Those given to an Eastern bent of mind are fond of quoting the saying that there are many paths up the mountain. It is no doubt true. But while the different paths may end at the same point, they are not the same thing, at least not when it comes to what we call the talking cure. The diverse therapies under this umbrella range far and wide, but I propose breaking them downs into two camps – those that rely on suggestion, the best example being hypnosis, and those that rely on Freud’s analytic technique; psychoanalysis being the exemplar. Both work with speech and deploy jargon but to keep it simple let’s use the analogy Freud employed to tell the difference. Freud, as he often did, turned to art to explain himself, in this case the formula that Leonardo da Vinci devised to distinguish painting from sculpture. Painting, the great artist declared, worked per via di porre – by adding a substance to where there was nothing – while sculpture worked per via di levare – removing substance to show what is hiding beneath. The first method is aligned with suggestive therapies while the second could be compared with psychoanalysis.
In a culture organised around winning, adding is pretty attractive, which explains why the can-do modalities, such as life coaching, and I would say, CBT, or Cognitive Behavioural Therapy, are with us. The second option, removing, or losing, however, is unlikely to make the cover of a glossy magazine, which goes some way to accounting for the marginal place today of psychoanalysis. Analysis did have its time in the sun after the war, but some analysts lost the plot, giving advice and much more to their Hollywood patients, like Marilyn Monroe – but that is another story. For now, let’s stay with the original da Vinci code: the formula that sees therapies as either adding or taking away. What fits in the first group? Advice giving, yes, but who does that? These are tricky definitional issues.
Psychoanalysis, according to the Shorter Oxford English Dictionary, is, “analysis of the unconscious forces believed to affect the mind.” This strikes a note of reserve – unconscious forces are “believed” rather than bound, to affect the mind – and terminology – the key word here is “unconscious.” Also mentioned in the definition are words Freud used to describe his invention; transference and free association. Not bad for a short description of a topic upon which professionals can’t agree. Psychotherapy is defined as: “The treatment of disorders of emotion or personality by psychological methods.” It is not clear what these “psychological methods” are, but no mention is made of the unconscious or any of Freud’s terms. The two approaches would then seem distinct, even though both owe their inspiration to Freud. I offer these dictionary definitions, not because they are expert or exhaustive, but because they represent what intelligent women and men in the street might make of fields that are confused and confusing. There is also something to be said for the brevity of the descriptions, and the boundaries they imply. The unconscious is the key dividing line and it is to the unconscious that we have to go to consider what a fuller definition of psychoanalysis and psychotherapy might be. Like novelist, L. P. Hartley’s past, the unconscious is Another Country; things are not only done differently there; they are opaque. For Freud it was Another Place, a kind of notional country, you can visit but not stay.
It was, however, not the same as what philosophers meant when the spoke of the unconscious. Freud wanted to avoid the “depths of philosophical obscurities,” though he admitted he could not sidestep “unpleasantness of various kinds”. This was because what he called the unconscious was that – not on the surface – as a result of deliberate forgetting. To uncover it meant remembering and that could be painful. As with removing stone for a sculpture, it involved a loss, not a gain. And unlike Dan Brown’s da Vinci code, it did not occur magically or even didactically, and not with any assurances.
If this definition holds, the dividing line between talking cures is the unconscious. Working with the unconscious – that is, what emerges unexpectedly in slips of the tongue, dreams, jokes and symptoms – is one thing, relying on suggestion, another. Novelist Martin Amis captured the flavour of this when he spoke of his mid life crisis. It puts you, Amis said, on a “beachhead of pain that your cliché has created”. Getting better was not a decision like say, buying a new car, or asserting that I will be a better person. It came from letting something go, in this case, the pleasure of something familiar and destructive – fooling yourself – Amis’s cliché. It was not a conscious act. “The conscious mind can afford to give itself a rest,” Amis said. “The big jobs are done by the unconscious.” His words reminded me of the patient who discovered he had been faking his life, getting up each day to plagiarize himself. After enduring the years of loss an analysis entails he realised, for the first time, he had a choice. It did not come by adding to what he thought he was, but from traversing the terrible weariness of finding out that he had never really been alive, that he was only being born, almost on the eve of his death.
