This is a shortened version of a paper presented at the Annual Congress of Iranian Association of psychiatrists on 2008 when our proposal for a Fellowship for dynamic psychotherapy was refused by the ministry of Health and medical Education on some ethical accusation. This shortened version was published in the Journal of Iranian psychiatry.
INTRODUCTION
An ethics essentially consists in a judgment of our action, with the proviso that it is only significant if the action implied by it also contains within it, or is suppose to contain, a judgment, even if is only implicit. The presence of judgment on both sides is essential to the structure. (Lacan,book Vll-p311)
Psychiatric ethics is based, in general, on medical ethics or bio-ethics. Recently has been influenced by professionalism. But ethics in the practice of psychoanalysis has taken an independent path from the beginning. Apart from ethics in its practice, psychoanalysis of culture and unconscious human motivations, have influenced ethical issues in the contemporary Western societies.
In this paper ethics in relation to psychoanalysis is discussed. Firstly; ethics of psychoanalysis or professional ethics in the practice of psychoanalysis and dynamic psychotherapy which is the principles and standards of ethics for psychoanalysts. secondly ethics from psychoanalytic point of view, and thirdly analysis of ethics on the bases of psychoanalytic thought or psychoanalysis of ethics.
The history of an old myth
But to begin with, an old myth regarding psychoanalytic ethics with a reference to a passage from Lacan’s seven seminar, is quoted; a myth that ‘psychoanalysis offers a return to instincts as a measure of our actions! In other words advocating a free instinctual or sexual behavior; a century old mythical understanding of psychoanalysis! Frightening conservative, traditional and religious parts of societies. Lacan writes:
If there is an ethics of psychoanalysis – the question is an open one – it is to the extend that analysis in some way or other, no matter how minimally, offers something that is presented as a measure of our actions – or it at least claims to. At first sight the idea may occur to someone that it offers a return to our instincts as a measure of our action. Such seems to belong to a time long past. But there are perhaps here and there whom that prospect frightens. (Lacan. book. Vii, pp 311)
Not only ‘return to instinct’ was perhaps, an early misunderstanding of psychoanalysis, but the meaning of sex and sexual satisfaction was, also, misunderstood.
Vulgar understanding of Freudian concepts and the Wild analysis
The vulgar understanding and misuse of psychoanalytic concepts. distorted Freudian terminology and widespread use of Wild analysis and their destructive impacts on psychoanalysis is discussed. Most of people, not just the masses, but even highly educated people, including academics, medical profession and the majority of psychiatrists in the 3rd world countries are, just, familiar with vulgar meaning of these concepts, if they are familiar at all. And most of fears and criticisms against psychoanalysis are coming from this source. The use of these distorted concepts in market-place and by entertainment producers and sex industry is very much like misuse of nuclear science for mass destruction. The criticism against Freud and psychoanalysis on the bases of wild analysis and vulgar conception of Freudian terminology is like criticism against Islam and prophet on the bases of wrong doings of bad Muslims.
Criticism against psychoanalysis by Modern Western thinkers
Psychoanalysis has been baselessly and unjustly criticized and vigorously attacked by, at least four ideological and dogmatic extremist groups in the West, i.e., Nazis and Fascists, Stalinists Marxists, Radical Liberals, and a group of neuropsychiatrists.
Nazis and Stalinists; two extremes on the right and the left, and two totalitarian political dictatorships being frightened of liberating prospect of psychoanalysis, one apparently was against it because of Jewish origin of psychoanalysis as Freud was a Jew! and the latter was critical of it as being part of liberal and individualistic Bourgeois capitalist culture!! Ironically, in the past 50 years, particularly since 1960’s, Liberals thinkers too, those such as Karl Popper, Michel Foucault and some post- structuralist Liberals, such as Derrida, Delouse and Guattari have been criticizing Freudian concepts “belonging to the history of metaphysics and are thus part of the logocentric repression” (Derrida reader, from to speculate—on Freud, in The Post card. p. 516) and that “Plato is behind Freud, or if you prefer, Socrates, with all the inversions” (Post Card p. 398). Karl Popper who declared himself a true and committing Liberal and an anti- Marxist philosopher, saw Plato as one of arch enemies of “open society” and vigorously criticized Freudian theories as being unscientific. Michel Foucault in The History of Sexuality, part one, places “the advent of the age of repression in the 17th century, after hundred years of open spaces and free expression” which “coincided with the development of capitalism” (p. 5) and became “an integral part of bourgeois order.” he called this capitalist repression, “bourgeois asceticism” and “the new work ethic” (p. 122) and, several times, he “denounces Freud for his conformism and normalizing functions of psychoanalysis” within this “monotonous nights of Victorian bourgeoisie” when “silence became the rule” (pp. 3,5,119). The French philosopher Jill Delouse who was admired by Foucault, being a strong supporter of ” freedom of desire and sexuality, likewise denounces Freud and psychoanalysis.
Iranian writers
Despite the fact that Freud wrote: ” the liberty of the individual is no gift of civilization. It was greatest before there was any civilization,.….the development of civilization imposes restrictions on it, and justice demands that no one shall escape those restrictions.” (civilization and its..p284) and Michel Foucault stressed that Modern culture and Victorian bourgeoisie have furthered repression of sexuality and its expression. In our society, in the past 50 years, out of misunderstanding and lack of knowledge, either due to some distorted and dishonest translations of supposedly Freudian texts or due to some ideological misinterpretations and political aims! Some Iranian leftist or religious intellectuals, partly on a Leninist-Stalinist model, coming from Soviet Union, with very similar terminology and partly with vulgar understanding of Freudian terms, strongly denouncing Freud and psychoanalysis as a representative of ‘bourgeois capitalist’ culture, and a grave conspiracy aiming at corrupting youths, both in the East and West!! (why they are corrupting their own youths God knows).
The other point they raised, is that ‘Freudism is addressing women’! and ‘calling them out of the house’! (shariati, ‘woman’, p221) It seems that the critic not only was unaware of the role of Bourgeoisie and Modernism in repressing sexuality, but he didn’t know either that Freudian psychoanalysis, rarely talked about women and never addressed them. That is why, it has been always criticized by Feminists as being a masculine psychoanalysis. The critic writes several pages (216-222) on baseless accusations against psychoanalysis as if it is the most unethical practice in the whole world!! And again not knowing that psychoanalysis, among all the therapies and various branches of medical practice and other professions, has the most elaborate ethical codes of practice.
sexual regulation VS sexual liberation: He, also, accuses Freud and his psychoanalysis for advocating “sexual liberation”! Again not knowing that Freud, on the contrary, was a strong supporter of sexual regulation which was, actually, challenged by Wilhelm Reich (W&R. Stainton Rogers, the psychology of gender and sexuality, p. 103).
The rule of abstinence: and one of the most important basic rules of the treatment of psychoanalysis is the rule of abstinence which is a fundamental method is not to gratify the patient’s libidinal or instinctual demands.
The Liberalization of sexuality began towards the end of the 19th century, when dissenting voices made the so-called “naughty nineties'(the 1890s, that is) as part of a broader continental fin de siècle, marked by publications such as the ‘nouvelle (Sheridan 1898) and a book by Havelock Ellis, and the formation of Legitimation League (1897) to campaign for sexual liberalization, the establishment of the British Society for the Study of Sex Psychology (BSSSP), which had very known socialist and Marxist members such as Bernard Show, Bertrand and Dora Russell, and, also, opening of the Institute for Sexual Science by Herschfield in Germany (1919) and the World League of Sexual Reform. The only psychoanalyst, being part of this campaign was Wilhelm Reich who was, actually dismissed from Psychoanalytic Association because of his radical and unethical sexual views. He was, then, imprisoned on charges of unlawful conduct and died in US prison in 1957 (W & R. Stainton Rogers, the psychology of gender and sexuality-p 101-4).
Despite the history of sexual liberation, and the fact that Freud and psychoanalysis had little direct impact on changing the law, but in our school books, with bold letters, Freudian psychoanalysis is blamed for advocating sexual freedom!
Psychoanalytic ethics
As it was mentioned earlier, there are three aspects of psychoanalysis in relation to ethics:
Firstly, ethics in psychoanalysis or ethical principles in the practice of psychoanalysis: All the psychoanalytic Associations and institutes such as APA stress Provisions of the Principles of Ethics for Psychoanalyst (approved December 1983):
These principles are intended to aid psychoanalysts individually and collectively in maintaining a high level of ethical conduct. They are not laws, but standards by which a psychoanalyst, or one in training to be a psychoanalyst, may determine the propriety of his conduct in his relationship with patients, with colleagues, with students, with members of allied professions, and with the public.
The principal objective of the profession of psychoanalysis is to offer a particular contribution to humanity, with full respect for enhancing the dignity of man. A psychoanalyst should strive continually to improve psychoanalytic knowledge and skill. He should make available to his patients and colleagues, as well as to other physicians, to other qualified professional persons, and to students, the benefits of his professional attainments.
The honored ideals of the profession of psychoanalysis imply that the responsibilities of the psychoanalyst extend primarily to the individual, but also to society; these secondary responsibilities deserve his interest and participation in activities which have the purpose of preserving and improving both the health and the well-being of the individual and the community…….A psychoanalyst should practice a method of treatment founded on a scientific basis; he should not knowingly and voluntarily endorse anyone who violates this principle.
A psychoanalyst should be courteous, considerate, professional and ethical in all his relationships. He should respect all laws, uphold the dignity and honor of the profession, and accept its self-imposed disciplines…. In all situations, a psychoanalyst should merit the confidence of patients entrusted to his care, ….. Should he be required by a court of law to give testimony relating to the confidences of his patient, he should make use of all legal means to safeguard his patient’s right to confidentiality.
When a psychoanalyst uses case material in exchanges with colleagues for scientific, educational or consultative purposes, he should exercise every precaution to assure that, unless specifically authorized by the patient, the identity of the patient is not revealed. When a psychoanalyst learns confidential information from a source other than the patient involved, he should, nonetheless, fully and appropriately respect its confidentiality. Sexual relationships between analyst and patient are antithetic to treatment and unacceptable under any circumstances. Any sexual activity with a patient constitutes a violation of this principle of ethics…..
Secondly, psychoanalytic ethics: Paul Ricoeur in his book on Freud and interpretation writes:
I contend that psychoanalyst is a leading participants in any general discussion about language. To start with psychoanalysis belongs to our time by virtue of Freud’s written work.
Then he continues
That work’s broadest aim: not only the renovation of psychiatry, but a reinterpretation of all psychical production pertaining to culture, from dreams, through art and morality, to religion. This is how psychoanalysis belongs to modern culture. By interpreting culture it modifies it.
In fact, Freud’s interpretation of culture is also an interpretation of morality in its relation to culture, and how civilization is built up upon a renunciation of instinct, on one side, and how psychoanalysis aims at liberation of the repressed and unmasking the culture and individual, on the other. Therefore, psychoanalytic ethics is searching for a transparent morality without hypocrisy and cover up, a morality which accepts restrictions and sacrifices imposed by culture.
The liberty of the individual is no gift of civilization. It was greatest before there was any civilization, though then, it is true, it had for the most part no value, since the individual was scarcely in a position to defend it. The development of civilization imposes restrictions on it, and justice demands that no one shall escape those restrictions. (civilization and its discontents – S.E., XXl -p 95)
If civilization imposes such great sacrifices not only on man’s sexuality but on his aggressively, we can understand better why it is hard for him to be happy in that civilization. In fact, primitive man was better off in knowing no restrictions of instinct. To counterbalance this, his prospects of enjoying this happiness for any length of time were very slender. Civilized man has exchanged a portion of his possibilities of happiness for a portion of security. We must not forget, however, that in the primal family only the head of it enjoyed this instinctual freedom; the rest lived in slavish suppression. In that primal period of civilization, the contrast between a minority who enjoyed the advantages of civilization and a majority who were robbed of those advantages was, therefore, carried to extremes. As regards the primitive peoples who exist to-day, careful researches have shown that their instinctual life is by no means to be envied for its freedom. It is subject to restrictions of a different kind but perhaps of greater severity than those attaching to modern civilized man.
And finally we know that:
If one were to yield to a first impression, one would say that sublimation is a vicissitude which has been forced upon the instincts entirely by civilization. But it would be wiser to reflect upon this a little longer. In the third place, finally, and this seems the most important of all, it is impossible to overlook the extent to which civilization is built up upon a renunciation of instinct, how much it presupposes precisely the non-satisfaction (by suppression, repression or some other means?) of powerful instincts. This ‘cultural frustration’ dominates the large field of social relationships between human beings. As we already know, it is the cause of the hostility against which all civilizations have to struggle. ( civilization and its discontents – S.E., XXl -p 97)
The functional importance of the ego is manifested in the fact that normally control over the approaches to motility devolves upon it. Thus in its relation to the id it is like a man on horse back, who has to hold in check the superior strength of the horse; with this difference, that the rider tries to do so with his own strength while the ego uses borrowed forces. The analogy may be carried a little further. Often a rider, if he is not to be parted from his horse, is obliged to guide it where it wants to go; so in the same way the ego is in the habit of transforming the id’s will into action as if it were its own. (The ego and the Id vol 11- chap ll- pp364)
Therefore psychoanalytic ethics is based on limitations of reality, cultural frustration and sublimation forced upon the instincts and rationality of mankind in order to remain civilized. This shows how wrong were those critics who thought psychoanalysis recommend return to instinct and total liberation of desire.
Lacan writes:
My thesis involves the idea that the moral law affirms itself in opposition to pleasure. (book Vll- 20)
Freud: a great moralist
Although he introduced one of the most revolutionary grand theories to the contemporary Modern civilization, Freud was rather a conservative modern man in his personal and family life, as he was being brought up in a Victorian Jewish family. In this respect he was very similar to other great radical modern thinkers; such as Descartes, Kant, Hegel, Darwin, Russell and Einstein. A great man of moral, very hard working, conscientious and resolute, with a rather obsessive personality make up who was somehow intolerant of unethical vulgar behavior
Freud, in Dostoevsky and parricide strongly criticizes the writer on a moralist ground:
A moral man is one who reacts to temptation as soon as he feels it in his heart, without yielding to it. A man who alternately sins and then in his remorse erects high moral standards lays himself open to the reproach that he has made things too easy for himself. He has not achieved the essence of morality, renunciation, for the moral conduct of life is a practical human interest. He reminds one of the barbarians of the great migrations, who murdered and did penance for it, till penance became an actual technique for enabling murder to be done. (S.E.-XXl- 177)
And in response to Reik’s critical review of his essay, he replies:
In spite of all my admiration for Dostoevsky’s intensity and pre-eminence, I do not really like him. That is because my patience with pathological natures is exhausted in analysis. In art and life I am intolerant of them. (S.E.-XXl- p 196)