The Psychoanalysis of the Absurd

Existentialism and Phenomenology in Contemporary Psychoanalysis

Mark Leffert

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000081770
• Topic: Philosophy
• Subtopic: Existentialism in Philosophy
• Edition: 1

The Psychoanalysis of the Absurd offers an interdisciplinary study of Existentialism and Phenomenology and their importance to the clinical work of Contemporary Psychotherapy and Psychoanalysis. The concept of Absurdity, developed by Camus, has never been applied to the therapeutic situation or directly contrasted with its antithesis; the search for personal meaning.

The book begins with narrative accounts of the historical development of Psychoanalysis, Existentialism and Phenomenology in 20th century Europe. The focus here is on fin de siècle Vienna and Paris between the Wars as the principal incubators of the two disciplines. Accompanied by composite case illustrations, Leffert then explores his own development of the Psychoanalysis of the Absurd, drawing on the work of Camus, Heidegger and Sartre. Absurdity is first discussed in relation to the Bio-Psycho-Social Self and Dasein is posited as a bridge concept, with personal meaning as the antithesis to Absurdity, before being discussed in relation to the world and how it impinges on self. A final chapter attempts to tie together particular issues raised by the book: Subjective well-being, Meaning, thrownness, Absurdity, Death and Death Anxiety and how we have become technologically enhanced human beings.

Existential psychotherapy and psychoanalysis have, until now, largely gone their own way: the goal of this book is to fold them back into Contemporary Psychoanalysis. Establishing that the concept of Absurdity is of singular clinical importance to both diagnosis and therapeutic action, this book will be of great interest to clinicians, philosophers, and interdisciplinary scientists.

1 Psychoanalytic knowing

A brief history of Psychoanalysis and Psychotherapy

Introduction

For as long as Psychoanalysis has existed, clinicians have searched for a theory that could explain human psychology and psychopathology with a related theory of cure. We have been concerned with the psychoanalytic knowing of our patients and, more recently, ourselves. Theories of care have come much later (Leffert, 2016). Fifty years ago (Gill, 1976; Gill & Holtzman, 1976; Klein, 1969/1976), we began to realize that there were two sorts of theories out there: One was a very successful clinical theory and the other was a set of very unsuccessful—to borrow a term from the attachment theorist Mary Main (1991)—theory theories. These theories range in complexity from the simplicity of a dynamic unconscious separated from consciousness by a repression barrier to the elaborate mathematics-like complexity of the now highly popular theories of Wilfred Bion (1963/1984). Our term for this kind of theory is metapsychology. There tends to be confusion on this point, and Gill and Holtzman’s work has largely been forgotten. Although there has been no shortage of metapsychologies, a century-and-a-quarter’s work has failed to yield proof or to validate any of them. Despite a general awareness of this fact, we have been loath to give them up. I have elsewhere (Leffert, 2010, 2013) offered critiques of these theories and spoken of the impossibility of verifying them. Nonetheless, they somehow remain in use, the idea of doing without them remains disturbing to some clinicians who continue to cling to them, and there remains confusion between fact, opinion, and supposition. That they endure and are still taught suggests that they may perhaps serve some clinical purpose,¹ and we need to review them in a macro-historical way to try to better understand what that might be. We will look at this century and a quarter of theory building, the theory theories and the clinical theories, from a macro perspective, a kind of flyover, if you will. Then we will look at how the two theories are used by clinicians today, from those adhering to a single theory to a large majority of Psychotherapists² who freely sample the theoretical buffet, at times without even knowing the antecedents of their choices. Indeed, Psychoanalysts are beginning to study these questions, a sort of meta-metapsychology, if you will. We will consider recent projects (Rudden & Bronstein, 2017; Tuckett, et al., 2008) aimed at studying the ways analysts work and the theoretical underpinnings of what they do. A section of a recent issue of the Journal of the American Psychoanalytic Association (Vol. 65, #5) was devoted to four papers (Blass, 2017; Cooper, 2017; LaFarge, 2017; Zimmer, 2017) on how analysts deal with theoretical plurality today.

1 If a psychotherapist successfully teaches a school of metapsychology to his patient and they both proceed to apply it to the patient’s unhappinesses, there will be some amelioration of their symptoms through suggestion and as a result of giving the patient a system whereby they can bind anxiety. (Whether or not there is any Meaning to be had in such a process alone is another question.) We must try to be on guard against such theoretical enactments in our work.

2 Many psychoanalysts see a sharp distinction between psychotherapy and Psychoanalysis and speak of converting the former into the latter. After much thought, I find myself unable to make such a clear distinction and see it as a quantitative rather than qualitative matter. I posit that Psychoanalysis sits under the umbrella of Psychotherapy. When I use the terms psychotherapist and psychotherapy, please take them to include Psychoanalysis and Psychoanalyst unless otherwise specified.

We will want to explore the history of psychoanalytic theory from its inception (Breuer & Freud, (1893–1895)/1955) in the late 19^th century until the 21^st century present (Leffert, 2018). We will want to know about how and why new theories came into existence and what happened to them. Some will have passed away while others remain, but in unnamed forms. We will be looking through a wide-angle lens at macro-historical trends, not at details of psychoanalytic thought in the various schools of Psychoanalysis.³

Before proceeding with this inquiry, we should, however, ask the question: How many clinicians are there, and how many of those do actually cling to a single or multiple named theory theories? This is a very hard question to answer, and we can only offer supposition based on assumption—always a dicey proposition.

The International Psychoanalytic Association in 2018 boasts on its website of 12,700 members throughout the world, of which approximately 3000 are also members of the American Psychoanalytic Association. Membership in these organizations requires graduation from a psychoanalytic institute credentialed by these organizations and suggests a commitment to organized Psychoanalysis. It should be safe to assume that these clinicians have some commitment to psychoanalytic theory. Meanwhile, there are approximately 30,000 clinicians in the United States who identify themselves as Psychoanalysts (Kirsner, 2009). Although we know nothing about the theoretical proclivities of these clinicians, we can say that, by choosing to identify themselves as Psychoanalysts, they have studied psychoanalytic theory in some depth and with some formality.⁴ The final question is how many clinicians in the United States identify themselves as Psychotherapists? According to the United States Department of Labor’s Bureau of Labor Statistics there were, in 2011, 552,000 mental health professionals practicing in the U.S. We would be inclined to think that this is a highly diverse group including counselors, social workers, psychologists, psychiatrists, and some psychoanalysts who no longer self-signify themselves as such.⁵ Members of this large group have almost certainly had some exposure to named psychoanalytic theory and theoreticians at some point during their education and, also, exposure to psychoanalytic ideas in contexts where they were not named as such. We have then four groups of Psychotherapists—the APsaA Psychoanalysts, the IPA Analysts, the self-signified Analysts, and the Psychotherapists—of whom we are going to want to talk about, their educational habits and habits of practice. This discussion can offer a background for a conversation concerning the current theory and practice in Psychoanalysis.

3 Schools can be named after some beloved father or mother—Freud and Klein are examples—or some fundamental theoretical idea—Self Psychology or Relational Psychoanalysis.

4 The questions of what a psychoanalytic education or a psychoanalytic practice consist of are highly contested with no certain evidence of superior validity or therapeutic efficacy of any of the differing parameters (beyond the strong opinions of members of the different groups) used to describe them.

5 Increasing numbers of committed Psychoanalysts market themselves, particularly on their personal websites, as Psychotherapists—an implicit acknowledgement of how the former term is viewed by the lay community of potential consumers of mental health services.

The broad sweep of Psychoanalytic history

A Surveille of Psychotherapy and Psychoanalysis from their rudimentary beginnings and up to the 21^st century would certainly require at least an entire volume but would contain nothing that isn’t readily available in the psychoanalytic literature. If this were an introductory text, one could argue for a need for such detail, but here it would be redundant. Metaphorically, I want to offer a history using a kind of time-lapse photography that enhances movement. It is a phenomenologically based inquiry in that it describes what was and what is, what existed in conceptual terms: It does not argue for one point over another, and does not worry about attribution. In our contentious discipline, we can’t get into detail without engendering conflict and uncertainty, and our approach here dispenses with these theory wars. It leaves a lot out, details, names in particular, that can be filled in by any student of Psychotherapy or found in any of the histories of Psychoanalysis. We will end up instead with a rather messy braid of different threads, threads that often oppose each other: What we will then have is a sheaf of différance (Derrida, 1982),⁶ a Post-Structural narrative that more accurately describes the state of things compared to any attempt at a linear account.

Psychotherapy evolved very gradually out of traditions of folk medicine and folk healing, almost certainly going back to prehistoric times, whereas Psychoanalysis appeared over the span of a few decades, initially out of medical roots. The preeminent history of these developments is to be found in Henri Ellenberger’s The Discovery of the Unconscious (1970). Although he writes about an evolution of dynamic psychiatry, in itself an implied slight of non-medical psychotherapists common at the time, it is as relevant for the latter group as for the physicians.

6 The idea behind the term différance is that a thing may be best described by a number of ideas, here threads, often in conflict with or opposition to each other, maintained in a tension that best describes its meaning. The tension persists between signs; there is no final meaning. One-person and two-person psychologies are examples of such threads held in tension in the therapeutic situation. We will have more to say about différance later in the chapter.

Ellenberger (1970) recognized the development of the healing professions out of aboriginal and undoubtedly prehistoric roots. The study of these aboriginal healers revealed that they used many of the techniques of modern psychotherapy albeit in different, at times subtly different, forms. He posited, “The study of primitive healing thus is of interest as being the root from which, after a long evolution, psychotherapy developed” (p. 3). We know that the healing arts were practiced in pharaonic times in Egypt dating back to the first Dynasty (3000 B.C.E.) with extant written records going back to 1700 B.C.E. (Nunn, 1996). Healing was practiced by physicians (swnw), priests (wab), and magicians (sau). It involved many of the elements present in modern psychotherapy⁷ that would be effective for the treatment of what we would call nervous and mental diseases. For our purposes, swnw listened to their patients, took a history, and examined them. (The medical papyri also use the term swnw in connection with the laying on of hands.) Treatment involved, in addition to the laying on of hands, the use of the placebo effect and of suggestion (Leffert, 2016); all were consistent with Freud’s early proto-psychoanalytic practice. Better documentation survives concerning the healing practices of ancient Greece (beginning ca. 800 B.C.E.). There were two kinds of health practitioners: the iatroi, the healers, and the medici, the early physicians. As I’ve previously written (Leffert, 2016, chapter 6), both threads were interested in healing, but the iatroi in particular focused on care of the patient and relief of pain and suffering. They practiced amicably together, side by side, through Roman times. After the fall of the Roman Empire, conflicts over market share and power resulted, with the Catholic Church,⁸ facilitating the depreciation of the latter by the former. The healers were, in effect, outlawed and forbidden to practice, an edict frequently enforced by charges of heresy. “Witchcraft” was, in effect, a power relations term. Healers were at best tolerated and were permitted to treat the poor.

These trends persisted into premodern times (1500–1800) but with a twist. Folk medicine remained as the purview of healers and apothecaries but pastoral counseling appeared, sanctioned by the Church and becoming a part of the job description of the parish priest or minister. A readily identifiable feature of these various practices was the way they accomplished healing through suggestion.

7 An active pharmacopeia and effective surgical procedures (including obstetrical and gynecological practice) existed in pharonic Egypt that offered successful treatment of some medical illnesses and physical trauma.

8 This was a power struggle that persisted into modern times. It was complicated by the fact that medicine, until the 20^th century, had, on average, less to offer patients than the healers and, in many instances, did more harm than good.

Psychoanalysts have often depreciated the clinical use suggestion. They have seen fit to ignore the reality that any intervention constitutes a suggestion to do or think something else. Suggestion falls along two axes. One is the explicit/implicit axis and the other is the advertent/inadvertent axis. Implicit/inadvertent suggestions account for much of what we unknowingly do in the Therapeutic Situation. I have argued (Leffert, 2013, 2017) that suggestion remains a significant salutary part of therapeutic practice.

During this same period, physicians became involved in the treatment of the mentally ill. In his magisterial work, The History of Madness, Foucault (1961/2006) described the care of the insane, the déraisonnés, during what he designated as the Classical Age dating from 1650–1800. The déraisonnés were defined by power considerations as much as illness and included individuals deemed moral reprobates (classified as individuals living at the margins of society and constituting a threat to society) as well as the insane. In Paris, 5000–6000 people, roughly 1% of the population, were institutionalized, to protect society from social and infectious contagion, over a period of a very few years: This Great Confinement, to use Foucault’s term, ushered in the Classical Age. In the Asylums where these people were confined, the role of the physician was to direct the efforts of what might be termed a treatment team comprised of “empirics,” nuns, monks, charlatans, druggists, and herbalists. The latter administered nostrums, potions, and herbs. Guards were also present in the asylums and at times dispensed “therapeutic” punishment. Prominent among the drugs dispensed were mercury, antimony, and opium. But what wa...