There is, of course, a progression in the degree of generality of concepts. As we know so well, the more general a law, the more valuable it will be. However, when we question the origin and unity of laws, we come across an indeterminate generality – the being of the Greek philosophers, a unicity, or the person of the German philosophers, equally indeterminate. The same way the being has no category for Aristotle, the person is also without category for Kant. In all cases, both are unique, while singularity – as we know since Aristotle – cannot be known by science because it is not a common object among others. On the contrary, singularity is the opposite of generality and therefore irreducible to it. In The Phenomenology of the Spirit (in which the philosophical concept of unconscious first appeared), Hegel would define the passage from the intellect of knowledge to its subject as a dialectic transit from cognition to… recognition. Which, in other terms, means the transit from epistemology to ethics.
The medical psychiatric act is also an ethical one
Consequently, the medical psychiatric act is also an ethical one. It brings into relation, from the very beginning, two subjectivities. It couldn’t be otherwise, given that a person cannot be confirmed by an object – be it of knowledge – but only by another person. As in philosophy, the psychiatric ethic has no “object of knowledge”. First, because the being is no object, secondly, because reducing a person to the status of object would mean a downright “personal offense”. Nevertheless, if the human being is reduced to a supposed (individual or group) “objectuality”, if he becomes a simple means and not an aim in itself (as Kant insists it should be treated), then the person may be indeed equaled with the sum of his functions (cognition, willpower, memory etc.). He becomes a sort of sui generis clerk, and in this case the clerk’s functions may be assessed by questionnaires. This happens every day in our world ruled by expert evaluators. But, we may ask, who evaluates the experts? We are confronted here with the eternal problem, which is also juridical, of the difference between legal and legitimate. A psychiatrist or psychoanalyst may apply the standard procedures, but misses the singularity of the patient. In this case, it is no longer about the ill person, but the illness. The procedures imposed by our contemporary society are hypocrite to say the least: we are not interested in the clerks’ “personal life” as long as “they do their job”. We do not refer to the person’s intimate life, but to her quality as a person (or not). Let us remember the famous case of Lubitz, who committed suicide by also bringing down to death the 149 passengers of the plane he piloted. All the inquests showed him as an excellent “clerk”: good pilot, well behaved, he paid his taxes, he had a proper conduct in relation to colleagues, neighbors etc. The journalists’ conclusion: “It could happen to anyone!” Here is a manner, rather frequent unfortunately, of indirectly attacking both psychiatry and psychoanalysis. Because there had been an “interruption” of six months in his training as a pilot (for “severe depression”), due to the fact that he had just been left by his girlfriend and because, seeing the state he was in, his psychiatrist prescribed medical leave… Which obviously he did not observe. A pure ethical issue therefore. What’s even more outrageous, a private psychiatrist called him a “psychotic”, a term not included in our politically correct ICDs. Why did the official psychiatrist fail to notify the patient’s superior about the potential danger for the passengers? Because he was constrained by law to observe the confidentiality of the medical data. Is there any value in a psychiatrist’s diagnosis? On the other hand, when questioned regarding the permission granted to Lubitz to pilot during his further “career”, his superior defended himself by showing the favorable reports of the repeated psychological assessments, all of them stating “fit to fly”. Assessments that, unfortunately, were a sum of procedures. A long and well established principle of psychoanalysis is that psychotics tend to avoid the anguish – often unbearable – of the “other”, who is by definition “unpredictable”, therefore “threatening”, an avoidance based on a well controlled, repetitive behavior, purely functional… namely procedural. But it is one thing to observe the rules due to simple training, answering questionnaires “properly” – especially by intelligent persons (which is also the case of perverts), and a totally different one to “understand” and assume subjectively the principle from which these rules spring. A purely cognitive understanding may be a passion, an ethical one is compassion. This is why the psychoanalysts find that the simple training of the patients proved to be guilty is not enough for their bailout on parole when they lack a minimal ethical internalization. Relapse into crime will be almost certain. We see this on the occasion of every amnesty. Despite the expectations, the limit of the “common knowledge” of the “soul” is applied quickly to the amateurs of psychiatry and psychotherapy (everyone seems so ready and capable for this vocation): the amateurs will never understand the satisfaction – indeed, satisfaction! – accompanying the acts of sadists, masochists or killers, the only possible explanation of the repetitive nature of their behavior.
Psychoanalysis would say: the satisfaction of the passage to act
Psychoanalysis would say: the satisfaction of the passage to act. Because they did not succeed in discovering, like Freud, that any psychic symptom is accompanied by joy, and not only the psychotic ones. What value and, consequently, what support could have nowadays a psychiatrist working in a prison, knowing that, according to French statistics, over 40% of prisoners have psychiatric problems? Spelt “psychosis”! It is a rhetorical question of course. In the beginning, I was also very surprised to learn that a good friend of mine, director of a renowned psychiatric hospital in France, asked to be transferred to the prison – no less renowned – of the same town. He would find there a very rich and at the same time “unwonted” psychiatric case variety. Moreover, he got rid of the tremendous “procedure” paperwork that thwarts a psychiatrist’s course of work.
(to be continued)