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

Nietzsche's exciting philosophical adventure was always meant as an experiment. Too imaginative for the greenhouses of academia, he was unceremoniously ejected, as a young gifted philologist, for having produced a rhapsodic account of the Greek tragedians that flew in the face of the self-appointed objectivity of so much insipid scholarship. His first published work, The Birth of Tragedy (2000), flirted with ecstasies and intensities that to this day frighten muzzled horses in their evidence-based stables. Despite slating the book years later for its 'Hegelian smell' and reproaching himself for his youthful infatuation with Wagner, with that particular work Nietzsche managed to pluck from thin air the now universally acknowledged (if seldom understood) categories of the Dionysian and the Apollonian. This and other ideas found their way eventually into academia, i.e. into a world where the adventures of philosophy turn into so many plastic gadgets in the bazaar of fetishized knowledge. A central point the author makes in this stimulating book is that there is an evident parallel between Nietzsche's philosophy and psychotherapy. Russell, a psychoanalyst in private practice in New York and managing editor of the journal The Undecidable Unconscious, does not refer to psychotherapy as a whole but only to psychoanalysis. Sadly, this is common practice among analysts, a stand-offish refusal perhaps to recognize some common ground with practitioners from other orientations, but the significant point for therapists of all orientations is that psychoanalysis was born outside academia. Not only was Freud denied access to a university position because of the anti-Semitism of fin de siècle Austria, which regarded psychoanalysis with disdain as a 'Jewish art'. The very art of psychotherapy, like Nietzsche's philosophy, is, the author rightly says, an experiment and as such cannot be easily translated into the recyclable knowledge of universities, least of all 'integrated' into a pseudo-discourse ruled by PowerPoint and data-ridden clichés that demand tiresome recitations in essays and case studies. What tends to happen through this soul-destroying process is that the art of psychotherapy becomes a commodity. Instead of the transmission of a living culture, this is a route to acculturation. Russell writes:

Academic institutions operate according to a logic in which what is accepted is not esteemed, and in which what is esteemed is not to be accepted... Nietzsche had perceived and suffered the effects of this logic. His vision of philosophy as a practice beyond mere scholarship led him to embrace experimentalism in style, and to practice textually in ways that would indicate the fault lines in all claims to universality.

(p 124)

There is no place for experiments in the museums of academia – only for factual knowledge. But if it has to have a future, psychotherapy will have to give primacy to experimentation and experience. The two are inextricably linked: 'in Nietzsche's beloved French "experiment" is experience' (p 124). This is one of the many areas where Nietzsche's work can be immensely useful to therapists. In the light of increasing demands for efficiency and standardization, it provides us with a new frame founded on experimentation and not-knowing, on open refusal of all-pervasive neoliberal, neopositivist approaches to psychology and therapy.

Before being a philosopher, Nietzsche (1983) saw himself as a physician of culture and a psychologist. He diagnosed the symptoms of the positivist age, its poignant for stifling ingenuity and elevating the gloomy compliance of the herd to models of normality. Russell boldly links the above to Helene Deutsch's (1942) fertile notion of the 'as-if' personality. Deutsch designated a particular form of mental distress: individuals who do not present at first any particular disorder or unusual behaviour; their 'intellectual abilities – she writes – appear unimpaired, emotional expressions are well ordered and appropriate' (p 302). These are socially adaptable, functioning people who nevertheless feel that 'something is wrong', yet to grasp what is wrong is very hard for both client and therapist. With these clients, Russell writes:

It is not clear if one is dealing with an absence of self-awareness or with a strange form of hyper self-awareness whose function it is to isolate the patient from 'life'. The sense one receives is that one is engaged with an 'automaton'.

(p 45)

Bollas (2011) came up with the notion of the abnormally normal person, what he called 'normotic personality', a person who may be able to live 'contentedly among material objects' and with a distinctive inability 'to experience evolving subjective states' (p 23), driven by a powerful desire to be and appear 'normal' and where all semblances of an inner life with its inherent contradictions and difficulties is seemingly absent. In the same text, he relates this type of personality to Joyce McDougall's notion of the anti-analysand. He does not differentiate the normotic from the 'as-if individual' but all of these similes seems to share and be at home within the cultural backdrop provided by positivism and neopositivism.

In Deutsch's 'as-if' individuals, 'all inner experience is excluded. It is like the performance of an actor who is technically well trained but who lacks the necessary spark to make his impersonations true to life' (cited in Russell, p 46). These very same characteristics Nietzsche described as typical of a human prototype brought about by positivism where 'the remarkable antithesis between an interior which fails to correspond to any exterior and any exterior which fails to correspond to any interior' (p 47). What is common to these various conditions is that they all register a normative adaptation to modernity. If this is true, then the positivist (and neopositivist) human model of mental wellbeing is pathological.

This question is broadly political before being psychological, if one agrees that at the heart of positivism (and of the neo-positivism in vogue today), there is a desire to control the unpredictability of human experience: a political act of subjugation of the externalized 'enemy' or the internalized other. It would be reassuring, at this point, to assume that only orientations like CBT are devoted to the neopositivist project; it would be comforting to feel that the beautiful souls of humanistic psychology are intrinsically and organically immune to its influence. But this means we seriously underestimate the insidious presence of the latter in the way therapy is taught, learned and practiced. Causal psychoanalytic explanations of symptoms fail because they short-circuit the psychotherapeutic experiment in the name of expediency, of finding a fake answer to the client's predicament via a formula: an example of neopositivist influence. In Nietzsche's terms,

this is an appeal to static 'being' instead of living, which is by its very nature unpredictable and organically 'becoming'. Intersubjectivity, a mode currently in vogue across most therapeutic orientations, also falls short due to its sympathetic efforts at interpersonal concern that turn away from the essentially symbolic domain of therapy. At times the author appears to suggest that psychoanalysis alone may represent an alternative to a culture dominated by cognitive, pharmaceutical and other 'evidence-based', 'result-oriented' interventions modelled on 'work' (p 69). His argument is nevertheless beautifully nuanced, as well as critical, of the practice of analytic neutrality. The latter needs to be retrieved, in his view, from the 'blank screen', depersonalized model – not towards humanist intersubjectivity but towards a quality of empathy that, inspired by Nietzsche, maintains a dignified distance from the other by appreciating more fully our intrinsic existential aloneness and autonomy. This point is crucial to the author's argument and can, in my view, be extended to most therapeutic orientations, provided the latter are not landlocked into parochial defensiveness. For instance, it is not alien to the debate within person-centred culture in relation to principled non-directivity, understood as respect of the client's autonomy and maintenance of a boundaried and paradoxically freer, symbolic domain. In Russell's psychoanalytic idiom, this is a movement 'towards individuation rather than integration', despite the fact that this might mean

more difference, more solitude, and more suffering when confronted with the casual self-destructiveness encouraged everywhere by the pervasive nihilism of contemporary culture

(p 69)

Not surprisingly, integration has become central in the current political landscape: a coercive demand for assimilation of difference, migrancy and otherness within the parameters set by institutional power. What is surprising is that mainstream psychotherapy and the bodies that represent it have joined the bandwagon. In the name of happiness and wellbeing, they have bypassed the vital step of individuation while paying lip service to diversity, internal loci of evaluation and imbalance of power in therapy.

The author presents an intriguing take on Nietzsche's will to power, a notion over which many esteemed colleagues fall flat on their face, misreading it as they do as desire to exert power over others. But for Nietzsche, who on this topic borrowed from Goethe, wanting to dominate others is the distinctive mark of the weak: the xenophobe who shuns his fear of otherness by erecting 'beautiful' walls and fences, the insecure politician who repeats 'strong and stable' in wooden speeches, the person whose only strength comes from recognition and validation, the individual who is afraid of perceiving and nurturing what Rogers called 'personal power' – a quality of presence, perhaps, what Russell aptly calls 'cultivated vulnerability' (p 73). The natural power of nature and the world can only be experienced through cultivating one's vulnerability. In this sense, Russell's reading of will to power directly appeals to the therapeutic enterprise. Despite the latter's inflation of subjectivity, will to power opens the exploration to radical (anti)metaphysical implications. As I understand it, will to power is another phrase for the directionless, purposeless actualizing of nature itself, a movement that is alive in our incarnate existence but that cannot find a home or ground in the body or in nature – let alone in so-called 'being' – or in any grand design such as the formative tendency. For Nietzsche, all these designs are but 'shadows of God', surrogates we create in order to fill the magnitude and uncertainty of existence and make our dangerous journey just about bearable.

While I am sympathetic to the subjectively-determined cultivation of vulnerability suggested by the author, I find his linking of will to power to the 'pre-Oedipal' domain less persuasive. But this is because I see psychoanalysis as derivative of Nietzsche's philosophy and do not fully believe that psychoanalytic principles can be convincingly used to critique Nietzsche. This is not because Nietzsche is beyond criticism but the implications of his thought have yet to be fully explored, particularly in the area of psychology, a science that is part of the same ressentiment Nietzsche fervently contested.

Russell makes interesting connections between Nietzsche's thought and psychoanalysis, particularly Winnicott and, in a beautiful tour de force in the final chapter, Lacan. Both Winnicott and Nietzsche valued play as a 'kind of doing that is not distinct from being, a kind of doing that being is' (p 105). As for Lacan, though he never drew on Nietzsche, he would have certainly appreciated (and said something effectively close to it), Nietzsche's astonishing idea of the self as neurosis (Bazzano, forthcoming).

Conspicuously absent from the book is Otto Rank, who not only parted company with Freudianism in the 1920s because, despite 'call[ing] itself a psychology of the unconscious', it promoted in his view 'the scientific glorification of consciousness' (Rank 1932, p 222). Not only did he exert a pivotal influence on Carl Rogers (Kramer, 1995), thus creating a link between post-Freudian and humanistic therapy, Rank was also last century's most coherent Nietzschean psychologist. His emphasis on the creative will of the individual; his understanding of incongruence and mental distress as a failure in creativity; his focusing on the client and on the client's ability to self-direct her creativity towards a more meaningful, individuated existence are only a few examples of Nietzsche's influence and of the correct application of his insights.

Manu Bazzano