Are there things that are
unsayable? What would it mean to say them? To utter the forbidden words? To
give voice to thoughts so terrible, so inexpressible that they might have the
power to crumble our world? What might it mean to be able to hear those words?

These are the questions that Annie
Rogers in her remarkable book begins to approach. It is a fascinating book for
a number of reasons. At first it is surprisingly frank and autobiographical. It
begins and ends with a deeply personal account of her own mental illnesses, or
experiences, and describes what appears to be a psychotic episode in which she
not only saw visions, but became convinced that she was Joan of Arc returned. She
was hospitalized and treated conventionally. She has been exploring her own
psychological trials every bit as much as she has those of her clients. This is
not the usual case based accounts that you might expect. The personal thread
weaves throughout; sometimes it is deeply intimate, sometimes it is a little
disconcerting.

Rogers is an experienced and
well-respected psychologist. She has worked with Carol Gilligan and others and
held prestigious academic and clinical positions. She is also vulnerable and
confused at times. The candor she shows in her self-revelations poses as many
questions as it answers. She has been mentally ill herself. She recounts that
she fell ill as a teenager. She describes how regained her health not through
the more mainstream psychiatric treatments, although she experienced them also,
but through the understanding of a "gifted analyst." It was this that
saved her, by her own account from being thought of as a hopeless case and
consigned to a mental hospital, presumably to rot and die of neglect. The
impact of her own experience in feeling understood rather than treated seems to
have carried on into her own practice as a psychotherapist, especially in her
work with abused and abusing teenagers.

Rogers attempts to show, through a
short number of case histories of various depth (the central one, Ellen by
pseudonym, is particularly detailed) how the unconscious makes itself heard
through language, however oblique it may be. There is, she insists, a logic and
a structure that can be heard. It may not be direct, and it may not be easy,
but it is there — if we have ears to listen. For Rogers, the guidance she
sought in becoming able to listen to this hidden language came from the work of
Jacques Lacan, who she admits is not enormously popular, well-known or
well-understood in the English-speaking world.

She explains Lacan’s insights as showing
that "the unconscious is structured like a language" and that every
individual person has a way of organizing and expressing the body, language and
all conscious and unconscious experience. These patterns are laid down early in
life, perhaps by the age of four or five, and hold their own internal logic,
which is there to be discovered, to be heard.

Lacan was a psychoanalyst and not a
conventional psychiatrist. He built on Freudian ideas, although interpreted
them anew, believing, for example that the Oedipal struggle is a symbolic one
in which the child struggles to become the object of desire, usually the
mother. However, Lacan can also be obtuse and allusive in his writing and his
manner of expression, choice of words of conflating of ideas can confuse as
often as its illuminates. He will, for example, use Freudian terms, such as
phallus, but interpret them in a radically different way, so that they have a
completely new meaning and the suggestion of Freud only muddies rather than
clarifies. Nevertheless, the essential idea of the unconscious having a
language and a logic seemed to help Rogers make connections with her clients
(all young girls in the case studies, but not, she says, solely limited to
girls) when no one had before.

The details in her case studies
highlight pivotal moments of insight and recognition — the connection with a
name, or like a child’s game of rebus in which the somatic expression of pain, "my
head hurts", becomes a clue to psychic pain, "Ed (the perpetrator)
hurts. Some of these case histories last for many years, from childhood to late
adolescence, some seem to be more connected to the maintenance of a
relationship than any particular interpretation. There are descriptions of
interactions that seem to have more to with listening and validating in the way
any good carer would do, from whatever background, be it psychoanalysis,
psychiatry or nursing, than any Lacanian insights.

It is clear that Rogers is a
sincere and skilled therapist. She is open and honest, and gains the trust of
the most suspicious and guarded. She is patient and careful and not a little
self-doubting at times. She says she wrote the book with three aims in mind.
First, she wants to advocate for the revival of the notion of the unconscious
and to protest, in a quiet way, against the dominance of biological psychiatry.
For her, the unconscious has gifts to bestow. If, as a reader, you accept the
reality rather than the metaphor of the unconscious, this may be appealing.

Her second aim is to encourage
people to listen to the unconscious for it seems to her that it harbors the
more profound truths. More than once this seems to both mystical and
metaphorical.

Her third aim is for people to
befriend their own unconscious, because otherwise "it will play havoc …
no matter what your intentions." It is as though the unconscious will find
a way no matter what you do, so you might as well work with it rather than
against it.

Rogers does not expect that
everyone who reads the book will become a converted Lacanian (perhaps more than
one reader will doubt the ‘truth’ of the unconscious, but she hopes that the
book will "tickle your hearing." The stories are indeed quite
compelling. Perhaps, one thought that will persist is that it may not be so
important what the professional thinks or understands the experience of the
client as how the clients make sense of their own experience. That may just
give them the strength to utter the unsayable — and who knows what will happen
then.

© 2006 Mark Welch

Mark
Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health

Categories: Psychoanalysis, Psychotherapy