WHAT'S IT GOT TO DO WITH PSYCHOANALYSIS? AND WHAT HAS PSYCHOANALYSIS GOT TO DO WITH IT?



What is the tragedy that has befallen psychoanalysis, the tragedy referred to, but not enunciated, by the Freud Memorial Professor at UCL, Peter Fonagy, in his article "Psychotherapy meets Neuroscience" and by Darian Leader in his incisive comment on it: "The Future of Psychotherapy".

Can it simply be the 'guildification': the splitting of a not very collective unconscious which has failed to locate the aggressive - some might say - the death instinct?

Is there not, and has there not always been, a far more serious threat from the steady implementation of behaviourism - a school of psychology which has far more appeal to thrusting politicians on account of its aim of coming up with the goods?

In its inward looking habit of mind, psychoanalysis has preserved a rather haughty splendour, which has not, however, found an effective means of communicating itself to the wider public. Indeed, it is central to its ethos not to make approaches, not to attempt to sell itself in the grubby marketplace, not to make promises. In this respect its orthodoxy has resembled a quasi-religious order, and perhaps a route to martyrdom.

The exchange of misery for ordinary unhappiness must seem to many more socially driven disciplines - in the present climate of 'the triumph of technology' to quote the title of the Reith Lectures of 2005 - absurdly ascetic.

The guildification of psychoanalysis finds something of an explanation in the rarification of the community of psychoanalysts who, accustomed to working with the unconscious, and therefore removed from the limitations of everyday banalities, find in their splintered groups a form of actively combative engagement together with an outlet for a profession not without its frustrations.

In times of revolution or radical change, such non-interactive orthodoxy becomes itself targeted by forces which, like the present technological tsunami, threaten to engulf it, since its subtlety, its concentration on the ephemeral and its very non-substantialism, act as an irritant, even perhaps a provocation, to those who have no use for meaning. That which has in previous decades signified a stoical form of sanity does not sit well for generations of twenty-year-olds who, funded by rich old industrialists, are churning out and marketing communication systems which offer methods of simulated sensory experience - even computer-enabled mental fusion - accompanied by a contempt for ethics which mirrors governmental disregard and lack of regulatory controls. Is it not this that represents the real tragedy befalling psychoanalysis?

However, when the neurotechnological tanks rumble into town, bringing with them the means to hack into the minds and lives of what was previously held to be sacrosanct, one hardly expects one of the first to run out with garlands to greet them to be the Freud Memorial Professor. We should be grateful to Darian Leader for his careful articulation and dissection of Professor Fonagy's confusing homily to neuroscience and its signposting for the psychotherapy of the future. Confronted by such a ground-breaking statement as" We increasingly appreciate that psychiatric disorders of adulthood are rooted in abnormalities already observable in childhood or adolescence", it is helpful perhaps to remind ourselves that the Freud Professor is writing for The Royal College of Psychiatrists.

Calling for 'well-targeted psychotherapy' while decrying the 'business-like ways' deriving from 'guildification', Professor Fonagy seems not to have resolved his own dilemmas about the course of future treatment. It is hard to see how the twin principles underpinning psychoanalysis - the transference, and making the unconscious conscious, could survive the pre-treatment sterilisation process of the scanning procedures he suggests as guides for appropriate and well-targeted treatment.

To take his own example: the promoter region of serotonin transporter gene (SLC6A4) involved in reuptake of serotonin at brain synapses: by whom and in what contextual relationship would potential psychotherapy patients be scanned as a pre-requisite for proper targeting? The medical profession? A white lab-coated technician? Would the psychotherapist to whom the patient is directed thumb through the neuroscientific notes with the new patient as part of the initial encounter? Presumably the transference is a thing of the past, dead but without proper burial.

But supposing there is something of real importance in future treatment of depressives in this new information. How would it work? How would it merge with psychological intervention?
Those with short (S) allele (the less efficient allele for the promoter region of the seratonin transporter gene involved in reuptake of seratonin at brain synapses) will be directed for 'enhancement' treatment as a preventive measure before or instead of psychotherapy.
Those with long (L) allele (with more efficient transcription for seratonin uptake) should be less vulnerable to depression. So a depressed patient with a long (L) allele would not be a suitable case for treatment of molecular biologically determined depression but…

Might there not be some worryingly incompatible combinations? Low testosterone and long allele? High oestrogen and short allele? What of the obsessional characteristics formed in childhood in efforts to suppress happiness? What will we make of hysterical repression, long alleles, and sexual dysfunction? Or for that matter, short alleles, childhood incest and sexual dysfunction? How confusing it will all be, and how difficult to train the psychotherapists of the future. Wouldn't it just be better to chuck it all in, Freud Memorial Chair included?

That the population is targeted for state determined methods of mental hygiene deriving from behaviourism is incontrovertibly true, but psychoanalysts in Great Britain have not made adequate reactions to protect their project against government inroads.

If one of the pre-requisites of psychoanalysis was confidentiality, there were important issues to be addressed with the extension of surveillance methods. The experiences of psychoanalytical groups under politically repressive regimes such as that of Soviet occupied Czechoslovakia, or South American regimes resulted in habitual betrayals not only of confidence, but of lives. In Great Britain and in what we have assumed to be democracies, these threats to privacy and confidentiality have never been taken with a great degree of seriousness. In view of the largely unacknowledged extent of intrusive surveillance methods in Great Britain today, a basic assumption of confidentiality in the consulting room - or anywhere else - is looking increasingly like fulfillment. The failure to think through this rupture has not provided psychoanalysts with the required mental preparation either to contemplate the consequences or to initiate a debate about what has been an ongoing movement of behaviourist dominated neurotechnology in its fifty year pursuit of the goal to access and control the mind.

Perhaps it is timely here to remind ourselves of the unopposed statement of one of the founders of this movement, Dr Jose Delgado, not just an aspiring fascist, but a Director of Neuropsychiatry at Yale University Medical School.

"Man does not have the right to develop his own mind. This kind of liberal orientation has great appeal. We must electrically control the brain. Some day armies and generals will be controlled by electric stimulation of the brain." (1)

Professor Fonagy doesn't address this issue either. His proposals - while abandoning the basic tenets of psychoanalytical treatment without apparent regret, don't address the real gravity of neurotechnological capability either.

This month, the philosophical journal, Philosophy Now (2), has published an article: "Hacking the Brain: Could advances in technology soon give us perfect knowledge of other minds? The latest devices in brain-machine interface technology have been developed to analyze the neuroactivity of the brain and figure out what you're thinking."
The article, by Bora Dogan, asks: "Why should philosophers care? Philosophy has a history of handing over its domains of inquiry to other disciplines - or, it might be said more generously that philosophy has given birth to other disciplines."

Is Professor Fonagy's proposed hybrid a counter-move, an act of collaboration, or a skilfully disguised effort to salvage at least something of Freud's project? If the latter, then in the undoing of the basic principles, is there anything left of psychoanalytic discipline? Are we psychoanalysts - to quote another eminent academic, the philosopher A.C. Grayling - just a few relics, as outdated as Zoroastrans? Will we eventually come to our senses and, in place of the couch, equip our consulting rooms with a sturdily constructed chair fitted with an overhanging transcranial magnetic stimulation device, and display a technical certificate from Brain Gate or Cerebrus (3) to show we have a qualification to operate the machinery? 'Just lower your head a little' will replace the basic injunction, rather as one rests one's chin on the opthalmologist's eye-testing equipment.

With the dawning of the new psychotherapy of the future, 'more firmly rooted in developmental psychopathology' what will we be looking for? Are we not being goal directed to stamp out delinquency in the service of the State? Having encouraged women to get back to work as quickly as possible after giving birth, the government now urges us to spot signs of trouble in toddlers and to act quickly. Or, to use Darian Leader's interpretation of the prescribed guidelines, we will be screening for mental hygiene. And make no mistake - this will be at the behest of the State.

French psychoanalysts have escaped the "evidence" categorisation by a whisker this time round, as a result of the concerted effort of the Lacanians and the removal of a damning report from the Minister for Health's website. Just published (4), the collection of 40 essays by Freud sceptics, Le Livre Noir de la Psychanalyse, has sold out in its first two weeks. One of its contributors accuses psychoanalysts of being guilty of 10,000 deaths because, in wanting to promote therapy, they 'for years stood in the way of the development of substitute drugs'.

This will come as good news to the pharmaceutical companies who, in 2004, funded the President's New Freedom Commission on Mental Health in the form of the Bush promoted Texas Medication Algorithm Project whose initiative was for the screening and psychiatric assessment of every pre-school child for detection and subsequent medication of any psychiatric 'abnormalities'.

The editor of Le Livre Noir, Catherine Meyer, claims she wants the book to serve as a wake-up call for France, the 'world champion in anti-depressant consumption', but maintains that Freudian techniques have retained credibility in France because the generation of 1968 has raised them to the level of an untouchable dogma. It is time 'to open our minds and stop blaming our parents'.

Left to the forces of change, and to the market place, things look bad for the future of the talking cure. Professor Fonagy certainly has set the cat amongst the pigeons. We are exhorted to urgently develop non-biased, non-subjective measures. Some of us might have thought that we were already doing our best to practise non-biased, imaginatively empathic relationships which could hardly be accomplished non-subjectively. If we have been thought of as lofty in the past, denying our patients the crumbs of ordinary friendship in the aid of their treatment, what will this new directive do to our relationships with our patients. What indeed is a relationship?

There are areas in psychoanalysis that clearly have to be addressed. If the schematic topography that Freud introduced to guide us to an understanding of the dynamics of the conscious, the preconscious, the super-ego and the unconscious, has been taken too rigidly, psychoanalysis must come to terms with an outdated simplification. To surrender to the neuroscientists' brain mapping will not be, however, to acquire any more meaningful dynamic, but rather a behavourist's handbook. Indeed, it would represent a regression to a new flat earthists' view of the mind, where the capacity for simultaneous thinking and feeling represents more an interesting synchronous firing on the fMRI scan, rather than the pursuit of sobriety and the healing of splits.

CAROLE SMITH

November 2005

1 "Physical Control of the Mind, Toward a Psychocivilized Society"
Jose M. R. Delgado, M.D. (Harper & Row, NY, 1969)

2 August-September 2005 - Philosophy Now.

3 The Cerebrus is being developed by Media Lab Europe, is worn over the head, and can read brain waves using a technique called electroencepholography, tuning in to nodes of the brain that are associated with processing information such as light, colour and distance, allowing the wearer to manipulate a computer.
Cyberkinetics, an American company, is testing a system called BrainGate which uses a 2-millimeter square computer chip surgically attached to the brain, and looks like allowing a person to control devices by thought alone.
Brain Fingerprinting Laboratories in America is using the brain wave patterns to reveal what a person knows or remembers.
DARPA (Defense Advanced Research Projects Agency) are developing ways of using this technology to create remote-controlled and 'enhanced' robot soldiers. Neural activity, and hence thoughts, can now be - have been for years - manipulated as well as read from outside the brain.
Whole Brain Emulation (WBE)(or mind uploading) is an actively pursued technology by which is achieved the transferral of a human individual identity into an artificial system. This need not be carried out consensually.

4 September, 2005

 

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