The official contribution of the Uruguayan Psychoanalytic Association to the Nineteenth Latin American Congress of Psychoanalysis (Montevideo, Uruguay, August, 1992), this paper is by an important theorist in contemporary Latin American psychoanalysis. Bernardi uses as background a similar paper he wrote in 1982, in which he raised similar questions. What are the origins of the malaise in psychoanalysis? Are they related to psychoanalytic institutions, their difficulties in growing and, in some countries, their involution? Or are they related to the nature of the profession, the increasing competition from other therapeutic techniques, and the growing number of psychoanalytic groups developing independently of the official institutes? Finally, is Latin America, with its special social, political, and economic characteristics, the source of the malaise?
In the 1982 paper, Bernardi focused on the growing difficulties of psychoanalysis as a science. But in his 1992 paper, he thinks that we can no longer talk about the malaise of psychoanalysis without also speaking of its well-being—that there are reasons to dwell on both. Bernardi proposes to explore the causes of malaise in three areas of analysis: as a treatment, as a theory, and as a research method.
Psychoanalytic practice is difficult, requiring the analyst to keep exposing his or her psyche throughout his or her professional life, making it easier to become an analyst than to keep on being one. Still, the practitioner works with passion and idealizes the profession. This passion and idealization has beneficial effects, but also creates problems in analytic institutions and in society at large. Regarding the problems
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in institutions, the training analyst's dual function of analyzing and educating creates problems of technique which have not been sufficiently conceptualized. The successful spread of psychoanalysis in Western civilization has also caused problems. Analytic jargon hides the fantasy that everybody can be a psychoanalyst. The multiplicity of therapies aggravates the picture. In the United States, the discredit of the psychotherapies and the advance of biological psychiatry are other contemporary, though possibly cyclical, phenomena. As to the malaise within the discipline, there is an increasing need to know the limits of analysis as a therapeutic method, its relationship to other forms of psychotherapy, and its results as to outcome compared with other forms of treatment. This kind of research is urgent, since the new Ethical Code of the IPA requires the analyst to discuss with patients the benefits and contraindications of analysis. Wallerstein's outcome research questions the benefits of expressive versus supportive psychotherapy. On the other hand, we now know that "supportive" is a complex concept with numerous elements (Winnicott's "holdingenvironment," Kohut's empathic response, Bollas's self-experience, etc.). From this discussion, one conclusion is evident: we need more outcome research in Latin America. A second conclusion is that we need to know more about the elements of cure, both within one theory and between theories.
In the 1982 paper, Bernardi proposed the separation of theory and technique as a way to better understand which data, in clinical work, originated in the experience and which in the theory. He suggested that psychoanalysis is a discipline composed of multiple paradigms or languages, not always logically or smoothly intertwined. The theme of plurality was openly discussed by Wallerstein at the 1987 IPA Congress in Montreal. The answer to this challenge was the need to find similarities, and this was the theme of the 1989 Congress in Rome. The pluralistic approach threatens Freud's unitary ideal and provokes fears of fragmentation. These fears become malaise when they impede thinking about differences and learning how to process them. There is no consensus that different psychoanalytic theories coincide with each other; they contradict each other or they are complementary. Therefore, what is important is how the analyst utilizes the theory and how it influences interaction with the patient. The "implicit" theory (Sandler) with which the analyst operates is usually different from the official or "explicit" theories. This phenomenon is probably more notable in Latin America, where the tendency is to apply French or Anglo-Saxon formulations in a noncritical way. The validity of analytic theory is discussed from an epistemological and methodological point of view as well. For example, Grünbaum believes that the analyst introduces a "placebo effect" that contaminates the clinical data. Wallerstein thinks that the fundamental question today is the nature of psychoanalysis as a science, a question that gives rise to passionate discussion. Is psychoanalysis a model of natural science (e.g., the Freudian schools of thought: ego psychology, Kleinian, self psychology, etc.)? Or is it humanistic (e.g., hermeneutic, intersubjective, etc.)? Why the dilemma? Bernardi believes that within a given session, there are moments when the analyst can take a hermeneutic or quasi-artistic posture, while at other times the material can be studied by means more closely resembling a rigorous investigation. This was the thrust of David Liberman's work, distinguishing the investigation within the session from the session itself as an object of study.
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Why the dilemma between using only the clinical evidence versus methods of rigorous investigation? If analysts are to be frank, they should say that the essence of the psychoanalytic experience is not captured by rigorous scientific studies. Should such studies, which produce only indirect or partial evidence, therefore be abandoned? On the contrary, Bernardi believes that they are necessary precisely because of their partiality. The great temptation of the twentieth century was to believe in the total and reject the partial, with consequent disappointment in the results obtained. Bernardi thinks that because their work requires immersion in a global experience, analysts need the philosophical and ethical reflection that external data provide, through epidemiological monitoring and indirect studies, to complement and counterweight their clinical perception. Why not leave this kind of research to others? To be an analyst is already difficult enough. If we abandon this kind of research, we limit the concept of analysis to its classical form, restrict its indications, and fail to respond to the new synthesis that life requires. It is not strange that malaise should make its appearance.
If psychoanalysis is capable of producing such passionate exchanges in these areas among its practitioners, it is because its frontier is never reached: the one that opens to our inside. It is not easy to keep it open, but neither is it easy to close once it is open. We can say the same for the scientific domain opened by Freud. There is no other example to which it can be compared in terms of gaining the most access to subjectivity and understanding of the forces that condition it.
But this "opening" needs care. We related the feeling of malaise to the challenges that psychoanalysis is facing, and the difficulties involved in finding a new synthesis, which will always be partial and provisional.
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Schneider, J. (1994). Revista Uruguaya De Psicoanálisis, LXXVI, 1992. Psychoanal. Q., 63:175-177