Textes bilingues

1) The subject in psychiatry and the subject in psychoanalis

2) The subject of psychiatry and the subject of psychoanalysis

3) Finding the subject in Psychiatry and Psychoanalysis

4) Psychiatry and Psychoanalysis - what is the subject?

5) Psychiatry and Psychoanalysis - where is the subject?

We are structured in such a way so as to ensure that we are not disturbed in what we already know, so as not to know. Ignorance is our passion. From birth, from the very moment we come into the world, ignorance is the first misfortune to befall us.

So what is our second misfortune? It’s the fact that as beings, we are usually quite binary. When we ask ourselves the question – “what is the most important thing for us?” - the most vital and fundamental thing, we usually come up with two different sorts of replies. Not three! Just two! You could see this as a sort of common ‘poverty’ that we share as humans, whereby we are all equally ‘lacking’ in that respect.

And those two replies are the following. Either you take the stance that only science matters, that the only important thing is rigour, logic and all that is rooted in mathematics. That stance presupposes that anything to do with subjectivity should be brushed aside. Indeed, science establishes a form of writing that is made up of letters and formulas that are only capable of functioning in a machine or computer, without any human involvement at all. So there is no subject in the equation. He is wholly excluded from all scientific operations.

The alternative stance is to maintain that science is inhuman, impervious to feelings, and cannot understand man. That means taking the view that it is incapable of helping us on a personal, intimate level, and that the only thing that is truly genuine, real and desirable, is subjectivity. And added to this is the assumption that reason is ruled out as far as the subject is concerned. Why? Because the subject spends his time putting a spoke in the cogwheels of logic, always making irrational mistakes, his daily life forever peppered with instances of unconscious actions and Freudian slips etc.

So when we suffer from a symptom, what exactly can really help us? A technique rooted in science? Or quite the opposite? A method rooted in subjectivity. Or both? Or indeed do these two approaches cancel each other out? What is the correct course of action? What is the most advisable path to take?

Yet, what is extraordinary to note is that in psychiatry today we find these two conflicting schools of thought, these two diametrically opposed ‘plans of attack’ coexisting side by side. On the one hand, what you see is an approach that strives to be increasingly scientific, and therefore do away with the subject. And on the other hand you have quite the reverse - an approach angled more towards speech, which strives to give full importance to the subject.

So how do you rise above this contradiction, this paradox? First of all, we must recognize that in reality both of these two points of view reflect our true make-up – they are part of each and every one of us. That means that by definition - unless of course you are mad - all of us are divided in two, made up of a rational side and a sensitive side, each contradicting the other, and indeed neither in agreement with the other. On a psychological level, our minds are built on conflict. And that is at the root of our third misfortune as humans, our third source of torment. We are all plagued by complex questions that we cannot answer. Why? Because reason points us in one direction towards an answer, and our heart points us in a completely different direction. In Les Pensées the philosopher Blaise Pascal wrote: “the heart has its own reasons that reason itself doesn’t know”. This in-built lack of harmony, this incongruous equation that lies at the very foundations of our minds is what makes us guilty beings. And this guilt is what drives our intelligence. It forces us to think, to try to invent news ways, to always be looking for alternatives.

Yet the situation is a lot more complex than it might appear on the face of it. And that is where psychoanalysis comes in. The modern breakthroughs that it has brought into the equation have turned this notion of the dual nature of man upside down. Why and how?

If we think carefully, the subject does have a place in science. And this is what Albert Einstein demonstrated with his theory of relativity, which incorporated the position of the observer in the experimental process. In other words human observation was an integral part of the theory. In this light, the subject proves to be a determining factor in calculating mathematical results in the field of physics. And therefore from that standpoint, the subject can no longer be brushed aside and removed from the equation in the field of science.

And this also holds true in psychoanalysis. The subject - the focus of psychoanalysis – that very subject that inhabits our unconscious proves here to be just as equally rooted in a formal system, built on a structure that is just as serious and concrete as the structure underpinning science. It is a whole system in its own right, with its own set of rules, modes of expression and logic. The unconscious is defined by a whole interplay of letters, with its own specific syntax etc.

So the point I am trying to make here is, this being the case, one can therefore assume that there is a possibility of science and psychoanalysis finally crossing paths and finding a common ground. And this would mark a change from the usual battle between the two sides! It would mark a giant step forwards towards convergence and mutual respect.

Psychiatry is a branch of medicine, and has always liked to see itself as being leading edge, at the forefront of modern ideas. So what does that mean in the context of today’s world? It means that modern psychiatry must take on a scientific appearance. In short, it has to dress itself up to look like hard science. But is it realistic or even possible to create a science centred around man? When we talk about ‘the human sciences’, we can’t count them as being basic sciences. Psychiatry is angled towards the neurosciences, psychopharmacology and genetics. And this leaning produces explanatory models for mental illness. Yet these models are sometimes a far cry from the discoveries made in clinical medicine. A clinician is less inclined to seek explanatory models. Rather, he or she will try to find a pathway to help patients find their footing, find a possible solution to their symptoms, and a way to lead a dignified life.

The difference between a clinician and a pure theoretician is that clinicians see the brain as being nothing more than just a tool. It is not necessarily seen as the ‘central control’ of the mind. The body is also an instrument, by or through which human unease and discomfort is conveyed. But the cause of that human discomfort is not bodily. Its actual essence is to be found elsewhere. But where? A psychoanalyst would answer that question by saying that discomfort is rooted in a certain link between the subject and language. The symptom is formed in language itself. It is a consequence of language. It is forged through figures of speech (such as metaphors and metonymy), and therefore it only follows that language alone is capable of solving and removing that sense of discomfort.

Let’s take a small example. Imagine a person who has an anxiety attack sparked as a result of being in a crowd. This anxiety attack, like all forms of anxiety, triggers a rise in the levels of catecholamines in the blood. Obviously, that is something that can be measured through a blood test. But the actual cause of the attack, the reason behind it never has anything to do with catecholamines. The body, and the mechanisms at work in biology, are only vectors of phenomena that affect us. They are certainly not the cause. Indeed, every example of totalitarianism throughout time has sought to reduce human beings to a merely biological level. This breed of horrendous violence was responsible for sustaining racism and a host of other cases of social exclusion and segregation that left an indelible mark on 20th-century history.

Where does psychiatry stand in this debate? It remains torn between being at pains to emulate medical diligence, yet at the same time being plagued by philosophical concerns, in other words questions of ethics.

Why is it so important to know which type of philosophy lies beneath the theoretical understructure that drives any particular movement in psychiatry?

It’s a vital factor, because it’s impossible to identify a phenomenon if it is not already provided for or if it is not foreseeable within a particular system. A phenomenon can only be observed if it already has a place within the very same system observing it. It has to be recognized. The history of science offers us a myriad of examples of concepts that have been identified in the past, yet man was incapable of realising it at the time, simply because those concepts hadn’t yet been given a place in the theory that was observing them as potential phenomena. So it’s nonsense to assume that phenomena are just sitting around waiting for someone to come along and ‘discover’, ‘recognize’ and ‘define’ them. And to push the point further, we could even go so far as to say that it’s our own theories, our own self-made reference points that are behind these phenomena, the ones bringing them to life.

Let’s take a few examples. It was Emmanuel Kant and his vein of philosophy that shaped the structure of the work of German psychiatrist Emil Kraeplin. Back then, what German psychiatrists identified as symptoms were largely rooted in Kant’s ideas. Kant’s Pure Reason opened up the horizon to an infinite range of possibilities for exploring mad reasoning. Henri Bergson’s “élan vital” (vital force) was a key influence in French psychiatry, which formally invented a condition for the loss of this ‘force’, in other words the notion of depression. Again, a final example from English philosophy, which was profoundly influenced by David Hume’s associationism, and which was the impetus behind identifying dissociation related to schizophrenia, so beloved to the Anglo-Saxon world.

Psychoanalysis is constantly reminding us that the way in which we perceive the world is merely the product of our own underlying fantasies. As Freud points out, the reality that each of us face in daily life is first and foremost a mental reality. And the reason why we have this fascination for science, is because we all entertain the hope that it holds within it a form of wisdom that applies to all human beings across the board, a universal truth that will invent a universal language so precise that it would enable us to understand and manage the world and all the different phenomena at work. And when you apply that to the world of psychiatry, there again you see the same pattern. Psychiatry carries that hope of one day finding a method that will finally manage to tame the wild and uncontrollable ‘beast’ that is Real order, which is throwing its weight about in psychosis. But the cruel truth of the matter is that we are lacking this universal key.

Once again, psychoanalysis reminds us that our human language, the one we use to speak to each other, the one we like, is not the same as scientific language. It’s quite the opposite. It’s full of impurities, ambiguities and misunderstandings. And yet our desire, our most inner self and our symptoms are all derived from this naturally imperfect language. And this is all we have at our disposal with which to work, live and exist. This language gives us no guarantee at all of understanding and controlling the world. The very opposite of that dream of full understanding offered up by science. Such is our lot. The unconscious is attached to that rickety, unstable language that is our own. It holds on to it. And however much we may want to lose sight of it, it always makes sure we never forget, always coming back to find us.

So, to conclude, psychiatry and psychoanalysis don’t tend to make an easy match. They are not what you would call extraordinarily well suited, and they could obviously get on a whole lot better. But as we all know, the couples that last in life aren’t always the ones you would have imagined … So here is some food for thought to throw into the debate about the relationship between psychiatry and psychoanalysis.