On the reconciliation of psychoanalysis
and psychiatry
Henri
Ey’s (1900-1977)[1]
life’s work was an attempt to unify psychiatry and psychoanalysis,[2]
which means no less than bringing together a view of the mind as a functional
process of the whole body focussed on the brain and a view of the mind as an
intellectual-emotional product of the individual growing, living and developing
in historical society. It involves also
something more than co-ordinating two different sorts of medical regimes and
descriptions of mental illness.[3] The lengthy career of this Catalan scientist
shows that it also requires a thinking through some of the greatest
philosophical problems of the last several hundreds of years, from the
Enlightenment to the present, taking into account as a further consequence the
bases of Western civilization in its classical, medieval and Renaissance
roots. Like other great French thinkers
of this century, Ey was self-consciously aware of this task and confronted it
in a series of books written over more than fifty years as the implications and
the opposition to his work became clearer to him.
Though we do not always
see eye to eye—or have the expertise to judge and make an assessment—on all the
points in Ey’s writings, especially the clinical reports, as summarised and
expounded in this brief study by Robert
M. Palem,[4]
himself now one of the stalwarts preserving and studying the late analyst’s
heritage in Perpignan, in the south of France, what does seem clear is that
what the Catalan scientist-philosopher (philosophe)
set out to synthesise accords well with the emerging programme of this journal,
as we too attempt to reconcile psychoanalysis, psychiatry (in its specific form
of psychohistory), and the history of mentalities, with our particular focus
not on the aetiology or cure of mental illness but on its effects on
individuals living in the matrix of history.
Given the relative
inaccessibility of Ey’s books outside of France, whether in French and
more rarely in translation, our first task here will be to give a resumé of Palem’s seven chapters and to
comment on the key points pertinent to the endeavour of this current book. This
should help clarify our own problems, questions, and programme of study further. Later I shall deal more directly with Ey’s
own writings and try to comment upon them in such a way as to enter into a
creative fusion with psychohistory and the history of mentalities.
Chapter 1,
“L’organo-dynamisme d’Henri Ey: Définition” sets out to define the nature of
this Organo-dynamism at the heart of Ey’s lifework, his attempt to describe and
explain the nature of mental activity in terms neither of a purely
physiological nor a (depth-)psychological phenomenon, but rather as a synthesis
of the two. He is therefore as much concerned with the organism as the
organisation of the mind-brain, and therefore attempts to bridge the gap
between psychiatrists and psychoanalysts.
We believe that this is the direct correlate of modern studies of the
mind and that Ey must therefore be seen as a pioneer in the field.
Chapter 2,
“Précurseurs et genèse de l’idée (concept) organo-dynamique” establishes the
scientific and philosophical roots of Ey’s synthesis. While the immediate influence is Jackson, one must
look back through Cuvier and beyond to the classical guides in Plato,
Aristotle, Plotinus and Hippocrates, along with Zeno and Chrysippus, to name
but a few, who have developed the ideas of an architectonic ontology (a growing
and developing organisation of the mental faculties and passions) and of
vitalism (the organic, self-inspiring quality of nature). Yet Ey gives a peculiar twist to this
tradition by running through the scholasticism (such Catholic doctors of the
Church as Aquinas) of the Middle Ages to the Rationalists of the Enlightenment (from Leibniz to Kant) in order to establish
his views on the bases of hierarchical forms and an architectonics of
being. Yet to this heritage he adds the
dynamists (Maine de Biran, Bergson, Krüger and Würzberg), particularly in the
sense of a bipolar evolution-dissolution (Ribot and Janet) and the
transformists (Spencer and Jackson), with their concern to consider the psyche
as a dynamic, living being which unrolls its structure through
ontogenesis. Significantly, we also have
to see what Ey is not, and which traditions he backs off from: namely, the
dualists, especially the Cartesian tradition of separating the spirit from the
body and the professors of monomania, in which mental illnesses are treated as
singular entities.
With Chapter 3, “John
Hughlings Jackson and Jacksonism”, Palem comes to immediate influences in the
development of Ey’s scientific philosophy and philosophical science. Jackson
(1835-1911) was a neuro-psychiatrist from Yorkshire inspired by the
evolutionary thinking of Herbert Spencer, and so indirectly to the theories of
both Lamark and Darwin. Palem sets out
what he considers the four key concepts in Jacksonist evolutionary
thinking—differentiation, specialisation, co-operation and integration. Among the eight points Palem makes, there are
two of salient interest to us. One is
that “In the organo-dynamism of Ey, the principle {that a progressively evolved
function includes its primitive predecessor} becomes: superstructures contain
and frame infrastructures. This is,”according
to Palem, “a psychopathology which inverts disymmetrical relations” (p.
21). Although this is probably a too
rigid way to state the case, I think we have here a key principle for
understanding how the mind—as the sum of the processes of the organic brain-body’s
sentience—transforms and yet retains its own historical (ontogenetic)
consciousness as both species-unit, individual somatic unit, and group-identity
(in a variety of stable and fluid collectivities).
The next point Palem
makes in the way Ey adopts and adapts Jackson’s evolutionary principles is that
“Pathology is the mirror inversion of evolution, of ontogenesis: it is an
involution, an insubordination, destructuring disintegration, dissolution,
decomposition, disorganisation of the favour in favour of “loss of control”
(Anstie)…” (p. 21). What it is not,
therefore, is a “regression” in Freudian terms, and only distantly related to
Lacan’s sense of a hierarchy of phenomena.
As will be evident soon, this principle forms the basis of Ey’s notion
of the unconscious as something created by a breakdown consciousness, and not
the other way round.
What Ey tries to do is
to bring Freud and Jackson together, or at least to go back to the place where
they were once close, and then to develop a new synthesis based on both men’s
mature thoughts, so that “there is no pure psychogenesis and so that an organic
disorder lies at the base of all mental illness” (p. 23), since “the body is
the organ of the mind” (p. 25). What Jackson
lacks, such as the notion of a hierarchy of deep structures of instinct and
affect in the personality, can be compensated for from a Freudian perspective
(p. 25). Thus the concepts of Jackson
are given a sense of evolution, history, and personal development, the
personality having a history, an ontological growth, and an integration into
social groups.
Chapter 4, “Ce
qu’apporte Ey: l’organo-dynamisme ou néo-jacksonisme,” looks more carefully at
what Ey has contributed to neo-Jacksonism.
For Ey, the term “organic” has a metaphorical sense of organisation
which, despite what Palem sees as an exaggerated French enthusiasm, conceives
the brain as the organ for integrating
the relations of life and the human body as a hierarchized system. Following Janet, Ey understands the nervous
system as orchestrating the various relations of life, such as intellectuality,
praxis, linguistic functions, conditioned reflexes, as well as psychic
energising functions and the integrating or synthesising functions of
consciousness (p. 33).
Yet psychiatry is not
reduced to neurology, and Ey becomes a philosopher by dealing with the
dialectic between the two sciences. By
speaking rather of a conscious being than of consciousness as a reified mind,
the unconscious emerges as a breakdown or abandonment of consciousness. This
results from Ey’s organicism constituted not by nerves but by nervous functions
and processes. From this emerges the
notion that sleep is an integrative function and the dream is at once the
guardian and prisoner of sleep. Thus Ey
says, “The unconsciousness of sleep is still a state of consciousness and, may
I add, of cesnorship, but of another species” (p. 39). Consequently, he argues that “all mental
pathology is the effect of disorganisation in the conscious being and consists
‘at once and necessarily a negative structure (analogous to sleep) and a
positive structure (analogous to the dream)’” (p. 39). There is also in his scheme an idea which can
be traced back to the early nineteenth century “psychist” Heniroth, of “the
pathology of liberty”, namely, the loss of freedom to consciously control
thoughts which is the essence of mental illness (p. 45).
The purpose of
therapy, then, is twofold: first, to
restore the individual to consciousness and liberty, meaning moreover that no
one can be fully healthy except in a liberal society—and not, for instance, in
Nazi Germany; and second, to undertake this therapeutic programme the
psychiatrist must be as free as possible him or herself (p. 47). What the psychiatrist/analyst does is to
continue the processes of psychogenesis in which the individual develops into
the fullness of consciousness—and individual freedom in a civilization of
liberalism (p. 49). It is not, however,
that the unconscious is pathological per
se, but is now defined as that part of the mind which has not yet fully
been liberated. Pathology occurs when
functions of the mind are disintegrated and slip back into the state of
un-liberty, that is, unconsciousness.
Because of these moral and historical values, Ey’s psychiatry is also an
anthropology in which being and becoming human depends on the attainment of
liberty and consciousness both as an individual and as a member of
society. Mental illness therefore
involves a “double dissolution” (p. 53), the loss of individual consciousness
and the diminution of the individual personality as a functional member of
society.
In
this way, we are told, Ey builds his organo-dynamism as a synthesis of Jackson,
Freud, and Janet (p. 57), the individual being becoming free through the species
and individual development of consciousness, the overcoming of drives back into
the unconscious, and the growth of a
social personality. This shows where
Ey’s main modifications of classic psychoanalysis lie: the Freudian hierarchy
of Id, Ego and Superego can now be centred in a field of consciousness where Id
and Ego overlap. The Superego would then
be a projection forward of the ideal self and therefore in the place where
consciousness pushes itself, while the area of Id contains both what is in the process
of becoming conscious as Ego and what is sublimated and lost to
consciousness.
A
significant factor in all these transformations is the power of time, of
developmental movement, or the ontogeny of the individual growing from infancy
to maturity, along with the intellectual and emotional formation of increasing
consciousness of self, and, finally, the
participation of the individual in group experiences, both those which are
continuing from a time before the individual was born—language, culture, ideological
debates, social and family relationships—and those which come into being by the
presence of the evolving personality—friendships, marriage, parenthood,
artistic and scientific creativity.
In
other words, the hierarchical scheme of the mind Ey inherited from Freud is
turned into a multi-layered evolutionary model with reversible and integrative
possibilities. The danger that threatens
normal growth of consciousness and liberty is a form of negative entropy, a
self-destructive drive that opposes liberty because it seeks a relapse into
unconsciousness, and its effects of disintegration, disorganisation, and
slippage create the various mental illnesses.
These diseases, however, are not merely functional products of the
mind’s emotional and intellectual activities.
They manifest failures in the physiological processes themselves. As contemporary science confirms, they are at
once the cause and the effect of electro-chemical constituents of the
brain-body nervous system. For instance,
stress changes the chemistry of the brain, just as lesions and invasive germs
do, with motor, affect, and intellectual consequences. At a ,mopre abstract level, instead of
memories or ideas stored up in the mind, there are only chemical discharges and
complex sheets of synaptic connectors which can come unstuck in various
ways. Treatments come from both drugs or
dream-analysis, from physiological therapies or counselling.
Palem writes that “Ey
introduced, beginning in 1970, a psychophilosophical dimension into the Jacksonian
model of neurology, and this gave renewed life and a considerable expansion to
its model” (p. 74), and the epistemologist C.J. Blanc has noted a key
relationship between Ey’s theory of three worlds and Karl Popper’s work. There are other philosophical connections
noted in this chapter, particularly in the last years of Ey’s attempts to
construct a structural phenomenology to explain the pathology of mental
illness: a dialectic of absence and desire, of deficit and intentionality (p.
76). Another key feature of Ey’s attempt
to add a temporal dimension to the concept of the mind is his adaptation of
what Von Weisaecker calls a Gestaltkreis,
or cycle of structure, relating history and form into the dialectic of spirit
and letter of the organo-dynamic (p. 77).
Finally, the
brain-mind dichotomy is expanded to include the body as an open system,, that
is, as Palem explains, the psychic body—and it is a body fixed in time--is
animated by the same movement which never ceases to incorporate the world into
its own organisation (p. 79). This
concept of the psychic-body also implies a subordination of the unconscious to
the consciousness, a bipolar concept: “between these two poles there circulates
a current of sense which is the same direction as its movement,” of the id
travelling towards the ego which is to come, in conformity with the earliest
assertions of Freud (p. 80).
This brings us to the
fifth chapter of La modernité d’Henri Ey, “Les quatre thèses fondomentales de
l’organo-dyanmisme”, the Four Fundamental Theses of Organo-Dynamism. Palem reports these four points as:
1. that
which evolves and which is virtual in a
psychic organisms constructed for self-defence dissolves itself;
2. the
modalities of dissolution;
3. the
complementary pathogenesis, negative and positive, of symptom; and
4. the
classification of neurological and psychiatric symptoms according the levels
and the partial
or global character of the dissolution. (p. 83)
Evolution is an appropriate word
to describe these phenomena, because of the functioning of time in the
conception of Ey’s organo-dynamic brain-mind-body structure, and it means that
each human being’s personality is a product of both species development and
social integration, as well as growth of the neuronal and emotional dialectic
of the individual. Similarly,
phenomenology allows us to see that “mental illness” is constituted by a
“regression which confers on the symptoms their formal qualities” and its
essentially negative structure (p. 86).
Palem goes on to explain that “The pathogenic process is a destroyer of
the structures of the conscious being (synchronically and diachronically),
integrated in and by its order (its control and direction). This process liberates the forces of the
unconscious, under the forms of automatism and fanaticism,” making it—and this
is a key element in Ey’s whole approach—the mirror image of evolution, of the
original ontogenesis; it is therefore an
involution, an entropic movement, an insubordination or even a regression (p.
87). A passionate monist, Ey would say that the organisation which dissolves is
also the psychic body—for, as Palem points out, they are the same thing.
In this way, the old
dilemma of psychogenesis and organogenesis loses its power, since the whole
process of the mind in relation to the brain and the body is one of
heterogeneity. In clinical terms, this
leads to what Ey calls the principle of antinosography
(p. 88). For the concept of the
organo-dynamic mind inserts itself into the vitalism of traditional medicine
and moreover reintroduces and re-established the concern for the human
personality into the study of mental problems (p. 90). The conscious being has two structures—one of
which, the synchronic, as Palem explains, is the field where conscience is
lived in reality; and the other, the diachronic—which is where the ego is
constituted by its own history, or as Palem, puts it,. Its axiological being
(p. 93).
Like Russian dolls, François
Jacob explains, the mind Ey constructs hierarchicizes space, size, and
evolutionary direction, so that pathology is contained within existence as the
unconscious is held within consciousness” (p. 94) As Ey himself puts it, “the
psychic contains the biological which is also what it depends on” (p. 95). Unlike Freud, who sees things from the bottom
up, Ey tends to look at the mind from above.
For the mind is neither conscious nor unconscious, but a process which
includes the reciprocal relation-ship between surface and depth.
Chapter 6, “Critiques
de l’organo-dynamisme” offers a brief survey of the objections raised to Ey’s
work and the kinds of responses he and his followers have given. One of the key confrontations has been
between Lacan and the organo-dynamists.
Ey’s argument is that while the consciousness needs to be restored to a
major role in the workings of the mind, it is in itself not the ego, or reason,
no more so than it is really all id and unconsciousness. It is also not only a question of recognising
in a human being a conglomerate of neurones and synapses, as Edelman calls for,
but of a more complex personality with a history as both an evolving individual
and a member of an historical society, taking psychiatry and psychoanalysis
beyond Althusser into moral philosophy and traditional arguments deriving from
Plato and Aristotle.
The seventh
and last chapter, “La portée de l’organo dynamisme” contains a question as a
sub-title: “L’organo-dynamisme a-t-il encore un avenir?” Does organo- dynamism
still have a future? To begin answering
this question, Palem sets Ey’s science besides psychoanalysis and
biologically-based psychiatry, and of course he sees that organo-dynamism’s
role is to reconcile these two competing views of the mind and of therapy, and
to develop the best that each has to offer.
With the moral philosophy that turns the programme also into an
anthropology—the study of mankind in its species, individual, and social
development—Palem sees Ey is trans-anatomical and trans-catagorial (p.
117). The mind cannot be understood
merely as a physical organ (the brain even adding the psychic body) or as
merely a hydraulic machine repressing and releasing psychic energies from
unconsciousness to consciousness and back again. Nor can the moral and social questions that
arise in historical groups be dismissed: no more so than can deep unconscious
forces be neglected in the study of how we evolved as a species, how each
individual grows into his or her own body’s emotional and intellectual
identities alone and as part of a family, a clan, a guild, or a nation. Above all, what Ey teaches is that the
psychic being, the human individual, must be approached with dignity and
offered a chance to attain as much freedom—and therefore consciousness—as
possible.
NOTES
[1] Though little known to general readers or even specialists outside
of France, Ey was for many years the head of the French Institute of
Psychoanalysis and for a time of the International Association. In a struggle that cantered on the support or
non-support for those incarcerated in the Soviet Union and declared mentally
ill, Ey took the position that the psychiatric establishment in the USSR was
wrong and the rest of the world should condemn this abuse of power and travesty
of medical science. The issue came to a
head at a World Congress held in Mexico.
Lacan and his followers won the day—and the control over the official
version of psychiatry and psychoanalysis in the West. In addition disgust with the gobbledygook
that marks Lacanian writings, I find it difficult to sympathize with the
institutionalized version of the French school and their acolytes in America
and elsewhere.
[2] Sometimes there are confusions
remaining between psychologists and psychoanalysts. A psychologist is not a medical doctor and
engages in therapies with neurotic patients, as individuals and groups, in
private practice and in clinics, often in the form of counselling and through
the use of interviews. Psychiatrists are
medical doctors who treat patients with both neurotic and psychotic symptoms,
today often through the use of drugs and other interventions. Close to neurology, the study and treatment
of neurological diseases—that is, illnesses in the nervous system occasioned by
chronic diseases, inquiries or various biological infections—psychiatry treats
both symptoms and causes. At times the
psychiatrist may utilize the various techniques of psychoanalysis. Psychoanalysts may or may not be medical
doctors to treat neurotic patients.
Psychoanalysts follow such schools of thought as Freudian,. Jungian,
Lacanian, in which the individual mind is considered to exist as an evolving and
developing function of the brain and to have various levels of consciousness,
unconsciousness and subconsciousness, as well as being shaped and constituted
by relationships to other individuals and small groups. Traditionally, psychoanalysis or “the talking
cure” does not rely on drugs or non-verbal interventions (hydrotherapy, diet
control, family training, etc.).
[3] “With an Ey(e) to the Future of Psychiatry”: Review Essay of Henri
Ey: Psychiatre du XXIe siècle in Mentalities/Mentalités
15:2 (2001) 53-64.
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