The pathology in question, it seems, is the desire of the state to regulate psychotherapy - to intervene in that intimate relationship between therapist and what is called, for want of a better word, ‘client’. This has come to a head in France, where Lacanian dominated psychoanalysis is both prestigious and well known. Jacques Alain Miller is Lacan’s son-in-law. Here is Miller’s reply on behalf of all psys (psychoanalysts and psychotherapists) in France against the state regulation of the ‘neither-nors’ as we are called. That is, all those psys who simply ‘screw a plaque to their door’ who are neither doctors, psychiatrists, nor clinical psychologists.

According to the Accoyer Amendment of 8 October 2003, these ‘charlatans’ or ‘scoundrels’, without heretofore recognised qualifications, will not be allowed to practise in France. This proposal, passed unanimously by the National Assembly without consultation with the psys, was allegedly to close an existing lacuna in the law, part of a more generalised move in society towards more state control of services, ‘total quality control’ and ‘evidence based’ delivery. It meant that psychoanalysts who are not also already doctors, psychiatrists or clinical psychologists would be unscrewing their plaques because they would become illegal overnight. The outcry was loud and clear across France. The result was a manifesto, created by the hastily convened, ‘Forum of the Psys’, to which about nine hundred people came at short notice, on 15 November 2003.

Is there any more to this response than self-interest on the part of ‘unqualified’ psys, or do they in fact serve an important function? Miller argues in his strong defence of contemporary psychotherapy and psychoanalysis that, ‘the psy is now being expected to substitute himself for the forebear to assure the transmission of values and continuity between generations. The listening ear of the psy, qualified or not, constitutes the compassionate cushion to the ‘society of risk’ …[meeting] the need for personalised attention’ (p50-51). Over and against this uniquely personalised listening to the suffering other, lies the desert of ‘abstract and anonymous systems’ and society’s woes, or pathology, listed by Miller: detraditionalisation; loss of bearings; disarray of identifications; dehumanisation of desire; violence in the community; suicide among the young; the passages á l’acte of the mentally ill. Miller says psys are required to be ‘constitutive or re-constitutive of the social bond which is going though a process of restructuring probably without precedent since the industrial revolution’ (p51).

Against this exemplary, ethical vision for psychoanalysis, we could admit that psychoanalysis has also been a central intellectual component of the modernising process which has deconstructed all social bonds, identifications and traditions over the past decades. To claim now that psys are now constitutive of the social bond, or transmitting values, or acting in place of forebears, may be somewhat disingenuous. In fact, not so long ago, Miller’s fears for the social bond would have been rejected in terms of ‘moral panic’ anyway. Miller may have been forced into making too high a claim for the psychoanalytic listening process. But that psys are radically alternative to the global process, outlined by Miller, which aims ‘to suffocate all those practices that are employed to treat mental pain without medicinal prescriptions’ (p43), will be readily conceded. Powerful economic forces are pressurising doctors and psychiatrists to prescribe psychotropics, and fuelling the argument that depression is under-diagnosed and more anti-depressants should be prescribed - ‘why not sweep away the last obstacles’ says Miller, ‘namely psychoanalysis and the psychotherapies?’ (p43). The French are already the largest consumers of psychotropics in the world.

The massive opposition to Accoyer created a number of compromises to the legislation and by August 2004, the final form was in place. Now, all trained psychotherapists, who are qualified members of their associations, must be registered on a record maintained by the government, regularly updated and open to public inspection. Miller, however, was still against this concession, fearing creeping medicalisation of practice, administrative control and the increasing favour being found with (anti-Lacanian) Cognitive Behavioural Therapy approaches. Other psy groups however were quick to include themselves in the registration process. Doubt remains as to what the bureaucracy may do in the future in terms of new controls and regulations. As Bernard Burgoyne says in his introductory chapter, panels will be in positions of control over all psy-work: referral, practice, supervision, training. Little matter, he says, the ignorance of the state on questions of the relationship of psychoanalysis to psychiatry, to psychology, to various psychotherapies. What matters to the state is state control.