Why Psychoanalysis? (review)

In the current age of pharmacology, psychoanalysis risks seeming not only obsolete, but perhaps even fraudulent and fundamentally flawed in its most basic assumptions. Psychoanalysis costs too much; it takes too much time; it doesn't address the underlying physical causes of the pathologies it treats; it lacks objectivity, allowing its practitioners to offer arbitrary interpretations of patients' sufferings; it seems unable to produce curative results that can be registered at the empirical level. Does analysis still have legitimate claims to a place among the various techniques for diagnosing and curing mental illness?

Elisabeth Roudinesco, an analyst and distinguished historian of psychoanalysis in France, thinks that an adequate justification of analysis involves going on an aggressive counter-offensive against the assumptions about human nature informing the standpoint of its critics. Why Psychoanalysis? is an attempt at launching just such a rebuttal. The book consists of three parts, with four chapters each. Roudinesco spends most of the first part, "The Depressive Society," lamenting what she sees as the regrettable consequences of embracing pharmacology as the privileged means of treating mental illness. She starts out by arguing that, in contemporary Western cultures, there is a strong desire to eliminate both psychological as well as political conflict at all costs: "Modern democratic society wants to banish from view the reality of unhappiness, death, and violence, even as it seeks to integrate differences and resistances into a single system" (5). Roudinesco, a former member of Lacan's École freudienne, relies here on socio-political assumptions held by many in this school during the '60s and '70s, assumptions echoed by contemporary leftist complaints that capitalist democracy tends to promote a "McWorld" homogeneity despite its supposed preservation of difference and contestation.

In Roudinesco's picture of a "brave new world," modern psychiatry and psychology—as opposed to psychoanalysis—are cast as instruments of larger socio-cultural forces in which the absence of overt political tyranny is gradually replaced by the pressures of powerful conformist norms and economic demands for individual productivity at all costs: "In place of the Freudian conception of a subject of the unconscious . . . there is the more psychological conception of a depressive individual fleeing his or her unconscious and concerned to rub out the essence of all conflict in himself" (8). For Roudinesco, following Lacan, psychoanalysis isn't a branch of "psychology" or "psychotherapy." ¹ Lacan's ways of distinguishing between these terms are varied and complex. However, as employed by Roudinesco, the crucial difference is that only psychoanalysis emphasizes the irreducibility of intrapsychic conflict, the constitutive dysfunctionality of the mind, and the indelible stains of tragedy that are an inherent part of the human sexual and mortal condition. Thus, the genuine practice of analysis rejects social integration as a therapeutic goal and refuses to promise any kind of happiness as a deliverable cure.

Roudinesco goes on to note that the administration of drugs is the favored technique for effacing the divided subject of psychoanalysis. Speaking of psychopharmacology, she claims that "what it did was to shut subjects up in a new form of alienation by claiming to cure them of the very essence of the human condition" (11). Roudinesco doesn't dogmatically deny the efficaciousness of drugs in alleviating the intense pain of psychological pathologies. Nonetheless, one of her primary theses is that the heavy reliance on chemical substances is symptomatic of a "depressive society," a manifestation of a collective refusal by people to ask why they suffer from specific problems and to be concerned instead solely with "getting results."

In the concluding chapter of part one, Roudinesco also takes to task social constructivist theories and therapies. In her view, blaming all of an individual's mental problems on gender, ethnicity, or cultural background is just as reductive and dehumanizing as maintaining that one's experiential being is an epiphenomenal residue of a thoroughly corporeal condition. For Roudinesco, what ultimately deserves condemnation is any entirely determinist depiction of human nature. The...