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Piehl and Austin on Pharmaceutic Therapy

From “Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s ‘Plato’s Pharmacy’ to Psychoanalysis” in Pastoral Psychology (2013):



In “Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s ‘Plato’s Pharmacy’ to Psychoanalysis” (2013) therapists Robert O. Piehl and Maria D. Austin want to know “what causes the curative effects of interpretation” (498).

If we know what causes the curative effects of interpretation, we can adjust our interpretations to better effect cures. The authors, drawing on Atwood and Stolorow (1984), recognize that the cause is not the accuracy of the interpretation, since false recovery can be curative, “objective descriptive accuracy is not the proper attribute to use when assessing the value of interpretations” (499). And certain interpretations can make a patient’s condition worse. Nevertheless we are left with an interpretive schema for a psychoanalytic cure: your neck and upper back hurt; analysis leads you to realize you repeat a fantasy of being a hero; analysis leads you to state, “I feel like I have the weight of the world on my shoulders;” your recognition of the punny connection between your symptom and your fantasy allows you to consciously regulate exposure to your triggers; your fantasy and its symptom, while perhaps still existing, no longer totally control your life. Perhaps you make your fantasy a reality by becoming a social justice educator, and your ‘symptom’ is externalized as a pain in the neck for someone who stands in our way. Perhaps the pun was not the truth of one’s traumatic shaping, but its expression through analysis effected a change nonetheless. In Bruce Fink’s terms we would say that one’s fundamental fantasy was formed by the investigation of symptoms in analysis, and this formation combined with our avowal of the formation gives us a small degree of freedom from our symptom, if not a new symptom entirely.

Freud’s early theme of ‘accurate recovery’ is no longer the truth of psychoanalytic cure. The authors discern a movement in psychoanalysis towards new therapeutic goals, in particular “the newer intersubjective conceptualization of interpretation” (500). However, “intersubjective” is an unsatisfactory label for a new trend in psychoanalysis because the Freudian subject is already intersubjective. Nevertheless, the authors believe their analysis “helps differentiate classical psychoanalytic conceptions from intersubjective views through the metaphor of ‘interpretation as pharmakon’” (500).

Piehl and Austin appeal to “Plato’s Pharmacy” by Jacques Derrida in order to argue that psychoanalytic work shares the structure of a pharmaceutical. The authors note that Derrida, a Freudian academic who was not a therapist in the traditional sense, locates the Platonic positioning of pharmakon as an indeterminate space of both cure and poison. Piehl and Austin suggest that “the English word ‘drug’ best exemplifies the ambiguous nature of the Greek ‘pharmakon’” (502). Perhaps ‘potion’ would better capture the ambiguity of a pharmakon. A pharmakon, indeterminately curative and poisonous, shapes and limits “the path of its recipient” (502). Altering one’s pharmakoi alters one’s limits.

The partial indeterminacy of any drug’s effect on ego tonicity/toxicity severely limits our knowledge of drug effects. Perhaps like an education in swimming, our knowledge of drugs cannot be achieved (or at least is not best achieved) through technical explanation manuals; we should move back and forth in the water, perhaps guided by someone in the water with us. Thus Piehl and Austin claim, “although the pharmakon is impossible to master and there is a temptation to rely on prescribed recipes, a true antigen exits [sic] - dialogic relations with others - that brings some semblance of wise control” (503). I preserve the typo here, in which the first ‘s’ or S1 of “exists” is only present as erased, because for Piehl and Austin this merely supposed subject is the space of the antigen, which also truly exits one’s self. To understand drugs one should avow one’s water or give one’s self over to the water, tarrying with one’s limits to recalibrate one’s self accordingly.

Thus the art of interpretation is likened to the art of drug administration, learned in the same mode in which the art of swimming is learned. Piehl and Austin believe that psychoanalytic interpretation must be learned through empathizing with a patient to understand the subtleties of their reactions to various interpretations. Piehl and Austin’s figuration of the psychoanalytic interpretation “permits analysts to devote their energies to tracking the vicissitudes of personal experience in the clinical exchange rather than focusing on rules for applying cumbersome ad hoc hypotheses” (508).
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