It appears we are indeed all agreed in principle that psychoanalysis is, as Freud had once put it, located 'in a middle position between medicine and philosophy' – although there is perhaps some difference in terms of the relative weight of the two types of discipline. There are no doubt some in our field who believe that 'medicine' – say, in its modern guise of neuroscience – can settle questions of philosophy, or vice versa. I am not so sure it can; or, if it could, what the relevance of these findings would be, if we agree with Andre Green (and I am not sure we all do) that psychoanalysis is first and foremost pensee clinique, as Dr Bernardi reminds us. Green challenged Stern in a debate on the relevance of infant observation for psychoanalytic practice asserting that not a single concept of any significance for our clinical work had emerged from developmental research. I feel inclined to ask a similar question in relation to neuroscience: what has it produced that makes a marked difference for our practice? Even if we managed to establish that our capacity for empathy was connected to the firing of those mirror neurons (which, I understand, is a misunderstanding of how mirror neurons work) – what would be added to our work? I freely admit to being, how shall I put it, under-informed as far as neuroscience is concerned; so maybe there are examples of this type of research making a real difference – if so, I would like to hear about them. In the meantime I guess I shall remain sceptical that understanding the brain will help us understand the mind. Or, by extension, that neuroscience can settle – as in decide – differences between the various strands within our field.


Equally, when Dr Bernardi asserts that it is 'the benefit of the patient' that should be our overriding concern, I want to say, “Yes yes, of course, how could it be otherwise,” etc. But, I have to add, the way in which that benefit is conceived – or thought to be perceived – is not exactly self-evident. There are many amongst us who would readily concede that it is always very difficult to know, even with hindsight, what if anything turned out to be the helpful ingredient in all that transpires between an analyst and his or her patient in the process of analytic work. Even if we think we know what is beneficial for our patients, it remains notoriously difficult to predict whether these benefits are going to be realised in the course of the work. Furthermore, if a group of clinicians discusses a set of clinical data, especially if this material is, as is mostly the case, narrated by the analyst involved, how can anyone claim not be caught up in an essentially hermeneutic process which, as we all know, involves a degree of circularity. It is far from clear therefore how 'the court of the clinic' can arbitrate in our disputes.


On a further point, Dr Bernardi writes, 'the core ideas of psychoanalytic approaches are certainly immune from controversies'. I am not at all sure whether that is right. As far as I can see every single one of ourcore ideas is subject to so many interpretations and revisions that I find it difficult to imagine there being wide agreement even on what must be surely two of our most central concepts, i.e. the unconscious and the transference. At best, I think, we can still identify a certain 'family resemblance' between the different versions of any given psychoanalytic concept. But what interests me most about this is that I find it difficult to decide whether this state of affairs is something we ought to deplore. Whilst we appear to be highly adapt at creating the impression of a field of study that can't even define its most fundamental concepts – an impression which can always be used to call the credibility of our whole enterprise into question – I am not sure it would be good to combat that danger by exempting certain core ideas from exposure to questioning and debate. As I indicated in a previous contribution to this discussion I find it interesting to think about our work and about our field in terms of immunity (and its counterpart community, as suggested by Esposito). But what a functioning immune system requires is not the walling off of the system from the environment. Like a healthy organism a field of inquiry and practice stays alive and generative only if it engages with what the world throws at it, even if this triggers the occasional crisis.


If we agree with these ideas (or are they sentiments?) then perhaps thinking about controversies mainly as something that it would be good to settle is not the best way of approaching them. In any case, if we were to employ our empirical faculties – or our memory – to the question of the life of controversies we'd have to conclude that they tend to be rather good at surviving. Like viruses or cancer cells they appear to have this nasty habit of adapting themselves only too well to whatever remedies we employ, and they come back strengthened, if anything, by the work-out we have put them through. Maybe, rather than seeking to end controversies by coming to an agreement, we could think of making them more productive. We could, after all, think even of what must surely have been one of the most ferocious battles in the history of psychoanalysis, i.e. the famous, or notorious, Freud-Klein controversies of the 1940s, as being generative of thought, rather than, as is usually the case, as nearly fatally destructive to psychoanalysis in Britain.


Outside these times of major historical crises controversial ideas tend to work in a quieter and perhaps more personal fashion.  I like, and agree with, the thought that what is probably happening in a shift of one's orientation is that, in the first instance, we 'import' what we take to be a single and somewhat isolated new idea, only for that new idea to start affecting the existing network of our other ideas (what we took to be our understanding of things). A new idea can take hold in a fertile mind and sprout, and, under certain circumstances, upset the existing ecology of our thinking...


Happy Easter, everyone!


Werner Prall

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