The Failed Assassination of Psychoanalysis

The Rise and Fall of Cognitivism

Agnes Aflalo, Adrian Price

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781782201649
• eBook ISBN:
  9780429920721
• Topic: Psychology
• Subtopic: Medical Law
• Index: Psychology

It can happen that a law incurs the wrath of the very people it set out to protect. This is what happened in France at the end of 2003 with the Accoyer Amendment, a Bill that intended to regulate the exercise of psychotherapies even at the cost of the disappearance of psychoanalysis itself. The public that this law was supposed to protect thus ran the risk of finding themselves stripped of certain freedoms that democracy usually guarantees. How had it become possible to reach such a point? This is what this book sets out to examine. Evaluation and cognitive-behavioural scientism, which have been progressively infiltrating different forms of knowledge with destructive effect, undoubtedly played a major role. And then, the International Psychoanalytical Association, despite having been founded by Freud to protect his invention, started to endorse the forced cognitivisation of psychoanalysis. Meanwhile, psychiatry slid back into its nineteenth century hygienic obscurantism and its new recruit, epidemiology, began playing host to racialist discourses.

CHAPTER ONE
The Amendment

Everything that fails to kill us can only make us stronger.

—F. Nietzsche, Twilight of the Idols

The failed assassination

The “Accoyer Amendment” was passed on 8th October 2003.¹ It claimed to introduce regulation of the exercise of psychotherapies, but did so without any prior consultation, thus spelling a threat for the future of psychoanalysis in France. Indeed, within the space of a few days, a huge movement of public opinion led by Jacques-Alain Miller² had come out to express its great concern up and down the country. This movement saw several phases of intense mobilisation, the first of which lasted until Easter 2004, that is, until shortly after the Amendment went before the French Senate, at which time Inserm³ had just brought down public wrath by openly siding against psychoanalysis. It was during these months, from October 2003 to Easter 2004, that the failed assassination of psychoanalysis was perpetrated.

This moment is well worth examining because psychoanalysis is a public good and it deserves to remain one. Yet, since 2003, the determination of its adversaries has continued to make itself felt, not only with respect to the Amendment, with its décrets d’application and other decrees, but also through publications that are hostile to psychoanalysis and which have usurped the term “science” with a view to using it to their advantage. Furthermore, to come back to this attack on psychoanalysis is also to show how these false forms of knowledge, which are exceedingly seductive on account of their scientific allure, could well come to enslave our democracies if adequate care is not taken. The history of the twentieth century harbours a painful memory of one such seduction. So, shedding light on this historic moment and specifying what is at stake in it is no small matter.

Psychoanalysis came into existence at the start of the twentieth century. That is a fact. Since then, it has continued to spawn a long line of different types of psychotherapy. Most of them have only maintained a small portion of psychoanalysis. They do purport, however, as does psychoanalysis itself, to be serious in their theoretical lucubration. Things had doubtless evolved a great deal since the beginning of the last century, but right up until the new millennium, never once was the practice of psychotherapies regulated. Passing the Amendment was the sign that this period was over once and for all. To begin with, psychoanalysis had been fairly hush-hush; it attracted only a wealthy few. Later it became far more democratic, to the point that “going to see a shrink” became fairly commonplace. This practice is still in vogue today because it corresponds to a deep desire, even though some find it hard to get their bearings amid the different shrinks where the “psych-” prefix abounds: psychoanalysts, psychiatrists, psychologists, psychotherapists, and so on.

Psychoanalysis was born in Europe. Next it spread to the New World and it was above all these new continents that saw the patching together of multiform variants of psychotherapy, before making its way back to Europe. The renown of psychoanalysis rubbed off on its derivative psychotherapies, to the point that psychoanalysis became a victim of its own success: the sprawling “shrink sensation” first gave rise to a market of psychotherapies, which then in turn tended to efface the singularity of psychoanalysis. With hindsight, we must acknow ledge that the psychoanalysts didn’t see this coming in time, or else, which boils down to the same thing, they didn’t know how to draw the necessary conclusions from it in such a way as to orient their action. It was quite predictable, however, that the psychotherapy market would end up attracting the interest of Trusts, and that governments would be calling the psychotherapies to account. Yet, at the time the Amendment reared its head, not one serious incident in psychotherapy had ever been reported in the media, and thus the reason behind the absence of consultation leading up to the vote in the National Assembly remained obscure.⁴ Why was it so urgent to “seal this legal loophole”?⁵

Beyond the legitimate question from the legislator, it very quickly became apparent that, under cover of “reassuring the general public”, this was in reality about seizing hold of public freedoms. Indeed, the consequences of the so-called expert knowledge that had served as the Amendment’s “scientific” guarantee amounted to just that. This knowledge emanated from a close-knit academic clique who for three years had been launching a large-scale editorial offensive with the objective of having its obscurantist discourse triumph over psychoanalysis. Once the alarm bells had been sounded, it soon became clear that the Amendment was just the tip of the iceberg. It was part and parcel of a strategy that was now plainly legible. The editorial offensive had consisted in readying the ground by scientifically discrediting Lacanian psychoanalysis with an eye to taking the next step of getting legislators to outlaw it by decree. This unprecedented attack on psychoanalysis shook the therapists to the core and brought a lasting reconfiguration to their world. The dividing line was no longer drawn between the psychoanalysts and the rest, but between those for whom speech must remain free and the others. To form some idea of the events that whipped up this struggle, it is worthwhile calling to mind a few dates.

On 2nd October 2003, the Ministry of Health issued a statement announcing a “Comprehensive Mental Healthcare Policy” put together on the basis of the roadmap drawn up by Dr Cléry-Melin. The consultation that preceded it had excluded all representatives of psychoanalysis, clinical psychology, and the psychotherapies.⁶ With neither prior public debate nor dialogue with the professionals concerned, the deputies who passed the Amendment a few days later had not been informed of the role that the French Ministry for Health had given to the “Cléry-Melin Roadmap”. This vote thus constituted in itself what was keenly identified by philosopher Yves-Charles Zarka as a “pathology of democracy” (Zarka, 2003).

At the end of October 2003, having been informed of the above by a major daily newspaper that was asking his opinion on the matter, Jacques-Alain Miller lost no time in giving the alert. No one had noticed the “Cléry-Melin Roadmap” until after the Amendment was passed. Some swift research from Dr Sophie Bialek and Dr Pierre Sidon brought to light the fact that the roadmap and the Amendment were two faces of one and the same project. In the Cléry-Melin report, the evaluation of the psychotherapies and their medical supervision constituted not only an infringement on the exercise of psychoanalysis, but also a breach of civil liberties. The report established a systematic bleeding of “mental healthcare” in France and its subordination to medical power. It set out how psychiatrists would become regional coordinators and decide authoritatively which kind of therapist a citizen should consult. Speaking to a therapist on order does not, of course, have the same effects as speaking to a therapist because one desires to do so.⁷ Gripped by the dangerous prospect of a society in which psychiatrists would become “prefects of the soul”, Bernard-Henri Lévy voiced his concern by throwing himself into an immediate and lasting engagement, shoulder to shoulder with the psychoanalysts in this enlightenment struggle,⁸ in keeping with his duty as a philosopher, entering the fray of public debate to ensure that philosophy remains “an instrument for lucidity”. Psychoanalysis owes him a great deal.

Through until February 2004, a series of fortnightly Forums were held, each bringing together over 1500 people, first in Paris and then, later, in the provinces. A number of intellectuals from all sides engaged in the battle. The writer Philippe Sollers, an ally from the start, put his renown in the service of the analytic cause without hesitation. The philosopher Jean-Claude Milner, who used to attend Lacan’s seminars, also came forward, as did the courageous and committed intellectual Catherine Clément, along with many others, including: Roland Castro, Gérard Miller, Élisabeth Roudinesco, Maître Charrière-Bournazel, Maître Lévy, and other younger contributors such as Anaëlle Lebovits who had just created the group DIX-IT, Raphaël Glucksmann, and Alexandre Renault, to name but a few. Personalities from what we may fittingly call “enlightened public opinion”, such as Françoise Castro, also addressed the public. Politicians from all the major parties participated in the Forums: François Bayrou, Renauld Dutreil, Jean-Michel Fourgous, Robert Hue, Bernard Kouchner, Jack Lang, Jack Ralite, and Jean-Pierre Sueur among them. Men and women from the world of arts and entertainment also contributed: Arielle Dombasle, Anne-Lise Heimburger, Brigitte Jacques-Wajcman, Gérard Pape, Marie-France Pisier, Andrée Putman, Jean-Pierre Raynaud, Pablo Reinoso, Irina Solano, and many more. Journalists from the press, radio and television were present: Jean-Pierre Elkabbach chaired debates, and Edwy Plenel took the floor. The events were covered by Jean Birnbaum, Éric Favereau, Maurice Szafran, Cécile Prieur and Catherine Petitnicolas, amongst others. Some of them published articles in the major broadsheets and weekly news magazines, but also in the journal Le Nouvel Âne. The offensive stood as a declaration of war on psychoanalysis, but once it was seen to be infringing upon freedoms it also provoked a debate on the kind of society we live in, with, at the heart of the torment, the “steering state” and its demand for scientistic evaluation.

Mid-November 2003 saw the drafting of a manifesto, the Manifeste Psy,⁹ bringing together practitioners of all persuasions: psychoanalysts, psychotherapists, clinical psychologists, and psychiatrists. It called for a retraction of the 2nd October Ministry of Health statement and a freeze on the Accoyer Amendment. Considering the “Accoyer/Cléry-Melin” project to be a breach of civil liberties and privacy, a joint committee was set up, the Coordination Psy, proposing a declaration that established two principles: the right of the suffering person to choose his or her own therapist without state interference, and the duty of therapists to stand before the public as guarantors, via their associations and schools.

By the end of November 2003, more than 3000 people had called either for the withdrawal of the Accoyer Amendment or for it to be modified after a debate between the psychoanalytic associations, the elected representatives, and the ministers concerned.

At the start of December 2003, different personalities from the political sphere were showing signs of appeasement. Laurent Fabius asked then Prime Minister Jean-Pierre Raffarin to withdraw the Accoyer Amendment and initiate a dialogue. Bernard Accoyer himself acknowledged that several clauses in the Amendment could be revised. Bernard Kouchner voiced his disapproval of the plan, and came to the third Forum to take part in a debate.

In mid-December 2003, the Minister for Health met, each in turn, the main psychoanalytic associations, followed by the psychologists and psychotherapists. The Minister proposed to the psychoanalysts that he withdraw them from the scope of the bill in exchange for the handover of their directories. The directories would be entrusted to the Ministry to check that no unauthorised psychotherapist had slipped in. Putting psychoanalysis under ministerial control, which everyone immediately perceived as the ushering-in of a ministry of the mind, was an unacceptable measure. In the name of the École de la Cause freudienne, its president Lilia Mahjoub refused to go along with this procedure. This was the case for Élisabeth Roudinesco too, who also let it be known that the representatives of the most powerful psychoanalytic societies would, however, be consenting to it. These included:

The Société psychanalytique de Paris (SPP), the Association psychanalytique de France (APF), both affiliated to the International Psycho-Analytic Association founded in 1910 by Sigmund Freud, along with the Organisation psychanalytique de langue française (OPLF), the Association lacanienne internationale (ALI), and the Société de psychanalyse freudienne (SPF). (Roudinesco, 2004, p. 14,

(Roudinesco, 2004, p. 14, note 1)

In other words, for the first time in France, the state was taking it upon itself to worm its way into a debate between learned societies, even though such action falls entirely outside its jurisdiction. The psychoanalysts of the École de la Cause freudienne refused this slide. Their adversaries, essentially those from the IPA then under the leadership of Daniel Widlöcher, immediately fingered them as the “charlatans” targeted by the Amendment.

If evidence is needed of this, take the declaration by Bernard Brusset, a member of the SPP. No sooner had the Amendment been passed by the Senate than he rushed, with the complicity of the “good Lacanians” who had rallied to his policy of lists, to pillory the other Lacanians, those from the ECF, accused of imposture for not having respected the “international norms” imposed by the IPA.

(Roudinesco, 2004, p. 21)

On that same day, midway through December 2003, the Minister met the psychologists and psychotherapists in the presence of Christian Vasseur and Jean-François Allilaire. Jacques-Alain Miller wondered what significance their presence might hold:

Who are they? Christian Vasseur, president of the French Psychiatric Association, is Bernard Accoyer’s mentor […] [and he] explains that the “incontrovertible invariants” of psychotherapy are to be found in medical psychopathology. Allilaire speaks down-the-nose in the Minister’s office. He refers to his texts: his white paper,¹⁰ his report for the Académie de médicine, and the Cléry-Melin roadmap too. What does he say? That the Accoyer Amendment is going in the right direction, but that already we should be thinking about drafting the implementing decrees. That the psychotherapists of the future, as well as the future clinical psychologists, will have to be trained in “highly standardised psychotherapies”. That this teaching will be taken care of by training institutions, offering programmes “akin to those offered by the Faculty of Medicine”. That these institutions will provide training in cognitive-behavioural treatments as well as in psychoanalysis, and even in further specialities, still within a medical framework, or contractualised with psychiatry. That he has major reservations about the approval, stipulated in the Accoyer Amendment, of the “neither-nors” (neither doctor nor psychologist) currently practising. That medicalisation is at any rate unavoidable.

(Miller,2004)

In February 2004, the move to liquidate psychoanalysis saw the opening of a new chapter with a publication from Inserm. Its “assessment” of three types of psychotherapy, one of which was psychoanalysis, concluded by awarding the dunce’s cap to the latter. Needless to say, the gold star went to the cognitive-behavioural therapies (CBT). The venerable institution showed no hesitation in passing off the idea that psychoanalysis was merely a branch of medicine and an undeserving one at that. This was made to look like something plain to everyone. Moreover, this coup de grâce was dealt shortly after the hostilities began. They were counting on the effect of surprise. What they didn’t count on was the wilful courage of a determined few. It had only taken a few months to decipher the situation. Foreseeing the next step would not be impossible. The French department of health, La Direction générale de la santé (DGS) had financed the Inserm report. Our research allowed us to anticipate its conclusions. Until then, Inserm had never been contested as a serious institution, and indeed seemed incontestable. Its declaration of war on psycho analysis was a first. This came as a deep shock not only to the therapists but to the public at large.

In February 2004, William Dab, the director of the DGS, was sufficiently satisfied with the assessment of the psychotherapies for him to hold a press conference on the Inserm premises. The calamitous handling of the previous year’s heat wave had hurried on the resignation of Lucien Abenhaïm, and Dab had replaced him at the helm. Trained in Canada, he made no secret of his support for CBT and the biopsychosocial psychiatry he wanted to see develop in France. Listening to him that day I was struck by his determination. One point nevertheless remained obscure. It seemed that, to begin with, the report commissioned by the DGS only concerned CBT. It was in no way a question of comparing CBT and psychoanalysis. How had this report, which was initially dedicated to CBT, all of a sudden become a report that included psychoanalysis, which had never been assessed, contrary to what was being stated? This was not explained.

In Spring 2004, after the regional elections, Philippe Douste-Blazy became Minister of Health. Didier Houssin then took over as head of the DGS. On 20th March 2004, Christian Vasseur organised a debate at Marly-le-Roi under the title Les Assises de la psychothérapie [Psychotherapy in the balance].¹¹ Twenty or so speakers were present, including Allilaire and Brusset, who together drafted a new version of the Amendment.

Chronicle of a defeat foretold

In February 2005, Philippe Douste-Blazy came to the Forum. He sided with the...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• PREFACE
• CHAPTER ONE The Amendment
• CHAPTER TWO Procrustes and the river of sludge I
• CHAPTER THREE Procrustes and the river of sludge II
• CHAPTER FOUR Cognitive-behavioural calculation
• CHAPTER FIVE Discipline and banish
• CHAPTER SIX Bioreligion
• CHAPTER SEVEN The commodification of knowledges
• A FEW WORDS OF CONCLUSION
• APPENDIX I The new Amendment
• APPENDIX II "Scientifically" discrediting psychoanalysis and attacking civil liberties
• NOTES
• REFERENCES
• INDEX