Psychoanalysis as the story of a crisis
[Paper presented on June 10, 1990, at the Annual Meeting of the Rapaport-Klein Study Group]
I thank dr. Eagle and the other colleagues for inviting me to this meeting. This opportunity represents to me one of the most beautiful moments of my life as a scholar. It's like "coming to the Temple," since David Rapaport's works and the myth of Austen Riggs Center have always been a point of reference in my intellectual and scientific education. Since the mid 1950s, after my degree in Medicine, I started to be interested in psychology and psychoanalysis, and I discovered Emotion and Memory (1942) when I was doing a research on Korsakow Syndrome. The methodological consistency of Rapaport's thinking are a point of reference to me, even today. My reading of the transcription of his seminars, in the version edited by Miller, made me familiar with his collaborators, who were not Gill, Holt, and Schafer, but became known to me as Merton, Bob, and Roy, as he used to call them when, with severe attention, he was asking the maximum of precision for every single concept that was made explicit. I envy those of you who have listened his "yes", or "that's right", or even the terrible "wrong."
I introduced Rapaport's works to Italy, where they appeared in the
series of books of psychiatry, psychology, and psychoanalysis, that I
direct, of the publishers Feltrinelli (Milan) and
(Turin). It has been like paying a debt of gratitude. No opportunity
of international work has meant to me what it means to be here today
with you. The "memory" of my "emotions"
is all here, while I try to give you an acceptable form to the line of
thinking I am trying to present.
As we know, the heart of Lacan's argument centers on a return to Freud, but his return to Freud indicates a return to a "real" Freud, Freud as the prophet of the Other, as the prophet leading diversity back to the Unity. The unity of Idea and Representation is placed outside the bounds of real contradictions, with the consequence that Lacan's founding psychoanalysis in language leads to the "full" word, and to the unconditioned desire as the subject of the "Truth."
In point of fact, the implied revaluation of the subject in the name of the unconscious and of its desires leads to a form of subjectivism without history: the history of the subject is only the history of the deformations that have occurred in as much as it is impossible to transmit the Idea in its integrity. In the case of Lacan, the problem has been solved in a philosophical and ontological standpoint. This is the ultimate risk run by all those perspectives that have attempted to solve the "problem" set by psychoanalysis by adopting a semantic approach.
Some methodological considerations
I also wish to draw your attention to the implications of fundamentally analogous stances which, however, stem from different and rather heterogeneous conceptions that nevertheless fall into the mainstream of psychoanalysis, and which adopt an ontological stance to solve the problem of motivational drive while claiming to remain on an exclusively clinical level. I am referring here to the unitary and a-historical conception of the ego in Fairbairn, which pushes the point of view of object-relations to its extreme consequence; to Winnicott's nuclear and a-historical "real self"; to conceptions which, even on a strictly clinical level, consider the ego to be simply an apparatus which is the product of historical deformation (even some of the implications of Kohut's thought lead in this direction); to Jung's postulate of the collective unconscious, which is extremely similar to the primary fantasies of the Kleinians and post-Kleinian authors. It is not a chance event that the speculations deriving from these positions lead to an ontological stance on communication, whose roots lie in grammar, mathematical style formulations, or the identification of original codes which are even postulated as being genetically endowed.
The next step in my argument is to propose a return to Rapaport. This bold statement is to be interpreted as meaning a return to a method of critical analysis, by means of which all the implications, even the most recondite, of every hypothesis or conceptual model are made explicit, and which encompasses all the aspects and stages of scientific investigation, integrating them into a single linear continuous process: from the observation of the "thing", to the transformation of the thing into an object of knowledge, the construction of the scientific universe of the discipline, the establishment of intersubjectivity as an object of knowledge, an opposition to any form of solution to problems which contemplates the "non-contradiction" of empiricism.
Following this path enables us to verify the limits of scientific objectivism and paves the way for a discipline called psychoanalysis, which is not "decided on" by other disciplines but which keeps undauntedly to its own path of insecurity and of "undecidability." Seen in this light, a return to Rapaport does not mean interpreting his line of thought only as an attempt at constructing a systematic theory of psychoanalysis or as the careful deciphering of the implications of the various points of view existing in psychoanalysis: if we were to restrict Rapaport's contribution to this limited perspective, then the criticism of neo-aristotelianism and neo-rationalism leveled at his work would be justified. If, however, we interpret his modus operandi as the constant practice of describing "what is there" in order to identify the place occupied by "what is not there", then we are fully justified in claiming that we have entered the operative sphere of negative dialectics.
The proposal of a tertium datur by definition avoids the logic of non-contradiction. What can be defined as rendering redundancy explicit, in order to recover entropy when couched in the language of information theory, means - when formulated in the terms I have expounded - maximizing the reins of rationality in order to comprehend the significance of the word "reason" in opposition to the arrogance of the Enlightenment concept of reason.
The process by which the theory is constructed guarantees its autonomy from ontology and from pragmatic oversimplification. The category of the "interminable process" permits us to classify psychoanalysis as an utopia, to consider it a project and not a discipline, to avoid the risk of searching for a specific essence for psychoanalysis which is pure and a-historical or of dissolving psychoanalysis into methodologies or into the various psychologies. Following this path, psychoanalysis forms part of the investigation into humanity's reaction to nature. Psychoanalysis thus represents a form of knowledge which is based on the presupposition of constantly changing its relationship with reality, and which is oriented more to what might be possible than to what is possible (Ranchetti, 1986).
What is at stake here is not an abstract choice between an "idealistic" philosophical solution as opposed to a "realistic" solution, but which philosophical position to adopt or to be adopted by.
I hope I have made totally explicit my intention both to place psychoanalysis at the heart of the critical issues which involve each single discipline, and to overturn the challenges of illegitimacy which the individual disciplines have launched against the existence and the survival of psychoanalysis. In this perspective, the appearance of psychoanalysis in the history of knowledge is the principal sign that the foundations of each discipline are undergoing a profound crisis. I do not believe we are obliged to fall into the trap of interdisciplinary falsifications in exchange for the short-term result of social legitimization in a scientifically predefined universe, which includes the therapeutic domain.
The market of salvation
I will not dwell further on these problems and will now go to the heart of the question of the crisis of psychoanalysis, viewing the question from two angles: first of all, from the perspective that sets psychoanalysis within a sociological framework, which deals with the crises which all the scientific disciplines and, consequently, the professions are going through in general; secondly, the analysis of the main proposals for salvation which have been advanced on the present scenario. It is only within this limited and limiting perspective that we can debate the crisis of psychoanalysis and face the question marks on its fate full on.
In my opinion, the brand of psychoanalysis which is riding the full gale of the crisis is "positive" psychoanalysis, namely, that brand of psychoanalysis which provides "a reply." That brand has always been in the throes of a crisis over its own internal question marks. Awareness of the crisis has been avoided by replacing a critical cultural stance with an institutional cultural stance. When the institutional cloak became incapable of controlling the diaspora of post-analytical dialects, a distortion which had lasted several decades became clearly visible. The attempts at an "ecumenical" recovery of psychoanalytic pluralism are to be seen in this light.
I am of the opinion that the very logic of pluralism is a living demonstration of the crisis that critical culture is going through in as much as it furnishes unlimited space to positive cultures. Positive cultures produce adepti and in the field of mental health they have produced a system of mono-cultures. These positive mono-cultures unite and split up under the constraint of social pressures with ever increasing frequency. With regard to psychoanalysis, never as in the last decade has the space been occupied by a false form of interdisciplinarity, increasing the number of disciplines which have exported their own crisis of survival, by proposing to decide on psychoanalysis, about psychoanalysis and for psychoanalysis.
The essence of the problem is that this approach delineates a field of "parallel tolerances" which one can be part of, in so far as one accepts the rules the approach has established. This tendency once again increases the risk of the weakness of critical thought being substituted by the force of institutional culture. As the culture of survival, the field of institutional fragmentation organizes itself into groups of interdisciplinary alliances, whose most important values are immediate social relevance and the "culture of getting results."
One example which greatly concerns psychoanalysis is the international tendency to reinstate biologism in the field of psychiatry; this has sparked off a mechanism which is expelling psychoanalysis from the public health sector and, on a theoretical level, is pushing it towards the humanities. On the part of psychoanalysis, a tendency is emerging to knock timidly on the door of the "culture of getting results", thus replying to the social force of DSM-III (and later editions) with the opportunist version of psychoanalytic diagnosticism.
I wish to underline the fact that I am not questioning the pragmatic value of the results obtained in this sphere. I am merely making explicit the ideological frame of reference on which such studies are based. If accepting the "socially powerful" ideology permits psychoanalysis to speak of efficacy, this is only achieved at the cost of accepting the criteria dominant today: measuring efficacy in the short-term period and obtaining the scientific legitimization which is a function of the number of variables which are eliminated.
The limits inherent in the attempts at achieving salvation by means of an ecumenical recovery (whose practical utility I do not doubt) are extremely significant because they allow us to highlight two factors: (a) the defensive nature of the theoretical proposals, which define their thought in utilitarian and pragmatic terms; and (b) a globally restricted position which establishes the limits of the hypotheses it advances placing excessive attention on the search after consensus.
Let us examine some examples. With regard to point (a), the preoccupation with defining psychoanalysis "positively" means that Freud's definition of 1914 is still employed today: the distinctive features of psychoanalysis are transference and resistance. Clearly the discarding of even only one of these two pillars would provoke the collapse of the entire edifice of psychoanalysis. The problem is not about the clinical validity or the status of these two or of any other concept in the theoretical system. As Wallerstein (1988) points out, at the time when Freud based psychoanalysis on these criteria of truth, he was heavily influenced by the divisions that had taken place in the psychoanalytic movement. This explains why the Freud of dialectic and destructuring negativity exposes his flank by adopting a positive line of argument, which becomes an easy target for any scientificizing position, even the most trivial. The positive stance replaces the force of the search after truth with the weakness of Truth.
With regard to point (b), I will briefly examine the theoretical formulation by Sandler & Sandler (1984) of the concepts of "past unconscious" and "present unconscious." Their proposal allows us to sustain M. Klein's pre-genital theme, to furnish a new basis for the theme of displacement, to consider the challenge inherent in the issue of the hic et nunc. Let us now examine at what price this is achieved on a different level of abstraction. The Sandlers operate by creating a division between the category of time and that of memory. In this manner, solutions are provided to pragmatic problems by placing memory (and time) within the sphere of the reality of events. This implies advancing the proposal of a dialectic contrast between the twin concepts "even-result", which in its turn implies the contrast "truth-judgment." The Sandlers' "realistic" position casts aside the distinction between reality and the "reality principle", while the advantage of psychoanalytical thinking lies in its excluding the proposal of objective reconstruction and its denying the existence of "historical" time in memory.
The key point of this discussion is that realistic propositions (useful as they may be) nevertheless bring psychoanalysis back into the realm of the psychologies. Once this road has been taken, it is obvious that one possible outlet to solve the problem of the identity of psychoanalysis is to place it within the framework of the theory of communication; within a systemic approach; in the container of various psychologies as Pine (1988, 1989) has done in a highly differentiated manner; in the psychology of cognitive dissonance as Levy had already done in 1963 in freeing the problem of interpretation from the need for the concept of the unconscious; in the enthusiasm for developmental psychologies whose present leading light is Daniel Stern (1985) and his line of inquiry.
These referential categories engrave their name in the predefined universe of events by seeking consensus on the ontology of space and time, even if that is not explicitly stated, thus exhibiting all the limits of the phenomenologies.
I now turn my attention to neo-humanist salvation. Psychoanalysis is proposed as the discipline of the subject and it develops a rhetoric which shifts its focus of attention from an emphasis on the "person" to the attribution of importance to empathy. One of the end results of this stance is the ideology of the Self. As is common knowledge, the concept of empathy has found a theoretical location in psychoanalysis only through its connection with consecutive reflection. This has also produced a "usefulness value" in clinical practice. This usefulness value removed the category of empathy both from intuitive knowledge and from the original doctrinal status this concept had in philosophy.
At the beginning of the nineteenth century, Schleiermacher had ascribed to empathy the characteristic of constituting immediate knowledge: the single individual contains within himself the totality and knows it by means of empathy. The moment the ideology of the Self opts for empathy as a method of assigning value to the subject and to the person, empathy is often advanced as something which is free, spontaneous, released from the bounds of rationality. In this way one fails to contemplate stereotypes, rigidity, the repetitiveness of our affects, and one loses sight of the fact that reflection and reason are the means which enable us to guarantee the possibility of autonomy and the interruption of repetition. On the gnoseological plane, this marks a return to Schleiermacher's position. At the same time, when empathy is defined as the possibility of constituting the subject in the relationship and is classified as a positive value in itself, we find an ontology which neglects the methodological component of the use of empathy as a criterion for rendering interior experience objective.
I will now attempt to demonstrate the limits of this "humanistic" position by examining the theme in a completely different conceptual area, namely in the field of descriptive psychopathology. In the 1950s, traditional European psychopathology was undergoing a crisis provoked by the attacks of the results of the psychotherapeutic treatments of psychotic patients, which had demonstrated how even the most serious forms of psychopathology were ultimately reducible to something else in the relationship. This threatened the very foundations of classical psychiatric nosography, in as much as it annulled qualitative differences in favor of quantitative differences.
The German psychopathologist Rümke (1957) was one who tried to oppose this tendency, building his line of defense on the hypothesis of separate clinical entities as regards the diagnosis of schizophrenia. To carry out this operation he identified a factor which he considered a determining factor in the presence of the so called first-rank symptoms identified by Schneider. He indicated this factor as a sentiment, as an interior experience of schizophrenia, attributing it the name Praecogefühl, thus resorting to a criterion which leads back to the theme of the objectivization of interior experience.
Let us examine the implications of this position. Rümke affirms first of all that this is a tool which only the expert observer is capable of using. This therefore implies that it must be placed under the category of learning and removed from the category of intuitive knowledge. This instrument enables the identification of schizophrenia in the presence of symptoms which by themselves do not allow the psychiatrist to differentiate between the various forms of schizophrenia and what he termed pseudo-schizophrenias (it is of interest to note that he included in the latter category a schizophrenia of the "Sechehaye type", in opposition to the hypothesis of the reducibility of schizophrenia deriving from the therapeutic result obtained by Marguerite Sechehaye [1951, 1956] in her famous case of Renée by employing the technique of symbolic realization).
The instrument also enables any psychiatrist anywhere in the world to recognize schizophrenia, thus subtracting him/her from the influence of socio-cultural forces. As Müller-Suhr (1961) pointed out, since we do not have to indicate a position on a scale ranging from determinate to indeterminate, this form of recognition takes on the characteristics of phenomenological determinateness, thus permitting the psychiatrist to recognize the schizophrenic. Hence not schizophrenia, but the schizophrenic.
This path therefore also brings us to the identification of a basic nucleus, which is pertinent to the problem of the constitution of the subject, attributing the value of knowledge to the emotional component. Over and beyond the heuristic value of these considerations, I wanted to underscore the fact that, even in the field of descriptive objectivity, recourse has been had to a criterion linked to experience and affect. In this case this was determined by the need to uphold a position which permitted the biological investigation into schizophrenia as a specific entity to be redefined in terms of necessity, in order to support a given system of though. By following the path of empathy, we arrive at the constitution of the subject taking pathological behavior and strangeness as our point of departure.
The proposal of salvation through hermeneutics and through reconciliation with the historical sciences poses two types of problems. On the one hand, it pushes the semantic approach to its extreme consequences, in that it advances a total epistemological solution. On the other hand, and for this very reason, it involves a double risk: the first risk, and the one at which the majority of the criticisms in the literature have been leveled, is that of the consecration of the text; the second risk, which is connected to the "narrativistic" solution of interpretation, is much more subtle. The adoption of this solution appears to make it possible to relativize the criterion of the "truth of interpretation."
At a descriptive level, this approach turns out to be more suitable to the phenomenology of clinical processes. Suffice it to pass on to a second level of implications and we immediately encounter the theoretical dimension of absolute relativism and the "dictatorship of the phenomenon." The category of shared intersubjectivity proposes an objectuality which escapes any process of verification: one can only "change one's mind" and propose alternative absolute "objects." The "constructivist" solution, which seems to propose an infinite world of objects, in actual fact renders the relationship of discovery of the object monolithic and "finite."
Paradoxically, it would be possible to construct a complex system of independent linguistic entities whose lexicon could be found in an enormous DSM-III of history. The hermeneutic perspective is the one which tends more than any other to make the method and the process of discovery overlap with the object to be discovered, in a sort of semantic neo-positivism.
The reasons of clinical practice
Before concluding, I would like to consider one final problem which belongs to the clinical sphere. My starting point is an old definition I had adopted in 1962, when the debate on clinical method had again come to be recognized as a fully-fledged member of Science after the crisis it had gone through brought about by the radical neo-positivist formulations. The criterion of an a priori check on each datum, which was introduced into the process of hypothesis building, had led to methodological sterility and redundancy. In defining the historical function of scientific discoveries, the position of empirical realism had utilized the concept of the capacity of the human individual to carry out operations of prediction with a minimal amount of information.
Seen in this light, the specific and irreplaceable role of the human being represents the central problem in clinical practice. In my analysis, I had connected this position with the category of the learning of this ability and consequently with the instruments that had to be acquired so that a certain number of people could obtain the best results possible from the approach: in this way, I viewed the problem of the psychotherapist's training and the foundations of therapeutic practice of the light in what these themes implied with respect to the problem of measurement in terms of a posteriori checks, and therefore with respect to a problem of great importance to psychology.
If we recognize the central importance of the operation carried out by the human individual, this key role can be subjected to a process of decomposition into its component elements. The observation of the levels of transformation which the therapist carries out in actual practice, compared to the operations he should carry out as deriving directly from theory, enables us to identify the characteristics which are typical of clinical procedure. In the field of psychoanalysis, the concrete clinical operations which are carried out in practice have a rather tenuous link with theory. If, in fact, we examine the history of what have been considered the prescriptive rules governing the so called classical technique, it is immediately obvious that actual therapeutic behavior has been realized in an "as if" relationship with theory. This "as if" relationship has been handed down in dogmatic terms, thus constituting the fantasy that a classical psychoanalytic technique really did exist. In point of fact, what has actually been transmitted as derived from the theory is, in reality, the system of social consensus of a group.
Justification for this statement may be found in the fact that the history of psychoanalysis is falsified when, on the basis of the written word, its reconstruction is couched in terms of the history of ideas. If an "emotional history" is to be real, then it must be entrusted to oral transmission, which must consequently be considered to constitute an essential part of research, if it is not our intention to build a monument to the theory of psychoanalytic technique. In this way, we can avoid the overabundant temptations to adhere to continuity and historicist justificationism, so frequent in recent years. One aspect of this phenomenon is the affirmation, which may still be heard today, that the "figures of speech" of psychoanalysis are metaphors.
This simply indicates that in the psychoanalytic field it was deemed correct to believe that they were something else and, consequently, for decades it was held that the foundation was built on nominal realism. From this point of view, the cage which imprisoned clinical practice was not constructed by metapsychology or general theory, but by the dogmatic relationship of consensus on a criterion of truth. For years this criterion was the Truth of the interpretation. When, at the end of the 1950s, the truth of the interpretation came under the cross-fire of the reality of clinical practice and the critique advanced by Ricoeur (1965), it began to vacillate.
It might be noted that this is when the search after the truth of psychoanalytic frame or "setting" began, a search which still continues today. There still exist analysts who are quite capable of swearing that the distinguishing feature between psychoanalysis and psychotherapy lies in the number of sessions per week. When considered from the point of view of the theoretical advances a concept may yield, the concept of "frame" or of ground rules (i.e., the extrinsic criteria) is much weaker compared to the sophisticated implications that may be derived from the concept of interpretation. The former concept may achieve greater theoretical dignity only within the framework of object relations theories. To cite an example, Modell's (1988) complex formulation comes very close to founding an ontology of psychoanalysis in Freud's "chance" discovery of the psychoanalytic frame.
With regard to clinical theory, it is of interest to note that the definition Modell advances of "symbolic actualization" harks back to Sechehaye's concept of "symbolic realization." In particular, the technical expedient Sechehaye adopted in treating the case of Renée can, upon reexamination, be considered to fall within the communicative-interpretative approach, rather than a form of acting on the part of the analyst or a corrective emotional experience.
Nevertheless, I believe that the functions of metapsychology and of general theory are irreplaceable, and that neither of the two are responsible for technical dogmatism. Probably, many have preferred to cut down on the theoretical side rather than question "technical truth." In this fashion, approval has been gained for new clinical experiences without being obliged to call them psychotherapy any longer. The difference between those who have willingly undergone the clinical reality involved in treating even the most serious forms of psychopathology while still maintaining the tie with theory, and have continued to feel they were psychoanalysts, and those who merely enacted the therapeutic ritual, "bending" one or two of the parameters here and there, is that if the latter laugh during the analysis or accept a gift they immediately feel the need to write an article on this "new experience."
To conclude my contribution, I would like to raise one final problem. If we decide to maintain psychoanalysis as a practice which cannot be reduced to other subjects, and which continually transforms itself and its object of investigation, then psychoanalysis is definitely not undergoing a "crisis"; rather, it is quite capable of causing a crisis. Each instrumental positive reply goes "beyond" the confines of psychoanalysis. In this sense, the very problem of the distinction between external reality and inner world risks being falsified, when both the poles are treated from the same point of view: the object changes without, however, the relationship with the object being changed.
This, in my opinion, seems to be the implication behind the recovery of the hypothesis of "real trauma", over and above the fortune and social utility it may have: in essence, each hypothesis could be led back into a sophisticated system of conditioned reflexes, and the category of real contradictions would disappear under the force of the logic of apparent contrast. The destiny of the "finite process" could mark the end of the existence of psychoanalysis, and open up the era for the measurement of the degree of success achieved on the market by the therapies and the psychologies. Propaganda, the size of our audience, academic culture, and the number of psychotic patients cured, would represent our future abode.
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[Note: A version of this paper, titled "Crisis of psychoanalysis? From the scientistic solution to the semantic perspective", is published in the Italian Journal of Psychiatry and Behavioral Sciences, 1994, IV, 1: 23-28. An Italian version, titled "Le psicoanalisi e la crisi della psicoanalisi", appears in Ricerche di Psicologia, 1990, XIV, 4: 39-58, and in Canestrari R. & Ricci Bitti P.E., editors, Freud e la ricerca psicologica, Bologna: Il Mulino, 1993, pp. 173-188, and also in Galli P.F., La persona e la tecnica. Appunti sulla pratica clinica e la costruzione della teoria psicoanalitica, Milano: Il Ruolo Terapeutico, 1996, pp. 57-75 (new edition: Milano: Franco Angeli, 2002). A German version, titled "Die Psychoanalysen und die Krise der Psychoanalyse", appeared in Kuster M., editor, Entfernte Wahreit, Tübingen: Diskord, 1992, pp. 146-165.]
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