On the difficulty maintaining an analytic practice in the United States and a resulting movement toward the application of Lacanian psychoanalysis to cultural and political analyses, Sinthome writes:
"It's nearly impossible to work solely as a clinician in the United States due to how therapy has here been structured via the mediation of insurance companies, government, and a particular ideology of medical science. Moreover, with the exception of a handful of institutions such as Duquesne (and increasingly Emory), psychology departments tend to see psychoanalysis and Lacan as a form of arcane quackery that has been thoroughly disproven or discredited. The only other option is for the defender of Lacan to shack up in social sciences (rarely) or humanities departments and to transform psychoanalysis into a form of cultural and political analysis."
In connection with this trend, Sinthome sees an imaginary sense of certainty and fixedness associated with academic cultural analysis that contrasts with the awareness of uncertainty arising more insistently within the two-party clinical relationship:
"[O]ne of the central things we quickly learn in the analytic setting is that just when we think we have an understanding of what is going on the analysand throws us a curve ball that violates all our expectations. That is, there's a dialogical dimension to analysis such that the analysand responds back and this is lacking in the interpretation of cultural artifacts. Absent this dit-mension of response, psychoanalysis easily becomes a discourse of imaginary mastery, generating the attitude of a university discourse that is confident it is able to interpret all formations of the unconscious and culture."
Sinthome is on to something when he speaks about a difference between the analytic products of non-clinicians and the experience of the analytic endeavor familiar to those of us in clinical practice. I find it difficult to imagine how the non-practitioner comes to appreciate the illusory sense of certainty that makes a fool of us in clinical practice whenever we become convinced of some fixed and final meaning in the patient. The experience of such certainty is not analysis as much as it is resistance to analysis.
There are a number of other interesting insights woven through Sinthome’s post and I would highly recommend checking it out.