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1 2 311 4 5 THE PATHOLOGY 6 7 OF DEMOCRACY 8 9 A letter to Bernard Accoyer 10 1 and to enlightened opinion 2 3 4 Jacques-Alain Miller 5 6 with contributions by 7 Bernard Burgoyne and 8 Russell Grigg 9 201 1 2 Translators 3 Adrian Price and Victoria Woollard 4 5 6 Ex-tensions (A JLS supplement) 7 8 9 30 1 2 3 4 5 6 711 KARNAC 8

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1 2 311 CONTENTS 4 5 6 7 8 9 10 Series Preface 1 Dany Nobus v 2 About the Authors vii 3 4 PART I 5 Introduction 6 Love of the Real 7 Bernard Burgoyne 3 8 9 PART II 201 1 Amendment 336 17 2 3 PART III 4 5 Letter to Bernard Accoyer and to 6 enlightened opinion 7 J.-A. Miller 25 8 9 PART IV 30 The Psy Manifesto 1 J.-A. Miller 55 2 3 PART V 4 5 Postscript 6 Regulating Psychoanalysis 711 Russell Grigg 61 8 Miller/prelims correx 8/12/04 4:57 pm Page iv

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1 2 311 SERIES PREFACE 4 5 6 7 8 JLS Ex-tensions 9 10 A book series from Karnac edited by Dany Nobus 1 2 Since its inception, Lacanian psychoanalysis has demon- 3 strated a remarkable capacity for inducing acrimonious 4 conflicts and facilitating tumultuous struggles between its 5 own constituency and other areas of inquiry, as well as 6 within its own ranks and amongst its most loyal adherents. 7 Although Lacanianism has spread like wildfire across the 8 academic disciplines, Lacan’s intellectual legacy has main- 9 tained a highly unstable equilibrium at the theoretical, 201 clinical, and institutional levels of its modus operandi. At 1 the same time, Lacanians have often been at the forefront 2 in addressing the socio-political and cultural tensions that 3 pervade our contemporary living conditions and they have 4 often taken the lead in responding to the pressures of our 5 market economy to control and streamline the psychoana- 6 lytic profession. Published in association with the Journal 7 for Lacanian Studies (JLS), this series of short books aims to 8 address ‘extant tensions’ affecting the broad field of 9 Lacanian psychoanalysis, whether they originate within its 30 own boundaries or outside its direct sphere of influence. 1 The objective is not to resolve these tensions, nor to inter- 2 pret them through the application of psychoanalytic know- 3 ledge, but to pinpoint their significance and assess their 4 implications for a world that has psychoanalysts in it. 5 6 711 8 v Miller/prelims correx 8/12/04 4:57 pm Page vi

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1 2 311 ABOUT THE AUTHORS 4 5 6 7 Bernard Burgoyne is a psychoanalyst practising in 8 London. He is a Member of the World Association of Psy- 9 choanalysis, and a Professor of Psychoanalysis at Middle- 10 sex University. He was educated at the University of 1 Cambridge, the London School of Economics, and the 2 University of Paris. He has published extensively on ques- 3 tions of structure in psychoanalysis. 4 5 Jacques-Alain Miller is graduate of the École normale 6 supérieure, a member of the École de la Cause freudienne and 7 the founder and former president of the World Association 8 of Psychoanalysis. Editor of the books of Jacques Lacan’s 9 Seminar, he has published several books under his own 201 name, including Lettres à l’opinion éclairée (Seuil), Le Neveu 1 de Lacan (Verdier), and recently, Voulez-vous être évalué? 2 (Grasset) with the philosopher Jean-Claude Milner, a tran- 3 scription of two sessions from his weekly seminar at the 4 Department of Psychoanalysis, Paris VIII, of which he is 5 the director. Jacques-Alain Miller lives and works in Paris. 6 7 Russell Grigg is a member of the Ecole de la Cause freu- 8 dienne and of the New Lacanian School. He lives in 9 Melbourne, where he practices psychoanalysis and teaches 30 philosophy and psychoanalytic studies at Deakin 1 University. 2 3 4 5 6 711 8 vii Miller/prelims correx 8/12/04 4:57 pm Page viii

1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 In memory of Françoise Giroud 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 1

1 2 311 4 5 PART I 6 7 8 INTRODUCTION 9 10 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 2

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1 2 311 Love of the Real 4 5 6 Bernard Burgoyne 7 8 9 Stuart Hampshire and Iris Murdoch once engaged in a dia- 10 logue about human nature and the meaning of freedom. 1 Hampshire stressed the importance for human freedom of 2 ‘crystal-clear intentions’; Murdoch responded by insisting 3 on the functioning of ‘something more obscure, more his- 4 torically conditioned, and usually less clearly conscious’. 5 He thought that ‘the history of the individual’ ought to be 6 accessible to philosophical reflection, and that this could 7 be achieved through having access to ‘a “science” which 8 concerns itself especially with the history of the individual: 9 psychoanalysis’. She took his notion of such a ‘perfect psy- 201 choanalysis’ to be too grounded in a philosopher’s view of 1 ‘scientific therapy’; the real issues at stake she thought lay 2 in establishing techniques that directed a human being 3 away from what is bad – for themselves and others – and 4 towards what was good. He took it that a study of fan- 5 tasies would bring some enlightenment about the mecha- 6 nisms of the mind; she agreed that people could be 7 brought to tolerate and engage with what is real in their 8 lives through ‘the liberation of the soul from fantasy’ – she 9 disagreed in taking it that there was a point ‘outside the 30 fantasy’, attachment to which would produce the condi- 1 tions for human progress (Murdoch, 1970). Neither of 2 these two philosophers thought of promoting the hypoth- 3 esis that the State knew enough about these difficult ques- 4 tions to find itself in a position where it could effectively 5 decide and resolve them. 6 Jacques-Alain Miller, in his commentary on the recent 711 sudden intervention into these fields by the French State, 8 3 Miller/correx 8/12/04 2:48 pm Page 4

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1 points out the simplistic modes of thinking governing 2 the motivations of those who initiated it. The aim of the 3 Accoyer Amendment was to subordinate all psychothera- 4 peutic practice in France – including psychoanalysis – to 5 the control of psychiatrists and psychologists. The inten- 6 tion was to move to the appointment of individuals and 7 panels who would be in positions of control over all levels 8 of psychotherapeutic work: referral, practice, supervision, 9 training. Little matter the ignorance of the State on ques- 10 tions of the relation of psychoanalysis to psychiatry; little 1 matter the ignorance of the State on questions of the rela- 2 tion of psychoanalysis to psychology; little matter the 3 ignorance of the State on internal questions of the nature 4 of psychoanalysis and of the various psychotherapies. 5 What mattered for those promoting this manoeuvre was 6 the administrative taking over of the profession of psy- 7 chotherapy in France. These recent developments were 8 very swift. By comparison the situation in the UK is very 9 different – in fact nowhere else in Europe has such an arbi- 201 trary and ill-considered transformation by the State been 1 introduced, even though the laws brought in by the com- 2 munist deputy Adriano Ossicini in Italy came close to it. 3 Let me describe a little some of the history of how things 4 have been determined in this field in the UK. 5 The State in Britain responded to a period of moral panic 6 about the effects of Scientology in the late 1960s by com- 7 missioning enquiries that led to the publication of the 8 Foster Report in 1971 and the Sieghart report in 1978. The 9 outcome of this was the recommendation to introduce a 30 control into the practice of psychotherapy in the UK by the 1 setting up of a form of ‘indicative’ registration. By this was 2 meant a registration that pointed out the various forms 3 and ‘modalities’ of psychotherapies that were available, 4 avoiding any intention to allocate to the State the tasks of 5 determining the appropriate content and training require- 6 ments for psychotherapy – these tasks were to be left to the 711 practitioners and their professional associations. In 1982, 8 Miller/correx 8/12/04 2:48 pm Page 5

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1 the British Association for Counselling offered the use of 2 its headquarters in Rugby as a secretariat for the develop- 311 ment of a professional body that could represent the inter- 4 ests of all forms of psychotherapy across the UK. This offer 5 was accepted, and the corresponding ‘Rugby Conference’ 6 met from 1983 to 1989, when a free-standing professional 7 agency was judged able to be constructed to replace this 8 preliminary Rugby Conference. The new association took 9 the name of the United Kingdom Standing Conference for 10 Psychotherapy: it voted overwhelmingly to set up and 1 monitor a voluntary Register of Psychotherapists in 1990. 2 The Conference took the name of the United Kingdom 3 Council for Psychotherapy (UKCP) when it published its 4 first National Register in 1993. 5 Here, then, was a British solution: it was to be that of a 6 national professional organization holding a Register. The 7 component member organizations within this national 8 umbrella structure were to form (federal) subsections, and 9 were to be themselves the agencies responsible for discus- 201 sions and debate about the style of therapeutic work char- 1 acteristic of that section’s activity. Throughout this period 2 of development the term ‘psychotherapy’ was used in a 3 generic sense, including the field of psychoanalysis. 4 Initially there were two psychoanalytic societies in the 5 organization – the British Psychoanalytical Society and the 6 Centre for Freudian Analysis and Research. In these years 7 the organization functioned as a place for debate; discus- 8 sion, exchange of views, critical engagement with presup- 9 positions and foundational assumptions of the field 30 dominated this era. Socratic elements in the early days of 1 the UKSCP – and then the UKCP in its initial period – 2 formed a valuable (some think the valuable) activity intro- 3 duced by this institutional step. But it soon became appar- 4 ent that – despite the very high level of esteem that was 5 accorded the British Psychoanalytical Society – the Society 6 was ill at ease with the lack of an ability to impose its own 711 criteria and ‘standards’ on other organizations. So two 8 Miller/correx 8/12/04 2:48 pm Page 6

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1 poles developed: one Socratic, cherishing debate; the other 2 somewhat authoritarian in tone. The British Society finally 3 lost patience with this situation and, together with a num- 4 ber of allies, proposed a motion at an Annual General 5 Meeting of the Council to the effect that it be given pow- 6 ers ‘equivalent to those of the United Nations Security 7 Council’ – this phrase was part of the motion that they pro- 8 posed. It may be that they expected to win the vote – 9 whether or not, the size of the opposition to it may well 10 have come as a shock to them: the voting was five organiz- 1 ations in favour, fifty against. This led to the British 2 Society’s secession from the Council in 1992, and its for- 3 mation of an alternative body, also running a voluntary 4 Register. Any seceding authority that knows something of 5 the history of the United States would do well to avoid the 6 term Confederacy, but that was the term that they chose: 7 the new body was called the British Confederation for 8 Psychotherapy. This BCP soon adopted a policy of forcing 9 member organizations of the UKCP to withdraw from the 201 UKCP by means of its ‘single-membership’ policy – organ- 1 izations that wished for close contacts with the kernel of 2 the British Society and its allied organizations were told 3 that it was incompatible to belong to the BCP while main- 4 taining membership of the UKCP. So at this point there 5 was quarrelling, disagreement, and dissent, but still within 6 the context of discussion and debate. The next step in the 7 story was to be a turn towards the authority of the State. 8 The turn to the State was effectuated by John Alderdice, 9 a psychoanalytic psychotherapist who was trained at the 30 Tavistock Clinic. He chose to introduce a Private Member’s 1 Bill into the House of Lords that would, among a range of 2 things, have given the State the authority to determine 3 what was an appropriate character for a psychotherapist to 4 have, and what was an appropriate content for a training 5 in psychotherapy, including psychoanalysis. By January 6 2001 this Bill had reached its Second Reading in the Lords. 711 After the debate at the Second Reading, Lord Caithness 8 Miller/correx 8/12/04 2:48 pm Page 7

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1 introduced some of the history of psychoanalysis into his 2 commentary: ‘It is common knowledge,’ he said, ‘that 311 Freud and Jung parted acrimoniously in 1913 and went 4 their separate ways to form completely different theoreti- 5 cal bases for their approach to analytical work.’ He wanted 6 the differences between these two orientations to analyti- 7 cal work to be recognized by the State, and expressed the 8 hope that ‘these [organizations – the Freudian Inter- 9 national Psychoanalytical Association and the Jungian 10 International Association for Analytical Psychology] be 1 split in the UK’ by means of the intended legislation. 2 Historical discussions and scientific developments within 3 and between these two fields were to be replaced by the 4 dictation of the State. He insisted on this one proviso for 5 the intended Act: that the existing lines of division within 6 a ‘divided profession’ were respected: ‘What the followers 7 of Jung and Freud have put asunder the noble Lord, Lord 8 Alderdice, should not join together’. This joining and sep- 9 arating was being done in the Lords in the early months of 201 2001; not by the profession, and not by the body of practi- 1 tioners, but by someone acting in the name of the profes- 2 sion and with the interest of introducing the kind of 3 control that the British Society had sought at the time of its 4 secession (Lords’ Hansard Report). 5 Before this move to legislation, there had been difficult 6 but productive and ongoing discussions. They had been 7 set against a background of the work of the country’s best 8 philosophers, of the country’s best reflections on the nature 9 of science and its relation to affine fields; the country’s best 30 practitioners repeatedly and regularly found a forum 1 where they could discuss their work, and its implications. 2 Now, to these facilities were added the country’s Junior 3 Ministers of Health, and the interference of government. 4 The intended legislation was suddenly rendered null and 5 void by the withdrawal of government support. There was 6 an oncoming General Election, and a Manifesto to write for 711 it: the government found that it had an interest in shifting 8 Miller/correx 8/12/04 2:48 pm Page 8

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1 the direction of the intended legislative path. So the 2 Alderdice Bill fell, and instead a process was invoked that 3 revolved around the Privy Council. An Order in Council 4 was established that set up a Health Professions Coun- 5 cil (HPC), covering a wide range of ‘health professions’ 6 including osteopathy and chiropody. With this move to the 7 Privy Council, parliamentary debate was no longer possi- 8 ble; but some advantages appeared. Any profession has to 9 approach the HPC to ask to be registered within it: psy- 10 chotherapy so far has not done this. Moreover, any profes- 1 sion making such an approach has to demonstrate that it 2 is a unified profession speaking with a single voice: this is 3 hardly the case with the ‘divided profession’ of psycho- 4 therapy with its multiple debates. A profession where there 5 is not a complete agreement on questions of the scope of 6 practice, on relations with other professions, and on its 7 ‘knowledge base’ is not in a state that renders it eligible to 8 take this route. There is growing disquiet within the sec- 9 tions of the UKCP about the wisdom of moving in this 201 direction; in the meantime – in this and in other forums – 1 a debate continues about the nature of psychoanalysis, 2 about the relations of psychoanalysis to morality and to 3 science, and about the consequences of such issues in rela- 4 tion to the direction of the field. 5 Iris Murdoch and Georg Kreisel discussed the nature of 6 morality in Cambridge in the 1940s, she as part of what she 7 saw as Wittgenstein’s influence on political and moral phil- 8 osophy, he as part of what he saw as Wittgenstein’s influ- 9 ence on the foundations of mathematics and logic. She 30 thought it a great achievement when she got him to admit 1 that moral problems exist. As a philosopher, she was con- 2 cerned with the nature of the bad. Kreisel is an outstanding 3 logician, but provides a very good candidate for a remark- 4 able man who replaces common morality with a presenta- 5 tion of character more generally experienced as bad. She 6 threaded him – in the form of an anti-hero – into several of 711 her novels: his character as it appears in her work builds an 8 Miller/correx 8/12/04 2:48 pm Page 9

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1 ethical vehicle for the investigation of human motives, for 2 an investigation of the relation of good and bad. The 311 constructions that they made – the philosopher and the 4 foundationalist in mathematics – are pertinent to an investi- 5 gation of human nature. The debate between them sup- 6 ports a complicated investigation of how an individual 7 maintains a position in relation to morality and science. The 8 State so far has displayed no interest in this debate. 9 Freud and James Putnam had much earlier discussed the 10 relations between morality and science. Putnam – an 1 American psychoanalyst and psychiatrist who met Freud 2 on his visit to the USA in 1909 – wanted to give to moral 3 philosophy a directing role in the orientation of the field of 4 psychoanalysis (Hale, 1971). Freud disagreed totally. He 5 maintained that the field of psychoanalysis had no need of 6 such a world-view to orientate it – it was already orien- 7 tated, he said, by the ‘methods of the sciences’ (Freud, 8 1933a). When did any State last involve itself in a discus- 9 sion of such issues: of the relations of morality and science, 201 and the function of this relation in giving a direction to this 1 very particular field of psychoanalysis? The literature con- 2 cerning these problems exists, and is accessible to profes- 3 sionals in the field; psychoanalytic institutions – to varying 4 degrees – encourage their students in training to work on 5 these texts, and to relate the results to their practice. Where 6 is there a Department of State that will encourage such 7 work? Professional institutions have their problems, but as 8 long as they encourage debate they play an invaluable role 9 in the development of a field that addresses itself to the 30 suffering inherent in the human condition. Where, mean- 1 while, is the philosophical State? 2 Horacio Etchegoyen and Jacques-Alain Miller, in one of 3 their several (Socratic) discussions – this one in Buenos 4 Aires, in 2001, as part of the Lacan centenary celebrations 5 – turned to these questions of organizational structure 6 and the direction of psychoanalysis (Etchegoyen & Miller, 711 2004). All organizations of practitioners have good and bad 8 Miller/correx 8/12/04 2:48 pm Page 10

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1 aspects – just as any organization whatsoever has institu- 2 tional vices together with institutional virtues. Etchegoyen 3 puts it in terms of thorns and flowers – both his own IPA 4 and Miller’s AMP, he says, have thorns accompanying 5 their flowers. He recalls inviting Meltzer – his second ana- 6 lyst, after Racker – to talk for the IPA Society in Buenos 7 Aires. After some lengthy discussions about institutional 8 difficulties and impasses, Meltzer was asked what to do 9 about them: ‘Dissolve the Society,’ he said, ‘and replace it 10 with informal study groups.’ ‘But then,’ was their reply, 1 ‘who would have invited you here?’ 2 Newspapers from time to time take up these themes: they 3 recently irrupted into the pages of the New York Times and – 4 several days later – the Guardian. The discussion revolved 5 around the nature of the newly formed College of Psycho- 6 analysts, which aims at constructing a new public forum for 7 the discussion of psychoanalysis, and which is made up 8 of Members who have trained psychoanalytically with 9 organizations recognized by the College. Fights between 201 institutions can be expected where a forum for discussion is 1 set up, and another institution interprets it as a challenge to 2 its authority. The British Psychoanalytical Society again 3 contests the founding of the College in this way – as a chal- 4 lenge to its standards. As the article in the NYT puts it: 5 ‘battle lines are forming over who sets the standards and 6 who keeps the lists’ (Guttemplan, 2004). The President of 7 the College, Dr Jacques China is quoted in the article in the 8 Guardian: ‘Psychoanalysis has always been contentious, 9 and there have been many different trainings . . . it’s been a 30 myth for a long time that there is only one training’ (Gillan, 1 2004). This claim seems evidently true: it is, however, con- 2 tested. As this contestation moves from the headlines into 3 a more extended text, a climate of debate will provide a 4 richer environment for a psychoanalytical culture. 5 Some commentators in the House of Lords had insisted 6 on the importance of preserving the climate of discussion 711 and debate. Here is Lord Wedderburn on Alderdice: 8 Miller/correx 8/12/04 2:48 pm Page 11

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1 The Bill cannot succeed except on some basis of professional 2 consensus . . . there is no point in regulating for the sake of 311 regulation, nor indeed of choosing a form of regulation which 4 loses something which has been built up in the recent past. 5 He stressed that ‘undue control’ might not be compatible 6 with the European Convention on Human Rights. But, 7 more importantly, he raised his questions within a consid- 8 eration of the detail of the field of psychoanalysis. 9 10 Historically, problems which range across the field of psy- 1 chotherapy have arisen because of various orientations, or 2 modalities, as they have come to be called, which find their 3 interpretation either in different analytical fields . . . or in more 4 recent analysts than the masters such as Klein, Lacan, or 5 Winnicott. 6 7 He continued: 8 We must be careful not to lose what is a precious historical 9 oddity; namely the freedom of groups to find new ways to 201 practise and to introduce new concepts in the field . . . I have 1 always thought that when Sigmund Freud was convinced that 2 he had to leave Vienna, he came to the right place where free- 3 dom of enquiry is something which regulation must respect. 4 5 Freud had been reading David Hume and the Anglo- 6 Scottish reception of Socrates in the late 1870s: in this 7 respect he chose, sixty years later in his flight from tyranny, 8 the country where these critical texts had been written, a 9 country whose political institutions valued debate. 30 Miller’s text addresses the threat to psychoanalytical cul- 1 ture in France today; a similar threat existed in Britain a 2 few years ago. A critical and constructive environment – a 3 Socratic culture – can easily be degraded by administrative 4 interests within the State. The steps are simple and in some 5 ways automatic: give the State control of ‘quality’ and 6 detriment will follow. Quality becomes trivialized; those 711 best able to judge it are silenced; their work is replaced by 8 Miller/correx 8/12/04 2:48 pm Page 12

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1 reporting to grand (and little) inquisitors; their work 2 suffers; quality ratings improve. The traditions of Mill 3 and his friend Grote – later to be Vice-Chancellor of 4 the University of London – are among the first political 5 theories that Freud took seriously. These traditions are 6 attempts to search for, and recognize what is real: their 7 programmes represent an attempt to value a ‘love of the 8 real’, and to transform it into organizational structure and 9 everyday activity. Contrary to Plato’s claim, the State has 10 neither the right nor the ability to determine the content of 1 science, and this holds too – a fortiori – for the domain 2 of psychoanalysis. A light touch is often called for when it 3 is a question of relating professions to the State. Locke pro- 4 posed a nightwatchman role for the State: but it is when 5 this nightwatchman claims to be awake, and insists on 6 interpreting his own and other people’s dreams, and, 7 moreover, appoints himself the guardian of such work, 8 that real difficulties begin. The misery in the world is 9 increased rather than mitigated through regulation by 201 administrator. 1 2 References 3 4 Etchegoyen, R. H. and Miller, J.-A. (2004) ‘Dialogue à 5 Buenos Aires’, Ornicar?, Revue du Champ Freudien, 51: 6 49–60. 7 Freud, S. (1933a) The Question of a Weltanschauung. New 8 Introductory Lectures on Psychoanalysis, Lecture XXXV, in 9 J. Strachey (ed.), The Standard Edition of the Complete 30 Psychological Works of Sigmund Freud, 22: 158–182. 1 London: Hogarth Press. 2 Gillan, A. (2004) ‘Psychoanalysts line up for psychothera- 3 peutic row’, Guardian, 9 June. 4 Guttenplan, D. D. (2004) ‘Calling all ids: Freudians at war’, 5 New York Times, 29 May. 6 Hale, N. G. (ed.) (1971) James Jackson Putnam and Psycho- 711 analysis, Cambridge, MA: Harvard University Press. 8 Miller/correx 8/12/04 2:48 pm Page 13

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1 Lords’ Hansard Report of UK Parliamentary Proceedings 2 for 19 January 2001, and for 21 February 2001. 311 Murdoch, I. (1970) The Sovereignty of Good, London: 4 Routledge. 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 14

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1 2 311 4 5 6 7 PART II 8 9 10 AMENDMENT 336 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 16

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1 2 311 Amendment 336 4 5 Extract from the Journal officiel 6 de la République française, 7 Thursday, 9 October 2003. 8 9 10 NATIONAL ASSEMBLY 1 2 Parliamentary Debates of Wednesday 8 October 20031 3 4 Suspension and resumption of the session. Presided by 5 M. Rudy Salles. Public Health Policy. Continuation of dis- 6 cussion on a governmental bill. 7 8 M. LE PRÉSIDENT. ‘Two amendments have been referred to 9 me, Nos. 71 and 336, second rectification, both of which 201 can be opened up to a joint discussion. 1 ‘Amendment No. 71, presented by M. Dubernard, a 2 reporter, and M. Accoyer, is worded as follows: 3 4 ‘“After article 18, insert the following article: 5 ‘“After article L. 4111–7 of the public health code, an arti- 6 cle L. 4111–8 is inserted, which reads as follows: 7 ‘“Art. L. 4111–8. The psychotherapies are medico-psycho- 8 logical treatments for mental suffering. As with any thera- 9 peutics, their prescription and their implementation may 30 fall only to professionals qualified in psychiatry, to clinical 1 psychologists, and to doctors who have undertaken the 2 required training. Professionals not holding these degrees 3 or qualifications who have been practising psychotherapies 4 for more than five years at the date of promulgation of 5 the present law will be able to pursue this therapeutic activ- 6 ity, after evaluation of their theoretical and practical know- 711 ledge by a jury composed of university lecturers and 8 17 Miller/correx 8/12/04 2:48 pm Page 18

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1 professionals whose composition is fixed by a decree from 2 the Conseil d’État.” 3 4 ‘Amendment No. 336, second rectification, presented by 5 M. Accoyer, runs as follows: 6 7 ‘“After article 18, insert the following article: 8 ‘“i. In book II of the third section of the public health 9 code, a title III is created, entitled, ‘Special clauses, includ- 10 ing a single chapter entitled “Psychotherapies”.’ 1 ‘“ii. In title III of book II of the third section of the pub- 2 lic health code, law article L. 3231 is inserted, which runs 3 as follows: 4 ‘“Art. L. 3231. The psychotherapies constitute therapeu- 5 tic tools employed in the treatment of mental disorders. 6 ‘“The different categories of psychotherapy are fixed 7 by decree from the minister of health. Their implementa- 8 tion may fall only to doctors or psychologists with the 9 required professional qualifications fixed by this same 201 decree. The Agence nationale d’accréditation et d’évaluation en 1 santé (National Agency for Accreditation and Evaluation 2 in Health Care) is assisting in the elaboration of these 3 conditions. 4 ‘“Professionals currently in activity and not holding 5 these qualifications who have been implementing psycho- 6 therapies for more than five years at the date of promul- 7 gation of this law will be able to pursue this therapeutic 8 activity subject to the satisfaction, within three years of the 9 promulgation of the present law, of an evaluation of their 30 knowledge and practices by a jury. The composition, attri- 1 butions and functional modalities of this jury are fixed by 2 joint order of the minister for health and the minister for 3 higher education.” 4 ‘I give the floor to M. Bernard Accoyer.’ 5 6 M. BERNARD ACCOYER. ‘These amendments are in line with 711 the work carried out within the commission for social 8 Miller/correx 8/12/04 2:48 pm Page 19

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1 affairs and on these benches. They aim to secure the prac- 2 tice of psychotherapies. 311 ‘The psychotherapies are of various kinds but, above all, 4 they can be conducted in France today without the least 5 monitoring of those who declare themselves capable of 6 conducting them. As strange as that may seem, there is 7 therefore a lacuna in the law, which means that anyone can 8 screw their plaque on the front of a building, assuming the 9 title of psychotherapist. 10 ‘Those who undergo psychotherapies are more fragile 1 than others, as they are in need of help, of psychological 2 support. Yet, they may be subjected to diagnostic errors, 3 they can be prescribed ill-adapted treatments, and the peo- 4 ple they deal with might not identify more serious condi- 5 tions that veer towards illnesses of a psychotic type, which 6 presents a risk for both the sufferers and those around 7 them. 8 ‘What’s more, some commercial drifts have been 9 observed. The interdepartmental team for the fight against 201 sects has even identified sectarian drifts that constitute 1 numerous dangers. 2 ‘It needs to be specified that psychotherapies may be 3 implemented only by doctors of psychiatry or clinical psy- 4 chologists with prior training. 5 ‘My amendment No. 336, second rectification, provides 6 precisely for those people who conduct psychotherapies 7 but who don’t belong to these professions and who are 8 without the required qualifications, allowing them to pur- 9 sue their therapeutic activity on condition that they’ve 30 been exercising it for five years and subject to the satisfac- 1 tion, within three years of the law’s promulgation, of an 2 evaluation of their knowledge and their practices by a jury 3 whose composition would be fixed by order. 4 ‘I should like, monsieur le président, to make a slight rec- 5 tification to this amendment, by rewriting the second 6 sentence of the second paragraph of the text proposed for 711 article L. 3231 of the public health code as follows: “Their 8 Miller/correx 8/12/04 2:48 pm Page 20

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1 implementation may fall only to doctors of psychiatry or 2 doctors and psychologists with the professional qualifica- 3 tions required by this same decree”.’ 4 M. LE PRÉSIDENT. ‘This amendment becomes then amend- 5 ment No. 336, third rectification.’ 6 7 M. BERNARD ACCOYER. ‘These clauses are the culmination of 8 extensive work which began under the previous legisla- 9 ture, with the then health minister, Bernard Kouchner, and 10 his cabinet. This work hadn’t been able to reach this cul- 1 mination even though we weren’t far from our goal. 2 ‘I would be very grateful, monsieur le président, if you 3 would accept this amendment.’ 4 M. LE PRÉSIDENT. ‘What is the commission’s opinion?’ 5 6 M. JEAN-MICHEL DUBERNARD, President of the Commission, 7 reporter. ‘The commission is in favour of amendment No. 8 336, third rectification, amendment No. 71 being with- 9 drawn.’ 201 M. LE PRÉSIDENT. ‘Amendment No. 71 is withdrawn. What 1 is the opinion of the Government on amendment No. 336, 2 third rectification?’ 3 4 MINISTER FOR HEALTH, THE FAMILY, AND THE HANDICAPPED. 5 ‘Absolutely in favour!’ 6 M. LE PRÉSIDENT. ‘I give the floor to Mme Catherine 7 Génisson.’1 8 9 MME CATHERINE GÉNISSON. ‘Naturally, we’ll be voting for 30 this amendment, which is in line with a pursuit of “total 1 quality control” and which, as M. Accoyer has said, fills a 2 lacuna in the law.’ 3 M. YVES BUR. ‘It’s not for want of its having been presented 4 many times!’ 5 6 MME CATHERINE GÉNISSON. ‘As our colleague has rightly 711 recalled, the work had been largely undertaken during the 8 Miller/correx 8/12/04 2:48 pm Page 21

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1 previous legislature. But a certain number of events 2 occurred – the minister who’d initiated this work wasn’t 311 re-elected and has been replaced by another minister 4 who’s given a very favourable opinion on M. Accoyer’s 5 amendment. We can only subscribe to this clause, which is 6 in line with a “total quality control” that protects a partic- 7 ularly fragile part of the population.’ 8 M. LE PRÉSIDENT. ‘I put amendment No. 336, third rectifica- 9 tion, to the vote.’ 10 1 The amendment is passed. 2 3 4 Note 5 1. M. Accoyer is UMP deputy for Haute-Savoie; M. Bur is 6 UMP deputy for Le Bas-Rhin; M. Dubernard is UMP 7 deputy for Le Rhône; Mme Génisson is PS deputy for 8 Le Pas-de-Calais; M. Salles is UDF deputy for Les 9 Alpes-Maritimes. The amendment is reputed to have 201 been voted in unanimously. Furthermore, M. Accoyer 1 confirmed to me during our debate of Thursday 13 2 November on the Radio France-Culture broadcast ‘Tout 3 arrive’, that his name is pronounced, not ‘A-kwa-yé’, 4 but ‘Ako-yé’. Why? I wondered. I queried this the 5 evening of that same day with an eminent linguist, my 6 friend Jean-Claude Milner, who soon after addressed a 7 8 scholarly notule entitled ‘Pronunciation’, which I repro- 9 duce here with his authorization. – JAM 30 ‘In the combination ‘oy’, the letter ‘y’ generally takes on the 1 value of a double ‘ii’; the first ‘i’ combines with the preceding 2 ‘o’ and notes, as would the graphic combination ‘oi’, the diph- 3 thong /wa/; the second ‘i’ notes a semi-vowel, as occurs in 4 mien, tien, sien. Thus today we pronounce the first syllable of 5 royal like roi, whereas the second rhymes with impérial. But the 6 1694 dictionnaire de l’Académie recommended a different pro- 711 nunciation; the letter ‘y’ used to take on the value of a single 8 Miller/correx 8/12/04 2:48 pm Page 22

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1 ‘i’, noting a semi-vowel, and the ‘o’ maintained its usual pro- 2 nunciation. The first syllable of royal used to be pronounced 3 like [the French] rot and not like roi. ‘The former pronuncia- 4 tion was still attested in the time of Littré, who points it out; 5 it has been conserved for some words such as oyat, goyave, and ouïr oyant oyez 6 for the forms of the verb , and .’ 7 8 9 10 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 23

1 2 311 4 5 6 7 8 PART III 9 10 1 LETTER TO BERNARD 2 ACCOYER AND TO 3 4 ENLIGHTENED OPINION 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 24

1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 25

1 2 311 J.-A. Miller, Psychoanalyst, 4 to Bernard Accoyer, Deputy for Haute- 5 6 Savoie, Mayor of Annecy-Le Vieux, 7 Co-President of the Commission for 8 Cultural, Familial and Social Affairs 9 10 and Vice-President of the UMP Group 1 of the National Assembly, etc. 2 3 4 Paris, Monday 17 November 2003 5 6 7 Truly, guided by a good bird I never was. 8 Du Bellay 9 201 1 Why should it be, monsieur le député, that I have something 2 to say to you? What common language can we speak? 3 How are we to hear one another? And what is there 4 between you and me? 5 You need to be answered, however; you yourself are the 6 one who is forcing me to do so. Had you merely expressed 7 your wariness of psychoanalysts, I would have let you 8 be: but you mean also to regulate psychoanalysis, and 9 30 you claim to evaluate its practitioners; the representatives 1 of the nation have fallen in behind you in their entirety; 2 and the more authority you have among men, the less it is 3 permitted that I silence myself when you mean to com- 4 promise psychoanalytic discourse and enchain those who 5 serve it. 6 711 8 25 Miller/correx 8/12/04 2:48 pm Page 26

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1 THE WAKE UP 2 3 On Saturday 25 October, the front page of the newspaper 4 Libération gave the alert to the entire ‘psy’ population and 5 threw it into a state of alarm. 6 Éric Favereau had told me of the existence of your amend- 7 ment two days before. In response, I had entrusted to him a 8 page of mockery, singling out the latest avatar of the 9 ‘Strategist-State’, and promising evaluation to the evalu- 10 ators, in the tradition of he who is hoisted by his own petard. 1 As chance had it, the psychoanalytic association to which 2 I belong, the École de la Cause freudienne, was then holding 3 its annual study days at the Palais des Congrès, dedicated 4 this year to the clinic of the short session. The corridors 5 were buzzing with nothing but this news. The ordinary 6 general meeting of the École, which was taking place on the 7 evening of that same day, adopted an unequivocal position. 8 The following day, the 1,500 participants of the Con- 9 gress, practitioners from France nationwide, from Belgium 201 and French-speaking Switzerland, welcomed our ‘No to 1 M. Accoyer’, with an ovation the like of which had never 2 been seen in this milieu where one deals in a certain 3 impassivity. The various European delegations, the presi- 4 dent of the World Association of Psychoanalysis, who is 5 from Latin America, pledged their solidarity. 6 That was only the beginning. 7 8 CLÉRY-MELIN 9 30 While I was asking her for her feelings about your amend- 1 ment, one of my students, a psychiatrist–psychoanalyst, 2 Mme Sophie Bialek, replied that it did not seem to her 3 without relation to a text she had just been acquainted 4 with, a report from a certain Doctor Cléry-Melin. He and 5 his collaborators had, it seems, found themselves entrusted 6 in March of this year, by the Minister for Health, with the 711 mission of proposing ‘a plan of actions [sic] to reorganise 8 Miller/correx 8/12/04 2:48 pm Page 27

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1 the supply of psychiatric and mental health care’, which 2 the Minister was intending to turn into the basis of a ‘gen- 311 eral plan on Mental Health’ that would be adopted in the 4 first quarter of 2004, once the associations of psychiatrists 5 and the patients’ associations had been consulted. An offi- 6 cial communiqué on 2 October testified to this. 7 It did not take me long to understand that the Cléry- 8 Melin document was in fact striving to change the mental 9 health system in France from top to bottom. One would no 10 longer have to formulate a ‘demand for analysis’: how 1 would the man or woman in the street know that they 2 needed a psychoanalysis, or even a psychotherapy, and not 3 simply one or two pills? No, the State would be failing in 4 all its duties were it no longer to leave the choice of thera- 5 pist to the initiative of the subject, to leave the subject at 6 the mercy of scoundrels, of charlatans without qualifica- 7 tions, claiming to cure by speech, you might as well say by 8 the operation of the Holy Spirit. A police state wants other 9 ways. Has it ever been seen that a sick man may know the 201 treatment suited to his case? When sick, a doctor, if he is 1 wise, goes to see a fellow doctor. Procuring experts for the 2 public with the legal capacity to interpose themselves 3 between analyst and analysand, therapist and therapied, 4 will henceforth be the regalian prerogative. If one is ‘not so 5 well in one’s head’, one will henceforth have to present 6 oneself to an evaluator approved by the State; he will pro- 7 ceed to the assessment of your case; he will indicate the 8 therapy best adapted to your case, medicinal or psycho- 9 therapeutic; in psychotherapy, three options: psychoanaly- 30 sis, cognitive-behavioural therapy, systemism. He will 1 recommend serious therapists to you. 2 The icing on the cake. The text upon which the Minister 3 is resolving to re-found the mental health system in France 4 openly organizes the stagnation of the public psychiatric 5 service: ‘there will be no increase in beds in the public sec- 6 tor’. It is, in a way, the national health map the wrong way 711 round. 8 Miller/correx 8/12/04 2:48 pm Page 28

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1 ‘MANNA FROM HEAVEN, A GODSEND . . .’ 2 3 I mailed the strange document on to another of my stu- 4 dents, Mme Anne Debruyne-Ganivet, whom I know to 5 have run, over ten years, several private clinics specialis- 6 ing in psychiatry. She analysed this dense text for me, and 7 confirmed all my fears. 8 She remarked to me that the plan foresaw that, ‘certain 9 regions lacking in private supply will be able to be bal- 10 anced out’: ‘That means,’ she told me, ‘creation of private 1 clinics. The report specifies that the private establishments 2 will be able to develop alternatives to full time hospital- 3 ization: all the activities that carry a charge will therefore 4 be open to the private sector, hence bigger profits. At the 5 same time, the market will be limited to those establish- 6 ments having signed an agreement with the ARH, the 7 Agences régionales d’hospitalisation: the market will therefore 8 be a protected market. 9 ‘Yes, the Cléry-Melin “plan of actions” will go quickly, 201 very quickly. On page 29, it was asking for “the imple- 1 mentation of a tariff system consistent in nature with the 2 restoration of financial balance”. Its wish has been granted 3 as of Thursday 30 October, when the National Assembly 4 adopted article 20 of the bill for National Health Service 5 financing, according the private sector tariffs identical to 6 those of the public sector for any given procedure, with- 7 out, moreover, requesting any return as regards teaching, 8 research, emergency, nor even the reception of the most 9 impoverished, etc., all domains in which the public sector, 30 for its part, is held to act. The impact on the price per day 1 will have to be calculated, but I believe I can tell you 2 already that this is an unprecedented financial godsend for 3 the private clinics. Have you read what M. Mattéi said 4 about the Cléry-Melin plan in Le Monde? “An adventure is 5 beginning”. 6 ‘To finish off, can you imagine that in the past I accompa- 711 nied the first steps of Philippe Cléry-Melin in the direction 8 Miller/correx 8/12/04 2:48 pm Page 29

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1 of the private psychiatric clinics, of which he has since 2 made his profession.’ 311 ‘Manna from the heavens, a godsend . . .’ I knew enough 4 about it on Tuesday morning to quickly address an e-mail 5 to Edwy Plenel. I had the delight of seeing it no later than 6 the following day on the front page of Le Monde, without 7 a single cut. 8 9 10 YOU AND ME 1 Furthermore, on Monday, Jean-Pierre Elkabbach had pro- 2 posed to me two debates with you, monsieur le député de 3 Haute-Savoie 4 : Thursday on the television channel of the 5 Senate, ‘Public Sénat’, of which he is director, and Friday on 6 Europe 1. 7 At the Palais du Luxembourg, I walked up to you with my 8 hand extended, having taken the trouble to consult the on- 9 line register of deputies’ ‘mug-shots’. That the representa- 201 tives of the French people admit to having a ‘mug’ is a 1 charming trait that makes one love the Republic. You were 2 certainly an ENT specialist cherished by his patients, and 3 when you say, carefully articulating each syllable, ‘sé-cu-ri- 4 ser le publique,’ we can hear that butter doesn’t melt in your 5 mouth.1 People believe you, it’s a gift you have. This is to 6 tell you that I wouldn’t dream of suspecting your good 7 faith. 8 I believe you sincere, concerned for the good of the pub- 9 lic, and anxious to attach your name to a reform that 30 would be useful to the French people. At the assembly, you 1 won over everyone’s heart. And the socialist deputy for Le 2 Pas-de-Calais, she couldn’t find enough words to compli- 3 ment you, and your amendment was adopted under the 4 debonair presidency of the UDF deputy of Les Alpes- 5 Maritimes. 6 We had hardly shaken hands when you pronounced the 711 name of Bernard Kouchner: ‘I subscribe to the same line,’ 8 Miller/correx 8/12/04 2:48 pm Page 30

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1 you told me. And no doubt the backing of France’s most 2 popular politician according to the polls would not be 3 nothing to you. He will certainly have to take a position. I 4 wouldn’t know how to predict what he’ll say. 5 Monsieur le député de Haute-Savoie, it is no small thing for 6 a psychoanalyst, a man trained to receive people one by 7 one for short sessions in his office, as the practice of psy- 8 choanalysis that proceeds from Lacan has it, it is no small 9 thing for a university lecturer, which I am also, more famil- 10 iar until now with libraries and amphitheatres than play- 1 grounds and studios, to interpellate such a distinguished 2 member of the nation’s representatives and suggest to him 3 that perhaps he has not been well informed. Believe me 4 that I am measuring my audacity, and that I would not 5 have ventured to do this had I not been led, driven to do 6 so, by the present turmoil of the ‘psy’ milieu, and above all 7 by concern for the good of the public. 8 To this may be added the gratitude that attaches me to 9 psychoanalysis, the benefits of which I have been able to 201 experience in my own person. There is, finally, the feeling 1 of what I owe to the memory of Jacques Lacan, who was 2 not only my master, but who received me into his family. 3 All of this means that I have a duty to address myself to 4 you. 5 I do it alone, without affectation, in my own name, 6 engaging no one but myself. But I am not at all alone, 7 since, as I told you, the members of the École de la Cause 8 freudienne are with me, and now the ‘Forum of the Psys’ 9 and the ‘Movement of 15 November’. 30 As for our colleagues from other psychoanalytic associ- 1 ations, if most of them have so far conserved the ‘wait and 2 see’ attitude they are well accustomed to in their practice, 3 it is certainly because they have not fully understood what 4 is at issue, because they have been prompted to dissociate 5 themselves from the other psys, and because some were 6 obsessed by the prospect of occupying places – an old 711 French passion – on your juries of ‘evaluation–accredita- 8 Miller/correx 8/12/04 2:48 pm Page 31

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1 tion’. Now that the light is starting to peep through, I don’t 2 think you can hope that they will accept the Accoyer– 311 Cléry-Melin strategy without resistance. We shall see at the 4 end how many come out for you. 5 This word ‘psy’: in truth I still abhorred it not so long 6 ago, but so far as language is concerned, one does not go 7 against the vast murmur, the vox populi: in order to be 8 understood, you have to speak the Other’s language. Since 9 the psys are being laid into with no half measures, since 10 the masses are being stirred up against the charlatans who 1 would infest their ranks, since a veritable manhunt is being 2 launched, well, don’t count on me to prove that I am 3 acceptable, and sell out my brothers while praising the 4 excellence of my own house as some do without scruple. 5 Slandered together, the psys will not be divided as had 6 been anticipated, but shall defend themselves together, 7 and together will they respond. 8 The psys owe their unity to you, monsieur Accoyer. 9 201 1 THE GREAT MINDS 2 3 I confess that I am not that well acquainted with the work- 4 ings of the State, just as you do not claim, monsieur le 5 député, to be an expert in psychoanalysis. The legislator 6 whom I respect in you could not know everything of the 7 matters on which he votes, and he solicits every possible 8 qualified opinion. Then he comes to a decision in the name 9 of the French people. Therein lies the greatness of his act. 30 You are confident, so you said, that you have ‘the com- 1 munity of scientists and lecturers’ behind you, as well as 2 ‘the highest authorities in psychiatry, in clinical psychol- 3 ogy, and in psychoanalysis.’ And from where, monsieur le 4 député de Haute-Savoie, did you learn this? You said it 5 before the cameras of the Senate: for having presided, on 6 23 March 2000 at the National Assembly, a symposium 711 where you were told that all whom France could count 8 Miller/correx 8/12/04 2:48 pm Page 32

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1 among her greatest minds as far as mental health is con- 2 cerned were to be found. You said so and you believed so, 3 I am persuaded of that. Well, monsieur le député, let me tell 4 you, with all the respect that your position inspires in me, 5 that you are mistaken, or else you have been misled. 6 What you presided over three years ago, three floors 7 down in the basement of the Palais-Bourbon, was a confi- 8 dential symposium, accessed solely by invitation, and 9 whose existence was unbeknown, if not to all, at least to 10 the greater majority. Nothing of it has filtered through in 1 these three years, nothing of it has been published. Only 2 150 privileged people attended. This does not bode well, 3 you will admit, for the way in which the juries of ‘evalua- 4 tion–accreditation’ would be composed, those juries that 5 you intend to constitute if your amendment passes beyond 6 the senatorial level. 7 It has taken nothing less than the present turmoil for the 8 proceedings of this symposium to be found on the Internet 9 by many of my correspondents. We will gladly publish 201 these proceedings, monsieur le député, if you don’t mind, 1 and with commentaries, for the edification and the enter- 2 tainment of the public. In the meantime, it seems to me 3 that the leading experts behind whom you believed you 4 could shield yourself are being noted for their discretion, 5 and are leaving you well alone in the storm. 6 Do not see an enemy in me, nor even an adversary, if I 7 tell you that, all in all, you are making a mistake. You do 8 so in good faith, I give you credit for that. It is true that 9 Jacques Lacan, who sometimes evidenced a certain intel- 30 lectual terrorism, wrote that, ‘the error of good faith is of 1 all errors the most unforgivable’. But hey! Is what is true 2 in psychoanalysis necessarily so in politics? It may be that 3 good faith has the value of an absolutary excuse in your 4 discipline. 5 You will tell me, monsieur le député de Haute-Savoie, or 6 rather your friends will tell you. I have no skills whatso- 711 ever on that point. 8 Miller/correx 8/12/04 2:48 pm Page 33

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1 TO CREATE BY DECREE 2 311 On opening that symposium of Spring 2000, you confessed 4 to having been alerted the previous year by one of your 5 correspondents – M Martinet, a psychologist, he himself 6 came forward with his name, and wanted to specify that 7 he had set you in motion by the sending of a fax – to the 8 existence of a lacuna in the law ‘which means that, as you 9 well know, there is no legal framework in France for defin- 10 ing the usage of psychotherapies.’ This lacuna appeared 1 dangerous to you, you rolled up your sleeves, and under- 2 took to fill it in. 3 Back on 13 October 1999, you submitted a bill to the 4 National Assembly relating to the prescription and the 5 conduct of psychotherapies, no. 1844, co-signed by 81 6 deputies, which aimed at ‘reserving the usage of the title 7 of psychotherapist for those people holding university 8 degrees, since, currently, anyone who wishes may screw 9 up his “psychotherapist” plaque and claim to “treat”.’ 201 Now, this text is tangibly different to amendment 336, 1 second, then third modification, which you presented to 2 the approval of the Assembly on 8 October this year. 3 In April 2000, in your bill, the psychotherapies are 4 ‘medico-psychological treatments for mental suffering’; 5 and it is stipulated: ‘Like any therapeutics, their prescrip- 6 tion and their implementation may fall only to qualified 7 professionals: doctors qualified in psychiatry and clinical 8 psychologists.’ 9 In October 2003, the psychotherapies are henceforth 30 ‘therapeutic tools employed in the treatment of mental dis- 1 orders’; they constitute specialities distinct from one 2 another, and you leave it to a decree from the Minister for 3 Health to define both these specialities and the profes- 4 sional qualifications that these specialities require: ‘The dif- 5 ferent categories of psychotherapy are fixed by decree. 6 Their implementation may fall only to doctors or psychol- 711 ogists with the required professional qualifications fixed 8 Miller/correx 8/12/04 2:48 pm Page 34

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1 by this same decree.’ Furthermore, the famous ANAES 2 makes its appearance: ‘The Agence nationale d’accréditation 3 et d’évaluation en santé is assisting in the elaboration of 4 these conditions.’ 5 In other words: in 2000, the psychotherapies formed one 6 same speciality, which any psychiatrist or clinical psychol- 7 ogist was supposed to be apt to practise; in 2003, the psy- 8 chotherapies are multiple, they are simple ‘tools’; being a 9 doctor or psychologist is a necessary condition, but no 10 longer sufficient to manage them; hence the recourse to the 1 ministerial decree to constitute as such both the scientific 2 categories and the practical skills. It is a creationism by 3 decree, a ‘decreation’, if I may say so. 4 What is constant from 2000 to 2003 is the formation by 5 decree of juries of evaluation–accreditation that will judge 6 the files of those who are called throughout your sympo- 7 sium the ‘neither-nors’, neither doctor, nor psychologist. 8 In this way then, you, legislator, place in the hands of the 9 Minister a power to decree that you extend so far it ends 201 up covering everything. To the point that a layman like 1 myself, who is ignorant of the ways and customs of 2 Parliament, ends up wondering whether it is really a law, 3 and whether it would not be rather a case of the pure and 4 simple surrendering of legislative power to executive 5 power. Certainly, the power conferred on the Minister is 6 not discretionary, since the decree is taken up by the 7 Conseil d’État, and since it thus remains subject to its cen- 8 sure. None the less, it is disconcerting. Disconcerting, I’m 9 not saying any more than that. 30 Is that it then, the role of our deputies? I must seem a 1 trifle candid to you. 2 3 THE ‘OR’ AND THE ‘AND’ 4 5 Something else is bothering me. 6 8 October, on the point of putting 336 to the vote and 711 obtaining the triumph that we know about, you request, at 8 Miller/correx 8/12/04 2:48 pm Page 35

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1 the last minute, and you obtain, a final modification of a 2 detail concerning the second sentence of the second para- 311 graph of article L. 3231. 4 In 336, second modification, this sentence said that the 5 implementation of the different categories of psychother- 6 apy fixed by decree from the minister ‘may fall only to 7 doctors or psychologists with the required professional 8 qualifications fixed by this same decree’. Now you want: 9 ‘. . . may fall only to doctors of psychiatry or doctors and 10 psychologists with the professional qualifications required 1 by this same decree.’ What is the difference? 2 Before, the psychotherapies are the prerogative of ‘doc- 3 tors or psychologists’; after, the prerogative of ‘doctors of 4 psychiatry or doctors and psychologists’. 5 How curious! The psychiatrists, mentioned in the 2000 6 text, and who had disappeared in 336, second modifica- 7 tion, resurface in 336, third modification. They escape the 8 regulatory power of the Minister now; the legislative text 9 protects them and recognizes their skills. 201 Second difference: in 336–2, the psychotherapies are 1 administered by ‘the doctor or the psychologist’; in 336–3, 2 by ‘the psychiatrist or the doctor and the psychologist’. 3 No, written thus, it is not clear. Should there be brackets: 4 (the psychiatrist) or (the doctor and the psychologist)? Or 5 should we even, to spin out the mathematical metaphor, 6 set down the equivalence: 7 1 Psychiatrist = 1 General Practitioner + 1 Psychologist 8 9 Should it be understood that, according to the amend- 30 ment that you have succeeded in getting voted by the 1 unanimity of the Assembly, UMP, UDF, PS, PC, and tutti 2 quanti, every psychologist is reckoned to be incapable of 3 carrying out any psychotherapy whatsoever, if he is not 4 coupled with a doctor, that is to say, if he does not prac- 5 tise under strict medical surveillance? What is beyond 6 doubt is that you want everyone to have obtained a prior 711 accreditation – and from what juries, my God? 8 Miller/correx 8/12/04 2:48 pm Page 36

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1 Do you know, monsieur le député de Haute-Savoie, what 2 you have done with your ands and your ors? And, more 3 serious, what you have made the entirety of your National 4 Assembly colleagues do? Do you know that with an and or 5 an or placed this way or that, you turn the professional 6 lives of thousands of practitioners upside down? That you 7 upset the everyday lives of tens of thousands of patients? 8 That you light the fuse if not of a revolution, at the least of 9 a social dissidence? 10 You make me think again of Le nozze di Figaro: 1 2 THE COUNT: Does it say and in the act, or or? BARTHOLO: It says and. 3 FIGARO: It says or. 4 BRID’OISON: Dou-ouble-Hand, read for yourself. 5 6 7 A REAL THAT LIES 8 The successive palinodes that have punctuated your leg- 9 islative work over the last four years – the October 1999 201 bill, then amendment 336 first modification, second, third, 1 and . . . bingo! – have led precisely to this: the unprece- 2 dented legislative triumph of the least enlightened faction 3 of medical opinion. 4 France is no doubt the only country in the world where 5 the medical authorities have not resigned themselves to 6 sharing their ancient sovereignty over therapeutic speech 7 with anyone. This one idea is anathema to the major insti- 8 tutions of the Corporate Body: the Académie de médecine, 9 the Ordre des médecins. They stubbornly hold, and against 30 all likelihood, that every doctor, and a fortiori every psy- 1 chiatrist, is naturally a psychotherapist. 2 The thesis, or the postulate, would fuel a lengthy dispu- 3 tatio, had we the time. 4 It is correct that medical intervention has always been 5 psychotherapeutic, it might not have been anything other 6 than that at the beginning. ‘Always’ says Lacan, ‘medicine 711 hit(s) the bull’s eye with words.’ 8 Miller/correx 8/12/04 2:48 pm Page 37

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1 This is what Molière put on the stage: a medicine that is 2 nothing but rhetoric, a scholastico-humanist art, proceed- 311 ing by the citation of major authors, by prestige, by sug- 4 gestion, intimidation. If this drivelling chatterbox of a 5 medicine made seventeenth century France laugh, it was 6 because the age of science was beginning, and the Zeit- 7 geist, the spirit of the time, sensed the ridiculousness of 8 this ancient medical discourse, aspiring already, without 9 knowing, to seeing it become scientific, which was only 10 accomplished in our time, the innumerable benefits of 1 which we welcome. 2 This medicine that chatters, a medicine of pure prestige 3 and conjuring, was still vivid enough after the First World 4 War for Jules Romains to have embodied it in the immor- 5 tal character of Knock, revisited not so long ago by Fabrice 6 Luchini at the Théâtre de l’Athénée, and I was there 7 applauding. People are still laughing; they are laughing 8 more than ever at the ‘Does it tickle or does it prickle?’ but 9 do they laugh at the modern doctor? Certainly not. For all 201 the time that they haven’t been speaking, or not much, or 1 not enough, but calculating in silence, the great doctors 2 haven’t been making people laugh, it even happens that 3 these benefactors make people afraid, which is the limit. 4 No, Knock, today, would be Freud instead, even Lacan. See 5 for example Terry Johnson’s crazy Hysteria, Fragments of an 6 Obsessional Neurosis, recently played in Paris with direction 7 from the marvellous John Malkovich. All this to say that, 8 now that medicine has become something so serious, psy- 9 choanalysis, or the psychotherapies, have taken on the 30 major comic roles of the medical repertoire. 1 What medicine, having become scientific and techno- 2 logical, bears so badly in psychoanalysis and its emanci- 3 pated offspring, is the rediscovery within them of the 4 trimmings and the splendour it was stripped of when it 5 was beaten by a desire until then unknown to it, the desire 6 of science. What medicine cannot bear in psychoanalysis, is 711 that which it was and which it is no longer, its art of saying, 8 Miller/correx 8/12/04 2:48 pm Page 38

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1 of saying-well, of ‘half-saying’ (Lacan), and this narrow 2 winding path between truth and lie, imposture and authen- 3 ticity, which has always made for the drama, or the tragi- 4 comedy, of speech. 5 Medicine has renounced the powers of speech, it purses 6 its lips, it has become mute. It expects nothing, or very lit- 7 tle, from what the patient might say, cry, stammer or mur- 8 mur. On the other hand, it is employing a growing 9 ingenuity in interrogating the real of the body, and this real 10 responds in mathematical language, in figures, in formu- 1 lae, in knowledge. 2 The real doesn’t lie; the subject does. To decrypt, to 3 ‘sequence’ the human genome, whom can you speak to? 4 It’s a question of executing the procedures as quickly as 5 possible, with an eye on your rival who is doing the same 6 – and who gets the patent? It’s not hard to understand that 7 medicine seized by, or even stripped bare by scientific dis- 8 course, thereby liberated a space that psychoanalysis came 9 to occupy, and then, in turn, the psychotherapies. It is the 201 logical sequence of the scientifization of medicine. 1 Is the domain of psychoanalysis merely mirages and 2 lies? Is hysteria merely simulation? Is the analyst merely a 3 charlatan? That is what the scientist doctors believed, and 4 believe still. Do they believe it more than ever, or, justly, a 5 bit less? I don’t know. What I do know and test every day, 6 is what Freud discovered, ‘evaluated–accredited’, to speak 7 the lingo of ‘total quality’: the consistence and the impos- 8 sible-to-bear of the pure suffering-of-thought. Lacan put it 9 differently: that the analyst too, like the scientist, deals 30 with the real, but it is a different real, new and strange: 1 the real of the scientist always tells the truth, not so the 2 psychoanalyst’s real. It is a real that lies. 3 Curiously, since Max Planck, the real of the scientists has 4 also been starting to lie, hence Einstein’s horror of quantum 5 mechanics (see the fine article by Mme Françoise Balibar, 6 711 due to appear in the forthcoming issue of Ornicar?). 8 Miller/correx 8/12/04 2:48 pm Page 39

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1 THE MEDICAL MONOPOLY 2 311 Is the Corporate Body lying? Let’s say that contradiction 4 doesn’t put it off. 5 Its problem is as follows: how can the training of psy- 6 chotherapists be controlled without recognising that this 7 training exists? Well! The Corporate Body sometimes says: 8 ‘There is no training that holds good as concerns psy- 9 chotherapy, if not medicine; every doctor is a psychother- 10 apist in function or in essence.’ But, if need be, it also says: 1 ‘Our doctors receive a training in psychotherapy, which 2 trains them perfectly in this practice, even if this teaching 3 only numbers a few hours per year.’ Finally, it says: ‘It is 4 perfectly possible for us to deliver an adequate training in 5 psychotherapy to non-doctors and to control that training.’ 6 The third and final modification to amendment 336, 7 voted unanimously on 8 October, is being made to give full 8 satisfaction to the august Pichot, glory of French psychia- 9 try. The master, with the support of Professor Allilaire, 201 who took the floor at your symposium, monsieur le député, 1 drafted a report on this topic, dated 11 April of this year, 2 and adopted by the Académie de médecine during its session 3 of 1 July, unanimously – really! – minus two abstentions. 4 But did the Academicians even read it? Psychiatry has 5 always been the poor and despised parent of medicine, its 6 freak of a cousin, and it only gained its independence from 7 neurology in the aftermath of May 1968. This handsome 8 report we shall also publish, monsieur le député, and we 9 shall give it some publicity. One can read here that, in 30 every case, psychotherapy must ‘be the object of a medical 1 prescription, the doctor being responsible for the diagno- 2 sis, the choice of treatment and its evaluation’. 3 Could one not fail to see how these prestigious cautions 4 must have impressed the modest ENT practitioner that 5 you were, monsieur le député de Haute-Savoie? 6 However, the powerful legislator that you now are 711 might recognize that in having the psychoanalysts and the 8 Miller/correx 8/12/04 2:48 pm Page 40

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1 psychotherapists pass under the yoke of the Medical 2 Corporate Body, France is isolated from all its neighbours 3 in Europe. It is true that none has the good fortune to have 4 so powerful a Corporate Body to its credit. 5 I too am fond of the French exceptions, but it seems to 6 me to be preferable for them to be exemplary, for them to 7 show the paths to the future rather than wearing them- 8 selves out constructing defences to hold back the Pacific. 9 The psy phenomenon is a phenomenon of civilization; all 10 the European countries recognize as much, or will. 1 On the other hand, the amendment that bears your 2 name in the press and in public opinion, the Cléry-Melin 3 ‘plan of actions’ that complements it, the Livre blanc de la 4 psychiatrie and the academic Pichot-Allilaire report that 5 approves it, all this tasteless literature converges in one 6 same result: the authoritarian imposition of medical 7 monopoly. 8 9 A DANTESQUE DISASTER 201 1 Do you really want, monsieur le député, to attach your name 2 to the reconquest of the domain of the psychotherapies by 3 a Corporate Body, respectable certainly, but which in the 4 end cannot wind back the clock of history? 5 To impose point-blank medico-psychiatric monopoly or 6 supremacy as far as psychoanalysis, psychotherapy, and 7 clinical psychology are concerned, would, for the State, 8 amount to the head-on opposition of a phenomenon of civ- 9 ilization that is in all likelihood irreversible. It would be to 30 provoke a veritable revolt, going from the ‘bourgeois 1 bohemians’ to the working-classes. It would be to go 2 against the flow of the harmonization of European legisla- 3 tion. Moreover, to over-regulate and re-medicalize the psy 4 domain would produce serious difficulties in the treatment 5 of concrete situations, I’ll demonstrate that another day. 6 Let’s imagine that your heart hardens and that the 711 senators deem it impossible for them to go against the 8 Miller/correx 8/12/04 2:48 pm Page 41

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1 unanimous deputies. Imagine then that the Conseil d’État 2 does not refuse this text that one eminent jurist told me 311 was ‘insufficiently justifiable’. Let’s imagine finally that the 4 implementing decrees get taken on, by this government or 5 by another, left-wing or right-wing, in spite of the maquis 6 of appellations and the ‘polysemy’ that infects all the terms 7 in play, to take up Dr Olbrecht’s expression, adviser to 8 Bernard Kouchner when the latter was in charge of Health. 9 In short, let’s suppose hypothetically that your amend- 10 ment takes on the force of law. What happens then? 1 It’s grande terreur for the psys. The famous ‘plaques that 2 anyone can screw on to their door’ are unscrewed at the 3 double. Many of them, having become illegal practitioners 4 overnight, will go underground, and, given their number, 5 will naturally be tolerated. Others will hasten to make new 6 plaques with new appellations. They will henceforth call 7 themselves: 8 9 Psycho-advisers? 201 Psycho-synthesizers? 1 Psycho-abracadabras, certified by the Faculty of Hocus- 2 pocus? 3 4 As for the psychoanalysts, they will register on the side of 5 ‘counselling’, as distinct from healthcare, and parallel net- 6 works will be constituted in order to bypass the ‘regional 7 psychiatrist co-ordinator’ and the approved evaluator. 8 So it is that the zone of psychotherapies, which was hith- 9 erto unregulated by the State, becomes frankly a zone of 30 no-law. 1 The situation is no better in the regulated sector. The 2 inevitable creation of reimbursed ‘psychotherapeutic treat- 3 ment’ for accredited clinical psychologists as exists already 4 for the psychiatrists will put all the more strain on the 5 social security budget. The Minster in office is thus obliged 6 to continuously revise the conditions of access and the 711 modalities of psychotherapies, to restrict their cost. 8 Miller/correx 8/12/04 2:48 pm Page 42

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1 Stagnation of the public sector, increased number of pri- 2 vate clinics, as we have said. The strict definition of ‘good 3 practices’ has as its first effect the proliferation of malprac- 4 tice lawsuits, as in the United States. And so on. 5 Do you really want, monsieur le député, the name of 6 Accoyer to be associated with this Dantesque disaster? 7 8 9 INSTRUMENTALIZATIONS 10 1 The ancient regulatory pruritus of the French, when it 2 encounters a phenomenon of civilization, would only give 3 very poor results. But the national quirk is not in question. 4 One day I’ll speak to you, or one of my colleagues, 5 Professor Maleval, will speak to you of the three major 6 hysterical epidemics triggered in the United States in the 7 1970s by the reign, uncontested over there, of quantitative 8 evaluation: many tens of thousands of patients affected, 9 with sometimes serious legal and social consequences. 201 That’s not all. 1 You see, it seems to me, monsieur le député, that your ini- 2 tiative – in so many respects commendable and sympa- 3 thetic, and which has the merit of having brought into the 4 public arena the problems of a sector too often neglected 5 by the administration, save the spectacular circumstances 6 that reveal how the accountant’s logic that is suffocating 7 psychiatry has, after all is said and done, an elevated social 8 cost – that your initiative, I say, has been instrumentalized 9 by various interests. 30 I will cite, just for the record, the hope that you gave to 1 the epidemiologists and neuroscientists that they might 2 finally introduce their methods into psychiatry, even 3 though ‘this choice is in opposition to the position taken by 4 the majority of practitioners, expressed during the recent 5 États Généraux de la psychiatrie in June this year: the quan- 6 titative methods of evaluation promoted by the neuro- 711 sciences are unsuitable for clinical practice, and treat its 8 Miller/correx 8/12/04 2:48 pm Page 43

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1 theoretical fundaments with disdain’ (Sophie Bialek and 2 Pierre Sidon in Monday’s Marianne). 311 Neither shall I dwell on the satisfaction that you give to 4 the private clinics through the intermediary of Doctor 5 Cléry-Melin. 6 There are more serious things. Giving your all to your 7 combat against the sects, you are neglecting the major 8 pharmaceutical groups. What else could they desire other 9 than to bring to heel, to compromise, to suffocate, all those 10 practices that are employed to treat mental pain without 1 medicinal prescription? There you have their eternal, logi- 2 cal ambition, in keeping with their conatus. 3 These are very powerful economic forces, intellectually 4 dogmatic, without concession in the quest for maximum 5 profit. For years they have been exercising a constant pres- 6 sure on the psychiatrists and the general practitioners to 7 lead them to prescribe psychotropics, and on the public to 8 lead it to desire the medicinal prescription. The volume of 9 anti-depressants prescribed is already two to four times 201 higher in France than in neighbouring countries; the 1 French have the sad privilege of being the biggest con- 2 sumers of psychotropics in the world, why stop when 3 making such good headway? Why not ‘have a big clear 4 up’, and sweep away the last obstacles? Namely, psycho- 5 analysis and the psychotherapies. 6 The legislator that you are, monsieur le député, certainly 7 knows that the pressure from these interests is also being 8 exerted upon the authorities: they are doing their best to 9 convince them that depression is under-diagnosed and 30 under-treated, they are calling for the launch of educational 1 health campaigns aiming to convince the public of the 2 virtues of medication, they are requiring that the rate of 3 reimbursement of anti-depressants be maintained, higher 4 in France than neighbouring countries, while restrictions 5 are scheduled for all the posts in public healthcare. 6 Transposing the concept of ‘health studies’ to the psy 711 domain, due to Alain Juppé, was already an aberration. 8 Miller/correx 8/12/04 2:48 pm Page 44

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1 Was it really reasonable to count on a report from INSERM 2 (submitted at the end of this year) to define ‘good prac- 3 tices’ in psychoanalysis, and attempt to outlaw Lacan’s 4 short session? 5 6 A PATHOLOGY OF DEMOCRACY 7 8 I have tried to explain to you, monsieur le député, that there 9 are more things in the ‘psy world’ than a lacuna in the law 10 to be filled in. 1 Alain-Gérard Slama laughed, this Thursday on France- 2 Culture, where I was the guest of Nicolas Demorand, at the 3 haste, so very French, to search out lacunae in the law and 4 fill them in. As for Yves-Charles Zarka, director of research 5 at the CNRS, who teaches modern political philosophy at 6 the Université Panthéon Sorbonne, last week I shared with 7 him, at Lille’s celebrated ‘Citéphilo’, a round table discus- 8 sion dedicated to the theme ‘Psychoanalysis and Politics’, 9 and I heard him qualify the way in which your amend- 201 ment was voted in unanimously by the National 1 Assembly, without prior public debate and without men- 2 tion of the Cléry-Melin ‘plan of actions’, as a ‘pathology of 3 democracy’. At the ‘Forum of the Psys’ he developed an 4 analysis of arbitrary legal power which gripped the audi- 5 ence, and which allowed the psys to understand what they 6 were dealing with. Not all the sectors on the way to being 7 reconfigured, and harshly so, have the faculty of making 8 themselves heard. 9 If you will allow me, monsieur le député, to make an 30 incursion beyond my field of competence into your own, I 1 will tell you that the episode of your amendment will stick 2 in everyone’s mind as the example of what not to do in 3 politics. 4 As painful as particular cases may be – and it is neces- 5 sary that those responsible for criminal actions be pursued 6 ruthlessly – statistically, the psychotherapeutic risk is 711 infinitesimal. It is being trumped up, the threat is being 8 Miller/correx 8/12/04 2:48 pm Page 45

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1 spectacularized. Those who find in the psy, even the barely 2 competent psy, a place of address and reassurance, are 311 being thrown into a panic; the therapists are being tar- 4 nished; patients and their close ones are being put off; and 5 from one close one to another, that’s everyone. 6 Furthermore, one is letting oneself be manipulated by 7 certain interests, certain appetites, even certain currents of 8 thought, thrilled to be mobilising the might of the State 9 against their rivals. Having wanted to act by surprise, but 10 misreading the yield of real, intellectual and media forces, 1 the extent of the emotion and vigour of the response have 2 left them surprised. 3 To crown it all, one would like, I am told, to make a few 4 allies by promising, already, places on the future juries of 5 evaluation and accreditation, as in days gone by tobacco 6 counters were offered out. Were that to happen, what cred- 7 ibility would these juries have in public opinion? 8 But I cannot believe that this will be: it would not be 9 worthy, would it not, of the nation’s representatives. They 201 would only know how to censure such corrupt practices. 1 2 SAINT BARTHOLOMEW’S DAY FOR THE PSYS 3 4 A good many heavenly angels have come to help you in 5 your enterprise, monsieur le député. 6 In 1999, it was the fatal fax from M. Martinet Didier, 7 which alerted you to the existence of a ‘lacuna in the law’. 8 On 13 October of the same year, you submitted your bill 9 from the eighty-one deputies, designed to fill it in. The 30 argument of the ‘plaque screwed on to the door’ makes its 1 appearance. 2 But this law would initiate medical monopoly. So, peo- 3 ple take an interest in you, take you in hand, educate you. 4 The excellent Cournut, no stranger to the readers of my 5 Lettres à l’opinion éclairée (Seuil, 2002), puts you in contact 6 with Christian Vasseur. The choice is of an exquisite deli- 711 cacy: he’s ‘someone from back home’, ‘from the same 8 Miller/correx 8/12/04 2:48 pm Page 46

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1 valley’ as yourself, and a bitter, disappointed Lacanian. 2 You abandon your first project, and in the aftermath, your 3 new mentor organizes for you at the Assembly the sym- 4 posium of 23 March 2000, that you preside together, the 5 two Savoyards, in the third floor basement. All the 6 Savoyards are thought to be mountain dwellers. Some are 7 potholers though. 8 One can read on the SPP site dated 6 November the fol- 9 lowing note, ‘that has been addressed to us by Christian 10 Vasseur, member of the Société Psychanalytique de Paris and 1 president of the Association Française de Psychiatrie’ under 2 the title, ‘Accreditation Committees’: 3 4 Since the beginning of the relationship with B. Accoyer, ini- 5 tially prompted by Jean Cournut, it has been clearly stated that 6 the accreditation committee(s), particularly important for the 7 psychoanalysts who are neither psychiatrist nor psychologist, will be open to psychoanalysts. The places will be hot, as not 8 all the societies will be able to participate. For the time being, 9 one of them must be reckoned essential since it is ‘recognised 201 as being of pubic benefit: the SPP. This is the argument that I 1 have sustained over four years to B. Accoyer, the Ordre des 2 Médecins, the Académie de Médecine, and commissions from the 3 Minister for Health. It seemed to go without saying for all the 4 interlocutors.’ 5 6 Here, then, is how the neutralization of predictable 7 opposition to the assassination of French psychoanalysis 8 from the oldest psychoanalytic society in France has been 9 thought through: by the granting of a few ‘hot places’ on 30 miserable juries of evaluation, negotiated by an ‘indis- 1 pensable’ who has been pacing the corridors of the 2 Assembly, of the Ordre des Médecins, of the Académie de 3 Médecine, and of the Ministry of Health, relentlessly for 4 four years. 5 At the beginning of 2001, no less than fourteen work 6 groups co-ordinated by Jean-François Allilaire were 711 formed at the Fédération Française de Psychiatrie with a view 8 Miller/correx 8/12/04 2:48 pm Page 47

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1 to drafting a ‘blue book’; at the end of that same year, a 2 work group on the practice of psychotherapy was created 311 by the Permanent Secretary of the Académie de Médecine; its 4 secretary: the same Professor Allilaire. This was also the 5 year that the Revue française de psychanalyse slandered both 6 me personally and the École de la Cause freudienne, then 7 refused me a few lines of right to reply, provoking my ire 8 and the distribution of my first letter ‘to enlightened opin- 9 ion’, dated 3 September 2001. I must say that in the context 10 that is now coming into view, the slandering of the ECF by 1 the old Revue and its refusal to let me have my say is much 2 easier to understand. 3 Who is this Jean-François Allilaire, who crops up time 4 and again in this affair? He is not known to the general 5 public, but he is a distinguished professor, pupil of profes- 6 sor Widlöcher and the late lamented Pierre Fédida. He is 7 also the Secretary of the Société médico-psychologique, 8 who publish the famous Annales; J.-F. Allilaire is personally 9 in charge of them; Philippe Cléry-Melin is on the Editorial 201 Board. 1 In 2003: 2 3 JANUARY: publication of the Livre blanc da la psychiatrie, 4 co-ordinated by Allilaire. 5 FEBRUARY: letter from the Minister for Health, M. Mattéi, 6 entrusting to Cléry-Melin the task of ‘proposing a plan 7 of actions targeting the reorganisation of the supply of 8 psychiatric and mental health care’ to be submitted at 9 the end of May at the latest in order to be ‘presented to 30 the États Généraux de la Santé Mentale which will be 1 held in Montpelier this coming June’. 2 APRIL: Allilaire finishes the drafting of the report from the 3 Académie’s work group. 4 JUNE: meeting of the États Généraux de la Psychiatrie (name 5 change); the participants reaffirm the primacy of the 6 clinic and the subject; the Cléry-Melin report is not 711 ready: it is not therefore submitted. 8 Miller/correx 8/12/04 2:48 pm Page 48

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1 JULY: the Académie unanimously approves, minus two 2 abstentions, the Report on the Practice of Psychotherapy, 3 signed Pichot and Allilaire: psychotherapy ‘must be 4 carried out by doctors’; it can also ‘remain open to non- 5 doctors on condition of the validation of criteria of 6 qualification duly controlled’; the future? ‘The integra- 7 tion of psychotherapeutic and biological approaches’. 8 SEPTEMBER: Cléry-Melin submits his report to the 9 Minister; 10 2 OCTOBER: communiqué from the Minister for Health, 1 announcing that the Cléry-Melin ‘plan of actions’ will 2 be the basis of a ‘general plan on Mental Health’, elab- 3 orated during the first quarter of 2004, after ‘wide con- 4 sultation bringing together the professionals and the 5 representatives of all the modes of exercise of psychia- 6 try (public and private) as well as the associations for 7 patients and their families’; the ‘plan of actions’ is put 8 on the Internet. 9 8 OCTOBER: vote of the amendement Accoyer by the 201 National Assembly, voted in unanimously; there was 1 no mention of the Cléry-Melin ‘plan of actions’. 2 25 OCTOBER: Libération alerts public opinion to the 3 amendement Accoyer. 4 29 OCTOBER: Le Monde publishes my ‘opinion’ entitled 5 ‘On the social utility of listening practices’ on the front 6 page. 7 30 OCTOBER: debate on the television channel Public 8 Sénat. 9 11 NOVEMBER: Nicolas Demorand receives me on Matins 30 de France Culture. 1 13 NOVEMBER: Marc Voinchet hosts the debate on Tout 2 Arrive, on France Culture. 3 15 NOVEMBER: The ‘Forum of the Psys’; distribution of 4 the ‘Psy Manifesto’; creation of the ‘Movement of 15 5 November’. 6 One might say to oneself: ‘What a fine weave! What a 711 masterpiece!’ I’m almost bearing a grudge against myself 8 Miller/correx 8/12/04 2:48 pm Page 49

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1 for having knocked this fine edifice to the ground with the 2 help of the media. 311 And I still haven’t been able to evoke, for lack of inform- 4 ation, the exact circumstances that governed the creation of 5 the Fédération Française des psychologues, which seems to 6 have been called upon to come to your aid. Will the psy- 7 chologists allow themselves to be led astray by this sub- 8 terfuge? – when the first reading of the Cléry-Melin plan 9 reveals that, ‘the people who would address themselves to 10 psychologists practising as much in private consulting 1 rooms as in health or medico-social establishments would 2 have to submit themselves to prior psychiatric expertise 3 by consulting a psychiatrist co-ordinator from a Medico- 4 Psychological Territorial Research Centre, alone able to 5 evaluate the validity of the request, to prescribe psycho- 6 therapy and to orient it toward the psychotherapist of his 7 choice; it is only on these conditions that the psychothera- 8 pies could be covered by sickness benefit.’ (Note from 9 Michel Normand on the Œdipe web-site, 8 November 2003). 201 As for the position of my excellent colleague, professor 1 Widlöcher, who resides, if memory serves, near Lion de 2 Belfort, I’m not saying anything, since I don’t know any- 3 thing about it: he doesn’t express himself these days, even 4 though I regularly use his name each time I’m invited to 5 speak on a radio or television channel. Certainly, there is 6 a lot to do, being president of the International Psycho- 7 analytic Association, whereas I handed over the presi- 8 dency of the World Association of Psychoanalysis last year. 9 It must be that. 30 The fact remains that I am rather proud that psycho- 1 analysis should have rallied, so as to clap it in irons, so 2 many leading experts and dignitaries, so many Savoyards 3 and Academicians, so many colleagues some more Mach- 4 iavellian than others, and that this prestigious assembly 5 should have judged, in its wisdom, that it mattered to the 6 designs of Providence that the École de la Cause freudienne 711 and myself be kept well out of what was being prepared. 8 Miller/correx 8/12/04 2:48 pm Page 50

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1 Who knows? Maybe we were destined to be the first vic- 2 tims of the massacre of the Innocents . . . 3 I believed that psychoanalysis was accepted, recognized, 4 and even commonplace in public opinion. I am discover- 5 ing with trepidation that it is nothing of the sort, and that 6 it will thus be up to us to fight for it, as Freud had to in his 7 time, and Lacan in his. 8 Thank you, monsieur le député de Haute-Savoie – even if 9 everything is now making it appear that you were but the 10 blind instrument, or perhaps one-eyed, of the other side of 1 contemporary history. 2 3 PSYCHOANALYSIS, HOW MANY DIVISIONS? 4 5 I am being much less severe with you than many of my 6 colleagues will be. 7 The State just took too long to intervene on the question, 8 and it was no doubt fatal that it did so first of all in the 9 wrong way, in view of the divisions in the professional 201 milieu and its political incompetence, which is structural. 1 The trouble has been created, people are speaking about it 2 a lot, and are going to be speaking about it a lot more after 3 this letter. A parliamentary select committee with public 4 hearings wouldn’t be a bad idea. 5 People in analysis, in therapy, feel threatened to the 6 innermost. Expectation from the instigator of the plot, from 7 the Deus ex machina, is growing. A problem in suspense for 8 two decades is going to find a solution. The manifesto that 9 I had approved on Saturday by the ‘Forum of the Psys’, 30 convened in a few days by way of the airwaves and to 1 which nine hundred people flocked, indicates a way and 2 promises a counter-position. 3 It is a fact that the demand for the listening practices of 4 the psys has not stopped rising over the last ten years; con- 5 sultations for children are multiplying; the psy is now 6 being expected to substitute himself for the forebear to 711 assure the transmission of values and continuity between 8 Miller/correx 8/12/04 2:48 pm Page 51

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1 the generations. The listening ear of the psy, qualified or 2 not, constitutes the compassionate cushion necessary to the 311 ‘society of risk’: the trust given obligatorily to abstract and 4 anonymous systems gives rise dialectically to the need for 5 personalized attention: ‘I’ve got my psy’, ‘I’ve got my 6 coach’. In the last year, the growing power of the psy has 7 been confirmed in the press, in publications, on the radio, 8 and soon on television. 9 Everything is indicating that mental health is a political 10 stake for the future. Detraditionalization, loss of bearings, 1 disarray of identifications, dehumanization of desire, vio- 2 lence in the community, suicide among the young, passages 3 à l’acte of the mentally ill insufficiently monitored due to 4 the state of shortage that psychiatry is having to endure: 5 the ‘Human Bomb’ in Neuilly, the killings in Nanterre, the 6 attacks against the President and the mayor of Paris. All 7 this is unfortunately just the beginning (cf. USA). On this 8 point, yes, we do need the unanimity of the nation’s repre- 9 sentatives that you have aroused around your amendment, 201 and which, better orientated, could do better, by with- 1 drawing this stake of public salvation from the usual 2 quarrels of political life. 3 As for psychoanalysis, do not ask, monsieur le député, as 4 in the past Stalin did of the Vatican: ‘how many divisions?’ 5 5,000 psychoanalysts is not nothing, no doubt, statistically. 6 But it is also a strategic knot. Psychoanalysis is much more 7 than psychoanalysis: it is constitutive, or reconstitutive, of 8 the social bond, which is going through a period of restruc- 9 turing probably without precedent since the industrial rev- 30 olution. For half a century, philosophy in France (Foucault, 1 Deleuze, Derrida) has been a dialogue with psychoanaly- 2 sis (Lacan). The entire psy nebula gravitates around it. The 3 training it requires, long and highly supervised in all the 4 self-regulated associations, demands respect. 5 I honour the neuro-biologist Vincent for having said it, 6 much better than I, on Franz-Olivier Giesbert’s programme 711 on France 3. 8 Miller/correx 8/12/04 2:48 pm Page 52

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1 RESPECTFUL DUST 2 You shall read, monsieur le député, what I ask for, in the 3 manifesto that I’m attaching. This manifesto has been cir- 4 culating since Saturday evening, we shall see whether it 5 meets with the approval of the large masses of the psy 6 population. Accept that, in the meantime, your amend- 7 ment shall be frozen at the Senate. 8 For myself, I maintain what I said at the beginning: I 9 believe in your good faith. 10 I am more irritated when I consider the 2 October 1 Communiqué put out by the Ministry of Health, and when 2 I see M. Mattéi, coming out of a national catastrophe, con- 3 cocting the reorganization of the entire Mental Health 4 System in France whilst ‘conferring’ with a handful of psy- 5 chiatric associations and patients’ associations. 6 In mentioning that, two days ago at the ‘Forum of the 7 Psys’, I felt my voice take on the vibrato of Jean-Jacques 8 Rousseau’s Letter to Christophe de Beaumont: 9 ‘May you discourse at your ease, you other men consti- 201 tuted in dignity! Recognising no other rights besides your 1 own, no other laws than those that you impose, far be it 2 from you to do the duty of being just, you do not even 3 believe yourselves obliged to be human. Upon the least 4 conventions of interest or state, you sweep us aside before 5 you like dust. When you insult us with impunity, we are 6 not even permitted to complain; and if we display our 7 innocence and your wrongs, we are again accused of lack- 8 ing respect for you.’ 9 But hey! We’re in a Republic now. 30 Sincerely yours, monsieur le député de Haute-Savoie, 1 2 Jacques-Alain Miller 3 4 Note 5 1. [Translator]: Miller’s use of the French idiom, ‘on vous 6 donne le Bon Dieu sans confession’, is the first of many 711 allusions to M. Accoyer’s Christian pursuasion. 8 Miller/correx 8/12/04 2:48 pm Page 53

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1 2 311 THE PSY MANIFESTO 4 5 Paris, 15 November 2003 6 7 8 9 We, the psys, who treat ‘the demand that comes from the 10 voice of the sufferer, of he who suffers from his body or his 1 thought’ (quotation from Lacan). 2 We, professionals from all the modes of exercise of psycho- 3 analysis, of clinical psychology, of the psychotherapies, of 4 public and private psychiatry, gathered together in a forum 5 this 15 November 2003, in Paris, declare the following: 6 2 October, the Minister for Health announced in an offi- 7 cial communiqué, ‘the elaboration of a general plan on 8 mental health’ based on the Cléry-Melin ‘plan of actions’, 9 preceded by a so-called ‘wide’ consultation bringing 201 together ‘the professionals and the representatives of all 1 the modes of exercise of psychiatry (public and private) as 2 well as the associations for patients and their families’. 3 Which clearly means that there is an intention to exclude 4 the professionals and the representatives of all the modes 5 of exercise of psychoanalysis, of clinical psychology, and of 6 psychotherapies from any consultation. 7 8 October, the National Assembly, Left and Right 8 together, voted unanimously in favour of amendment 336, 9 third modification, of the Public Health Code, known as 30 the ‘amendement Accoyer’ and this without opening a prior 1 public debate, without consulting the professionals con- 2 cerned, and without being itself informed of essential facts, 3 one of which being the role that the Minister for Health 4 intended to give to the Cléry-Melin ‘plan of actions’. This 5 vote constitutes in itself a ‘pathology of democracy’. 6 The Communiqué and the amendment are two sides 711 of one and the same project whose realization would 8 55 Miller/correx 8/12/04 2:48 pm Page 56

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1 systematically bleed mental health in France in favour of 2 private clinics, and would bring psychoanalysis and the 3 psychotherapies to heel in favour of pharmaceutical labo- 4 ratories: indeed, our professionals are the principal obsta- 5 cles hindering the complete triumph of psychotropic 6 drugs, of which the French are already the world’s largest 7 consumers. 8 In consequence of which: 9 10 1. We request that the Communiqué of 2 October be 1 purely and simply withdrawn. 2 2. We respectfully ask the Senators to begin consultations 3 with the qualified representatives of our professions, 4 then to freeze the voting of the amendement Accoyer 5 while awaiting the proposition of the ‘Forum of the 6 Psys’ presently under elaboration. 7 3. We request of M. Mattéi, the Minister for Health, M. 8 Aillagon, the Minister for Culture, and of M. Dutreil, 9 the Minister for the Liberal Professions, to receive the 201 delegation known as the ‘Forum of the Psys’, who will 1 show them what is at stake in this present affair and 2 the reasons for the stir in the public and the media: 3 the stakes for public health, the stakes for civilization, 4 and the professional stakes. 5 4. We would suggest to Alain Juppé that it would not 6 be ill-timed for the President of the UMP to consider 7 taking a position without delay on the poorly orien- 8 tated initiatives of M. Accoyer, the UMP Deputy for 9 Haute-Savoie, which are unfortunately making the 30 news. 1 5. We hope for the constitution of a work group, includ- 2 ing, together with the delegation of the ‘Forum of the 3 Psys’, representatives from the two Chambers and 4 those from the entire group of professionals interested 5 in the ‘psy’, from the psychiatrists to the social work- 6 ers and nurses, without forgetting the associations of 711 the ill and users. 8 Miller/correx 8/12/04 2:48 pm Page 57

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1 We consider ourselves mobilized until Mattéi’s Com- 2 muniqué is withdrawn and the amendement Accoyer is 311 frozen. 4 5 Text drafted by Jacques-Alain Miller 6 ADDRESS SIGNATURES TO: 7 ORNICAR?-FORUMPSY 9, rue Duguay-Trouin, 75006 8 Paris, 9 or the website: www.forumpsy.org 10 1 2 3 4 5 6 7 8 9 201 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 711 8 Miller/correx 8/12/04 2:48 pm Page 58

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1 2 311 Regulating Psychoanalysis: Why We 4 Should Be Concerned Over the New 5 6 Psychotherapy Legislation in France 7 8 Russell Grigg 9 10 1 2 On Wednesday 8 October 2003 the French National 3 Assembly passed a bill intended to regulate, for the first 4 time, the practice of psychotherapy in France. Moved by 5 Bernard Accoyer, a medical doctor and member of the 6 Union for a Popular Movement, the conservative Party of 7 which Jacques Chirac is a member, the purpose of the leg- 8 islation was to restrict the practice of psychotherapy to 9 psychiatrists and clinical psychologists; it would effec- 201 tively no longer be legal for any other practitioners, includ- 1 ing psychoanalysts, to practice in the sphere of mental 2 health. 3 Although the bill was passed without debate and, 4 apparently, without objection in the Assembly, there has 5 been a mixed but on the whole vociferous public response 6 since. Most notably, an action group called the ‘Forum des 7 Psys’ established by Jacques-Alain Miller has brought 8 together, in united opposition to the new legislation, the 9 École de la Cause freudienne and various groups from the 30 field of ‘Psys’, as the vast therapeutic industry in France is 1 commonly referred to.1 There have been other offshoots as 2 well, such as the association called ‘Vive la Psychanalyse!’ 3 which Judith Lacan has founded with the aim of pro- 4 moting psychoanalysis in the public domain. Catherine 5 Clément, Roland Dumas, Bernard-Henry Lévy, and 6 Philippe Sollers, all members of the association’s council, 711 have been vocal opponents of the new legislation, both at 8 61 Miller/correx 8/12/04 2:48 pm Page 62

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1 public forums and in the press. Bernard-Henry Lévy has 2 described the legislation as a giant backward step that 3 takes us back some hundred years to a scientism that one 4 would have thought the Freudian ‘break’ had done away 5 with. He predicted that the legislation would be the death 6 of psychoanalysis. Jean-Claude Milner, eminent linguist 7 and social commentator, has referred to ‘a mortal alliance 8 between scientism, managerial ideology and unrestricted 9 regulatory control’.2 10 Despite the unremarkable passage of the bill through its 1 first reading in the Assembly, by the time it arrived at the 2 Senate on 19 January 2004 it had become clear that the bill 3 would not pass unchallenged. The Government was able 4 to curtail opposition to, and circumvent possible failure of, 5 the legislation in the Senate by presenting a modified ver- 6 sion of the ‘Accoyer Bill’, as it had come to be known, and 7 to present it as a ‘Government Bill’, presented by the then 8 Minister for Health, Jean-François Mattéi. The effect of pre- 9 senting the legislation in the form of a Government bill 201 was that the text would have to be voted on without 1 amendment. The novelty of this second bill, now known as 2 the ‘Mattéi Bill’, was to propose the establishment of a 3 National Register of Psychotherapists maintained by the 4 Prefecture. Three categories of practitioners were exempt 5 from the requirement: those with medical degrees, regis- 6 tered psychologists and, last but not least, psychoanalysts 7 who are registered members of a psychoanalytic associa- 8 tion, as indicated by the membership records of their asso- 9 ciation. It might seem that this modification would be 30 sufficient to appease the psychoanalysts opposed to the 1 legislation and to allay the concerns it gave rise to. Indeed, 2 one group of psychoanalytic associations, which calls itself 3 ‘the Contact Group’, embracing Lacanians and non- 4 Lacanians alike, welcomed the new legislation, citing its 5 recognition of the ‘specificity’ of psychoanalysis and the 6 ‘irreplaceable role it plays in the training and the qualifi- 711 cation of its members’.3 The response of Jacques-Alain 8 Miller/correx 8/12/04 2:48 pm Page 63

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1 Miller, on the other hand, was immediate and categorical: 2 this legislation is worse than the original; a view he has 311 been supported in by both the École de la Cause freudienne 4 and members of the public. I return to this issue below. 5 When the bill was referred back to the National 6 Assembly for the second reading, it was to undergo yet 7 further modification. The bill, now referred to as the 8 ‘Dubernard bill’, opined that 9 10 the practice of psychotherapy requires either theoretical and 1 practical training in clinical psychopathology or training 2 recognized by a psychoanalytic association. 3 Use of the title of psychotherapist is restricted to profes- 4 sionals who are registered in a national register of psycho- 5 therapists. Registration is recorded on a list maintained by the State in 6 the department of residence. 7 This list indicates the training undertaken by the profes- 8 sional. It is updated, made available to the public and pub- 9 lished regularly. 201 Accredited medical doctors, registered psychologists and 1 psychoanalysts who are registered members of their associ- 2 ation are exempt from registration. The application of the 3 present article is fixed by decrees in the Conseil d’État.4 4 5 Finally, on Friday 9 July 2004, the Senate’s second read- 6 ing of the bill took place. The Dubernard bill, which had 7 been adopted by the National Assembly on its second 8 reading, was further modified and adopted as the Giraud 9 bill. This bill refocused on the use of the title of psy- 30 chotherapist rather than on the practice of psychotherapy. 1 The details are not important because, as the text of the 2 Senate and National Assembly bills remained at variance 3 following the second reading in both houses, a joint com- 4 mission of the two houses was convoked in order to estab- 5 lish a form of legislation that would be acceptable to both 6 houses. 711 The Joint Commission met at the end of July and 8 Miller/correx 8/12/04 2:48 pm Page 64

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1 adopted the final form of the legislation, which was gazet- 2 ted in the Journal Officiel on 11 August, thereby becoming 3 law.5 It states the same requirement that 4 5 1. all psychotherapists must be registered on a record 6 maintained by the Government; 7 2. this record must be made available to the public and 8 published regularly. 9 10 It then re-states the by now familiar exclusion clause con- 1 cerning doctors, psychologists and psychoanalysts. 2 3 Medical practitioners and qualified psychologists and psycho- 4 analysts registered as members in the records of their associa- tion have a legal entitlement to register. 5 6 And it adds a final clause concerning the decree that will 7 be all important to its implementation. 8 9 A decree in the Conseil d’État specifies the manner of appli- 201 cation of the present article and the conditions for the theoret- 1 ical and practical training in clinical psychopathology that 2 must be fulfilled by persons referred to in the second and third 3 paragraphs. 4 5 Now that the legislation has become law in France, the 6 question is what to make of it. As mentioned above, 7 Jacques-Alain Miller was even more vigorously opposed to 8 the amended version of the original that was endorsed on 9 the first reading in the Senate. To see why, and to consider 30 whether these concerns still apply to the final form of the 1 legislation, one needs to understand the place of decrees 2 in French law, where the difference between statute law 3 (adopted by the parliament) and regulation by decree is 4 fundamentally important. The manner in which a law 5 is applied can be determined by decrees drafted by the 6 executive branch, rather than by the legislature; they are 711 administrative actions and as such, though sometimes they 8 Miller/correx 8/12/04 2:48 pm Page 65

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1 require approval by the Conseil d’État, they are obviously 2 not drafted as openly, and are not subject to as much 311 debate, as parliamentary legislation is. There are different 4 sorts of decree in France, but the basic principle remains 5 the same; the Government establishes, through its bureau- 6 cracy, the means by which the statute is to be imple- 7 mented. In the present case, the wording of the legislation 8 combines with the behaviour of the Government over this 9 issue to lead one to fear the worst: boards responsible 10 for making the decisions sympathetic to the position of 1 the Minister of Health and acting from a perspective that 2 favours a medicalization of psychotherapeutic practices 3 and the ascendancy of cognitivist currents in psychology. 4 Note that the final legislation no longer gives a medical 5 practitioner the right to automatically register as a psy- 6 chotherapist, irrespective of his training. Mr Giraud main- 7 tains that registration of medical practitioners will be 8 restricted to those who have specialist training, but while 9 it was difficult to see how the Giraud bill could be inter- 201 preted to support this assertion, it has been inscribed in the 1 gazetted law. 2 Nevertheless, there are other difficulties with the legisla- 3 tion. There is, for instance, the somewhat arbitrary distinc- 4 tion between psychoanalyst and psychotherapist, the 5 grounds for which have not been well argued. 6 Furthermore, to suggest, as did Bernard Accoyer when he 7 initially proposed the legislation, that it was motivated by 8 a desire to protect the public from charlatanism and all the 9 snake-oil merchants (my words, not his) of this world who 30 prey on an unsuspecting public would appear to be an idle 1 claim if the legislation leaves it open to any group of psy- 2 chotherapists to unite as a group of ‘psychoanalysts’ and 3 register under that category. 4 The strategy of some analytic groups in France has been 5 to accept the legislation as guaranteeing their presence on 6 the list of categories of professionals authorized to practise 711 psychotherapy. This has been the position of the ‘Contact 8 Miller/correx 8/12/04 2:48 pm Page 66

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1 Group’, for instance, who have simply noted that the 2 Senate recognizes the ‘specificity’ of psychoanalysis and 3 the irreplaceable role associations play in the qualification 4 and training of their members. 5 Philippe Douste-Blazy, the new Health Minister since 6 April, has indicated that while he has not had the time to 7 meet representatives of all the professions involved, as the 8 person responsible for drafting the future decree regarding 9 the training required for registered psychotherapists, he 10 ‘undertook to allow an extensive debate, a wide-ranging 1 gathering of information and reflection that would pro- 2 duce a consensus amongst the professionals’.6 3 The expansion of administrative control over the lives 4 and practices of members of the public and professions is 5 a feature of contemporary society and, although it may 6 appear innocuous, there are grounds for thinking the 7 movement insidious. Whatever the reassurances of the 8 Minister concerning seeking consultation and achieving 9 consensus, increased regulation, with its needless time 201 wasting and costly compliance process, now appears 1 inevitable. Perhaps this is nothing more than a nuisance, 2 and if it produces a higher standard of professional prac- 3 tice, then the price may be worth paying. But the fear is 4 that the temptation to further increase regulation and 5 control is one that bureaucracy finds difficult to resist. 6 Once the door of accountability is opened – and it is 7 always opened with the best of intentions – control and 8 compliance requirements expand. Who can be confident 9 that the decrees will not, with time, impose increasingly 30 arbitrary and irrelevant restrictions on the requirements 1 that must be met for practitioners to practise and 2 expanded measures for exclusion? What information will 3 be gathered, what databases set up and how will the infor- 4 mation be used? 5 The legislation will have the effect of introducing a de 6 facto distinction between psychoanalysts who are qualified 711 medical practitioners or registered psychologists on the 8 Miller/correx 8/12/04 2:48 pm Page 67

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1 one hand, and the rest, which in France have been dubbed 2 ‘the ni-ni’ or the ‘neither-nors’. While the legislation gives 311 de jure recognition to doctors, clinical psychologists and 4 psychoanalysts, the consequences are different in each 5 case, owing to the differences between medical registration 6 via the Ordre des médecins, which has statutory recognition 7 in France, the registration of psychologists on the basis of 8 academic qualifications, and the registration of psychoana- 9 lysts on the basis of their membership of a psychoanalytic 10 association. It is foreseeable that registration of psychoan- 1 alysts will significantly modify the status of psychoanalytic 2 associations, which will henceforth have a legal reporting 3 status, given that they will be required to maintain a reg- 4 ister of members which has a legal status. 5 Moreover, some associations currently have non-practis- 6 ing members. This includes the École de la Cause freudienne 7 whose directory speaks of ‘members who practise psycho- 8 analysis’, implying that practising is not a requirement of 9 membership, and adds that practising members come 201 under two categories: those who, admitted as members of 1 the school by the School’s Council, have declared that they 2 practise psychoanalysis and are registered as Practising 3 Analysts; those whom the ad hoc Committee of the 4 Guarantee has guaranteed as having met the training that 5 the School provides and on whom is conferred the title of 6 ‘Analyst Member of the School’.7 The number of non- 7 analyst members of the École de la Cause freudienne may be 8 small, but the principle is nevertheless a venerable one, 9 having its origins in the École freudienne de Paris. 30 A moment’s reflection is enough to make one realize 1 some fairly specific and detailed criteria for the registration 2 of psychoanalysts will have to come out of the administra- 3 tive decree to be presented by the Minister of Health. In the 4 absence of such measures, the legislation alone, absurdly, 5 might allow for any two people to found an organization 6 which they could call an association of psychoanalysis, 711 have it registered at the Prefecture and subsequently 8 Miller/correx 8/12/04 2:48 pm Page 68

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1 declare oneself a member of this psychoanalytic associa- 2 tion. This even suggests a sort of guerilla response in the 3 form of bureaucratic sabotage, with a series of spurious 4 organizations, all with one or two members. . . . 5 Something like the category of Analyst Member of the 6 School may well be destined to become all-pervasive 7 under the new law, since this is the one category that will 8 really matter from the point of view of legislation. One can 9 expect that the basis upon which the title is to be conferred 10 by the School will be compelled to comply with whatever 1 the requirements of the decree are. Either that or a new, 2 fourth, category will need to be introduced. In either case, 3 the new legal obligations of the School will no doubt chal- 4 lenge the principle that Lacanian psychoanalysis is a prac- 5 tice with ‘no standards but not without principles’. The 6 category of ‘practising analyst’, at least in the sense in 7 which it was introduced by Lacan and adopted by the 8 École de la Cause freudienne, seems destined to disappear 9 because the ministerial decree will establish conditions for 201 registration that any association will effectively be required 1 to see that its practising analyst members satisfy. 2 While the new legislation speaks in terms of guarantee- 3 ing the qualification and training of psychotherapists, by 4 framing the law in terms of membership of an association, 5 it leads to potentially absurd situations. There are psycho- 6 analysts who have opted not to belong to any psychoana- 7 lytic organization, but whose training and competence 8 have never been at issue. Equally, the situation has arisen 9 and could always arise again where, for different reasons, 30 analysts resign from their Association. On the basis of the 1 new legislation, in such cases the analyst will no longer be 2 able legally to practise; and in reality the force of the law 3 will commit an analyst to remaining throughout his or her 4 professional life a member of an association. 5 We do not know at this stage what requirements will be 6 imposed upon psychoanalytic associations, and will not 711 know until the content of the ministerial decree (or décret 8 Miller/correx 8/12/04 2:48 pm Page 69

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1 en Conseil d’État, as it is more strictly called) is released; 2 however, the following are possibilities. 311 Legal requirements: will associations be required to 4 exclude members if they have been convicted of a crime? 5 The implications of this not only for the vetting of admis- 6 sions and policing of the activities of members are rather 7 horrific, but the scenario is not unrealistic. 8 Ethics: will associations be required to implement a code 9 of ethics and a complaints procedure? These typically 10 cover such issues as responsibilities to the ‘client’, as it has 1 become increasingly common to call the ‘consumer’ of 2 therapeutic services; matters of exploitation; matters of 3 confidentiality; contracts, involving informed consent; 4 responsibilities to other professionals and the wider com- 5 munity; and a complaints procedure. It is highly unlikely 6 that once psychoanalytic associations come under the juris- 7 diction of the law they will escape the requirement to 8 implement a code of ethics and complaints procedure, the 9 broad shape of which can be predicted on the basis of what 201 such codes look like in the case of other regulated profes- 1 sions and professional bodies, and it is likely that every 2 psychoanalytic association will be required to address all 3 of the above issues. 4 What will the implications of such measures be for psy- 5 choanalysis, if, as I think is likely, they are implemented? It 6 is possible to be rather blasé about the whole thing and 7 declare that nothing much will change for either the better 8 or the worse; on the one hand, cases where issues of com- 9 pliance and complaints arise are extremely rare; and on the 30 other it is not clear that a formal code is going to solve the 1 more egregious perversions of psychoanalytic practice. It is 2 not clear, for instance, that the Masud Khan scandal would 3 have been any better addressed if a code of conduct had 4 been in existence at the time. As was stated by the President 5 of the British Psychoanalytical Society, Donald Campbell, 6 Although there were rumours of inappropriate professional 711 behaviour by Masud Khan, a case of malpractice could not be 8 Miller/correx 8/12/04 2:48 pm Page 70

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1 brought on the basis of rumour. I believe that attempts were 2 made to encourage patients and ex-patients to come forward 3 with a complaint, but none did so.8 4 5 It is not too cynical to think that the Code of Conduct func- 6 tions mainly as a public relations device to reassure the 7 public that Something Will Be Done in the case of ethical 8 misconduct. 9 There is the further point that Government regulation 10 will not improve standards of clinical training and theo- 1 retical formation; in fact, there is a case to be made for 2 thinking that it will lead to their deterioration. There are 3 two reasons. First, the standards of training required by 4 Ministerial Decree will be both minimal and quantitative: 5 together these characteristics imply that the conditions for 6 qualification will be purely formal, as is the case with the 7 registration of psychologists in France and elsewhere. The 8 duration of the training will erroneously come to be taken 9 to be the measure of the quality of the trainee. In the École 201 de la Cause freudienne, which prides itself on being the 1 School of the Pass, the pass is constructed around a com- 2 pletely different ethics, one that is consistent with and fol- 3 lows from the ethics of psychoanalysis: in the procedure of 4 the pass analysands give testimony not only about the 5 process of an analysis – their own – thereby addressing, 6 most valuably, the issue of research into the analytic expe- 7 rience, its outcomes and its subjective effects; but it is also 8 expected that they will make a contribution on ‘crucial 9 problems of psychoanalysis’.9 30 The last remark leads to a more disturbing trend in the 1 current tendency towards regulation, or increased regula- 2 tion, of psychoanalysis. In the mind of the regulators, one 3 suspects, there is a conception of psychotherapists and ipso 4 facto of psychoanalysts as technicians, as technicians of the 5 unconscious as it were, whose technique and practice is 6 straightforward and uncontroversial, at least amongst 711 themselves. The consequence is that regulation, stagnation, 8 Miller/correx 8/12/04 2:48 pm Page 71

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1 and lack of innovation can all too naturally go hand in 2 hand. Supposing the regulated environment had been put 311 in place in 1954 and not 2004, would Lacan have been free 4 to innovate in the way he did and change forever the 5 nature of psychoanalytic practice? 6 In making these comments I am assuming that the new 7 legislation is just the first step in a process of increasing 8 regulation. Certain of the further developments discussed 9 here flow directly from the legislation enacted in August; 10 this includes the conditions that we can expect to see stip- 1 ulated in the Décret en Conseil d’État dealing with the 2 implementation of the new law. This will occur in the short 3 term. If the experience elsewhere and in other domains is 4 anything to judge by, we can expect that further down the 5 track the legislative and/or administrative interference in 6 the ‘Field of Psys’ will increase inexorably. If this is correct, 7 then it is a curiously short-sighted approach to think that 8 psychoanalysis is protected by the new legislation which is 9 only a threat to psychotherapy. It was Freud who spoke of 201 psychoanalysis as the primus inter pares in the field of psy- 1 chotherapy. And abandoning the larger psychotherapeutic 2 community to its own devices, as agreeable as the sense of 3 superiority may be, its origin is the narcissism of minor 4 differences, and the attempt to form a united front of all the 5 professionals directly concerned by the initial Accoyer bill 6 via the Forum des Psys will be shown to have been correct. 7 Jacques-Alain Miller is no doubt correct in his judgement 8 that the amended Mattéi legislation was worse than what 9 it replaced, and there is a logic to this development that 30 will continue to unfold to the disadvantage of psycho- 1 analysis: the inclusion of psychoanalysis in the amended 2 legislation may turn out to be a hollow and short-lived vic- 3 tory if it leads to an increasingly significant impact upon 4 the training and development of psychoanalysts. 5 It is important to view the legislation of the practice of 6 psychotherapy in France in the context of what is poten- 711 tially a profound change in the mental health sphere in 8 Miller/correx 8/12/04 2:48 pm Page 72

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1 France. The move towards quantitative, so-called ‘evi- 2 dence-based’ forms of intervention, along with the recent 3 Cléry-Melin ‘Plan of Actions for the Development of 4 Psychiatry and the Promotion of Mental Health’ that 5 Jacques-Alain Miller refers to and critiques in this volume, 6 combine to indicate a disturbing tendency in approaches to 7 issues in mental health. 8 9 Notes 10 1 1. For much of what follows, see the website of the 2 ‘Forum des Psys’, http://www.forumpsy.org/index. 3 html 4 2. Quoted in Agence Lacanienne de Presse, Bulletin spécial 5 Accoyer n° 5, Paris, 1 December 2003, website www. 6 forumpsy.org 7 3. See the website of the Société Psychanalytique de Paris, 8 http://www.spp.asso.fr/Main/Actualites/Items/21. 9 htm 201 4. The text of the Dubernard bill can be found on any 1 number of websites, such as the following: http:// 2 www.etatsgeneraux-psychanalyse.net/actualites/ 3 Dubernard.html 4 5. For the full text consult the website http:// 5 www.legifrance.gouv.fr/ 6 6. See the website of the Senate, http://www.senat.fr/ 7 cra/s20040709/s20040709H35.html 8 7. Annuaire et textes statuaries, École de la Cause freudienne, 9 2001, p. 16. 30 8. London Review of Books, Letters, vol. 23, no. 6, 22 March 1 2001. 2 9. Annuaire, 16. 3 4 5 6 711 8