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PSYCHOANALYSIS AND THE PUBLIC SPHERE: THE PROJECT IN CHANGING TIMES
Final Plenary Discussion paper given at Ninth Annual Conference, November 18-19, l996, at the University of East London
Michael Rustin and Andrew Cooper
We thought it might be useful after eight years of this annual event to attempt an overview of what one might think of as the ongoing project of the Conference. We have noted that the final plenary sessions of the Conference have sometimes generated rather contradictory sentiments, on the one hand of hope and expectations of some more concerted thought or action that might follow from our gatherings, and on the other hand of frustration that this does not in practice happen. Perhaps an attempt at review, and also at a more programmatic look forward, might enable us to think about these issues whilst this Conference is still in session, so to speak.
The wider political context of Psychoanalysis and the Public Sphere (henceforth PPS) has been a bleak one, almost throughout. Most of those attending have been workers in the public sector, in health, social services, or education. Even those who work in private practice as therapists usually also have some significant involvement in publicly funded or community based institutions. This has probably been one of the implicit principles of attraction to the Conference, which does after all say it is about the 'public sphere.' So one of the main themes of the Conference over the years has been the fear, anger, pain, and frustration of these professional workers faced with threats to the services they provide.
The Conference has framed a continuing antithesis between the market driven, managerial, and authoritarian ethos of 'Thatcherism', and on the other hand a commitment to reparative work with the patients, clients and other members of institutions devoted to community health and education in their various forms. This has seemed to most participants in PPS to be a deep contradiction between opposed values and purposes, frequently enacted in battles over service provision both in terms of quantity (deleted posts, etc.) and quality (recognition of client or patient needs, or indeed of the needs of professional workers themselves). Even those in quite privileged organisations, like universities, have experienced these conflicts in severe forms, let alone those in more vulnerable settings like a local child guidance clinic or therapy service which may have been threatened with complete closure.
Despite tensions inherent within the Conference, one has the impression that it functions as a positive resource for those who attend. Struggles enacted within the bounds of the annual event surely reflect those with which participants engage year round. It is worth reminding ourselves then, that the Conference is not simply an annual retreat from which a particular group of more or less like-minded people draw some renewed strength. As Gordon Lawrence suggested in one final plenary, the Conference itself is an intervention in society. The fragility and in many cases the loss of organised means of taking action within public services and civil society is one of the recurring themes announced by Conference participants. At the same time much discussion over the years has been devoted to the centrality of a capacity for containment and thought (rather than action) to the project of working with mental pain. In turn, it has been proposed that the necessity for this kind of 'depressive' orientation to our work may be an achilles heel, militating against the concerted action required to protect and sustain the very social conditions which make possible better mental health, and mental health work. These are continuing dilemmas with which the Conference's constituency seems to grapple.
Within the prevailing climate of threat and anxiety even creative thinking has not always been easy. Solidarity in denunciation can be a comforting form of retreat from uncomfortable realities which seem to provide so few possibilities for resistance or development. The idea that we might also be part of a structure of feeling called a 'dependency culture', put to us by Olya Khalilee many years ago, provoked a storm of hostility which led her to leave the Conference before the issues raised and the feelings associated with them could even be addressed in discussion. But the demands for accountability, for demonstrations of value for money (outcome studies of the effectiveness of psychotherapy, for example), the pressures of the various internal markets in students, pupils, patients and clients, have been experienced by many of us simply as invasive attacks on our professional values and practices. It has been difficult to come to terms with this environment simply as the reality, unwelcome as it may be. It has been still more difficult to recognise that some of the demands on professional providers made by these budgetary and audit regimes might even have some points of validity. Just as medical specialists are going to find it difficult to phase out some widely practised forms of surgery when research shows they do little good, so a department providing mental health services may not like to be told that it does not have enough patients to justify its staff establishment, and needs to be become more active and innovative to justify its income.
In this area, psychoanalysis experiences an increasing threat from a number of near and not so near therapeutic relations. More than one established NHS Psychotherapy Department offering psychoanalytic intervention has recently lost out to supposedly cheaper, more efficient, outcome-oriented therapy. Recent contributions to and debates sponsored by the British Journal of Psychotherapy have, we feel, engaged with this development in a positive spirit. In the current climate there is little alternative but to come out fighting and engage in open-minded critical debate, develop strategies to preserve the organisational base of psychoanalytic work, and learn to defend our tradition. Psychoanalysis has with some justification been criticised for its cultural closure and lack of accountability. In the 1990s, professional mystique and a strong cultural inheritance are unlikely to be an adequate basis for this defence. Current debates about registration and accreditation have divided a number of training institutions, although a settlement is in sight for many. By and large we suggest, and hope, that these schisms will prove to have been a temporary diversion from more pressing questions of which 'What kind of mental health services do we want in this country, and what role can psychoanalysis play in them?' is but one.
There has certainly been little opportunity, in the years of the Conference so far, for programmatic thinking about mental health, in either its narrower clinical or wider social aspects. When the realistic political question was not, what can be done to develop community mental health services, but rather, what is the next area of provision which is going to need defending, it was hard to look forwards. But the situation is now changing rapidly, as a change of government comes to seem likely, and as the climate of political thinking begins to shift towards a concern for 'communities', moral obligations, and social ties, and away from individuals, rights, and interests. We may not like some of what appears under the rubrics of 'community', suspecting an implicit conservativism or sexism in some of it, and noting too that it seems much stronger in rhetoric than in policy substance. Still, there can be little doubt that this discourse of inclusion, of the need to nurture and develop human resources, and of social support, is more compatible with the ideas of a socially committed psychoanalysis than the dominant ideology which has preceded it. It therefore seems to provide us with a new space.
Another factor in this opportunity is the apparent exhaustion and degeneration of the ideology of the market. It needs to be recognised that at an earlier stage in the rise of the New Right, it did embody a certain kind of moral and political energy. Its advocates believed, unfortunately with some reason, that they were in certain respects closer to the minds and aspirations of unprivileged people than were the professional managers of the welfare state, or some ideological socialists. Real deficiencies and rigidities in public provision were identified, and a latent authoritarianism (the product no doubt of its moment of emergence in a hierarchical industrial society) was vulnerable to attack. Parts of the public sector were no doubt sometimes inefficient, producer-dominated, and complacent. Sometimes their professional elites had too much confidence that they knew what was best for their clients.
We now know from experience that the alternative to these structures is often the dismantling of any supportive structure'; that 'quality' is demanded when, and indeed because, resources are reduced, as a kind of diversionary tactic to displace blame; that it is not a better, more differentiated, consumer oriented, welfare system that many of the reformers had in mind, but a minimal welfare system, or virtually none at all. We can also see, in the dog days of this system, its corruption, its dishonesty, its ruthless appetite for power at almost any cost. So we are now going to be told that we can achieve a society without class divisions by abolishing inheritance tax! This miserable spectacle at least removes any moral sway that capital's counterrevolution might have claimed. It is making it clear to nearly everyone that there must be a better way of governing a society than this!
There will, and indeed should, be many different views of the role of psychoanalysis at a moment of political change. It will be very useful for the future of the Conference if different perspectives on this can be articulated. A Conference like this thrives on its differences, as well as on its elements of common purpose. Our purpose is not to try to crystallise a single position. For example, some may see opportunities to influence social policies in benign directions, by taking better account of developmental needs through the lifecycle. We might think of this as a 'positive' contribution of applied psychoanalytic ideas. Others, at the opposite end of this spectrum of positivity negativity, may prefer to insist on the role of psychoanalysis as a critical discourse. 'Community', from this point of view, is less a space, than a mystification, an idealisation whose effect is to suppress differences (of gender, sexuality, race, class) and which will inevitably generate new exclusions and convenient projective enmities. These perspectives are not necessarily in conflict, but we should not forget that there will continue to be more than one valid way to think psychoanalytically about the social.
We want to stay at the programmatic end of this spectrum, for the moment. The ideology of individualism has for twenty years or more eclipsed alternative visions and definitions of social life. (Individualism had its left-wing form too, as Raymond Williams pointed out during the l970s, in some collective assertions of sectional interests and rights without much regard for any wider totality). The left's capacity even to imagine or define a different form of life has been eroded and damaged by the experience of the past twenty years. In the absence either of a coherent imaginative vision, or of an embedded alternative social practice (such as the lived institutions of the working class once provided to the socialist movement, as Williams again pointed out), policy formation takes place in a vacuum. In this situation, accommodation to the values of the market, and their presumed reflection in voter preferences, seems like the only political option available.
Psychoanalysis in Britain is one discourse and social practice which has retained its autonomy and distinctness from the prevailing ideology, in a rather remarkable way. Indeed it has continued to develop new dimensions of its view of human life for example the idea of 'space for thinking' elaborated through Bion's work. The strongly ethical emphasis of the work of Melanie Klein and the first generation of Kleinian interpreters (for example Hanna Segal, Isca Wittenberg), has slowly broadened, giving greater weight to ideas of creative discovery (one form of Bion's 'catastrophic change,') and to expressive and cognitive dimensions of experience (the 'aesthetic' in Meltzer's work). It is probably because British psychoanalysis has continued to develop, in its technical understanding, in the range of clinical phenomena it feels able to take on, and in its theories, that it has not been unduly sapped or compromised by the destructive cultural climate around it. This gives psychoanalysis the possibility of having some fertile influence in the broader field of social theory. It brings a number of 'foundational ideas' to the idea of society. These include its 'strong definitions' of social dependency, from birth; its grasp of the role of sentient relationships in virtually every human activity; and the idea that the effective exercise of responsibility requires the containment and toleration of anxiety and mental pain by those temporarily in authority, whether they be parents, managers, or political leaders. These are ideas of 'the social' which are grounded in the self-understanding achieved through psychoanalytic experience, in clinical practice, in observational studies, and in the application of psychoanalytic ideas to many working settings.
It may seem surprising to suggest that a necessary core element of socialist thinking might be derived from so specialised a practice as psychoanalysis or psychoanalytic psychotherapy. But there are a number of reasons why this is not as paradoxical as it seems. The first, and most important, is that psychoanalysis does after all set out systematise and theorise what in a sense everyone already knows, even if they deny this knowledge for reasons of anxiety of one kind or another. The contemporary psychoanalytic study of infancy seeks to understand, and to support and repair where necessary, the normal human functions of parenting. It seeks to recover the idea of the 'good enough parent' (that is to say the normal parent) from the misdirection and denigration of more reductionist psychologies. Something similar can be said about the psychoanalytic understanding of mourning and bereavement at the other end of the lifecycle. Its discoveries and remedies here are related to recognition of the normal experience and vocabulary of suffering, where these might otherwise be denied, by individuals or social groups. Psychoanalysis tries to develop an understanding of the reality of human experience, not to impose arbitrary categorisations on it. The most lucid philosophical defence of psychoanalytic ideas in Britain, made by Richard Wollheim and some of his colleagues, takes its stand on the affinities between complex ordinary language descriptions of mental states, and the conceptualisations of psychoanalysis, in contrast to the more impoverished vocabularies of scientific psychology.
Evidence for the contemporary relevance of psychoanalytic thinking to the whole range of everyday welfare practices is not hard to find. Given the opportunity, students on social work courses will opt in large numbers to examine their ordinary practice experiences in these terms, just because psychoanalytic theory makes sense of large dimensions of this experience in ways other psychological or psychosocial models do not. The development of a cluster of psychoanalytic studies courses within higher education is a significant achievement, and readers of Free Associations may recall Martin Stanton's paper reflecting on the resistance encountered to the first of these initiatives. The growth in numbers of peripatetic consultants in the social welfare field has led in recent years to a much broader dissemination of psychoanalytic thinking in non-clinical settings. Workers in these agencies are often untrained and theoretically unsophisticated, but thrive on sensitively attuned consultation with respect to the complex and disturbing dynamics which they encounter daily. The therapeutic community movement itself has effectively broadened to include a wide range of derivative community mental health initiatives. Many of these developments remain comparatively unrecognised and await proper conceptualisation, although they have been the subject of a number of lively Conference presentations. There are subtle and important questions about what differentiates psychoanalysis in 'clinical' and 'non-clinical' contexts, and which sometimes lead to divisions among us when more discriminating conceptual frameworks might allow for assimilation of recognised differences within a common project.
We need secondly to remember that other contributions to a 'socialist', or perhaps we should merely say at this point 'social' vision, have equally been rooted in specific callings and spheres of life. William Morris's idea of good lives as full of expressiveness, craftsmanship, and a sense of beauty, derived from his work and life as an artist and designer, and his membership of a particular tradition of this work in late nineteenth century England. The tradition which Raymond Williams reinterpreted as ultimately a socialist one, in his Culture and Society, was a tradition of writing, of the critique of industrialism and capitalism expressed in the individual voices of imaginative writers, poets and essayists. Neither of these ways of reimagining the social came directly out of the common life (wherever that may be found), but were the world-view of a specific vocation. Even the democratic political institutions which Williams (and E.P. Thompson) credited to the working class movement were in practice the creation of minorities within the working class, devising new forms of activity which were shown to correspond with wider aspirations and needs. Although it seems a new idea that politics is constructed out of experiences of difference, it is likely that this has always been the pattern. The suppression of difference through various homogenising definitions of nation, mass or class has been an ideological imposition on a process of cultural formation that was perhaps always of its nature pluralist and polycentric. What psychoanalysis can distinctively bring to political discourse at this point is its vocabulary of feeling, both conscious and unconscious. This is a dimension of life little theorised or considered in socialist discourse. There are various possible explanations of this deficit, in the past. One is the apparently self-indulgent and individualist quality of dwelling on private states of mind, in contrast with the imperatives of solidarity and collective action. A second is the rationalist bias of the Hegelian tradition, and then the economistic focus of much of the Marxist. Neither have had much time for mere emotions. Another is the largely male-dominated culture of the labour movement, given that emotions are in patriarchal societies held to be more women's than men's business. But a more differentiated and individualised social order enlarges these 'private spaces,' and gives individuals both greater opportunity and necessity to reflect upon the self and its needs and difficulties. The opening up of the 'gendered order', with greater space for sexual self-expression, and with real challenges to male authority in many spheres, also removes various traditional certitudes. As Anthony Giddens has pointed out, many different theories and practices of self-understanding seek to colonise this new cultural space, as resources for managing the tasks of reflexivity. But of these, psychoanalysis is the deepest and most rigorous. Psychoanalysis is, however, not simply an all-purpose vocabulary of feelings. It has always been focused in its investigations and interventions on mental suffering and pain. Even though it has largely escaped in its practice from the diagnostic labelling which dominate the medical model of psychiatry, it is nevertheless a clinical discipline, centrally concerned with problems of mental health. The 'deficit' or negative state that it attends to is in the domain of mental pain. It is little different from the other 'emancipatory discourses' referred to above in identifying a particular sphere of human suffering or deprivation (these are elsewhere material, or expressive, or of liberty or self-determination) as its primary sphere of concern, for possible understanding and remedy.
Such discourses first discover or define the phenomena of which they treat. Or, more often, they redefine a phenomenon in new terms. A deficit, for example of literacy, assumed at one time to be natural and inevitable, even biologically given, for large sections of the population, became reinterpreted as cultural deprivation. So with the language of psychoanalysis. Phenomena of madness were once deemed to be beyond rational understanding. They generated extreme persecutory fears, which were then lodged punitively in the mad themselves, as inmates of bedlams or as persons possessed by the devil. Freud sought to extend the scope of understanding to include madness, arguing that all human minds contained rational and nonrational elements, that the boundaries between these were fragile and fluctuating. Madness was redefined and elaborated, became less violently defined as mental illness, and was subdivided into relatively normal neurotic elements and the more severe disturbed psychotic disorders. Later writers in the psychoanalytic tradition, as we all know, extended these frontiers of understanding in many ways, including moves towards the understanding the most severe mental pathologies.
The recognition of the normality of psychic pain and suffering seems to be one of the principal emancipatory contributions of psychoanalysis. This involves the extension of human recognition and sympathy for states of being which are generally found unbearable. Bearers of these states of being are in these circumstances of incomprehension and denial banished, or medicated, or treated with cruelty, or incarcerated. States of mind having much in common with those of the mentally ill, except that they find some perverse containment in conventional life, are simply not recognised as such. The willingness of political systems to blandly risk the destruction of half of mankind for the sake of transient political ideologies is an example of this capacity for psychic denial which psychoanalysts such as Hanna Segal tried to draw public attention to. The social mission of psychoanalysis is the recognition of the ubiquity and normality of psychic pain, and of defences against it. The vulnerability of human lives, at its inevitable moments of stress and change, to encounters with the pressures of 'the irrational', is what the psychoanalytic tradition compassionately insists on. Supporting individuals and groups at these moments of vulnerability (which occur for example in the course of parenting infants, at adolescence, in war, when facing job loss, in illness or bereavement), and seeking to alleviate the psychic consequences of such experiences, is what psychoanalytic practice does, in clinical and applied settings. What this tradition can also do is to support and inform practitioners who are not psychotherapists, in the various settings in which stress is managed, or in which it arises as a natural consequence of normal tasks (learning, or medical treatment, for example).
Understood like this, Freud's original formulation of the project of psychoanalysis as the transformation of 'neurotic misery' into 'common unhappiness' might be recast in terms of the recognition and social assimilation of the 'ordinariness of misery'. As the politics of difference has become established in our culture, psychoanalysis has been posed with a familiar theoretical problem how to offer itself as a universally-applicable framework of understanding without collapsing into reductionist and totalising modes of explanation which deny difference and specificity. One potentially fruitful development is renewed theoretical interest in 'the work of unconscious experience' (Christopher Bollas) as a fundamental datum, the operations of which are differentially elaborated in the social world to produce distinctive 'idioms'. There are links here to the work of MatteBlanco, never very enthusiatically adopted in Britain, in which the operations of unconscious logic are understood to inform creativity as much as destructiveness. No longer 'where id was there ego shall be' but rather the dynamic interplay of both in the production of the best and worst aspects of individual and social existence.
Clearly a society which sought to minimise unnecessary mental pain, and which had institutions and practices where this was understood and worked with, would be a better one than a society where such conditions are largely out of all control for whole sections of the population. To this extent, a psychoanalytic way of thinking generates a prospective programme for, or way of thinking about, the public sphere. This is not a particularly sentimental or optimistic social vision, it must be noted. The idea of a compassionate relation to ubiquitous suffering does not imply that sympathy will solve all problems, or that sufferers may not themselves sometimes be perpetrators of severe damage to others. The English judges' recent insistence on some respect for the well-being of prisoners, against the opportunistic vengefulness of the Home Secretary, was a model of the possibility of combining compassion and respect with an undoubted realism, as has been Judge Tumim's attempts to improve the prison system. Psychoanalysis is committed to a certain kind of psychic realism, but holds that improvements in individual lives and society can be made possible by that.
It may now be possible to put forward programmes which address these issues, with some hope of obtaining a political hearing for them. Insecurity, the breakdown of social ties, and social exclusion, are becoming recognised again as problems, rather than being rendered invisible or seen as the necessary costs of competition and market incentives. Yet there are few articulate ideas or practices which are available to support this shift of mood. Mere moralising about obligations and a spirit of membership will not take anyone very far.
The psychoanalytic tradition could now play a significant part in thinking about the renewal of social membership and relationship. Its new focus on thinking space has implications for organisational forms and for the exercise of leadership roles. It has something to offer to the understanding of the idea of 'risk', held by some (e.g. Ulrich Beck, Anthony Giddens) to be a central feature of 'modern' social orders, through the more specific idea of 'psychic risk.' Its commitment to the idea of individual autonomy and development, although always within structures of both internal and external 'object relations', enables this tradition to relate in dynamic ways to a society of differences. It is not a solution to contemporary social problems to impose a general return to traditional familial, class, or even national or ethnic identities. Conceptual and practical resources are needed which will support individuals in negotiating situations of change and conflict. The 'cost-effective' aspect of psychoanalytic interventions, both clinical and applied, is that they can help individuals to survive or avoid specific life crises, and support their own autonomy.
Psychoanalytic thinking had a significant, if minor, part in the development of the postwar welfare state, at an earlier moment of reconstruction and reparation. So in its more complex contemporary form it should earn itself a role in the debates which should now begin on the limits of individualism, on the need for institutions other than, or complementary to markets, and on a definition of social goals that goes beyond material consumption.
Michael Rustin is Professor of Sociology, University of East London and Visiting Professor at the Tavistock Clinic.
Andrew Cooper is Professor of Social Work at the Tavistock Clinic.
Both have been involved with the annual conferences on Psychoanalysis and the Public Sphere for many years and both are members of the editorial board of Free Associations.
© The Authors
Address for correspondence:
Tavistock Clinic 120 Belsize Lane, London MW3
email: rustin@uel.ac.uk