In his talk, Dr. Carveth differentiated conscience, an evolved and adaptive function, from the primitive superego, which often works against us. He noted that the superego, or inner judge/critic is a narcissistic, self-hating presence. It's not going to help us make amends; instead it's "all about me" and about self-punishment. It's a one person system.
On the other hand, in order to manifest a conscience, we need to admit the presence of another, and to care about that other.
Dr. Carveth employed quite evocative language in describing the superego, for instance calling it a "unconscious hanging judge". He noted that many depressed people, who possess rigid and strong superegos were quite narcissistic as well. Depressed people, he noted, do tend to be all about themselves.
He went on to describe how guilt was split off early in life, so we become unaware of its presence (much as Allan Schore talks about dissociated shame). The guilt remains active in the unconscious, and we become aware of its presence through what Karl Menninger termed "guilt-substitutes". These include depression, masochism, fear of success and self-saboutaging behaviours. So the guilt, until uncovered in depth psychotherapy or psychoanalysis, remains split off, while the urge to self-punish and fail reveals itself explicitly in our thoughts and actions. Dr. Carveth told stories of seeing Ph.D. candidates in his clinical practice who struggled and finally earned their doctorates, only to then end up in a car accident, or fight with their spouse.
Conscience, Dr. Carveth noted, is about reparation. It, unlike self-punishment and inner criticism, is about demonstrating creative, constructive actions. Instead, the superego is about an eye for an eye, where nobody comes out better than when they started. He noted that Melanie Klein was the first of the great analysts to differentiate between two types of guilt. Freud did see the need to reduce guilt for the betterment of society, as he noted in Civilization and Its Discontents, written in 1929. But he did not describe the task or replacing punitive guilt with reparative guilt.
Responding to a question, Dr. Carveth noted the tragic truth that the more traumatic or adverse our early childhood, the more we will be saddled with guilt and a harsh superego. He described a process where the parents are not attuned to the child, who becomes enraged via his narcissistic injuries, and - being unable to bear his rage - develops guilt, which is then dissociated. The rage may, in itself, also be active, commonly turned against the self, or against others who will carry the projection of the childhood parent.
Dr. Carveth ended with the message that we, within the therapeutic alliance, have a duty, like a revolutionary cell, to fight against the cruel, tyrannical and irrational superego, establishing in its place, a working, adult conscience. This becomes one of the major goals of analysis.
After his talk, during the Q&A, I asked Dr. Carveth about any guidance he could give to those of us in early or mid-careers about maintaining passion and enthusiasm during the length of our clinical practices. I noted that I had become interested in this topic after just reading Still Practicing: The Heartaches and Joys of a Clinical Career, by Sandra Buechler, a New York writer and training analyst. I also noted the growing rate of career attrition in our field.
Dr Carveth responded that he had the good fortune to be married to an analyst, allowing him to share his emotions and frustrations, and to be met in an understanding manner after a long day at work. He also stressed the importance of regular meetings with other analysts. He noted that balancing his time between writing and teaching and practicing had added to his career resilience. He urged audience members to write up their cases, suggesting that this would be an opportunity to become more involved in the mystery and depth of their practice and their patients' lives.
This talk reminded us of the value of depth psychotherapy, and the frequent inability of more superficial approaches to do more than create some willfully imposed restraint. Unfortunately, these attempts at self-restraint tend to fail when we are highly stressed. Also, they do not interrupt unconscious patterns. Until we are able to contact our pre-oedipal and oedipal rage and our split off guilt, it becomes a sometimes futile task to interrupt our repetitions of self-harm, whether through business failures, a continuous string of cruel and abusive partners or lifelong dysthymia. Otherwise, we vow to do things differently the next time, and - lo and behold - we end up at the very destination we chose to avoid.
You can find Dr Carveth's website here: http://www.yorku.ca/dcarveth/ It contains some of his publications and papers as well as information on his book, The Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience, published by Karnac, U.K.
