Friday, March 30, 2012

In Defense of the "Talking Cure"

Over at the New York Times, Benjamin Y. Fong posted a defense of old school talk therapy, an art that medicalized psychiatry is trying to make obsolete. There is considerable evidence (see Shedler, 2010; Shedler, 2006) that psychodynamic psychotherapy, of which post-Freudian psychoanalysis is one version, is more effective in the long-term than cognitive-behavioral models or psychopharmacology.

As the second Shedler article (2006) makes clear, what most people think of when they hear mention of psychoanalysis is pretty inaccurate. Post-Freudian theory is actually more precisely founded in Kohut's Self Psychology. And more than most models, it has adopted insights from attachment theory and neuroscience, not to mention philosophy, to make it more effective.

Anyway, here is Fong's article. For the record, few psychoanalysts still hold to Freud's drive theory (that neurosis is based in repressed instinctual drives) - and this if what Fong refers to with the primary and secondary processes in the article.

Freud’s Radical Talking

The Stone

The Stone is a forum for contemporary philosophers on issues both timely and timeless.
Death is supposed to be an event proclaimed but once, and yet some deaths, curiously enough, need to be affirmed again and again, as if there were a risk that the interred will crawl back up into the world of the living if fresh handfuls of dirt are not tossed on their graves. One such member of the living dead, accompanying the likes of God and Karl Marx, is Sigmund Freud. How often one hears, thanks recently to the fetishization of neuroscience, that psychoanalysis is now bunk, irrelevant, its method decadent and “dangerous,” as the recent David Cronenberg film, “A Dangerous Method,” informs us.
Over the years, the “talking cure” — so dubbed by Bertha Pappenheim, a.k.a. “Anna O.,” who became Freud’s first psychoanalytic case study — has received quite a bit of ridicule and reworking. With countless children and adults taking behavior-altering drugs, many are again tolling the bell for psychoanalysis. Who wouldn’t choose fast-acting pills over many years on the couch, health insurance companies most of all? Perhaps, after surviving scandal, revision and pop characterization, drugs and money will definitively put old Sigmund to rest.

If psychoanalysis were simply a way of “curing” certain individuals of socially unwanted behavior, then I would have no problem with its disappearance. Similarly, if psychoanalysis were just a way for wealthy individuals to talk to one another about their lackluster existences, it might as well continue on its way to the dustbin of history. And if, God forbid, psychoanalysis has devolved into just another addition to the theory toolkit of academics in the humanities, someone ought to put it out of its misery now.
radical talking
That said, I think there is something of great worth in the “talking cure” that would be troubling to see succumb to a cultural death. That something has to do with the relation between two realms of psychic activity that Freud called the “primary” and “secondary” processes. The former domain is instinctual and relentless, a deep reservoir of irrational drives that lie just beneath the apparently calm façade of our civilized selves. The latter is the façade itself, the measured and calculating exterior we unconsciously create to negotiate everyday life. Although these two terms are somewhat obscure, the basic divide between them is familiar to the point of obviousness.

We know all too well, for instance, that the secondary process often fails to contain the depths below, which sends envoys to the surface in the form of anxiety, depression, prejudice and hypocrisy. The more we devote ourselves to the dominant cultural norms, the more those drives begin to fester within us, until eventually they seep through the cracks in most unexpected ways. It is, therefore, necessary to confront the “problem” of the primary process, which has in recent times received two “answers.”

The first stresses the need for the secondary process to conquer the primary by means of an “education to reality.” From a very early age, we are asked to recall facts, to support our statements, to string together arguments, to anticipate counter-arguments, to make decisions, and, if our teachers and parents are sufficiently sensitive to the ways of our pluralistic society, to remain respectful towards those who disagree with us. Some social critics would have us believe that the only thing wrong with this picture is its disjunction with reality: if only our schools and our families were better training our youth in the public use of reason, our democracy would not be in the decrepit state it is in.

No doubt there is some truth here, but this general attitude blinds us to how crippling the exercise of our reasoning faculties can often be. In professional settings, of course, this kind of objective problem-solving and collective decision-making is needed and rewarded in turn. When problems have a clear and precise answer, the gears of production can keep spinning. Nothing, however, could be more detrimental to the sort of understanding required by our social existence than the widespread belief that all problems have answers (or, for that matter, that all problems are problems).

The second “answer” calls for the liberation rather than the repression of the primary process. We all need, so the logic goes, to appease our inner selves. So we may take vacations, pop pills, go to the movies, drink, smoke or shop. And when we are done caring for our “self,” that uniquely American preoccupation of the 20th century, we may resume our rational behavior all the better, unencumbered temporarily by that pesky inner turmoil that makes us human.

Freud himself suggested neither of these alternatives. Rather, he proposed that we engage in a particular kind of conversation that runs something like this: one person talks without worrying about whether his words are “right,” in the sense of their being both correct and appropriate, and the other listens without judging any disclosure to be more important than another. In contrast to most conversations, which have certain culturally-defined limits and rhythms of propriety, this exchange has no such rigid rules. It ventures to awkward places. It becomes too intense. And more often than not, it is utterly boring, reducing both partners to long bouts of silence.

From an outside perspective, the conversation is pointless. And indeed, most of the time it appears to be a waste. But in its disjunction with routine human interaction, it opens a space for our knotted interiors, so used to “having a point,” to slowly unravel. As each piece flakes off, it is examined and seen in relation to other pieces. After a long while, we gain what might be called, to borrow a term from Martin Heidegger, a “free relation” to these parts of ourselves and our world, such that the unmovable density they once comprised becomes pliable and navigable. Some key pieces appear and others vanish, but the puzzle is never complete. The aim of the conversation, however, is not completion, which short of death itself is an illusion, but the ability to change. This change involves neither the victory of the secondary process nor the liberation of the primary process but rather the opening of lines of communication between them.

We have become accustomed to temporarily putting aside our knotted interiors only to return to them as they were. “Reality will always be what it is; we can only hope for breaks every once in awhile.” This is a dogma both psychological and political. What Freud proposed, and what remains revolutionary in his thought today, is that human beings have the capacity for real change, the kind that would undo the malicious effects of our upbringings and educations so as to obviate the need for “breaks from real life,” both voluntary and involuntary.

What is paradoxical in his proposal is that this revolution requires less “work,” not more. There is a premium today on “doing,” as if we are now suffering, amidst astounding productivity, from an essential passivity. Freud’s conversation is, of course, a kind of work that is often very taxing. Yet it is always and inevitably what the classical economists called “unproductive labor.”

Against our culture of productivity and its attendant subculture of “letting off steam,” Freud hypothesized that the best way to refashion our world for the better is to adopt a new way of speaking to one another. Above all, this radical way of talking is defined by what appears to be extended pointlessness, something we are increasingly incapable of tolerating as the world around us moves ever faster. There are books to read, mouths to feed, meetings to attend, corporations to fight or defend, new places to visit, starving children to save…who has the time? And yet it is precisely in not allowing ourselves the time to be “unproductive” that reality is insured to remain rigid and unchanging.

According to Hannah Arendt, the world, as opposed to the earth, is something man-made. It is planned out with the ideas from our heads and composed of the work of our hands. But without deep human relatedness, it is but a static “heap of things,” a hardened reality that we run around while remaining in the same place. What lends pliability to reality, she claims, as Freud did decades earlier, is taking the time to talk with one another without any predetermined purpose, without hurrying from one topic to another, without seeking solutions, and without skirting the real difficulty of actually communicating with one another. It is here that the continuing value of Freud’s discovery asserts itself. If psychoanalysis is dead — that is — if we no longer care about Freud’s problems, then so too is the human capacity to enact change.

Benjamin Y. Fong is a doctoral candidate in philosophy of religion at Columbia University, and an affiliate scholar at the Columbia University Center for Psychoanalytic Training and Research. His dissertation is a reevaluation of the psychoanalytic concept of the death drive.

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