Applied psychoanalysis in mental health: Can we reconcile the pragmatism and the poetics of practice?

There is arguably a deep paradox at the heart of psychoanalysis and it is one that can easily be caught sight of. Thus, on the one hand, one is confronted with the undoubted significance and importance of psychoanalysis which, ardent critics aside, is arguably alone among the psychologies in being capable of reaching deeply and intensely into the human soul. It achieves this via a theory and clinical process that is at once complex, reflexive, richly descriptive and finely differentiated in its approach to human subjectivity. Indeed its significance and impact extends well beyond this, especially when one sees how psychoanalysis has left, and continues to leave, its impress on so many areas of human endeavour; ranging from developmental psychology to psychological treatment, from feminism and identity politics to social theory, from art and media studies to philosophy, and so on. Despite this it can be fairly stated that psychoanalysis today is in crisis and especially so in the English speaking world. This is evident when one considers, firstly, the sheer level of what might be termed “Freud bashing” in the popular media, secondly, the diminishing numbers of trainees in psychoanalytic institutions and/or interested students within the Universities, thirdly, the lack of public demand for psychoanalysis as a therapy, and, fourthly, its marginalisation in terms of having neither a well established public funding base nor a meaningful and influential voice within society at large. Given this paradox (of being simultaneously valued and dismissed), and more particularly the nature of the above mentioned crisis, it is essential that this state of affairs is both understood and addressed especially by psychoanalysts. The idea that psychoanalysis, at least as we know it today, could disappear needs to be treated as a simple reality which exists on the horizon of possibility. Moreover, it needs to be recognised that the sources of its demise are potentially multiple. Consider, for example, the inevitable progress of psychopharmacological interventions, the growth in alternative therapies such as cognitive-behavioural therapy, cognitive-analytic therapy, dialectical-behavioural therapy, and the many so called “brief” and “narrative” therapies (to mention but a few), alongside the economic, moral, and political forces at play in the arena of mental health and the possibility of such a marginalisation in this essential field of practice, seems more than just a mere possibility. While this latter area will form the main focus for this paper it is worthwhile, at least initially, to consider the nature of this crisis from within a broader perspective.