Post-Modernism and Psychoanalysis: Fiddling While Rome Burns

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Post-modernism and Psychoanalysis: Fiddling While Rome Burns

Michael Bader is a psychoanalyst practicing in San Francisco and is on the editorial board of TIKKUN.

Our culture has increasingly given up on the possibility of alleviating human suffering. When Bill Clinton vowed to "end welfare as we know it"--and then did--he was expressing the tip of an iceberg of cynicism about the value and moral imperative of helping the poor, the needy, and the sick. Whatever sense of community and collective responsibility we had during the New Deal or the Civil Rights movement that made helping others seem virtuous and achievable--that we're in this mess together and together we could fix it--has yielded to a collective pessimism and cynicism about fundamentally changing anything.

The collapse of liberal ideals and moral responsibility in the political realm has also been reflected in the academic realm. As writers like Russell Jacoby, Christopher Lasch, Todd Gitlin, and David Lehman have argued, the enervation of the Left, the collapse of progressive movements in the late 70s and 80s, and the increasing conservatism in politics, the media, and academia contributed to a heightened interest in post-modern philosophy. This philosophy, often taken up by former radicals and trumpeted as a sensibility critical of the established order, rejected claims that there were universal truths, an essential canon to be taught, an objective standard of morality and ethics that should prevail, or universal longings and needs that animated human beings regardless of culture, class, gender, or race. The post-modernist was, instead, interested in the particular social context of an idea, the particular cultural point of view of the speaker, and/or the particular and biased interests lying behind so-called "objective" facts. For the post-modernist, universal claims always masked particular interests.

This critique tended to expand to make all idealistic and moral claims untenable and intellectually embarrassing to embrace. In this sense, post-modern theory has contributed to the broader embarrassment in our culture concerning making passionate arguments about Right or Wrong on behalf of progressive causes. It's one thing to argue that right-wing ideology about the universality of Evil, individual responsibility and meritocracy, and the inevitability of class conflict should be deconstructed and made to reveal the hidden hierarchies and elites that really benefit from these values. It's another thing to embrace a philosophy that calls all objective ethics into question, critiques all truth-claims as mere matters of perspective, and makes human suffering anything less than an absolute Evil that we should feel collectively responsible for eradicating. An ethos that emphasizes perspective, context, interpretation, and cultural relativity and particularity can ultimately sanction a retreat from idealism, from a belief in something transcendent and transformative in the social world. It can be used to undermine our right to say "this social condition is objectively wrong and should be fixed," or "this condition violates fundamental human aspirations for connection and mutual recognition," or "it is a moral necessity that the world be changed so that people are treated as ends and not means." By relativizing truth and morality, post-modernism tends to undermine our confidence in the possibility of transformation.

Since the post-modern sensibility can provide a justification for our resignation about practically changing both the world and our own natures, it's not surprising that this sensibility has begun to appear in the ideologies of those professions whose mission is explicitly to help heal human suffering. Psychoanalysis is one such profession. The problem has been transposed from the classroom to the consulting room. Post-modernism has begun to influence psychoanalytic theory in ways that, at first, appear liberating, but eventually tend to sanction a retreat from its mission of practical healing and cure.

In order to understand the receptivity of the psychoanalytic community to the post-modern message, one has to appreciate the predicament in which analysts--and other therapists committed to long-term, depth psychotherapy--find themselves today.

Psychoanalysis is on the run. The current move toward managed care and biological explanations and treatments of mental illness has posed the following challenge to psychoanalysts (myself among them): Why should anyone see you when your approach takes too long, is too expensive, and has never demonstrated its efficacy? With psychoanalysis no longer enjoying the cachet it once had among mental health providers, increasingly ridiculed as self-indulgent navel-gazing, and deemed irrelevant by the media in the face of the almost daily "discoveries" of behavioral geneticists and psychopharmacologists, psychoanalysts have found their practices dwindling, their training institutes unable to attract students, and their social standing among mental health care providers increasingly precarious. Old lines of defense sound hollow. Responses such as "You can't study the unconscious empirically," or "You have to be in analysis to really understand analysis," or "You can't take what a patient says about the process at face value because of unconscious resistances," or "The point of analysis isn't to make someone happy but more self-aware," sound increasingly like the rationalizations of a theory and practice that is being marginalized by a society preoccupied with results and efficiency.

Some psychoanalysts have responded to this crisis by attempting to study and systematize what they do. Others have simply put their heads in the sand, dismissing their critics as tragically uninformed or, better, as resistant, and going about their business as usual, pining away for the "good old days." Post-modern theory has begun to offer, unwittingly at times, a third kind of response wherein the issue of therapeutic outcome is indirectly avoided in the interest of engaging the philosophical dilemma of what constitutes psychoanalytic truth and knowledge. In other words, the post-modernists are fiddling about the impossibility of making claims to objective truth in a clinical situation while Rome burns, i.e., while the widespread social cynicism and pessimism about psychotherapy really curing anyone goes unchecked. It is important to understand this contradiction as an instance of a broader intellectual tendency in contemporary culture.

The post-modern turn in psychoanalysis has involved a special interest in questions of epistemology--what is the nature of the "data" upon which we base our psychoanalytic hypotheses and how does the analyst "know" for sure that these understandings are correct? Just as post-modernists in the academy critiqued the white-male sensibility that assumed the authority to define good and bad literature, so post-modernists in psychoanalysis have challenged the privileged authority of the analyst to divine what the patient "really" feels. The progressive and democratic element of this critique is obvious: The analyst isn't some omniscient scientist sitting "on high," seeing the patient's unconscious mind better than the patient ever could. The analyst is as biased by his or her theory, personality, and social prejudices as is the patient. In fact, the patient might, at times, be able to see the analyst, him- or herself, and what's going on between the pair better than the analyst. Furthermore, whatever the analyst thinks he or she sees as being in the patient might be a contingent response to the analyst. And, finally, the multiple ways that culture informs the analyst's understanding, as well as the patient's symptoms, contribute to the tremendous complexity, ambiguity, and indeterminacy of the analyst's formulations. The post-modernists argue that analysts should be modest; self-reflectively accept the limits of what they know; and give up any pretense to objectivity, prediction, or other pseudo-scientific myths that have sustained their authority up to now. The post-modernist cherishes surprise, the analyst's ability to tolerate not knowing, the constructed nature of knowledge, and the uncertainties and indeterminacy inherent in language and other forms of communication.

This is the new zeitgeist that is emerging in psychoanalysis. Students flock to the conferences and read books that feature theories with labels like social constructivism, hermeneutics, and intersubjectivity theory. Irwin Hoffman, Steven Mitchell, Charles Spezzano, Robert Stolorow, and Donnell Stern are just a few of the new breed of analysts whose writings contain elements of this post-modern interest in epistemology. Unfortunately, the potentially progressive message of this new sensibility (and many of these analysts are personally progressive, their writings often deeply human and clinically sensitive)--that reality is socially constructed and that one class of people, analysts, don't have a privileged access to rationality--is often lost in the translation. First of all, postmodern theorizing is highly abstract and philosophical. Therapists looking for clinical guidance often have to wade through a dense philosophical discourse. When the clinical situation is described using this discourse, the clinician quickly comes to feel as if his or her work is almost infinitely complex. And if you're looking for guidance in how to more effectively help patients get better (which most of us are), the technical consequences of the postmodern position can be rather vague, if not daunting. After all, whenever you think that you know something, you don't. Whenever you have a hunch, question it. Whenever you want to tell the patient what's wrong, you have to do so modestly, understanding always that what you're saying is partial, contingent, limited, biased, and probably saying as much about you as about the patient. In critiquing of the "analyst-knows-best" arrogance of traditional analysis, the post-modernist tends to idealize uncertainty. We used to fool ourselves into thinking that our analytic neutrality and training gave us a clear lens through which to view the patient's psychology; now we're being forced to face the epistemological fact that our lens is distorted by our psyches and our theories. Analysis is more like a hall of mirrors than a microscope; misunderstanding is the theoretical norm. We construct new "stories" with our patient rather than discover the truth. We can't use the patient's responses as the primary arbiter of whether we're "getting it" because, first, there is no "it" to get, and, second, there is too much room for misunderstanding, resistance, compliance, and distortion. The only mind we can really come close to "knowing" is our own, and that, only imperfectly. Therapists come to feel almost foolish for presuming to understand the patient's "real" feelings and for wanting to develop a more rigorous or even scientific methodology for confirming that they've done so.

I'm all for modesty, and heaven knows psychoanalysts could use a lot more of it! But as an analyst I also want my hypotheses (modestly given) to be right. By "right," I mean something quite commonsensical: I want my interventions to conform to the subjective experience, conscious and unconscious, of the patient. The patient, after all, wants to be understood "correctly," and when something that I say falls into that category, there are ways to know this. I don't believe it's self-deceiving to develop a systematic way to judge whether or not I am correct. Therapists do this all the time. In my view, it's not infinitely complex. For instance, when I say something that empathically and helpfully articulates an experience with which a patient is struggling, the patient will signal me somehow. Sometimes the signal is simply a believable expression of agreement. Sometimes it's the sudden emergence of a feeling that the patient has been working to ward off. Sometimes the patient has an extremely strong memory of something that bears directly and obviously on what I said. Sometimes a symptom gets better, or the patient is able to move forward developmentally. It is possible to systematize these responses so that the analyst can use them as validation measures, as observable guideposts that he or she is on the right track. There's no danger to thinking you're "right," as long as you're open to changing your hypothesis in response to new data. The value of developing such validation systems should be obvious: It helps us put our patients' progress, their therapeutic outcome, in the forefront of our thinking at all times. It helps us ground our technique in something other than simply our own psychologies or philosophical theories. It grounds our theories in results.

We do this constantly in everyday life. We intuitively sense what the other person is feeling, asking, or needing, and we respond. We note the response, and alter our behavior accordingly. In fact, we intuitively use a kind of low-level experimental method of hypothesis-testing to judge reality. That is, we form hypotheses about other people and we test them. We make predictions based on these hypotheses and change them if the predictions fail. Consider, for instance, how parents figure out what their children are feeling or needing. The baby cries. Is she or he wet or hungry? The parent changes the baby's diaper. The baby continues to cry. The parent feeds the baby. The baby stops crying. The parent has tested an hypothesis and used behavioral criteria to decide that the hypothesis was correct. Based on repeated occurrences of this "experiment in nature," the parent learns to differentiate the "I'm wet" cry from the "I'm hungry" cry. The next time the baby is hungry, the parent will be more likely to provide a correct response immediately.

That's what we do, at our best, as therapists. We form hypotheses, make predictions, test them out with what we say, note our patient's responses as confirmatory or not, change our hypotheses if indicated. We ought to acknowledge this, and use this kind of model to make increasingly better hypotheses. In our wish not to be arrogant, we shouldn't mistake open-mindedness with not being able to know another's mind. This process of knowing can get stuck, go awry, or become distorted by everything from our own hang-ups or overly rigid theories to our cultural blindspots. But this isn't to say that accurate understanding and prediction isn't possible; it's more or less possible, the goal being more. In fact, the post-modernists have to agree with me, more or less, in the privacy of their day-to-day clinical work, i.e., they must have all sorts of standards by which they judge the moment-to-moment "correctness" of what they say and do. Unfortunately, the epistemological emphasis in their theory doesn't help them do it. Their theory tends to remain abstract and philosophical and not clearly helpful in the day-to-day challenge of figuring out where the patient wants and needs to go, and how to help him or her get there.

The disjuncture between post-modern theory and practice is important. It accounts for the fact that in reading this literature, one gets the feeling that what is being argued is simultaneously obvious and obtuse; obvious if all it's saying is that we can never be completely sure of anything, but obtuse when it attempts to work out how a therapist can somehow ground his or her clinical work in this epistemological truism. If a theory doesn't help improve our practice, what can we say about it? It seems to me that this problem of demonstrating important practical clinical consequences of post-modern theory flows from one of the underlying needs behind the postmodern tilt in psychoanalysis: to rationalize our therapeutic pessimism as psychoanalysts and comfort ourselves with an idealized vision of how complicated and difficult our jobs are.

In response to a social world that is increasingly cynical and pessimistic about the possibility of alleviating human suffering in general, a post-modern epistemology that reminds us of the impossibility of discovering "essences" is a comfort. In response to our frustration at poor therapeutic results, an attitude that underlines complexity and uncertainty is a tonic. In response to our declining status among mental health providers who promise a cheaper, more efficient, and thorough product, the complicated and abstruse flavor of post-modern language and writing is personally and professionally restorative. Yet, in this way, we as analysts accommodate to the prevailing ethos that is objectively undermining our position while reinstating ourselves as worthy in our own imaginations. By this I mean that the post-modern analyst doesn't directly take on the challenge to talk about cure, prove that it's possible, dissect exactly how to do it, or feel challenged to do it better. Instead, post-modernism risks encouraging a new kind of navel-gazing in which the navel isn't one's deepest unconscious mind but the idle preoccupations of philosophy about the nature of reality. The post-modern emphasis on complexity, ambiguity, and misunderstanding subtly helps us justify our confusion about how exactly we help people, and our pessimism about whether we can help them more.

And help them we must. Too often, psychoanalyses go on forever without substantially ridding people of their symptoms, changing their lives, or making them happier. Analysts have always been embarrassed about their therapeutic ambitions, acting as if their goal was only "understanding" and not "change." In this way they differentiated their professional turf from that of other helping professionals, but also allowed psychoanalysis to be caricatured as an endless process of self-exploration for its own sake. While the new theorists have done a lot of good in psychoanalysis by making the process less authoritarian, they have unwittingly also contributed to this anti-therapeutic bias by undermining the urgent project of developing a more rigorous system by which we use feedback from the patient to sharpen our efforts to help. Instead, there is a tendency to fetishize uncertainty, idealize ambiguity, and admire complexity. In this kind of atmosphere, we are told that we have to be particularly cautious of using the patient's therapeutic progress or failure as reliable guideposts for our technique. In fact, the idea of using objective markers at all as a check and balance is viewed with epistemological skepticism. Therapeutic progress, in other words, remains as theoretically secondary or incidental as it always has in classical psychoanalysis; it's just that now we have a more philosophically elegant rationale for it. However, in an era in which psychoanalysis is starting to look like the woolly mammoth, this kind of rationale for our confusion is a bit like passengers on the Titanic being told not to worry about that iceberg because they're on the most beautiful ship of its class. One gets the feeling that the turn to epistemology, the current emphasis in psychoanalysis on the critique of scientific rationality, and the repeated emphasis on what the analyst does not know, have all arisen in response to the declining status of psychoanalysis and the historical confusion in our field about our ability and moral obligation to "really cure" people.

Psychoanalytic theory has a claim on our attention as therapists for only one reason--to increase our understanding of psychological suffering in order to improve our therapeutic attempts to cure it. As an analyst, I use theory to understand what ails my patient. All analysts, naturally, would say the same thing. But I also think that I can use theory to develop validation measures to tell me if I'm on the right track. One of the main measures of this, by the way, is whether patients are doing better in their real lives in response to our work together. I can help "cure" you better if I am on the right track and your improvement is one marker that my track is an accurate one. Again, this sounds like a truism, but while analysts may think this way in their day-to-day clinical work, their theory tends to obfuscate it. In my view, only a theory that explicitly serves my therapeutic aim and my sense of moral responsibility is of interest. A theory that does not help me do so might be aesthetically pleasing but can't possibly be clinically compelling.

The problem is that psychoanalytic post-modernists have gone down the same road as their academic counterparts. Born of a progressive critique of the hierarchies of power lying behind the traditional values and canons of academic subjects ranging from English literature to history to architecture, post-modern scholarship drew its power, its passion, and its appeal from the social change movements of the 1960s and 1970s that were challenging various structures of power and privilege in the public arena. With the decline of the New Left, and increasingly unhinged from the real progressive activity that had given these academic critiques a sense of broader meaning, post-modernists in the academy turned their energies toward more conventional uses--publishing, getting tenure, professional status, and so forth. Its critical edge blunted, post-modern discourse became increasingly abstract, rarified, specialized, and politically irrelevant. In the context of an enervated and dissipated Left, politically apathetic and economically worried student bodies, and a prevailing conservative cynicism about the ideals of the past, former radicals--now academics--took to developing theory for its own sake and not for the sake of inspiring real social change. As Todd Gitlin put it in his book The Twilight of Common Dreams: "While the Right was occupying the heights of the political system, the assemblage of groups identified with the Left were marching on the English department."

The post-modern emphasis in psychoanalysis on epistemology, initially offering a useful corrective to a rigid authoritarianism in classical technique, now risks going in the same direction because the emphasis on epistemological uncertainty is never translated into concrete clinical principles of technique. Instead, this emphasis becomes an ethos, a sensibility that reflects and encourages a retreat from the concrete task of helping people change, of getting better results. Like its cousin in the university, post-modernism in analysis unwittingly rationalizes a retreat from the clinical trenches into a relatively academic discourse with questionable applicability.

I believe a better response is for psychoanalysts to make the goal of therapeutic change--of helping patients make concrete changes in their lives in the service of greater happiness--a more explicit, avowed, publicly stated aspect of their identities, their theory, and their technique. Our energies ought to be put into developing principles of technique that help people get better.

This sounds obvious, a rather prosaic call to arms, but it's not. You see, all psychoanalysts want their patients to get better and all think that their theories will facilitate that eventuality. These are people of good will who care about cure. Unfortunately their theories often discourage them from making this explicit, and from single-mindedly attempting to operationalize it. Because of their theory, their history, and their need to differentiate themselves from other practitioners, psychoanalysts are often ambivalent about representing themselves, first and foremost, as psychological healers. This needs to change. Psychoanalysts have to get rid of their aversion to research, and study what in their technique is helpful to patients and what isn't, what works and what doesn't. They need to study the efficacy of these techniques, and when it is good, proclaim it from the mountaintop and when it is bad, take this as their main theoretical challenge to study and improve. The idea that there is great value to understanding without change is not only ridiculous and morally indefensible for a helping professional to hold, but, worse, it is professional suicide. We can't go the way of the post-modern academic and lose ourselves in elegant but potentially solipsistic theory that can't be translated into improvements in our therapeutic outcomes. Above all, we can't leave ourselves open to the charge that we're more interested in what we can't know in our attempts to be helpful than in what we can know.

In the last analysis, however, psychoanalysts can't solve this problem within the confines of their theory. The drift away from a therapeutic sensibility to a philosophical one requires a long-term solution that isn't to be found in better philosophy but in changing the general atmosphere that is causing this drift in the culture as a whole. Yet just as analysts (even post-modern ones) don't like to view their intimate clinical work as influenced by social processes, so too are we resistant to looking for social solutions to the problems facing psychoanalysis. Ultimately, however, our attempts to re-commit ourselves to the business of practical cure will be nourished only if they occur in the context of a society in which the ethic of helping is cherished, transformation considered inevitable, and confident idealism about our ability to make it happen a fundamental article of faith. Psychoanalysis would be well served if analysts not only renewed their commitment to clinical cures but brought this same commitment to curing the public cynicism that has made this commitment seem so hopeless.


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