The Unsayable

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