Book Review: Nietzsche and the Clinic: Psychoanalysis, philosophy, metaphysics

To be successfully normal, then, we rather have to dumb ourselves down

(Russell, J., 2017: p 154)

This is an attractively presented book with the text running for 154 pages, a respectable reference list of six pages and a useful index of five pages. The author, Jared Russell, is a psychoanalyst in private practice in New York City. He received his PhD in philosophy from The New School for Social Research, while undergoing analytical training at The Institute for Psychoanalytic Training and Research, where he is now a faculty member and clinical supervisor. He is also managing editor of The Undecidable Unconscious: A Journal of Deconstruction and Psychoanalysis (University of Nebraska Press).

His hybrid book portrays Nietzsche as a thinker of tremendous practical import for those treating the pathologies of the twenty-first century with an interpretive response. Russell gives us clinical means of reading arguably one of the most important and prophetic thinkers of the nineteenth century. At no point does his argument try to coast on the seductive purchase that the psychoanalytic theory contained in this volume enjoys a non-clinical, academic audience. As a practicing psychoanalyst, Russell's intention is to contact clinicians who face the everyday conundrums that the discipline encounters everywhere today. In every way, Nietzsche lived up to his insistent portrayal of himself as untimely. It is Russell's contention that psychoanalysis today would do well to learn what Nietzsche meant by this. Occasionally, the author might indulge in a somewhat polemical style; however, if the reader is patient, he will find that there is nothing at all unscientific about this.

For me, the fact that the author focuses entirely on psychoanalysis, and does not refer to psychotherapy nor practitioners from other orientations, makes the book more concise, original and successful. The book is spread over five chapters, and a very interesting postscript of six pages. The subject matter of the chapters are as follows: Nietzsche's perspectivism; Nietzsche, psychoanalysis, individuation; projective identification from Nietzsche to Klein; Nietzsche, Winnicott, play; and Nietzsche, Lacan, madness. I found each of the chapters to be useful for the existential psychoanalyst. I will therefore view each of the main issues contained in the text, in a straightforward and logical fashion. We shall see that the clinical practice of psychoanalysis as a non-metaphysical science is an effort to resist the 'intentional stupidity' (p 154) of our time, and create other possible futures.

The book begins by exploring the fact that Nietzsche allows us to reconsider the practice of interpretation as a technical procedure, and the conditions under which it is effective in facilitating difference, transformation and change. He would claim that 'there are no facts, only interpretations' (p 2). Perspectivism is a term that has come to encapsulate his position with regard to an alleged absence of facticity; a defence of the irreducibly subjective character of all human experience and as a rejection of the enterprise of modern science. Before the advent of psychoanalysis, tending to the singularity of experience in this way, rejecting any consideration of universals in favour of an appreciation of the unusual, the rare, the unpredictable and the distinct was the essence of Nietzsche's critique of metaphysics. 'The criminal becomes lawgiver, medicine man, demi-god' (p 28).

Moving on to the second chapter, we read of the strength of individuation, as opposed to the nihilistic inherent weaknesses of group identifications that promote herd mentality. If we read him the way he demands to be read, with great care, Nietzsche can be a tremendous resource in the efforts of psychoanalysts to bring about such daring­ness both within a clinic and in the world at large, as it relates to the clinic. Today, to teach slow reading, taking time and becoming still is an effort not only to resist commercialism and the needs of the consumer but to interpret otherwise, according to other needs, affects and desires. The modern world consists essentially in a relentless splitting apart of self and environment, expressed as the opposition between subjectivity and objectivity that drives the marketplace of modern technological science, or what Nietzsche calls 'the blind powers of the actual' (p 43). Youthful disgust with the adult world, less and less in evidence these days, as already for Nietzsche, at the very least manifests a healthy attitude of rebelliousness and a desire for change. He associated this uncreative, competitive effort with the weakness of commercial culture as a form of 'slave morality' (p 62). It must be said that despite the warmth the analyst may exude, neutral interpretation always involves a kind of automaton-like quality, although the analyst as interpreter might be uncanny. Promoting inter-subjectivity must always be central, with the current prevalence of this kind of thoughtlessness outside the clinic.

Chapter three considers the strong, which is capable of joyously discharging strength, and the weak, who are not so capable and who as a result substitute negativity and destructiveness for enthusiasm and worldly engagement. Nietzsche describes the way in which empathy and cruelty are not necessarily intrinsically opposed. Perhaps Christian forgiveness constitutes an exercise of domination: if I am forgiven, what is implied is my ignorance, as to some ultimate, transcendental law according to which true value ought to be assigned. According to Klein, either something is all good, and so identified with the nascent sense of self, or it is all bad, and therefore refused as part of the world. Interestingly, Klein indicates that certain psychotics have not abandoned all contact with the reality of other people; rather they are open to, and empathise with, others so painfully, so voraciously, that as a result their basic sense of self feels constantly under threat of total annihilation. We can read in Kleinian literature what the individual finds unacceptable in him or herself, he or she puts into me, in a way that forces me to experience it, and to feel and behave accordingly, so that he or she does not have to. This is the concept of projective identification.

The next chapter, which considers Winnicott and the concept of play, was enchanting. 'A man's maturity – consists in having found again the seriousness one had as a child, at play' (p 93). Playing describes not the transformation of being into doing, but the possibility of establishing one's being in such a way that doing can be done in a meaningful way. Whereby analysis is conceived as an effort at playfully abandoning those structures that govern life outside the consulting room, the opposition of the subjective and the objective has no place in the clinic. Although Winnicott had no way of thinking what this might mean, his natural inclinations and curiosity seem to have oriented him in this profoundly Nietzschean direction.

Finally, in the last chapter, we encounter madness. Nietzsche spent the last eleven years of his life in a state of catatonic psychosis, having witnessed a man cruelly beating a horse in the city of Turin on 3rd January, 1889. Directly hereafter and before he was committed to the asylum, his landlady peeped through his window one night, and witnessed the famous author dancing and singing in the nude. She guessed that he must have been drunk on wine.

Similarly, Lacan believes that the psychoanalytic clinic, unlike the university, is not part of the service industry. It only climes to the medical discourse by continuing to refer to its 'patients'; this is because analysand remains too unfamiliar to those who find novelty intolerable: unique experience is the encounter with jouissance. Perhaps, then, the fate of psychoanalysis will be that of Nietzsche's fabled madman upon having announced the death of God:

Here the madman fell silent and looked again at his listeners, they too were silent and looked at him disconcertedly. Finally, he threw his lantern on the ground so that it broke into pieces and went out. 'I come too early', he said; 'my time is not yet …'

(p 148)

In conclusion, I would have to agree with the comment made in the postscript, that 'any effort to treat schizophrenia other than at the level of its irrefutably biological basis was morally unconscionable given the sophistication of contemporary psychiatric knowledge' (p 152). Historically speaking, the analyst should be aware that the Nazi genocide of schizophrenics is not widely known. Between 73% and 100% of all individuals living with schizophrenia in Germany between 1939 and 1945 were sterilised and murdered. The academic schizophrenic as present day holy homo sacer is accustomed to intimidation, mockery and disparagement by the prevailing trash. The gross over-medication and forced termination of their offspring is something that every psychoanalyst analysing a psychotic patient should be aware of.

Having said that, I can recommend this brave book to the existential psychoanalyst; the rare phenomenon of the mad genius should always be valued and even celebrated.

Gregory M. Westlake

References

Torrey, E.F. and Yolken, R.H. (2010). Psychiatric genocide: Nazi attempts to eradicate schizophrenia. Schizophrenia Bulletin. Vol.36. No.1. 26-32.