Author Archive

One Woman’s Encounters With Psychoanalysis

New York Times contributing writer Daphne Merkin has just published a piece in the New York Times magazine, chronicling her encounters with numerous psychotherapists – primarily psychoanalysts – over four and a half decades.  As Merkin puts it,

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive. Projection. Repression. Acting out. Defenses. Secondary compensation. Transference. Even in these quick-fix, medicated times, when people are more likely to look to Wellbutrin and life coaches than to the mystique-surrounded, intangible promise of psychoanalysis, these words speak to me with all the charged power of poetry, scattering light into opaque depths, interpreting that which lies beneath awareness. Whether they do so rightly or wrongly is almost beside the point.

Does Alcoholics Anonymous Work? How Would We Know?

Since its founding in the U.S. in the 1930s, Alcoholics Anonymous (AA) has proven to enjoy the support of a wide range of individuals, authorities, professionals, and civic organizations.  According to AA, it was estimated in 2007 that worldwide there were over 116,000 AA groups, with more than 2 million members.  Yet for all its popularity, relatively little is known about how and the extent to which AA actually works.  The organization’s insistence on anonymity has made research about members difficult, and estimates of its success rate have ranged wildly, from 5% to 75%.

Wired magazine and the blog offer up two articles, attempting to explain the draw of Alcoholics Anonymous. Brendan I. Koerner’s “Secret of AA: After 75 Years, We Don’t Know How It Works” examines the history of AA in a critical, yet balanced, fashion, discussing both the successes and shortcomings of the group’s approach. Mark Flanagan’s “Hard Drinkers Meet Soft Science” is interested in addressing the question, “Why do so many science-based medical providers recommend AA?”  His answers: it’s free, it’s convenient, and it comes with passionate anecdotal evidence to support it.

The Pharmaceutical Industry Leaving Psychiatry?

As noted by Vaughan Bell over at the blog Mind Hacks, Science magazine correspondent Greg Miller has just published a piece entitled “Is Pharma Running Out of Brainy Ideas?” Miller notes that GlaxoSmithKline has announced it is getting out of drug development in some areas of neuroscience, including pain and depression. At the same time, AstraZeneca has announced it is closing facilities in the U.S. and Europe and ending its drug-discovery research on schizophrenia, bipolar disorder, depression, and anxiety. According to Miller,

These cutbacks by two of the top players in drug development for disorders of the central nervous system have raised concerns that the pharmaceutical industry is pulling out, or at least pulling back, in this area. In direct response to the cuts at GSK and AstraZeneca, the Institute of Medicine Forum on Neuroscience and Nervous System Disorders organized a meeting in late June that brought together leaders from government, academia, and private foundations to take stock. But the biggest problem, researchers say, is that there is almost nothing in the pipeline that gives any hope for a transformation in the treatment of mental illness. That’s worrying, they say, because the need for better treatments for neurological and psychiatric disorders is vast. Hundreds of millions of people are afflicted worldwide. Yet for some common disorders, like Alzheimer’s disease, no truly effective treatments exist; for others, like depression, the existing drugs have limited efficacy and substantial side effects.

Miller also discusses the topic in the magazine’s podcast here.

Dworkin: The Rise of the Caring Industry

Ronald W. Dworkin – Frank Henry Sommer Professor of Law and Philosophy at New York University and Jeremy Bentham Professor of Law and Philosophy at University College London – has a piece entitled “The Rise of the Caring Industry” in the June 2010 issue of Policy Review.  The essay can be accessed online here.  The author of the 2006 book Artificial Happiness: The Dark Side of the New Happy Class considers how the growth of the helping professions (particularly those concerned with mental health) represents not simply an institutional change, but a shift in ethos.  As he puts it:

In this way the caring industry exercises a double fascination — on the one hand as a sounding board for lonely, unhappy individuals, and on the other as emblematic of a new ethos of civilization. The age of caring is a more skeptical age, but also a more tolerant one, expressing a distrust of authority and an antipathy to old enthusiasms that wavers between laughter and disgust. It would be wrong to say that people today deny the world; they simply prefer to ignore it, presenting a blank wall of indifference to how people live and what they believe. They prefer meeting their psychological needs through a therapy session rather than through a community of blood brothers.

The topic has been of particular interest to observers in the United States, and, over the past fifteen years, a number of scholars and writers have written on the subject, including Ellen Herman (The Romance of American Psychology: Political Culture in the Age of Experts, 1995), Eva Moskowitz (In Therapy We Trust: America’s Obsession with Self-Fulfillment, 2001) and Barbara Ehrenreich (Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America, 2009).

BMA on Conversion Therapy and Homosexuality

The British Medical Association has approved a motion that supports calls from a number of other professional organizations and gay and lesbian rights activists in rejecting so-called “conversion therapy” of homosexuals.  The organization calls on the NHS to “not fund ‘discredited’ conversion therapy for homosexual people,” according to the BMJ website.  The American Psychological Association has also taken a stand on these kinds of interventions, citing some of the prominent research on sexual orientation, pastoral counseling, and ethics.

Laqueur, “We Are All Victims Now”

The recent issue of The London Review of Books has a fascinating review by historian Thomas Laqueur (“We Are All Victims Now”) of The Empire of Trauma: An Inquiry into the Condition of Victimhood by Didier Fassin and Richard Rechtman (translated by Rachel Gomme).  Cutting a bit against the grain of accepted wisdom on the subject among historians of the human sciences, Laqueur concludes:

I take trauma as it is wielded even in these [various professional] communities to be largely epiphenomenal and strategic, and part of a larger story. The empire of trauma, the elevation or degradation of the term into a floating signifier, is the result of processes that we see at work elsewhere. Like so many others (‘tragedy’, ‘agony’), it is a word that has been translated from another realm and retains only wisps of its original meaning. Many more people are ‘passive aggressive’ than ever before; Bernard Madoff is a ‘sociopath’ not a ‘scoundrel’. This doesn’t matter very much; I don’t think that the drift of any of these words away from their narrower technical meanings into common usage makes much difference; I don’t think, and I am not sure Fassin and Rechtman do either, that the ubiquity of a word speaks to its efficacy, though they do seem to think that it testifies to the power of the newly constructed category.

More important, I don’t think they make the case that the category of trauma as it has been constructed in particular professional communities has in fact transformed reality, offered a language for victims to speak about historical wrongs and so on. I would suggest that the empire of trauma, in the sense of a universal acceptance that the suffering of others matters, that psychic wounds demand our attention, is part of a revolution that began in the 18th century, and whose moral dilemmas are still with us. ‘I do believe that in the end humanity will win,’ Goethe wrote in 1782. ‘I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everyone else’s humane nurse.’

The review is available here to subscribers.

Diagnostic Ambivalence and Psychiatric “Workarounds”

The Science, Knowledge and Technology section of the American Sociological Association has awarded this year’s Hacker Mullins Student Paper Award to Owen Whooley (NYU) for his paper “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders” (Sociology of Health & Illness, vol. 32, 2010: 452–469).


In 1980 the American Psychiatric Association (APA), faced with increased professional competition, revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric expertise was redefined along a biomedical model via a standardised nosology. While they were an integral part of capturing professional authority, the revisions demystified psychiatric expertise, leaving psychiatrists vulnerable to infringements upon their autonomy by institutions adopting the DSM literally. This research explores the tensions surrounding standardisation in psychiatry. Drawing on in-depth interviews with psychiatrists, I explore the ‘sociological ambivalence’ psychiatrists feel towards the DSM, which arises from the tension between the desire for autonomy in practice and the professional goal of legitimacy within the system of mental health professions. To carve a space for autonomy for their practice, psychiatrists develop ‘workarounds’ that undermine the DSM in practice. These workarounds include employing alternative diagnostic typologies, fudging the numbers (or codes) on official paperwork and negotiating diagnoses with patients. In creating opportunities for patient input and resistance to fixed diagnoses, the varied use of the DSM raises fundamental questions for psychiatrists about the role of the biomedical model of mental illness, especially its particular manifestation in the DSM.

%d bloggers like this: