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.

Categories: Psychoanalysis

Tags: Psychoanalysis, Psychotherapy