Knowing the Causes of Power, Research Time, 21/02/2018

There were a lot of reasons Félix Guattari broke with Jacques Lacan and the whole rest of the Freudian-influenced schools of French psychiatry. I talked about a couple last time.

How one point of unquestioned rationalism survived into the science of psychiatry – to understand the causes of the condition is itself part of the cure. How the images arising from singular cases were taken for universal symbol structures of human personalities. Both thanks to the influence of Freud.

Here’s a third issue that constituted such a radical break – the image of the therapist’s authority.

I don’t mean this in the sense of practical, institutional authority. Guattari understood that therapists, clinicians, and those who are responsible for the care and cure of the severely mentally ill required authority to do their jobs. They needed to prescribe drugs, coordinate clinical activities, design a therapy regime.

You don't really want anyone to be authorized only by themselves, do you?

All those required legal authority – the power of a signature. Your decisions had weight, and so needed to be taken with responsibility. That responsibility required thought and devotion, an ethical weight of obligation to act in the patient’s best interest – to let their good guide you.

I read an essay by Guattari a while ago that described the dominant culture of psychiatry and mental health care practice drifting from that ideal. He gives us Lacan’s words, “The analyst is authorized only by himself.”

There are two ways to read this. One is ontologically. The cause of some practicing psychoanalyst in some little town – call him Jack from Paris* – having his authority doesn’t come from Jack himself.

* Paris, Ontario.

Jack has to earn degrees and certifications in the fields you need to be expert as an analyst and therapist. He’s cultivated deep technical and philosophical medical knowledge. His legal powers are enabled by a complex web of institutions, laws, and regulations.

Another way you can read it is ethically. Jack’s authority flows from the trust people put in him – those who hired him, administer his certification renewals, maintain the laws that give him the right to prescribe drugs and therapies, and enforce those laws when they're broken.

Both are correct, of course. And not mutually exclusive. Just looking at different features of the world. The conclusion from both sides of that argument is that the statement “The analyst is authorized only by himself” isn’t adequate to empirical reality. Such an attitude isn’t going to fit properly with the real circumstances of an analyst’s working life.

What happens when a guiding philosophical element of training conflicts so brutally with the reality of practice? Breakdown. You end up with a body of professional analysts who tick the institutional boxes, but practice with none of the respect for the mentally ill that you need to practice properly.

Certainly not enough to transform respect into mutual respect. That’s the authority of expertise, an inescapably ethical relationship. Guattari understood that a philosophical principle of considering the analyst an absolute power – the revealer, prober, curer – undermines the possibility of ethical relationships among therapists and patients.

You can't really hold such a principle and practice medicine at the same time. Thought conditions reality when the reality is our actions and relationships.