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What is the essence of psychoanalysis? Although most analysts have at least an intuitive sense of what characterizes clinical work as “psychoanalysis” or, at least, “psychoanalytic”, it is not often explicitly elaborated. Yet today, psychoanalysts work increasingly in a world of social, political and economic upheaval, and face growing challenges from outside our field as to the value and relevance of our work. At the same time, in the current post-pluralistic era within our field, there is a growing need for clarity on this question as we attempt both to delimit the boundaries of psychoanalysis and to integrate multiple ways of understanding and working clinically with the human mind. Gregorio Kohon’s book Concerning the Nature of Psychoanalysis: The Persistence of a Paradoxical Discourse gives serious consideration to this question. Despite its relative brevity (there are 118 pages of text, including a preface, but not including its extensive bibliography), and the clear and extremely readable quality of Kohon’s prose, this is a book that is both deeply thoughtful and thought-provoking.
Kohon frames his argument as a response to challenges to psychoanalysis, particularly from within the public health sector, which rest on the discourse of evidenced-based medicine, with its underlying assumption of the universal value of operationalized procedures and outcomes measurable by quantitative means. What Kohon argues is that psychoanalysis achieves its clinical results through the establishment of a very particular kind of discourse between patient and analyst; that the results arise out of the process of the discourse itself rather than “answers” that are obtained through the discourse. The discourse is fundamentally a creative one rather than a problem-solving one, highly individual to each patient–analyst pair, and thus does not lend itself to being operationalized.
The clinical results, although they can be life-changing, are in the realm of qualitative differences in