Why Psychoanalysis is not (Pseudo)scientific, but Philosophical | The Revolutionary Potential of Psychoanalysis in the Artificial Intelligence age
I:
THERE ARE THREE POSSIBLE MEANINGS OF A “SCIENTIFIC” THERAPY
Much
has been said about the scientific status or ‘validity’ of various psychotherapeutic
approaches, especially of the oldest one: psychoanalysis[1],[2],[3],[4],[5].
The commonly-held, mainstream view is that psychoanalysis is an outdated,
pseudoscientific or unfalsifiable practice based on excessive speculation
without enough grounding in empirical, everyday experience or in strictly
verifiable (and/or falsifiable) claims about reality. This is usually contrasted
with the (in)famous Cognitive-Behavioral Therapy (CBT) as well as its related
cousins (DBT, ACT, MCT, MCBT, REBT, etc.) which is considered the most
scientific “evidence-based practice”. The third type of psychotherapies,
humanist therapies (existential, Gestalt, person-centered therapy, etc.) are
either viewed as somewhere ‘in-between’ psychoanalysis and CBT, or simply
ignored in this debate.
What
is most wrong in this debate is not the answers that are given to the
questions, but the very way this debate is held. The question of whether a
therapy is “scientific” or not is a bad question because it is not clear enough
in the first place. Let’s split it up into multiple categories - generally
speaking, there are at least three different ways in which a therapy can be
scientific or not:
1. In
the results of the practice. Various psychometrics can be used
in a double-blind controlled study in order to test the effectiveness of the
therapeutic practice itself on a sample of patients. A meta-analysis, then, can
gather the results of multiple such studies, measuring the effectiveness of a
therapy in reducing various symptoms (over a period of time) of mood disorders,
anxiety disorders, psychotic spectrum disorders and many more. In this
particular case, the theory behind the therapy has no relevance, we are
simply empirically testing whether applying it in practice “works” in reducing
symptoms or not, we are not yet testing why it works. In this way of
defining the scientific status of a therapy, almost all mainstream therapies
are pretty much on equal ground in treating mood and anxiety disorders. Psychoanalysis
in particular is just as effective as CBT5, so if all you care
about is that a therapy ‘works’ in reducing symptoms, there is no reason for
you to privilege one over the other.
2. In
the theoretical foundation of the practice. CBT is a theory
of how thoughts, emotions and behavior influence each other. Psychoanalysis is
a much more complicated theory of how the ego, the unconscious and other
aspects of our minds similarly influence each other. In this case, both CBT and
psychoanalysis are unfalsifiable[6],[7],[8]. The problem that most
psychologies suffer in this regard is a reversal of time itself in the
scientific process: instead of coming up with a predictive model that starts
with a cause and waits to see if the effect will be the one predicted, the
theories attempt to retroactively explain an effect by speculating upon its
causes. Skinner’s radical behaviorism and most of evolutionary psychology are
the two best examples of this, but most of CBT and psychoanalysis apply too. Most
of these theories do not even attempt to make predictions about the future, but
instead find a human behavior or symptom, speculate upon its causes and find a
bunch of concrete examples proving only that it is possible for the
cause to be that one, not that it definitely is the one they claim it
is. For example, you can prove anything with evolutionary psychology: No matter
what human behavior you observe, you can always speculate with clear logical rigor
that it is possible for it to have had an evolutionary advantage
millions of years ago, but way harder to prove that this is the advantage it
had out of all the possible ones. If we live in a society in which people spend
a long time getting to know each other before having sex, the evolutionary
psychologists will say that it is because millions of years ago, these couples
had a higher chance of surviving by forming a more stable bond, but if we lived
in an alternate universe in which everyone had sex within the first hour of
meeting a person, the evolutionary psychologists in that universe would say
that it is because millions of years ago these people who did not wait spread
their genes faster. With evo psych, you can prove anything and its opposite.
Just like evolutionary psychology, most of CBT and psychoanalysis are also full
of vague, abstract and unfalsifiable assumptions about the possible causes of
certain symptoms, only being able to prove that it is possible that the
cause they identified is the real cause, but also not being able to remove out
of the list of possible causes all the other ones speculated by the other
therapies.
3. In
the cabinet itself. Whether a therapy is ‘scientific’ in the
cabinet itself with each individual patient has nothing to do with whether it had
scientific validity in the research lab (1st version of the
question) or whether the theory it is founded upon has scientific validity (2nd
version of the question). In this 3rd way of viewing the scientific
validity of a psychotherapy, we are asking ourselves whether the
patient/client themselves is put in the position of a scientist of their own
psyche. Only in this 3rd way of defining the scientific status
of a therapy, only here is CBT “more scientific” than all the other therapies
combined! Indeed, the theory behind CBT is unfounded, but the patient
themselves is put in the position of empirically searching for the validity of
their own thoughts. In other words, there aren’t good scientific studies proving
or disproving the theoretical foundations upon which CBT is built, but the CBT
therapist is definitely making the patient do a study on themselves, trying to
find, for example, evidence that their thoughts are ’realistic’ or not. Every CBT
therapy session is a scientific study where the patient is the little scientist
and the object of study is their psyche. That does not automatically logically
imply that the theory as a whole is scientific.
To sum up this first
part: CBT and psychoanalysis, as well as most other popular therapies, have a
lot of scientific research to prove that they can effectively reduce symptoms
over a period of time. Here, neither CBT nor psychoanalysis “wins” over the
other one. Both CBT and psychoanalysis fail to provide a consistent and
empirically valid theoretical foundation upon their therapeutic practice,
instead engaging in mental gymnastics where an effect is retroactively searched
for its causes. Here, again, neither of the two ‘wins’. Only in the cabinet
itself, CBT “wins” over psychoanalysis, because the patient is put in the
position of being the scientist of their own psyche. It seems that CBT scored 2/3 while psychoanalysis scored 1/3, does that necessarily make CBT generally a
“better” approach than psychoanalysis? No, and this leads us to the next section.
II:
SCIENCE VS. PHILOSOPHY
Where psychoanalysis
excels and is 10000 times better than CBT under every metric is its philosophical
value. By this, I do not only mean that psychoanalysis is a more useful framework
when a philosopher tries to do philosophy. That is only one way in which it
excels (ex: film theory, literary analysis, semiotics, the philosophy of
symbolism and the interpretation of mythology and pop culture, critical theory
and social philosophy, etc.). But beyond this, there is a finer distinction
between science and philosophy.
Deleuze and Guattari
define philosophy as “the art of forming, inventing, and fabricating
concepts”9. One consequence of this is what while science
attempts to (truthfully) answer questions, philosophy attempts to tell us that
we’re asking the wrong questions, or that the very way we’re framing the
questions is part of the problem. Where science settles things, philosophy
disturbs them. Where science comes with solutions, philosophy comes with more
problems. For Deleuze, a good philosopher is one that knows how to come with
the right questions and problems, not one that comes with the right answers and
solutions.
Our crisis today is a
crisis of the atopic, a crisis that only philosophy can solve, not
science. The atopic is the radically different, the wholly Other, the
completely foreign, the incomparable. The atopic is whatever is
placeless, whatever does not fit under the current system. The atopic does not
only stand out, it also stands out from all the ways in which everything else
stands out. It’s not only different, it’s also different from all the ways in
which everything is different. The atopic is meta-different, it confronts us
with difference-in-itself. Any system of categorization has a certain gap or
inconsistency that it cannot account for, like the human eyeball’s blind spot,
or like Achille’s heel. The atopic is precisely that invisible blind spot, and
a confrontation with the atopic forces us to invent an altogether system of how
to categorize things just to be able to talk about this new “thing”.
The atopic is not only
something new, it’s something that’s so new that it could have not even been
imagined up until the encounter with it, making you retroactively reinterpret
your entire past just to make sense of this new encounter. The encounter
with what is atopic is related to what Jacques Lacan calls a confrontation with
the real or what Alain Badiou calls an event. Imagine one day waking
up being able to perceive a new color – after this event, you have to rethink
the entire way you view colors in general, redesigning the entire color palette
just to accommodate for this new one.
For example, an atopic
lover is outside the logic of compatibility, they are incomparable. They are
not the same as you, nor are they your opposite. Your entire system of how to
compare people in the dating market made you think that it can describe
everyone, and yet this new person is so strange, so foreign that you have to
entirely re-invent your system of how to compare people just to accommodate for
this new person. Another example: an atopic politician is not only different
from all the other politicians, they are meta-different, they are incomparable.
They do not fit into the mainstream left and right wing, but neither are they a
moderate or ‘centrist’ compromise, they are so radically new that you have to
re-design your entire “political compass” just to accommodate for this new
politician.
One can now easily see
that only philosophy can confront us with the truly different Other, the atopic.
Whereas science applies a pre-existent framework of how reality works in order
to accurately make predictions (it solves problems, it answers questions),
philosophy tries to make us rethink the very a priori conditions for how we do
science in the first place, like that framework about how reality works, for
example. A truly groundbreaking philosophical discovery does not attempt to
answer our previous questions, but tries to reframe the entire way we ask
questions, making us realize that our previous questions did not even make sense.
In other words, the
problem with a science without philosophy is that it’s too smart. Nowadays,
everything and everyone is smart. We have smartphones, smart TVs and smart
fridges. Artificial intelligence is, at its name suggests, intelligent,
and as such, it is too perfect. What AI cannot do is philosophy, because
the philosopher is not “smart” or “intelligent”, the philosopher works
precisely in those imperfections inside science. As such, a philosopher affords
being a good idiot. In a course in Spinoza, Deleuze remarked: “To the
letter, I'd say they play the fool. Playing the fool, that’s always been one
function of philosophy.”10 Byung-Chul Han describes idiotism
like this:
“Every
philosopher who has brought forth a new idiom - a new language, a new way of
thinking - has necessarily been an idiot. Only the idiot has access to the
wholly Other. The history of philosophy is a history of idiotisms. Socrates
knows only that he does not know; he is an idiot. Likewise, Descartes - who
casts doubt on everything - is an idiot. ‘Cogito ergo sum’ is idiotic. It takes
an inner contraction of thinking to make a new beginning possible. Descartes
thinks by thinking Thought.
Today,
it seems, the type of the outsider - the idiot, the fool - has all but vanished
from society. Thoroughgoing digital networking and communication have massively
amplified the compulsion to conform. The idiot does not ‘communicate’. Indeed,
he communicates with the In-communicable.”11
III:
WHY THE ANALYSAND IS A PHILOSOPHER
Lacanian psychoanalysts have
avoided referring to that person on the couch as either a patient or a client,
instead calling them the analysand. Being a patient implies that there
is something ‘wrong’ you with that needs fixing and that the psychoanalyst
knows better than you, that they are an expert on a problem that you have less
knowledge of. But this is not how psychoanalysis works. Being a client implies a
business-like contract under the logic of capitalism, it implies buying
a service that the therapist sells, and as such, it implies predictability.
In other words, a client (of a hairdresser, of an IT company, of a car washing
service…) knows what they are getting themselves into. But this is also
not how psychoanalysis works, since psychoanalysis confronts the client with
the atopic, radically Other. Only a CBT therapist has clients.
The way CBT was intended
to be practiced was in a rigidly planned-out business-like way. Judith Beck,
the daughter of the inventor of CBT, wrote one of the most popular manuals for
Cognitive-Behavioral therapists12. In it, she wrote an entire sub-chapter
about “Setting Initial Goals for Treatment and Relating Your Treatment Plan”, a
sub-chapter about “Expectations for Treatment”, one about “Devising an Initial
Cognitive Conceptualization and Treatment Plan”, one about “Goals and Structure
of the Initial Session”, one about “Setting the Agenda” and one about “Problem
Identification and Goal Setting”, and the list can continue. In other words,
the CBT client is instructed from the very first session that it is favorable
for them to have a very specific list of what problems (symptoms) they have,
and very specific goals and expectations are set from the very beginning. This
is a scientific approach, not in the 2nd sense of the word (the
theory is not scientific), but the client himself is instructed to be a little
scientist of his psyche. Because the client is put in the position of the
scientist, no true radical change can happen. The client is constrained by the plans
they initially set out. They are even given homework, most of which is composed
of finding “evidence” proving or falsifying their thoughts. Small deviations
can be made from the initial plan, how small depending on the therapist
themselves, but these are secondary. CBT is a scientific approach geared
towards solving problems and answering questions. The theory is not
evidence-based, but the client is.
Psychoanalysis works in
the opposite ways. The analysand is neither a patient, nor a client, but a philosopher.
If the analysand is not a scientist (as psychoanalysis doesn’t force on them a scientific
approach towards their mind), that doesn’t automatically make them a pseudoscientist.
The psychoanalyst teaches the analysand on how to philosophize, where the
object that they philosophize about is their own psyche. While the CBT client
is occupied with doing scientific experiments on their own psyche, the
analysand is busy philosophizing about their psyche. Because of this, much more
radical changes can happen. One huge implication is that in psychoanalysis,
you usually do not solve the initial problems you came to treatment for, but
seek to find the deeper underlying problems. This can also (more rarely)
happen in CBT, but if it does, it’s unintended, a coincidence. But in
psychoanalysis, you are taught that the problems that you came to therapy for were
not even the real problems to begin with.
CBT hides an implicit
utilitarian philosophy geared towards the maximization of happiness. As such,
it is extremely ideological. CBT is a product of the material relations
of production in society. The compulsion to enjoy is a neoliberal imperative
towards productivity. “Hustle culture”, the obsession over achievement and
success, and the imperative to be happy as a moral obligation are other
examples. “Unlimited Can is the positive modal verb of achievement society.
Its plural form—the affirmation, “Yes, we can”—epitomizes achievement society’s
positive orientation. Prohibitions, commandments, and the law are replaced by
projects, initiatives, and motivation. Disciplinary society is still governed
by no. Its negativity produces madmen and criminals. In contrast, achievement
society creates depressives and losers.”13.
The discourse of the
self-help industry is indicative of the alarming ways we talk about change
today. Nowadays, we do not treat ourselves as subjects, but as projects.
Everyone wants to “work on themselves”, everyone wants to “invest” in their potential,
to “develop” their skills. Personal change itself is viewed as a business-like
transaction with goals, plans and expectations set from the very beginning14,
just like in CBT. As such, the ‘subject-project’ of the self-help industry or
of CBT can never be truly taken by surprise. No atopic change can follow
from a business-like contract with your own self. But to be truly free, one
must be free from the constraints imposed on oneself. As such, I believe that in
order to be free, one must be able to take one’s own self by surprise. Radical,
atopic change is truly painful: you are quite literally “shocking”
yourself; it is felt like an electric shock.
Psychoanalysis, on the
other hand, is geared not only towards the reduction of symptoms like
depression and anxiety, but such a radical change in personality and life
philosophy that it is often felt like a metaphorical death. The psychoanalyst
does not instruct the analysand in the first sessions to set goals and “a
treatment plan”, because the change it sets out to make is so radical that the
analysand should not even be able to truly understand its full glory in the
beginning (else they wouldn’t be truly taken by surprise). Psychoanalysis is a
leap of faith, an adventure into the unknown. Because of this, psychoanalysis
does not give in to the 21st-century neoliberal ideology of
happiness. After analysis ends, the analysand learns how to find meaning in
their suffering, not how to optimize their brain into being happy. The meaning
of life should not a utilitarian maximization of happiness.
After the death of God, a
nihilistic search for happiness, health and comfort is declared as life's
meaning by Nietzsche's last man. "‘We invented happiness,’ say the last
human beings, and they blink.”15
IV:
ARTIFICIAL INTELLIGENCE
Artificial Intelligence
will never replace a psychoanalyst, nor will they replace the analysand. Neither
of the two people in the analytic relationship engage in any behavior that may
be automatized by Artificial Intelligence. A CBT practitioner, on the other
hand, might be partially replaced by AI. In CBT, the client is instructed to
think that their symptoms (depression, anxiety, mania, etc.) are caused by
certain beliefs that are objectively wrong. The CBT therapist, then, is
automatically assumed to be an expert on how to think correctly, and they are
paid to train you how to think like them as well. Because of this, they
identify logical errors (‘cognitive distortions’) in your thinking. For
example, a depressed patient may claim “everyone hates me”, and the CBT
therapist will make them write a list of ten situations in life in which they
have valid, empirical evidence that another person in their life actually hated
them, hoping that the client will fail, realizing that their thoughts were ‘objectively
false’ (because of a cognitive distortion called “black and white thinking”).
If the client succeeds in writing this list, the therapist might now tell them
to do the same with situations in which someone loved them. Their hope is that
if their thoughts are corrected to be more realistic or “adapted to reality”,
their behaviors and emotion will also follow to be “corrected”.
First off, “adaptation”
or “being functional” are conformist categories. Second off, an AI can be
trained to identify logical fallacies and cognitive distortions. Both the
therapist and the client in the CBT relationship are put in the position of an
AI. The client is treated like an AI language model. Their thoughts are treated
like a piece of computer code that has a bug somewhere and must be “debugged”.
The therapist is also trained to think like an AI language model. Only chatbots
do not understand subtext and implications. AI chatbots have an autistic
relationship to language, they interpret social situations literally and do not
understand contextual cues or the hidden meaning behind people’s words. The CBT
therapist is trained to think like an AI language model: when the depressive
patient says “Everyone hates me”, they interpret it literally, instead of
understanding the possible implications (which change depending on context,
ranging from a provocation towards the therapist to do something, to a cry for
help or attention, etc.).
Under the regime of AI
automatization, every piece of reality that can be copied will be copied,
simulated and replaced. Only those people who are truly atopic will
remain, because they are unreplaceable, incomparable, they crash the entire
system of how to compare people in general where the AI has not been trained on
people like them. Those people who are atopic, who are not merely original or
unique, but also different from all the ways in which everyone else is
different, only those will avoid being replaced by AI.
Slavoj Zizek likes to
joke about how capitalism takes the essence out of commodities. We have coffee
without caffeine, beer without alcohol, soda without sugar, sugar without
calories (artificial sweeteners), smartphones without the possibility of
calling (tablets), etc. Now we also have natural selection without nature.
Artificial Intelligence is, quite literally, a form of unnatural selection.
It’s an artificial selection. Those who fit in with the crowd will be simulated
and replaced by AI. Those who stand out from the crowd will also be replaced by
AI. Only those who stand out in the very way in which they stand out can crash
the system and produce something radically new, atopic. Because of this,
both philosophy and psychoanalysis are more relevant than ever before.
Psychoanalysis is not outdated. Now it’s more relevant than it ever was, even
compared to its inception.
NOTES AND REFERENCES:
1: Oliver Burkeman, “Therapy wars: the revenge of
Freud” (2016); https://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy
2: Drew Westen, "The Scientific Legacy of Sigmund
Freud: Toward a Psychodynamically Informed Psychological Science" (1998); https://sci-hub.se/https://doi.org/10.1037/0033-2909.124.3.333
3: Mark Solms, The scientific standing of
psychoanalysis (2018); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020924/
4: Erik R. Kandel, “Biology and the Future of
Psychoanalysis: A New Intellectual Framework for Psychiatry Revisited” (1999); https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.156.4.505
5: Jonathan Shedler, “The Efficacy of Psychodynamic
Therapy”, (2010); https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf
7: https://melbournelacanian.wordpress.com/2014/02/03/a-critique-of-cbt-as-ideology-part-1/
8: https://www.amazon.com/CBT-Cognitive-Behavioural-Managerialism-Corruptions/dp/1782206647
9: Gilles Deleuze and Felix Guattari, “What Is
Philosophy?”, Chapter 1, p.2
10: Gilles Deleuze, Spinoza cours du 02/12/80, at
www2.univparis8.fr, and Philippe Mengue, Faire l’idiot. La politique de Deleuze
(Paris: Germina, 2013).
11: Byung-Chul Han, “Psychopolitics: Neoliberalism and
the new technologies of power”, p. 82
12: Judith S. Beck - Cognitive Behavior Therapy:
Basics and Beyond, 2nd edition (2011)
13: Byung-Chul Han, “The Burnout Society”, p. 9
14: https://lastreviotheory.blogspot.com/2023/06/change-today-why-both-stability-and.html
15: Friedrich Nietzsche, “Thus Spoke Zarathustra”, p.
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