the outrageous prince: winnicott's uncure of masud khan introduction

THE OUTRAGEOUS PRINCE:WINNICOTT’S UNCURE OF MASUD KHAN

Introduction

Lesley Caldwell

The Squiggle Foundation invited Dr Dodi Goldman of New York to give the2002 Madeleine Davis Memorial lecture on the topic of Donald Winnicott’streatment of Masud Khan following an article by the economist WynneGodley about his memories of his own analysis (1959–1966) with Khan. TheGodley piece appeared in the London Review of Books (22 February 2001)and was then taken up in The Times. The correspondence was of two types.The first recognized the seriousness of the charges and was concerned toinform the public about current regulatory bodies and enforcementprocedures designed to protect against such abuses. The bulk of the rest of thecorrespondence saw Godley’s piece as further confirmation of the prevalenceof unscrupulous therapists and fuel for the imminent demise of talking cures.

The paper reproduced here had been given in an earlier version in theUnited States and the invitation to Dr Goldman was envisaged as a steptowards reassessing the mistakes and failures of both Winnicott and Khanand looking at the implications for their contemporary legacy. Since TheSquiggle Foundation has been running courses, public lectures and confer-ences on Winnicott and the distinctiveness of his approach for nearly 20years, the directorate and the trustees felt we should offer a public forum toreflect upon a painful episode from our own history. Though Winnicotthimself was not the primary focus of the Godley piece, the specificreferences to him provided cause for concern, and highlighted the relation-ship between him and Khan.

In writing his account of his treatment by and relationship with MasudKhan, inside and outside the consulting room, Godley provided prac-titioners with very difficult information. It seemed a priority to use this infor-mation, along with that of others who have voiced their concerns and

British Journal of Psychotherapy 19(4), 2003© The author 483

LESLEY CALDWELL is an associate member of the Lincoln Clinic and Institute forPsychotherapy, and represents the Lincoln on the BJP. She is currently the Directorof The Squiggle Foundation and the Editor of the Winnicott Studies MonographSeries. She is a visiting fellow in the Department of Italian at University CollegeLondon. Address for correspondence: 16 Pyrland Road, London N5 2JD. [email:[email protected]]

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complaints about Khan’s behaviour, to think about how better to protect thepeople in our care. The speaker was asked to develop a discussion, informedby and grounded in psychoanalysis, while simultaneously acknowledging thedevastating psychoanalytic experiences of former patients who, we assumed(correctly), might be present. Both meeting and paper set out to offer aclinical way of thinking about why certain treatments can and do go horriblywrong. It was not concerned to engage directly with specific accusations butto raise general difficult issues. Aspects of the clinical practice of Winnicottand of other analysts, Ferenczi, for example, have been much debatedhistorically, precisely because there is a continuing awareness of the relationbetween clinical practice and theoretical issues regarding technique. Part ofthe difficulty here was to find a way of approaching the topic constructivelyin the wake of a deeply felt personal account. The task was to acknowledgethe undoubtedly different circumstances of psychoanalysis in the 1950s,while avoiding either a justification made on such grounds, or a retrospect-ive judgement about the past, from the vantage point of contemporaryawareness and developments.

Assessments of the relationship between Winnicott and Khan, in theirturn, risk foundering in wild analysis and psychobiographical assertion orpersonally motivated responses that may then be used as ‘evidence’ to justifycurrent differences between schools and approaches. But there is sufficientmaterial in the public arena and in the memories of people who knew themboth and were witness to their encounters to mount a discussion of some ofthe issues involved.

The meeting also aimed to address the continuing validity of a body of work,Winnicott’s and Khan’s, whose value Squiggle has always sought to endorse.The seeming discrepancy between the utility and richness of the texts of thesemen and their unacceptable professional practice on particular occasions, withparticular patients, poses dilemmas familiar from other analytic clinicians,Ronnie Laing and David Cooper, to confine the parameters to Britain, andfrom other creative fields, Ezra Pound, Martin Heidegger, Richard Strauss,Richard Wagner, Paul De Man. This was an area we wanted to raise.

But there are more general implications for all practitioners, who, whilecommitted to their patients and to their chosen area of work, are bound, onoccasion, to fail. The high cost of failure in professional arenas concernedwith psychological distress is always to exacerbate that distress and this issomething that is part of therapeutic responsibility. Neither Dr Goldman northe directorate was under any illusion that this presentation would consti-tute a definitive analysis of what really transpired in the consulting rooms ofMasud Khan or of Donald Winnicott; nor did we think that such a thing, inany case, could be done. But professional acknowledgment of such failures,attention to complaints, commitment to procedures for preventingunacceptable practices and a willingness to debate as openly as possible thearena of betrayal of trust and its implications are central. At the personallevel there may be little that can be said in a public forum to assuage the

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sense of pain, betrayal, anger, confusion and waste, of patients who havesuffered at the hands of their helpers, except to acknowledge it.

But the reality is that, regardless of how many regulatory bodies are estab-lished, there can never be absolute guarantees about psychotherapists orpsychoanalysts, any more than about any other professional. The late moderndemand for total guarantees about practitioners, particularly those concernedwith medicine and with the mind, forms part of a historical conjuncture datingfrom the eighteenth century. In the conclusion to his account of the develop-ment of modern medicine and its prestige, summarized pithily by the authorhimself as ‘health replaces salvation’, Foucault writes, ‘the importance ofBichat, Jackson and Freud in European culture does not prove that theywere philosophers as well as doctors, but that, in this culture, medicalthought is fully engaged in the philosophical status of man’ (1973, p. 198).The anxious implications of this are still being lived out and it seems hardlyby chance that Godley’s account of a rogue analyst should appear in aclimate where doctors and their concern for their patients is a preoccupationin a range of instances from pathology, general practice and gynaecology.

Articles about stress, depression, demanding life-styles, and so on testifyto a widening if reluctant awareness of the need of help on the part of many,but such articles are accompanied by equally widespread accounts of failure,scepticism, incredulity and despair about the possibility of finding that helpand the pointlessness of seeking it. The impossibility of avoiding, at best,disappointments and disillusion, at worst, malpractice and ignorance, thedemand for cures and solutions and the impossibility of finding them, formthe basic contradictions of a debate that is also driven by the wish to escapethe reality of depression.

Freud pointed to the inescapable place of disappointment in the consti-tution of the human subject and psychoanalysis offers a method of investi-gating that disappointment without any illusion that it can be removed. Hisaccount of the human subject shifted forever both how discussion about theperson is now conducted and how we see and understand ourselves ashuman. The practice initiated by Freud may be helpful, sometimes life-saving, but it is above all disquieting and disturbing. This is an uncomfort-able realization, but it is also a realistic one.

The texts of Donald Winnicott and of Masud Khan have furthercontributed to our knowledge of human potential, of the dimensions and ofthe roots of human suffering and of the place of disillusion in it. Thisremains, despite the experiences of Wynne Godley, the excesses of MasudKhan, and the anger and disappointment of us all in coming to terms withprofessional abuse and analytic failure.

Reference

Foucault, M. (1973) The Birth of the Clinic. London: Tavistock Publications.

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THE OUTRAGEOUS PRINCE:WINNICOTT’S UNCURE OF MASUD KHAN

Dodi Goldman

I would like to talk with you today about Winnicott’s 15-year treatment ofMasud Khan. I approach this topic with a hint of trepidation, concerned Imight be ‘rushing in where angels fear to tread’. I am well aware of howcharged and, perhaps, painful this issue is for some people. But I also thinkthat one way we can express our devotion to analytic work and pay tributeto Winnicott’s singular contribution is by candidly and carefully examiningboth his and our own successes and failures.

I believe that analytic work proceeds not only by the careful and deliber-ate interpretation of unconscious psychic elements but also through non-deliberate and unpredictable aspects of reciprocal influence within an‘interactive matrix’ (Greenberg 1995). One way of extending Betty Joseph’s(1985) idea of the ‘transference to the total situation’ is to include a carefulexamination of how each analytic dyad generates a psychic field to whichboth participants unwittingly contribute. This is one reason why no twoanalyses can ever be alike. While engaged in psychoanalytic work, we allinevitably participate in a particular transference–countertransferencematrix that sometimes revolves around mutually resonating areas of vulner-ability. Patients not only teach us about ‘pathology’ and the ‘workings of themind’; they also introduce us to dissociated aspects of ourselves. I hope wecan see our way into discovering how Khan’s and Winnicott’s experience –including their mutually resonating areas of vulnerability – might have somebearing on our own.

Certain analytic dyads, I believe, generate relational turbulence thatrequires the analyst to rethink theory or grow emotionally so as to becomemore available to help the patient in a deeper way. But this potentially

British Journal of Psychotherapy 19(4), 2003© The author 486

The paper was given as the Madeleine Davis Memorial Lecture, London, on 6 July2002.

DODI GOLDMAN is on the faculties and is a Supervisor at the William Alanson WhiteInstitute for Psychoanalysis and Institute for Contemporary Psychotherapy in NewYork. He is the book review editor of the journal Contemporary Psychoanalysis andauthor of In Search of the Real: The Origins and Originality of D.W. Winnicott(Jason Aronson, 1993) and In One’s Bones: The Clinical Genius of D.W. Winnicott(Jason Aronson, 1993). Address for correspondence: 37 Nassau Drive, Great Neck,New York, 11021. [email: [email protected]]

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creative turbulence might sometimes also severely disrupt the analyst’scapacity to function as an analyst. After all, it can be extremely difficult tobear the ongoing strain of analytic work, much of which proceeds beyondour conscious awareness.

The analyst inevitably and unconsciously takes up various positions inrelation to a particular patient. In so doing, he is potentially dislodged from asecure sense of himself. One moment, he sees himself in his patient’s eyes –recognizing how essentially alike they are. Then, suddenly, he sees himselfthrough his patient’s eyes – he sees the patient seeing him. Perhaps, in this light,he appears as a transference figure discordant with his usual sense of self. Or,alternately, the patient might apprehend shadows of what the analyst prefersto conceal from or about himself. As points of reference shift, bearings are lost,regained and lost again. The dyad may even become locked in what Lacan(1988) refers to as the seesaw relationship in which it is quite difficult to sortout ‘who is doing what to whom’. A frequent rapid reversal of opposites mightleave analyst and patient alike feeling the other is driving them ‘crazy’. At sucha moment, the analyst’s identity as an analyst is called into question. He issurprised at how deeply he’s been affected, startled by how previouslyunaware he had been about himself. Why this particular patient? Why now?

Since the introduction of the psychoanalytic method, analysts havestruggled to productively engage patients without becoming destructivelyentangled. Sometimes, we fail. Some of these failures are extremely costly.People get hurt. The potential for damage is so great that we may even needto deny the necessity of the very turbulence that often accompanies creativetheorizing and emotional growth.

Since Masud Khan’s removal from the British Society, most of us inAmerica have had the luxury of appreciating Khan’s writings, withoutnecessarily burdening ourselves with thoughts about who this man was andhow he lived his life. But recent biographical research, as well as publishedand unpublished accounts of Khan’s behavior, reminds us how seamlesslythreads of inspired genius and impaired living can sometimes be woventogether. These renderings of Khan’s personal story – of prolific talent bothexpressed and squandered, of a brilliant analyst whose personal behaviormakes us cringe – naturally leads us to seek some satisfying explanation.

Invested as we our in our own work as analysts, our thoughts naturallyturn to Khan’s analyst. And, indeed, serious questions have been raisedabout how, after three prior treatments and 15 years of five to six times aweek analytic sessions with Winnicott, Khan could self-destruct the way hedid. Linda Hopkins (2001), for example, who is currently writing a biographyof Khan, argues that Winnicott’s major deviations from the analytic framedeprived Khan of a true experience of regression to dependence. Winnicott,she says, also failed to ‘employ the power of the transference to compelKhan to stop drinking’. In her words, ‘Winnicott would have been a good-enough analyst of Khan if he had done just one thing differently: focus on

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Khan’s drinking and insist that he get it under control’ (p. 343). She, andothers, point to examples of Winnicott’s flagrant collusion with Khan to failto adequately address his destructive envy. To say I disagree with thesecriticisms would be oversimplifying. It would be more accurate to state thatI approach these matters quite differently. But before I elaborate, I have animportant personal reservation I think it best to state up front.

Khan’s anti-Semitic invective is repugnant to me. When I hear how hereferred to Harry Karnac as a ‘filthy Jewish tradesman’, talked about ahomosexual patient as having a ‘dirty Jewish arse’, or proudly declared hisyearning to ‘free himself of the rigid Yiddish shackles of the so-calledpsychoanalysis’, I confess to feeling virtually no desire to engage with thisman. Naturally, I could choose to relate to Khan’s anti-Semitism as asymptom of projection or identification with the racial arrogance of theBritish ruling class of the Raj. Alternatively, I might think about his hostil-ity as a matter of the narcissism of small differences in which particularpleasure is found in hating immediate neighbors with whom one actuallyshares much in common. It may also be that Khan was giving voice to thedeep strains of anti-Semitism bubbling beneath the surface among Britishmembers reacting to the ‘invasion’ of the mostly Jewish émigrés. But for meto think about Khan in any of these ways, I would have to either detachmyself or be willing to register his outpourings empathically. In this case, Iacknowledge a reluctance to do either.

Having said that, I already find myself in the midst of the fray. Khan hasviscerally provoked me. I am repelled, disgusted, angry. Khan has actedoutrageously and I am outraged. I am incited and unforgiving for he is intel-ligent, erudite, insightful, and yet acts hatefully, allows himself to grosslyoffend any sense of right or decency, forcing others to bear the brunt of hisobnoxiousness. In short, he employs his considerable resources to shock and,in response, I want to consign him to oblivion.

Now, what happens if I do allow myself to step outside this destructive,imaginary seesaw relationship? How then might I think about Khan’sprovocative self-destructiveness? How might I understand a gifted man who,after rising to such prominence, collapsed into a lonely, rageful state of sicklyimpenetrable isolation? And can we usefully generalize from Khan’sexample to other patients we encounter who appear, despite our best efforts,to be heading towards a private hell of their own making?

I guess one place to begin is with outrageousness itself. There can be nodoubt Masud Khan at times behaved with an intention to shock. The Frenchuse the word ‘jouissance’ to express the rise or kick a person gets from aparticular way of being. I think the word fits well for the kind of pleasureKhan appears to have derived from provocative behavior. How can weunderstand outrageousness? Is it simply a transformation of hostility?

As far as I know, Khan (1986) himself is the only analyst to ever havewritten explicitly about outrageousness as a distinct affective state. It is not



surprising that he would engage this topic. The psychological terrain weknow best, after all, is that which we know from the inside out. He was avirtual Geiger counter for the insincerity, phoniness and half-truthsconcealed in outrageous behavior. Earlier, Freud had pointed out thatdemands felt to be outrageous were one of the precipitant causes of warneuroses. Shell-shock, in other words, was a dissociative response to anoutrageous current demand. Khan looks at outrageousness developmen-tally, linking maternal over-indulgence to a restriction in spontaneity in thechild. Obsessional over-care, he argues, inhibits aggressivity. In discussingsuch a patient, Khan remarks:

He did not succeed with me, because I had been a more outrageous person inmy private life. I knew all the ruses of that affect, both in private life and profes-sionally. I was a much-cuddled child, who grew up, very precociously . . . So hecould not get the better of me. (p. 648)

Now, I would like to turn to another dimension of outrageousness, whichI feel I have learned from some of my own work with patients. From anintersubjective point of view, a crucial element to provocative outrageous-ness is the opportunity it affords the individual to see himself making animpression upon another. What is psychologically vital is not so much themaking of the impression as the profound relief in observing the impressionthat one has made. Observing the impression affords the vulnerable indi-vidual a fleeting sense of substance. Like footprints in sand, the impressionmomentarily reassures that desire remains alive. We can detect this in theway Khan romped through life with the self-indulgence of a wealthyplayboy. He once came to an International Congress with a HabsburgPrincess as his guest. They both wore riding habits and brought nearly thewhole stable along with them. Glamour – which displays both vitality anddecadence – is uniquely designed to generate opportunities to observe reac-tions. Perhaps there is something akin to a psychological law: in the absenceof quiet recognition, one needs desire noisily confirmed to survive psycho-logically.

Masud Khan’s outrageousness, however, was also the leading edge of afar deeper self-destructiveness. But if what I said before about needing tonoisily confirm desire is valid, we are, it appears, right in the heart of aparadox. How can it be that self-destructiveness preserves psychologicalaliveness? There is no easy answer to this question. All I can offer is thefollowing working hypothesis: in the absence of recognition, self-destruc-tiveness becomes a last-ditch effort to preserve a semblance of control as theillusion of the integrity of the self collapses.

Winnicott (1963) was one of the first people to introduce us to the seem-ingly odd link between personal agency and the destruction of the self. Evenin the infant, he argued, there exists a rather fierce morality, a willingness,sometimes through life-threatening refusals to ingest food, to guard the selfagainst threats to the elusive sense that ‘I am’. In his words:

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The fiercest morality is that of early infancy, and this persists as a streak inhuman nature that can be discerned throughout an individual’s life . . . Forinstance, a child of any age may feel that to eat is wrong, even to the extent ofdying for the principle . . . This leads many people who seem to be doing welleventually to end their lives which have become false and unreal; unreal successis morality at its lowest ebb. (p. 102)

In a similar vein, Eric Erikson (1959) offers us the idea that some peoplewould ‘rather be nobody or somebody bad, and this totally, or indeed, deadby free choice than be not-quite-somebody’ (p. 143). For Erikson, suchvindictive choices can serve a restitutive function in restoring urgentlyrequired feelings of inner stability and control.

Peter Fonagy’s (Fonagy et al. 1993) research suggests there is a profounddifference between a ‘pre-reflective or physical self’ that is the immediateexperiencer of life, and a ‘reflective or psychological self’ that is theinternal observer of mental life. Most importantly, these two aspects ofour experience develop differently and exist in a rather precariousrelationship to each other. Mental processes, in another language, are asvulnerable to disruption as are mental representations. This is consistentwith a view put forth by Spruiell (1975) who noted that among the strandsof narcissism is ‘the pleasure in efficient mental functioning . . . the regu-lation of mood . . . and . . . a sense of inner safety and reliability’ (p. 590).Feeling oneself to be in control of one’s mind is apparently a vital humanaspiration.

Thus, clinicians of varying orientations appear to be converging on asimilar observation: self-soothing and self-preservation do not necessarilygo hand in hand. The illusion of the integrity of the self – extending or re-establishing an area of omnipotence – is sometimes guaranteed throughself-destructiveness. The problem, of course, is that self-destructiveness asguardian of integrity is analogous to blood-letting; there is a race betweencure and bleeding to death.

I would like to turn my attention now to the question of Winnicott’streatment of Khan. In doing so, I am reminded of what one of yourhistorians, Philip Guedalla, once quipped about writing biography: ‘Bio-graphy, like big game hunting’, he said, ‘is one of the recognized forms ofsport; and it is as unfair as only sport can be.’ That captures a little of whatI feel hazarding speculations about what went on in the treatment, especiallyconsidering that I never even met either of the two men involved. There isobviously no way we can ever really know. Perhaps I am a bit of an extrem-ist on this point but, frankly, I have serious doubts about what we even knowabout our own analyses. The best I can attempt, therefore, is to projectWinnicott and Khan’s experience onto the screen of my own informedimagination. Hopefully, I can avoid the temptation to believe that I possesssome privileged vantage point outside the treatment from which I canaccurately judge what transpired. Holding that in mind leads me to propose



three distinct, yet overlapping, conjectures: Winnicott helped Khan enor-mously; Winnicott failed to ‘cure’ him; Masud Khan could not be helped. Iwill try to open these up, one at a time.

Winnicott Helped

Masud Khan, despite his tragic end, led an incredibly productive life. He wasa prolific contributor to the psychoanalytic literature and a brilliant carto-grapher of the territory of archaic mental states. We have no way of knowingif Khan could have sustained these achievements without Winnicott’s help.

I would like to read an excerpt from Khan’s diary, written four months afterWinnicott’s death. I have chosen this entry because it feels to me like one ofthose moments where Khan is being fairly honest with himself. It reads:

What a difficult thing psycho-analysis is to report about to others. No, even tomyself . . . 25 years of analysis with four analysts is a long odyssey and each ofthem helped me, without my being able to talk to any of them significantly aboutmyself ever . . . D.W. alone was aware of it and allowed for it . . . It is for thisreason that . . . I did succeed at three occasions to sink into my Self, be silent . . .and related to him. All these three occasions were physical . . . He was in hischair seated and I had got off the couch and buried my head into the side of hiscoat. I can still hear his heart and watch beating. All else was still . . . and I wasat peace. And D.W. never interpreted those three occasions. He had enabled meto reach to that point . . . (May 1971)

Now, three occasions in 15 years may not seem like a lot when viewedfrom the outside. But it appears to me that moments like these both tetheredKhan as a person and gave him a sense of what it means to care as a clinician.This is not an insignificant gift. Let me read another excerpt, written, as faras I can tell, about two weeks after Winnicott’s death:

One of the most valuable contributions of D.W.W. has been that he has changeda catastrophic threat of loss of object into separation anxiety. He is the firstsignificant person in my life who had facilitated me to cope with losing him . . .without it becoming the total loss. (6 Feb. 1971)

This, too, is no small achievement. In fact, I believe that it made life rela-tively bearable and productive for Khan. Winnicott appears to have offeredKhan a sufficient sense of recognition so that his worst tendencies, evidentlong before Winnicott’s death, were held more or less in check for decades.

By saying Winnicott held these tendencies in check, I am suggesting it isunrealistic to expect psychoanalysis to successfully inoculate a personagainst all future strains. Although there is documented evidence thatKhan’s behavior was, at times, thoroughly reprehensible even while he wasin treatment with Winnicott, after termination in 1966 there was a notabledeterioration in his overall mental stability. The worst in him came out infull force. A year or two afterwards, he had his first affair with an analysandand became increasingly withdrawn, isolated and depressed. Then, in thecontext of his mother’s death, Svetlana’s decision to move out, Winnicott’s

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death, the removal of a cancerous lung, and a doctor’s mistaken verdict thathe had only three to six months to live, Khan engaged in a vengeful, raginglast-ditch effort to regain control over a diminishing sense of continuitythrough self-destructive drinking and attacks upon the world. If he couldn’tconquer death, it seems, he vowed to defeat life.

Winnicott Failed

Now Winnicott, of course, had his fair share of blunders. He even toldMarion Milner that his analysis of Khan had not been properly completed.Khan wouldn’t have been surprised to hear that. In response to a condolenceletter following Winnicott’s death, he wrote:

[Winnicott’s] genius was in his capacity to fail each of us according to our needto refuse him. If Freud had the Judaic courage to refuse cure, Dr Winnicott hadthe Christian humility to take responsibility for the uncure. And I, as aMohammedan, praise them both – since I am the beneficiary of each! (9 Feb.1971)

And in a private diary entry a few days earlier, Khan elaborated on the linkbetween Winnicott’s willingness to go on treating those, like himself, whostubbornly refuse what is offered and aspects of Winnicott’s character. ‘Itwas most typical of his type of omnipotence’, writes Khan:

that he could never refuse those he knew would compel him to fail . . . I knowall this on my own pulse . . . Yes, I have known all his failings and he never eventried to hide them . . . He knew and allowed for the margin of weakness anderror in every human individual and worked with the three per cent that wascreative and vital. (4 Feb. 1971)

As I imagine Winnicott and Khan together, I would like to offer somethoughts about what might have gone wrong. In his unpublished autobio-graphical fragments, Winnicott laments never having had a son of his own.Envisioning his own death, he writes about his difficulty in dying without ason both to kill imaginatively and to survive him, that is, ‘to provide the onlycontinuity that men know’. It is no coincidence that Winnicott employsnearly identical language in describing, late in his life, his relationship to hisown father. In his words:

my father was there to kill and be killed, but it is probably true that in the earlyyears he left me too much to all my mothers. Things never quite righted them-selves. (quoted in Winnicott, C. 1989, p. 8)

Perhaps, part of the tragedy of Winnicott never having had offspring ofhis own is that he ended up investing part of his desire for a son in Khan.And, as we know, it is as disastrous to treat our patients as children as it isto treat our children as patients. Although the relationship with Khan mighthave satisfied some felt need for Winnicott, it probably did little to affordhim a genuine opportunity to rework internally and better integrate someof his own dissociated feelings in relation to his father.



Winnicott, of course, was certainly not the only childless analyst to formcomplicated relationships with patients; he was probably not even excep-tional in this regard. I think this is an area we might benefit from studyingin some detail. Whatever our conscious intent might be, we sometimesunconsciously use our patients as we struggle to grow or become entangledwith them because of mutually resonating vulnerabilities. I am well awareof Freud’s dictum that we need to somehow ‘purify’ our desire. But, frankly,I find that to be actually a rather odd proposition, more religious thanpsychoanalytic.

I realize how hard it is to make this part of our public discourse. We areunderstandably reluctant to think of ourselves as engaged in a self-absorbedenterprise. It is also a mistake to reduce analytic work to ‘nothing but’ theanalyst’s disguised self-indulgence. But I do believe we profit from candidlyexamining the varieties of transference–countertransference matrices thatget constellated in our work. I would take this one step further: if we fail todo so, we end up attributing to the patient aspects of a relationship to whichwe have unwittingly contributed. Doing so mystifies and creates bad faith.

Given Winnicott’s complicated investment in Khan, I was struck whenreading Khan’s personal diary by the relative absence of genuine grief in theentries following Winnicott’s death. It reminded me of a remark IrisMurdoch once made: ‘Love’, she said, ‘is the extremely difficult realizationthat something other than oneself is real.’ But at the same time, Khan wasclearly devastated by the loss and furious that Winnicott hadn’t appointedhim literary executor of his estate. To the extent that Khan might not havefelt particularly lovable, he needed desperately to make himself extremelyvaluable. Winnicott, for his part, had cultivated the illusion of Khan asnatural heir. For the narcissist, the truth always comes in blows. So, inresponse to feeling suddenly disinherited, Khan lashed out to destroy Winni-cott. If he couldn’t do this in the flesh, he would do the next best thing:destroy the father’s reputation. He did this both directly – by repeatedlygossiping about Winnicott’s impotence, as if to say: ‘He’s not a man and, ifI’m not his son, let it be known that there could never be a son!’ And healso did this indirectly by his outrageous behavior, which would, of course,announce to the world that Winnicott had failed.

What we might be seeing, therefore, is Winnicott’s failure to help Khantolerate disillusionment, particularly in relation to father, and thereby findhis place among others. I think Khan knew Winnicott failed him on thispoint. It is no coincidence, therefore, that the clinical exploration of affec-tive states involving rage and anxiety over disillusionment became centralthemes in Khan’s writings. After all, what from the outside appears as theor-izing can also be understood as tentative attempts at self-cure. Nietzsche hadit right when he noted that every philosophy is ‘a confession on the part ofits author and a kind of involuntary unconscious memoir’. Similarly,analysts, I believe, discover and create their theories because they in some

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way speak to their personal struggles. That is why Freud’s staunch determina-tion to be sane and contempt for the ‘weakness’ of illness, Jung’s innertorment and fragile sense of self, Ferenczi’s wild enthusiasms and symbioticlongings, Sullivan’s intense loneliness, shyness and anxiety in the presenceof other people, Winnicott’s perpetual strain to keep inner and outerseparate but interrelated – to give just a few examples – contributed to howeach of these analysts eventually theorized about the human condition.Disturbing personal struggles brought into relief and worked through inrelation to patients become symbolized as theory.

Khan, it seems, lived in perpetual dread of the ordinary, as if to say, ‘If Iam like everybody, then I must be nobody’. It is precisely around these issuesthat Khan and Winnicott might simply have had too much in common.Winnicott, like Khan, had a profound, somewhat compulsive, personal needto approach things in a way that felt original and real to him. In a privateletter to David Rapaport dated 9 October 1953, for example, Winnicottwrote:

I am one of those people who feel compelled to work in my own way and toexpress myself in my own language first; by a struggle I sometimes come aroundto rewording what I am saying to bring it in line with other work, in which caseI usually find that my own ‘original’ ideas were not so original as I had to thinkthey were when they were emerging. (Rodman 1987, pp. 53–4)

Khan (1975), himself, recalls calling on Winnicott one Sunday morningand urging him to read Lionel Trilling’s Freud and the Crisis of our Culture.Khan writes:

He hid his face in his hand, paused, convulsed himself into visibility and said:‘It’s no use, Masud, asking me to read anything! If it bores me I shall fall asleepin the middle of the first page, and if it interests me I will start re-writing it bythe end of that page.

In a similar vein, Winnicott was reluctant to read the works of Ferenczi,lest he discover that he had actually stolen ideas from him. Winnicott’s needto defend his own sensitivity helps explain why Charles Rycroft, forexample, once described him as a ‘crypto-prima donna’ (Grosskurth 1986,p. 399). It was inevitable, given such a temperament, that some would ignorehim and others feel alienated by him. Michael Balint, feeling slighted, voicedin a private letter to him what many felt:

Perhaps I ought to say here that this has happened several times during ourfriendship. You emphasized on more than one occasion that ‘though’ – (I quotehere from memory) – ‘Ferenczi and Dr Balint have said all these many years ago,here I am not concerned with what they said,’ or, ‘I have not had time to readthat but I shall ask the Honorary Librarian (Khan) to fill this gap,’ etc. Of course,in this way you always have the audience laughing and on your side – no-oneamong us likes to read boring scientific literature and if somebody of your statureadmits it in public, he can be certain of his success . . . Your way of expressingyour ideas forces one into the position of either saying ‘this is splendid andentirely new’ or of remaining silent. (quoted in Rudnytsky 1991, p. 86)



Obviously, Winnicott’s need to be splendid and original had its cost.Let me mention a few things I have both heard about Winnicott and

gleaned from many of his private correspondences. I invite you to correctany misperceptions I might have. There was, apparently, a ‘great air offreedom’ about him (Clancier & Kalmanovitch 1987, p. 133). Many whoknew him used the word ‘pixie’ to describe him. Betty Joseph called him ‘abit of a Peter Pan’ (Grosskurth 1986, p. 399). Until very late in his life, hewould ride his bicycle with his feet on the handlebars and drive his car withhis head through the roof and a walking stick on the accelerator. In fact,when he was 71 years old, his cycling behavior brought a warning from theMetropolitan Police about his infringements of important traffic regulations.

Winnicott was what I would call a graceful narcissist. He apparently lovedpeople watching him conduct therapeutic consultations or listening to hiscase presentations. Although somewhat of a loner, he also displayed a streakof vanity as he surrounded himself with younger acolytes. He allowedhimself latitude with patients that would not have been tolerated in lessprominent clinicians. Winnicott offered tea to patients, sought one out in apublic restaurant to change an appointment (he commented that observingher eating from afar gave him new insight about her), held another’s handsfor a long period of the analysis, and even gently rocked a patient’s head.He was frequently late for his appointments at Paddington Green, which henicknamed his ‘psychiatric snack-bar’. Eric Trist told me he once sawWinnicott shout advice across a crowded room to a mother whom he hadmerely overheard having a discussion with another woman. Winnicott oftenagreed to see children on an irregular basis, rather than transfer them tomore available colleagues. A psychiatric social worker, who worked withhim at Paddington Green, said to me: ‘It is as if he felt that an ounce ofWinnicott was worth a pound of pedestrian psychotherapy’. As a result, atleast some of the children were sorely ‘short-changed’.

Fortunately, Winnicott’s own narcissism remained relatively ‘healthy’, inthe sense that it did not preclude imaginatively and lovingly entering intoother people’s lives. It did not have the dead-end quality of more patho-logical forms of narcissism in which empathy is employed to exploit orshame others. Although his overt behavior might have appeared, at times,to be narcissistic, he genuinely enjoyed being used by others. As much as hewanted to be himself, he wanted others to be themselves. As he wrote onceto Augusta Bonnard: ‘Let’s enjoy being ourselves and enjoy seeing what wedo when we meet it in the work of others’ (Rodman 1987, p. 117). Althoughhe knew what it felt like to be ashamed, he was not crippled by mortifyinghumiliation. If Simone Weil is right when she says that ‘the belief in theexistence of other human beings as such is love’, then Winnicott, I believe,had a genuine capacity to love.

I guess what I am trying to say is that Winnicott’s narcissism might havecaused him to both overestimate what he could do and underestimate the

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difference between him and others. He was obviously blessed with a geniusfor quickly and intuitively grasping other people’s core conflicts andcommunicating this in a way the person could take in. He took for grantedthat others were equally competent. As a result, he was insufficientlyconcerned with how the formal structure and boundaries of analysis mightserve as a safeguard against potential abuses.

Winnicott’s botched treatment of Khan, however, can be understood notonly as a matter of ill-provided frame but also as a failure to more fully takeinto account overlapping areas of mutual vulnerability. When he enteredanalysis at the age of 27, Winnicott suffered from what he described as a‘serious symptom’ in which his larynx would follow the sounds he wouldhear and particularly the voice of someone talking to him. He becameincreasingly preoccupied with the illusory boundary between inside andoutside and lived in dread that he might be trapped by either solipsisticsubjectivity or the deadened claims of objective perception. As he onceacknowledged publicly:

I have this need to talk as though no one had ever examined the subject before,and of course this can make my words ridiculous. But I think you can see in thismy own need to make sure I am not buried . . . Evidently, I must be alwaysfighting to feel creative. (Winnicott 1986, p. 41)

From the point of view of Joan Riviere, the pride he took in his inven-tiveness, his insistence on stating theory in his own language, and theconcomitant fear of any inauthentic ventriloquism were all symptomatic ofhis personal illness. She felt he was struggling too hard to be his own realself. She saw this as a ‘block’ in him and did not hesitate to tell him so(Rodman 1987, p. 94). Winnicott ended up feeling Riviere failed him aroundthis issue. As he wrote privately to Klein:

This matter which I am discussing touches the very root of my own personal diffi-culty so that what you see can always be dismissed as Winnicott’s illness, but ifyou dismiss it in this way you may miss something which is in the end a positivecontribution. My illness is something which I can deal with in my own way andit is not far away from being the inherent difficulty in regard to human contactwith external reality. (Rodman 1987, p. 37)

Winnicott’s personal vulnerability – which was a source of great creativeinsight – might also have blinded him to more effectively handling certainaspects of Khan’s character. Khan fabricated case material. He falselyclaimed he was a prince. Charles Rycroft noted that those closest to himwere never clear about many aspects of his past or whether what he said wastrue. Pearl King said he ‘was very skilled at confusing a story’. He artfullydescribed the character structure found in perversions as a collage ofidolized parts of self and object that are never coherently related to eachother. His chosen metaphor was life as a dream. Although a man of immensetalent, he was notorious for resorting to ploys. He lost an opportunity tobecome an editor of the International Journal of Psycho-Analysis because of



his lying. In a letter to a friend he acknowledged suffering from ‘a delusionof sincerity’. The thrust of his theoretical contributions focused on mattersof authenticity and the privacy of self. Following Helene Deutsch’s notionof the ‘as-if’ personality, he writes that you don’t have to feel much aboutothers as long as you imitate them. The convergence of these aspects ofbehavior, theoretical interest and character suggests, in my opinion, anabiding personal struggle to distinguish appearance from reality.

Current developmental research is helping to illuminate how theorigins of self-reflexivity coincide with the emergence of pretend play.While 2-year-olds are adept at distinguishing between make-believe andreality, they have difficulty prior to age 4 or 5 in grasping the distinctionbetween how things look and how they actually are and in understand-ing the subtleties of secrecy and lying. A 3-year-old does not yet have thecapacity to appreciate the merely representational nature of ideas andfeelings. He operates in what Fonagy (1995) has referred to as a mode of‘psychic equivalence’, behaving as though his own and others’ thoughtsfaithfully mirror the real world. It is only in the fourth and fifth year oflife that a child begins to acknowledge that things may not be what theyappear to be, that another person may perceive external reality differ-ently, that a person can hold different beliefs at different times. We nowunderstand that the failure to make this developmental leap is related toconfusion between the mind of the other and the mind of the self. Winni-cott – who has taught us more about the positive life-enhancing value ofillusion than any other analyst – might have been insufficiently attentiveto how Khan was apparently flailing about in its potentially destructiveundertow.

Khan Couldn’t be Helped

I imagine Winnicott knew Khan was engaged, as Robert Stoller put it, in ‘aprolonged fuck with death’ which might be simply another language fordescribing Khan’s hypomanic temperament, or what Keats once describedas being ‘half in love with easeful death’. It is fruitless to try to tease apartwhat part of this was constitutional and what part environmental. We arenow, for example, discovering that attachment to people and chemicaldependency are even mediated by the same neuroendrocrine system. Khanobviously suffered enormously from a profound sense of powerlessness vis-à-vis his own mind. And it is this sense of helplessness that constitutes theessence of the cumulative psychic trauma that seemed to plague him. Hyper-reactive to the presence of others, he was also easily dislocated by theirabsence. Put differently: he was vulnerable to shock. To protect himself, heclung ever so tenaciously to the precarious pretence of self-sufficiency. It isnot so much that relationships, in this state, are unsatisfying; it is that thedim recognition of the need for any relationship at all engenders reactive

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rage. One cannot make full use of analysis, if one desperately needs not toneed. As Khan confessed in an entry in his diary:

There are some of us who cannot share our woes with others. This is neitherconceit nor arrogance, but a very personal and private stance of stammer . . .This is why I made such meagre use of analysis. Some of us can find our owncomfort only from within our own disciplined silences. (28 June 1970)

In another language, Khan became hatefully indifferent to others. And heeven knew that his indifference ripped through the affections of all thosewho cared the most about him. As he wrote in a private letter to RobertStoller:

I am aware of my profound debt to my colleagues who have put up with all theantic and bizarre provocativeness of my temperament and character. I can nowsee that all these wild antics which antagonized most of my colleagues werealmost a magical way of keeping myself reminded that I was not where I was . . .It is impossible for anybody outside to relate to a person who is hiding himself.(letter to R. Stoller, 30 Jan. 1970)

Masud Khan had a precocious mind. But a precocious mind is no substi-tute for the smooth intermingling of the psyche-soma. Insights of the reflec-tive self never adequately compensate for impaired relationships involvingthe prereflective self. Khan knew this about himself. Winnicott had told himas much. As he wrote in a private diary entry:

I have never been able to share my Self with others through language spoken.And yet language has enabled me to know others – and often beyond my owninsight into them. D.W.W. often used to say: ‘You speak wiser than you know’.And that is true. (5 May 1971)

Although Winnicott might not have been able to fully alleviate thisproblem for Khan, he managed to creatively use what he sensed to fashionan important clinical insight: the child deprived of sufficient early experi-ences of finding his or her own mind in the mind of a devoted Other is leftwithout a personalized, authentic and vitalized sense of self. If the child isparticularly bright, the outcome is often a precocious, inauthentic pseudo-vitality that reflects mother’s defensive attempts to compensate for her owndepression. As adults, such people – and there can be no doubt that Khanwas one of them – are inordinately prone to internal collapse.

Despite the tragic dimension to Khan’s wasted potential and acute vulner-ability, I imagine Winnicott approached the work with a certain acceptancethat there was really little he could do, particularly following his ownrepeated heart attacks as he grew older and weaker himself. Perhaps, hefigured, if he can’t cure Khan, he would at least be good to him. Now I knowthat, from the outside, one is tempted to shout ‘collusion’. Khan, himself,even referred once to Winnicott as ‘my most generous yet abominableexploiting accomplice’ (21 June 1979). We want to believe that destructive-ness, like evil, is eradicable. Blaming Winnicott, of course, keeps hope alivethat things could have turned out differently. We are tempted to fault



Winnicott for not holding, forty years ago, current notions of ‘boundaryviolations’, or possessing contemporary conceptual tools like ‘mutualenactments’. But it’s not even that we want so much to blame as that weprefer events to be rational and people knowable. We would rather hold fastto the idea that someone must be held accountable than resign ourselves tothe vagaries of fate.

It is precisely the accidents of fate, however, that psychoanalytic theory isreluctant to take into account. We are experts at searching for childhooddeterminants, patterned regularities, compulsions to repeat, adhesive objectrelationships and unresolved transferences. It is much harder for us toaccommodate our theories to the unexpected contingencies of adult life. InKhan’s case, the loss, within a single decade, of his analysis, his analyst, hiswife, his sobriety, his mother and parts of his body combined to overwhelmhis basic sense of continuity. As Irwin Hoffman (1998) points out, in psychiclife there is a dialectic between a sense of being and an anticipation of non-being. For some individuals, there is nothing more shameful than the contin-gency and finitude of human life, the intractability of our limits. Perhaps,Khan’s traumatic encounter with mortality – particularly in the absence oftreatment and given the vulnerability of his temperament – precluded thepossibility of his going-on-being. Enslaved by necessities impervious to hiswill, Khan suffered unbearable humiliation. Outraged in the face of what ismysterious and therefore resistant to his control, he was prone to both hidefrom the world and increase his effort to penetrate its secrets. Sensing theever-presentness of death, he wrapped himself in it, corrosively poisoninghimself with a reservoir of evil and destructiveness.

Freud, following the First World War, had no problem in being pessimisticabout psychoanalysis as a treatment, particularly given his unwaveringconviction in the scientific truth of his theory. We, on the other hand, havebecome quite shaky – and rightfully so, I might add – about the absolutetruth-value of our theories. Unfortunately, however, this is sometimesaccompanied by certain zealousness in our beliefs about therapeutic efficacy.There is a very powerful and distinctly optimistic current that tends tobelieve that almost anything is possible clinically. Generally, this takes thenarrative form: ‘If only . . . then’. If only Winnicott had forcefully managedKhan’s grandiosity and destructive envy, then he wouldn’t have behaved soshabbily after terminating treatment. If only Winnicott had maintained thetreatment frame, then Khan wouldn’t have begun sleeping with his patients.While there may be some truth to this, it is also possible that no prior amountof good-enough analysis (remember there were three others who treatedhim before Winnicott) would necessarily have altered the way Khan, as anadult, responded to the accidents of his fate.

Winnicott, too, began his clinical career with no small measure of naïveté.As a young man, he entertained the idea that psychoanalysis could easilymobilize a person’s will against unwanted tendencies and that he might even

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one day join his father’s business and practise psychoanalysis as a hobby. But,as he matured, Winnicott fashioned a clinical sensibility quite distinct frominstrumental notions of cure. He came to believe people differ in theircapacity to profit from nurturance and he stopped believing everyone couldbe helped. He thought it a mistake to explain a person’s life solely in terms ofanalytic results or to reduce a complicated personality to its failings. Winni-cott’s focus was not on morality, or adaptation to reality, or interpersonalcompetence. He did not seem to care about the ‘ego replacing the id’ or the‘finding of adaptive substitutions’. In his quiet non-doctrinaire way, Winni-cott saw these as a colossal piece of ideology that instates the analyst as masterof reality and knowledge. What was blasphemous about him – and by the way,even as a child his older sisters frequently referred to him as blasphemous –was that he did not see himself as serving any normalizing function. As aresult, he was sometimes excessively reticent about telling others what to do.He had an enormous tolerance for patients’ symptoms, which is part of bothwhy he was willing to take many cases dismissed by colleagues as hopelessand the reason quite a number of patients committed suicide during thecourse of treatment with him. A bit of an eccentric himself, he cared, for betteror for worse, less about the good, and more about the unique.

In 1968, three years before his death, Winnicott spoke before a closedmeeting of the 1952 Club on ‘The transmission of technique’. According tothe notes of one of the participants, Winnicott remarked: ‘It is not a verygreat thing to fail in an analysis. The awful thing is to go on with an analysisafter it has failed.’ Winnicott must have known that awful feeling since hewent on with his analysis of Khan long after, I think, he knew it could neversucceed. I believe he did this because of his wry appreciation of the humanpredicament, his dedication to the ‘three per cent that was creative and vital’,and because he never imagined curing himself from taking responsibility forMasud Khan’s uncure.

ReferencesClancier, A. & Kalmanovitch, J. (1987) Winnicott and Paradox: From Birth to

Creation. London: Tavistock.Cooper, J. (1993) Speak of Me as I Am: The Life and Work of Masud Khan. London:

Karnac.Erikson, E. (1959) Identity and the life cycle. In Psychological Issues, Monograph 1.

New York: International Universities Press.Fonagy, P. (1995) Playing with reality: the development of psychic reality and its

malfunction in borderline patients. International Journal of Psycho-Analysis 76:39–44.

Fonagy, P., Moran, G. & Target, M. (1993) Aggression and the psychological self.International Journal of Psycho-Analysis 74: 471–85.

Greenberg, J. (1995) Psychoanalytic technique and the interactive matrix. Psycho-analytic Quarterly 64: 1–22.

Grosskurth, P. (1986) Melanie Klein: Her World and Her Work. New York: AlfredA. Knopf.



Hoffman, I. (1998) Ritual and Spontaneity in the Psychoanalytic Process. Hillsdale,NJ: The Analytic Press.

Hopkins, L. (2001) Masud Khan’s descent into alcoholism. In J. Petrucelli and C.Stuart (eds), Hungers and Compulsions: The Psychodynamic Treatment of EatingDisorders and Addictions, pp. 319–45. Northvale, NJ: Jason Aronson.

Joseph, B. (1985) Transference: the total situation. In M. Feldman and E. Spillius(eds), Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph,pp. 156–67. London and New York: Routledge.

Khan, M. (1975) Introduction to D.W. Winnicott. In Through Paediatrics to Psycho-analysis, pp. 11–48. New York: Basic Books.

Khan, M. (1986) Outrageousness, compliance, and authenticity. ContemporaryPsychoanalysis 22: 629–50.

Lacan, J. (1988) The Seminar of Jacques Lacan: Book I. Freud’s Papers on Technique;Book II. The Ego in Freud’s Theory. New York: W.W. Norton.

Rodman, F.R. (ed.) (1987) The Spontaneous Gesture: Selected Letters of D.W.Winnicott. Cambridge, MA: Harvard University Press.

Rudnytsky, P.L. (1991) The Psychoanalytic Vocation: Rank, Winnicott, and theLegacy of Freud. New Haven, CT: Yale University Press.

Spruiell, V. (1975) Three strands of narcissism. Psychoanalytic Quarterly 44: 577–95.Winnicott, C. (1989) D.W.W.: a reflection. In D.W. Winnicott, Psychoanalytic Explo-

rations, pp. 1–18. Cambridge, MA: Harvard University Press.Winnicott, D.W. (1963) Morals and education. In The Maturational Processes and the

Facilitating Environment. London: Hogarth Press.Winnicott, D.W. (1986) Home Is Where We Start From. New York: W.W. Norton.

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the outrageous prince: winnicott's uncure of masud khan introduction

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