Paul Verhaeghe - On Being Normal and Other Disorders: A Manual for Clinical Psychodiagnostics

W hen I was a student, my professors taught me that man was something made. Gender was nothing but a sociocultural construction and psychopathology the effect of an adverse environment. The emphasis in both the human sciences and in the wider cultural and artistic milieu was on the interpretation of the underlying layers. Looking back, we should have anticipated how a couple of decades later the pendulum would swing back in the other direction. Now were in the heyday of genetics, where everything is supposed to be genetically determined. Interpretation is no longer necessary, everything substantial can be found on the surfacewhat you see is what you getand psychology has been reduced to a behavioral science.

Happily, there are signs of a movement away from this polarization. Im seeing evidence of an increasing interest in the original imbrication of both heredity and environment. The sheer complexity of human behavior demands that we reconsider the nonvisible mental, constructions directing it. And for this, of course, interpretation is indispensable.

This book emerges out of the same context, focusing on clinical psychodiagnostics. Nevertheless, a reader looking for a discussion of methods and specific testing procedures will be disappointed. This is not to say that I consider such techniques unimportant. Its just that, for me, such methods are productive only when they are applied from within the framework of a determining metapsychological theory, and this is where the books emphasis will be placed. The real need for such a theoretical foundation is demonstrated in Part I, where I show how a categorizing diagnostic based upon atheoretical observations is doomed to fail. Such a diagnostic, furthermore, leads to a paradigmatic approach in clinical practice that loses the vital connection between diagnosis and therapy.

It is this connection that becomes pivotal in Part II, which serves to develop the theoretical ground mentioned earlier. In this section, I argue that the connection between diagnosis and treatment can only be made through a conceptual understanding that holds the vicissitudes of identity as utterly central. In this case, the emphasis will be on the relation between the subject and the Other. This is not by coincidence: the main contention of this book will be that identity is acquired only in relation to the Other. Consequently, any potential pathology must also be diagnosed on the basis of this relationship. Finally, it is only through this relationship that the treatment can be effective. This latter idea is confirmed by numerous studies that reveal the therapeutic relationship itself as the decisive instrument.

This argument is based on my reading of Freudian and Lacanian psychoanalysis, simply because this is the theory I know best. The expression my reading is deliberate. Even Freud and Lacan need to be submitted to empirical scientific evidence, and I have tried to do this as much as possible. In the process, a number of their theses have been contradicted, a number of them confirmed. But all current clinical theories have significant data that have no way of being empirically tested. The question of whether one will ever be able to completely test everything is moot.

With this theoretical background in hand, the chapters in Part III analyze the various possible differential-diagnostic relationships occurring between subjects and the Other. The reader will encounter a number of the classic concepts of psychoanalysisneurosis, psychosis, perversionas well as the less well-known opposition between an actualpsychology and a psychopathology. Wherever possible, I refer to the DSM categories and, especially, to recent findings in empirical research. In keeping with the general intent of this book, I discuss the implications of a certain differential diagnosis for the treatment at every turn. More specifically, I indicate what kind of therapeutic relationship we can expect, depending on a given diagnosis, and how this relationship will determine the treatment, in whatever form it takes.

Combining analytic theory with contemporary empirical research in this way carries a double risk: analysts may reject this diagnostic theory on the grounds that it is not analytical enough. Clinicians coming out of other traditions, on the other hand, may consider the book unserviceable because of its foundation in what they consider an outdated theory. I can only hope that I reach the critical reader who is prepared to test his or her own experiences against what is put forward here.