Freudian Ethics

No one was more surprised than I was at discovering that a meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) (psychoanalysis, in other words) published in JAMA last year concluded that "In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow-up." It turns out that statistical analyses have made an at least plausible case that those years spent in the "talking cure" are measurably effective, and even more effective than the more putatively efficient forms of therapy like Cognitive-Behavioral Therapy. What surprised me most about this study was the surprise that it engendered in me. "Psychoanalysis is effective as a treatment?" I thought to myself. "Who knew?" I realize that I had been perfectly happy handing over the notion of "cure" to other forms of therapy.

For those who simply can't function in life, even at the normal state of human malaise, "whatever works" -- cognitive therapy, yoga, medication, exercise -- seems like a good rule of thumb. Whatever gets you back on your feet, talking to your friends, making love to your wife, going to work, enjoying the spring. Living life is, not surprisingly, what makes us able to live life. That thing that gets us vertical again, into the shower and out into the world, living in a way that will, if all goes well, become habitual, is what we can call "the cure." Cures are for illnesses. They are what intervene to stop the downward spiral, whether it be the spiral to death, to suicide, or to emotional paralysis and madness.

I have been willing to surrender the notion of cure in my own thinking on psychoanalysis because I realize that psychoanalysis, although it was labeled "the talking cure," makes one of its greatest contributions in the very problematizing of the notion of cure in the first place. As gratified as I am that psychoanalysis still has a role in curing disorders, it is the same gratification I feel knowing that having a fun and happy time with my girlfriend has also led me to lose weight and feel more healthy. A nice side effect, but hardly the key point.

Now, what I'm saying may be veering dangerously close to sacrilege. Freud, after all, was a practicing therapist his whole life. His first models of how the mind functions came out of the study of people whose physical and emotional sufferings were very real. But more and more, and building on fairly early insights, Freud became fascinated with the condition known as normalcy. One of his central insights is that illness is often an excess of those very mechanisms that we cannot do without for turning children into fully fledged and functional human beings. In order to become people who can live with others with a minimum of looting, rape and murder, we have to go through the wringer of socialization (I will have more to say in later posts on the Oedipus complex, that most effective of mechanisms for inducing normalcy). We all have stories of being thwarted, emotionally amputated, misdirected, punished, cajoled, shamed and conjured into the fine human specimens we are today. This mutilation of the self is something that most of us mostly survive. But the normalcy that results is, to say the least, worthy of a closer look. Freud was, we might argue, the first to really look. What is truly fascinating for Freud is not how the mechanism breaks down, but how it works in the first place, not just at the level of the individual, but at the level of entire societies. What is worth study, after all, are the ways the relative calm of the human maelstrom is maintained.

This is why the whole notion of cure misses the mark when we talk about psychoanalysis. What kind of "cure" acknowledges the indispensability of the disease? Freud did not offer us psychoanalysis as a cure for the human state, but as an ethical engagement with that state, and it is as an ethical stance that psychoanalysis is most important to me.

The ethic of psychoanalysis is as strange as the human condition that it addresses. The intellectual gesture that begins psychoanalytic thinking is the acknowledgment and subsequent emptying out of the banal truth that we are all alike. It is not particularly difficult to prove that we tend to share impulses and wishes. We all want happiness. We all bask in the approval of others, we all fear loneliness, pain, rejection. We all experience our own limits as we run up against the world. What makes us fascinating and worthy of study is not this commonality of wishes, but the dizzyingly imaginative and specific defense mechanisms we have each evolved to deal with these wishes, and the singular product that emerges from the encounter of the wish and the defense.

The ethic of psychoanalysis is based in the willingness to value the emergence of what comes into being from this encounter. It is the ethic of the encounter itself. This is why psychoanalysis refuses to value the defense alone (it is not an ethic of socialization, of social control) or the wish alone (it is even less a glorification of the impulses or pleasures). Nor is it the attempt to reach some soggy compromise between the two. The "compromise" that Freud speaks of in the encounter of the wish and the resistance is only a compromise in the same sense that a boxing match is a compromise: it involves two principals who need each other, it requires a clash that unfolds in time and in a structured environment, it requires that one fighter win while the other lives to fight another day. Each fight is -- like any individual -- known by its proper name: Ali-Foreman, Hagler-Hearns, Gatti-Ward. The fight is as much an individual as it is an event, and the person as much an event as an individual.

Psychoanalytic ethics begins with this recognition of the individual as event, the event of the coming together of the wish and the resistance. To be true to this event (as Alain Badiou might put it) requires an ongoing openness to its emergences and reemergences. It also requires that subjectivity function from outside of any location. Neither in the wish, nor in the resistance, subjectivity is what emerges again and again. Not a foundation, not a guarantee of reason and rationality, not a domesticated space, subjectivity is a kind of continual birth, appearance, flash, shimmer of the event.

How can such moments of the human adventure ever be captured by the notion of "cure." We cannot be cured of the radical split in our being, of our attachment to our fantasies, of that unknown and uncanny space of the unconscious from which the embryo of our lives comes. There is, in short, no cure for coming into a world where all space and all time are not ours, where we are entangled in the desires of others, living and dead, where the unknown is the parent of the known. In such a world, what most increases our power to act and to know is not a cure, but an ethics, a way to shape the event of the self as it flows through our hands. If psychoanalysis can also break the paralysis of excessive suffering, so much the better, but the power by which it can cure illness is, I would argue, just an offshoot of the power by which stakes its claim to truth: the power to never stop welcoming the next emergence of whatever event is to come.