It is not unusual to hear Lacanians snicker when references to Guattari come up, joking about how the La Borde clinic eventually resorted to giving its patients insulin shots. I’ve certainly made jokes like this in the past. It is almost a requirement within Lacanian circles. The subtext of this joke is that schizoanalysis had failed and that they could only have recourse to chemical straight jackets in treating their patients. I do not know the details of La Borde’s insulin treatments, but if this is a particularly stupid joke then this is because it is both reductive, suggesting that this is all that was taking place at La Borde, and because it assumes that treatment with psychotropics is inherently a failure. With respect to this latter point, what is reflected is a sort of idealistic, anti-materialist tendency within the theory community that would like to disavow the body and anything neurological, instead treating the signifier as the only legitimate approach to treatment.
As many who read this blog know, I spent about seven or eight years in Lacanian psychoanalysis with one of the foremost analysts in the United States. In addition to this, I myself practiced for about four or five years and underwent a training analysis as well. I certainly got a lot out of my analysis in terms of general self-knowledge, though I don’t know that this analysis had much in the way of efficacy where symptoms were concerned.
I’m hesitant to write this post and almost a bit embarrassed by what I’m about to say, but about a year or so ago I was overcome by a very serious depression. Despite the fact that things were going well, that I was getting all sorts of requests for work, that I was getting recognition, that my classes were going well, and all the rest, I was in a very black place. Suicidal fantasies would plague my thoughts. It was not that I was contemplating or planning killing myself. Rather it was as if certain images, fantasies, would flash through my mind, giving me thoughts of driving into oncoming traffic or of slipping downstairs in the middle of the night to slit my throat with my butcher’s knife. My thoughts became extremely persecutory, perpetually telling me how awful I am as a person, how my work is rotten, how I’m trapped in my life, and all the rest. I was no longer able to take pleasure in anything, nor concentrate on anything. I no longer enjoyed cooking. Movies and televisions shows were unable to capture my interests. All books seemed bland and without interest. It was a very black time.
read on!
At a certain point I simply couldn’t stand to live like this any longer and realized that I had to do something about my state. Going back into analysis was out of the question for economic reasons. And besides, analysis had never had a marked effect on affects pertaining to anxiety and depression (though I am aware that talk therapy can have a profound effect on some for depression). In light of this I decided to take the leap, visit my physician, and see about anti-depressants.
As somehow who has argued passionately from a Lacanian perspective about the evils of psychotropic drugs, I am ashamed to publicly make this admission. However, in the year since I’ve been taking these drugs, the changes have been profound. Within a couple of weeks of taking these pills, the suicidal ideation had entirely disappeared. It was a strange sort of disappearance, where everything changes and you don’t even notice the change, having forgotten what things were like before. My temperament became much more calm and less erratic in terms of angry outbursts towards friends. My interests came back and I found myself cooking again, writing again, reading again. The persecutory thoughts disappeared. It was really a remarkable change.
From a Lacanian point of view, this sort of change cannot but be perplexing. At the heart of the Lacanian theory we are told that affects and symptoms are structured by the signifier. “The unconscious is structured like a language,” we are told. The symptom is thus a sort of mute speech. It disappears when we bring it to real speech. Our compulsion to repeat arises from our constitutive alienation in language that produces an irreducible gap that can never be filled. Our symptoms and repetition, moreover, are intersubjectively structured as messages, as it were, to the Other.
Yet here, in this drug, there was no signifier, no Other, no language, but a simple chemical transformation. Had I gone to analysis to treat this depression I would have talked a good deal about the thoughts I was having, I would have produced signifiers, and my thought process would have seemed absolutely convincing. Yet chemically my brain would have remained the same (though it’s important to remember that speech, thought, and activity can actually change neurochemistry). The Lacanian might say that the drugs have simply clothed, dulled, or disguised my symptoms, hiding my unconscious. Yet I don’t think so. There has been a basic shift in thought and affect that isn’t simply a matter of signifiers. We find analogous phenomena with other substances. When you are suffering from nicotine withdrawal, the angry thoughts you’re having are absolutely convincing, seem justified, and seem completely disconnected from the absence of nicotine in your system. Yet when you smoke that cigarette, these thoughts and affects disappear like so much mist. Likewise, when I drink chardonnay, and drink wine or beer generally, I tend to become extremely affectionate and warm towards others. There is a shift in my entire thought process.
It seems to me that these sorts of phenomena pose a significant challenge to the Lacanian hypothesis of symptoms structured by the signifier. Of even deeper concern, it seems to me that phenomena like this, speaking as they do to neurochemistry rather than the signifier, pose a significant challenge to the Freudo-Lacanian concept of the compulsion to repeat and the death drive. Freud discovers the compulsion to repeat towards the end of his career, when he finds that there’s a limit to interpretation and its ability to dissolve symptoms. What if this limit has nothing to do with the signifier or language, and everything to do with certain neurochemical structures in certain patients?
My point is not that we should ignore language, talk, “the subject”, signs, etc. My point is that if we adopt a Lacanian approach to treatment we are very likely to miss these other factors. Indeed, it is not unusual to hear Lacanians dismissing those patients that say they benefited from these things, that they don’t think their particular symptom is structured around the signifier, and even hinting that they’ve been duped by the pharmaceutical industry and by neo-liberal capitalism, in a way that is morally culpable for not recognizing their status as a desiring subject. I know I certainly made these sorts of arguments, much to my regret, to my dear friend Melanie, and I made them persuasively. For that, Mel, I’m sorry. I should have listened to your arguments with a more open ear at the time and I should have not been surprised when you expressed such shock and anger when I told you that I had made this decision.
When the patient in analysis protests that nothing is happening– and I’ve known analyses that have lasted 20 years –the analyst guilts them, suggesting that they are not working and that they haven’t delved deep enough yet. In other words, since it is held a priori that the subject has a particular structure, since any sort of empiricism or alternative is ignored, it must always be the patient that is mistaken or duped, not the theory. It is never, in other words, that the treatment is not working, but rather that the patient hasn’t gone far enough. We then, on top of everything else, told that the aim of analysis is “ethical”, that it is not improvement or a better standard of living, that we’re falling into bourgeois, neo-liberal ideals of “happiness, and that we should hope to become pure desiring subject through analysis, not happy subjects. And we are given a heroic ethos about how we are the ones against the system in pursuing this. What strange animals us humans are, that we can believe such things and be persuaded by them.
Again, I am not suggesting that drugs are the answer (they really effect everyone differently– pot, for example, makes me miserable, but others seem to like it a lot) or that we should ignore our personal histories, signs, culture, etc. No, not at all. I think Guattari had the right idea in proposing a model in which we strove to think the intersection of regimes of signs, the biological body, economics, nature, etc… A highly complex ecological, networked model. The problem lies in dogmatic theoretical orientations that, ironically, suffer from Zizek’s definition of metaphysics: any orientation of thought that raises a part of the whole to the explanatory principle of all other elements in the whole. Certainly this is the case with Lacanian psychoanalysis.
Larval Subjects . 
April 6, 2009 at 3:10 am
I love this post – thanks for it. I’ve just written a brief comment about it on my blog.
Cheers,
Adrian
April 6, 2009 at 6:17 am
This is very useful thanks, have been thinking about Lacanian psychoanalysis and schizoanalysis and what you say raises many important points.
Seems to me that there is so much to continue along the lines of research with the use of not only anti-depressants but also other psychoactive substances… its really a shame psychedelic research has been shut down for decades and is only in recent years making a comeback…
“when the patient in analysis protests that nothing is happening”
I know of too many cases where analysts / psychotherapists more or less make patients stay on even when nothing is happening after years and years… and in some cases i think these professionals are serving their own economic interests at the expense of the patient.
Isn’t it also problematic when analyses presume to complete individuals, as though after analysis things are more or less sorted… it seems more the case to me that life is a matter of intensities, ups and downs, and subjects may be better conceived as open wholes or assemblages where flows of words are no more special than flows of images, affects, chemicals, etc…
April 6, 2009 at 7:50 am
Following Freud’s remarks, I’ve always been under the impression that psychoanalysis was a treatment solely appropriate to the neuroses, the mental illness whose mystery, defying explanation by Victorian neurology, the entire psychoanalytic apparatus is designed to elucidate. So I ask for clarification when you argue the possible benefits of pharmaceutical drug use as a viable alternative to analysis if you mean this in the context of the neuroses. For myself, Freud seemed to go out of his way, even in his philosophical and ethical wanderings, to make clear how particular analysis was to a certain pathology.
April 6, 2009 at 12:00 pm
I read your post with much interest. My circumstances were almost the reverse. After having suffered from a terrible ‘depression’ and ‘anxiety’ for two desperate years, I took the plunge, and was prescribed a popular ‘SSRI’. Within two weeks, or so, the anxiety and depression ceased. This was eight years ago.
And yet during this time something was stifled. I could operate in the world, and yet repetition, and the compulsion to repeat was profound, and dominated my life. I think that K-Punk has written very well upon the effects of ‘SSRI’s’, they induce a certain reality which is very close to the depressive state, and yet protects you from the most debilitating aspect of it.
Two years ago, I entered the Psychoanalytic clinic. It was in some sense a last throw of the dice, after having been on this drug for six years, I had become so tired of its predictable pathways. In the first few introductory sessions I had with my analyst, she suggested that maybe one of the long term goals of my analysis could be to stop taking the ‘SSRI”s’. This seemed a ridiculous suggestion, even though my life had become intolerable, my memory of those years of anxiety and depression was still strong.
After having been in Analysis now for two years, and I can say that these two years have been the most impossible two years of my life. A two years in which I have never known such struggle, a two years in which I was very close to suicide twice. I now find myself almost off the ‘SSRI’s’, writing more than I have ever done in my life, and having made encounters which have totally altered the very fabric of my existence. I find myself in a territory that I would of never imagined.
I understand your point that drugs effect everybody differently, and of course I would have to make a distinction between the drug which failed totally in my case, and the possibility of the emergence of new drugs in the future.
Jan.
April 6, 2009 at 5:12 pm
Hi Jan,
No disagreement here. The first round of SSRI’s I tried were pretty awful. I had a number of very negative physical and psychological symptoms as a result. Likewise, during my time in analysis I had an experience similar to the one you describe with respect to writing and productive and, more generally, arriving at a better sense of what I desire. I do not know, however, that I would go as far as K-Punk goes with regard to asserting that somehow SSRI’s intrinsically something that places us in a depressive state. First, something similar could be about psychoanalysis with respect to how transference comes to function in the psychic life of the individual undergoing analysis. Indeed, this is one of Deleuze and Guattari’s central criticisms of psychoanalytic process. Second, this simply discounts first hand experiences of those who claim to have been helped by these drugs. As Lacanians one of our first and highest duties is to take seriously the word of the analysand. This is part of what it means to center analysis on the subject (rather than a set of abstract medical categories). This line of argument strikes me as being strangely at odds with this ethical dimension of analysis, suggesting that even if an analysand claims they have been helped by these things they are still somehow duped (here, often, there’s an ideological dimension to this critique where pharmaceuticals are seen as bound up with capitalism and neo-liberalism). Third, it seems to me that this critique is implicitly based on a dualistic, anti-materialist ideology that is perplexing from a psychoanalytic standpoint. That is, the thesis runs that psychotropics are bad because they are material and mechanical, and therefore artificial, whereas analysis is good because it is spiritual, characterized by freedom, the subject, etc. Yet if we’re good materialists, don’t we concede that no such distinction cannot be drawn? Doesn’t the materialist Lacanian hold that speech has the power to change matter in the sense that it affects our brain chemistry?
Again, I am not suggesting that drugs are the answer, only that I think Lacanianism often goes too far in one direction, ignoring our material embodiment and how it functions. Here I think Benoit makes a good point when he reminds us for Freud at least– I’m not so sure about Lacan –not all symptoms are treatable by psychoanalytic technique. That said, I’m on the fence as studies have shown that talk therapies are statistically as effective in treating depression as drugs, and without all the nasty side effects. I’m not sure what the evidence shows for anxiety disorders. All I’m looking for is a multi-stratified understanding of psyche that is able to both make room for our biological and chemical nature and the signifier.
April 6, 2009 at 6:41 pm
LS: “I’m hesitant to write this post and almost a bit embarrassed by what I’m about to say, but about a year or so ago I was overcome by a very serious depression.”
Kvond: I’m very sorry to hear that. It is a heavy horse to ride. But when you get the reigns, it can ride well and strong into the night.
I think though that the above comments about drugs is why Guattari thought in terms of a semiosis (not Peircian) and not signifiers. There are chemical “signs” in the material.
April 6, 2009 at 8:56 pm
LS,
I think the interesting question in relation to drugs is the one of transference, which can, in fact, have the analysand acting like a user (‘I need a session and I need it now!’). My feeling is that you are against the use of transference, even to take the analysand ‘beyond’ desire. I do wonder, however, whether drugs are the price the clinic without transference has to pay.
It’s a question that also relates to the place of desire in ethics as touched on in previous posts/comments. My feeling is that your desire for an ethics without desire is a desire for a process without transference. I’m not suggesting that transference is to be preserved – quite the opposite – I just wonder whether we can simply remove desire from the question of ethics altogether, whether the place beyond desire is not somehow ‘internal’ to the process of desire itself.
April 6, 2009 at 9:19 pm
Hi Ghost,
I certainly think there’s a transferential dimension to drugs. A number of the studies indicate that placebos can have marked effects on ailments such as depression. On the other hand, the issue is certainly complex. We’ve all seen movies where a character begins to behave in a drunken way believing themselves to be drinking when they’re drinking a non-alcoholic drink (100 First Dates). It would be going too far, however, to say that transference is the cause of drunkenness. I’m not sure I understand your remarks about a process without transference. The end of analysis, I think, is also the passage through and beyond transference. I certainly wouldn’t claim that various talk therapies don’t involve transference whether or not the therapist is aware of the important role transference plays in that process.
April 6, 2009 at 9:51 pm
I just mean that I couldn’t have got through my analysis without transference.
April 21, 2010 at 6:44 pm
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