At the Occasion of On Being Normal and Other Disorders

JLS interviews Paul Verhaeghe

JLS: How did you become interested in psychoanalysis? Who were the people you met or read that inspired you?

PV: When I was a student in Belgium, during the 1970s, clinical psychology had only just got off the ground. During our training we mainly studied Rogers and Gestalt therapy, yet slowly but surely we were also introduced to little bits of Freud, because one of the psychology professors at the time had begun his own training analysis. The climate was very “psy” -orientated, and this of course included the contemporary anti-movements (predominantly anti-psychiatry), although they were more visible outside the lecture theatres than inside. Anyway, as a result we hardly attended lectures and we began to read Freud in small groups. This simply led to a revelation: The Interpretation of Dreams, The Psychopathology of Everyday Life, The Three Essays on the Theory of Sexuality became as it were bedside reading. This was also the time of “psychological films”: Bergman, Tarkovsky, Loach,... To all of these we could apply our psychoanalytic knowledge. Via two Assistant Professors we then learnt that there was someone in Paris who was in the process of reinventing Freud’s oeuvre, a man named Lacan, and so we thought we should try to read him as well. Since his works were not available in Ghent, we drove to Lille to buy the Ecrits, Télévision and the available seminars in Le Furet du Nord.
The situation was really quite unique, for we had a double advantage. Because we were from Belgium we could read French reasonably well and moreover the myth of the unreadable Lacan did not exist at the time. Secondary literature hardly existed. We began to read, didn’t understand much of it, and started to read again, this time in a group and with Freud’s technical papers in hand, because Lacan referred a lot to these papers in his first seminar. The result was that we began to discover a completely new Freud, but also that, from this reading of Freud, we began to make sense of Lacan. By the way, this is still a very positive aspect here in Flanders: Lacan is read on the basis of the Freudian text and vice versa. For me it is impossible to consider the two as separate. I remember well that during that period we also began to study linguistics, in particular Saussure and Benveniste, and I subsequently based my Masters thesis on the linguistics/psychoanalysis combination. After my studies I did a postgraduate course in psychoanalytic psychotherapy, in which many Lacanian analysts from Brussels and Paris were invited to speak. I remember in particular Serge André, who died recently. He was an extraordinary teacher and clinician. He was without a shadow of a doubt the person from whom I learned the most about Lacan, and not just me I can tell you. I do have to mention one negative aspect though: mainly as a result of the emphasis on Freud and Lacan, other figures such as Klein and Bion remained too much in the background for me for too long.

JLS: What is the state of psychoanalysis in Belgium at the moment and what are the challenges to psychoanalysis in your national context?

PV: In the French speaking part of the country psychoanalysis is without a doubt still dominant, and especially Lacanian psychoanalysis. In the Dutch speaking part the situation is completely different. Psychoanalysis as a signifier never penetrated the general discourse here. To give but one example, when Woody Allen refers to “my analyst” in his films, the subtitles always read in translation “my doctor”. On the other hand, I should also say that for over ten years the Faculty of Psychology of the University of Ghent and the Faculty of Philosophy of the University of Leuven have provided a training in psychoanalysis. This has repercussions for the clinical field: many clinical psychologists and psychotherapists who work in state subsidized therapeutic institutions work within a psychoanalytic framework, alongside colleagues whose orientations are behavioural or cognitive. It is also remarkable that every kind of treatment is nearly always referred to with the general term of “psychotherapy”. And then there is an increasing number of psychoanalysts who set themselves up in private practice, and who call themselves “psychoanalyst”. Mind you, the fee cannot be paid by the health insurance system, which means that psychoanalysis is only really accessible for the few who can afford it. Recently, attempts have been made to allow patients to claim fees back for private psychotherapy, via new legislation concerning health insurance. Unfortunately this has failed and quite paradoxically this is partly because analysts from the French speaking part massively resisted this idea. They did not want to be categorized as psychotherapists because that term has a strong negative connotation in their discourse. This is not the case in Flanders.
The main challenge I envisage does not only apply to Belgium. The demand for the increase of cost-effective measures requires shorter and more evidence based treatments. The psychoanalytic approach is at odds with this idea. It is an illusion to think that with the DSM in hand one can “solve” a depression or an anxiety disorder within twelve sessions. If this trend continues, however, the consequence will be that psychoanalysis will only be available to a small financial elite. From the perspective of the ethics of psychoanalysis we, and certainly those that work in the university, have to expose as much as possible the illusion of the brief regimental approach. Otherwise there is a real chance that in the not too distant future treatments will be reduced to prescribed pharmacological interventions in combination with ten sessions of additional psychotherapy.

JLS: You are Professor and Chair of the Department of Psychoanalysis and Clinical Consulting at the University of Ghent. You have been working in the university for a long time and consequently you have built up a lot of experience teaching and researching psychoanalysis within a university framework. Based on this experience, what are the difficulties you encounter teaching Freud and Lacan at the different levels within academia?

PV: Here at the University of Ghent we are in a privileged position. In Belgium the study of psychology takes five years and I teach at all levels except the first year. As a result of this I find myself in the lucky position to be able to create, with the other members of my department, an interesting environment in which students can complete their studies with a rather solid, albeit mainly theoretical, knowledge of Freud and Lacan. The main difficulty is that our students have hardly any clinical experience; they have to do a mandatory six months clinical work placement in the last year, but by then their theoretical studies are nearly finished. Moreover, our students are usually very young, which of course implies that most of them have less life experience to rely on. Frequently I meet ex-students, say fifteen years later, and they always tell me: “yes, only now I know what you were talking about then…”. “Deferred action” also applies to education. Apart from the regular undergraduate curriculum we also have a postgraduate course in psychoanalytic psychotherapy. Registration for this course is limited to a certain number of students, by contrast with the undergraduate curriculum, which everyone with a secondary school diploma can enter. The psychoanalytic psychotherapy students are a bit older and already have some clinical experience, which means that the teaching can be done quite differently. In this course we work around clinical themes and we invite guest speakers so that we can broaden the education of these students.
To teach psychoanalysis is by no means self-evident, precisely because psychoanalysis demonstrates the limits of conscious knowledge. To find oneself as an analyst in the position of a teacher is therefore a strange experience indeed. In fact, I have written a text in which I processed my own experience in this area. A psychoanalytic practice is the exact opposite from the practice of teaching, which is illustrated very well with Lacan’s discourse theory (the discourse of the analyst is the opposite of the master discourse). I still hear too often that these two discourses are being confused with one another, namely that analysts give explanations to their patients during clinical practice, that is to say they “teach them”. In this sense they work, without realizing it, in the same way as cognitivists. One time, during a psychoanalytic congress in the Netherlands, an analyst asked me “how I was able to explain all these difficult Lacanian concepts to my analysands”. I responded by saying that I do not explain these concepts to my analysands at all, but that, to the contrary, my analysands explain these concepts to me. The man could not understand what I was saying, and I fear that he is a typical example of a particular way of conducting analysis, also within the Lacanian field, where an analytical treatment is sometimes confused with education and indeed even with indoctrination.

JLS: There appears to be an increasing prioritizing of the empirical method in most psychology departments and faculties. Considering your department is part of a psychology faculty, do you think the relationship between the empirical method and psychoanalysis could develop in a way that is fruitful to both, and if so, how do you think this development will or should take shape?

PV: The current state of affairs is very strange indeed. Psychoanalysis is attacked from all sides for “not being empirical”. This is madness, because it is very much a theory which begins and ends with clinical practice and hence it is possible to say that psychoanalysis grew out of the empirical environment. If one looks at Freud’s trajectory one realizes that he continuously adapted his method – and theory – in function of his clinical experiences. In so far as it is possible to say that therapy took place in the pre-freudian period, it was never more than a very rudimentary form of behavioural therapy, namely punishment and reward. This is clear when one reads historical studies on the treatment of hysteria. Freud was the first to experiment with a real psychological treatment, with an emphasis on bringing material into consciousness and on insight. Fairly immediately he observed two things: firstly, that communicating insights to the patient leads to massive resistance, and secondly, that the most important therapeutic factor was the transference relationship.
What’s been happening over the past fifty years? The original black and white behaviourism has had to restrain itself. Its principles may have had a scientific foundation, but in terms of therapeutic effects it was less successful. That is why today all emphasis is on cognitive-behaviourism, which comes down to the diagnosis of “faulty cognitions” in the patient, and the subsequent correction. In other words, therapeutically or clinically these people are doing what Freud initially did. In a little while they will discover that when the therapist takes up a position like that, he or she will mainly provoke resistance in the patient, and they will then discover that this has something to do with the relationship between the patient and the therapist, namely with the transference. By the way, all recent evaluation studies dealing with the effectiveness of therapy appear to indicate two main factors: the therapeutic relationship, and the degree to which the patient can actively participate in the treatment. Freud already argued that these were the two most important elements.
Thus, for me, psychoanalysis is very empirical; concepts such as resistance, transference, division of the subject, repetition, the Oedipus Complex are easily verifiable in every clinical practice. It strikes me every time, also in Lacan, how our theory is totally penetrated by the clinic. Of course, the problem today is that the conception of what is “empirical” has changed somewhat. When I read current so-called empirically-based applications of psychotherapy, I wonder whether these people actually ever worked with real patients, whether they ever treated a subject suffering from anxiety hysteria, or indeed whether they have experience working with a schizophrenic patient over a long period. A while back I was at a meeting that was held in preparation for a study day on the effectiveness of psychotherapy. All the various forms of psychotherapy were represented and all members (except myself) were vastly experienced psychiatrists. One of the first theses proposed concerned the gap between therapeutic practice and its scientific background. This was put very sharply in the following way: were we to do psychotherapy as it is prescribed in the textbooks and as it is scientifically grounded we would fail completely in our effort to work with patients. This thesis was proposed by eminent representatives of various scientifically grounded therapeutic schools, whereby they also asked themselves the question whether their own researchers had experience of any long-term clinical work. The emperor is still walking around naked, but it is only rarely that someone has the courage to say it aloud. The combination of neo-positivistic empirical requirements on the one hand and clinical work on the other is impossible. No single clinical theory and practice can fulfill the requirements set by neo-positivism, for a very simple reason, namely that clinical practice is far too complex to be able to fulfill these requirements. When empirical research is conducted next to clinical work and it focuses on a limited number of factors it becomes a possibility. I am convinced that psychoanalysis in the university has to take up this challenge and that it should participate in this kind of research. An example: Lacan’s mirror-stage is not just confirmed by recent research in developmental psychology, it is even refined by that research, albeit without any reference to Lacan. Why wouldn’t analysts do this research themselves, especially those who work within an academic context? The time of pure scholarly work, in which all one did was studying texts, is long gone. I am convinced that a combination of Anglo-Saxon empiricism and continental contemplative idealism is perfectly imaginable and that it can work. Recently, I myself and some assistants, finished a project on “burn-out”, the results of which were published, amongst others, in “Human Relations”. To research “burn-out” empirically from a Freudo-lacanian perspective, and indeed to have the results published in such a way that they are accessible for a general academic public, must seem an impossible thing to do. But we have done it, and without making any concessions concerning our concepts. We have just started two new, large-scale empirical research projects, one concerning trauma and one concerning depression. Another research project on addiction is still running, and two others are also in the pipeline, one concerning outcome and another concerning chronic fatigue syndrome and somatisation. I am convinced that in those projects too we will benefit fully from our theory as well as produce clinically relevant results.

for the rest of the interview please see JLS Vol 1, No.2