Therapy in Psychoanalysis
If psychoanalysis is not simply a psychotherapy, what significance can be attributed to the signifiers therapy and cure in the context of the analytic discourse? The Author, after having stated that an analysis is always an inextricable interweaving of therapy and subjective formation, extrapolates and re-proposes some reasons for which psychoanalysis ought to be considered a different practice with respect to psychotherapeutic practices: they are different with respect to aim and objective; they are incompatible with respect to the question of knowledge; and they have different positions with respect to subjectivity. The analytic cure, in fact, is a practice which implies a particular ethics, which Freud brought out by exploring the logic of the unconscious.
Reconsidering the experience of the passe, in a lecture of 1973, Lacan confirmed how the distinction between therapeutic and didactic psychoanalysis was vain and wrong. And it was in that context that he debated the word “didactic” itself.
Although this might seem to be fussiness or an excess of rigor, on the contrary, one cannot actually speak of lay (non medical) psychoanalysis, as long as this point has not been (is not) clarified. A consultation of the parliamentary discussion as regards the Italian law of 1989 regulating the profession of psychotherapist, makes it immediately clear that legislators only with difficulty were able to include psychoanalysis in the category of psychotherapy. Consequently, the members of parliament have resorted to simply removing the word “psychoanalysis” from the list of psychotherapies leaving the question open as to whether or not psychoanalysis was in fact included.
In my opinion psychotherapy does not include psychoanalysis not because psychoanalysis is a supertherapy of sorts, as it has on occasion been referred to, but that an analysis is always an inextricable web of therapy and subjective formation. Therapy does not occur without subjective formation and this proceeds producing therapeutic effects. The will of forcibly and even compulsorily splitting therapy from didactic was the effect (albeit perhaps, although this has not yet been demonstrated) of the institutionalization of psychoanalysis. That separation occurred in 1924, when the teaching commission of the Berlin society, for the first time in the psychoanalytic history, took the decision to control its own activities through regulations. Bernfeld’s description, at a conference in 1952 – thirty years later – was more than likely correct: “In Vienna, being close to Freud, we preferred to offer to the new movement the opportunity of serious studies in psychoanalysis and its application to all fields of therapy and education. Whereas in Berlin, the aim was at separating the societies of psychoanalysis from the cultural movement as a whole and setting up psychoanalysis as a specialization of the medical profession.”
As a result, the effort to reduce psychoanalysis to psychotherapy has become one of the longest lasting resistance to psychoanalysis itself. Thus I insist on pointing out the concrete reasons why psychoanalysis could not be included among psychotherapies: the radical differences existing between the two practices.
These differences can be summed up briefly as follows:
– Differences in purposes and aims. Psychotherapy is essentially concerned with the immediate welfare of the patient, attempting to eliminate the symptom in the briefest possible time. In an analytical experience, on the contrary, the aim is above all the integration of the truth of the subject in his discourse. To achieve this, one must attempt to avoid – as Freud explains – the so called furor sanandi, which is the therapist’s typical approach.
– Incompatibility with the matter of knowledge. Psychotherapy has a utilitarian relationship with knowledge. As it is a kind of offspring of modernity (giving to this expression an Heideggerian meaning), psychotherapy proposes technique as the only possible approach to the illness of the patient, while in psychoanalysis the relationship with knowledge is a peculiar one, given that it is at the very origin of transference. In other words, love is what knowledge summons up during an analysis: and love cannot easily be controlled or utilized. On the other hand, the definition of unconscious given by Freud shows that it is a matter of real knowledge (“knowledge in progress”). However, it is precisely together with that uncontrollable knowledge that an analysis takes place. This is why that technique in psychoanalysis is so problematic for analysts.
Subsequent to the above two differences is a third one which could be understood as:
- Different position of the two practices as regards subjectivity.
According to Freud, if the unconscious subjectivity is the effect of the significant relationship, psychoanalysis was created and structured leaving space for the emergence of this subjective possibility. From the free associations made by the analysand to the listening position assumed by the analyst as the third, everything proceeds to allow the function of speech act in the direction of subjectivity, without the authority of the analyst substituting the ego of the subject. Psychoanalysis (it should be remembered), arose from Freud’s refusal to use hypnotic techniques. “My job with patients affected by nervous illnesses had a further result: the change of cathartic technique”, Freud wrote in his Autobiography of 1924. The reason that Freud considered was that: “Even the most brilliant results disappeared all of a sudden… when the personal relationship of the doctor with the patient was in some way upset.” I would place an emphasis on this passage of Freudian writing as it introduces important problems.
Freud remarks how hypnosis, which might be considered the prototype of every psychotherapy, while obviously fundamentally a practice producing therapeutic effects, but not the recovery. Once ascertained the above, it will be evident that psychoanalysis is a practice mainly involved with recovery; but this is not so evident. Lacan, for example, has repeatedly pointed out how recovery is simply a bénéfice de surcroît, that is an additional benefit of the cure. Freud says no less when he advises analysts to avoid the furor sanandi, even admitting (up to ascertaining) that he himself was a bad therapist. And yet psychoanalysis was created following the admission that it was impossible to bring about the recovery of patients using other practices. Freud himself, in many of his writings, affirms that psychoanalysis is certainly the most effective practice when compared to other therapeutic procedures.
How might this apparent contradiction be explained? The decrease of psychic suffering of the patient – therapy – takes place, during an analysis, on a different register (although strictly connected) from that on which what we call recovery – the only evidence that a therapy took place – occurs. In this context, according to Freud, recovery is achieving the modification of the subject’s libidinal economy – according to Lacan, it is subjective subversion. Up to this point, I have stated that psychoanalysis, in its passage from hypnosis to the managing of transference, determines also a going in the direction of suggestion. Psychoanalysis does not exclude suggestion from its field of action – which would be impossible, since it is a practice based on words – but precedes in the attempt to articulate it. Every psychotherapy proceeds as a practice essentially based on suggestion, due to its very structure.
Let’s now consider the last and most determining difference, although my list of differences is partial:
- Psychotherapy and psychoanalysis differ, above all, because they represent two different structures of discourse.
In his Seminary of 1954-55, Lacan stated that “There has always been psychotherapy, without knowing well what one was doing; in any case the function of the speech was always present”.
Then, the persisting confusion between psychoanalysis and psychotherapy is due to the fact that in both practices the function of the speech is present and produces its effects. This is the common feature shared by psychoanalysis and psychotherapy and cannot be eliminated.
In fact, if we define psychoanalysis as an experience of discourse, thus making explicit the difference between function of the speech and structure of the discourse, we are one step closer to the necessary clarification. On the other hand, as recent psychoanalytical literature amply states that psychotherapy is just a protasis of the medical discourse, sharing completely its structure, it would only be a further waste of time to labor this point. Moreover, the medical discourse is diametrically opposed to the analytical discourse.
If psychoanalysis is not a psychotherapy, what signified meanings can we attribute to the signifiers therapy and recovery in the context of the analytical discourse? I do not agree with those who consider recovery a concept extraneous to psychoanalysis, or even a preconceived idea of the analyst. This would be true only if one simply extrapolated the word recovery from the medical discourse transferring it then to the analytical discourse without re-articulating it. Freud instead affirms that recovery is a mainly metapsychological concept. Hence, in addition to my distinction between therapy and recovery, I will specify that, unlike the medical practice where recovery is the happy conclusion of therapy, as the (as it does not exist) contrast between therapy and recovery does not exist, but only continuity, in the analytical practice the effects produced during the cure do not proceed spontaneously towards recovery, but at times even oppose to it.
Psychoanalysis reveals that the subject wants to improve, to eliminate or decrease his psychic suffering, but does not want to recover. However, i am not saying anything particularly new because this is precisely that problem which Freud pointed out in Analysis Terminable and Interminable (1937) (1). It is a problem strictly connected with the end of every analysis. It is a well known fact that many analyses are either suddenly interrupt or tend to become interminable. Freud points out the difficulty of bringing an analysis to its conclusion before what we could call the ‘rock of castration’ is confronted. So, let us examine what has always been cause and object of every therapy: the symptom. In fact, the key is provided by what psychoanalytical theory states about the neurotic symptom. We can define a neurotic symptom as the cause of the demand for analysis. This is not the only possible definition – and perhaps not even the best – but it has the advantage of providing a clear connection between the symptom and the demand, thus accounting for why both, symptom and demand for treatment, are suspended by the analyst in order to let the subtended desire emerge. For psychoanalysis, the symptom exists only when it becomes manifest in the demand formulated to an analyst – previously and subsequent to this moment the symptom does not exist. Not previously because only a subjectivity formulating a demand qualifies the symptom as such. Not subsequent to, as at the very moment the symptom becomes articulated in the demand it is no longer treated as a symptom, because it has already become something else, that is, a matter of transference. The aim of transference is to accompany the patient along the way that leads to the fantasy nucleus of the analysand. Thus, also from this point of view, the connection between the symptom and the structure determining it is evident. In other words, Freud intended the symptom as a formation of the unconscious. We can at this point summarize Freud’s definition of symptom:
- as a formation of compromise;
- as the coming back of the ‘repressed’;
- as the substituting satisfaction of an unconscious desire.
What, then, distinguishes the symptom from the other formations of the unconscious, that is, slips of the tongue, dreams and wit? One thing mainly: the neurotic symptom always implies psychic suffering and just this problem leads the subject to formulate a demand for recovery. On the other hand, there is another side to the symptom, according to Freud’s definition of it, which should be recalled in its most radical essence – suffering. The symptom, according to Freud, is a substituted enjoyment of an unconscious desire, which occurs instead of another enjoyment. But it is precisely this enjoyment, that the symptom stubbornly encloses, which interposes to the end of an analysis. In fact, this enjoyment is reached in spite of the Law, avoiding castration. The famous expression “rock of castration” can be read as a dialectical process between desire and enjoyment. Lacan writes in this context: “Castration means that it is necessary to refuse the enjoyment to reach it on the upside-down scale of the Law of desire.” An analysis reaches its end only if it provokes an ethical revision of the position of the subject, allowing him or her to face castration. Therefore, we see once more that psychoanalysis cannot be included in the melting-pot of psychotherapies, because it is a practice implying the peculiar ethics that Freud derived exploring the logic of the unconscious. It is not a matter of ethical generalization, that is of moral or deontology, nor is it a matter of an ethics similar to other ones in the history of Western thought – for example, the ethics of Aristotle and Kant. This ethics of psychoanalysis is in opposition to the ethical deformation made by neurosis.
The argument is, with Lacan, very easy to follow and convincing. If, according to Freud, the symptom is a substituting satisfaction, i.e. a formation of compromise between desire and enjoyment, it is thus necessary to admit that the neurotic structure of the symptom implies, first of all, that the subject yield to his desire. The sense of guilt originates from this yielding – as does that side of the symptom I have called suffering. In psychoanalysis, the symptom is also an ethical deformation. For this reason the analytical cure is an ethical one, as it leads the analysand to face dialectically the truth of his unconscious desire, in order to reach a subjective position from which what Freud calls revision of judgement (Urteilsverwerfung) and eventually even condemnation (Verurtelilung) of drive become possible.