The Freudian unconscious now has a translation in the language of the neurosciences. At least, this is the new paradigm that, following Eric Kandel, the advocates of cognitive psychoanalysis are attempting to establish throughout the field.
Kandel wants to have psychoanalysis shift from its prescientific ‘context of discovery’ to a higher, scientific level, absorbing it into the new discipline of cognitive neuroscience (1). This project took shape in two famous articles preceding his Nobel Prize in Medicine for his work on memory storage. The Kandel project is radical and he is out to convince all psychoanalysts of its sound foundation. According to him, it is necessary to modify everything in the existing forms of psychoanalysis: psychoanalysts’ training, their practice and their forms of institutional organisation. Training has to be brought into the university, practice has to be open to quantitative evaluation, research has to be brought in line with accepted forms of research in the sciences.
Kandel’s neurological work concerns the isolation of the module for what he calls procedural memory. The repetitive procedures of this memory call neither on consciousness, nor on language which presupposes a subject. This module employs various systems: the sensorimotor cortex, the amygdale and the neostriatum. This memory specific to behaviour that unfolds without recourse to consciousness is, for him, the realisation of unconscious Freudian processes. Thus he has coined the term ‘procedural unconscious’.
For Kandel, what is most essential in a psychoanalysis takes place at the level of processes of repetition and changes in the patient’s behaviour, the analysis modifying and sharpening the patient’s procedural habits. What is most essential is produced outside of interpretation and the dimension of meaning. The few moments when the procedural unconscious may be accessible to consciousness, or to meaning – the two terms are interchangeable for Kandel – are hardly important. (2)
The model for the inscription of experience proposed by Kandel acknowledges its origins in Pavlov, but he generalises it using the notion of contingent association proposed by Leon Kamin in 1969. Likewise, the Freudian signal anxiety faced with a trauma seems to him to be perfectly explained by Pavlov, and the role of the amygdale in the regulation of anxiety allows him to account for the treatment of post-traumatic stress. Anything that relates to the loss of the object finds its translation in the functioning of a mechanical system outside meaning.
This translation in terms of a neuronal system of subjective processes like the treatment of memory is unacceptable. As Bennett and Hacker put it, ‘it is very tempting to think that the various forms memory takes are all due to the fact that what is remembered is recorded and stored in the brain. But this is nonsense. What one recalls when one recalls something or other is not something left on traces in the brain, but something that has been learnt before or experienced. What the neuroscientists have to discover are the neuronal conditions of memory and the neurological concomitants of memory… the expression of a memory has to be distinguished from neuronal configurations, whatever they may be, which condition the memory of what someone remembers. But these configurations are not memory: nor are they representations, descriptions or expressions of what is remembered.’ (3)
In the classic phase of his teaching, Lacan treated the Freudian unconscious as memory. From this he immediately deduced the circuits of impossibilities that this memory engendered. He also made of the Unconscious a circuit not of familiarity [connaissance], but of mistake [méprise]. Finally, in his late teaching, the Unconscious is defined as a form of knowledge that acts on the body of the speaking being, the parlêtre, through an absence.
‘I say, for my part, that knowledge affects the body of the being that only makes itself be on account of words, this on account of dividing up its jouissance, on account of thereby cutting up that body to the point of producing the offcuts from which I make the (a).’ (4)
It is not on the basis of representations of events or the memory storage of those events that the body’s jouissance comes about. It is a memory that does not go via these traces. It acts through the absence of trace. Castration marks this absence through the powerlessness to attain a full jouissance.
‘It is jouissance that thinks, calculates and judges, and jouissance, being of the Other, requires that the One, the same which makes of the subject a function, simply be castrated, that is, symbolised by the imaginary function that incarnates impotence, in other words, by the phallus. In psychoanalysis, it is a question of elevating impotence (the same that gives an explanation of the fantasy) to logical impossibility (the same that incarnates the real).’ (5)
Like our theoreticians of cognition, Lacan trusts in the hors sens, in what lies outside meaning, and is wary of meaning itself, but runs counter to their specious constructions about representation and its storage. It is a question of the locus of loss, and its encounter, or tuché.
‘When the space of a lapsus no longer carries any meaning (or interpretation), then only is one sure that one is in the unconscious. One knows. But one has only to be aware of the fact to find oneself outside it… There is no truth that, in passing through awareness, does not lie.’ (6)
Kandel’s plan is endorsed by the most scientistic current of the IPA, which, for its part, is not a homogenous milieu. The three currents in psychoanalysis, the scientistic, the humanist and the traditionalist, isolated by Jacques-Alain Miller in his paper delivered during the most recent WAP Congress in 2004, are to be found there at all levels. It does seem however that it is this scientistic current that has taken the direction of a far-reaching reform of the institutional system of psychoanalysis. Three decisions recently taken by the Executive Committee, or with its agreement, go in this direction. We shall examine them from this angle.
I. Handing over the training of psychoanalysts to the university: creation of a qualification in psychoanalysis
On 12 May 2005, our colleagues in the EOL sent us the text of a decree of approval for the creation of ‘a University Institution for psychoanalysis and mental health’ on the initiative of the Buenos Aires Psychoanalytic Association.
The text of this decree constitutes a world first. It transforms the title of psychoanalyst bestowed by a psychoanalytic association into an academic title. The promoters of this initiative are well aware of this: ‘The novelty of the new Institute is that the programme of psychoanalytic training that the Buenos Aires Psychoanalytic Association has provided for nearly thirty years and which meets the requirements of the International Psychoanalytic Association (personal analysis, supervisions and seminars) will have university certification and will be made up of a specialist qualification in psychoanalysis. This point deserves to be underlined because university accreditation of these criteria in psychoanalytic training constitutes something new at both the local and international level.’ This policy is thus that of the Kandel plan: the integration of psychoanalytic training and research in the university framework.
II. DSM statistics and the politics of the subject
Replying to questions posed by the Revista Latinoamericana de Psicopatologia Fundamental in August 2004, Prof. Claudio Eizirik, the elected president of the IPA, defined the IPA’s policy with regard to the DSM: ‘The pretension of successive DSMs to being a-theoretical has turned out to be an illusion. We need to discuss the whole system of classification over again, because we are witnessing an attempt at mastery that ends up with an impoverishment of the psychiatric clinic. In fact, claiming to diagnose complex clinical pictures, often accompanied by dual diagnoses, with the international diagnostics manuals alone without considering either psychopathology or the natural history of the illness and the multiple variables at play leads to an ever poorer practice, a reductionist practice that in turn leads to therapeutic options that are mostly medicinal. It is therefore necessary to add a sixth axis to the five axes of the DSM, on the psychodynamic aspects, the transference relationship, in sum, a subjective dimension that you yourselves highlight.
‘The IPA isn’t simply positioning itself in favour of a subjective promotion of psychiatric diagnostics, but it’s actively engaged in an initiative from the North American Psychoanalytic Association to discuss the current systems of classification and propose modifications in this direction. Our current president, Daniel Widlöcher, like numerous European and Latin American colleagues, are involved in this activity.’ (7)
This policy seems then to be inspired by the commendable effort to re-introduce an axis of inter-subjective processes into the international classification. The real stake of this attempt is revealed in a study undertaken by Philippe La Sagna: ‘Today the boom is no longer on the side of intra-subjective illnesses but inter-subjective disorders: personality disorders, relational disorders. Michael First who is overseeing the preparation of DSM V has chosen this domain… Personality Guided CBT no longer aims at changing behaviour but rather the personality’s attributes and its modes of reaction.’ (8)
The battle between the CBT orientation and psychoanalysis will be played out here. The IPA is going to try to obtain an axis measuring an inter-subjective dimension just as Kernberg had negotiated the existence of the second axis of the DSM that saved the personality disorders! Axis VI of DSM V will have the same fate as Axis II of DSM IV. It will be hailed as a victory even though it is a defeat since the CBT rhetoric will have already given a mechanical and easily calibrated vision to the entirety of the axis in accordance with its cognitivist rhetoric. This will lead to the same impasses as those of Axis II and will in no way serve to prevent what DSM V is really aiming at: the advance of the simplified clinic of medication and evidence based medicine.
III. The university alliances and the IPA
The thesis of the IPA’s academic current is clear: we should form an alliance with the cognitive-behavioural psychotherapies in order to constitute a united front against the pharmaceutical industry and the clinic of medication. In France, the alliances that exist to set up a teaching in psychopathology show this very clearly. A recent article spoke of the requirement put forward in negotiations with the Ministry of Health for a ‘practical and theoretical training in clinical psychopathology which would be assured, over two years, by the University…’ (9) Our politics consists in not preferring in any way the alliance with a cognitive-behavioural current supported by departments of psychology and medicine. The latter is a dupe’s politics. It ends up with results that here in France we know already. University qualifications in two years (the Diplôme Universitaire) have already been organised by the faculties of medicine alone and are training low qualified ‘psychotherapists’, ‘accompanying persons in mental health.’ Our alliance with the advocates of the relational current is made as much within the university (Roland Gori’s current of the SIEURP) as outside of the university (the Psy Co-ordination).
In the northern countries, where psychology is entirely cognitive-behavioural, an original strategy of alliance will have to be defined, so as to do some judo with the CBTs as Jacques-Alain Miller commented at the NLS Congress in London on 22 May 2005. It will be useful to study the multiplicity of currents of CBT. The mass marketing of these ‘therapies’ is showing discrepancies that need to be highlighted. In the Latin countries and Latin America, we have to pursue our strategy following the developments of the situation and the practices of the relational therapies.
The Kandel project, or neuropsychoanalysis, is a further attempt at using the discourse of science to ‘make things speak.’ (10) In contrast to the orientations chosen by the IPA, we are ‘stepping out of line’ [déboîter], to employ Jean-Claude Miller’s expression, on the three points we have examined.
We teach what it is possible to teach within the para-academic formats such as the Institutes of the Freudian Field, but we do not hand over the training of the psychoanalyst to the university.
It is not about negotiating an axis of intersubjectivity in the DSM, but saying that taking intersubjectivity into account is incompatible with the DSM project as such. Finally, the alliance with the relational psychotherapies, in and out of the university, has to be clearly expressed. We must also remain attentive to the rapid development of practices of psychotherapies and encourage the relational currents properly speaking. Associations like Interco-psycho and Psychologues freudiens are helping us to keep abreast of these developments.
19 July 2005
Translated by Adrian Price
(1) Kandel, E.R.,‘Biology and the Future of Psychoanalysis: A New Intellectual Framework for Psychiatry Revisited’, in American Journal of Psychiatry, April 1999, No. 156, p. 506. The article may be consulted on-line at: ajp.psychiatryonline.org/cgi/content/full/156/4/505
(2) Op. cit. p. 509.
(3) Bennett, M.R. & Hacker, H.R., Philosophical Foundations of Neuroscience, Blackwell, 2003, p. 170.
(4) Lacan, J., ‘…ou pire’, Autres écrits, Seuil, 2001, p. 550.
(5) Ibid, p. 551
(6) Lacan, J., ‘Preface to the English-Language Edition’, The Seminar Book XI, The Four Fundamental Concepts of Psychoanalysis, Hogarth Press, 1977, p. xxxix.
(7) Revista Latinoamericana de Psicopatologia fundamental, ‘Entrevista com o Prof. Dr. Claudio Laks Eizirik’, VII, No. 3, 2004, p. 164. With thanks to Jorge Forbes for providing me with this reference.
(8) La Sagna, P., ‘Les impasses à venir des TCC’, paper given at the Meeting of the Councils of the European Schools under the aegis of the WAP-Europe, 22 June 2005.
(9) ‘Le ministère de la santé veut confier à l’Université la formation des futurs psychothérapeutes’ article by Cécile Prieur published in Le Monde, Sunday 10/Monday 11 July 2005, p. 8.
(10) Milner, J.-C., La Politique des choses, Navarin, 2005.