The Ethics of Psychoanalysis

 

The following is taken from one session in a series of introductory seminars as part of the Lacan Circle of Melbourne’s activities.

 

There is an interesting remark by Miller, in a paper from 2012 on the aims of psychoanalysis. ‘The psychoanalyst’s routine is therapeutic. His business is with the symptom that has to be cured.’ Psychoanalysts can put on airs, and ascribe lofty goals to their practice, but people come to consult with an analyst because something is causing them suffering. As Miller says, ‘If somebody goes to see a psychoanalyst for the sake of knowledge and not to get rid of a symptom it is not very certain that his demand can be received’.  So, whatever one may learn of oneself in the course of analysis, analytic praxis is not reducible to a quest for knowledge. Continue reading

On “Borderline” Diagnoses

In retrospect, it is ironic, perhaps, that it was within psychoanalysis that the category of the ‘borderline’ was invented. More specifically, it derived from the ego psychology of the US, which situated the borderline as a category of exclusion between neurosis and psychosis. There are strong grounds for concern about the aims, ethical underpinnings and conceptual rigour of ego psychology (see here for a brief summary). As I’ve tried to point out elsewhere, the blunders of ego psychology did not prevent it from having a formative influence on many other forms of North American psychotherapy, including those that prevail in the Anglophone world today. In general, for an idea to have emerged from ego psychology constitutes a serious objection to it; if it is also taken up by bureaucrats and panel-beaters of the psyche, this amounts to a refutation. Continue reading

The problem with diagnosis is not diagnosis, but discourse

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In the UK and elsewhere, there is a growing movement to abolish diagnosis in psychiatry and clinical psychiatry. Leading the movement are a group of clinical psychologists and a range of critics of mental health practice. I would like, once more, to revisit the question of diagnosis from a psychoanalytic perspective, in the hope that it may shed some light to those without an analytic approach. Continue reading

Ordinary Psychosis

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There are no shortage of psychoanalytic theories of psychosis. The Lacanian account of psychosis that derives from the 1950s – and which we may think of as ‘classical’, in Lacanian psychoanalysis – can be found best expressed in Seminar 3, and the paper entitled ‘On a question prior to any possible treatment of psychosis’ in the Écrits. To put it very simply, psychosis is conceived of as a structure, not a checklist of symptoms, or a particular phenomenological condition. Where neurosis is characterised by the fundamental operation of repression, and perversion by disavowal, in psychosis, foreclosure is paramount. To illustrate: in repression, signifiers and thoughts become unconscious. It is as if they were swept under a carpet; out of sight, but leaving a lump, nonetheless. In foreclosure, not only is the same material not swept under the carpet, but it is never admitted entry in the first place. This has ramifications for a subject’s entire place and function within the symbolic order (i.e. the order of discourse and law). It is as if a set of organising principles are lacking, at least, relative to those found in neurosis under repression. Continue reading

Understanding Psychosis

The British Psychological Society has released a major report on psychosis, which pushes the debate on this topic further than anywhere else in mainstream psychology in the Anglophone world. The report calls for, among other things, listening to psychotics themselves; seeing psychotic experiences as ‘understandable’ responses to distress, on a continuum with ‘normal’ phenomena; a rethink of bioreductionism and the medical model more generally; advocacy of ‘formulation’ rather than diagnosis, and advocacy of patient rights more generally; and finally, the provision of psychotherapeutic treatments alongside pharmaceutical approaches. There are numerous online responses to this report already, some supportive, some hostile. I would like to offer a few words from a critical, psychoanalytic perspective. Continue reading

The Other, clinical and empirical: A review of Fonagy et al. on Affect regulation, mentalisation, and the development of the self

The following is taken from a presentation delivered late in 2011. Despite the age of the piece, I thought it worth sharing, as it touches on issues from more recent debates such as the nature of psychosis, the meaning of neuroscientific data, and the ethics of treatment. My views on certain matters below, such as phobia, or the nature of signification, have changed since then, but my views on Fonagy are more or less the same.

 
Anglophone psychology has long objected to the alleged individualism of Freud and
psychoanalysis. Psychoanalytic theory, they say, focuses on the intrapsychic, not the
intersubjective. Adler was one of the first to add a “social‟ element to psychodynamic
theory, positing a lack of “social interest‟ as the cause of every neurotic illness (Adler,
1928/1998). Later, a number of largely US-based psychoanalysts, led by Heinz Kohut,
championed an “intersubjective‟ or “relational‟ psychoanalysis. Continue reading