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.