The Therapist (1937) by Rene Magritte
I recently attended a lecture entitled “Bridging Psychoanalytic and Psychedelic Therapies: Ethical Considerations” hosted by the UNC School of Social Work. It was sponsored by the North Carolina chapter of the American Association for Psychoanalysis in Clinical Social Work.
The lecture was light on both psychedelic and ethical considerations, focusing mostly on a “case” of long-term therapy — eight years — and, late in the presentation, the introduction of ketamine into the therapeutic relationship. In the case history, the introduction of ketamine is closely associated with what is suspected to be the impending conclusion of the relationship.
The respondent, a psychiatrist on the faculty at Duke University, expressed his worry about ketamine-assisted therapy like this: ketamine exposes therapists to the temptation of “magic,” or the allure of mysticism. We are in big trouble, he warned, if what we are left with is mysticism.
By magic, the Psychiatrist seemed to mean the “unknown” — the worry that ketamine will situate therapists in theoretical territory beyond the reach of standard psychoanalytic technique. But his concern about mysticism reveals something more.
Mysticism is often anti-authoritarian. It is also, in my view, masturbatory. It does not lend itself to a relationship outside of the self.
The difference between psychoanalysis and, say, reading a book is that there is another person in the room. A therapy that collapses into mysticism loses that other person — and with them, the entire point of the treatment.
During the audience question period, the anti-authoritarian subtext became text. The predominant concern felt like this: Is ketamine like “AI” in the therapeutic space, reducing the importance — and authority — of psychoanalysts?
What is ketamine figuring in this conversation between medicine and psychoanalysis?
Ketamine is becoming another chapter in a long history of attempts to alter the analysand’s consciousness (think hypnosis). The idea is that because psychoanalytic treatment is so beset by defenses, the time and effort involved in treatment could be signfucantly reduced by relaxing or altering consciousness.
It is already quite clear that ketamine does alter consciousness, allowing repressed or traumatic or embarrassing materials to surface. But what is one to do with that material, especially if it is revealed outside the therapeutic “container”?
The so-called “medical model” clearly threatens psychoanalytic “practitioners” (a strange fact given the early wedding of medicine and psychoanalysis: e.g., Freud, Winnicott, and Laing were all medical doctors). If the mere appearance of unwanted material, combined with the specific neurological repair ketamine provides, resolves the underlying psychological issues — then why, indeed, is a therapist necessary?
This is where an unexpected ethical consideration surfaces, and it is not the one the lecture explicitly promised. The question it raises is: What is the analyst’s responsibility to the analysand?
Let us assume that one of the things ketamine does is alleviate psychological pain — more or less, and for good — thereby empowering patients to better live their everyday lives outside the doctor’s office.
Why isn’t a goal of psychoanalytic treatment to free analysands from psychoanalysts, by training them, through the treatment itself, to think psychoanalytically for themselves, outside the therapeutic container?
I asked a similar question of the presenter. It was taken in the most trivial way possible: Isn’t the goal to help the patient live without the analyst?
Practitioners may need ketamine treatment to think about the question I did ask: why must psychoanalysis end when the psychoanalytic relationship does?
The Psychiatrist dismissed my question as an instance of the “fetishization of Freud” (Freud was never himself analyzed). But I would describe my ongoing obsession with Freud as a desire to think psychoanalytically about my everyday life.
The liberation of psychoanalysis from the “therapeutic container” is not mysticism. It is, or ought to be, psychoanalytic politics.
Several practitioners attending the lecture were explicitly curious about — and, it seemed to me, suspicious of — the presence of a theologian in their midst. With good reason, perhaps.
Why would “patients” (like me) want to hear themselves spoken of as “cases,” as susceptible to falling off the wall of dissociation as Humpty Dumpty, as incapable of learning to think about their own lives in such a “specialized” way?
There is a reason psychoanalysts don’t run for office or have much to do with public policy.
What was presented at that lecture as an ethical consideration was, in fact, an institutional one. And, as far as I could tell, nobody in the room wanted to see the difference.
I left the lecture feeling depressed.
In fact, my experience of the lecture is best illustrated by what I witnessed beforehand.
I arrived early (as instructed) to park and register. The School of Social Work was locked. I only got into the building because a door was left ajar.
People started showing up for the lecture, but now all the doors to the School were locked. I let people in. In fact, the School’s representative mistook me for the lecturer.
Eventually, the Organizer of the event noticed the locked doors and propped one open: a very reasonable, and long-overdue, solution to the locked-door problem. Even so, the Organizer asked the School’s representative if “they had a better or different solution.”
What would that be, exactly?