Thursday, 8 March 2007

Giving psychoanalysis its due

You can find an interview with Darian in April's edition of Psychologies.

And a review by Christopher Tayler appeared in last Sunday's Telegraph. It's curious how people assume in a jointly authored book that they can tell who did what. I'm taken to have "dug out lots of interesting stuff from the medical literature on psychosomatic illnesses, while Leader, an analyst, provides anecdotal case histories". How does someone think they can guess correctly about this matter?

To make the point once again, we insist on using 'psychosomatic' to describe an approach to medicine rather than a type of illness. We document the extensive research which indicates the mind's involvement in a wide range of conditions, from allergic reactions to heart disease. If there was one aspect of the book to which I contributed predominantly it concerns what physiologists have discovered of how nervous, endocrine, and immune systems intercommunicate, and of how these systems may impact on the blood vessels and on tumours. From the reviews I've seen you'd hardly guess that the book contained a murmur about T-cells or the endothelium.

If I'm allowed to return the guess, perhaps this imagined division of labour helps Tayler to recognise psychosomatic medicine without acknowledging its debt to psychoanalysis. At the very least one can say that he does not look favourably upon the latter.
...the authors don't acknowledge the fact that psychoanalysis has a poor track record when it comes to distinguishing psychosomatic complaints from ones with less mysterious causes.
Again that use of 'psychosomatic' we wish to avoid. But what is this 'fact' alluded to? Psychoanalysis is a broad theory. Certainly excessive claims have been made by individuals in the past, but we're very careful to distance ourselves from the non-Freudian idea that all medical conditions are a form of bodily speech - the unconscious speaking through the body - a position which did find its voice in the 1920s and 30s.

The theorists we turned to were physician-analysts such as George Engel, Michael Balint and Jacques Lacan, and more recent Parisian analysts, such as Joyce McDougall and Rosine Debray.
The authors do address 'the failure of classical old-fashioned psychoanalysis as a clinical treatment', but they get round the problem by recommending the less classical methods of Jacques Lacan.
I don't see where we even do that. But whatever one's attitude towards psychoanalysis, surely we should at least give some credit to these people, and to the way psychoanalysis framed certain questions for them. In the middle of the last century we see Lacan considering whether the structure of society plays a role in the incidence of heart disease, a thesis later research confirmed. Meanwhile, Michael Balint was speculating about the mind's involvement in chronic illnesses by means of the immune system's inflammatory response. This was a wonderfully accurate prediction.

Even someone who is distrustful of psychoanalysis should acknowledge that its capacity to look to the patient's story beyond simplistic personality profiling kept the psychosomatic flame alive in the third quarter of the twentieth century. Which other forms of psychology can boast as much?

No comments: