Freud is a liar and a hoaxer, cry the partisans of cognitive behavior therapies. They say so in the Livre noir de la psychanalyse (ˇditions Les Ar¸nes). Jacques-Alain Miller, one of the leaders in psychoanalysis, responds to these " bawling haters of Freud". Emilie Lanez
Definition of the occupation of psychoanalyst: "A profession that, after all, owes its very existence and its propagation to a plethora of credulous people ready to pay themselves the luxury of abdicating their mental sovereignty to someone else and of all too often desperately trying to discharge themselves of the moral responsibility for the wrecking of their life." Definition of psychoanalysis: "An omniscient theory that ultimately depends solely on the lifelong dependence of suffering people." So much for the content ... and for the form as well. Livre noir de la psychanalyse, published by ˇditions Les Ar¸nes, does not play on understatement. Its aim is warlike: to unmask psychoanalysis that, while pretending to treat, would only serve to sustain patients in their narcissistic complaint.
This collective work accentuates the fierce battle that has pitted psychoanalysts, disciples of Freud, against the partisans of cognitive behavior therapies in France for the last two years. These still little known CBTs were born in the United States in the 60s. They are used by nearly a thousand practitioners (psychiatrists and psychotherapists) who, basing themselves on theories of learning and conditioning, bring the patient to rid him or herself of a symptom in a few sessions. For example: through a series of exercises, a shy person will be brought to speak in front of others, then to get noticed in public, and finally, he will sing "Happy Birthday" at the top of his lungs in a jam-packed subway car. An "efficient" therapy, say its practitioners.
The adepts of CBTs, among them two authors of Livre noir de la psychanalyse, Mikkel Borch-Jacobsen and Didier Pleux, reproach psychoanalysis for being "a dominant ideology that vehicles arguable truths". A therapeutic lure, "it pretends to be a therapy and to cure, therefore it must be evaluated", adds Cristophe Andrˇ, a psychiatrist at Saint-Anne Hospital in Paris, because "in the year 2005, it is not possible to dispense medical care without evaluating it". Evaluation, is the name of the hatchet that so directly opposes CBT partisans and psychoanalysts. CBTs have been evaluated in Anglo-Saxon studies for twenty years and, so assessed, give satisfying results. Psychoanalysts refuse to hear tell of evaluation. An accounting craze, they say, arguing that it is impossible to evaluate a treatment, based on language, whose therapeutic effects can vary, be invisible or deferred, and are not quantifiable in any case. According to these grandchildren of Freud, to evaluate psychoanalysis is to reduce the complexity of human existence to a mathematical diagram in an aim to please Social Security managers.
Is Freud outdated? Livre noir de la psychanalyse marks a virulent phase, and is preceded by two episodes. In June 2003, it is the Accoyer Amendment, named after its UMP-deputy creator, which aims to regulate the use of the title of psychotherapist. The psychoanalysts raise their shields. The law will be passed, but, for lack of a decree specifying how it should be enforced, it is still not applicable.
The second phase, in June 2004, an experts' report based on international studies, published by the INSERM, concludes that CBT's are more efficient than "relational psychotherapies", including psychoanalysis. And, much to everyone's amazement, although this report emanates from a public organization at the request of a governmental service, the Minister for Health, Philippe Douste-Blazy, withdraws it at the last minute. The psychoanalysts are jubilant. CBT partisans evoke that this report began with a request made by several associations, representing some 4500 patients, that did not know exactly who, how or why to get treatment when they were unwell.
Since then, it has been a call to arms. Why not admit, clamor CBT partisans, that Freud is outdated, that he was wrong, that the neurosciences prove it so, and that their therapies are better than the endless sessions on the couch where patients pour out their heart in a in conspiratory silence?_Absolutely false, answer the psys. A person with an elevator phobia, who has learned through CBTs how to take an elevator, will have eliminated the symptom, but without having dealt with the unconscious origins of the phobia.
And, they predict, the symptom will return. "Psychoanalysts are in dire straits. Our tools are simple in the face of complex sufferings, but they get results," adds Cristophe Andrˇ "and I sometimes send patients who are ailing to the psys". The opposite is rarely the case. What does that mean, Doctor?
Le Point: First the Accoyer Amendment, then the I.N.S.E.R.M report, and finally Livre noir de la psychanalyse; how do you explain these increasingly virulent attacks?
JAM: A book like that, I'd like one a year! It does the greatest good for psychoanalysts to be regularly brushed up, curried with stiff bristle or iron wire. President Mao used to say; "To be attacked by the enemy is a good, and not a bad, thing". Let's notice that psychoanalysis strongly exists to be so besieged over the last two years by political, scientific and now, media attention. One must suppose that it conceals something very precious, of which psychoanalysts are the, possibly ignorant, guardians.
Le Point: Why do psychoanalysts refuse the comparative evaluation between therapies?
JAM: Cognitive behavior therapies, CBTs, are recent products, custom-formatted to help health managers lower costs. Because what is at stake in the argument, is the mental health market. How far can the mental be "merchandized" and "societal-ized" without stopping to be a free society and a constitutional state? Today, psychoanalysis is like an enclave where cost/profit ratios do not apply. It is that much more necessary and that much more besieged because the profitability ratio governs all the rest. Psychoanalysis is like Astˇrix!
Le Point: Does psychoanalysis lead to a cure? Is it a therapy?
JAM: Without a doubt, psychoanalysis has therapeutic effects. There is no question of entering into analysis "to see". It requires a determined desire and that existence is a suffering for you. However, these effects may only be obtained on the condition that you question the very notion of cure, because for the human condition, there is no cure. As for CBTs, they are training and conditioning techniques and not at all psychotherapies. They only take observable behavior into account and when they integrate psychic functioning, it is only in terms of the treatment of information. In times past an eminent mind, the Soviet Pavlov, revealed the efficiency of conditioning, in the dog. To influence humankind using the same means, is horrible. Did you know that the U.S. Army has special behaviorist units, referred to by the acronym BSCT, and that operate at Guantanamo and Abou Ghraib? There would be a subject for a real "Black Book", if anyone were willing and interested.
Le Point: But tell us what psychoanalysis is?
JAM: A psychoanalysis, consists in speaking freely, in not hushing the ideas that go through your head, like we're doing right now. Little by little, from within your own words, another meaning forms and surprises you, then falls apart, taking the pain with it. Usually, you discover just how conditioned you had been by apparently minute elements encountered in hazardous circumstances: things from childhood, meetings, certain words said to you, and we keep coming back to them until the malevolent charge of these elements softens. Each case is different.
Le Point: And how would you define cognitive behavior therapies?
JAM: You see, they are trainers of humans, like there are bear, horse or seal trainers. Having triumphed in animal training, they embark upon the same thing with human beings. Only, just hold on a minute! In humans, the cause and effect relationship of "stimulus-response" is always upset by what we call as we may; the unconscious, desire or jouissance. This Livre noir de la psychanalyse is the monstrous fruit born of the union between behaviorists and a group of famous howling haters of Freud, in motion for the last twenty years. I remember one of them who, many years back, ran after me in New York: "I have all the proof right here," said he, pointing to his brief case, "that Freud was sleeping with his sister-in-law".
translated by Julia Richards
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