epistemological violence & psychoanalytic theory
Note: This is part 1 of an as-of-yet unknown number of posts.
Beginning with Jean-Martin Charcot, modern psychiatry began largely with the study and control of the other. A French neurologist, Charcot routinely saw women of all ages in his clinic for any manner of perceived ills. And ultimately, in part due to his now infamous student Sigmund Freud, It was his focus in this area that gave rise to psychoanalysis.
But first a little about hysteria
The presentations Charcot studied were varied, but his fixation on women’s bodies and particularly women’s sexuality led him to categorize the majority of these complaints under the umbrella term "“hysteria” (from the Latin hystera). While the construct of “hysteria” in various forms had existed for thousands of years, contemporaries of Charcot began to postulate that it could be “cured”, or at least temporarily relieved, by inducing a hysterical paroxysm — or if you want to use a slightly less oblique word for it, an orgasm. Charcot’s contemporary Thure Brandte suggested this could be accomplished by palpating the vagina, giving rise to the modern vibrator. Previously this had been used for other ailments, perceived and real, mostly surrounding pregnancy and fertility.
But as you can imagine, the idea that this thing existed, whatever it was, gave license for men to classify women’s bodies and sexual behaviors. And while the history of medicine is often one of heroics, it is just as often a history of subjugation, domination and exploitation. The search for an etiology of hysteria is one dramatic example of the latter.
Beginning in antiquity with the “wandering uterus” theory (for real, google it), Western physicians had long believed that there was some sort of psychiatric malaise unique to womanhood. Following in his teacher’s footsteps, Freud began to explore the possibility of traumatogenic illness as the culprit.
However, Freud’s work was quickly hamstrung by those who controlled his purse strings. As Freud began to share his hypotheses, this attracted the attention of a medical community both suspicious and furious at what he was proposing. In the end, rather than defy the industrialists who had sent their family members — often who it was clear had become distressed as a result of prolonged childhood sexual abuse perpetrated by the very men who hired Freud in the first place, Freud developed an alternative hypothesis that would be more pleasing to his financiers.
Later dubbed the Electra Complex by contemporary Carl Jung, Freud proposed that girls and young women were inherently in a competitive struggle for sexual attention from the patriarch of the house. This struggle, Freud and Jung argued, played out like the famed Oedipus Complex which Freud is perhaps best known for.
In this struggle, the competition for male affection created a jealousy so powerful that it consumed the self. Exactly how they imagined this translated into anxiety, catatonia, and spontaneous crying is unclear. The specifics never seemed all that important to them when they lacked salacity. The idea of an ever-present sexual jealousy driving “hysteria” supported Freud’s call for the sexualization of all things related to the human experience, and it positioned male physicians to counsel their patients into self-blame. It remains one of the most egregious abuses of human rights in psychiatric history (which as you will see later, is a sadly long, morbid list).
What is clear, however, is that this was the template for much of how psychoanalysis would come to operate over the next half-century. While Freud is notorious for having suggested that a degree of bisexuality was universal in younger humans before “resolving” into a monosexual identity, this didn’t exactly position Freud as the ally that many of his present-day acolytes would want you to believe. Eager to “solve” one of the more taboo topics seen at the time as a mental disorder, Freud proposed an explanation for homosexuality that went something like this:
Boys vie for the attention of their mothers and ultimately seek to become them. In the process, the sexual gaze is turned back inward at the self, stripping the ego of masculinity and creating a desire for male attention.
Depending on the year and the theorist, this was alternately seen as the product of narcissism or psychic injury, but nevertheless involved a redirection of desire away from heterosexuality.
This was, of course, total nonsense, but the idea stuck.
We can see linguistic clues in early 20th century terms for gay people. Emma Goldman writes in her autobiography in one passage about the struggle of “inverts” in society for acceptance. Inverts was a name commonly given to LGBT people at the time, along with the even more anachronistic term “Uranians”, which was specifically for transgender people. While inversion as a concept fails to pass even the most basic scientific scrutiny, it would continue to see daylight for a full century, and among conversion therapists, even to this day.
Inversion, having been used alternately to explain both gay and transgender people, as well as those who recreationally “cross-dress” got very murky very fast. This quote from a 1957 article in the prestigious Journal of Pediatrics and accompanying screenshot from the same author’s article in the American Journal of Orthopsychiatry gives us a window into just how confusing this became:
“It is hypothesized that inversion has its roots in the earliest years of life when the child forms, at first involuntarily and later consciously, an identification-attachment to the parent of the opposite sex and thereby introjects the sex role of the opposite sex. The invert, then, is a psychosomatic misfit, having the body of one sex and the personality of the other sex.”
— Brown, Journal of Pediatrics, 1957
Despite Brown’s attestation to the alleged clarity of the use of the word, even Brown has to admit that Freud, in describing the word, wrote the following sentence:
“It is, therefore, very surprising to find that there are men for whom the sexual object is not woman but man, and that there are women for whom it is not man but woman. Such persons are designated as contrary sexuals, or better, inverts, and the situation of such a relationship is called inversion.”
— Sigmund Freud, 1905
Despite the claim that many anti-trans groups make that gay men and transgender people (or in the parlance of the day, transvestites and transsexuals, as “transgender” as a word wasn’t invented until the 1960’s) are a distinct political entity, social cruelty towards LGBT people rarely distinguished between the two. In fact, many psychiatrists referred to the state of being transgender as “the most extreme form of homosexuality”, and asylums had no compunction about incarcerating either.
These anti-gay ideas were heavily baked into the Diagnostic and Statistical Manual (DSM). After sustained pressure, the diagnosis came correctly under fire beginning in the 1970’s, and in 1980, with the release of the third edition of the DSM (typically written as DSM-III), this was switched to ego-dystonic homosexuality. Dystonia is a term for that which goes “against the self”, causing inner conflict. People who have dystonic conditions wish to be free of them.
The APA however did not at the time take a position on the correct way to “treat” ego-dystonic homosexuality, and options diverged into two diametrically opposed factions: conversion therapy, and affirming therapy that sought to reconcile the conflict by de-stigmatizing queer identity. History and science are very clear on whose ideas won. Those who were affirmed flourished, those who attempted what were increasingly called reparative models struggled, and many died as a result of the torture they experienced at the hands of practitioners.
[note: I am currently working on a longer form essay about what conversion therapy has entailed throughout history, but I would highly recommend Florence Ashley’s work on the topic.]
It was not limited, however, to cisgender LGB+Q people: In the late 1980’s and early 1990’s, Ray Blanchard became famous for publishing his “typology” of transgender women, which he divided into “autogynephiles” (AGP) and “homosexual transsexuals” (HSTS). While different, and largely focused on two different groups of people with different sexual orientations, Blanchard proposed that the latter group, HSTS, were confused gay men who, in a desperate attempt to rescue themselves from the taboo of being gay, attempted to sublimate their sexuality into bodies and therefore relationships that could be perceived as heterosexual. His ideas were championed by Lawrence, who coined the language of “erotic target location errors”, which presume there is a “normal erotic target” for sexual desire which drives attraction. It’s different language, and has the veneer of nodding towards the cognitive revolution, but is in fact, simply Freud all over again.
Transgender women, to the sexologists of the day, were men who either desired to be women to escape attraction, or desired to be women to access the object of that to which they were attracted.
But in all of this, it seemed to be lost on most theorists that there was an alternative possibility, which is just that differences in sexual orientation and gender identity and modality are simple natural variations on the human experience. Perhaps, no one in mainstream sexology seemed to have thought to ask, if there is actually nothing wrong with being gay or trans then it is society that is sick, and it is the fear of the other that creates problems. This was given a name in the 1970’s, in an attempt to move away from pathologizing gay people to pathologizing the obsession the heterosexual world had with the alleged dangers of our existence: you know it as “homophobia”.
Even as LGBTQ people began to join the throngs of sex researchers and therapists, the idea of decentering both maleness and hetereosexuality seems to been a non-starter. And with such a warped foundation, only crooked houses could be built. As such, much of the literature continued to drive towards new etiologies and explanations for queerness.
And these explanations have continued to be used as a weapon against LGBTQ people in psychotherapy. Despite having been removed from the part of the DSM that deals with gender identity and relegated to the anachronistic diagnosis “transvestitic fetishism” (F65.1, which is decidedly not F64), Blanchardianism still infects much of the modern discourse.
I often wonder what my life would have been like if Ray Blanchard had been an architect or a clown at a travelling carnival, rather than merely playing one in real life.
But whatever would be different, I suspect it would be better, and full of a lot less suffering.
to be continued.
Addendum: You’ll notice the original URL slug to this article reads “psychodynamics and epistemological violence” not EV and psychoanalysis. Before you fill up my DMs with explanations about the difference between psychoanalysis and psychodynamics: slow down. This is what I teach for a living. I narrowed the focus after setting the headline, and the CMS used it as a URL slug before I noticed.
I don’t think the problem with analysis is solved by the evolution to psychodynamics. I think the field is at least somewhat suspect for the same epistemological reasons. All schools of psychotherapy should be rigorously interrogated before we use them lest we cause real harm.
Psychodynamic psychotherapy, by holding onto the idea of client “resistance” very often simply amplifies the existing power dynamic between client and therapist, taking the maxim that it’s hard to see something clearly when you’re too close to its illogical extreme— that only those without experience near can truly understand what they are going through. The first statement is true. The second is categorically not.
Where this gets tricky is, of course, in the case of defense mechanisms as outlined by Anna Freud. Anna’s defense mechanisms were based on observation. While they certainly rhyme with the work done by her father, they stand out in that they represent the first step away from the obsession with psychosexual stages and into what, had they been proposed separate from analysis, would have beaten Aaron Beck to the punch fifty or so years early. Because defense mechanisms are ultimately complex cognitive distortions. What Aaron got right he likely stole from Anna.
But resistance in classical terms is about resistance to the therapist. And this presumes that the therapist is able to discern what the person seeking therapy cannot. Why bother with such a cracked foundation when we have tools like Narrative Therapy which are built on anti-oppressive values with checks and balances built in to mitigate presupposition by the therapist, and a constant feedback loop for the therapist to check in about what they are getting wrong, and about which they should defer directly to the client? There are many psychodynamic concepts which I find useful, and while I use them only once a year or so, when I do they work. But I always try and find something else first because we have such better tools.
