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08/05/2006

Me?

Daniel Binswanger reflects on Freud on the occasion of his 150th birthday

Sigmund Freud, 1914 Β©: Max HalberstadtSigmund Freud, 1914
Β©: Max Halberstadt
I'll admit from the outset; having never gone through psychotherapy, I'm not really qualified to be writing this article. On top of that, I should confess that there have been a few Freudian psychiatrists among my forefathers – so I'm clearly not untainted. My relationship to analysis has more to do with geographic than genealogical circumstances, at least from the profane standpoint of the uninitiated. I live in the fifth arrondissement in Paris, the quarter with the highest concentration of analysts in the world. Because many of my friends come to the neighbourhood for regular, weekly (if not more frequent) therapy sessions, I have come to realise over the years that much of my social life takes the form of post-seance aperitif. Often, the somewhat shaken up self-explorers have to be revived with a glass of dry Chablis, after which they either talk non-stop or not at all about their exploits with the talking cure. The listener - friendly, interested - is thus confronted with the blessings of the Freudian revolution.

Paris is indisputably the psychoanalysis capital of the world, possibly because it all began with Dr. Charcot's passion for his harem of female hysterics. Charcot hypnotised his patients in order to draw the truth of their suffering from them. A young Viennese neurologist by the name of Sigmund Freud was so fascinated by Charcot's method that he spent a research semester at the Parisian Salpetriere. The results are well known: the Freudian doctrine of neuroses, a revolutionary discovery for the world. The unconscious rules over the entire soul and sexuality rules over the unconscious.

Perhaps psychoanalysis' ultimate triumph lies in the fact that it was initially met in France with great resistance. The French rejected the "science allemande" which began stretching its tentacles westward from Vienna after the First World War. But as analysts know all too well, where there is deep hatred, there is also deep love. After the Second World War, Freudian doctrine made inroads in France like nowhere else. It dominated in universities, it was the basis of therapies for the elevated classes, it was the defining principal. No reputable bookstore could do without a shelf on psychoanalysis. A feuilleton debate was incomplete without a contribution from an analyst. Parisian intellectuals rarely turned down baptism on the couch. There are proportionally more psychoanalysts in Buenos Aires but this is only thanks to the example set by Paris. In Zurich there are more couches than along the Seine but analysis doesn't have the same kind of public authority, not any more at least. Especially spectacular is the fall in prestige in the former analysis Eldorado of New York. The only shrinks left are in Woody Allen films. But in Paris, the high times don't want to end.

Freud has an unusual position among the classics. Although he revolutionised our understanding of humanity more than any other thinker of the twentieth century, although fashion magazines are still full of vulgarised Freudianism, his work is not really considered scientifically sound. To the contrary, clinical psychiatry doesn't tire of piling up the case against him. In the 1970s, psychiatrist J. Allen Hobson put forward the thesis that human dreams, which Freud places at the centre of his deciphering project, are no more than the result of chaotic neural jitters: meaningless synaptic garbage.

But even if the great deconstruction has been underway for years, especially in the USA, there is no shortage of biological evidence in Freud's defence. Neurophysiologists like best-selling author Antonio Damasio or South African researcher Mark Solms (books) are ever more interested in the unconscious, emotional steering of cerebral processes. Genius of the century or charlatan? The debate has been going on for decades and the match keeps spilling over into overtime. A case of the compulsion to repeat, Freudians would say, even if such a thing may not exist. Periodically, the German magazine Der Spiegel plasters the Viennese Übervater on its cover, at times the last great fraud, at times the genius.

In the face of such moody fluctuations, the constancy of Freudian reverence in Paris is quite impressive. And French psychoanalysis forms a total exception, not just in its unshakable prestige but also in its content – it brought with it several congenial standard bearers. Jacques Lacan is the most brilliant, most respected and most hated eccentric in the long line of Parisian great minds. He managed to sell himself as a pure Freudian, while at the same time mixing psychoanalysis with every theoretical adventure that came out of the 60s. Formalist linguistics, structural anthropology, Althusserian Marxism: everything was mixed into one foamy discourse cocktail. Never before had French great minds been so exciting, so bubbly, and so impossible to understand. Never before had a thinker been so convoluted theoretically and so powerful institutionally. To date, French psychoanalysis is dominated by the sect-like sworn Lacanians. The highly complex, highly erudite, and frequently totally absurd theoretical acrobatics of the inscrutable Dr. Lacan hold an unbroken fascination for philosophers and cultural theorists alike.

To date, but perhaps not forever. Since a certain "Black Book on Pyschoanalysis" entered French bookstores last fall, nothing has been the same. Now the analysts in the stronghold of Freudianism are even succumbing to pressure. High noon on the couch edge: was all that dream analysis and childhood plundering for nought after all? Have the wild outgrowths of those unsupervised analysts actually caused more damage than healing? The ladies and gentlemen of the ecole freudienne are up against a brisk wind. And as it is with debates among analysts, the tone quickly gets hysterical.

Those who stand up for psychoanalysis are subject to the first rule of nude beaches: only those willing to expose themselves are allowed in. The bloody polemics that are coming from analysts in Paris – the orthodox Freudians and dominant Lacanians in particular – tend, as a matter of principal, towards the personal. The veteran Freudian Andre Green calls the Lacan inheritor (and stepson) Jacques-Alain Miller "a con-artist." "He has to take any kitchen stool as a platform for his torturedness and impotent outbreaks of rage," writes Miller of his distinguished colleague. And critique of Freud is simply not tolerated. "You strike me as a little whining kid," said the analyst J.-D Nasio in a debate with Jean Cottraux, one of the authors of the "Black Book." In the 70s there were also attacks on analysis, mostly from feminists, but never as aggressive as today.

The agitated Freudians do have a point: the ominous "Black Book" that is making their lives so difficult does not offer the most objective critique. It's a confusing conglomeration of everything that has been or can be said against psychoanalysis. The spectrum reaches from accusations of falsification against Freud himself to a stripping down of his students to a universal critique of the process of clinical analysis. Less would be more. Nonetheless, the book contains several painful truths (most of which have been known for a while). The analysts are stepping out of the line of fire. "We won't defend ourselves, we'll fight back," writes Jacques-Alain Miller in the forward of the "Anti Black Book" that he's published. "Why so much hatred?" asks the Lacan biographer Elisabeth Roudinesco in the title of a pamphlet which is also a response to the "Black Book." Of course, she has a psychoanalytic explanation.

Openness to criticism is not a strength of Freudians. He who attacks analysis demonstrates – to those on the inside – "resistance" and is thought to confirm the truth of the doctrine. Being an analyst doesn't just involve applying certain proven methods and concepts. It also involves submitting oneself to analysis and thus penetrating spheres that are not to be accessed through strictly objective reconstruction. Analysis is verified more through an initiation rite than a theoretical edifice. And that can be a dodgy matter.

Take, for example, my friend Jerome*, who is going through therapy with the best known analyst in Paris. We were all jealous when he began his analysis with the great M. That was in 1993, and since then, there have been many opportunities for post-seance aperitifs. The great M was known to have been a good friend of the philosopher Jacques Derrida, Derrida who we greatly admired and whose Wednesday seminars were not to be missed at any price. The proximity to philosophy, even if mainly for purposes of glamour, is part of Parisian analysis. It's a significant reason for its unique success. Academic philosophy is far too grey and technical to be interested in the existential demands of the individual. A political welding of the public to the private has proven unsuccessful. The analyst serves, at the very least, as a proxy for worldly wisdom. In his person is a professional who supervises the cradle, the love life and the blockages of every earthly citizen. Division of labour makes this possible (assuming that the earthly citizen is willing to pay).

Of course, virtually nobody undertakes analysis out of frivolous intellectual curiosity. One signs up for analysis because one is not doing well. The clinician who's treating acute psychic problems has enough worries before he starts adding questions of a higher order to the daily lives of his patients. But all things therapeutic are located in the grey zone between the pragmatic reduction of suffering and the possibilities offered by various Weltanschauung. The public prestige of psychoanalysis is more due to its ideological profile than its therapeutic effectiveness. This is evident in the fact that most analysts don't consider themselves foremost therapists, nor do they want to be identified as "therapists". They're not concerned with the healing of symptoms but rather with the recognition of truth. The truth of the unconscious.

It's no coincidence that psychoanalysis' star began ascending as that of Sartre's existentialism was falling. Sartre had already said that no philosophy of the world could show a person how he should act in a particular situation. One can read as much moral philosophy as one likes, it's not going to help with the decision of whether to join the Resistance – this was the claim of the engaged intellectual, who, of all people, should know.

Nonetheless, Sartre embodied something, the possibility of which he actually denied: apprehension of the world in one go, a way of thinking that formed a playful bridge between the meditations of Descartes and strategies of everyday life. Today we need a specialist for everything. We have therapists to handle our personal fates, although they should be more than just psycho-coaches. The analyst should mediate between the spheres, he belongs in a rarefied atmosphere, even if that just means that he's talking to the philosophers. Lacan made "intellectualisation" an imperative. Where better to do that than in Paris?

So now Jerome's been lying on the couch for 13 years and there's no end in sight. Analysis often becomes a trap that holds onto patients for decades. The procedure is ineffectual if the analysed does not transfer the deepest elements of his emotional life to his analyst – the first step in his being able to manage them. The "transfer" is the lever with which the analyst gains access to the patient's unconscious. Theoretically, this should be a transitional state; the emotional attachment to the analyst should dissolve after it's been worked through. But if the procedure fails – and defining success in this case is difficult - then the existing blockages are supplemented by an awkward additional problem: one becomes dependent on one's carer.

Other therapies don't go as deep. They don't muck around in the bases and the abysses of the soul; they let childhood traumas lie. They leave the transfer out and they don't put the therapist in the position of a sovereign knower of all. But they work faster and they give the patient his autonomy back sooner. That, at least, is the main argument of the "Black Book on Psychoanalysis."

Does it work or not? Psychoanalysis does not let itself be reduced to this question, but one would like to know anyway. In this matter, France is like anywhere else in the world. Statistically speaking, therapeutic success can only be considered modest. Where empirical experiments with control groups have been conducted, it can be shown that analysis works better than spontaneous healing in the case of only a few illnesses. And in comparison with other therapies, analysis does not fare very well. It is less effective in treating the symptoms of psychic dysfunction than behaviour therapy; on top of that, it takes longer and costs more. A study by the French Health Ministry reached this conclusion in 2004 – and was opposed so stubbornly by analysts that it had to be withdrawn. An earlier study by the WHO and the British Health Ministry came to similar conclusions. And the highly controversial study conducted by the Bernese psychologist Klaus Grawe for the German supervisory body bore similar results. There is no question that the methods of behavioural therapists, which are leading the charge against the Freudians in Paris, seem rather crass, given the subtle exegesis of the unconscious. The question is not, however, one of refinement but of efficiency.

Unfortunately, empirical psychology is not medically omnipotent in the broad field of mental suffering. Although some progress has been made with psycho-pharmaceuticals, it's not totally absurd to choose the talking cure over chemical surface bombing, even if the chances of success may not be as good and the process more protracted. Psychoanalysis is the luxury class of psychiatric treatment. One might conclude that health insurance should not cover the costs, or only under particular circumstances. But in the French Eldorado of analysis, this argument is irrelevant. The insurance companies contribute nothing and the Lacanians have made it dogma that healing is only possible if the patient is willing to pay for it himself. As with prostitutes, you lay the money on the table after each sitting: financial and political responsibility for the self at its best.

Sigmund Freud, London 1938
But the puzzle remains: what mysterious things happen in an analyses that make people willing to pay so much for them, year after year? Basically "nothing" is done, but to astonishing effect. The Cambridge philosopher Ernest Gellner wrote in his 1985 work "The Cunning of Unreason" (arguably the smartest anti-Freud manifesto ever written) that the fact that so many analysis patients are enthusiastic about their treatment doesn't say much about the truth or falsity of the theory on which it is based. And nonetheless, most people in analysis are convinced that they are learning something fundamental about themselves. Even when the analysis fails.

So what does the analyst actually do? He is silent. Most of the time, at least. And sometimes, rarely, he makes a sound. Says a short, enigmatic sentence. Grumbles quietly. Clears his throat discretely. Establishes "quilting points" in the patient's discourse, to use Lacanian jargon. And then associates further. In Freud's technical writings, there are digressions on the art of throat clearing, hmming, quickly interjecting. Lacanians have made icy laconism their dogma. In his last years, Lacan wrapped himself in silence – if only because, as we know today, he had suffered a stroke and was struggling with mental absences, even as the Parisian intelligentsia continued to stretch out on his couch. Analysis is a big echo chamber that the patient talks into. And obviously there is little else that takes such a strong hold of a disturbed soul than this silent hall of mirrors. "Discourse without words": this was Lacan's definition of psychoanalysis.

After one session, Jerome was especially happy. The great M had, for the first time, asked him a direct, concrete question. Jerome had brought the great M a package of Davidoff Culebras, those monstrous woven cigars which Lacan had pretty much permanently clenched between his teeth. They're not easy to find. "Where did you get these?" was the great M's question. It was 1997, four years into Jerome's analysis.

Corina, a German exchange student in Derrida's Wednesday seminar, once showed M's art of the nonverbal to me. She was one of the select few who was allowed to do analysis with him. Shortly after the beginning of her analysis, she slept with Jerome who was a little surprised to learn that she intended to tell M the next day how she had seduced one of his patients. M made no noises and then just a little one. It was like a quiet, tired fart. The sound that one hears when an old party balloon lets out its last gasp of air. A weak burp of irritation. Corina imitated the magical sound for me and then burst into tears. Whether such things help? At some point, Corina's therapy came to an end. Whether it was spontaneous healing or the result of the great M's ability to let the air out of hysterical aberrations with a little cut, we'll never know. As the Freudians like to say: statistics have little to say about the fate of the individual.

It gets more precarious for those who can't detach themselves from their analytic Übervater. There's only one solution: for them to become analysts themselves. Jerome began to practice. He had no particular qualifications, but because he spoke exotic eastern European languages, a famous Parisian master analyst asked him if he could take over two patients who didn't seem to be able to speak French. The timing was good; Jerome, who was still having trouble getting through the day, was also out of work and was in danger of becoming fully marginalised. It was 2004. He bought a gold plaque and had name and the word "psychoanalyste" engraved on it. He invested his last pennies in two Romanian illegals, who gave his living room a new layer of paint. Then he was all set.

Now I should explain, in Jerome's defence, that he was in the process of studying psychotherapy and had already entertained thoughts of trying to follow in the footsteps of the great M. A survey has shown that over 50% of patients who do analysis for over 5 years want to become analysts themselves. Nonetheless, as he set out on his unexpected career, Jerome was a long way from getting his diploma in psychology. And it wouldn't have brought him any further anyway. Analyst in France is an unprotected title. An analyst is someone who has completed studies in training analysis, although Lacanians make no distinction between training and normal analysis. Which means that anyone is an analyst who is called such by his training analyst. A chain letter of co-optation.

The Parisian polemic about the "Black Book" was also ignited by the question of whether the state should demand something like admission standards from the various psychoanalyst associations and whether the title of therapist should be protected in some minimal way. This totalitarian, authoritarian intervention was promptly recognised as such and obliterated. Didn't Lacan himself say that "the analyst acquires legitimacy through himself"?

Patients do agree, however, on one thing; there are a lot of incompetent analysts out there. Serge, one of my few Parisian acquaintances who has never submitted himself to analysis, told me that he once started one but ended it shortly thereafter. It was the only time in his life that his mother literally pleaded with him. When she heard of his couch plans, she begged him to tell her with whom he was planning to do his analysis. There are too many crazies out there, she said, menaces to the public good who call themselves analysts. She needed to know whose hands he would be in. Serge's mother is a practising Lacanian. Maybe that's what gives Parisian psychoanalysis its extra kick; it functions like a slightly snobby game of mental health roulette. Those who choose the wrong analyst are in bad luck.

One day Genevieve, an old acquaintance, called me to cancel her post-aperitif seance. She had had bad luck. Her psychoanalyst had died two days earlier. Her voice was full of fury and tears. "I began this analysis because I was having a hard time getting over my father's death. I lay on the couch for four years and paid thousands of euros and now the idiot goes and dies on me. You're not going to understand this, but now I have the feeling that I'm falling into an even deeper hole than after my father's death." She paused and then said, as though a light had just gone on, "Psychoanalysis has one serious error in its reasoning: analysts are not immortal." Many patients elevate their analysts, their father figures, models, confidants to the pantheon of the gods.

Genevieve took comfort from a friend who had been made an couch orphan. Her analyst had had a stroke in the fifth year of her treatment and slipped into a coma before finally dying. Genevieve's friend was so disturbed that she finally got the therapist's spouse to allow her to visit the comatose guru in hospital. Often, she sat at the bed of the unconscious one in the half-darkness of a room of coma patients and talked to the light peep of the supervisory apparatus. She said she did it for him.

The shrink as a mummified oracle; that's one of a kind. But given the bizarre entanglements that patients get involved in, it's worth asking if analysis might be a kind of religion. It is definitely interesting to note the theological tones in Lacan's thinking. According to Freud's innovator, the unconscious is always oriented to a "Great Other," an all-encompassing über-authority that has astounding similarities to the classic notion of God. The psyche gains access to this "Other" through the symbolic power of language. The "symbolic" opens itself to the psyche only when it accepts prohibitions and laws (in particular the incest prohibition) and thus gains structured access to the world. Only those who desire these prohibitions will be able to communicate with the Great Other, will free himself from obsessions, fixations and neuroses. Put differently: only those who submit to God are granted his mercy. Lacan is best understood in this very Christian way. And it's a way that's enjoying increasing popularity.

The eccentric master thinker was a hero among the 68ers but that was based in large part on a misunderstanding. Even if the inner convictions hiding behind Lacan's theory loopings will never be completely understood, it is clear that his Catholicism played a major role. In 1953 he offered his services to the Holy Father in Rome; the Vatican politely turned him down. A significant number of French analysts are or were ordained priests. Here lies the main reason for the particularity of French analysis. It had no problem hooking up with the church's pastorate.

Sigmund Freud and his daughter Anna, 1913
In historical terms, psychoanalysis belongs to the sexual liberation movement. It allowed people to feel drives without guilt and took a critical look at family structures. But today, Lacanians have become the actual apostles of "paternal authority," who lament the decayed values of the "fatherless society." Even the development of psychoanalysis is being understood as a reaction to the "crisis of the father function," as a mobilisation against the downfall of a patriarchal basic social structure which is God or at least nature-given. Everything that threatens the traditional role of the father – and thus the classic "Oedipal triangle" of mother, child and genitor – is to be combated or at least labelled pathological by them: homosexuals, gay couples, single parent families. It's a strange reversal in intellectual history. The analysts who were looking for the great Marx-Freud synthesis in the 60s and wished for the revolt, who lost their faith in the political in the 70s but at least were able to contribute to the betterment of the world in their protected studios – today they find themselves in the same boat as Benedict XVI.

The therapists form a small minority in the boat; after all, Parisian analysts are notorious for fighting among themselves. The most important in the public view are the students of Lacan. And even if this group seems to be divided into innumerable little orders, their quasi-theological foundation seems to be solid. In his recent tome "Fin du dogme paternel" (the end of the paternal dogma), analyst Michel Tort demonstrates how popular it is to preach the renewed sacredness of paternal authority as the generic response to "Triebschicksal" (drive destiny). His biting settling of accounts with the quasi-Catholic Freud followers reads like a "Who is who" of Parisian Lacanians.

There has been no shortage of attempts to adapt Freud's teachings to rapid changes in society without preaching about the restoration of values. The question is: what remains of Freud when the rapid dissolution of family structures is brought to his teachings? What remains valid when the spine – the theory of the Oedipus complex – is adapted to a world that is ever less defined by patriarchal structures and gender asymmetries. Analysts have a particularly hard time with homosexual marriage and the right of homosexuals and lesbians to adopt children. Can psychic steering still function when the aura of patriarchal omnipotence no longer legitimates the word of the analyst?

Presumably, Paris will arrive at a new order, closer to the muddle of Germany and Switzerland and which is be codified, in the latter case, in a long-anticipated psychotherapy law which will allow for a relatively peaceful, state-regulated pluralism of therapy forms. With respect to the question of the truth, it seems somewhat strange for Freudians and Jungians to be sharing the market in psychic need with behavioural therapists and practitioners of biodynamics. The battle cries of the Parisian berserks seems more fitting.

But from a pragmatic standpoint, tolerance makes sense. If nobody can offer universal prescriptions, the patients should not be spared the burden of choice. Unlike the rank growth in France, the Swiss therapists have good reason to accept the concordance model because nobody wants to jeopardise his chances at admission into the health insurance funds.

Only one thing is certain; the therapy market is growing. The more social ties relax, the more stable life models and classic family structures – which Freud was so obsessed with – give way to more flexible forms, the greater the need for therapy.

The churches are emptying, the practices are filling up. That Freud's nimbus should begin to fade in what was once his stronghold - Paris - is a clear signal. Analysis is in need of a fundamental revision. The trade fair of the psyche is over.

One of Freud's greatest followers was Thomas Mann. He chronicled the downfall of the class for which the analytic talking cure was designed. Nonetheless, at the beginning of "Buddenbrooks", he presents Dr. Grabow, the family doctor who can never help with anything and who prescribes "a little French pastry" for whatever ails. Maybe he was right. A "little French pastry " or a little Chablis.

* Names have been changed.

*

Daniel Binswanger is Paris correspondent of Die Weltwoche.

This article originally appeared in the print edition of Die Weltwoche.

All photos courtesy of the Sigmund Fred Museum Vienna, currently showing the exhibition "The Couch: Thinking in Repose".

Translation: nb

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