Is there a difference between psychology and psychoanalysis?

Institutionally, psychologists graduate from university graduate schools of psychology rather than medical schools and receive a Ph.D. rather than a M.D. After graduate school a psychologist can choose to get a supplementary degree in psychoanalysis, which if pursued rigorously conflicts with his/her university degree, for contrary to popular belief, psychoanalysis is not psychological. The reasons for the assimilation of psychoanalysis to psychology are as instructive as they are complex, and go a long way in revealing what it is in psychoanalysis that is currently being avoided. They explain why modern psychology textbooks represent psychoanalysis in a chapter of 'ab-normal psychology', as this is one means, among others, to trivialize problems of desire and the unconscious to that which deviates from the norm.

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What is the difference between psychoanalysis and psychiatry?

Contrary to what many believe, Freud is not the father of modern psychiatry. Indeed, one can find him making statements that imply the opposite: "Psychoanalysis is not against psychiatry, but psychiatrists" . Without claiming to resolve the confusions in this format, it will be enough if we simply clarify the problem.

Psychiatry, born in the asylums of the 19th century, is a late cousin of psychology (the former is to body as the latter is to the soul). Its aim is to construct a normative view of madness around a scientific plan for society. Although its modalities have been many (biological psychiatry, neuropsychiatry, organic psychiatry, behavioral neurology, etc.) they all can be grounded on three main characteristics: (1) mental disorders are brain disorders (2) causes cannot be symbolic or effected by language and speech (3) psychiatry is based on scientific evidence.

Psychoanalysis emerges in the 19th century when Freud puts all three criteria into question by introducing a 'talking cure' that begins to speak to forms of psychic suffering that had formerly been reduced to silence and classified by psychiatrists as organic illness. Today, most post-Freudian psychoanalysts, especially Lacanian, would continue in this direction in spite of the recent return towards physical and biological explications.

In the United States psychoanalysis is most often assimilated to a possible therapy for neurosis; it is not usually extended to the treatment of more serious mental illnesses such as psychosis and schizophrenia, which are thought to be the sole province of the psychiatrists.  

This much said, modern psychoanalysis has found certain inroads into such resistant cases through two antithetical approaches: one, following the schools of American Ego-psychology and British Object Relations, has sought to reinterpret and extend psychoanalysis into the medical clinic (or asylum) and the psychiatric classifications; the other, following the work of R.D. Laing, David Cooper, etc., have sought to establish an anti-psychiatry basing the reality of mental illness on social and cultural factors, thus, either dismissing Freud altogether, or largely reading him as a cultural theorist.

Counter the pros and cons of the existentialist Anglo-American schools, Jacques Lacan's structural 'return to Freud' had the effect of deconstructing psychoanalysis in a way that neither assimilated its theory and practice to psychiatry nor rejected it in the name of anti-psychiatry. Instead, contemporary Lacanian analysis achieved the work of Freud in a different way: in a purely psychoanalytic theory that constructs its practice and clinic in spite of the current sociological assimilations and rejections. (see Clinic) Although Lacanian psychoanalysis has had a grand influence on the psychiatric and anti-psychiatric milieu in France, it has just begun to make inroads into the United States.

Today, psychiatrists in the U.S. graduate from medical schools and are fully qualified physicians. Many psychiatrists have no training in psychoanalysis or psychotherapy and do not aim to interrogate the symptom as something to be listened to or constructed (as in psychoanalysis), but only as something to be suppressed. As physicians, psychiatrists have the right to prescribe drugs, electroshock therapy, or treat people against their will. In recent years some groups have sought to make psychotropes (drugs for the treatment of mental symptoms) more available to the public by allowing psychologists as well as medical doctors to prescribe them. Currently, however, the law only allows a psychiatrist, or indeed, a general practitioner, to administer them.

So why would Freud claim to go against psychiatrists, but not psychiatry ?  One may well find reason to state that Freud was not against psychiatry, just as he was not against any field of investigative research, but was calling attention to the ill effects psychiatry can produce on society, especially in the generalization of its theories to the whole of humanity and the investment in a society of psy-experts.

The authors and literature treating the derivations of Psychiatry and Society are not only numerous (see Michel Foucault's Histoire de la Folie; abridged English trans. History of Madness; Marcel Gauchet and Gladys Swain's Madness and Democracy: The Modern Psychiatric Universe), but have been responsible, mostly in the non-English speaking countries, for sweeping changes in government mental health programs, such as the closure of mental institutions in Italy and the creation of alternative mental spaces in France (la Borde).

For examples of the total disregard of the differences between psychoanalysis and psychiatry witness most of the journalistic writing coming out of the L.A. Times.

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What is the difference between psychoanalysis and psychotherapy?

Because the crucial distinction between psychoanalysis and psychotherapy is more difficult to explain than its differences with psychology or psychiatry, it is all the more necessary to take the time to disentangle the threads.

1) Psychotherapy includes a very broad spectrum of people who, in one way or another, not necessarily psychoanalytically, talk to people about their problems. At the minimum, this 'talk-therapy' reduces to counseling or a type of care that can be provided by a social worker or a qualified nurse; at the maximum, it becomes a type of psychoanalytic therapy – Psychodynamic Psychotherapy, Kleinian, Neo-Lacanian, etc. – once the care relation between the doctor and patient is formulated in terms of a subjective transfer — a relation imitating the passion of love — and practiced as a 'talking-cure'.  

Contrary to the fashionable accounts, Freud is not the founder of psychotherapy or psychodynamic psychotherapy: on the contary, one often finds Freud not only admonishing the various 'off-shoots' of psychodynamic psychotherapy as only a partial picture, but he shows quite clearly how psychotherapy systematically results in an 'interminable analysis' or a 'negative therapeutic reaction'.

In a more modern presentation by J. Laplanche and J.B. Pontalis, the authors have defined psychotherapy "under the name of  'psychoanalytic therapy', as a form of psychotherapy that is applied to the theoretical principles and techniques of psychoanalysis, without realizing the conditions of a rigorous psychoanalytic cure" (Vocabularie de la Psychanalyse; PUF, 1967 p.359).  After reading the responses to the questions on this site, it is hoped that the reader will have found sufficient material to allow him or her to begin to make the distinction. The more experienced reader will perhaps foregive us in such a forum, if we only state the essentials without a detailled argument.  In regards to the field of Lacanian analysis, it must be asked further: Do the current Neo-Lacanian best-sellers ever truly achieve an introduction to Lacanian practice in the theory of psychoanalysis or do they repeat a therapeutic caricature of Lacan as captured by the psychotherapist Granoff some occurred 51 years ago ? (see:J. Lacan, W. Granoff, Perversion. Psychodynamics and Therapy; Random House, 1956.)..

The position of P.L.A.C.E. is, in taking seriously not only the historical, but theoretical development, that psychoanalysis has never been a branch of psychodynamic therapy or psychotherapy.  No doubt, if the reasons for this difference were merely a question of doctrines, preferences, and schools, then there would be no need to make it.  If on the contrary, this separation is fundamental to a practice and theory of psychoanalysis, then it should be stated simply. What follows only sketches an outline of why this is so.  In an another article on this web site (http://topoi.net/place6/thequestionbrief.html) entitled: The Topological Turn – Constructing the Intension of Psychoanalysis in Extension,  we have begun to show how the common distinction between psychotherapy and psychoanalysis can be reformulated more precisely in terms of analysis in intension and analysis in extension. For what concerns us in this initial probe, we will begin with Freud and the habitual distinctions made in medicine.

Firstly, a distinction between psychotherapy and psychoanalysis proper can be drawn by bringing out the significations of the word 'therapy' in the common medical acceptation of the term: if prognosis reads those symptoms that preceed the onset of illness, and diagnosis reads those which are concurrent to the illness, therapy reads those symptoms that follow the disease. At this common level, psychoanalytic psychotherapy becomes a medical branch of therapeutics and the transference is seen as a way of helping the patient speak about and resolve emotional problems that were supposedly caused by previous experiences (real or imagined).  Needless to say, it is this coming 'after the fact' and treatment of mental disorders that distinguishes psychotherapy from psychoanalysis proper, as the former is left with merely managing a symptom and not addressing mental causality in its present and structural dimensions. 

Digression - The reader should be aware that in the U.S – and elsewhere – the confounding of psychoanalysis with psychodynamic therapy is the rule, not the exception. For instance, you will often find it wrongly stated that "psychoanalysis is a branch of psychotherapy". One of the reasons we have included this common questions section on our site is to re-introduce terms that have been understood too quickly and too well by the average medias. For instance, a good example of such misunderstanding can still be found in U.S. news papers and academic journals; witness the recent article in the New York Times (Feb. 14, 2006) by Alix Spiegal: http://www.nytimes.com/2006/02/14/health/psychology/14psyc.html which confounds psychoanalysis with psychodynamic therapy. To be fair to the author though, each new claim of progress - whether cognitive, neuro-suggestive, behavioural. etc. - is in the embarassing situation of committing a 'straw-man' argument by either trying to refute or revamp something psychoanalysis is not – psychodynamic therapy.

Secondly, many contemporary therapies, liberal theologies, and self-help books make the transfer a 'loving relationship' on which to base the success of their practice: "Love reaches to the heart of the spiritual relation to the other and makes healing possible"; "You have to love yourself before you can love others," etc. Nevertheless, such empathetic programs reveal an investment in the other that is a lot closer to religious charity — "Love thy neighbor as one loves thyself" — and philosophical therapies of desire (stoicism, epicureanism, skepticism, etc.) than psychoanalysis proper. Whether modern or ancient, it is precisely at this place that psychoanalysis must be carefully distinguished from charity work and an empathetic (religious) or apathetic (stoicism) therapy for desire. It is therefore all the more necessary to know not only what is psychoanalytically involved in not confusing a passion — love and hate — with emotions, but to distinguish the work of the analytic session from the dramatic problem of narrating the problems of the self and others.

A properly psychoanalytic conception of the transference begins when it is no longer simply encountered in practice as an emotion, or used as a healing relation to the other, but is constructed in a theory of passions. Yet from the beginning, the transfer in the theory of psychoanalysis could not take its 'talking-cure' for granted, as it has always had to ask why it is so difficult to speak of and in love in the first place. What is that ignorance which speaks of love most faithfully, not merely in expressing one's emotions, but in the comedy and tragedy of mis-recognizing the consequences of one's speech and acts? Freudian psychoanalysis originally defined the transfer not as an emotion, but as a pathetic ambivalence (as the reversal of love and hate) resisting, and not aiding the psychoanalytic cure:

"...it remains a mystery why in analysis the transference provides the strongest resistance to the cure, whereas in other forms of treatment we recognize it as the vehicle of the healing process, the necessary condition for its success" (Freud, Dynamics of the Transference, 1912).

2) By establishing a theory of the transfer, Freud founded its objective conception in a way that went beyond a subjective, emotive, and therapeutic use of love. As such, psychoanalysis began to propose not to therapize desire by using love as a remedy (as an AIDS support group might), whether it be through a dramatic rehearsal with a therapist or in the use of mountain retreats, but to disclose a passionate object relation which had previously been undecipherable, or at least, found resistant to the transfers of everyday life (those relations of fidelity presupposed of the subject in the communications of the group — the family, the workplace, society, etc.). This does not mean to say that today psychoanalysis invites one to construct this object as a fetish or by becoming more creative — it neither proposes its cure as a form of perversion nor artistic sublimation. On the contrary, it seeks to open up a place for the construction of an object whose reality goes systematically unrecognized in those dominant transfers whose traditional aim is to establish a relation of fidelity to others: art, politics, science, religion, sports, etc.. If the mistakes of psychotherapy have taught the psychoanalyst anything about the cure and transfer, it is about the necessity of constructing the object of passion as a psychic reality, beyond any form of pragmatism or utility, and yet not merely as dramatic forms of literature and art. It is on this condition, in the de-dramatization of the transfer and the construction of its object, that psychoanalysis initiates a progress in the well-being of the subject. (although it is well known that an intuitive recognition of this object lies at the heart of many films and narrative - see Alfred Hitchkock's MacGuffin Theory  - many Freudian and neo-Lacanian commentaries have been content to leave their practice at the level of such intuitions/ see: Is analysis an Art of Interpretation?).

3) In order to explain the analytic symptom and its practice one should begin with Freud:

"The theory of repression is the cornerstone on which the whole structure of psychoanalysis exists" (Freud, Standard Edition, XIV, p.16).

Most psychotherapists view the cure as a way of getting rid of a symptom which has been caused by a repression. Get rid of the repression, it is commonly held, and the symptom falls away, thereby allowing the person to experience their emotions and life in a more satisfactory manner. Once this is assumed psychoanalytic therapy becomes the reenactment of a three-part drama: firstly, an inertia of small transfers - dreams, slips of the tongue, word-plays, forgetting, flirts, etc. — furnish the material of the scene, secondly, a larger transfer supposes the patient identifies with and projects her feelings onto the analyst in discussing this material. Lastly, the climax of the drama begins with an interpretive moment (most often offered by the analyst) that presumably reveals a specific lineage of mental connections that lead back to the source of the repression. If one is still trying to suggest this dramatic method maintains a relation to Freud's theory, then one states the cause was a trauma of a sexual nature, if not, then one suggests a myth or some real life shock. Again, the reader should be aware that nothing could be further from psychoanalysis than this psychotherapeutic misreading of its theory and practice: the question of psychoanalysis, its writing of the cure and repression lie elsewhere.

To begin to get a tighter grip, one can simply read Freud:

"Twenty-five years of intensive work have had as a consequence of assigning to psychoanalytic technique goals immediately different from those of the beginning. At the beginning, all the ambition of the medical analyst was to conjecture what was hiding in the unconscious of the sick person, and to reunite these elements in a whole and communicate them when it was proper. Psychoanalysis was above all an art of interpretation. But the psychotherapeutic task was not however resolved by this." (Freud, Beyond the Pleasure Principle, 1920).

The originality of the psychoanalytic interrogation of the cure consists, contrary to the therapeutic and 'psychodynamic' derivations, not in lifting a repression (by speculating on a hidden cause), but in concentrating its focus on the discovery of the mechanism of repression itself: that is to say, in focusing not on bringing out what is repressed (blocked memories, emotions, pleasure) but constructing what is repressing.

Freud states: "The theory of repression became the cornerstone of our understanding of the neuroses. A different view had now to be taken as the task of therapy. Its aim was no longer to 'abreact' an affect which had got on to the wrong lines but to uncover repressions and replace them by acts of judgement which might result either in the assumption (annahme) or in the rejecting (verwerfung) of what had been formerly repudiated" (Freud, XX, p.30).

 (to be continued:  The Lacanian notion of Repression - A Topology of Repression).

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What is Lacanian Psychoanalysis?*

The epitaph Lacanian Psychoanalysis began in France with the celebrated psychoanalyst Jacques Lacan (1901-81). It is most widely recognized by a return to Freud and a linguistic axiom - "the unconscious is structured like a language"; both situating a critique and reconstruction of Freudian and post-Freudian psychoanalysis.

Habitually, contemporary psychoanalysis claims that it goes beyond Freud, that is to say, that today it is possible to read Freud in the tradition of psychoanalysis somewhat as a paleontologist reads a fossil – as a quaint object that belongs to the folklore of the past of psychology and psychotherapy.  It is easy to understand this movement, for in order to modernize psychoanalysis within the tradition, what is most important is bypassed the moment Freud gets a makeover into the human sciences (cognitive theory, neurophysiology, psycholinguistics, etc.) and humanities (hermeneutics, lit-crit theory, philosophy, etc.).

Without attempting to dis-entangle here such assimilations and trivializations of Freud’s theory, it suffices to state that Lacan’s return to Freud no longer reads Freud in the tradition, but reads the tradition with the discoveries and concepts that Freud invented.  Of course, the Lacanian return to Freud proceeds by a critique and testing of Freud's theory, but his theory can also be used in a more extensive and primary way to critique the theories of the generation of post and neo-Freudians who, in the effort to “keep up with the times”, have understood too quickly and too well.  The effects of Lacan’s return to Freud has, therefore, produced a new generation of psychoanalysts who have slowed things down and gone back to the basics: no longer desiring to go beyond Freud in the latest fashion, as if one ever really goes beyond any great writer from Euclid to Marx, the Lacanian analyst of today goes further into what is impossible to understand in his theory, or rather how such discoveries and inventions, were systematically effaced and dissimulated not only by the post-Freudians, but Freud himself into the tradition of the  human sciences and humanities. 

Although the heterogeneity of psychoanalysis is often homogenized by attempting to anchor its theory and practice down in already established academic fields and schools, Lacanian psychoanalysis establishes the stability of the theory in a more adequate manner: through the introduction of a topology.  We have introduced elsewhere the importance of such a return to Freud - http://topoi.net/place6/thequestionbrief.html  . What we will do here, is comment on how the tradition of psychoanalysis, in its practical and clinical dimensions, can be read with Freud, since Lacan.

Traditionally, psychoanalysis is often reduced to psychotherapy or psychodynamic therapy: a form of medical or therapeutic advice that still carries with it a certain stigmatization of being a place where sick people go. While not denying that this domain cuts across its field, Lacanian psychoanalysis is neither concerned with a return to a norm (therapy) nor a diagnosis of an illness; it does not  address someone who is 'ab-normal', or who needs to be re-educated or cured, but rather it opens up a place where a problem – where something that is suffered and insists in one's daily life – can be isolated as something 'real', in spite of the fact that it may be systematically misrecognized not only by the one who has the problem, but those claiming to want to cure it. Thus, a certain irony must already be posed in a psychoanalytic intervention in face of something real which falls neither into a biological illness, nor a cultural maladaptation imposed by the dominant paradigms of the human sciences. At which point many become resigned to thinking such problems are 'imaginary' or subjective and consequently have a disbelief in getting any help at all. Or oddly, in talking to some it seems only 'others' have such subjective problems, while it is precisely this rejection that establishes a precarious normality. For example, it can often be observed that those 'others' who actually go to see a therapist, whether on their own or not, may be stigmatized as having problems, whereas it would be more true to say the opposite: such persons have had the courage, perhaps in spite of themselves, to resolve a problem that is often shared, though unrecognized, by their normal family members, friends, co-workers, or society.

The unfortunate question remains, however, as to why should one have to 'mask' the real and its subject at the level of a therapy to discover the truth that such symptoms reveal ? Or further still, one should ask whether the person or association to which one addresses his or her questions would have a theory and practice capable of reorienting a demand for a therapy to a just theory and practice of psychoanalysis.

In responding to these questions and the difficulty of addressing the symptom, Lacanian psychoanalysis reopens a place for this 'other' orientation to occur - through its sessions, seminars, and work groups - without the need for the 'mask' of a therapeutic intervention and not in an analysis of 'others', but by an analysis of an Other of thought, i.e., the unconscious.

For more detailled information see: What is the difference between Psychoanalysis and Psychotherapy ? above and Clinic page: Question of Psychoanalysis ]

Who is a Lacanian Psychoanalyst and how is this title to be determined ?

(response in editorial review)

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