Physic Himself Must Fade: A View of the Therapeutic Offering through the Lens of Mortality

On love, on grief, on every human thing, Time sprinkles Lethe’s water with his wing.

—Walter Savage Landor

I did dispute the pessimistic poet’s view that the transience of what is beautiful involves any loss in its worth. On the contrary, an increase! Transience value is scarcity value in time.

—Sigmund Freud (1916 [1915], p. 305)

I

No social institution is more peculiar to the twentieth century than psychoanalysis, the “talking cure” discovered and shaped by Sigmund Freud a little over a hundred years ago. Resisted and suspect as a bold upstart in the early years, then climbing to immense cultural prominence in the first half of the century, by century’s turn psychoanalysis was beleaguered: a superannuated dowager under attack, lagging behind new medical technologies, new social and economic realities. Moreover, while from the outside the social place of psychoanalysis (and its offshoots) remains ambiguous, from the inside the basic philosophy of the talking cure remains vague.

And yet this unusual professional arrangement retains its prominence, even centrality, despite revisionisms, evolutions, adaptations, withering critiques, and formidable rivals. Why? Two people meet alone in a room regularly, over time, and they talk, with their relationship itself an object of scrutiny. No one had ever before thought of asking two people to engage one another in quite this way. Nor is there agreement about how such inspection works to benefit the one who pays. Only urgent needs can have allowed so strange and vaguely defined an institution to survive and even flourish, in so many mutations, for so long. What is the appeal? What need is filled? Among the many factors underlying such sweeping questions, I am focusing here on one I consider central, though it may not seem so: the analyst’s mortality.

The striking resilience of the talking cure, its fallibility, and its dilemma of definition all have roots in the mortal nature of human beings. The therapist is mortal both literally (he or she can die) and figuratively (he or she is fallible). In that double limitation—in the analyst’s ordinary human vulnerabilities—we can detect the appeal and utility, as well as the imperfection, of talking therapy. The psychoanalytic situation itself is defined by carefully structured limitation that creates freedom, by restriction that creates range: a “No, we will not touch” that says “Yes, you may freely speak your desire.” Only an imperfect being can energize this extraordinary therapeutic offering, as no god or robot could do.

First, mortality in its literal sense. When Antony reports to Cleopatra that her rival Fulvia is dead, Cleopatra asks a question we might ask about the psychoanalyst: “Can Fulvia die?”

Suppose in fact that happens. Consider the patient’s role at the late therapist’s public memorial: the ambiguities and uncomfortable exposure in the social realm of what the social realm has sanctioned but also segregated. The patient’s awkward presence may recall that of the mistress at a funeral, the loneliness and social derangement epitomizing the peculiarity of psychotherapy as a social encounter—ordinary manners do not cover the case.

Figuratively, mortality is a metonymy for mere humanity. We all die, and know that we will die, a knowledge that embodies and sometimes ennobles our imperfection. The therapist’s mortality is an existential reality central to the therapeutic relationship: uniquely among vendor-consumer relationships, imperfection is a requisite for the process. Mortality (sometimes along with ordinary defects such as folly, self-delusion, greed, lustfulness) pervades that relationship, its risks and possibilities, its useful fictions and awkward truths, its paradoxes and its accomplishments. Unlike the funeral, the therapeutic session offers a place where something may be gained from the possibly disjunctive, unique mingling of actual life and a stylized reflection of that life. Yet, on the vendor side of the relationship, that imperfection has been variously bracketed, with the therapist’s mortal nature (in both senses of the word) controlled or held implicit or suppressed or denied outright. Why?¹

That the “talking cure” is problematic was learned at the start, with the...