Psychoanalysis in an age of the quick fix

At the moment, at least in the UK, psychoanalysis is having a rough time of it.  In fact, it’s probably fair to say that even if someone was feeling really desperate, a psychoanalyst is probably the last person they would think of contacting.  As someone once said, psychoanalysis takes a long time, it’s very expensive and there’s no clear outcome.  Furthermore, it doesn’t make any sense.

There is certainly more than a grain of truth in all this, but in many ways this is to miss the point entirely.  Or to put it another way: so what?  So what if it can take take a long time, and, consequently, can cost a lot of money?  So what if there is no clear ‘result’ at the end of it (if indeed, the ‘end’ ever comes)?  And why does it have to make sense?

The point here, of course, is that there is nothing intransigently ‘good’ or ‘bad’ about something which costs a lot of money, takes a long time, has no clear (and measurable) outcome, and makes little or no sense.  However, the fact that this criticism is even possible – and it is repeated many times in various ways – says a lot more about how people (mis)understand their mental health and the nature of words, than it does about the nature of psychoanalysis.

What I mean by this is that, for many people, any sign of discomfort – physical or psychological, is something that simply cannot be tolerated.  Whether it’s a headache or a depression, it has to be got rid of as soon as possible.  And when it comes to something like a depression, or a sense of anxiety, the idea that talking about it at any length – and particularly to a stranger – is anathema to a lot of people.  Yes, they might admit they feel anxious and depressed, but usually this is a precursor to getting rid of such feelings as soon as possible.

This is not to ‘romanticise’ feeling anxious or depressed.  On the other hand, why not just accept anxiety and depression as part of life?    Or, even more radically perhaps, why not explore one’s anxiety and depression, in order to see what it tells one about one’s life?  But, of course, this view is also anathema in a culture of the quick fix and instant gratification, and of being constantly entertained.

The term ‘quick fix’ is itself quite revealing, because of its ambiguity.  ‘Fix’ as in put right, mended, made better; but also ‘fix’ as in the injection of a (narcotic) drug.  Interestingly enough, although brief talking therapies such as cognitive behavioural therapy (CBT) do not overtly describe themselves as ‘quick fixes’, in many ways they emulate the idea of ‘fix’ in terms of its second meaning, i.e. the injection of a drug.  In fact, CBT is promoted as being ‘evidence based’, and what this means is that it’s being subjected to the same kinds of randomised controlled trials (RCTs) that are used to test (prescribed) drugs, e.g. anti-depressants.

People are used to being prescribed drugs by their GP to make them feel better; and, of course, others take proscribed drugs for the same reason.  So it’s hardly surprising that they will be interested in any talking therapy that is presented in a very similar fashion, but one which (apparently) has no side effects.

What drugs and brief talking therapies also have in common, as well as being presented as ‘evidence based’, is that they are both forms of sedation.  With drugs this may seem fairly obvious; with talking therapies perhaps less so.   However, whereas drugs such as antidepressants sedate chemically, talking therapies sedate through words – and, more specifically, through meaning.

With CBT this process of sedation is fairly straightforward: if someone is feeling depressed they are invited to consider and even challenge the assumptions they make about the situation that is giving rise to their depression.  So, for example, if someone has just lost their job they might be invited to think about what this job meant for them and why its loss was so distressing.  They might then be invited to think about such a loss in another way, for example, as an opportunity for a new career.  In the process the loss of the job creates a new set of meanings for the individual.

Of course, in themselves such meanings are neither ‘good’ or ‘bad’, and neither are they ‘true’ or ‘false’;  or rather, they can be, but only in terms of how the individual in question views them.  The key point here is that there are a whole range of meanings that could be constructed on the basis of losing one’s job.  The question then becomes why one person constructs one particular meaning, whereas another constructs a completely different one.  For one person, the loss of their job could be apocalyptic, whereas for another it could indeed be the golden opportunity they’ve been waiting for all their life.  And for another person it could be both apocalyptic and a golden opportunity..

But if meaning is to serve as a sedative, then only particular constructions of meaning can be permitted, and contradictions have to be excluded.  Otherwise, ambiguity and contradiction could soon give rise to anxiety.  And this brings us back to the question of why it’s so hard for so many people to bear feelings of anxiety, of depression, of feeling awful; why, in fact, it’s so hard for so many people to be able to live in their discomfort.

This also brings us back to the question of where psychoanalysis sits in such a culture.  In many ways, psychoanalysis is discomforting by the very fact of its existence.  And it invites people to sit (or lie) in their discomfort; to live their anxiety, their depression, their suffering.

This is why psychoanalysis is never going to be popular in our culture – because it calls into question the whole ethos of the quick fix, the sedation (and seduction) of meaning, of having to feel ‘good’ and ‘happy’ at any cost.  At the same time, at least in my view, it shows why we need psychoanalysis more than ever.