Why the Clinic is Politics

This paper was presented by Ian Parker at the ‘Psychoanalysis and the Public Sphere: Social Fault Lines’ Zoom conference hosted by the Freud Museum in London in September 2020

The clinical work we do is political, the clinical is political, but that’s easy to say, and it’s a statement that is dangerously multivalent, with consequences that take us in diverse contradictory directions, clinically and politically. The real question is how it is so, how does the political realm enter into our clinical practice, and, as the flip-side of the question, how does clinical practice find its way into politics.

The difficulty we face in trying to answer that question is, among other things, because the conditions in which the clinical and the political are linked, the ways they intersect, are profoundly contextual and historical. There isn’t one answer to the question, and the underlying nature of the political-economic system that has given rise to the ‘clinical’ as a distinctive phenomenon, a recent phenomenon, is characterised by unremitting mutability, by continual deep transformation of what is social and what is personal.

Marx captured the nature of this specific difficulty in this political-economic system, capitalism, when he noted that its innovative spirit is such that all existing social relations are dissolved, repeatedly dissolved, that, as he put it, ‘everything that is solid melts into air’. But just as certain configurations of social structure and interpersonal relationships seem to evaporate, so others form to take their place.

They re-form around the underlying material parameters of this society in which alienation is endemic, capitalist society, the kind of society that calls upon clinical practice to heal the psychic wounds and to adapt people to unliveable circumstances. And they re-form around relations of power, including hetero-patriarchal relations that were critically challenged by the socialist feminist slogan that the personal is political.

So, we have a task of mapping the coordinates of a complex changing society, a society which constitutes the ‘clinical’ in a particular way. And we have a more difficult task, of mapping the changes that make some kinds of political intervention at the level of subjectivity possible. That second more difficult task includes mapping changes that make some kinds of political intervention at the level of subjectivity impossible or, at least, that make it susceptible to immediate recuperation, neutralisation and absorption of our work back into the very thing we thought we were pitting ourselves against.

Now it is understandable that one response to this situation is to appeal to what is really there under the surface, to what has been disclosed by scientific reason, as if the rot set in with postmodernism and relativist cultural discourse rather than being a condition of life under capitalism. That way, in our clinical training and practice, lies the lure of neuroscience and, to put it simply, a return to psychiatric versions of psychoanalysis.

It is equally understandable that another response to this situation is to appeal to deep connection between people, an intuitive relationship in which there is quasi-telepathic access of unconscious meaning via counter-transference or even a reciprocal disclosure of experience in order to create deeper social bonds. That way, in our clinical training and practice, lies the lure of commonsensical humanism and, to put it simply, an embrace of psychotherapeutic versions of psychoanalysis.

We learn from historical analyses of surveillance and confession that operate in such a way as to provide the cultural apparatus of a globalised capitalist economy that these two responses are not in simple immediate competition with each other, but are twins. They, surveillance and confession, together lock us into social relationships that, at the one moment, define how patients are expected to think and feel, and, at the next moment, require clients to configure their experience according to dominant structures of feeling.

The danger is that psychiatric and therapeutic versions of psychoanalysis very easily channel their own clinical discourse into paths that intensify the public character and public evaluation of personal life as well as the political moral regulation of the private sphere. Rather than provide gentle reminders that it is good to talk and to share feelings, psychoanalysis is thereby drawn into an incitement to speak in a certain kind of way and to reinforce models of subjectivity that pretend to define what is normal and what is abnormal.

Psychoanalysis that respects the singularity of the human subject also necessarily stands against the globalisation of its discourse as if it were a universal grid, as if it were a worldview, and against the reduction of analysands to particular constellations of pre-defined characteristics. We shift our focus from the fantasy of an immutable biologically given bedrock of development and disorder to the relation between the subject and language. We treat the elements of the mind we refer to in our work not as having been discovered by Freud and his colleagues but as being invented for us to make use of in our clinical work. And we refuse to use our own understanding of these processes as a tool of suggestion either inside the clinic or outside it.

That is why we need political analyses of the place and role of the clinic, to treat the clinic as a form of politics as a problem as well as an arena of struggle, as an arena where we struggle against the very form that enables our work to take place.

This is one part of the FIIMG project to put psychopolitics on the agenda for liberation movements