SUNY series, Insinuations: Philosophy, Psychoanalysis, Literature

Joel Goldbach, James A. Godley, Joel Goldbach, James A. Godley

• Publisher: SUNY Press
• Year: 2018
• ISBN:
  9781438467894
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

In contrast to the way inheritance is understood in scientific discourse and culture more broadly, inheritance in psychoanalysis is a paradox. Although it's impossible, strictly speaking, for the unconscious to be inherited, this volume demonstrates how the concept of inheritance can occasion a rich reassessment and reinvention of psychoanalytic theory and practice. The collection enacts a critical traversal of inheritance for psychoanalysis: from the most basic assumptions of natural or biological inheritance, such as innateness, heredity, evolution, and ontogenesis, to analysis of the ways cultural traditions can be challenged and transformed, and finally to the reinvention of psychoanalytic practice, in which the ethics of inheritance is fully realized as the individual's responsibility to transform the social bond. Featuring strong interdisciplinary analysis rooted in both psychoanalysis and philosophy, this volume further engages science, politics, and cultural studies, and addresses contemporary political challenges such as autism and transgenderism.

Cultural Inheritance

CHAPTER 6

Drug Is the Love

Literature, Psychopharmacology, Psychoanalysis

Justin Clemens

How does opium induce sleep? “By means of a faculty,” […] replies the doctor in Molière […]. But answers like that belong in comedy.

— Friedrich Nietzsche1

The Current Dominance of Psychopharmacology in Mental Health

Everybody knows that the prognosis for psychoanalysis today is dire. Perhaps not everybody is as forthright as the English psychoanalyst Darian Leader, who has famously announced that psychoanalysts today are “mutants scavenging after a nuclear holocaust.”2 But the consensus is patent. Moreover, the diagnoses of the historical preconditions for this situation seem always to finger the same malevolent culprits. Take Kate Schechter’s recent anthropology of Chicago analysts, Illusions of a Future.3 As Schechter details, we live in a time in which the dream of technological solutions to mental disorders dominates the governmental-corporate-medical provision of services, hence the ubiquity of psychopharmacological treatments for an enormous range of disorders, dispensed by a range of state-ratified medical officials (from general practitioners to high-end psychiatrists) and supported by a wide and powerful range of institutions (from private research bodies and universities to governments, the mass media, and Big Pharma itself).

Drug treatments are pragmatic, not exploratory, and biotechnical, not personal or sociological; above all, they are directed at neutralizing sets of psychophysical symptoms, not towards illuminating and transforming analytic structures. So-called evidence-based medicine has trumped the qualitative narratives of psychotherapy; automated management tools have increasingly taken over the burden of diagnosis and prescription for the ever-shorter face-to-face sessions available to practitioners; and commandments issuing from the insurance industry more and more determine the micropractices of psychiatrists and psychologists. Given their clear and present supremacy in the treatment of all sorts of alleged disorders, the new-generation management strategies for mental illness have utterly overrun psychoanalytic methods of diagnosis, treatment, and theory. The latter now appear protracted, expensive, unstable, and untestable—if not downright noxious.

It is certainly not the case that the domination of Big Pharma has gone unnoticed. On the one hand, there is a slew of popular books that itemize the effects of such domination upon economies, mental health provision, and individuals globally; on the other hand, there is a barrage of technical, institutional studies mapping the consequences.4 As Emmanuel Stamatakis and his collaborators have announced,

[t]o serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harm issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.5

One can immediately see how this global domination of the pharmacological industry entails a new kind of total corruption, in which there is no significant countervailing agency able to produce counter effects. In sum, one can see how, since the 1950s, mental health has been reconceptualized as part of general health. As a consequence, mental health has been linked to economic productivity and, thus, to industrial and labor relations within a global frame. As part of general health, mental health can be subjected to the same sort of governmental attentiveness already familiar in, say, epidemiological affairs. Diagnoses are “manualized” according to dominant institutional taxonomies (for example, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5]), and technological innovations (functional Magnetic Resonance Imaging [fMRIs]). Treatment is now predominantly pharmacological. Prognosis is linked to the ongoing management of symptoms, including the management of the so-called side effects of treatment itself.

Søren Kierkegaard once wrote that “[t]he more profound the anxiety, the more profound the culture,” and “[a]nxiety is neither a category of necessity nor a category of freedom; it is entangled freedom, where freedom is not free in itself but entangled, not in necessity, but in itself.”6 This is not at all a popular opinion in either the official or unofficial worlds of mental health, in which vast investments require happy results. On the contrary—and this is itself a significant development—“anxiety and depressive disorders” (the two now often produced and confounded together) have become the contemporary targets of political, medical, and chemical interventions, that is, deleterious symptoms to be mitigated and monitored. That such a program of eradication may well help to spread the symptoms of anxiety and depression further and further afield is clearly no argument against it.

As Mikkel Borch-Jacobsen noted over a decade ago,

[a]dmittedly, SSRIs [selective serotonin reuptake inhibitors] sometimes lead to diminished libido and even, among men, to impotence, but that is surely a small price to pay for a restored capacity for happiness. Twenty million people worldwide are thought to be taking Prozac, and we are hearing reports of a new era of “cosmetic psychopharmacology,” in which drugs will be used to treat not only depression, but daily mood swings and existential angst. So farewell Kierkegaard and Heidegger.7

This is not even to mention the serious politico-scientific issues around prescription, testing, and governmental ratification. As Peter Kramer notes (surprise, surprise!), “drug companies manage the information about antidepressants, promulgating positive studies and suppressing evidence of harm or failure. […] It turns out that drug companies are shockingly inept at testing their own products.”8 Yet, for Kramer, the paradox is that drugs may turn out to be even better than their manufacturers claim; moreover, such a situation puts paid to the old-style talk for good. We will return to Kramer shortly, as his own writings proved to be prominent propaganda for the emergent, personalized drug therapies of the 1990s and 2000s, and precisely as an assault against talking cures.

I believe these transformations express the force of a desire. For my purposes here, I will reduce this desire to a formula: There should be an end to talk. All of the features of contemporary psychological politics I have already elaborated bear integrally upon this desire. There is general agreement that “depressive” and, to a lesser extent, “anxiety” disorders are the greatest threats to personal and social well-being in the current dispensation of mental health; concomitantly, enormous resources are poured into the study and fabrication of “positive emotions”—happiness, for instance. There is general agreement that the most promising research into the causes and solutions for these disorders come from psychopharmacology and the neurosciences. There is general agreement that psychoanalysis and its offspring—including versions of family therapy—have little or nothing to contribute to either research or solutions.

These features have a variety of consequences. In the new world of descriptive psychiatry, affects such as anxiety are at best symptoms of biochemical imbalances (genetic or physiological); they are neither irreducible affects nor guides toward truth and freedom but symptoms of the aforementioned imbalances or disorders, themselves now most likely biophysical, if not “genetic.”9 If psychoanalysis was invented in an encounter with hysteria, and if problems of psychosis and perversion came to occupy psychoanalysis in the wake of its Freudian origins, psychoanalysts seem mainly at a loss to know how to situate themselves with respect to these new disorders.

For reasons that will hopefully become clear, I want to reexamine this situation from a slightly unfamiliar angle, by way of a modern genealogy of drugs. This will involve examining the relation between psychoanalysis and drugs, a relation that is not merely contingent but rather goes directly to an issue that persists at the heart of psychoanalysis and its institutions. I will suggest that the present dispensation of drug therapies was established not by research chemists and pioneering doctors but in a literary register by William Shakespeare. Thereafter, the modality of drug therapies was forwarded in an aesthetic register by the great Romantic writers and in a governmental register by plumbers.10 The subsequent development of drug treatments undergoes four further major shifts. From its origins with Shakespeare, there is its subsequent extension by the Romantic litterateurs; drugs are then subjected to medico-moral scrutiny; thereafter, they are subjected to repressive state apparatuses and a logic of expulsion; and, finally, in our own times, drugs are subjected to administrative control and market restriction.11

Having briefly sketched this genealogy, I will focus upon an influential popular text by Kramer about the relations between mental health, psychoanalysis, and drugs in order to show how the new regime of personal psychopharmacology was accompanied by specialist publicity expressly aimed against psychoanalytic theories and practices. In so doing, I will suggest how commonplace understandings of the relation between psychoanalysis and drugs fail to recognize certain crucial antagonistic complicities between psychoanalysis and drug therapies. These solidarities also provide, as we shall see, an unfamiliar angle from which to rebroach the ancient squabble within psychoanalysis in regards to its relation to science. I will offer several propositions about this relation, suggesting that a particular concept of the place, temporality, and powers of language is at stake. Finally, I want to suggest that the “real enemy” of psychoanalysis—if this phrase has any sense—is not the neurosciences or psychopharmacology per se, but rather the expropriation of language itself as an independent force that underpins all of the preceding conditions. Indeed, if psychoanalysis is to survive, it should perhaps forge a compact with other treatments that share the following fundamental axiom: Language is not simply a technology. As I will try to show, something troubling remains about psychoanalysis that cannot be dispensed with, even for and by persons who are deeply against it.12

Love’s Drugs in Shakespeare and Freud

A Midsummer Night’s Dream opens with a tormenting imbroglio of love and marriage. As the besotted Lysander declares to his paramour Hermia, whose father Egeus has promised her to Demetrius,

Ay me, for aught that ever I could read,

Could ever hear by tale or history,

The course of true love never did run smooth.13

Never did run smooth—A Midsummer Night’s Dream henceforth shuttles and stutters between the town and the woods, between the high- and low-born, the natural and supernatural, the waking and the dreamed, the real and the pantomimed, and the king and the ass. Moreover, as Lysander’s own impassioned discourse suggests, the unquiet course of love is so deeply bound to language’s own courses and curses—for which stories of love not only provide the matter but also the form of story itself—that, at the limit, love and language threaten to become coextensive with one another.

Shakespeare was writing the comedy of A Midsummer Night’s Dream at the same time as the tragedy of Romeo and Juliet, where we also find—desp...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgments
• Introduction: Inheritance in Psychoanalysis
• Natural Inheritance
• Cultural Inheritance
• The Inheritance of Psychoanalysis
• About the Contributors
• Index
• Back Cover