Before the semester has us all swamped, I want to take a moment to respond to a point made by Dr. Prall. He points out that however much psychoanalysis may resemble  the disciplines from which it draws, it is also different from each of them, and that that difference includes the high value we place on the analyst being analyzed.

The fact that, as he says, "subjectivity is our tool" allows me to continue to plead for more emphasis on the humanities than on natural science. Dr. Bernardi, in our pre-holiday exchange about empiricism, cited Jonathan Shedler's outcome studies as an example of how research can and should be important to psychoanalysis. Although Dr. Bernardi is probably right, I can't  resist  a gloss on Shedler's work. At a conference in New York 2 years ago, Dr. Shedler--whose papers have earned well-deserved adulation, sounded a pessimistic note about their effect.  At his own university, he said, students come to the counseling center requesting Cognitive Behavior  Therapy. This is not for lack of access to the outcome data on psychoanalytic therapies.  Students  there are encouraged to consider engaging in the kind of treatment we do, as it is now "evidenced based" as well.  It is also offered at no or low-cost to them. According to Shedler, the students persist in requesting CBT. However, (I quote from memory here) "When it doesn't work, they don't say 'CBT didn't work.'  They say: 'Therapy didn't work.'"       

This is surely not the only example of a situation in which cultural discourse, not empirical data, shape social practice in the form of consumption.  If Nietzsche's rhetoric on this topic is offensive, there are many others who make the case more plausibly. The poet Muriel Rukeyser, for example: "The world is made not of atoms, but of stories."

Thus, to me, a movement much more encouraging than the renewed interest in empirical studies by  analysts is its obverse--the effort by some in the health sciences, for example, to pay attention to  language --to what sick people SAY.  The past 15 years has seen the emergence of a movement--albeit small and quixotic--called "narrative medicine."  I have no idea of its  status outside the US. It began, if I remember correctly, when a Ph.D. in literature decided to go to medical school.  Primed as she was to attend to the power of words, she saw  each medical chart as more than a tome of lab values and differentials; it was a post-modern narrative, complete with protagonists, antagonists, political struggles, telltale gaps, letters that arrive too late, and cures through love. Rather than bracketing this discovery, she and her colleagues have attempted to help physicians and patients alike to understand that illness is inseparable from our representation of it, and that we must ask not only what disease the person has, but what person the disease has.

Dr. Prall asks: "What enables an analyst to change his or her mind?"  I don't know, but it might be interesting to reflect on the case of those analysts who have done so.  For example, both Andre Green and Didier Anzieu began their careers interested in Lacan, but switched in medias res to the work of the British Middle Group.  The ability to change one's mind may account for some of the innovation we see--particularly in the case of Dr. Green. He clearly found Winnicott extremely insightful, and while growing ever more contemptuous of Lacan as the years passed, nonetheless continued to make use of Lacan's   theory of the signifier. It wasn't simply a conversion from one religion to another. Green seems to have incorporated the best of  British and French psychoanalysis long before the recent avalanche of interest in the Winnicott-Lacan   connection and in what I have called "a new Middle Group."

Final  point: I thank Dr Prall for the communitas/immunitas dialectic. I was not aware of Esposito's work and find this to be a fresh and inviting set of terms.

Warm greetings to all  from freezing Philadelphia.

Deborah Luepnitz

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