Lost in Cognition

There is a tradition among certain psychoanalytic writers and schools, to decline any engagement with the world outside of analysis. In this tradition, psychoanalytic literature becomes a continual exegesis of the master(s), devoid of reference points to the world beyond. Thankfully, Eric Laurent and his colleagues are most definitely not of this tradition, as Laurent’s new book, Lost in Cognition, demonstrates amply.

For years, in the Psychoanalytical Notebooks of the London Society (and elsewhere), Laurent has been situating Lacanian psychoanalysis in relation to other forms of analysis, the neurosciences, the fetish for evaluation and the cognitive paradigm. In France, positions on these matters are not merely theoretical, as analyst have been locked in a political struggle with standardised, quantitative clinicians, academics, and bureaucrats, the latter of whom seek to marginalise psychoanalysis out of existence. (Some of this has been well-documented by a colleague of Laurent, Agnes Aflalo).

Thus, Laurent begins with a critique of the cognitive paradigm, which began with a rejection of behaviourist dogma, but soon devolved into cognitive-behaviour therapy (CBT), a coercive treatment by way of rigorous self-observation and ‘techniques’ which aims to correct a patient’s ‘distorted’ thoughts. It’s main selling points are firstly, that it is cheap, and secondly, that it purports to be ‘empirically validated’ as a treatment. This latter is of course a fiction, and Laurent does an excellent job of showing how such empirical validation does not exist when it comes to psychological treatments of subjective problems. For, in order to even pretend to such ‘validation’, CBT (and other treatments) have to be tested with so many patently absurd assumptions (that treatment is standardised in the form of a ‘dose’; that subjective effects are homogenous and readily quantifiable; that artificial research conditions bear any resemblance to clinical reality, etc) as to be intellectually and ethically bankrupt. Indeed, the very fetish for quantification in the psy-disciplines is itself a perverse factor in the sorts of treatments that emerge. Academics, who have wrested much of the say in these matters from actual clinicians, hold that RCTs and meta-analyses aim to gauge the effectiveness of a treatment, but Laurent correctly asserts that the contrary is true, namely, that sophistical ‘techniques’ masquerading as therapy adapt themselves to the artifice of standardised, quantifiable evaluations. As Laurent says, ‘the only thing that one really measures is not so much the effectiveness of the treatment…as the fact that the treatment lends itself to the systems of measure’ (p. 45-6).

Laurent does not aim his arrows at mere strawmen, and is aware that in CBT, for instance, there are two competing tendencies. On the one hand, there is the approach which emphasises clinical training and particularisation of treatment in order to better control and manipulate a patient’s psychopathology. On the other hand, there is the austere and manualised tendency to automaticity, in which a recipe-like treatment can be delegated to anybody with minimal training (though no doubt under some form of bureaucratic supervision). Neither tendency has anything to commend it, and, quoting Jacques-Alain Miller, they each amount to a ‘Panopticon on the cheap’, their quantitative garb and ‘neo-utilitarian puerility’ notwithstanding.

Part of Laurent’s work deals with many of the neurobiological approaches which have emerged in recent years, which, in contrast to the cognitivists, are not universally hostile to psychoanalysis. Indeed, ‘neuropsychoanalysis’ is a growing discipline, and celebrated researchers such as Kandel and Damasio cite Freud favourably, and regard the results of their studies as ‘confirmation’ of psychoanalytic theories.

Laurent does not accept this attempt at a rapprochement, and emphasises, repeatedly, that the psychoanalytic unconscious, and the sort of subject that it entails, has nothing to do with the findings of the neuroscientists, whether friendly or hostile. When neuroscience ventures into psychological territory, it generally takes up the computational reduction of the cognitive paradigm, in which human subjects are essentially learning devices. Or, it blunders into ill-conceived metaphysics, which, in the case of Damasio (for instance), amounts to a rather confused 18th Century epistemology of representation. For Laurent, it is not so much a case of the neuroscientists being wrong, but of being irrelevant, since psychoanalysis, and all talking therapies, are interventions in discourse, first and foremost, and only secondarily (if at all) ‘neural’. The unconscious is structured like a language, not a nervous system, and it arises in response to a lost object, not motivational incentives.

Some in the psy-disciplines may be puzzled by this repudiation of neuroscience from an analytic perspective. Even those who, like Laurent, reject the reduction of subjectivity to biology nonetheless seek neuroscientific support for their positions. Yet can anybody in psychology point to a single finding of neuroscience that has made any meaningful difference on clinical psychotherapy whatsoever? Indeed, the main contribution of  neuroscience to psychotherapy to date has been in the form of neurohucksterism (of Cozzolino, or Goleman, for instance, among many, many others), in which one author or another cherry picks neuroscientific findings in an effort to support his or her favourite platitudes. I suspect that this approach only flies in psychology because this discipline has profound doubts about its scientific status, and its practitioners are willing to seek support from almost any source.

Psychoanalysts are not immune to this insecurity. Whilst ego psychology is dead, it has many heirs, and it is against some of these that Laurent contrasts a Lacanian approach. In particular, he offers some remarks on Fonagy, and his attempt at an empirically-based psychoanalytic enterprise. (Both Fonagy and Laurent have touched on this debate in separate interviews with the Israeli daily Ha’aretz). Fonagy’s wager seems to be that if only psychoanalysts adopt the reductive quantification of their empiricist peers; if only they speak the technocratic language of the cognitivists, and take up some of their authoritarian, didactic goals; if only analysts truncate or omit altogether the more uncomfortable elements of Freud’s teaching (a radical unconscious, sexual aetiology, destruction as a drive), then psychoanalysis might find a place at the table of bureaucratically-endorsed treatments. Notwithstanding Fonagy’s success in the English-speaking world, there is a dearth of evidence to suggest that such recognition is forthcoming for psychoanalysis. Moreover, it looks like a classic case of bombing the village in order to save it, since whatever is particular to psychoanalysis is, in Fonagy’s account, assimilated into the pseudoscience of the cognitive treatments. As Laurent quips, ‘the humble and modest analyst…has lost his way and is ready to latch onto any scientistic verification that is offered to him’ (p. 139-140). Such a position is neither a repudiation of science nor evidence per se, but rather, a rejection of the ridiculous premises under which ‘evidence’ is sought in the contemporary clinic.

This highlights a broader problem. Many clinicians in mental health have delivered scathing critiques of the pharmaceutical industry, the DSM, bioreductionism, etc. (As Laurent notes on p. 142, the academics have been much quieter, but then, the DSM is an academic rather than clinical project). Yet when clinicians reject the DSM on the grounds that it is ‘unscientific’, without actually questioning the junk procedures that constitute scientificity in mental health, they risk the coming of another DSM. And this is precisely what is happening. One sees clinicians attack the evidence-base and poor ethics of Big Pharma, yet promote CBT coercion and conformism without a hint of irony. Bioreductionism has come under much-deserved attack, yet often only to be replaced with a similarly reductive account of a pathogenic society which elides subjectivity altogether. The separate notions of ‘fear’ and ‘anxiety’ are essentially collapsed into one, and the clinical imperative becomes mere manipulation of negative (or non-compliant) affects. Hence, ‘humanistic’ and alternative therapies (mindfulness, ‘positive’ psychology, etc) operate on exactly the same assumptions as the grim, utilitarian methodologies of the cognitivists and behaviourists.

Psychoanalysis remains strong in many parts of the globe, and in particular, those which speak Latin languages. The contrast with the Anglophone world could not be clearer. Yet it is precisely this contrast which marks the necessity to reaffirm that which distinguishes psychoanalysis from the many cheap imitations that pass for ‘therapy’, and to critique the sorts of treatments that flourish under the conditions of scientism, austerity, and surveillance. To this end, Laurent makes a fine contribution to the discussion.






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