This book is something of a goldmine; it is the product of those authors who spoke at the College of Psychoanalysts UK conference on ‘Psychoanalysis and State Regulation’. Anyone who reads it I hope will be unsettled. Our complacency will be costly. I will look at a few of those papers which grabbed my attention.
The book comprises twenty-four short essays which, overall, set the context in which psychoanalytical practice is produced and ordered, becomes a set of interwoven and enmeshed practices and predispose itself to State Regulation. At the same these same practices, by their very nature, are bound to oppose such regulation. As an art which uses free-association, psychoanalysis is tolerant of the invasion of its space with forms of thinking which reduce the psychoanalytical encounter to a series of well- (or ill-)judged interventions: to this extent the teleologies which connect design, purpose and outcome have little place in the domain.
Thus, we might agree with John Miller, in his essay entitled ‘Why Is Psychoanalysis Not in Trouble?’ when he makes the case that psychoanalysis differs radically from medicine in the sense that the latter apparently operates within a unified body of knowledge. Psychoanalysis, by contrast, is held together by far looser ties. How has medicine achieved this state of affairs? Here, I think his analysis begins to run into problems.
If we take the profession of the law, as an example of a ‘real’ profession and look at the court system, we see a clearly established hierarchy. We see that lower courts have less latitude to interpret the law than, say, the Court Of Appeal which, consequently is more able to produce definitive judgements. In other words, the field of the law is produced through a form of governance which controls both the interpretation of
the law and governs the rules and channels for dissent. Whilst these structures are not quite so clear-cut in medicine, they are there nevertheless. For instance, The Royal College valorises expertise and seniority: the power to establish knowledge is inextricably linked to position and hierarchy. What is more, medical training is always practiced from universities, all of which have their own governing practices and structures. We find similar hierarchies in operation at hospital level. As such, medical knowledge becomes established and subject to organisational government in much the same way as legal knowledge. It would therefore be a mistake to assume that medical knowledge is agreed—house officers for instance are enmeshed within a system akin to a barristers' pupillage and their opinions carry very little weight. Therefore we must avoid the assumption that homogenous knowledge is a reflection of its inherently stable qualities. Rather, it is the reflection of a powerful hierarchy which produces it. So, on this point I disagree with John Miller.
Although psychoanalysis is prone to the establishment of stultifying hierarchies, it is also liable to resist them. We should not be surprised if one wing of the psychoanalytical community seems to be in favour of unifying psychoanalytical knowledge and therefore, we might suppose, wishes to ape the scientific establishment. The International Pyschoanalytical Association's (IPA) website gives the following advice to prospective users of psychoanalysis, ‘We recommend that you work with an analyst who is a member of the IPA. As a graduate of a psychoanalytic society or association and the IPA, your psychoanalyst is connected to a tradition of training, treatment, scholarship and research that meets exacting standards recognized around the world.’ The italics are mine. The tenor is medical and bears the hallmark of the university. An arch-proponent is Peter Fonagy, cited by Darian Leader, in the final essay in this book. Fonagy describes a field in which the findings of neurology are being used to supplement psychoanalysis. By his own account, Fonagy is far down the line of establishment-produced knowledge of the kind described above. Fonagy and his colleague Bateman are defining a ‘self’ devoid of an unconscious (and thereby not only concealed but rendered open to doubt, imprecision and all the other trappings of uncertainty). This self becomes a rational economic decision-making unit which, when faulty, can be cured on a prescribed mixture of psychoanalysis and neurobiology. This will appeal to governments who
seek to control the ways in which individuals make decisions. The most potent opposing agent to totalitarianism is the subject's ability to ‘make unconscious’ and thus to straddle contradictions by making the whole edifice inherently unstable and uncertain. It is this capacity which produces people who are able to resist linear and normative thinking. Leader reminds us that the psychoanalytical subject is conflicted; the patient presents for treatment and then resists, seeks delusion and turns away from painful truths. Fonagy, contrarywise, is offering governments the illusion that these attributes can be bypassed and thus produce more compliant subjects.
We are now in the province of Levinasian and Laplanchian Ethics, discussed in an essay by Del Loewenthal. Using the work of Laplanche, Loewenthal sets out a scene in which the analyst installs a space to resist outside interference—which is exactly what governments do not want to happen. Rather, we endure unremitting efforts of governmental authorities to regulate and control the finer details of our everyday life, carried out via the dubious motive of protecting an ignorant public from rogue practitioners. Loewenthal's analysis makes a case for psychoanalysis as the practice of ethics. Whether we are regulated or not, says Loewenthal, we will have ethical problems. Evidently, but has psychoanalysis lost its nerve? Can we be sure that Levinas is saying that we should be putting the Other ‘first’. How can we put the Other anywhere? Surely the ethical demand is to somehow bear the radical alterity of the Other and resist reducing it, with all the qualities that make it alien, to a system of thinking which implicitly privileges the knowledge of the analyst over the patient? In this respect it might be considered our ethical duty to preserve and defend the place of the unconscious, not, in fact, qua Fonagy, to overcome it.
Haya Oakley also uses the threat of regulation to explore psychoanalysis and ethics. She turns to Lacan who disturbs our fantasies of omnipotence with some troubling questions. Fundamentally, it seems, if we are behaving properly, then we promise nothing; we certainly should not promise happiness nor, for that matter, mental health. According to Oakley, we have failed to challenge our own omnipotence and have therefore implicitly colluded with those who say that we need to be controlled. Her paper reminds us that we have done well enough operating
with a simple set of ethical rules and that outside authorities are not likely to improve the situation one jot!
Lorenzo Chiesa, in a paper entitled ‘On Teaching and the University Discourse’ discusses Lacan's Seminar XVII, The Other Side of Psychoanalysis where the latter proposes four discourses. This paper connects with Haya Oakley's paper above. Lacan argues that the aim of teaching is not to convey knowledge; rather, we are barred from knowledge. Chiesa asks us to consider what Lacan means when he says that the transmission of knowledge, like feelings of love, should be treated as a kind of love affair where we are taunted with the promise of fulfilment of knowledge/love, only to be barred from it. If I understand him correctly, Chiesa senses a paradox in Lacan, namely that the offer of knowledge conjures up a master-figure as originator, whom the authorities will forbid us from emulating. Are we doomed to be set in the master's gaze? It would seem that regulation wants it that way.
Leslie Chapman argues that psychoanalysis, in common with other psychotherapies, can be both an agent in the regulation of subjects, having within its gift the capacity both to resist and to subvert this very process. He argues that psychoanalysis should be more alert to the political imperatives of its work. The solution, he suggests, is to rethink the notion of ideology and the notion of false consciousness. In a radical departure from Platonic versions of ideology found in the Marxist tradition, we can overturn the notion of true consciousness; instead we can argue, via Zizek and others, that ‘social reality is the fantasy sustained by ideology’. The fantasy conceals the failure of social control. How can we make use of this insight? Chapman suggests that we ask the very questions which point to this failure. One wonders how those kinds of psychoanalysis which use the idea of distortion and underlying truth, will fare.
The international experience is well documented—read Christian Ingo Lenz Dunker on the Brazilian experience, Jalil Bennani on the fascinating experience of the establishment of psychoanalysis in Morocco, and Kazushige Shingu in ‘Psychoanalysis, Psychotherapy And Psychiatry in Japan’. The latter's message is solemn; the state regulation of psychoanalysis should be treated to a state funeral. Gillian Clayton's experiences in Italy are chilling.
Let us be under no illusions. There are many psychoanalytical practitioners in the CPJA, and outside of it, who look forward to regulation. I somehow doubt that they will want to read these papers—preferring instead a self-aggrandizing delusion that we will be an elite, therefore smaller in number and more powerful. I have only touched on a few of the many creative and interesting ideas in the powerful and extensive resource that constitutes this book. Read at your leisure—be ignorant at your peril!
Reviews Policy
Part of the remit of Sitegeist is to encourage new thinking in psychoanalysis and philosophy, and we see reviewing new books in those fields as a crucial way to do this. Books for review should be sent to: Philip Derbyshire, c/o Department of Spanish, Portuguese and Latin American Studies, Birkbeck College, 43 Gordon Square, London WC1H 0PD. Email: .