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p. 1139. The struggle is not yet overlocked

  • Daniel Pick

Abstract

‘The struggle is not yet over’ provides further thoughts on the achievements, difficulties, impact, controversy, and possible political relevance of the analytic approach. Analysis is both an intensely private encounter and a public conversation that has by now gone on for more than a hundred years. Psychoanalysis—the talking cure—has been attacked for being unscientific, or worse a pseudo-science, but perhaps it needs to remain on the cusp of science and art. The field continues to evolve, open to innovation and development, not only in the consulting room but also in its other applications, such as therapeutic work in schools or with families and groups. Psychoanalysis is, in short, a continuing work in progress.

I started my professional activity as a neurologist trying to bring relief to my neurotic patients. I discovered some important new facts about the unconscious … [and] the role of instinctual urges. Out of these findings grew a new science, psychoanalysis, a part of psychology, and a new method of treatment of the neuroses. I had to pay heavily for this bit of good luck. People did not believe in my facts and thought my theories unsavoury. Resistance was strong and unrelenting. In the end I succeeded … But the struggle is not yet over.

So Freud told the BBC in 1938. In the same breath he suggested and undermined the notion that the status of psychoanalysis was settled. Did Freud succeed ‘in the end’ as he hoped and claimed? There will never be consensus, but in my view, in several senses, the answer is yes. I want to conclude with a few further thoughts, prompted by Freud’s radio interview, regarding the achievements, difficulties, impact, controversy, and possible political relevance of the analytic approach.

Freud created an important field; produced a remarkable body of writings; inspired innovations in culture, social theory, approaches to biography, and political thought; built up a flourishing if often fractious movement; encouraged many to follow in his tracks; and established astonishing new paths of clinical and theoretical inquiry.

p. 114Analysis was from the start applied both directly to patients and to social phenomena, offering new perspectives on culture and collective beliefs. Some analysts admittedly became incautious, for instance conflating minds, groups, and nations, or treating characters in novels and plays as though patients on the couch, with little attention to the genre or context of the works in question.

We can argue this the other way too, noticing how Freud’s real cases are artfully constructed, drawing on his great skills as a writer. He was steeped in the classics and his clinical accounts can be read as gripping stories. Many of Freud’s theories resonate with ancient myths and the stories and theatrical dramas that he held most dear. But the dramatic quality also owes much, no doubt, to the manner in which the patients concerned recounted their troubles, how they too shaped the messiness of life into compelling narratives, revisiting and reworking their own histories.

Freud’s BBC interview reminds us too that the dissemination of analysis is not confined to treatment behind closed doors, nor is it just the stuff of learned papers in professional societies: it is on the airwaves, in film, and now part of an ongoing conversation on Twitter, Facebook, and the rest. Elements of analysis passed into common language, as when people talk of themselves or others as being ‘in denial’ or ‘repressed’.

Analysis is both an intensely private encounter and a public conversation that has by now gone on for more than a hundred years. Many cases have been published and it is also possible to read the reminiscences of, or interviews with, former patients which offer their own windows on to analytic experiences. These contain their share of acute observations and painful revelations, appreciation and praise, disappointment and humorous anecdote. Among the most evocative is the American poet and novelist Hilda Doolittle’s Tribute to Freud, a record of her sessions in p. 115Vienna during the 1930s. She found the talking cure haunting, poignant, revealing, and a dramatically life changing experience.

Sometimes an ambivalent, quizzical stance towards analysis has been used to powerful literary effect. Freud’s writings were taken up admiringly, and also parodied by writers such as D. H. Lawrence. Among his engagements were appreciative but also wittily mocking essays on Freud’s unconscious after World War I. Virginia Woolf, whose brother became an analyst, read Freud avidly late in her life and her diaries are seasoned with a few glowing impressions and more scathing asides about analysts she met and observed at close quarters. Freud’s love of jokes and interest in puns were deftly trumped by James Joyce’s artful references to his methods. There was an added poignancy to the allusions too, given that Joyce’s daughter suffered serious mental illness. He wrote in Finnegans Wake of ‘we grisly old Sykos’, and a time when people ‘were yung and easily freudened’.

‘Now vee may perhaps to begin’ is perhaps the most widely known psychoanalytical line of all in American fiction. Thus did the hitherto silent Dr Spielvogel (author of a solemn essay on ‘The Puzzled Penis’) conclude Philip Roth’s Portnoy’s Complaint, one of several notable post-war novels that take readers into the consulting room.

Images of analysts and patients in comedy and cartoons, especially in New York (and The New Yorker), or on television series (think of The Sopranos or In Treatment) would merit a book in their own right, as would the jokes that have featured in psychoanalytic writings or been directed back at the talking cure. Two will have to suffice: in the first, savoured by Freud, there is a married couple, one of whom says to the other: ‘When one of us dies, I shall move to Paris’; in the second, following the death of his analyst a patient remarks to a friend: ‘I would have gone to the funeral but he would have charged me for the session’.

p. 116Countless films revel in allusions to Freud, use the toolkit of analytic concepts, and/or satirize claims about the efficacy of the talking cure. Hitchcock’s Spellbound (1945), with its dreamscapes by Salvador Dali, set the stage for the post-war Hollywood love affair with Freudian thought. Consider in turn how Žižek reinterprets and affectionately sends up the Freudian Hitchcock in his popular film A Pervert’s Guide to Cinema. He places himself back on the water in the opening of The Birds, and even suggests that the layout of Psycho may be understood as a vision of the three-part Freudian mind. On the first floor, the ferocious (dead) mother—no father in sight—berating Norman Bates: this is the superego; on the ground floor, the reception area, where inner and outer worlds meet: the ego; in the basement, a terrifying cauldron of surprises: the id.

‘Resistance was strong and unrelenting.’ In a provocative argumentative manoeuvre some analysts, including Freud, have suggested that much public criticism (philosophical, literary, historical, religious, or scientific) could be discounted as merely the protestors’ ‘defensive’ strategies against discomforting psychoanalytic insight. There may often enough be elements of truth in such ‘diagnosis’: Freud himself had indeed sometimes encountered knee-jerk resistance when he first set out his ideas, but according to analytic theory itself we are all bound, to some degree, to resist. This diagnostic approach to cultural critiques of analysis has led—understandably—to all the greater complaint: as though it might suffice for the analyst to interpret hostile motives, and be spared the bother of the critique itself. Some even turned the tables, suggesting here the analyst was defensively in search of bulletproof cover for his own assumptions and unargued beliefs.

If some criticisms of Freudian ideas or the analytical movement may be moralistic, crass, even hysterical, others are more troublesome to practitioners; certainly not all can be loftily dismissed as just ‘defensive’. Among the most interesting challenges are some observational studies by social scientists that have described the internal workings of analytic groups and societies. p. 117Ernest Gellner’s mordant exploration of the profession is among the most famous. These inquiries have noted the degree to which the Freudian institutions acquired features of orthodoxy, redolent of religion, even as they analysed as illusory such tendencies elsewhere. A number of Freud’s writings, such as Totem and Taboo, Group Psychology, and Moses and Monotheism, can also be seen as, among other things, oblique commentaries on the psychodynamics of the analytic movement itself.

It will always perhaps remain a contentious matter how far analysis should remain spontaneous, free, even ‘romantic’, in its creative aspiration; and to what degree codified, regimented, firm about technique and training, and insistent upon policing its boundaries. Many critics noted the irony when analysts, so probing in their accounts of the unconscious craving for authority, created requirements in their own organizations of rigid hierarchy and sometimes blinkered allegiance. One prominent analyst in America has referred to some current rigidities over training and other matters as akin to an institutional ‘suicide note’. The analytic communities, various observers point out, are never short of rituals and devotional practices. The psychiatrist and writer Robert Jay Lifton, in a 1961 book on political ‘thought reform’ in Mao’s China, touched in passing on an analytic institution in which he had started clinical training. He referred pointedly to ‘milieu control’, ‘the supremacy of doctrine over experience’, and ‘sacred language’.

Looking to Britain, I’d argue that analysis benefited in several ways from its relative autonomy from other institutions, its independence from the medical profession, and its separation, for the most part, from the universities. But this very freedom of manoeuvre risked insulating and marginalizing the analytic community too. Sometimes analytic edicts were strikingly rigid, as when, in the 1930s, candidates were told they had to choose between working at the more publicly orientated and methodologically eclectic Tavistock Clinic in London and pursuing the more rarefied ‘pure’ analytic tradition championed by the British p. 118Psychoanalytical Society (a requirement that Bion, among others, then notably defied).

In fact, many practitioners have managed to work effectively in dual settings, for instance in public health facilities or university departments. Thereby they could debate their claims with colleagues who use other methods of inquiry and of treatment; in this way analytic work could be disseminated and be made more open to revisions and critique from outside.

Analytic ideas about anxiety, defensiveness, denial, and enactment have value in the exploration of analytic institutions, and in probing the structure and unconscious interactions that occur within other professions too. Analysts have undertaken important studies for example of the often difficult emotional experiences of nurses, and investigated the ways they may find themselves routinely treated by doctors and managers in health services. They have also looked at what can go right—and wrong—in the practices of policing and of social work.

Not only in the ‘caring professions’, but also in industry, business, and the sciences, analysis has played a part in exploring the factors that facilitate creative, thoughtful work, or that destroy cohesion, that enable reality testing or delusional beliefs, that lead a group to spot dangers and intervene to deal with a crisis, become excessively alarmist, or, worse still, turn an insistently blind eye to the most harrowing human suffering.

The child psychotherapist Margaret Rustin well describes psychological, political, and interpersonal factors that led many professionals to fail to act upon evidence of the mortal dangers facing an eight-year-old child Victoria Climbié before she was murdered by her guardians in London in 2000, despite coming to the attention of the authorities many times. The case had attracted wide notice and precipitated a public inquiry. Rustin drew upon psychoanalytic ideas to show how and why it was possible for so p. 119many participant observers (doctors, social workers, teachers, police) in effect to refuse to see this horror, as is the case in many other comparable unfolding tragedies.

‘Important new facts … a new science.’ Freud certainly viewed and wanted it thus. To find himself exchanging letters in 1932 with Einstein on the subject of war and psychology, or six years later honoured by august scientists from the Royal Society, was for him far more important than avant-garde enthusiasm for his Interpretation of Dreams. Freud sought recognition, but tended to be unimpressed by the popular exploitation of analytic ideas, already so evident in interwar Europe.

One can only wonder what Freud would have made of a post-war buzzword such as ‘shrink’; it is hard to believe he would have accepted it without interpreting the animus and fear it contains. An invitation Freud received in 1925 to collaborate on an American-financed film about Antony and Cleopatra left him cold, despite large promises of cash. He was equally underwhelmed when courted by artists such as Dali. Some of his colleagues however, including Karl Abraham, collaborated on films such as the silent German drama Secrets of the Soul (1926) directed by Georg Wilhelm Pabst.

With the spread of analytic ideas and societies came new rounds of criticism. Some attacked the talking cure for being unscientific, or worse a pseudo-science; for sapping the will, encouraging moral turpitude, or again for fostering rather than exploring and challenging narcissism. Freud had always made claims for analysis as a science, and this has laid it open to frequent attack. A caricature has it that the session is necessarily a catch-22 world, in which objection or disagreement by the patient is interpreted by rote as a defence against the truth of the analyst’s certain interpretation.

The most influential version of the ‘heads I win, tails you lose’ critique came from the philosopher Karl Popper: although he p. 120admired Freud in part, he also argued that psychoanalysis was not scientific because it could never be ‘falsified’. Scientific experiment, he claimed, presupposed the possibility of another scientist devising a means of showing that the first’s hypothesis was not right.

Too often however, worst cases of analytic theorizing or practice come to be taken as the norm. Coercive or circular forms of persuasion—in writing, teaching, and in the consulting room—are certainly possible, but not in my experience necessary, still less inevitable, outcomes. Analysts with appropriate integrity are open to alternatives, seeking to remain aware they may not have understood, or to consider whether the treatment is helpful; their interpretations are best regarded as openings to investigation, not the last word. Even if the analyst interprets accurately, there is the further question about whether the timing is useful and bearable to the patient at that moment.

Debates about whether analysis is a science or not may also largely miss the point: its multiple contributions, clinically and culturally, need not ultimately hinge upon such verdicts either way. But before dismissing analysis as necessarily an unscientific procedure, you would need to ask yourself what alternative, more rigorous method might serve as well as this, in order to explore subjective experience and unconscious processes of the kind described in these pages. For at stake here is not the kind of knowledge you can glean from a brain scan, a treatise on philosophical logic, or questionnaire. Perhaps analysis needs to remain on the cusp, aiming at rigour, open to the complication, even falsification, of its own truth claims, while concerned above all with creativity and effectiveness along the lines of an experimental craft or art.

Idealization of analysis is as possible as demonization, and can also be damaging. As the ever more popular Pope Francis quipped in 2014 in response to the phenomenon of ‘Francescomania’: ‘Sigmund Freud used to say … that in every idealisation there is an attack’ (as quoted in the Guardian, 6 March 2014). He may well p. 121be the first leader of the Catholic Church to make use of Freud so directly in an interpretation of the excesses of devotion to a man, or a cause, and the possible aggression behind it. Ambivalence, according to Freud, is likely to be aroused in all of us by analysis itself, and those who profess only their undying love of the talking cure would of course also be suitable cases for its treatment.

Freud’s desire was to shake up the way we habitually think, hear, and see, and to insist on treating phantasy and dreams as central to our lives. He was also ever determined in his attempts to seek psychic roots, and provide new routes to the study of the unconscious. His cases, it has been said, had certain affinities with the genre of detective stories, which also came of age in the late Victorian period when analysis was invented. Some have likened Freud to a Sherlock Holmes, connoisseur of overlooked clues. Freud also compared himself to a conquistador.

But as the original circle of devotees expanded, and analysis developed into a more formal empire of knowledge, something of the early, buccaneering spirit was lost. Like other professional organizations of worldwide scale, psychoanalytic institutions inevitably and in many ways necessarily tightened up as they moved from an early exploratory phase to a more settled stage of development. Very few clinicians within the field, admittedly, have even a trace of Freud’s genius for writing, and none have matched the boldness of his experiments in both thought and practice. Nonetheless the field continues to evolve, open to innovation and development, not only in the consulting room but also in its other applications, such as therapeutic work in schools or with families and groups. Analysis is, in short, a continuing work in progress.

‘Experience has taught us that psycho-analytic therapy—the liberation of a human being from his neurotic symptoms, inhibitions and abnormalities of character—is a lengthy business’, Freud remarked in 1937 in one of his final essays, ‘Analysis Terminable and Interminable’. Part of the problem was indeed the p. 122time the work takes. Freud celebrated what analysis made possible, but also seemed troubled by the puzzle of why deeper psychic change can be so slow moving, and how in some cases symptoms or other serious life difficulties returned to afflict previously treated patients. There may well be a constant struggle, as recent analysts have suggested, between the desire for psychic equilibrium and for change.

Typical analyses grew longer in the course of the 20th century. Now, however, the reverse may be happening. The time-consuming form of classical analysis has placed it on a collision course with the ever more hectic circumstances, and the predominant values of speed in our contemporary age. We live in a culture and economy that assumes, clamorously, the case for endless ‘growth’, and that measures its ‘results’ on the narrowest of terms and with the shortest of timescales. True, there is much to be said for administrative efficiency, and, not least in the health service, for minimizing waiting lists or auditing the successes and failures of professional service providers. Pressure to reduce delay and test cost effectiveness has become, understandably, ever greater in these financially straitened times. But speed of delivery has also become for many an unquestioned value in itself. The Internet no doubt feeds into this, encouraging us to expect an instant response to any of our questions, with demand met by supply in split seconds.

Many service users even in relatively well-organized health systems such as Britain’s, report their impressions that less and less regard is paid to the human experience and quality of care, with insufficient time allowed to provide much by way of human contact. A culture of ‘targets’ has too often neglected the psychological element—for example the importance, where possible, of seeing the same person continuously over time, not just being assigned an interchangeable, anonymous doctor. Bed-ridden patients may benefit too from a few minutes talking with a nurse, who is not simply undertaking a designated function p. 123and speeding past ‘efficiently’. (This tendency is apparent in many other fields too: note how school children’s and their teachers’ time is ever more accounted for, in the UK at least, with what often seem deadening and endless tests.) Supposedly ‘slack’ time out of which new ideas can emerge may now be dismissed as unaffordable, a luxury, or the preserve of ‘losers’.

Some critics of analytic psychotherapy, including various prominent gurus of modern ‘happiness’, suggest that a short course of CBT suffices anyway to get the show back on the road, and insist that the longer-term therapies, and the entire notion of the Freudian unconscious, can be consigned to the dustbin of history. Clearly in most public health facilities it is highly unlikely that the classical, open-ended approach that Freud pioneered will ever be possible when resources are so scarce. But analysis seems to be reviled and at risk of being removed even from the small spaces it had previously occupied within health services, precisely because it may invite us to question the very framework within which we are operating.

Certainly analysis requires that we pause and allow space for second, or third, thoughts. And in its basic ethos perhaps it stands out too against a culture that values human inquiry, education, or social investment only by the next quarterly profit figures. Moreover, it offers a way to think about the defences that exist against facing the mutual dependency that is a fact of life for all of us. To contrast with Bion’s psychotic clockwork man, whom I described in Chapter 7, it might be worth recalling Herbert Marcuse’s vision of a more pervasive and ordinary modern impoverishment, captured in a book he entitled One Dimensional Man.

Meanwhile, in recent decades various scholars have devoted great energy to the compilation of ‘black books’ on all that has gone awry within the analytic profession since Freud invented the procedure. The list is certainly not short. But the question of the continuing relevance of psychoanalysis is far from a settled p. 124argument. Even within contemporary neuroscience, there is a resurgence of interest in and support for Freud’s models of the mind, a renewed wish by some to marry the disciplines, thereby belatedly fulfilling Freud’s own desire that these fields would one day converge. But one might also argue that there should be no cause for lament if analysis retains its particular edge and focus, without too anxiously seeking to amalgamate itself with other modes of thought or science.

There is no space here to delve further into such loaded terms as ‘outcomes’, ‘happiness’, ‘fulfilment’, or ‘improvement’, let alone ‘cure’. Of course there is some value in seeking to test therapeutic methods, so that a patient with bipolar symptoms, an eating disorder, an obsessional compulsion, or acute depression is appropriately referred for treatment to this specialism or that. Yet we must also recognize that clustering patients into groups, defined by symptoms, might easily draw us back towards the terrain of an old psychiatry, and its questionable classificatory schemas where people tend no longer to be viewed in their complex individuality.

In fact a lively debate is in progress, and trials, and scrutiny, of ‘outcomes’ are now in full swing. CBT is by far the most widely tested method (in part because its advocates have for decades tended to be enthusiasts of such empirical testing in the first place). And as a recent study What Works for Whom? warns: ‘In the worst case, we could arrive at a monoculture in which CBT became eponymous with evidence-based practice.’

We would need to ponder further the question of what analysis is best served to do, before instantly giving an answer to how it might be ‘tested’. A movement of ‘anti-psychiatrists’ led by R. D. Laing pointed out over fifty years ago that to measure the success of a method by its capacity to adjust the putatively mentally ill to a ‘mad’ realm outside, in the polity, or in the family, begged the very questions that most urgently needed asking. While I would argue, p. 125unlike some of those anti-psychiatrists at their most combative, that there is indeed such a thing as mental illness, I would endorse their view that neither analytic work, nor for that matter psychiatry, nor any other form of therapy, should be there to manufacture conformity or, like some World War I shellshock doctors, regard cure to mean simply the presumed fitness of the patient to return to active service in the trenches.

Well may we lament in our own time the facile and pernicious reduction of the human being to Homo economicus, and rail against the short-termism of most dominant contemporary forms of political thought. Psychoanalysis has long been an important part of the toolkit in the study of political ideology; it may be as potentially useful in considering denials of greed and aggression in utopian communism as the murderous paths of fundamentalist, fascist, or totalitarian fervour; and it may also help illuminate the complacent occlusions of reality that are required in states of liberal cynicism or self-congratulatory capitalism as well.

To understand how politics and psyches interact, we cannot bypass the realm of phantasy and the role of defences. Of course, particular and powerful material interests knowingly bend truth, for instance employing manipulative lobbyists to throw dust into our eyes, to foster avarice, or to justify cut-throat competition and a ‘winner takes all’ mentality. But a propensity to myopia and a tendency to wishful thinking are all too easily stirred up, because, as Freud showed, there is much we all may prefer, quite actively and insistently, not to know, even when the means of knowing are available. Manic and omnipotent states of mind can exist, analysis suggests, in all of us. One can see as vividly in the consulting room as in the political arena, for example, how awareness of vulnerability can be denied, or the capacity to protect and nurture a viable, liveable future mocked, dismissed, or trivialized.

A myriad of factors, to take a pressing example of global import, now converge to threaten environmental havoc. Many communities, p. 126even entire states, are in jeopardy, to say nothing of the threat of extinction for numerous other species across large areas of the planet as the climate continues to change. Psychoanalytic thought is no substitute for practical struggles for greater social justice or for a different economic settlement. Yet analysis has a valuable contribution to offer in examining how we may opt to avoid considering even the possibility of other ways of living, or facing square on, ‘an inconvenient truth’.

Suffice to say here that analytic thought may yet have some role to play in such urgent political debates, and in challenging what passes, individually or collectively, for the given ‘order of things’. Certainly psychoanalysis remains an important antidote to the current assumption that quick fixes, personal or political, are always good value. Perhaps the analytic method might even be compared to the return of the slow food movement in the age of the Big Mac.

Mournful or gleeful obituaries have existed almost as long as psychoanalysis. And I am far from the first to insist that these requiems to the talking cure should invite the same dry response as Mark Twain’s: ‘The report of my death was an exaggeration.’