In Prozac On The Couch, Jonathan Metzl argues that
the notion that biology replaced psychoanalysis is undone in moments when biology is expressed as psychoanalysis, or performs the cultural work of psychoanalysis, or assumes the same definition of civilization as psychoanalysis…
Metzl’s point is deceptively simple and it is that rather than there having occurred – as many have bluntly perceived – a shift during the late twentieth century from psychoanalysis to medical psychiatry – that is, a shift from ‘Freud to Prozac’– psychiatry, by contrast, during its climb in becoming the ubiquitous institution, industry and research and development strength that it is today, subsumed the psychoanalysis into the architectures of its own knowledge, and adopted in its practices, albeit insidiously, all of the ideological character and foundational knowledge of twentieth century psychoanalysis. I refer to Metzl’s argument, here, as deceptive because although it seeks to recharecterise the so-called ‘shift’ from psychoanalysis to psychiatry as a assumption by psychiatry of psychoanalytic knowledge, it can be difficult to perceive the precise ways in which psychiatry has done so. After all, are not psychoanalysis and psychiatry completely different kinds of sciences: the former, a social, academic, and creative science, and the latter, a hard, neurological, and medical science?
In my view, the locus at which these divergent sciences converge, ultimately, is in (and through understandings of) the body. Metzl supports his argument by writing about the way in which the psychiatrist has adopted the role of the psychoanalyst, and has thereby changed the structure and method of the analysis of the human subject. However, there is perhaps more to be learned from examining ways in which to synthesise both disciplines. In looking to the body, then, we must ask why the body – and not just the mind – is important in analysing contemporary psychoanalytic and psychiatric understandings and expressions of subjectivity. While the foundational paradigm of dualist thought, which inscribes the mind-body dualism, pervades the structure of knowledge-making throughout the eighteenth and nineteenth centuries, the point at which this dualism (often referred to as Cartesian Dualism) becomes problematic, is in examining it as against the findings of twentieth century medical science. Indeed, the problematic of dualist thought is made evident in both psychoanalytic and psychiatric scholarship throughout the early twentieth century to the present.
The idea that the subject owns a mind which is ‘rational’ and perceptive, and knows or that may know the subject entirely, and a body which serves as a receptacle of sensory glands and a vehicle for the mobility of the brain is untenable in the face of medically documented cases of the emergence of an unconscious mind, or in cases of behavioural change in the subject which reflect a force beyond merely either the mind or the body. Indeed, the unconscious emerged in the twentieth century as precisely that place whose unknowability, whose mysteriousness and estrangement to our own cognition, to our conscious mind, is also the very place in which the subject’s conscious minds, or this subject, overall, is constituted.
Thinking, then, in literary terms, the unconscious may serve as a broad metonym for all that is unknown or unknowable by a subject about itself, and to others. It is not a finite place within the mind, or even within the brain, in which the real, subjective brain does its work, behind the curtains as it were, and without the observation of the active, thinking, and percipient mind. Nor is the unconscious the grand processor of the brain that both oversees our senses, governs and produces those thoughts not recognised by the mind, and about which or through which there can be no thought in and of itself. Rather, it may be understood metonymically as the very site of non-knowledge, the very container of all of the unobtainable aspects of the mind, and which may only be witnessed, if ever, in the medically inexplicable acts of its subjects, or may only be understood as reflected in activity and discourse by the subject which is aberrant, uncanny, unknown. Thinking about the unconscious not as an aspect of the mind, then, but, rather, as the very number of aspects that are unknown about the subject, enables the terms of discussion to be reframed in such a way that strikes at dualism and reveals the inadequacy of dualism for conceiving of the subject. As such, psychoanalysis engenders new interest in the body, at the very least, as a place in which clues toward the unconscious may be found.
In a different way, and in a way that is less commonly the subject of research, psychiatry similarly disposes with dualism by conceiving of the subject as, for example, contingent upon the effectiveness of the neurotransmission of certain neurotransmitters within and throughout the brain. While psychiatry, in this sense, conceives of the subject as dependent upon its mind, and in a way that appears to suggest that the subject’s body is enslaved to its brain, it similarly analyses the causative and ramifying effects of the subject through its language, including its body language. In this sense, psychopharmacological analysis of the subject proceeds by way of asking the subject particular questions about its body, related to its sleeping patterns, its sexual and other physical activity(/ies) and while assessing its general bodily performativity and its physical health. In this way, psychiatry is both more productive and more reductive: it is productive in that it observes the patient holistically as a subject governed by all things, not simply its mind and/or its body, but it is reductive in that it locates the precursor to mind/body (and all other) subjective change as within the brain itself in the form of neurotransmitter intervention.
If it is accepted that the unconscious constitutively resists signification, or is unamenable to the comprehension of others, since, by this definition, any utterance that is capable of comprehension is no longer an iteration of the unconscious, but rather an iteration that must be subject to interpretation within a particular contextual structure, (and, thus, is not aberrant or uncanny, but – in terms of its comprehensibility, is ‘appropriate’, logical, rational, or ‘makes sense, etc., such as, for example, an iteration that takes place within the context of a patient/doctor meeting (“I feel depressed”)), and, therefore, must be understood to represent not a specific feeling, but a broad and underdetermined symptom of a specific condition of circumstance, how does one even identify, or begin to assess, the revelation of the unconscious at all? While medical journals and psychoanalytic articles often focus on schizophrenia, depression, anxiety disorders and the like to examine the different articulations made as between the subject that suffers from a condition and the subject that does not, such studies also engage in a discussion about what is essentially unknown (both in terms of the (bio)linguistic scope of such studies, and the content of the articulations themselves). Furthermore, such studies proceed on the basis of observation, drug prescription, and then further observation, and depend on dialogical ‘change’ – this is an overdetermined and regulated form of trial and error. Of course, such studies also are written by the observer and in the observer’s own particular kind of scientific language, and in so doing, lose much of the substantive content related to, and offer little specialised analysis of, the subject’s use of language.
In the case of Prozac, Metzl has observed the particular effects Prozac has had on the language deployed in descriptions of subjectivity, not only in medical and scientific journals, or only in academic articles, but in the general discourse about the self. As Metzl observes,
the success of Prozac capped a shift in the discussion of selfhood away from symptoms, words, and understandings that implied prior events. In their stead, a language developed that focused on the here and now and on symptoms immediately observable and quickly treatable. Over the course of the revolution, men were replaced with medications, case studies by MRI scans…In the process, “I am in pain because of where I have been” became “I am in pain.”
In To Speak Is Never Neutral, the psycholinguist (psychoanalytic linguist) and semiotician Luce Irigaray examines the language of schizophrenics in order answer her question “does schizophrenic discourse exist?” In her study, Irigaray notes that language
includes a class of elements that permit passage from, or conversion of, language into discourse. These elements have a double function: on the one hand, they are part of language defied as a system of signs, and as the syntax of their combinations; on the other had, they belong to language as activity manifested in instances of discourse.
Discourse, then, may be conceived of as those elements of a language that refer not only to the structure that signifies and which conveys language with significance, but as that which assumes – in making general reference to certain unspecified ‘givens’ about the episodic place of enunciation – the very totality of the context in which the subject’s enunciation takes place. In so doing, particularised discourse indices (for example, the personal index of the ‘I-you’ relation, or demonstrative or place indices such as ‘this’ or ‘here’ – things that would only make sense to an immediate party to the enunciation) enable one to examine what may be called the ‘immediacy’ of the subject’s subjective experience.
Speaking generally, and hypothetically, then, it could be that a subject whose enunciation of certain discourse indices is frequent may suggest a certain immediacy of subjective experience; an awareness of their present, both temporally and ontologically.Alternatively, a subject whose enunciation of discourse indices is infrequent may suggest that their subjective experience is in some way ‘disconnected’ – that their narration of time takes place in ‘another place’, whose character reveals itself as symptomatic of depression or some other mental condition.
