I: Professional Squabbles
Psychotherapy is viewed with suspicion by biologically-minded psychiatrists, but amusingly, psychotherapists of different modalities are equally suspicious of each other1. This is a subliminal suspicion that reveals itself in the ebb and flow of private discussion concerning the underlying theory of therapy itself. It can be broadly observed that cognitive behavioural therapists give a wide berth to the meandering sessions, Freudian complexes and murky unconscious explorations of psychoanalytic and psychodynamic therapists. Likewise, some psychoanalysts express disdain for cognitive behavioural therapy’s target-driven brief interventions that bypass unconscious processes and adopt of a one-dimensional view of the mind, free of contradictions or conflict, for a quick and superficial fix of symptoms. Like a useful bureaucratic stooge, the cognitive behavioural therapist presents the shiny apple of target-based results to the institutional powers that be. The psychoanalyst Darian Leader, in a 2008 interview, despairs that in cognitive behavioural therapy the human mind becomes commodified, quantified and, like our wider society, outcome-obsessed. He comments that the process of traditional therapy, previously focused on the facilitation of thought and actualising of the Self, is replaced by a therapist-led mechanical process focused on the transactional results of not thinking.
To make is his point, Darian2 wryly compares cognitive behavioural therapy to Mao’s re-education of the population during China’s cultural revolution. This comparison can be taken yet further; closer to home in the West, cognitive behavioural therapy does indeed serve as a useful instrument for the sustenance of a population of achievement-subjects, as Byung-Chul Han terms them. Therapy is the self-help tool of choice to perpetuate the dysfunction of the overproductive, overachieving and overcommunicative self. Cognitive behavioural therapy has particular appeal to autistic productivity-machines who compulsively partake in auto-exploitative optimisation, since it’s based on unquestioningly accepting the assumptions of a positive-pressure society and moulding the individual to it; when wrong-think is removed, it leaves excess of positive thought that debases the complexity and authenticity of the individuals inner reality. It is exhausting, and cognitive behavioural therapy furnishes the subject with the tools to ignore and overcome their exhaustion.
Psychoanalysts, thus feeling confident that they have the monopoly on sincere investigations into the soul, distance themselves from behavioural therapy’s assumptions and summarily throw it under the bus. They emphasise that they themselves are the true facilitators of the patient’s unravelling of the Self, with no compulsion for the consequent revelations to abide to target-based outcomes. Though not all psychoanalysts consciously adopt Lacanian post-structuralism, they retain the liberty to retreat to this high-ground if they wished. But psychoanalysts are not immune from the criticism they level towards others. In fact, their assumptions are simply further upstream and more systemic than the cognitive behavioural therapist’s; Deleuze and Guattari point out that after identifying desire as the driving force of the unconscious, psychoanalysis immediately oedipalized it, institutionalised it and territorialized it3. Therefore, psychoanalysis does not give the unconscious a true voice as Darian claims, but instead displaces and imposes an alien socio-political structure upon it. Han alternatively considers psychoanalysis to be an outmoded vestige of a disciplinary-society, only applicable to obedience-subjects, and wholly inapplicable to the modern achievement-subject who cannot say no and only mourns his inability to do all. Psychoanalysis proves itself to be remarkably establishment-friendly, but attires itself in the nostalgia of radicalism that has not been relevant for more than half a century. Of course, psychoanalysts emphasise that their theory and practice has come a long way since Freud, but its foundations appear wanting to an increasing number of modern theorists.
II: The Threat of Objectivity
Psychotherapy, due to its subjective nature, experiences running tensions with objectivity; taking the example of Freud, psychoanalysts have taken great pains to reconcile their theory and practice with objective data. Finding it difficult to overcome the challenges of empirically verifying their core concepts, they shifted the focus of research to objective evidence of therapy’s positive clinical outcomes. To their chagrin, it is in this domain of objective evidence that cognitive behavioural therapy’s measurable outcomes really shine, at least from a cost-benefit point of view. Psychoanalysis struggles to match this proficiency due to the subjective nature of their patients, who may not improve in quantifiable terms that easily translate to an economic language. Psychoanalytic and psychodynamic therapies do produce evidence-based results, but require two to three times longer duration of therapy to achieve them. As Freud’s dream of establishing an objective science of the mind proves to be unlikely, psychoanalysts increasingly seek refuge in the imprecise subjectivities of the unconscious on one hand, or in Deleuze and Guattari’s antinomian expression of individual subjectivity on the other. By no means is the latter’s conclusion of schizoanalysis a viable mainstream alternative to traditional psychotherapy, it does represent the conclusions of anti-positivist individualism taken to the extreme, doing away with all structured therapies altogether. The psychoanalyst is immersed in subjectivity, and is therefore likely to intellectualise or pathologise claims of objective certainty in both theory and outcome.
Psychoanalysis not only loses ground to offshoots of its own discipline, but faces an existential threat from the rising general inclination towards objectivity in the wider population. Many find themselves fatigued by the subjectivity and relativism that psychoanalytical theory has had no small part in establishing within the general consciousnesses, and instead opt to explore traditional alternatives that claim grounding in an objective reality. This reality purports that the Self, like society, is governed from the top-down, from a higher transcendent principle to a lower human one. Its precepts, which are presented to be of a higher order, fundamentally resist the psychologised reductionism of the lower order. This offers relief from the psychoanalytical view that derives a higher order from the lower human experience. There is also an emerging politically reactionary conservatism that seeks to resist subjectivity of cultural relativisation and remains critical of psychoanalysis’s subliminal role in propping up the ideology of their opposition4. These conservatives observe that the authority of many of the traditional institutions in the West have eroded following the post-Enlightenment axiomisation of secular humanism, and consequently establish neo-traditional alternatives. Psychoanalysis therefore finds itself undermined on two fronts; internally against the popularity of behavioural therapies and externally in a shift of popular sentiment to what it would regard as regressive belief systems. However, the history of analysis shows that it feels well-equipped contend with its older adversaries that are the echoing vestiges of the disciplinary-society in which it was conceived. It will tolerate an ideological stalemate, taking advantage of the dominant relativistic view to avoid having to meaningfully engage with their grievances.
Ironically, the disruption of the stasis springs from the very culture of subjectivity and relativity that psychoanalysis engenders; one of the byproducts of mass-immigration into the West is the influx of ostensibly simpler minds who are far more certain of an objective reality than their native counterparts. Their straightforward, conservative, religio-cultural conception of the Self contends with the liberal, relativistic and supposedly psychologically-sophisticated conceptions of the native institutions. Each views the opposing position as needlessly difficult to accommodate, and we see its effects particularly in the realm of mental health; neither party can agree on a common psychological language to open an conversation on their main concerns. For the institutions, it is the increasing economic burden of migrant mental health that resists primary interventions, and for the migrants it is pressure to partially suspend their belief in an objective reality to entertain a subjective one5. It has necessitated the development of transcultural psychiatry in order to adjust diagnostic and therapeutic processes for those who conceptualise an integral objectivity in their world-view, lest those with fundamentally opposing beliefs to modern psychiatry be marginalised if they are not accommodated for. Thus the psychiatrist (or psychotherapist), as a matter of continuous professional development, must reacquaint himself with matters of religion, culture and spirituality that he may personally keep a sceptical distance from. Those psychiatrists that harbour no such scepticism will stumble over themselves to integrate cultural and religious flavour into mainstream psychiatric practice, without considering whether the two are fundamentally compatible.
Ultimately, it is the institutional collective that covertly justifies psychoanalysis’s ideological precepts that now demands that it address the concerns of an objective belief system. So how does psychotherapy account for these transcultural considerations? The psychoanalyst would respond that religious belief and culture are pre-empted and integrated into theory of the unconscious, thus requiring no accommodation. However, they conveniently gloss over the fact that it is either pathologised as a defence mechanism or neurosis by one major school, or a positive unification and integration of instinctual patterns into the psyche by another. Other more flexible modalities, such as cognitive behavioural therapy, are more easily able to integrate traditional viewpoints into themselves, but only to the extent that these traditions are able conform to the therapy’s established structure and underlying subjective assumptions. Both views would be rejected as incompatible by the people they are trying to court, who would not support the endeavour to perpetuate function in an intrinsically dysfunctional materialist society. They believe that the objectivity of their belief-system, with its corresponding religion, culture and civilisation, is in itself well-equipped to deal with matters of the mind, and more importantly the soul, independent of modern psychology. They repeat to psychoanalysis what psychoanalysts such as Darian preach to the behavioural modalities; there is no quick fix for the soul. They point out that knowledge of the self has not progressed proportionately alongside modernity’s techno-industrial strides; psychiatry and psychology still have many dark territories that remain uncharted6, awaiting elaboration by scientific discovery, or content to remain veiled due to denial of the Self’s spiritual component.
Psychoanalysis is not particularly interested in ideologically courting the traditional or conservative perspectives, not when it is able to pathologise their certainty in an objective truth. Adorno, influenced by psychoanalytic theory, correlated tradition and orthodoxy to the authoritarian personality, particularly pinging on the F-scale’s unconscious subscription to conventionalism, anti-intraception and superstition items, indeed if not all of the criteria7. Anti-intraception is particularly pertinent, as it pathologises the rejection of subjectivity and upholding of objective truths as a precursor to fascism, thus condemning most traditional positions by proxy. Adorno’s work is an extension of psychoanalytic principles, particularly repression and projection, that views objectivity as incompatible with the underlying ideology of psychoanalysis. This is not to say that all psychoanalysts align with Adorno’s views, but it is another demonstration that psychoanalysis inclines itself to the subjective and can only nominally acknowledge higher principles, if it does so at all. Meaning is assumed to be found within the unconscious, with the precepts governing the human condition to be humanistic rather than transcendental. Thus therapy becomes the means for humans to create their own subjective meaning, and an extension of existentialism itself. Yalom, an existentialist psychiatrist, reduces human existence to a personal navigation of isolation, meaninglessness, free-will and death, with the soul seeking to come to terms with itself, rather than a higher Truth. It is perplexing that such a bleak outlook is received as life-affirming, but demonstrates the extent to which subjectivity pervades the collective self-image: if objectivity cannot be pathologised, then subjectivity is presented as the enlightened position.
III: Closing Comments
“Analysis isn’t for everyone”, is not simply a palliative resignation for those deemed not to fit the psychological criteria for the modality. It penetrates into the essence of psychoanalysis’s elusion from criticism within the mists of subjectivity; the critic, they argue, misunderstands the finer points of the theory, but these finer points are themselves nebulous and subject to accentuation and minimisation according to what is expedient for the defence. Behavioural therapies may appear more straightforward, and their exclusion criteria far less enigmatic, yet the theoretical foundation is deeply interweaved into the structure of a dysfunctional system. Those who are themselves interveaved into a dysfunctional system will find the idea of “regression” to a traditional approach to the Self as ludicrous, no doubt due to uninformed biases and assumptions based on anecdotal experiences with superficial misapplications.
Yet, a traditional view of the mind provides a time-tested structure that is impermissive enough to regulate the excesses of the achievement-subject whilst having an esoteric dimension flexible, contemplative and lenient enough to liberate the limitations of the obedience-subject. It treats man as a theomorphic being rather than reducing his spiritual potentiality to psychological impulses or behavioural adaptations. It is this radical departure from psychoanalysis that critics of modern society gradually turn towards in search for an alternative. This alternative treats man as a complex reflection of a higher order rather than a fragmented, confused reflection of society. It provides hope instead of demoralisation, and certainty instead of uncertainty. Such is the extent of this demoralisation that some even resort to the saying that it does not matter which tradition is chosen as long as one doesn’t settle on the unstable foundations of the modern landscape; the chatter of two bickering believers is preferable to meaningless silence. Though this admittedly lacks a certain nuance, it highlights that for many even a merely pragmatic commitment is of some metaphysical value compared to the present alternative.
A traditional perspective grounded in objectivity cannot claim to “refute” psychoanalysis, since the core concepts of psychoanalysis pre-empt it and employ a complex rebuttal of repression and projection in order for it to remain consistent with itself. However it does provide a point of alignment for those who are sceptical of not only of the scope of what psychoanalysis and psychotherapy can truly achieve, but of the cultural, institutional and spiritual sequelae of accepting its axioms. For those who harbour this scepticism, it is worth contemplating committing to a tradition if one has not already done so, if only to escape the fragmented self perception of a dysfunctional therapy-culture. For those who cannot accept the ideological buy-in that comes with such a commitment, I’m afraid our hour is up.
Namely the psychoanalytic, psychodynamic, cognitive behavioural (CBT), dialectical behavioural (DBT) and cognitive analytical (CAT) therapy systems.
Darian, founding member of CFAR and former president of The College of Psychoanalysts, is hardly a fringe voice.
“It reduces all of desire to a familial determination that no longer has anything to do with the social field actually invested by the libido.” and “From the outset, the psychoanalytic relationship modelled itself after the contractual relationship of the most traditional bourgeois medicine: the feigned exclusion of a third party; the hypocritical role of money, to which psychoanalysis brought farcical new justifications; the pretended time limitation that contradicts itself by reproducing a debt to infinity, by feeding an inexhaustible transference, and by always nursing new "conflicts." Deleuze & Guattari, Anti-Oedipus: Capitalism and Schizophrenia
There is an awareness that idea of the unconscious has thoroughly weaved itself into the very foundations of the collective self-image, that the conservative point of view reflexively offers apologetics before alternatives. Neo-traditional movements seek to restore objectivity to the collective self-image.
Of course, this does not apply to procedural aspects of psychiatric diagnosis and treatment such as medication regimens. It most certainly does apply to public health or psychosocial interventions that require an insidious ideological buy-in.
As an aside, patients revel in this ambiguity, and sneeringly ask how I can prescribe Lithium without knowing how it works. There is no need to be flustered here; they don’t care to know why, they just wish to redress the imbalance of power.
Theodore W. Adorno’s The Authoritarian Personality, published in 1950, is a much criticised yet influential attempt to identify fascists based on psychological traits; anti-semitism, ethnocentricity, conservatism and the F-scale. Adorno’s work is an extension of psychoanalytic principles which he developed on during his time with the Frankfurt School, allowing his successors to dismiss politically disagreeable views on psychological and psychiatric grounds.