Caring, Austerity, Psychoanalysis
Reflecting on the psychoanalytic approach to care, then, helps us appreciate how psychoanalysis understands the absence of certainty as the presence of possibility.
Caring is typically associated with an active effort to fix a problem through the introduction of a solution. For a solution to be offered, it must be known. Thus, when we imagine acts of caring we think of calming someone by giving them a hug, making a food donation to alleviate hunger, or advocating for the repeal of legislation that unjustly effects a marginalized group. Psychoanalysis understands change, and thus caring, quite differently. From a psychoanalytic perspective, caring might be best understood as an openness to possibility. Rather than presume the need to know a solution to facilitate change, psychoanalysis emphasizes the potentiality that only becomes accessible when explicit attempts to know are replaced by efforts to engage more deeply and meaningfully with not knowing. Reflecting on the psychoanalytic approach to care, then, helps us appreciate how psychoanalysis understands the absence of certainty as the presence of possibility.
Reflecting on this dissonance between psychoanalytic and mainstream definitions of caring enriches efforts to understand a pressing social problem: the dearth of caring that is a defining element of our increasingly authoritarian world. Integral to this aspect of our world, I believe, is the obsessional need for certainty that permeates contemporary life. This mandate for certainty is evident in the way in which governments and corporations privilege efficiency, measurable results, and quick fixes over all other attempts at solution. Straying from certainty is quickly penalized; in a world of austerity, failure to demonstrate your value means being defunded, fired, erased. The unknown and its inherent potential becomes a thing to be feared and avoided.
It is no surprise, then, that there is little room in our world for an imperfect and resource-intensive endeavor like psychoanalysis. But my goal here is not to discuss the marginalization of psychoanalysis. Rather, I hope to explore how the social mandate for certainty informs an internal process, a psychical austerity, that plays an equally important role in terms of the absence of caring.
Let us begin with an example. We all know to be on guard when our employer tells us productivity must increase and attention to efficiency needs to be enhanced. We know this is codeword for exploitation. We will work more and earn less, work harder while having fewer of the resources needed to do our job. This austerity is not the psychic austerity of which I speak. That would be as follows: a patient of limited means seeks mental health services at a facility funded by a grant from the local city government and charitable donations from local businesses. The patient, who is apprehensive about asking for help given her less than positive experience with the government agency that recently denied her application for welfare, is told by the clinic intake staff that the treatment of choice is "evidence-based" therapy. The staff explains this therapy will lead to significant changes in her mood and behavior within six months. While brief, the treatment focuses on teaching her skills that have been shown by science to lead to change.
This all sounds very unlike what the patient had in mind. She had envisioned connecting with a therapist with whom she could talk about what is on her mind and have an opportunity to heard. But the prospect of a speedy solution to her issues was appealing and learning skills sounded a lot less threatening than opening up about private things to a new person. Also, the assurances from highly educated professionals who clearly came from much more privileged backgrounds than her own was reassuring. She put aside her instinct to find someone with whom she could talk openly and elected to participate in the recommended treatment. It felt like the right thing to do, the smart thing, the rational thing. She attended six months of manual-based therapy in which her job was to learn pre-determined skills taught to her by her therapist. After termination, she was told she had the option of joining a support group at the clinic or just continuing to receive medication from the clinic psychiatrist.
“Just as one cannot properly understand psychological problems without their social and cultural background, neither can one understand social phenomena without knowledge of the underlying psychological mechanisms.” Eric Fromm
While brief, I hope the above example brings to life my thesis: while some instances of austerity clearly leave a bad taste in our mouths, other examples go down easily, we may even choose to pursue them, and in doing so derive a sense of purpose and satisfaction. But this is not merely a psychological experience. It is simultaneously a social phenomenon, part of an exchange that brings to life and then reinforces political and economic ideas about how the world should be. From a socio-psychoanalytic perspective, this hypothetical patient's experience highlights Fromm's argument that, “Just as one cannot properly understand psychological problems without their social and cultural background, neither can one understand social phenomena without knowledge of the underlying psychological mechanisms” (Fromm, 1994, pp. 134).
The fear of possibility, inseparable from the desire for certainty, is a natural mindset that becomes exacerbated when material conditions are arranged in a way that intensifies the risk associated with engaging with the unknown.
And what is the dual psychological-sociological experience to be understood in the example I give above? It is the way in which the mind and the environment interact in a dialectical symbiosis. This symbiosis was first discussed by Freud in his ideas regarding the way psychical experience, and indeed the very psychic structure that mediates it, is grounded in the mind’s evolving relationship to the inevitable tension between the desire for pleasure and the demands of reality. Fromm expanded this conceptualization by emphasizing that, in our era, reality cannot be understood in its totality without appreciation of its relationship with capitalist ideas about how the material conditions of society should be arranged. In this model, the primary task of the psychic apparatus is to establish and maintain mental equilibrium in the context of capitalist reality. Our minds, Fromm says, maintain psychological equilibrium through a process that, in navigating the demands of capitalist life, simultaneously maintain and strengthen the same conditions. Thus, for Fromm, neurosis, and ideology both, “result from unbearable psychological conditions and at that same time offer a solution that makes like possible.”
Scott Graybow, PhD, LCSW, is a candidate at the Psychoanalytic Training Institute of the Contemporary Freudian Society. He is a member of the International Erich Fromm Society, the American Association for Psychoanalysis in Clinical Social Work, and the International Psychoanalytical Studies Organization. He is editor of Progressive Psychoanalysis as a Social Justice Movement (2017, Cambridge Scholars Publishing) and author of peer-reviewed articles about psychoanalysis, Marxism, and the political economy of mental health.
The fear of possibility, inseparable from the desire for certainty, is a natural mindset that becomes exacerbated when material conditions are arranged in a way that intensifies the risk associated with engaging with the unknown. In the process, fundamental aspects of the act of being human are discouraged and become marginalized: spontaneity, creativity, curiosity. While in the past socio-psychoanalysis most famously explored psychological alienation in the face of material exploitation to understand human attraction to authoritarian leaders, I argue today’s world requires we consider this phenomenon to better understand all aspects of our daily life. In a world where even mental health is considered fair game for privatization and austerity measures, we must remember that exploitation does not always feel or appear detrimental. To the contrary, it may be presented in language that is fully consonant with our ideas about fairness and our commitment to the primary importance of science. Internally, engaging with them may not only feel oppressive, but positive. Our world, a world in which even the research and practice of psychotherapy is considered evidence based when it operates according to market principles (high return for low investment), does little but exacerbate the psychological alienation Fromm identified as being behind the human desire to submit to authoritarianism. Individuals living in such a world become primed for an internal shutting down, a limiting of emotional openness and resulting discomfort with uncertainty, that alienates us from our humanness while enabling us to maintain the status quo without conscious conflict. Such a mind, perhaps, has little capacity for caring and the prerequisites for caring: openness to uncertainty and comfort sitting with the unknown.