Review - Why Psychoanalysis?
by Elisabeth Roudinesco
Columbia University Press, 2002
Review by Adrian Johnston, Ph.D.
Feb 20th 2002 (Volume 6, Issue 8)

            Few people need reminding that Freudian psychoanalysis, a little over a century after its invention, finds itself in a perilous position.  In the current age of pharmacology, where the treatment of various “maladies of the soul” (to borrow a phrase from Julia Kristeva) is conducted primarily through approaches dealing directly with the physio-chemical materiality of the body—this emphasis on the biological dimension of mental illness is itself a product of a complex convergence of numerous social, cultural, historical, and economic factors—analysis not only risks seeming obsolete, but perhaps even fraudulent and fundamentally flawed in terms of its most basic assumptions.  Psychoanalysis costs too much; it takes too much time; it doesn’t address the underlying physical causes of the pathologies it treats; it has no guarantee of objectivity, allowing its practitioners to offer arbitrary, specious interpretations of patients’ sufferings; it seems unable to produce curative results that can be registered at the empirical, experimental level; it fails the Popperian test of scientificity, operating as an unfalsifiable doctrine.  Furthermore, apart from these objections issued by the scientific and medical communities, various critics deplore the deleterious effects of Freud and his ideas upon humanity’s self-conception and the patterns of concrete practices stemming from such a conception (one need only recall Jeffrey Masson and the “seduction controversy,” as well as many feminists’ long-standing hostility to Freud).  Given this onslaught of arguments against the Freudian field, can anything meaningful and convincing be said in defense of psychoanalysis?  Does analysis still have legitimate claims to a place amongst the various techniques for diagnosing and curing mental illness?

            Elisabeth Roudinesco, an analyst and a historian of Freudian thought, thinks that psychoanalysis not only can and should defend itself from these attacks, but that an adequate justification of analysis involves going on an aggressive counter-offensive against the assumptions about human nature tacitly informing the standpoint of its critics.  Contrary to what one might expect at this point, Roudinesco doesn’t dogmatically deny the efficaciousness of drugs in alleviating the intense pain of psychological pathologies.  She is fully aware that pharmacology has invented a wide range of chemical substances that enable many people crippled by debilitating conditions to quickly become reintegrated as functional participants in the quotidian universe of the social order.  Instead of spending years on the couch, individuals, with the help of little pills that can be readily dispensed at the wave of a pen over a prescription pad, are able to modify the electro-chemical activity in their brains so as to stifle pangs of anxiety and dissipate the thick, gloomy fog of depression.  So, what is psychoanalysis useful for in light of the availability of these modern advances in scientific psychiatry made possible by the increasingly skillful and direct manipulation of the body?

            One of Roudinesco’s primary theses, constituting the core of her passionate defense of Freudian psychoanalysis against its medical establishment opponents, is that the heavy reliance upon chemical substances as a means of coping with mental illnesses is a symptom of a “depressive society,” a manifestation of a collective refusal of people to ask why, in each instance, they suffer from specific problems.  Two examples involving widely-prescribed drugs immediately come to mind:  Prozac supposedly renders investigations into the contextual precipitates of depression relatively superfluous, and Viagra allows men to avoid the awkward, uncomfortable task of inquiring into the life historical origins of their impotence.  In short, the triumph of pharmacology over psychoanalysis represents the eclipsing of “Why?” by “How?”—queries as to the experiential reasons/origins playing an influential role in the formation of pathological personality structures are ignored and replaced by a pragmatic agenda concerned solely with “getting results,” with making people “happy” by promptly silencing the complaints they bring to the doctor’s office.  The major problem with this, from a psychoanalytic standpoint, is that materialist medicine thereby addresses superficial effects often without tackling deep-seated causes.  So, if Freud is indeed correct about the cunning machinations of the unconscious in terms of its ability to weave repressed content into the fabric of daily life, then a failure to uncover such content is in danger of interminably flattening lumps in the proverbial carpet (with each flattened lump rising up elsewhere in a perpetual process of displacement). 

However, instead of engaging in a simple-minded procedure of assigning blame for this state of affairs (for instance, speculating about vague conspiracies on the part of the medical establishment), Roudinesco portrays the ascendance of a thoroughly biologistic portrayal of human nature, especially as the theoretical cornerstone of modern mental healthcare, as a widespread, general cultural trend.  Saying that psychiatrists and psychologists alone are entirely culpable for reducing patients to the status of mere bodies to be tinkered with is obviously untenable—as Roudinesco points out, contemporary patients themselves insist on being treated this way, demanding that their psychical problems be handled as strictly somatic dysfunctions (hypochondriac-neurotics are experts at acting outraged and insulted when someone dares to even insinuate that their problems aren’t of a physical sort).  Not only do today’s doctors tend to diagnostically favor somatic factors, but, in a reciprocally reinforcing manner, their patients generally expect them to do so too.  Furthermore, in (capitalist) societies placing a premium on the speedy and efficient dispensing of services, including medical care, construing all forms of suffering as situated in the body, rather than seeing mental pathologies as frequently the result of tangled, messy knots of experiential-historical difficulties, has a clearly comprehensible appeal.  This reassures and assuages the anxieties of patients and doctors alike, holding out the promising that a quick remedy (namely, a prescribed pill) can potentially be found to eliminate the troubling symptoms.  And, this materialist approach to psychical maladies functions to vindicate insurance companies in their increasing dismissal of longer-term, less “cost efficient” forms of treatment such as therapy and analysis.

Apart from criticizing medical materialism, Roudinesco also takes to task social constructivist theories and therapies dealing with the psychical subject.  In her view, blaming all of an individual’s mental problems on his/her gender, ethnicity, or socio-cultural background is just as reductive and dehumanizing as maintaining that his/her experiential being is an epiphenomenal residue of a thoroughly corporeal condition.  It quickly becomes clear that, for Roudinesco, what ultimately deserves condemnation is any form of determinist depiction of human nature.  The tactic of transforming the subject into a puppet whose strings are pulled by the body and/or a cultural milieu must be resisted.  And yet, isn’t Freud the epitome of a committed determinist?  Doesn’t analysis fundamentally assert that the individual is controlled and manipulated by a plethora of obscure forces issuing from the hidden realm of the unconscious?  How can Freudian analysis, in which the conscious ego appears to be enslaved to the savage and capricious id, be said to preserve an alternative to the prevailing versions of determinism offered by contemporary psychology and psychiatry?

Roudinesco explicitly situates psychoanalysis within the legacy of the Enlightenment and its overriding emphasis on autonomous subjectivity, a subjectivity that refuses being reduced to a mere aggregate of contingent, empirical features (such as bodily functions and socially conditioned attributes).  She makes a few cryptic proclamations about the freedom possessed by the psychoanalytic subject:  for example, “The Freudian subject is a free subject, endowed with reason, but a reason that vacillates inside itself” (pg. 53), and, “The Freudian unconscious rests on a paradox:  the subject is free but has lost the mastery of his or her interiority, is no longer ‘master in his own house,’ in the well-known formula” (pg. 56).  These propositions about analytic subjectivity are absolutely crucial for the persuasiveness of this volume.  Roudinesco must succeed in showing not only that there are serious problems with the reigning deterministic approaches to psychical suffering, but also, if she is to answer the question posed by her book’s title, that psychoanalysis, in its unique specificity, is the sole viable alternative available as a plausible paradigm.  Otherwise, a critic could easily and justifiably twist the sense of her guiding question—Why psychoanalysis, indeed?

And yet, despite the importance of explaining the manner in which the subject of psychoanalysis, unlike the brain of materialists or the identity of social constructivists, possess at least the potential for freedom, Roudinesco allows this matter to languish in a rather obscure state.  She does, however, scatter a few hints throughout her chapters (with echoes of Marx and Foucault frequently reverberating throughout the pages).  In fact, one could argue that, with sufficiently sympathetic squinting on the part of the charitable reader, the outlines of three separate theses concerning the autonomy of the metapsychological subject are faintly sketched here: one, the subject’s sexuality, as understood via Freud, is neither naturally inflexible nor socially bound, so the influence of sexual undercurrents in psychical life cannot be understood according to traditional ideas about (natural and/or social) deterministic factors;  two, the conflictual fault lines dominating the landscape of the Freudian psyche, a domain in which the placid inertia of a homogenous stasis is unattainable, make possible openings in which an escape from the cerebral automaticity of harmoniously functioning gray matter can be achieved;  and, three, the subject’s capacity for self-reflexive examination and comprehension of its own unconscious represents its actual, attainable freedom (analysis therefore serves to shepherd the individual towards the dawning of a greater awareness of his/her unconscious dimension[s]).  The first two claims would, in essence, articulate prerequisites for the third assertion—psychoanalysis can, through the course of each clinical engagement, potentially unveil an autonomous subject precisely because the individual it concerns itself with isn’t an instinctually governed creature of nature ruled by a smoothly operating cerebral apparatus.

Grounding the origins of the subject with reference to an idiosyncratic, denaturalized libidinal economy, coupled with the idea of a fragmented psyche in which oscillations occur between its heterogeneous facets (i.e., in which no function/sector attains absolute cognitive hegemony), allows the Freudian field to harbor a vision of human nature in which concrete meaning can be lent to the word “freedom.”  At this juncture, a surprising reversal of received wisdom about Freud is necessary:  rather than disseminating a bleak, “depressive” doctrine in which the flesh-and-blood person is stripped of freedom in being submitted to the domination of a tyrannical id, psychoanalysis is one of the few remaining theories where one can still speak of something akin to genuine “subjectivity” in the traditional sense.  Perhaps what Roudinesco is trying to convey is that psychoanalysis is the only contemporary discourse on the psyche that hasn’t broken with the Enlightenment project, refusing to fully abandon the modern motif of a subject irreducible to the automaticity of either nature or culture (thus, somewhat surprisingly, Freud stands as a bulwark against “postmodern” nihilism).

As the book draws to a close, Roudinesco, after having made her case in defense of analysis, sees fit to briefly take stock of the situation of psychoanalysis as an institution.  Having already portrayed the bio-materialist paradigm as utterly dominant at an almost global level today, she is consequently forced to concede that analysis itself remains far from untouched by this paradigm’s pervasive influence.  For instance, Roudinesco claims that individuals seeking to be trained as future analysts often approach the process with an impatient desire for rapid results characteristic of pharmacology’s clientele.  They thus have trouble submitting themselves to the protracted strictures of the transference, balking at the significant commitment of time (and, also, money) demanded by psychoanalysis.  Hence, doubts about whether many new analysts have been fully and adequately analyzed are worth raising.  And, more generally, Roudinesco expects that analysands (analysts-in-training as well as suffering patients) will display an ever-increasing inability/refusal to follow the analytic process through “to the end,” treating their analysts like pills to be taken only when a problematic symptom becomes painfully acute.  Instead of pursuing, through sustained interpretive labor, the fundamental unconscious determinants of their subjective positions, analysands nowadays are likely to exert a subversive influence on analysis precisely by using it as if it were a materialist-style mental medicine packaged and marketed with the instant-gratification consumer in mind.  It remains to be seen whether psychoanalysts will go along with this subversion.

What’s more, as part of her concluding assessment of the internal condition of psychoanalysis, Roudinesco also notes that psychoanalytic institutions heavily favor a professionalization of analytic practice.  Maybe in order to compete with allure of psychiatrists as supposedly scientific practitioners—one should recall that Freud himself betrays anxieties about whether psychoanalysis can achieve “legitimate” status as a science akin to the natural sciences—analysis tries to cultivate the appearance of being a mental health profession in terms recognizable by the general public.  Consequently, training institutions promote a certain model of the analyst, one that, as Roudinesco puts it, encourages “the effacement of the figure of the master” (pg. 130).  In other words, trainees are discouraged from attempting to emulate the originality and speculative daring of the psychoanalytic founding father (Roudinesco maintains that Lacan’s 1963 “excommunication” from the International Psychoanalytic Association wasn’t just because of the technical-clinical issue of his variable-length sessions, but, in a larger sense, because, through his teachings, he displayed the audacity of directly assuming the forbidden position of the “Socratic master” as occupied by Freud).  The idea, it would seem, is that by regularizing and normalizing the practice of analysts, institutional psychoanalysis will avoid looking like an arbitrary, unscientific exercise conducted via the inspired improvisations of adherents to a loose set of metapsychological tenets.  However, the risk is, of course, that by desperately trying to save face this way in the eyes of potential patient-customers, psychoanalytic institutions might choke off sources of creativity essential to the vitality and well being of psychoanalysis as a worthwhile theoretical discipline (as well as a flexible, dynamic clinical practice capable of adapting itself to the challenges posed by the changes in the types of subjects it encounters in its day-to-day applications).

Roudinesco declines to extensively speculate about the long-term future of psychoanalysis, leaving readers to wonder whether Freud’s thought will survive as a living discipline... or whether it’s doomed to whither and become a textual-cultural corpse to be picked over by historical scholars.  In a sentence evocative of the concluding lines of Michel Foucault’s Les mots et les choses, she closes her book by wondering if, “the farcical image of behavior-modification man might well disappear, like a mirage dreamed up by the desert sands” (pg. 143).  The overall grimness of the prognosis for psychoanalysis laid out by Roudinesco’s text leaves one with the impression that this final remark might express merely wishful thinking, a vain hope that, against all of the odds stacked against it by a plethora of obstacles and opponents, psychoanalysis will survive.  Written in an accessible style and designed to persuade non-specialists of the Freudian field’s validity, Why Psychoanalysis? merits perusal by all those who have any stake whatsoever in mental healthcare.  Unfortunately, the danger is that Roudinesco is stuck preaching to the choir, simply persuading those who already believe that Freudian psychoanalysis should continue to play an active, significant role in the paradigms and practices of treating psychical suffering.  This raises some urgent questions, ones which analytic thinkers absolutely must contemplate:  How does one respond to critics who have already completely dismissed one’s position?  By what means can one disseminate a defense of an entire discipline that might have already lost its audience?  Can psychoanalysis cooperate with and adapt itself to other approaches in psychology/psychiatry without, for all that, compromising its basic, fundamental principles, without either inadvertently or voluntarily destroying its theoretical integrity?  Roudinesco mentions the figure of the Socratic master:  at least Socrates, when tried and condemned, had the chance to publicly defend himself against his accusers; and, at least somebody bothered recording his defense for the benefit of posterity.  A much sadder possibility confronts psychoanalysis, namely, a neglected demise in which only its adherents hear its death throes.  One hopes otherwise.

© 2002 Adrian Johnston

Adrian Johnston recently completed a Ph.D. in Philosophy at SUNY Stony Brook. His dissertation was Time Driven: Metapsychology and the Splitting of the Drive.