Ten quick fragments on psychoanalysis
terminable and/or interminable, clinical or social-theoretical
Psychoanalysis has a chequered history treating psychosis and schizophrenia1, as well as autism2. Then as now, but especially in the 21C, the movement has hung its hat on clinical efficacy in treating ordinary unhappiness, especially neurosis, as well as the very many angsts, sadnesses and unrealities unamenable to prescription biochemistry and ten-session behaviourism (which… ).
What does it mean to lie on a couch with a human ear seated in one’s blindspot, and follow the injunction to free associate, so simple and so hard to follow? What does it mean – for mental health – to talk and talk (and talk), while a person listens and listens (and listens)?
At its best, psychoanalysis gives a sense to ‘going on (and on)’ where it can be a process of ‘getting to know (and know)’ one’s self as it gives an account of itself – in a way that is all aleatory process not beholden to the ordinary strictures of conversation (turn taking, topic supporting), relating a narrative (beginning, middle, end, point), even engaging in a harangue, monologue, or rant (coming to the point at the point of crescendo). In Anglocapitalist culture, where talking and asserting is given value over listening and questioning, where few people listen well and most people seldom listen much, it is a wonderful thing to be listened to, and a hard and great thing to speak freely, trusting that someone will listen.
A relationship of trust with a person who is not a friend, a family member, a colleague or a random stranger ‘in a bar’: how many of us have a person we could entrust many of these things we are thinking and feeling? In the absence of even one such person in our lives we know we can contact, do we not all carry around a lonely burden of shames and wishes we suffer from not being able to share?
I know of many people who have bad backs from carrying the carapace of their bad past upon their backs badly. So if psychoanalysis could be a relation of listening trust between a person and another, then it could always be of benefit.
Thesis one: it doesn’t matter at all if an analyst is a Freudian, Lacanian, Kleinian (&c), all that matters is how trustworthy they are, how well they listen – and above all their timing. Like comedians, an analyst’s power is only her intuitive ability to listen, carry trust, then intervene at the precise right moment and land the interpretation; and it must be juste. It is truly an art. This is where Ogden and Ferro land.
Thesis two: it matters deeply if an analyst is a Freudian, Lacanian, Kleinian (&c), because if any of these things are the case, the analyst’s commitment to a movement and its presuppositions structures-strictures-stories the analysand’s associations ‘as if’ they are (eg) rooted in drives, symbolisations around unutterable desire, or speaking from a depressive or paranoid-schizoid position. This was where Karl Kraus and Deleuze and Guattari’s critiques landed, in Freud’s Vienna and Lacan’s Paris.
As it usually transpires, I think thesis one and two co-exist, and this accounts for my strictly ambivalent feeling about the clinical practice of psychoanalysis in general, and finding a ‘good enough analyst’ in particular.
I think thesis one *might* be okay for psychoanalysis in a clinical setting, if one is wealthy enough to continue consistently, once a week for a year or twice a week for two, and the disquiet is not too serious, or rooted in neurobiology3. One might find an artist, one might finally be listened to and learn the deep sense and meaning of one’s suffering, and this could also be a lifechangingly enriching opportunity to excavate one’s own private Atlantis (or Idaho, if unlucky).
Yet I think thesis two becomes the only one admissable the moment psychoanalytic thought makes any general claims about politics, ethics, culture: once we shift to psychoanalytic social theory (which, I contend, we always do), the quality and rigour of our theory – above all, its epistemological underpinnings – they truly matter. In other words, there are substantive reasons why Adler, Jung, Horney, and Reich all risked their reputations in dissenting from orthodoxy here4; and the fact that one can speak of orthodoxy, and notice so many eminent splitters, also begins to tell us something we really ought to become and stay critically curious about.
As have psychiatry and clinical psychology – and the full-spectrum of psychotherapies excluded from these medical, scientific and social movement models. Check Rachel Aviv’s recent work on this, in this Guardian long read, her book, and this recent appearance on Ezra Klein. Olivia Laing’s Every Body also follow’s Reich into the woo woo and his relentless persecution by the US FDA.
I’m not suggesting autism is a mental illness! But as for analysis, Bettelheim’s ‘refrigerator mother theory’ is a case in point of where presuppositions will lead an analyst.
Of course analysis could be great for neurodivergent people, or those who have experienced psychoses and life-threatening depressions;, but this is where thesis two creeps into the clinic (and back to note two and Aviv’s re-covering of Chestnut Lodge in note one). The trouble I have in (anecdotal) practice is that analysts don't tend to keep up with what’s happening in cognate fields of research (Lacanians just tend to [re]re-read Lacan whenever they feel confused about anything, which, lol); and I haven’t yet come across an analytically-oriented clinician who really has a 2020s view of neurodivergence that is based on research and listening to people’s experience (the n=small here, happy to be wrong). Likewise, psychiatry and its medical power is so oriented around triage, diagnosis, and the rush for chemical-based treatment, and clin. psych is so hung up on its insecure position as a science, and trying to get its behaviourist paradigm up, that there also tends to be a trashing of anything that takes longer, holds diagnosis in abeyance, and/or is not oriented in efficient efficacy, results, behavioural ‘bumps’. Moreover, if ‘functioning’ for clin. psych just means efficient adjustment to contemporary suburban work-life, if being well means ‘back to work’, is this a good thing?
Adler split in 1911, Jung in 1913, Horney 1927-1937; Reich was expelled in 1934.