2013 This house believes that neuroscientific findings have limited significance for the meaning-making task of clinical practice.

 

For the motion: Ariane Bazan & Andrea  Clarici

Against the motion: Mark Solms & Yoram Yovell

Let me point right away that the motion is cleverly put, because it says “clinical practice” – and not “psychoanalytic clinical practice”. So, let me clarify: sure, neuroscientific findings can be of paramount importance to the clinical practice, and even in the meaning-making task, and if they can be, importantly, they should be. Say you know as a clinician that your patient has a neurological condition which, for example, has generally speaking as a consequence that there are difficulties to distinguish dreaming from waking life. Then it may be very important that this information is taken into account and e.g. given to the patient and this might have an important therapeutic effect. My point will be the following: working with this information, which can contribute to the clinical meaning making, is not in any way psychoanalytic. As soon as neuroscientific findings are brought in the analytic work by the analyst, the clinical practice at that very moment stops in being properly psychoanalytic. It may be very important, it may be very helpful, but it is, by definition, not psychoanalysis.

So I will reformulate the position I am defending: bringing in neuroscientific findings
(1) is not psychoanalysis
(2) hampers psychoanalytic clinical work

(1) It is not psychoanalysis.

· Why? Well, very simply put: because psychoanalysis as a clinical approach radically differs from all other clinical approaches since Freud realized this paramount epistemological shift: not the analyst knows the truth about the patient’s suffering, but the patient himself – it is not the analyst to know – and a fortiori, to tell the patient – what is happening to him, it is the patient to tell the analyst. The epistemological shift from the clinician who will tell the truth of the patient to the patient to the position where it is the patient who is expected to tell the truth about his suffering, is the condition for there to be psychoanalysis.

· Is the psychoanalyst then without any knowledge whatsoever? No, it is not that the analyst is supposed to have no reference points to orient his listening and thinking, and also in response to his patient, his Deutung. In German and in Dutch there is a difference between “deutung”, which would be something like “pointing out” without introducing new content elements and interpretation, which, when it implies bringing in new content elements, should be done in a very sober way. The analyst has general metapsychological knowledge and has the thorough experience of his own analysis.

· But in particular, introducing content elements which are statistical in nature, is incompatible with the ethical stance of psychoanalysis. Statistical here stands in opposition to dynamical and refers to logics such as: it is known that for people with your kind of lesion, your kind of condition etc., this kind of symptoms is to be expected. So, this not only pertains to neuroscientific elements but also to any kind of statistical element, e.g. general knowledge about depression, borderline, autism, etc. Why is the analytic stance incompatible with statistical knowledge?

− First, there is no determining relationship between any kind of statistical element and the singular subjectivity of experience. In the case of neurological conditions: First, no two patients have exactly the same neurological lesion or condition, and say you find ten patients with exactly the same neurological lesion or condition, then you will probably find quite different phenomenologies and certainly hear ten different ways of apprehending this phenomenology. The psychoanalyst should never side with biological or social logics (you are like that because of your body or because of society – which are statistical type of elements).

− Second, (2) it hampers psychoanalytical clinical work.

It is not that psychoanalytic work should imply both the analytic part where the singular story of the patient is heard next to the more informative part about elements of a general or statistical nature. What I am saying is that psychoanalysis is radically incompatible with this kind of information. Any kind of statistical element would hamper the analytic work. There might be different clinicians with different roles in the care for one patient. The unique role of the psychoanalyst in that care is to fundamentally and sincerely, with conviction, question and deconstruct any idea of determinism of a condition upon the experience or behaviour of the patient. His unique role by doing so is to introduce a margin of indeterminacy. It is in that margin of indeterminacy that the subject can take upon himself an active role as to what happens to him. The psychoanalyst should have as an ethical stance that the subject can play an active role as to what happens to him independently of his body or his social conditions. After all, it is true we have no certainty of any kind of determining relationship. For even if the lesion generally causes a particular kind of symptom how can we be so sure this is the case in this very patient – even when the patient is reporting the very symptoms belonging to the very lesion? How are we even entitled to be so sure that there is a hierarchy, that the way the patient assumes or tells his condition can only be of a less etiological or causal importance than the way the body is affected? How can we be so sure of that, when we see the radical non-linearity between bodily deficits at the one hand and behavioural symptoms or subjective experience at the other? And if we have no certainty, and specifically in our role as psychoanalysts, how can we then allow ourselves anything less then to radically leave out any of this type of information in our work? Indeed, the patient will be enabled to assume an active role in what is happening to him only when he is called upon this possibility of playing this active role.

So, in order for the patient to play an active role in what is happening to him, in order for the story of the patient to participate in its own right to the clinical approach, there should be, among the clinical offers to the patient, one window in time and space where the symptoms of the patients are radically not endowed with any pre-given meaning in lieu of the patient himself and that window in time and space is what to me is psychoanalysis, and only that is truly psychoanalysis .

PRE-VOTE: For the motion: 22, Against the motion: 125, Undecided: 13

POST-VOTE: For the motion: 35, Against the motion: 104, Undecided: 12

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