Prozac and the royal road to misery

modern (wo)man in search of soul in the wasteland of meaning

Epigraph: In 2006 I had occasion to spend Diwali in Mauritius with my then sister-in-law, Joanne Farah. One of the celebrants at the hotel where we were staying was offering Henna tattoos to the guests. I asked for the word ‘spirit’ to be tattooed on my arm. When my sister-in-law, seemingly bemused, inquired as to what exactly I considered ‘spirit’ to be, I was unable or possibly unwilling to answer. I did think about an answer later that evening though:

Spirit is the undefinable and ineffable essence without which we would be mechanistic meat machines.

Meaning as opposed to happiness

Carl Gustav Jung published Modern Man in Search of a Soul in 1933, which, except for one essay, was record of a few public lectures on this theme he delivered at the Psychological Club in Zurich, in the years prior. The title of this book is especially telling in describing Jung’s area of psychological research and focus. Jung grappled with the issue of meaning, specifically how the subject dealt with the central question:

What is the meaning of my life?

To add some flesh to that simple and yet in Jung’s assessment, critical question. The human condition is one which necessarily requires meaning, more specifically that the subject’s life is supported by and invested in a meaningful paradigm and structure. It is an essential and inalienable condition of mental health. Questions of meaning and our unslakable thirst to answer these questions concerning meaning, obviously predate Jung and is the keystone in the discipline of philosophy. That acknowledged, psychoanalysis[1] broadly speaking, and Jung more specifically, can firstly, be rightly credited with recognizing how central this question of meaning is for psychological health, and, secondly -and this is the kicker and the significant point here – that the human being is self-deceived to the degree that she believes her salvation and ultimate redemption lie in happiness. The goal of realizing a state of enduring and robust happiness is the pursuit of an illusion! It is admittedly an illusion with no small degree of utility. It drives consumerism, informs the advertising industry, and adds the necessary element of fantasy to the pursuit of fulfilling the instinctive drives, i.e.

If I acquire the object of my desire, I will be happy.

The breakthrough of psychoanalysis is the recognition of the illusion of the achieving lasting happiness. Much psychoanalytic theory, especially Freudian, is devoted to understanding and explaining this basic element of the human condition; specifically, why the human condition has an element of unhappiness threaded into it and what lies behind the illusion of happiness. However leaving psychoanalysis aside for a moment, I find myself here wishing to paraphrase something my twelve-year-old son, Teague[2], said to me recently that summed up the condition rather pithily. He said something to the following effect,

Happiness is the province of early childhood. It rests on the conditions of the stupidity and naïveté. Ergo, growing up necessarily involves an unavoidable departure from its paradisiacal shores.  He went on to relate two brief vignettes by way of illustration of the “stupid happiness” of childhood. One involved simply sitting on the lawn of the home he was born in with his surrogate African mother “Tia”[3] as a child of three or four, simply staring up at clouds floating across the African sky. The other involved his biological mother of European descent, Anja, where he was sitting next to her watching the film Brave. At the scene where the princess turned into a ferocious bear, Teague, momentarily terrified, snuggled up into his mother embrace. Both experiences filled him with a sense of sublime and essential joy that now as mature twelve-year-old he felt incapable of.

Notwithstanding Teague’s friend’s incredulity at his spontaneous philosophical observations and the fact that he has something of the senex’s soul in a twelve-year-old’s body, his observations are, whilst idiosyncratic from one so young, psychologically astute. This desire for happiness unconsciously expresses a return to the innocence and wholeness of early childhood. And, at a deeper level, a return to the mother’s womb, as symbolically evident in Teague’s two vignettes.

The ethereal nature of happiness named, psychoanalysis, and more specifically Jungian psychoanalysis, offers in its stead the possibility of meaning. Meaning as the arbiter and vehicle of the value of your life and your subjective experience.

Jung was sensitive to this underlying spiritual malaise in modernity. His challenge to the psychotherapist was clearly expressed,

“But what will he [the psychotherapist] do when he sees only too clearly why his patient is ill; when he sees that it arises from his having no love, but only sexuality; no faith, because he is afraid to grope in the dark; no hope, because he is disillusioned by the world and by life; and no understanding, because he has failed to read the meaning of his own existence?”[4]

Jung identified and named the spiritual and psychological crises of modernity. The ascendance of science, secularism, physical reductionism, accompanied by the dissolution of the religious and social structures that had previously acted as the symbolic and mythological containers for the inner life of the human being. His entire opus can be, not inaccurately, interpreted as addressing this challenge. Because of this, Jung is sometimes seen as the emblematic psychotherapist for the Western World.

His diagnosis of the spiritual malaise of (wo)man was perspicacious and today this issue is no longer limited in its applicability to the spiritually decadent West, but address square on the loss of meaningful mythological motifs in today’s world, both East and West, in the Developing and First Worlds.

The meteoric rise to fame of the previously little-known Israeli historian and philosopher Prof. Yuval Noah Harari and the reception of his two sweeping narratives on the history and future of humankind, Sapiens: a Brief History of Humankind, Homo Deus: a Brief History of Tomorrow, illustrate the profound and sometimes desperate need to identify some underlying meta-structure, some foundational mythology, in the wasteland of the real.[5]

“What are the roots that clutch, what branches grow

Out of this stony rubbish? Son of man,

You cannot say, or guess, for you know only

A heap of broken images, where the sun beats,

And the dead tree gives no shelter, the cricket no relief,

And the dry stone no sound of water.”[6]

The French Lacanians report encountering an increasing number of analysands, in this this wasteland of meaning, amplified by the disruptive and relationally alienating technologies, such as the ironically named “social media”, gaming, virtual reality et al. and the ideological void post 9/11, suffering with “ordinary psychosis”.^[7]  This apocalyptic time or pseudo-apocalyptic, if you prefer, is also the subject and focus of the Marxist-Lacanian philosopher, Slavoj Žižek’s work. Žižek speaks of the four horsemen of the apocalypse: the worldwide ecological crisis; imbalances within the economic system; the biogenetic revolution; and exploding social divisions and ruptures.^[8] This apocalyptic theme is heavily constellated in the cinematic culture of the nineties and two thousands, a time which also featured a number of predictions of an apocalypse. [9] The most perfect cinematic vehicle giving expression to this being, in the opinion of the author, the series The Leftovers. That, I would argue, is the prevailing unconscious zeitgeist. Those of us living today are indeed not only the literal but also the metaphorical leftovers.

How, one might ask, has the psychotherapeutic discipline, tasked as the contemporary caretaker of the soul, answered this challenge?

In offering anything like an objective answer based on the review of modalities and treatment strategies offered, we encounter several concerns. These concerns are wide-ranging, including socio-economic and political factors: elitism, lack of political will, ill-informed and ill-conceived national health policies, a severe lack of resources, therapists and training and the list goes on.[10] Related complications include intra-disciplinary factionalism, and national health policies in the register of the university discourse, which has deified physicalism to the point of wanting to reduce all mental or psychic phenomena to the level of neurochemistry. It is also difficult here not to see his master’s hand at work behind the scenes pushing the commercial agenda of psychopharmacology.

In a recent article[11] associate professor of psychiatry at the University of Colorado Jonathan Shedler tackled this issue: the failure of the psychotherapeutic discipline to fully appreciate the distinction between the registers of the mental and physical or between mind and the neurobiology it supervenes[12] on. The claim that mind is supervenient property of the brain is itself a physicalist stance which accords the brain, i.e. matter, as primary and mind as a property of the brain. Nevertheless, as Shedler illustrates, the supervenience theory precludes an analysis, and in this context read: diagnosis and treatment strategy, of the mental based exclusively or primarily on its physical properties.[13] This conceptual ambiguation, i.e. mind is just brain, has in no small part misdirected psychotherapeutic strategies and contributed to the current mental health crises.

The example Shedler uses to illustrate the fallacy of reducing supervenient properties to their underlying substrate and its relationship to psychotherapy is worth quoting in full,

“One of the most powerful constructs I know is called supervenience. It helps us understand why knowledge at one level of analysis can be irrelevant at another. For example: When you watch a movie on a screen, you are seeing arrangements of pixels. The movie is 100 percent dependent on pixels and cannot exist apart from them. But knowledge of pixels is irrelevant to understanding the movie. We could know everything there is to know about pixeIs and have no concept of Luke Skywalker, Darth Vader, or the battle for the empire. Movie supervenes on pixels. Likewise, mind supervenes on brain. Mind depends on brain and cannot exist apart from it. But knowledge of brain is not knowledge of mental life. They are different levels of analysis requiring different concepts and methods.”[14]

This conceptual fallacy has been costly. It is impossible to quantify this cost because every time a DSM style categorisation and consequent psychopharmacological intervention was favoured over a psychological one, can, in the final analysis, only be measured by the consequent increase in human misery and the lost  opportunity cost to work with the subject in the appropriate register. How does one tally the cost of dysfunctional relationships, broken souls and hearts, lost dreams, shattered hopes and lost lives?

Whilst that question does not lend itself to quantification, Shedler offers us an actual dollar amount if measured by misdirected research funding. He quotes Thomas Insel, former director of The National Institute of Mental Health (NIMH) who puts the figure at $20 billion during his tenure.

“I spent 13 years at NIMH really pushing on neuroscience… and when I look back on that I realize that while I think I succeeded in getting lots of cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.”[15]

One should, or at least I would argue, be cautious of drawing too far-reaching conclusions from both Shedler and Insel’s comments, and possibly resist the strong claim made by Insel, to throw out the DSM.[16] Mistakes, even disastrous ones, if that is what the DSM is, are typically not without value in furthering our knowledge. I do not propose to offer an opinion on the long-term value of the DSM to the mental health profession and will leave that debate to the subject matter experts tasked with it.

However, I do support the weaker claim made by Shedler that the DSM as the diagnostic bible and final word on “mental illness” and that the mind as reducible to its neurobiology, are profound category errors. This added to the case made by Samuels, Shedler and many others that the practice of psychotherapy is desperately in need of a paradigm shift.

I want to focus on a single aspect of this overarching challenge made by Shedler, for “psychology to lead not follow…to stop positioning psychology as handmaid to medicine and second-class citizen of healthcare…[and to] contribute to the world as psychologists using psychological concepts and methods.”[17]

It is here that a persuasive case can be made for the psychotherapeutic value of the depth approach adopted by Jungian (or analytical) psychology. Although complex and subtle in application the basic ethos can be simply stated: mental illness, ailments of the soul or psychic disturbances – whichever your preferred nomenclature, are not inherently or essentially pathological. This is not the denial of pathology, but the recognition that psychic disturbances are not meaningless phenomena to be trodden underfoot by Prozac, Zoloft, Lexapro and company. They can alternately and arguably more usefully be viewed as  expressing a deeply felt but unmet need of the subject, as a call to action, as a healing disease, an individuating impulse, a moral imperative or – and I especially like this idea from James Hillman, as the expression in the subject of a collective ill.

“My practice tells me I can no longer distinguish clearly between neurosis of self and neurosis of world, psychopathology of self and psychopathology of world. Moreover, it tells me that to place neurosis and psychopathology solely in personal reality is a delusional repression of what is actually, realistically, being experienced.”[18]

These approaches are, I would argue in symphony with Shedler, properly psychological. Regarding the psyche and, by extension, the hopes, dreams and fears of the subject as primary and not an epiphenomenal. They have the virtue of regarding the inner life of the subject as significant, worthy of attention and not a second-class member of society, usurped by the idealization of the physical and the consequent instrumentalization of subjectivity. They afford the opportunity for psychotherapy to regard beingness, consciousness and subjectivity as inherently valuable and worthy of respect and not as strictly reducible to symptomology. To quote one of the 20^th centuries greatest doctors of the soul, the poet, Rainer Maria Rilke.

“Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you? Why do you want to persecute yourself with the question of where all this is coming from and where it is going? Since you know, after all, that you are in the midst of transitions and you wished for nothing so much as to change. If there is anything unhealthy in your reactions, just bear in mind that sickness is the means by which an organism frees itself from what is alien; so one must simply help it to be sick, to have its whole sickness and to break out with it, since that is the way it gets better.”[19]

This paradigm shift also requires a shift in attitude of the psychotherapist towards not only the content of their client’s confession, but the client themselves. The client should be viewed less as a patient requiring a therapeutic intervention and more as a human being expressing the need to be heard, held and accompanied for a way on their soul’s journey. An accompaniment not from up on high with the imperious attitude of the detached scientist, coolly observing and objectifying the subject. Rather, as Jung put it, it requires the analyst to be willing to swim in the very same murky waters with the analysand, to be willing to undergo the same psychic transformation they advocate for the analysand.[20] In other words an attitude of empathy and shared humanity, difficult to achieve when psychotherapist themselves has been swallowed by the scientism of the age, which seeks to irredeemably reduce the human being to its instrumental conditions.

In conclusion, psychotherapy may benefit in distancing itself from it current perceived status as an essentially medical or pseudo-medical modality. This is not the denial of the need for medical intervention, diagnosis and the appropriate use of psychotropic agents. In that sense the psychotherapist, especially as a diagnostician, does occupy a liminal space, wherein psychiatry plays an important role. However, it is not only that the profession should guard against over diagnosis and physical reductionism. It is also about also the recognition of the psychotherapist as the contemporary secular version of the Shaman, the soul’s guide through the wasteland of broken meanings, shattered myths and lost spiritual coordinates. This is a sacred contract that the psychotherapist enters into in a psychotherapeutic alliance, and it is holy ground upon which it treads. The failure to recognize this, is a catastrophic cultural and social failure that can and regrettably has had the very worst of consequences.  

Postscript. The current mental health epidemic and its socio-economic roots are rather brilliantly portrayed in the instant cult classic Joker. By way of metaphorical and symbolic illustration of the issues raised in this post, I close with a dramatic scene enacted Arthur Fleck (Joaquin Phoenix) and talk show host Murray Franklin (Robert de Niro) leading up to Fleck shooting and killing Franklin on set.

Arthur Fleck: How about another joke, Murray?
Murray Franklin: No, I think we’ve had enough of your jokes.
Arthur Fleck: What do you get…
Murray Franklin: I don’t think so.
Arthur Fleck: …when you cross…
Murray Franklin: I think we’re done with the show. That’s it.
Arthur Fleck: …a mentally ill loner with a society that abandons him and treats him like trash?!
Murray Franklin: Call the police, Gene. Call the police.
Arthur Fleck: I’ll tell you what you get! You get what you fucking deserve!

[suddenly Arthur shoots Murray in the head and the audience start running off in terror]

Until we speak again,

Stephen.

Jungian and post-Jungian Clinical Concepts 2020 is now open for registration!

[1] I adopt the term “psychoanalysis” as an umbrella term for depth psychology, rather than to exclusively denote the Freudian school, unless specifically so stated.

[2] Teague Noa Farah

[3] Her proper name being Qhubekani in Shona or Inocencia in English. 

[4] Jung, C. G. Modern Man in Search of a Soul (1933)

[5] Or “the desert of the real” to quote Morpheus in the original Matrix, in turn quoting Jean Baudrillard’s Simulacra and Simulation. This was also the title of a book by Slavoj Žižek. A Marxian and Lacanian analysis of the ideological and political responses to the terrorist attacks on September 11, 2001. https://en.wikipedia.org/wiki/Welcome_to_the_Desert_of_the_Real

[6] The Waste Land, T. S. Elliot

[7] Peter Dobey, personal communication.

[8] Living in the End Times, (Verso publisher, 2011).

[9] Apocalyptic premonitions: a post-Jungian perspective (Farah, S. 2011, conference presentation at the IAJS conference Enchantment – disenchantment)

[10] One of the more perspicacious and outspoken commentators on this is the training analyst, scholar and co-founder of the post-Jungian movement, Professor Andrew Samuels. Andrew highlighted these issues, among others, at the 2017 IAJS conference: The Spectre of the Other in his keynote titled Sinking Like a Stone: Activism, Analysis and the Role of the Academy, due for publication in 2020.

[11] It’s Time for Psychology to Lead, Not Follow

Psychotherapy is not a medical treatment, (Psychology Today, October 27, 2019) https://www.psychologytoday.com/za/blog/psychologically-minded/

[12] In philosophy, supervenience refers to a relation between sets of properties or sets of facts. X is said to supervene on Y if and only if some difference in Y is necessary for any difference in X to be possible. The key idea here is the supervenient categories are conceptually and phenomenologically distinct and simultaneously at an ontological level essential related. For more on supervenience https://plato.stanford.edu/entries/supervenience/

[13] Jung as a philosopher of mind is a neutral monist, i.e. he accords neither brain nor mind with primacy. Alternately seeing both the mental and the physical as phenomenological aspects of an underlying noumenal substrate. (Farah, S. 2011, Consciousness: articulating the Archimedean point, Master’s thesis, unpublished)

[14] Shedler, ibid.

[15] Ibid, see also https://www.wired.com/2017/05/star-neuroscientist-tom-insel-leaves-google-spawned-verily-startup/  

[16] Ibid.

[17] Shedler, (Psychology Today, October 27, 2019).

[18] Hillman, J. The Soul’s Code (1996)

[19] Rilke, Letters to a young poet.

[20] Jung, C. G. The Problems of Modern Psychotherapy, Collected Works of C. G. Jung, volume 16.