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Product Details
| ISBN-13: | 9780367107376 |
|---|---|
| Publisher: | Taylor & Francis |
| Publication date: | 06/14/2019 |
| Pages: | 350 |
| Product dimensions: | 6.00(w) x 9.00(h) x (d) |
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Chapter One
Boundaries
Psychoanalysis is arguably the single most important intellectual development of the twentieth century. Comparable to the theory of evolution in the controversy it has caused and continues to cause, psychoanalysis informs part of our daily discourse in a way that evolution has never done. Terms such as unconscious, repressed, ego, ambivalent, complex, projection, denial and double-bind enter into conversations in every walk of life whenever people talk about mental states and the reasons for human actions. Psychoanalytic language and concepts have been integrated into Western culture through novels, poetry, drama and film, literary and film criticism. But a precise definition of the field remains elusive. What is psychoanalysis, really? How does it differ from psychology or psychiatry?
Psychoanalysis is a systematic attempt by many workers over the last 100 years to understand the structure and dynamics of the inner world of the experiencing human being. Simultaneously a theory and a therapy, psychoanalysis shares a boundary with literature, a boundary with psychiatry and medicine and a third boundary with academic psychology. These three boundaries define the concerns and methods that are uniquely psychoanalysis.
With literature, psychoanalysis shares a concern with the human subject, with the complexities and contradictions of human actions and with the richness of human emotional life. But whereas literature could be considered a means of describing — or symbolizing — human inner experience, psychoanalysisdiffers from the expressive world of literature in that psychoanalysis aims not only to facilitate a description of the human inner world but to understand it. Although psychoanalysis has many literary antecedents, the origins of psychoanalysis do not lie with literature. Historically psychoanalysis is located within the traditions of Western science as a systematic attempt to understand an aspect of human experience of the world — in this case, our experience of our own personal inner world.
Psychoanalysis shares a second boundary with psychiatry and medicine, the attempt within the medical traditions of the West to heal what the nineteenth-century Romantic psychiatrists called the sickness of the soul (Reil, 1803). The unconscious, before Freud, has an extensive medical history (Whyte, 1960; Ellenberger, 1970). But the intellectual traditions of psychiatry and psychoanalysis are entirely different. The origins of psychiatry lie in medicine, whose traditions are informed by trial and error, improvisation and the slow accumulation of practical clinical experience. Psychoanalysis shares with psychiatry a common goal of finding effective treatment for human mental pain. The early history of psychoanalysis is dominated by the engagement of two Viennese scientists turned physicians with the puzzle of the ancient medical condition of hysteria — the presence of physical symptoms such as paralysis, tics and anaesthesia with no organic cause. Psychoanalysis differs from psychiatry in that psychoanalysis offers a way to understand hysteria as the conversion of painful emotional experience into bodily symptoms. In offering this understanding, psychoanalysis introduces the possibility of a treatment — through talking — of causes, not of symptoms, causes that are located in human relationships as they have come to be represented in the individual's inner world, rather than in biological malfunctions of brain and central nervous system.
Psychoanalysis shares a third boundary with academic psychology. Here the intellectual traditions are similar. Psychology and psychoanalysis are both offshoots of the scientific sensibilities of the late nineteenth century: psychoanalysis as development of late nineteenth-century neuroscience and psychology as a development of physics in the psychophysics of Gustav Fechner and Hermann Helmholtz, the study of human perception of the physical signals of sound and light. But academic psychology identifies closely with the techniques of the physical sciences while psychoanalysis has developed its own technique of the spontaneous self-report — the free association — as the raw data of human subjective experience.
The three boundaries fluctuate in the intensity with which they are guarded. At present, a relative lack of interest on the part of academic psychologists in psychotherapy, and a relative lack of interest on the part of psychotherapists in the quantitative measurements that dominate psychological research, make for a live-and-let-live atmosphere. Within psychology more questioning attitudes have developed towards the allegiance of academic psychology to nineteenth-century models of successful scientific research based on physics (Barker, Pistrang and Elliot, 1994; Bem and de Jong, 1997). Within psychoanalysis there is an increasing interest in neuropsychology, the physiological substrate of human emotional response (Solms, 1996).
On the boundary between psychoanalysis and psychiatry and medicine there are increasing hostilities. In the United States, psychiatry has reacted to the past dominance of psychoanalysis within the mental health profession with an offensive based on the new discipline of molecular psychopharmacology. Targeting the many different molecules involved in the transmission or inhibition of nerve impulses across the synaptic cleft, cocktails of new psychopharmacological agents have proved, at least temporarily, effective in relieving symptoms of mental disturbance. From its new base in molecular psychopharmacology, psychiatric medicine has made deep raids into psychoanalytic territory, attacking both the efficacy and theoretical basis of the talking cure.
Attacks on psychoanalysis are an integral part of the history of psychoanalysis. From its inception in turn-of-the-century Vienna, psychoanalysis has inspired strong feelings. Early positive reviews of Freud's and Breuer's account of their novel treatment of hysteria emphasized the humanity of the talking cure, the intriguing methods it offered for exploring the inner world of human emotional life and for re-establishing the connections between the mind and the body (Ellis, 1898):
[Breuer and Freud] have succeeded in presenting clearly, at the expense of much labour, insight and sympathy, a dynamic view of the psychic processes involved in the constitution of the hysterical state, and such a view seems to show that the physical symptoms laboriously brought to light by Charcot are largely but epiphenomena and by-products of an emotional process, often of tragic significance to the subject, which is taking place in the most sensitive recesses of the psychic organism (p. 605).
At the same time, the negative reviews were hostile to the point of dismissal, attacking the subjective, unverifiable nature of the analyst's report as well as ridiculing the emphasis that Freud placed on the sexual origins of mental distress. A parody of psychoanalysis, based on Molièkre's The Imaginary Invalid, staged in the early 1900s by the Viennese Medical Society, had the new psychoanalytic doctor saying: 'If the patient loved his mother, it is the reason for his neurosis; and if he hated her, it is the reason for his neurosis. Whatever the disease, the cause is the same. And whatever the cause, the disease is the same. And so is the cure: twenty one-hour sessions at fifty kronen each' (Barea, 1966).
In the 1990s, the attacks on psychoanalysis from psychiatry have been joined by literary snipers along the border between psychoanalysis and literature. The mini-furore raised by an attack on Freud by a Berkeley literary critic in the pages of the New York Review of Books in 1993 reprised the critique of the Imaginary Invalid parody -- psychoanalysis did not know what it was talking about. The British novelist Fay Weldon entertained London audiences in the early 1990s with her scathing polemics against psychotherapy, in this case depicting a marauding therapist who subverts the real wishes of the patient. These literary critics invariably found it necessary to conclude their critiques by denouncing psychoanalysis as unscientific.
Border disputes between psychoanalysis and its neighbouring disciplines tend to be characterized by a lack of engagement with substantive issues in favour of playing on prejudice and received ideas about scientific work. Explicitly informing literary critiques of psychoanalysis and implicitly informing medical and psychological critiques as well, is a comparison of psychoanalysis to a mythologized natural science, a presumed paragon of precision whose language and methods all statements about the world must copy in order to be valid. What can an appeal by literary critics, of all people, to the presumed certainties of natural science be about?
When psychoanalysis is accused of being unscientific the charge is really that it is subjective, an accusation that raises loud alarms in the Western mind. We learn from an early age, especially if we are men, that we must strive to be objective, that feelings are not to be trusted, that, in some renderings, to be subjective is a peculiar weakness of the female of our species. The fear that psychoanalysis is 'only subjective', and therefore that it is unreliable or even dangerous, has provoked four distinct responses. The first is to accept as fair the charge that psychoanalysis is unscientific with an ensuing attempt to reconfigure it to produce the controlled studies that have proved so effective in biology. A second response is to accept the characterization of psychoanalysis as unscientific but to insist that scientific criteria are not useful because what is important about psychoanalysis is that it creates meanings in ways that are completely different from the natural sciences. A third is to insist that psychoanalysis is in fact a science, with clinical evidence being a form of evidence valid in its own right. And a fourth reply to the criticism is to argue that the problem lies not with psychoanalysis but with a fallacious concept of science and scientific success.
The fourth response is the response we will explore here because a fallacious concept of science lies at the heart of the critiques of psychoanalysis and the responses to them.
Consider the following definition of science. Following John Berger (1972), we can define painting as a way of seeing. Literature and poetry then become ways of telling, dance becomes a way of moving, architecture a way of building. Science is a way of understanding. As a way of understanding, science has only one competitor — which it has effectively supplanted — and that is religion. The superior efficacy of scientific ways to understand the world by locating causation in the world of matter rather than in the world of spirit has been demonstrated over the past 400 years. Psychoanalysis is a science in the sense that it is an attempt to understand human subjectivity in material terms — it locates its understanding of human subjectivity in the world of lived experience rather than in the spirit world of Western religious traditions.
But in every generation the dead hand of past successes lies over the efforts by the human race to make sense of our experience of the world. All the sciences have at some time felt dwarfed by the past successes of physics with its often quite beautiful ability to establish the unity of apparently unrelated phenomena. Newton, in the most celebrated example, united celestial and terrestrial motion into a common framework — the falling apple and the revolving moon are acted upon by a common gravitational force emanating from the earth, the differences in their motion due only to the fact that the moon is falling sideways and the apple straight down. For 300 years, the achievements of physics served as a model for success in all of science. Only fifty years ago biology was belittled for its lack of precision, for its 'stamp collecting' of specimens, for its lack of generality, for its apparent lack of the (mathematical) rigour of physics. But the spectacular results of molecular biology over the past thirty years offer quite a different model for scientific success, inviting an examination of our previous attitudes.
Beginning in the 1930s as a gleam in the eye of two former physicists at the Rockefeller Foundation, who felt that the mathematical precision of physics was necessary to bring order and structure to the perceived inadequacies of the descriptive biology of the nineteenth century, molecular biology has since confounded its patrons. Among the many important results produced in the 1950s and 1960s was the identification of the genetic material of living organisms as the macromolecule DNA, the discovery of the genetic code, the discovery of the detailed step-by-step process by which a bacterial virus replicates itself and the discovery of the detailed steps by which the metabolism of a bacterial cell is regulated.
The successes of molecular biology are descriptive. Our understanding has been advanced, not by the statement of precise quantitative laws of motion, but by describing in detail the specific structures and sequences of events occurring in the biological processes of interest. The original intentions of the grant-givers of the Rockefeller Foundation have been turned on their head. Instead of creating a quantitative biology in the image of the mathematical models of physics, the essential descriptive nature of biology has been confirmed.
There is a reason why the fundamental successes of molecular biology are descriptive. The phenomena of biology are historical phenomena. The genetic material of living organisms is the complex result of millions of years of accumulated evolutionary changes. Such complexity cannot be understood in terms of frameworks erected for simpler forms of matter dealt with by the physics and chemistry that appeared earlier in the history of the universe. Complexity is not a complication of otherwise simple basic laws of nature. Complexity generates new phenomena that need to be understood in their own terms. An identification of the fundamental constituents of matter and the nature of their interactions is not enough to tell us either how the biological structures of the world came to exist or how they function. There is nothing in the timeless laws of mechanical motion, the laws of thermodynamics, the laws of the electromagnetic field, or the laws of quantum motion that predicts the existence of DNA in its cellular environment.
Biology is not simply applied physics and chemistry, because although the properties of atoms and molecules make life possible it is their organization, not their properties by themselves, that produces the phenomenon of living matter. Similarly, there have been many vain attempts to reduce the phenomena of human psychology — consciousness, memory, human emotions — to no more than a (complicated) manifestation either of the molecular events taking place in the living cell or of events occurring in the individual neurones of the human central nervous system. But just as molecular biology is not simply applied physics and chemistry, psychology is not applied molecular biology or applied neuroscience. The phenomena of psychology emerge from the organization of the physiological and molecular substrate of the human organism and, like the phenomena of molecular biology, need to be understood in their own terms, not in terms of the successes of other disciplines.
At bottom, the critiques of psychoanalysis, no matter how accurately they may pinpoint real problems in theory and practice, carry as a subtext the nineteenth-century story about science being precise, neutral and objective. And since psychoanalysis is plainly subjective not objective, and is not only contaminated by human subjectivity but is in fact the study of the complexity and ambiguity of the human subject, the slightest comparison to this mythologized objective science is sufficient (and indeed necessary) to establish the point.
Within the definition of science as a way of understanding based in the material world, psychoanalysis is indeed a science. As the British historian of science, John Forrester, has emphasized, what else could it be? Psychoanalysis is the search for understanding of our experience of our inner world, an exploration of what we might perhaps call inner space. The claim that psychoanalysis is unscientific is a distraction, sometimes maliciously intended. What we need from an account of psychoanalysis is not a sterile debate about whether psychoanalysis conforms to the criteria of past scientific successes but an analysis of the problems of human subjectivity that psychoanalysis has set itself to solve and an evaluation of its successes and failures.
Psychoanalysis is a creature of the twentieth century, the century that has magnified the successes and disasters of the Industrial Revolution a hundred-fold. The conflicts, promises, dangers and instabilities of the nineteenth-century Industrial Revolution have been carried forward through the twentieth century and into the twenty-first century, not diminished but greatly amplified as a modern, privately owned, mass production civilization has taken over the globe.
Vast increases in wealth have produced a historically unique global consumer culture of dazzling promise. Goods and spectacles radiate out from the centre in the form of clothes, music, movies and sport, offering the world population the promise of participation in the advancing prosperity of the North. Vastly increased overall wealth has been matched by vastly increased inequality and vastly increased poverty. In the early nineteenth century, the wealthiest English landed families — then the richest in the world — had 1000 times the annual income of a day labourer. The gradient of wealth has now increased to the point that the wealthiest industrial and commercial families in the US can have annual incomes in excess of 100,000 times that of a modern blue-collar worker. In the first three years of the Clinton administration, 1992-5, the wealthiest 0.5 per cent of US families saw their assets increase by $1.6 trillion — an average of $3.2 million per family — a combined increase greater than the increase of the remaining 99.5 per cent of the US population. Worldwide, in 1998, 358 billionaires had assets equal to the combined income of countries with 45 per cent of the world's population. In Tanzania, the average annual income is less than the cost of a single mammogram in Britain. Of the world's wealth, 98 per cent is owned by men, 2 per cent by women.
Along with the increase in the scale and gradient of wealth has come an increase in the scale of violent disaster, precipitated by the instabilities generated by such steep gradients of wealth — millions killed in the trenches of the First World War, the Nazi death camps and extermination campaigns, the nuclear bombing of Hiroshima and Nagasaki, the pogroms in the 1990s against ethnic minorities in Europe, Central Asia and Africa, and the routine use of torture as a means of social control by governments throughout the world. In 1998 the United States had troops stationed in 100 countries of the world.
The anxieties created by the instability of global political and economic arrangements are augmented by anxieties about the effect of corporate-dominated economic activity on the global environment. Global warming has threatened the stability of the West Antarctic Ice Sheet. Recent best estimates conclude that unchecked emission of greenhouse gases over the next 100 years could cause a collapse of the Sheet that would take 10,000 years to restore. The release of this volume of ice (3.8 million km³) to the ocean would cause a rise in sea level of four to six metres and a flooding of the world's port cities.
Psychoanalysis has developed in close relation to the events of the twentieth century. As opposed to the natural sciences — the pride and joy of a triumphant bourgeois culture of the nineteenth century — psychoanalysis has been charged not with participating in the glory of the Industrial Revolution but with cleaning up the mess it left behind. As we enter the twenty-first century, we have still not fully digested how much of a mess is caused by our world system. Sometimes the news is indigestible.
In the spring of 1987, I met colleagues Sally Berry, Margaret Green, Susie Orbach and Tom Ryan at the Institute of Contemporary Art off Pall Mall in London to hear a first-hand report about the work of the Internationalist Mental Health Team in Nicaragua. Along with other politically concerned London psychotherapists we had heard by word of mouth that — unusually for post-revolutionary movements -- the Sandinistas were interested in mental health. We knew that the Sandinistas had been impressed by accounts of what had been achieved in Argentina and had invited exiled Argentinian psychoanalysts, then living in Mexico City, to make up a team to come to the city of León to help in the reconstruction of Nicaragua.
The meeting was crowded, lively, buzzing with optimism. Clear, straightforward descriptions of previous work at the Centre for Teaching and Research in Buenos Aires, details of the organization of the twelve-member Internationalist team in Mexico City, and outlines of the types of problems experienced by Nicaraguans in their postrevolutionary situation, including emotional withdrawal, anxiety and especially the widespread problem of frozen grief, moved us as we took in a tiny particle of what the Nicaraguan people had experienced in their civil war.
With the wisdom of twenty years of experience, team member Nacho Maldonado was careful to include in his account the many difficulties associated with the work, some of which were without historical precedent. Fifty years of terrorist rule by the ruling families of Nicaragua, led by the Somoza family, had produced many unusual practices. Foremost among these was the training of children in the arts of torture. When the Sandinistas came to power they inherited the problem of children aged seven to ten years old who had been trained by the Somocistas to pluck out the eyes of prisoners.
The problem of the rehabilitation of the child torturers of Somoza's Nicaragua is probably insoluble with present knowledge. Certainly an exploration with these children of the abuse they themselves may have been forced to endure would be a beginning. But the injuries inflicted on and by these children are the injuries of the entire century. Psychoanalysis has been called upon to treat the psychological consequences of the mess created by the social relationships of our time, as symbolized by the child torturers of Nicaragua. The twentieth century has created an urgent need for a therapy that can understand and treat injuries to the human psyche.
The history of psychoanalysis can be told in many ways. But in any telling there are certain markers in the historical timeline.
The first marker is the role of Sigmund Freud. Like all other aspects of human history, antecedents of the talking cure associated with the name of Sigmund Freud can easily be found — earlier in the century in moral cures practised by the medical profession, in the confessional practised for centuries by the Catholic Church, in literature, in practices in ancient Greece.
But tracing historical antecedents does not do justice to human originality. There are, after all, things that are new. Locating the roots of controlled heavier-than-air flight in the drawings of Leonardo da Vinci does not do justice to the achievement of the Wright brothers. There can be a kind of historical reductionism that weaves the threads of human activity into such a seamless web that one loses sight of those historical moments that are departures from, rather than extensions of, past human practices. Psychoanalysis is one of these.
Although it is true that genius is the mystification of accomplishment -- that is to say, that the overall movement of human history produced by forces greater than any single individual creates the necessary conditions for the new to appear — the new must nevertheless be created and is created by human effort. In the case of psychoanalysis, there is a uniqueness to Freud's contribution to the creation of a discipline devoted to the exploration of the human inner world.
A second marker is the roots of psychoanalysis in natural science. The presenting problem of psychoanalysis was to understand the so-called nervous diseases of the time — hysteria, phobias, obsessions and paranoia. The origin of the approach to treating these conditions by concentrated listening lay in the great unifying premise of nineteenth-century science, that the world could be understood. Freud, who came to the problems of mental health as a neuroscientist trained in one of the most prestigious laboratories of Europe, approached traditional medical problems from the perspective of basic research: to learn and understand. Freud's sensibility as a man who sought understanding struck a powerful chord in the sufferers of nervous diseases. For, as Freud came to realize, the symptoms in question were in fact messages that could not be expressed in any other way. The appeal of a dynamic psychoanalysis reflects our desire to make sense of ourselves, to be understood.
A third marker is the invention of the analytic hour. When Freud initiated the early theory and practice of psychoanalysis based on the use of concentrated listening to what sufferers had to say about their lives, a listening informed by a belief that symptoms could be made sense of if the listening were done carefully and at length, he created both a method for the exploration of the human inner world and a theory for understanding what one might encounter there. Among the lasting contributions of psychoanalysis to human knowledge and practice is the analytic hour — repeated listening sessions, not as an ancillary part of medical treatment as in a kind of extended bedside chat, but concentrated extended listening for the express purpose of understanding the analysand's experience of life.
Like the microscope and the telescope, the analytic hour is an instrument that opens up a previously unseen world. For what was discovered in the early years of psychoanalysis was that powerful, difficult thoughts and feelings came into view in hourly sessions repeated over long periods of time. The analytic relationship made possible the systematic exploration of what has come to be called the transference relationship between analysand and analyst. As Freud cautioned early practitioners in a famous paper published in 1916 — it may seem so, but it is not you that your patient is in love with.
A fourth and final marker is the splits that have accompanied the development of psychoanalysis. Like the physical outer world, the human inner world has a structure. Workers in the field have been attracted to different aspects of the structure of the inner world, leading to the great, publicized splits between Sigmund Freud, Carl Jung and Alfred Adler in Vienna in the years before the First World War. What is central to the history of psychoanalysis is not so much the content of the disputes — disputes occur in every field — but the fact that they could not be contained within the discipline. What the splits in psychoanalysis demonstrate, in painful detail, is that paradigm shifts do not occur simply but are accompanied by great personal stresses, rivalries and the divisive phenomenon of winners and losers, all set in particular historical circumstances which can act either to further or to inhibit the development of new understanding.
A single dominant theme connects the markers along the historical timeline of psychoanalysis. From its very beginning psychoanalysis has been undergoing a paradigm shift involving one great generalization about human psychology: the fundamental conflicts in the human inner world lie not in our seeking a reduction in tensions caused by unsatisfied drives but are associated with difficulties in satisfying a fundamental human need for relationship. The historical circumstances informing the playing out of the paradigmatic tensions between a drive-instinctual versus a relational point of view were the highly traumatic social events of war and revolution in Europe — the introduction of mechanized killing in the First World War, the failure of the German revolution of 1918, the failure of the Hungarian revolution of 1919 and the catastrophic counter-revolution associated with the name of Adolf Hitler. In the inter-war years psychoanalysis's centre of gravity shifted from Vienna and Berlin to New York and London. The tension between instinctual and relational points of view of human inner conflict then developed in two distinct strands, American and British. In America, an interpersonal approach to the most extreme forms of mental distress by a group of workers in Washington DC, amongst whom the name of Harry Stack Sullivan stands out, located the source of psychic pain in ruptured, non-existent or abusive relationships. In Britain, the powerful theory of object relations, associated originally with the name of Melanie Klein, who took psychoanalysis into the nursery to treat childhood terrors and anxieties, led to relationship failure being identified as the source of mental disturbance, as was later articulated by the Scottish psychoanalyst Ronald Fairbairn.
As important as markers and themes are to guide our way through a complex story, they can also be a diversion from the main point of the journey. The concerns expressed about the safety of psychoanalysis are not just about its objectivity and reliability. At another level, when we question the safety of psychoanalysis we are questioning how safe it is to be interested in the world of human subjectivity and emotion, a subject that, in the sexual division of labour in the West, has been primarily the concern of women. Part of the fear and hostility with which psychoanalysis has been received is due to the fact that psychoanalysis is the formalization of work historically done by women in the male-dominated societies of the West. Emotions and the subjective life have traditionally been the province of women. Women's work has included performing the unrecognized emotional labour required to facilitate, establish and maintain the human interpersonal relationships without which we cannot live. The old saw — women's intuition -- is a patronizing recognition of the sensitivity of women to the inner world of another's feelings. Our resistance to psychoanalysis — whether we are men or women — is in part due to our sense that what is being described is women's work, something, like the force of gravity, that we need not take notice of, unless of course we happen to fall. I have written this account as a guide to psychoanalysis, not only to show its strengths and weaknesses, but also to show just how interesting psychoanalysis really is.