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Les Jeudis de la B.I.U.M.


Salle de lecture de la BIUM (© Wikipedia)

Programme des séances 2012-2013

Le rendez-vous est fixé, à 14 heures 45, au pied au pied de la statue La Nature se dévoilant devant la Science, en bas de l’escalier menant à la bibliothèque de l’École de Médecine (Bibliothèque Inter-Universitaire de Santé):

12, rue de l’École de Médecine – 75006 PARIS

Pour tout renseignement :

8 novembre 2012

Présentation du programme de l’année. Actualités.

L’affaire Yves Bertherat – Stanilas Capitolin (1967)

6 décembre 2012

Thérapeutiques physiques et biologiques. Hasard et sérendipité

3 janvier 2013

Une épidémie hystéro-démonopathique en Savoie sous le Second Empire : Les possédées de Morzine (Haute-Savoie)

7 février 2013

Le Traitement moral de la lypémanie

7 mars 2013

Les premières femmes médecins en psychiatrie

4 avril 2013

Les psychiatres et l’Académie de médecine

2 mai 2013

Le haschich

6 juin 2013

Séance délocalisée à la Bibliothèque médicale de Maison-Blanche, 18 rue Rémy de Gourmont 75019 Paris


Book Review – Mikkel Borch-Jacobsen and Sonu Shamdasani, The Freud Files: An Inquiry into the History of Psychoanalysis (Cambridge Univ. Press 2012)

Mikkel Borch-Jacobsen and Sonu Shamdasani, The Freud Files: An Inquiry into the History of Psychoanalysis (Cambridge Univ. Press 2012)

Mikkel Borch-Jacobsen, Making Minds and Madness: From Hysteria to Depression (Cambridge Univ. Press 2009)


By Simon Taylor

Beginning with the French publication of The Freudian Subject in 1982, Mikkel Borch-Jacobsen has established himself as one of this generation’s foremost historians of psychoanalysis. Strongly influenced by the intellectual atmosphere of late-1970s France – including the thought of his teachers Philippe Lacoue-Labarthe and Jean-Luc Nancy – his work is known for its dense theoretical expositions, close readings, and forensic attention to detail. It has also, from the beginning, been characterized by a relentless and penetrating critique of Freud and the psychoanalytic endeavour as a whole; as early as The Freudian Subject, Borch-Jacobsen declared that, “All this (psychoanalysis, in short) was nothing but a great egoistic dream” bolstered not only by Freud himself, but also by “the throng of parricidal listeners and readers.” (239) He has, if anything, become more strident in his criticism since then, most notably in his work on hypnosis and his deconstruction of the “first analysis,” Remembering Anna O.: A Century of Mystification. Taken together, the two works under review – The Freud Files, co-written by the equally prominent Jung scholar Sonu Shamdasani, and a collection of essays dating from 1994-2008 entitled Making Minds and Madness – constitute something approaching Borch-Jacobsen’s definitive statement on Freud and his legacy.


The Freud Files takes the form of a full-frontal assault on what the authors, following the example of Henri Ellenberger and Frank Sulloway, refer to as the “Freudian legend.” The legend, at least as Borch-Jacobsen and Shamdasani conceive it, consists of two separate elements: the myth of Freud’s self-analysis and what they refer to as the “immaculate conception” of psychoanalysis. Combined, these myths constitute nothing less than a complete rewriting of the historical record, a sleight of hand that subsequent generations of analysts, historians, and the public at large have been complicit in perpetrating. In tandem with the sequestering of the Sigmund Freud Archives – a cache of material protected by an extraordinary set of restrictions engineered, according to the authors, to ensure that the true record of the birth of psychoanalysis would remain off-limits to all but the faithful “guardians” (28) of Freud’s legacy and justified by the spurious demands of patient confidentiality – these myths have for many decades deliberately placed the Freudian legend beyond the scrutiny of historians. “For a discipline concerned with the past,” the authors note, “psychoanalysis is strangely allergic to its own history.” (32)

Much of The Freud Files is devoted to undermining the myths that bolster the legend. Let us take them in turn, beginning with the immaculate conception. Although virtually every aspect of Freud’s theory that we take to be distinctively psychoanalytic had been formulated by his predecessors or contemporaries – from Schopenhauer’s adumbration of repression and the sexology of Krafft-Ebing and Havelock Ellis to Hartmann’s “philosophy of the unconscious” and Breuer and Anna O.’s development of the “talking cure” – Freud and his followers first argued, and then simply affirmed again and again, that these sources had played no role in the development of psychoanalysis. Indeed, by his own account, it was not until “very late in [his] life” that Freud even read Schopenhauer and Nietzsche (106). Alfred Tauber has recently demonstrated the extent to which Freud’s professions of philosophical ignorance were a fabrication, and Borch-Jacobsen and Shamdasani are unequivocal in their assessment of Freud’s claims to “theoretical virginity”: the history that Freud so carefully constructed is nothing more than “a fable, a scientific fairytale” designed to “establish [his] autocratic political authority through affirming the absolute originality of the theory.” (106-7)

Another crucial aspect of Freud’s attempt to affirm “exclusive rights over his creation” (106) were his claims that 1) he had carried out a successful self-analysis; and 2) that this self-analysis could not – in either a technical or a moral sense – be replicated by anyone else. Freud used the first claim – the example of his self-analysis, where analysis entailed not merely observing but actively curing oneself, as Freud claimed to have done – to insist that all psychoanalysts submit to their own analysis as a prerequisite of professional development; he used the second claim to insist that such analyses could only be carried out by an external authority. As the “primal analyst,” (38) this left Freud in an incredibly powerful position, especially in the initial years of psychoanalysis: as the only authority capable of dispensing analysis, Freud established himself as the profession’s gatekeeper.

In one stroke, Freud had cemented his own position at the top of the psychoanalytic hierarchy and delegitimized the authority of his rivals. He had, furthermore, simultaneously insulated himself from any attempts at being analysed by others – which would both call into question Freud’s own omniscience and strengthen the hand of his rivals – and reserved for himself a monopoly on diagnosing the (alleged) psychopathologies of others, a power that Freud and his followers made liberal use of in their disputes with Adler, Rank, Jung, et al. It is important to understand that Borch-Jacobsen and Shamdasani’s point here is epistemological as well as institutional: “Freud’s self-analysis,” they write, “became the central pillar of psychoanalytic theory. Without it, psychoanalysis would collapse into a chaos of rival interpretations, with no means to adjudicate between them.” (52) Unsurprisingly, however, the authors conclude that what they term Freud’s “heroic self-analysis” “never took place.” (54)

It is not so much that Borch-Jacobsen and Shamdasani doubt that self-analysis is possible, as they doubt that analysis of any kind is possible. Freud’s self-analysis, like all psychoanalytic case studies, was nothing more than a “retrospective construction.” (54) Indeed, this is the most that psychoanalysis can ever hope for. As Borch-Jacobsen argues in an essayentitled “Is Psychoanalysis a Fairy-Tale?” – the answer, it may not surprise you to learn, is a resounding yes – psychoanalytic case-studies are nothing more than “historical novels or romanticized biographies” (Making Minds, 151) in the vein of Zweig or Balzac, what the novelist Paul Auster once referred to as “the anecdote as a form of knowledge.” To use the slightly clumsy neologism coined by Borch-Jacobsen and Shamdasani, these case studies represent “interprefactions,” (144-45) a reificatory process through which “Freud created facts with words.” (Making Minds, ix)

The debunking of Freud’s case-studies, beginning with his own, is the most convincing section of The Freud Files: especially impressive is the manner in which Borch-Jacobsen and Shamdasani complement their epistemological critique with a highly controlled and precise use of archival material. There are times, however, when the sheer volume of archival and primary source material threatens to overwhelm and even undermine the argument. The authors have employed what they describe as a “polyphonic” approach to quotation, which in practice entails “deliberately cho[osing] to cite excerpts in extenso, letting the historical actors speak in their own voices.” (28)

Although the logic behind this method is sound – the material, lying behind the lock and key of the Freud archives, was so difficult to access and offers such a radically different interpretation of the origins of psychoanalysis that only direct and extensive quotation can do it justice – this maximalist approach can at times lend The Freud Files the appearance of a Renaissance commonplace book. Furthermore, and contrary to the apparent expectations of the authors, many of the passages quoted do not speak for themselves. Perhaps more damagingly, the sheer volume of critical material produced to dismantle Freud’s claims has the paradoxical effect of serving to, if not necessarily justify, then certainly explicate, the defensive and revisionary strategies of Freud and his disciples: faced with overwhelming hostility (painstakingly catalogued by Borch-Jacobsen and Shamdasani) from the established medical and psychiatric authorities, Freud’s efforts to carve out a position of professional security and prestige, and his subsequent policing of those boundaries, come across as unsurprising, even understandable.

More troublingly still, the argument of The Freud Files at times resembles little more than a sustained ad hominem attack on the integrity and character of Freud and his followers. No doubt Borch-Jacobsen and Shamdasani would counter that in a discipline as intimately bound up with the personality of its founder as psychoanalysis – a body of knowledge that, after all, regards the introspective reflections of its progenitor as both foundational and paradigmatic – such a strategy is not only fair game but inescapable. The problem with this line of argument is that it presupposes that psychoanalysis is nothing more than a series of case studies and personal anecdotes. It is, however, equally plausible to argue that psychoanalysis is nothing less than the series of extraordinary metapsychological papers, bookended by “Formulations Regarding the Two Principles in Mental Functioning” and “Mourning and Melancholia,” that Freud published between, roughly, 1911-1917.

The total omission of Freud’s metapsychology is especially problematic given the severity of the authors’ conclusions: psychoanalysis, they declare, is “Nothing – or nearly nothing […]: it is a ‘machine’, a ‘whatsit’, a ‘thingumajig’ which can serve to designate anything, an empty theory in which one can cram whatever one likes.” (303) More striking still are their claims about the implications for the contemporary practice of psychoanalysis: “one could say that psychoanalysis, in a certain sense, no longer exists – or rather, never did.” (307). Borch-Jacobsen reaches similar conclusions in a number of essays contained within Making Minds, including the aforementioned “Fairy-Tale” and a piece entitled “Interprefactions: Freud’s Legendary Science” (co-written with Shamdasani) that informs much of the methodology of The Freud Files, from which we learn that “what Freud actually did […] was to form a self-confirming apparatus which could produce, suggest evidence for whatever theory one liked.” (Making Minds, 171). In “Simulating the Unconscious” Borch-Jacobsen concludes that “there is no ‘psychic reality’ to discover or to describe in the subject, only realities to produce and to negotiate with him.” (Making Minds, 136).

These are huge claims, as befits a book of the scope, ambition, and prodigious scholarship of The Freud Files. For, despite the criticisms above, the monograph and essay collection under review constitute a formidable and, for the most part, highly persuasive critique of Freud and his legacy; indeed, this review can only hint at the depth of argumentation and rich analysis contained within their pages. Nevertheless, it is hard to shake the feeling that Borch-Jacobsen’s dismantling of the psychoanalytic edifice is perhaps a little too thorough, even as its implications remain underdeveloped. Assuming that we accept the logic of his criticisms, what are we left with? What is the mind? What is mental illness beyond constructivism? Nothing? Something? There are a number of contemporary philosophers, neurologists, and psychologists who offer potential answers to these questions, but Borch-Jacobsen isn’t one of them. As an historian, perhaps he feels justified in not having to engage with such questions. Equally, however, as an historian of psychoanalysis he has, or ought to have, a vested interest in offering alternative paths for investigation. After all, if, as Borch-Jacobsen argues in the methodological essay that opens Making Minds, mental illness is nothing more than a particularly complex and fluid social construct – an open dialogue between analyst, patient, and society at large – what more is there to say on the subject? In order to answer what then becomes the truly pressing question – why does a given form or manifestation of “illness” establish itself as the predominant mode of mental expression in a particular time and place? – we must surely seek an answer beyond the confines of the history of the psyences. We must become cultural historians: that is the true implication of a history that denies the existence of the object it studies.


Simon Taylor is a graduate student in the Department of History at Columbia University. He specializes in modern European intellectual history, particularly the history of philosophy and the psyences. He is writing his dissertation on the medicalization of the concept of anxiety. Simon previously reviewed Alfred Tauber’s Freud, The Reluctant Philosopher for h-madness.

Reconstructing What Happened to Phineas Gage

Christian Jarrett, editor/writer over at the informative and entertaining British Psychological Society Research Digest, has just posted a piece on the latest attempt by researchers to reconstruct what happened to Phineas Gage.  Gage, of course, is one of the most famous neurology patients in history.  In 1848, due to an explosion, a large iron rod went through his face and brain, out the top of his head.  Amazingly, Gage survived, living until 1860.  Jarrett looks at a new study using imaging data:

Now Gage’s skull has been analysed yet again. A team of experts, led by John Van Horn, based at the University of California and Harvard Medical School, has used diffusion imaging data, together with anatomical MRI, to try to find out how Gage’s injury affected the connective tissues of his brain. As they explain: ‘while many authors have focused on the gross damage done by the iron to Gage’s frontal cortical grey matter, little consideration has been given to the degree of damage to and destruction of major connections between discretely affected regions and the rest of his brain.’

The Filedrawer Problem: A Resource

Something brought to our attention by the Cheiron Forum (Cheiron = The International society for the History of the Behavioral & Social Sciences) –

The Open Science Framework – an open collaboration of scientists “to increase the alignment between scientific values and scientific practices” – recently announced its “Reproducibility Project,” a collaboration intended to estimate the reproducibility of a sample of studies from the psychological sciences.  You can read about this project here.

A related resource which may interest h-madness readers is PsychFileDrawer, an archive of replication attempts in experimental psychology.  The site explains its archive and the famous “file drawer problem” this way:

The “file drawer problem” (a term coined in 1979 by Robert Rosenthal, a member of our Advisory Board) refers to the bias introduced into the scientific literature by selective publication–chiefly by a tendency to publish positive results but not to publish negative or nonconfirmatory results. Awareness and concern about the file drawer problem seem to be growing explosively at the current time (early 2012). The pages below provide a fairly comprehensive list of recent discussions of this problem organized into different categories of publications–ranging from popular articles about the extent of the problem in many fields, to technical articles asking how failures to reject the null hypothesis should be analyzed and presented.

The Wolf Man – Graphic Freud

The Guardian contains an article about writer Richard Appignanesi and artist Slawa Harasymowicz’s latest project, a graphic novel entitled The Wolf Man, inspired by Freud’s famous case study.

The accompanying video, featuring interviews with Appignanesi and Harasymowicz, but also psychoanalyst and historian Daniel Pick as well as publisher Emma Hayley, contains various images from the graphic novel.

To access the article and video, click here.

Book review – Helen Lefkowitz Horowitz. Wild Unrest: Charlotte Perkins Gilman and the Making of “The Yellow Wall-Paper” (Oxford 2010)

By Daisy Dominguez

In Wild Unrest: Charlotte Perkins Gilman and the Making of “The Yellow Wall-Paper,” Helen Lefkowitz Horowitz presents a detailed reading of the bountiful diaries, journals, and correspondence of Gilman and those close to her leading up to the publication of her famous short story. Her papers reveal that during her courtship and marriage to her first husband, Charles Walter Stetson, she sought to reconcile both her conflicting desires to be in a relationship and to remain independent with Stetson’s more traditional views regarding women in marriage. By also analyzing Gilman’s reading habits to show how they shaped her social and political views, Horowitz demonstrates that they informed this internal struggle. A reader of Popular Science Monthly, Gilman picked up the deterministic philosophy of Herbert Spencer but also William B. Carpenter’s ideas on the importance of the will. Surprisingly, Horowitz also reveals that in her early twenties, Charlotte was uninformed about the women’s rights movement and lacked personal knowledge of role models for being an independent married woman. It wasn’t until 1886-1887 that she became immersed in the feminist Woman’s Journal.

Horowitz’s main argument is that despite her claim, Gilman did not write the “The Yellow Wallpaper” as a critique of the one-month “rest cure” she was prescribed by the famous Dr. Weir Mitchell in 1887. The rest cure consisted of a large amount of bed rest, seclusion, massages, electrotherapy, and a diet of increased fat. In contrast to the active “camp cure” prescribed for men who suffered from neurasthenia, the rest cure was symbolic of the circumscription of women in general. (Interestingly, by the time Gilman was treated, Mitchell had altered his views to allow for more physical activity, which explains his recommendation that she follow through on her interest in working at a gymnasium upon returning home.[1]) Twenty-six years after her stay with Mitchell, in a 1913 article in her periodical Forerunner, Gilman wrote that the “best result” of her short story was its influence on Mitchell, whom she had sent a copy. “Many years later,” she noted, “I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading ‘The Yellow Wallpaper’.”[2] Horowitz argues that while the rest cure was a significant event in Gilman’s life, the short story told more about Gilman’s feelings toward Stetson and the institution of marriage than how she felt about Mitchell’s treatment.

Noting that, “History has portrayed the reasoning Charlotte with the strong will as the true Charlotte,”[3] Horowitz does an admirable job of untangling the accepted truth from the more personal one detailed in years of correspondence and journal and diary entries. My only question surrounds the lack of documentation during a crucial time: Gilman stopped writing in her journal from 1887, the same year when she went to Mitchell and around the same time when she became a more avid reader of Women’s Journal, and 1890, when The Yellow Wallpaper was written. I would have been interested in some speculation about how Gilman’s deeper immersion in the suffragist publication and women’s issues might have begun to inform her writings and how she perceived them. Did it help solidify, in the remove of years, what she saw as the short story’s purpose? As it stands, Horowitz could not do anything about this gap and it does not, in the end, negate her well-researched and compelling argument. Wild Unrest would be a good read for anyone interested in knowing Gilman’s early years and influences.

Daisy Dominguez is an assistant professor at the City College of New York, CUNY.

[1] Horowitz, Wild Unrest, 138.

[2]Charlotte Perkins Gilman, “Why I Wrote ‘The Yellow Wallpaper’,” in The Captive Imagination: A Casebook on The Yellow Wallpaper, ed. Catherine Golden (New York: The Feminist Press, 1992), 51-53.

[3] Horowitz, Wild Unrest, 47.

DSM-V and grief

Last week, an interesting discussion went on in the comments section of a post we published two years ago entitled DSM-V: Getting Closer to Pathologizing Everyone? In order to give this exchange more visibility, we decided to publish it as a separate contribution. First the remarks of Ronald Pies, columnist at Psychiatric Times, and then the response from Alan Horwitz, author of the initial post. We would like to thank both authors for taking the time to share their thoughts on h-madness.

First, the original comment:

It is technically not true that “…anyone who is sad, fails to derive pleasure from usual activities, finds it difficult to concentrate, and has sleep and appetite difficulties for a mere two weeks could be diagnosed with Major Depressive Disorder,” either using DSM-IV or the proposed DSM-5 draft criteria. Those features alone would not meet the full criteria set required for MDD. The person would also need to meet the “C” criterion [in DSM-IV] of “clinically significant distress or impairment in social, occupational or other important areas of functioning.” Moreover, simply being “sad” does not satisfy the criterion of having “depressed mood most of the day, nearly every day…” for 2 weeks.

Most recently bereaved individuals will not meet full DSM criteria for MDD; do not have a “disorder”; and do not need clinical treatment. Furthermore, there are profound phenomenological differences between ordinary grief and MDD that the experienced psychiatrist will recognize. For example, the ability to be consoled, as Kay Jamison has observed, is typically present in ordinary grief, but rarely in MDD.

That said, many of us believe that the 2-week minimum duration is too short, in most cases, to make a confident diagnosis after bereavement or any other major loss, such as divorce. However, this is irrelevant to the validity of the bereavement exclusion, (BE) and focusing on the 2-week minimum both misses the real point of the debate, and obfuscates the many underlying problems with the BE; e.g., there are no controlled, clinical studies (as contrasted with community survey data) of bereaved, MDD patients to support the BE.

The 2-week minimum is a separate problem that must be addressed separately, and in no way justifies continuing the BE. Leaving the BE in the DSM-5 will not fix the general problem of the 2-week interval. Indeed, elimination of the BE from DSM-5 would also rid us of the bogus, 2-month limit on the duration of “normal” bereavement, for which there is no scientific or clinical basis. Ordinary grief related to bereavement is quite distinct from MDD, and may go on for months or even years; it is not a disorder, nor does it require treatment, if the grieving person functions adequately in the social, vocational, and interpersonal spheres.

I hope that readers will take a look at my upcoming blog on the Psychcentral website, entitled, “Grief, Bereavement, and the DSM-5: How the Public is Being Misinformed.” Also, I have developed a preliminary screening instrument, called the PBPI, aimed at helping clinicians distinguish, phenomenologically, between ordinary grief and MDD. It may be found on the Psychiatric Times website, after a free registration step, under the title, “After Bereavement, Is It “Normal Grief” or Major Depression? The PBPI, A Potential Assessment Tool.”

Ronald Pies MD

For further reading:

Pies R. The two worlds of grief and depression. Accessed January 27, 2012.

Zisook S, Shear K: Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8:67-74.

Zisook S, Reynolds CF 3rd, Pies R, et al. Bereavement, complicated grief, and DSM, part 1: depression. J Clin Psychiatry. 2010;71:955-956.

Lamb K, Pies R, Zisook S. The Bereavement Exclusion for the diagnosis of major depression: to be or not to be? Psychiatry (Edgmont). 2010;7:19-25.

Jamison KR. Nothing Was the Same. New York: Vintage Books; 2011.

Then, the response from Alan Horwitz:

Before the DSM-5 Task Force began its deliberations, the idea that normal grief could be a psychiatric disorder would have seemed preposterous. Freud, for example, following thousands of years of psychiatric thought, noted that:
“Although grief involves grave departures from the normal attitude to life, it never occurs to us to regard it as a morbid condition and hand the mourner over to medical treatment. We rest assured that after a lapse of time it will be overcome, and we look upon any interference with it as inadvisable or even harmful.”
Indeed, the notion that grief is a natural reaction to the death of an intimate is so deeply commonsensical that the general definition of mental disorder in the DSM itself uses it as the sole example of a condition that should not be considered disordered: “(Mental disorder) must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.”
There are also good empirical reasons for the bereavement exclusion. One of the causes for the original exclusion in the DSM-III was psychiatrist Paula Clayton’s findings that over 40 percent of individuals who had suffered the death of an intimate would meet the MDD criteria in the absence of the bereavement exclusion. Since Clayton used a one-month, rather than the existing two-week, duration that Pies’ suggestion would entail, a majority of the population could likely be diagnosed with major depression using the current diagnostic standards without the exclusion.
A recent study by Ramin Mojtabai uses prospective data from to test the validity of the bereavement exclusion by comparing the prognosis of bereaved and non-bereaved people who have had depressive episodes. Majtabai’s findings show that three years after the initial episode the rate of depression among the bereaved group (8.2%) was comparable to those who were never depressed (7.5%) but significantly lower than the depressed group that was not bereaved (14.7%). Bereaved people are no more likely than people who are not depressed to have subsequent depressive episodes; the prognosis of bereavement is benign compared to other depressed persons; and grieving people, as Freud predicted, are likely to self-heal without treatment. Providing further evidence for the wisdom of maintaining the bereavement exclusion, Majtabai also found that compared to those with other depressive episodes, respondents with bereavement-related episodes were less likely to have impaired role functioning, psychiatric treatment, or comorbid disorders. These findings are likely to understate the differences between the bereaved and others who met MDD criteria because the latter group included people who met these criteria because of other types of losses. Were this group excluded from the MDD group, the differences between the bereaved and non-bereaved group likely would have been even larger.
So, thousands of years of psychiatric history, common sense, and empirical findings all indicate that grief is a natural response to serious loss, not a mental disorder. Why then, does Pies suggest eliminating the current bereavement exclusion? Because the clinical significance criterion of the MDD diagnosis also requires: “clinically significant distress or impairment in social, occupational or other important areas of functioning.” Therefore, according to Pies, only distressed or impaired grieving people will be diagnosed as depressed in the absence of the exclusion. Pies’ rational is odd: obviously grief involves distress. It is part of our nature as humans to feel intense distress after the loss of a loved one. The clinical significance criterion will do nothing to stop the enormous pathologization of grief that abandoning the grief exclusion would entail.
Pies’ eccentric view flies in the face of empirical research, common sense, and thousands of years of psychiatric history, as well as the definition of mental illness in general and depressive disorder in particular, in every previous edition of the DSM. There is no better illustration of the intellectual bankruptcy of current mainstream psychiatric thought than the fact that the DSM-5 is likely to embrace this view. The general public will justifiably be astonished and scornful of the abandonment of the idea that grief is a natural part of life.

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