Infecting the Treatment: Being an HIV-Positive Analyst (review)

Throughout my reading of Gilbert Cole's riveting text, I felt myself in a steady state of shifting experimental identifications, compelled to ask what I, as either patient or analyst, would have wanted to do, and would have done, in predicaments like these. Cole's rhetorical strategy depends upon achieving this kind of complicity—the kind that unites performer and audience. He argues with the combined tools of dramatist and actor and, in his remarkable concluding section, likens psychoanalytic work to method acting.

Although the text is steeped in ideas, Cole as person is ever-present. Cole seems to write with, and through, his body, with the flair of a virtuoso. We not only hear about his disclosures and the thinking and feeling that led to them, but we also, and more importantly, feel ourselves as their recipient. Our relation to Cole seems congruent with his patients'. The sessions, the treatments, seem to extend out from the page. While we might be explicitly only asked to think about disclosure—its theoretical underpinnings, and its clinical impacts—we also, because of Cole's virtuosity, experience disclosure, and some of its effects, coming directly at us.

In this sense, I think, the text "infected," and thereby influenced, my reading of it. The infection both facilitated and impeded; clarified and distracted. It clarified in the sense that transference clarifies: as personal experience can clarify impersonal idea. And it distracted in the sense that transference distracts: as personal experience can distort impersonal idea.

For me, the foremost impact of Cole's disclosures was my sense that he was confiding in me, inviting me into a zone often kept private. This invitation made it very easy for me to go along with just about everything he was saying. This experience of "going along with," though, seemed to me quite distinct from full-throated agreement. I could never quite agree with Cole's arguments, in large part, because I found it difficult—nearly impossible—to imagine an effective way to disagree with them. One neither agrees nor disagrees with an effective performance of the method actor.

Cole's openness and disclosures both presumed and seemed to enforce a relation of complicity with him. Either there was complicity or there was disconnection. Agreement seemed identical with identification; disagreement seemed identical with disidentification. However happily infected I might have been, I was also wishing for a prophylaxis or antidote, imagined here as a more impersonal space, sterile perhaps, a space congenial to disembodied ideas.

In what follows, I will focus on my reading of one paragraph in the Preface. There, Cole writes:

The medical fact of my HIV seropositivity posed a formidable series of propositions. If we ask what it means to share information about a personal medical condition—something about one's substance—in the psychoanalytic encounter, we set in motion a chain of linkages, amounting to a sort of conjugation of disclosure. Openness, sharing one's substance, leads to interpenetration, which leads to contamination. The way that this chain of intersubjective events rhymes with the action of how I became HIV positive impelled me to examine the process in greater detail.

(xi)

The meanings and implications one draws from this daring paragraph depend directly on how one reads Cole's "personal medical condition," his seropositivity. He offers his "personal medical condition" to us as an example. What we must decide is how much reach, how much leverage, we will grant to this example. What categories do "personal medical conditions" and "seropositivity" exemplify?

If we restrict the reach and leverage of Cole's use of himself as an example, we wil read his seropositivity and personal medical condition as constituting a more or less self-contained, discrete, and sparsely populated set. This set may be limited to HIV-positive analysts or—giving the example a slightly longer lever arm—it might also include all those analysts living with...