me her slave, but she
stands infinitely above me in her need for my protection and
care, as do many others whom I do not allow to contact me in
the same way. In relation to her, my imagined freedom disappears.
Hostage but not slave: a small distinction, perhaps, but it
makes the difference between a responsibility that one can carry
as a hospitality, and one that rightly becomes—as Nietzsche well
Third, there is the objection that when one loves someone,
one does not feel obligated, taken hostage, traumatized, persecuted
by the other, as Lévinas said. Surely this is true, but
Lévinas was speaking not of intimate and personal relationships
but rather of the widow, the orphan, and the stranger.‡
He was speaking of the patient I have not yet come to love, of
the neighbor whom I watch taken away to the concentration
camps, of the muttering homeless person on the subway. He
was speaking of the man who threw himself onto the subway
tracks to save the life of a stranger, of the doctors without borders,
and of everyone who slows down enough to hold the door
open for someone else. “Apres vous, monsieur!”
Finally, any patient whom I am tempted to reduce to “that racist”
or “that hysteric” or anyone I may feel is unworthy of my
* Winnicott’s (1949) hate in the countertransference, a similar idea, requires the caregiver
to bear the objectification for a long time, until the patient is able to understand what
the therapist or analyst has undergone and survived. I think he would have understood
Lévinas’s distinction between enslavement and resentment. Both advocate responsibility
for the child, the patient, the suffering stranger.
† Among the aspects of Heidegger’s early philosophy in Being and Time (1962) was
Befindlichkeit, or how-one-finds-oneself-ness, which Lévinas valued and used to the end
of his life.
‡ Philosopher Avashai Margalit (2002), on the contrary, views ethics as regarding duties
of loyalty and care to the “near and dear,” while morality concerns treatment of the
60 • The Suffering Stranger
compassion or anyone to whom I allow myself to feel superior tests
my Lévinasian convictions. How do I begin again—even when I
feel besieged, persecuted, taken hostage—to see the suffering, the
vulnerability,* and the destitution in the face of the other? For
myself, I try to remember the “colleagues” we study in this book
and to stay connected with my living kindred-spirit colleagues.
(Other sources of physical, social, and spiritual self-care remain
indispensable, of course.)
As I have begun to know humanistic therapists outside my
psychoanalytic home—most especially gestalt therapists—I am
thankful that many of us have learned to notice and to care for psychological
fragility. In doing so, we have seen psychotherapy as an
ethical pursuit. Far beyond psychoanalytic techniques and gestalt
experiments, we are called to respond and not to abandon. The philosophy
of Emmanuel Lévinas reminds us that this sense of vocation
will always torment us.
To ignore the differences between Gadamer’s hermeneutic
practice and Lévinas’s ethics would be a mistake: (a) Both were
Heidegger’s students, and both worked out their philosophies
in relationship to him, but Gadamer remained much closer; (b)
Lévinas often sounded like a prophet on behalf of the vulnerable
other, whereas Gadamer engaged the other in conversation;
(c) Lévinas spoke the language of trauma and persecution,
and Gadamer spoke that of play† and learning and emergent
* In the view of Michael Kigel, translator of Salomon Malka’s (2006) Lévinas biography,
“This reevaluation of vulnerability is the basic task of Lévinas’s thinking … a phenomenology
grounded in an optical situation established in Auschwitz, established not by
Lévinas but by Hitler” (p. xxiii).
† Alford (2007) noted that play is anathema to Lévinas; we might speculate that 5 years of
dehumanizing captivity, together with massive family losses, could destroy the playfulness
in anyone. Similarly Gill Straker (2007), who wrote from the context of the struggle
against apartheid, speaks of “the trauma of morality.”
The Suffering Stranger and the Hermeneutics of Trust • 61
truth; and (d) Lévinas thought suffering was the purest evil,
whereas Gadamer considered it an unavoidable part of the
human condition.
Let us nevertheless finally consider, without minimizing differences
in their philosophical projects, the commonalities in spirit,
attitudes, values, and emphasis between Gadamerian hermeneutics
and Lévinasian ethics that make them useful to study together
for reading the psychoanalysts who follow.
The Unique Other, Face and Voice, Is Irreducible for Both
Neither Gadamer nor Lévinas gives me any room at all to reduce
the other to my categories. Gadamer’s concept of prejudice means
recognizing the inevitability of fore-conceptions in all understanding;
his dialogic attitude means readiness at every moment
to risk these to learn from the other. Lévinas reminds us at every
moment that categorizing is downright dangerous: racism landed
him in the Jewish section at Fallingbostel and countless others
in Bergen-Belsen and Auschwitz. The voice of Gadamer’s other
says many things, so the interlocutors must listen and engage
patiently, openly, and with endless goodwill. The Lévinasian face
speaks too, essentially, only one thing: You shall not kill me. Both
philosophers advocate, even require a hermeneutics of trust.
A Closely Related Commonality Concerns
Their Brief Against Knowing
Gadamer’s entire hermeneutic philosophy reads as a preference
for open and dialogic learning over closed-down and possessive
knowing: “The claim to understand the other person in advance
functions to keep the other person’s claim at a distance” (Gadamer
et al., 2004, p. 354). Although Lévinas never spoke, to my knowledge,
of hermeneutics, he often articulated a nonreductive signifying
or “saying”:
The signification which animates the affective, the axiological, the
active, the sensible, hunger, thirst, desire, admiration, is not due
to the thematization one can find in them, nor to a variation or
62 • The Suffering Stranger
a modality of thematization. The one-for-the-other which constitutes
their signifyingness is not a knowing of being, nor some
other access to essence. (1981, p. 69)
In his later work he often contrasted “saying” (the other speaks)
with “the said” (essence, thematization, reduction to the same,
knowledge, etc.).
Both Prioritize the Spoken Word Over the Written Text
(Versus Ricoeur and Derrida) and Emphasize Response
Gadamer often said that he hated writing—he always felt that a critical
Heidegger was looking over his shoulder—and he obviously enjoyed
conversation to the end of his very long life. Apart from this personal
predilection, he thought the spoken word had a living priority that
the hermeneutic study of texts attempted to restore by conversation
between the reader and the text. For Gadamer, a hermeneutic ethics
(not a method or set of rules) commands me to listen with the attitude
that the other may be right, that the other may teach me something,
that some new understanding may emerge between us.
So both philosophers loved the written word, but both sensed
the ineffable voice of the other in the spoken word. Had more
humanistic versions of our “talking cure” been known to them,
they might have disparaged our work less and understood our
commonality of spirit with them.
Both Philosophers Find the Encounter With the Other Disruptive
Nicolas Davey titled his superb book on Gadamer’s hermeneutics
Unquiet Understanding (2006); I would probably have chosen
“disquieting understanding” to emphasize the point a bit more.
Gadamer and Kierkegaard both wrote of “the other who breaks
into my ego-centeredness and gives me something to understand”
(Gadamer & Hahn, 1997, p. 36). Openness to the Thou, Gadamer
wrote, necessary for any real human bond, involves not slavishness
but still a kind of surrender:
The Suffering Stranger and the Hermeneutics of Trust • 63
Belonging together always also means being able to listen to one
another. When two people understand each other, this does not
mean that one person “understands” the other. Similarly, “to hear
and obey someone” (auf jemanden hören) does not mean simply
that we do blindly what the other desires. We call such a person slavish
(hörig). Openness to the other, then, involves recognizing that I
myself must accept some things that are against me even though no
one else forces me to do so. (Gadamer et al., 2004, p. 355)
Lévinas (1981) likewise insisted that exposure to the other is
not an active generosity but rather the passivity or vulnerability
of “having been offered without any holding back” (p. 75). The
vulnerability of the other makes me vulnerable, traumatizes me,
takes me hostage, puts me in a state of suffering where the most
I can do is offer my crust of bread, my hope from empty hands.
The all-knowing psychoanalyst whom nothing surprises or really
touches, held up to me as ideal by some of my earliest supervisors,
merits inclusion by Lévinasian perspectives, among Shengold’s
(1989) perpetrators of soul murder. As much as disruption disorganizes
and traumatizes early development—as all the psychoanalytic
authors we will study have written—both Gadamer and
Lévinas understood disruption of the comfortable complacency
of our inevitable prejudices and places in the sun as completely
necessary to seeing the face of the suffering other and to hearing
his or her voice. We need to be upset to respond.
Disinterested in Individual Subjectivity, Both Are Willing to
Surrender Self to See, Hear, and Respond to the Other
This follows directly on the previous point. Gadamer engaged in
an extensive critique of the whole notion of individual subjectivity
in Truth and Method that is beyond the scope of our discussion
here and considered intersubjectivity just the pernicious
Cartesian subjectivity doubled. For our purposes here, however,
the ethical point is that if the other’s voice has a claim at least
equal to mine to be heard in the dialogue, to define what will
count as important—as Gadamer would have it—consequences
64 • The Suffering Stranger
follow. Then we turn to Lévinas. If the naked and suffering face
of the other stands at a height infinitely above me, all full of
my comfortable categories and concepts and shoptalk, even
more consequences follow. In both views, “self” is worse than a
Cartesian mistake. In Gadamer, it frustrates conversation, hearing
the voice of the other. For Gadamer, treating the other as an
other means listening in a truly open way, holding oneself open,
vulnerably, to the conversation.
In Lévinas, the nominative I, insists, dominates, objectifies,
murders. The accusative “moi” is affected by the other’s devastated
face. (We must remember, as a biographical point, that although
Gadamer survived the Nazi period by keeping his head down and
avoiding controversy, Lévinas survived 5 years in the worst section
of a work camp in Germany and lost his parents and siblings
in Lithuania.) Both express an ethical responsibility; where
Gadamer sounds haunted, Lévinas sounds traumatized.
Both Accord to the Other the Benefit of the Doubt
For me this informal expression articulates well the hermeneutics
of trust. When the other’s words and doings confuse and confound
me, my hermeneutic of trust meets my responsibility to the
neighbor’s suffering in a way that Jurgen Reeder (1998; who notes
his debt to Lévinas) tries to express:
The Other is always beyond the reach of my knowledge, my fantasies,
or my wish to objectify him. Faith in the Other is the sustained
hope that I—despite his unrelenting unavailability—will
meet him in his subjectivity. Faith shapes a prospective horizon
that in its turn establishes a specific kind of analytical space, making
it possible for the analyst to await the analysand. This kind of
faith will in no way override or do away with the fundamental
mystery of the Other—but it does offer a way of living without
knowledge. (p. 74)
This “benefit of the doubt” attitude makes an enormous difference,
as we shall see in the following chapters, to our attitudes
regarding what has traditionally been called “resistance.”
The Suffering Stranger and the Hermeneutics of Trust • 65
If we assume that the other suffers from situations that are originally
not of her or his making but has developed patterns of
surviving that now look somewhere between quirky and insane,
we may be more inclined to listen more closely. We may hear
the cry of an abandoned child inside the raging adult or to see
the genuine despair in the face of the other who seems to be
doing nothing for himself. The hermeneutics of trust emerges
both from the dialogic spirit of Gadamer and from the ethics
of Lévinas. Clinicians who need support for their inclination
to give patients the benefit of the doubt can now tell themselves
that they are relying on these two great philosophers and on a
hermeneutics of trust.
Both Philosophers Embodied a Spirit of Hospitality,
in Their Writing and Also in Their Lives
In Gadamer’s version the dialogic person needs an attitude of
receptivity to what is other and unfamiliar, an attitude that welcomes,
he said, just that guest whom we were not expecting, who
breaks into our complacency. Lévinas often characterized the
response to the suffering other as hospitality. Gadamer, I am told,
invited a former student to stay in his home during a period of
his life that he might otherwise not have survived, hid and otherwise
protected Jewish friends during the Nazi years, and was
ever well-known for welcoming people into conversation. Lévinas
quietly helped students in need, and his Shabbat table was always
full of guests. This shared sensibility underlies the spirit that runs
through the quiet alternative road we are about to travel. It leaves
behind the strictures of “do not gratify” for Fromm-Reichmann’s
“How can I help you?”, Lévinas’s hineni (me voici, me here), and
Gadamer’s “welcome.”
Both Unsettle Our Complacency
Perhaps this point is already clear, but it bears repeating. Nothing
about the perspective shared by Gadamer, Lévinas, and the
later Ricoeur leaves us comfortable. What an irony, that the
66 • The Suffering Stranger
hermeneutics of trust should be so much more challenging than
the hermeneutics of suspicion! Nevertheless, entrusting ourselves
to a vocation—called out by the face and voice of the other—
means never fully being at rest. It means, as Lévinas often said,
bearing infinite guilt* and never being finished with the ethical
task. It means looking tired and persecuted sometimes. The other
side, however, can be seen in certain photographs of both philosophers,
where they are clearly responding to someone. Each looks
luminous, as if he had seen something beautiful, perhaps the trace
of the infinite. I believe both sides exist for us too, practitioners of
the hermeneutics of trust.
It might seem obvious (Young-Eisendrath, 2001) that the primary
and fundamental task of psychotherapy is to relieve suffering.
As we begin our study of unorthodox psychoanalysts with
Sándor Ferenczi in the next chapter, we will see immediately
that no consensus has ever existed on this point. Freud himself
took a greater interest in theory construction, behaviorists have
espoused social conformity, and the existentialists have devoted
themselves to personal agency. Because only the third of these
seems to me remotely to resemble a human goal in the face of
human misery, let us consider it for a moment before returning
to our central project.
It is easy to see why a sense and experience of agency seems
often to be equated with mental health. Infants, both research and
informal observation suggest, take great delight in discovering that
they can do things, can make things happen. Children and adults
feel better, or at least believe they will feel better, if they can only do
something about the problems and predicaments in which they find
themselves. It might be argued that the most admired American
* This Lévinasian and Dostoyevskian guilt, infinitely demanding (Critchley, 2007) as it is,
requires careful distinguishing from the useless “guiltiness” Stephen Mitchell (2000b) so
well described.
The Suffering Stranger and the Hermeneutics of Trust • 67
attitude, apart from but probably related to, the lonesome-cowboy
ideal of independence is a can-do, problem-solving approach. Even
in international affairs, Americans often seem to value doing or
“intervention” over conversation and collaboration.
But consider the alternative—the so-called victim mentality.
Who would want that? Among several groups of the 9/11 survivors,
for example, and among the families left behind, the popular wisdom
was that the way to recover was to do something. You should
get involved in airline safety issues, find out who failed and why it
happened, support the “war on terrorism,” and so on. Those who
“nursed their wounds,” or wandered around like lost souls, were
not “getting on with it.” They were blaming others for their troubles,
not “taking the bull by the horns.” Adults who find themselves
still suffering from child maltreatment or neglect are often seen as
“pathetic whiners.” The contempt humiliates and retraumatizes.
Psychoanalysis, of course, until recently, went against this activist
grain. The analyst’s doing was severely restricted by the rules
of technique, and the patient was cautioned against making major
decisions in order to allow unconscious impulses and their derivatives
to surface and become apparent. Neither participant was
supposed to do much. Current relational thinking, of course, has
changed this picture radically. The whole psychoanalytic process
is understood as interaction, punctuated by “enactments” (Hirsch,
1998; Maroda, 1998a; McLaughlin & Johan, 1992), in which both
patient and analyst are understood to be active participants. Now
a sense of personal agency—together with its moral concomitant,
a sense of responsibility—has become a psychoanalytic outcome
greatly to be desired (Frie, 2008). We relational analysts and psychotherapists
tend to value active participation—in life and in the
psychoanalytic process.
I believe, however, that a hermeneutic clinical sensibility opens
another perspective—one that neither is distant and disengaged
nor makes us into action figures. The best name I have found so
far is an attitude of receptivity, something I suspect is very close to
Emmanuel Ghent’s (1990) conception of “surrender.” The longer I
68 • The Suffering Stranger
live with Ghent’s idea, the less it connotes to me the pathological
accommodation described by Bernard Brandchaft (see Chapter
7). Instead, I believe Ghent meant to de-idealize agency and to
help us reconsider the kind of minimal subjectivity we find in
This receptivity, I believe, forms one of the most basic components
of a hermeneutic sensibility. Neither fully active nor passive,
it permits learning from the other and engagement with the
other. In the beginning, this receptivity must characterize the
analyst and can be very difficult. This receptivity goes counter to
the mastery ethos of our Western culture, where the nurturing
and the maternal often land in places of disparagement, to say the
least. But our three strands, from Ricoeur’s hermeneutic of trust
or faith, from Gadamer’s dialogic understanding, and above all
from Lévinasian ethics, situate us exactly in this countercultural
space. In Lévinas’s (1981) voice,
Where to be? How to be? It is a writhing in the tight dimensions
of pain, the unsuspected dimensions of the higher side. It is being
torn up from oneself, being less than nothing, a rejection into
the negative, behind nothingness; it is maternity, gestation of the
other in the same. [The other breaks into my supposed knowing
that reduces her to the objectified same.] Is not the restlessness
of someone persecuted [the accused moi] but a modification of
maternity, the groaning of the wounded entrails by those it will
bear or has borne? In maternity what signifies is a responsibility
for others, to the point of substitution for others and suffering
both from the effect of persecution and from the persecuting itself
in which the persecutor sinks. (p. 75)
There may be many reasons that we do not really want to allow
the patient to affect us so much. Suffering, as Lévinas told us, is
ungraspable; we cannot dominate it. It breaks down meaning,
at least until another responds.* Even more, he said, “The more
I answer the more I am responsible; the more I approach the
* An eloquent voice for the attitudes we are considering in medicine generally is Eric
Cassell (2004). See also Greenfield and Jensen (2010) for a more schematic approach.
The Suffering Stranger and the Hermeneutics of Trust • 69
neighbor with which I am encharged the further away I am. This
debit which increases is infinity” (Lévinas, 1981, p. 93). This infinity
for him had a double meaning: The suffering of the other faces
me with an infinite demand but also places me in contact with the
infinite, with the sacred, with the holy, whatever that may be.
But he also distinguished between useless and useful suffering,
the kind he had previously described as maternal. Suffering itself,
the purest evil, the meaningless condition of extreme passivity,
constitutes the challenge of ethics, the task of medicine and psychotherapy.
Its face accuses me:
Is not the evil suffering—extreme passivity, helplessness, abandonment
and solitude … the half-opening that a moan, a cry, a
groan or a sigh slips through—the original call for aid, for curative
help, help from the other me whose alterity … promises salvation?
(Lévinas, 1998a, p. 92)
Suffering, however, displays that peculiar asymmetry that
Lévinas called “a curvature of intersubjective space”: It is meaningful
in me but absurd for the other, unutterable. He thought
theodicy, the attempt to frame defenses of theology in the face of
unspeakable evils, obscene, and he wrote,
There is a radical difference between the suffering in the other,
where it is unforgivable to me, solicits me and calls me and suffering
in me, my own experience of suffering, whose constitutional
or congenital uselessness can take on a meaning, the
only one of which suffering is capable, in becoming a suffering
for the suffering (inexorable though it may be) of someone else.
(p. 94)
For me this sentence contains not only the possibility of finding
meaning in the bleakest moments of work with the most tortured
souls who entrust themselves to my care, when I too feel nearly
overwhelmed by their “useless suffering,” but also perhaps a way
to think about what actually helps people. Lévinas spoke in his
essay on useless suffering not only of medicine and psychology
but also of Auschwitz. Where others speak of witness (Orange,
1995; Poland, 2000), he spoke of taking on, of assuming the other’s
70 • The Suffering Stranger
suffering, where it takes on meaning as a for-the-other. The overwhelmed
and negated face of the other, he often said, says to me,
Do not allow me to die alone. With protection and care, the other
suffers somewhat less, and my suffering for her takes on meaning.
We could now make a comparative excursion into the religions
of the world and consider their rich and diverse considerations
of human suffering and ask whether they agree with Lévinas.*
Though such a project would require a book of its own, few, I suspect,
would dispute his claim that compassionate response to the
suffering of others adds meaning to human life. What should surprise
us, perhaps, is that such considerations have remained far
from the center of the psychoanalytic literature and that the voices
of those who have placed the care of the suffering patient before
the protection of theory or status have been largely silenced. This
book attempts to let their voices speak out.
Commitment to relief of suffering as our fundamental therapeutic
vocation has several corollaries, which scarcely need stating as
they are so obvious, so I will be brief:
1. A compassionate attitude of suffering with the other is
2. A dialogical, nonauthoritarian style is equally crucial. One
can support without becoming an expert-authority.
3. Consistency and reliability, not a propensity to wear ourselves
out, are essential to working with the profoundly
4. We should expect to be affected by our work to the core of
our being and sometimes to feel retraumatized.
5. We need our own supports, and sources of nourishment
and hospitality, if we are to continue.
* Sandra Buechler (2010) recently compared attitudes toward clinical work, especially with
respect to the analysis of defense, on the basis of attitudes toward human suffering.
The Suffering Stranger and the Hermeneutics of Trust • 71
Finally, it seems important to note that our ethical response
coincides exactly with our clinical vocation to restore dignity to
devastated, shame-filled, degraded, and suffering human beings
like ourselves. In my view, treating the other as a worthy partner
in dialogue—no matter what distress or symptoms the patient
brings to the encounter, and no matter what aversive preconceptions
the clinician carries or develops—creates the foundations
for working within what we designate here as the hermeneutics
of trust. Everything we can learn from every school of psychoanalysis
and psychotherapy, as well as from other disciplines and
from the arts, that helps us to meet and sustain the suffering other
nonevasively, without too much suspicion, is both good healing
therapeutic practice and good ethics.