In her column in “Le Monde”, the historian E. Roudinesco deplores the loss of prestige suffered by the discipline, and argues in favour of returning to so-called “humanist” psychiatry.
Saturday, Feb. 9, 2019, Le Monde.
Since Jacques Lacan’s death in 1981 – the last great representative of the Freudian lineage – the situation of psychoanalysis in France has changed. Common vernacular uses only the undifferentiated term “psy”. In other words, the term “psychoanalysis” used by Sigmund Freud in 1896 to designate a talking cure based on exploring the unconscious, which, by extension, became the foundation of a discipline, is no longer distinguished from a cluster made up of psychiatry (branch of medicine specialised in treating diseases of the soul) and of psychology taught in universities (clinical, experimental, cognitive, behavioural, social, etc.).
As for the term “psychotherapy” – a treatment based on the power of transference –, it is now shared by psychiatry, clinical psychology and psychoanalysis. Psychotherapeutic schools continued to emerge during the 20th century under different designations: 400 to 700 throughout the world at any given time. Among them, hypnotherapy, Gestalt therapy, relational therapy, behavioural and cognitive therapies (BCT), personal development, meditation, etc. Psychology magazines regularly update the list. What these therapies have in common is that they promise happiness to those who are suffering.
Since May 2010, these therapies are regulated in France: practitioners have to obtain a university diploma (Masters in clinical psychology) in order to call themselves psychotherapists. Otherwise, they use the title “independent psycho-practitioner”.
Today, there are 13 500 psychiatrists, 27 000 clinical psychologists and about 5 500 psychoanalysts in France; almost all of them have a diploma in clinical psychology. Since these regulations do not apply to the title of psychoanalyst, only the psychoanalytic schools (governed by the 1901 law) can train psychoanalysts, qualified on the basis of having been analysed, and having received supervision from a training analyst.
Statistics show that 4 million people in France are subject to psychic suffering, but only one third – 70% of them women – consult a psychotherapist. New terms have been created to describe the unwellness associated with the crisis existing in democratic societies characterised by economic precarity, social inequality and disillusionment: depression, anxiety, stress, burn-out, attention deficit disorder, obsessive-compulsive disorder, bipolarity and borderline, dysphoria, addictions, etc. These terms cover what used to be called psychosis (madness) neurosis (hysteria and its various forms), mood swings (melancholia), perversions. As a result, these conditions are now treated with psychotropic drugs prescribed by psychiatrists and general practitioners alike: anti-anxiety medication, antidepressants and sleeping pills, consumed excessively.
Strongly influenced by psychopharmacology, psychiatry – prominent in all University Hospital Centres (CHU in France) – has lost its former prestige because it has given up its dynamic plural approach based on subjectivity – psychic, social, biological – in favour of a practice based on symptom description, thereby reducing thinking to neuronal activity, the subject to a behaviour, and desire to a level of serotonin. This is made clear by the different versions of the Diagnostic and Statistical Manual (DSM) of Mental Disorders, whose definitions of pathology include the human condition itself: timidity, fear of dying, fear of losing a job or a loved one, etc. We have stopped counting the groups whose petitions object to this Manual and demand, like the “Manifeste pour un printemps de la psychiatrie” (Manifest for the rebirth of psychiatry) published by L’Humanité in January 22, 2019, a return to so-called “humanist” psychiatry.
“Psychoanalysis is no longer reflected in psychiatric know-how and no longer holds the place it used to hold in France in literary and philosophical circles since the Surrealists, up to the structuralists, with Marxists and phenomenologists along the way.”
Under these circumstances, psychoanalysis has entered an endless phase of decline. It is no longer reflected in psychiatric know-how, and no longer holds the place it used to hold in France in literary and philosophical circles since the Surrealists, up to the structuralists, with Marxists and phenomenologists along the way. Practitioners use incomprehensible language in their writings. Intended for their inner circle, these works are printed in small editions not exceeding 700 copies. As a result, publishers of literary works for a general readership have made psychoanalytic books the smallest portion of their output, or have eliminated them altogether. This is the case for Seuil, Gallimard, Aubier, Presses universitaires de France and Payot, where psychoanalytic writings flourished for thirty years.
The classics – Freud, Melanie Klein, Sandor Ferenczi, Winnicott, Lacan, Dolto, etc. – in paperback editions, continue to be sold on a regular basis. But contemporary works, with a few exceptions, have taken refuge at Erès, a publishing house in Toulouse, founded in 1980, which publishes books and journals in editions of less than 500 copies intended for mental health professionals, educators and pediatric specialists. As a result, psychoanalysts are no longer seen as authors or intellectuals, but as mental health workers.
Divided into nineteen associations with a majority of women members, psychoanalysts constitute an assemblage of communities which often know nothing about each other. They organise conferences, enjoy belonging to an association, like to travel and profess to love their profession. The gap between the generations has widened to the point where the private clientele sees the elders, those between 60 and 85, to the detriment of young analysts (30 to 40 years old), who are underpaid in institutions (medicopsychological centres, medicopsychological centres of learning, day hospitals, etc.).
Younger analysts have difficulty setting up their practices. To become known, they create Web sites with photographs of their couches and armchairs, and offer negotiable prices, listing a variety of therapies. Clients have become scarce: psychoanalysis attracts fewer and fewer patients. But, paradoxically, interest in its history, its past and its major figures is increasing, as if Freudian culture has become a museum piece, to the detriment of clinical practice.
“Humiliated by the success of abject rantings discrediting Freud, psychoanalysts have abandoned public debate, turning a blind eye to any undertaking critical of them.”
The most influential associations – with 200 to 800 members – are divided into three branches: the first (called classical Freudian) belongs to the Société Psychanalytique de Paris (created in 1926); the second is home to the Lacanians (created between 1981 and 1994); and the third brings together all the various Freudian groups (created between 1994 and 2000).
Not only is there criticism of their dogmatism and inflexible training program, but psychoanalysts have contributed to their own downfall by adopting, since 1999, an objectionable position against homosexual marriage, and by having endless and exhausting disagreements about autism. Humiliated by the success of abject rantings discrediting Freud, psychoanalysts have abandoned public debate, turning a blind eye to any undertaking critical of them.
Sébastien Dupont, author of a lucid study on the Self-Destruction of the Psychoanalytic Movement (L’autodestruction du movement psychanalytique, Gallimard, 2014), has experienced this disdain: “As soon as one dares to express a critical opinion, one is accused of anti-Freudianism.” Moreover, some psychoanalysts regularly play their favourite game on seedy media: analysing political figures. Emmanuel Macron is their preferred target: “He suffers from an unresolved Oedipus complex, he married his mother, he has no superego, he is narcissistic.”
For decades, psychoanalysis was taught in psychology departments as a psychopathological approach to the psyche. Until 2009, Roland Gari, an advocate of teaching the discipline outside psychoanalytic schools, and Pierre Fédida (1934-2002), played a major role in the training of Freudian clinicians, particularly through the recruitment of teaching researchers within the 16th district of the National Council of Universities (CNU). Unfortunately, Gari’s successors, unlike him, have been unable to gain the respect of their adversaries, who want to drive them out of their territory in the name of the alleged scientific superiority of psychology. They are about to take advantage of the imminent merger of Paris V-Descartes and Paris VII-Diderot to achieve their aims.
This is why the Training and Research Unit in psychoanalytic studies at Paris VII- Diderot, a huge Freudian stronghold founded in 1971 – with 36 tenured professors, 270 doctoral students, numerous teaching assistants and 2 000 students – is now threatened with extinction. Three professors of the 16th district of the National University Council (CNU) have resigned, stating that it is no longer possible to have a dynamic and humanist approach within the current framework of scientific developments in psychology (letter dated December 21, 2018). Once again, calls for help are heard everywhere.
No need to despair
Although the clinical training offered at Paris-VII is of excellent quality and achieves great successes – such as the general assemblies on radicalisation and Jihadism –, there are also questionable attempts to “modernise” psychoanalysis, such as “queer” and “decolonial” analysis. How can one read with a straight face the announcement of proposed topics of discussion such as (Dec. 15, 2017): “Although psychoanalysis adopts a stand contrary to Cartesian logic (…), how aware is it of the ethnocentricity of its own tools?” Or: “How does the consideration of gender and coloniality contribute to psychoanalysis, to influence its perception of minorisation and othering practices?”
Yet we must not despair, knowing that thousands of French practitioners trained in an intelligent form of the Freudian tradition are dedicated to treating children in distress, mentally ill patients in serious difficulty, and wounded families.
Translated from the French by Agnès Jacob