Archives for posts with tag: Symptom

In university classrooms across the United States, clinical psychology professors teach very little about Freudian or other types of psychoanalysis. These disciplines are claimed to be obsolete, since they are too imprecise or impossible to measure scientifically. What colleges do teach are the various types of treatment proven to show results (by HMO standards). Now, the question is, what kinds of results are these? The answer is to be found in the very name given to the broad category of mainstream treatments. That is, they are all called ‘therapies,’ whereas psychoanalysis is just that – analysis, not therapy.

The difference between the two terms is crucial. A therapy is a method of resolving a health problem. This means that a trained practitioner should aim to ‘heal’ the patient’s ‘wound.’ Analysis, however, is the breaking apart of a structure in order to understand it more thoroughly (from the Greek: ana = ‘total’ or ‘thorough’; lysis = ‘loosening’). Psychoanalysis is, as a favorite philosophy professor of mine has said, “a controlled deconstruction of the ego,” whereas the goal of psychotherapy is to (falsely) shore up a weak ego.

The therapist works with the patient to make life better, to make it more livable. So, the depressive, the neurotic, the hysteric, or what have you, look to the therapist for advice. More often than not, therapy sessions revolve around the patient’s disclosure of various aspects of his or her life; this is ‘talk therapy,’ in which the patient rattles off all of his or her problems, and the therapist has very little input, simply nodding as an indication of the therapist’s understanding, and every now and then asking a question, such as, “Why do you think you did that?,” or, “What do you think of that? How does that make you feel?”. When they do get more involved, as is the case in cognitive-behavioral therapy (CBT), therapists try to show the patient why a particular way of thinking or behaving is flawed or illogical.

What it comes down to is this: talk therapies leave in place the psychic problems of the patient; they only aim to give the patient relief from a difficult state of being. This is the same kind of therapy that goes on at the psychiatrist’s office: the patient describes her symptoms, and the doctor gives her medicine to make it feel better. Standard procedure for psychotherapy in the United States rarely calls for anything beyond giving out periodic doses of medicine (whether a verbal affirmation or a pill). These therapies are often necessary. The problem is that therapy only goes on until the patient stops complaining of symptoms. It therefore stops short of the promise of psychoanalysis: to give the patient the freedom to understand his or her relation to the symptom, to desire, language, perception, society, etc.

The problem with the talk-therapy and cognitive-behavioral methods is that they fail to ask why the patient experiences her symptoms. There is no concern with the root cause, because this is presumed to be a simultaneous malfunction of neurotransmitter activity and/or thought processes. And since there are easy remedies for both of these problems – medication and CBT – the practitioner simply follows these two methods and asks nothing more of herself or of the patient. Today’s therapist focuses on the symptom, not the cause; consequently, therapy offers a treatment, not a cure.

Therapists typically ask either very general questions meant to evoke the patient’s own interpretation (functioning like a mirror or a soundboard), or, when using CBT, they give the patient a virtually unquestionable answer (this is just an assumption built into the clinical situation). Note that this isn’t always an ‘easy’ answer; the patient does have to work. However, the whole approach takes for granted at least three things: that (1) the patient can directly state her symptoms, rather than, alternatively, revealing the symptoms as an epiphenomenon of the series of contents and forms of her statements and actions; that, therefore, (2) the particular content of the patient’s speech is enough to go on – what the patient says has enough merit to deserve a direct response in the form of a predictable answer or rebuttal; and also (3) the therapist has the correct, or at least the better, answers; i.e., there is a one-to-one correspondence between the patient’s statement and the therapist’s proper response, as if the conversation could be read like a dialogue based on the contents of a diagnostic manual. The therapist simply interprets what the patient says, showing the patient how to correct the problems, as a teacher would a student.

Psychoanalysis is different. The analyst is not a teacher in the ordinary sense of the word. She doesn’t presume to know what the patient should do, and she doesn’t ‘interpret’ the patient’s problems. But neither does she allow the patient to continue any way he wants during the session. Analysts ask a range of questions which may or may not seem to relate to one another. As such, their questions don’t necessarily appear to follow a linear or predictable progression of thought. But they are strategic. Analysts take two major steps during a session: they (1) provoke conflicts and antagonisms within the patient’s own thoughts and feelings, disrupting the normally unimpeded operation of the patient’s self-interpretation, in order to (2) open up space for the patient’s own discoveries and interventions. The first part is analysis proper, the breaking apart of stale modes of being. The second is the end of analysis: the patient, now seeing details of the broader structure of the psyche, the functions of desire and language in his life (thanks to the analyst’s strategic questions), is forced to re-collect his thoughts, establish a new Master-Signifier, and therefore gain control of his life, at least temporarily.

The shame of the academy’s obsession with the neurosciences is that they offer us only one piece of the puzzle, yet many believe they show it all. The psyche is complicated. It is irretrievably entangled in social life. But even behavioral therapies miss the point: it’s not simply about my own behavior, but about the functions of society and societal institutions. Theoretical psychoanalysis is the only discipline that seeks to understand, and to develop a universal structure to describe, how the logic of society and the logic of the psyche intertwine. Anthropology studies the logic of particular societies and cultures; sociology studies particular segments of a population, or particular phenomena, such as poverty or status, as they operate at the individual and societal levels; the behavioral sciences, including today’s psychology,  seek to understand the biological and cognitive mechanisms behind behavior, and the way that these mechanisms both affect and are affected by society.

In other words, we are witnessing a time when the mainstream academy has restricted the scope of its inquiry into causes and effects to include only particular societies, particular phenomena, or particular mechanisms. Psychoanalysis, however, employs the broadest possible scope of cause and effect, developing and applying a structure with which to critique – in the clinic or in the academy – all spheres of life; and yet, despite all of this depth and breadth, it remains cogent and effective, providing us with real insights. This isn’t to say it’s immediately clear or easy to understand; but little important knowledge is. Incidentally, because theoretical psychoanalysis takes up the challenge of developing universal, abstract categories and logics, it works well as a philosophical theory; hence the appropriation of psychoanalysis in nineteenth- and twentieth-century continental philosophy.

*Disclaimer and disclosure: I’m not a therapist. I’m also not an authority on this stuff, just a fairly knowledgeable student. I have a B.A. in psychology (and philosophy), with a concentration in neuroscience, and I’ve done extensive lab work in cognitive science at a major research university. I also have extensive personal experience in clinical psychology settings, as a patient.

According to a list of definitions provided by Princeton’s online dictionary, “melancholy” is:

  • a feeling of thoughtful sadness
  • somber: grave or even gloomy in character; “a somber mood.”
  • characterized by or causing or expressing sadness; “her melancholic smile”; “we acquainted him with the melancholy truth.”

What should strike us here is how different melancholy is from the ‘normal’ experience of sadness or depression: it is ‘thoughtful,’ ‘somber,’ ‘mournful,’ and may even result from the realization of some sort of ‘truth.’ Given this unusual ‘knot’ of emotion and thought, it makes sense to reflect on the significance of melancholic experience for us. There is something sublime about melancholy: it is frustrating, confusing, and difficult to understand. Indeed, this is where understanding runs up against a fundamental deadlock (after all, the emotion is distinguished by the vagueness of its object-cause; it rests on the indeterminacy of its meaning). How can we penetrate the ‘knotty’ core of melancholy to interpret its meaning? How do we pry meaning from it? What should it tell us about our lives? Here I want to give some reflections on this, mostly on my own experience, but hopefully providing, along the way, a general examination of the individual’s relation to melancholy.

If the question why I feel discouraged or out of place, lost, ‘out of joint,’ seems impenetrable, is it not likely that this thing which eludes my grasp is something unusual, something not present to hand, something ‘buried’ or muddled in the thickness of my everyday experience? Judith Butler frames this kind of melancholy experienced by the subject today as a ‘loss of a loss,’ a denial of the disavowal of some element of life that could mean something for us, something which we could experience, but which, for all that, we have chosen to exclude; it is, in effect, a realization that all is not well, that something, as a matter of fact, was just not right about our previous enjoyment, that something was actually covered up…

In The Psychic Life of Power, Butler claims that in contemporary society, ‘alternative’ sexualities and genders make up the excluded part, the sublime object of melancholy. It is this disavowal of the possibility of other sexual and gender experiences that structures the ways in which social groups and individuals interact, says Butler, whether they approach the topic explicitly or not. In fact, on her view, actions and attitudes can be seen to maneuver around these experiences – to avoid them – in a manner akin to the drive in psychoanalysis, as Slavoj Žižek has pointed out again and again in the context of ideological critique: the drive short-circuits desire, places limits on its circulation, restricts its possible trajectories, such that some things simply are not desirable; the disavowed Thing is that which appears invisible, which resists symbolization or explicit articulation. And so it is actually when discourse avoids discussing the thing itself – even as an attempt at ‘political correctness,’ as in the Liberal aversion to non-euphemistic language  – that its ideological functioning is most insidious.

Discrimination continues, therefore, insofar as the languages we speak, and the gestures we articulate, prohibit discussion/ articulation/ expression of these ‘alternative’ sexualities and genders, whether explicitly or not. This is the basic outline of melancholy, its basic meaning, seen in the context of contemporary society; it is the experience of a lost object, a lost possibility for desire. The implications, therefore, extend beyond the individual’s narcissistic experience of the emotion, of the guilt and strange soul-searching that set in once the emotion arises: we should see how this emotion can speak to society at large, how it can show us the underlying structure of society’s experience of itself, of the relations among its constituent parts (and excluded elements as well). This is not to anthropomorphize society, as though it could experience emotions, but rather to say that the constellation of relations among persons and their emotions, between the set of rational self-reflections and the set of excluded, denied emotional experiences, parallels the relation between society’s ‘normal run of things’ and its excess, excluded, and marginalized dimensions, the existence of which reveals, precisely, the inadequacy of that very same ‘normal run of things’ for explaining the true structure of society – and that explanation is exactly what cultural critique is for.

But after that somewhat lengthy excursus into cultural criticism, I want to return to the original object of this entry: my own experience and reflections on this peculiar emotion. My sense is not that this melancholy should conjure guilt or initiative to reflect on my attitudes toward disempowered social groups. Rather, what comes to mind is another kind of concern, a basic question: precisely, what should be my relationship to melancholy? Regardless of the particular content of the disavowal – regardless of which forms of life, which forms of social activity I have undertaken to disavow – the question remains how to relate to the emotion as such. For if we cannot know the particular content, but can only interrogate our feelings and attempt to outline the intimations which those feelings, in combination with our actions, our social life-histories, and so on, suggest – that is, if we can only probe toward ‘the thing itself,’ and thus only approach the ‘real’ content asymptotically – then we are left with a plain relation to ‘melancholy’ as such. In other words, because the particular content is simply unknowable, the thing left to do seems to be to determine a manner of relating to the emotion’s form, not its content. So what actions should result from our acknowledgement of the importance of melancholy, when the particular content is itself insoluble? What should it matter that there is this disavowal? What practical conclusions can we draw?

My intuition is that we should fully embrace melancholy as a reason to pause, as a cause for reflection, for the ceasing of activity and the beginning of a more receptive, and perceptive, sense of the environment, especially the people around you. And so the virtue of experiencing the emotion to its fullest extent – instead of hurriedly putting an end to it or simply avoiding it – is that it initiates a kind of humility in the face of one’s fallibility; one comes to realize that there is yet more to be done, that there is always something that one has not yet understood, cannot understand, or has even consciously avoided: we are, in other words, always human, and others are always non-systematizable, ‘unfinalizable’ (as M. M. Bakhtin says). In a sense, melancholy is the middle-point along the continuum of experience, halfway between the opposite poles of insecurity/ fearfulness/ sadness, and arrogance/ pride/ overzealousness; it teaches us to come back down to earth, to disengage from the easy, though false, security of (self-)reflection, of ‘transcendental ideals,’ and to get to work in practical activity, with love and respect for other human beings.

Indeed, if we take the basic coordinates of this peculiar emotion to map fairly well onto the Lacanian relation between the symbolic and the real, between the ‘all’ and the ‘part of no part,’ then it stands to reason that melancholy is a kind of reaction to obsessive-compulsive neuroticism; the subject whose desire is sustained by a drive to match a perfectionistic ideal, to match its behavior exactly to the (imaginary) demands of the Other (the Master-Signifier, the set of relatively clear social roles and distinctions, etc.), and thus to deny itself to exposure or vulnerability to anything outside this order must represent the exact opposite of melancholy: and in just this way, when melancholy falls upon the obsessive-compulsive subject, is the true message not that this drive has resulted in the massive exclusion of other ways of being?

My contention is that this is precisely what my obsessive personality leads me toward; it seems in these moments of bewildered sadness that I am guilty of harming someone else – if even in the most vague manner, such as by imposing myself in a conversation, talking excessively, not listening, feeling too elated, etc. – and that such harm is, in effect, a denial of the place of the other in the symbolic, a denial of the importance of another in my own life.

Thus the solution would seem to be a return to listening to the voices of those who I have temporarily excluded from my perception of the world. This isn’t difficult. And I believe that this fact reflects the way that melancholy passes over me, its strangely transient nature.

Again, this is just a reflection on how I want to try to think of melancholy. But I think the psychoanalytic coordinates of this odd symptom are also helpful for explaining the basic structure of the symptom in general, and for understanding how we are to relate to others based upon our emotions.