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Evidence–based practice and psychoanalysis: thought disorder and the dream

The Letter, Issue 46, Spring 2011, Pages 57 - 71


Evidence–based practice and psychoanalysis: thought disorder and the dream

Patricia McCarthy

Post-modernism, quantum theory, psychoanalysis-buzz words of the twentieth century likely to be misunderstood by the non-specialist – are domains that are governed by abstract sets of laws whose effect cannot be predicted and, into which, participants have to make their way. To acknowledge such domains is to broaden the definition of science and perhaps allow for a better understanding of one of them - psychoanalysis, which is governed by the laws of the unconscious. Freud discovered these laws, Lacan formalised them. How they work is the ‘evidence base’ of psychoanalysis which uniquely serves subjectivity and thereby excludes the objectifying eye of measurement. My argument is that to ignore this ‘evidence base’ is a loss to psychiatry and psychiatry’s patient – especially the psychotic. The implications of this loss will be further discussed by examining the parallels between thought disorder and the process at work in forming that simple ‘given’ of our psychical lives – the dream, continuous as it is with waking thought.

Keywords: evidence-based practice; quantum theory; thought disorder; the dream; subject –effect; schizophrenia

In the half hour allocated to me to speak to you, I am confronted with an immediate difficulty. In addressing a mixed audience of psychoanalysts and psychiatrists I am aware of the gaps in knowledge that define both groups differently. To impute a gap in knowledge to such august groupings is to risk alienating both sections of my audience all at once, but of course that is not my intention on this April Fools' Day[1] where it has already emerged so far from the papers and the questions arising, that the gaps in knowledge displayed are more badges of honour, equivalent to the participants, like knights of old, having handed in their individual weapons of knowledge at the registration desk this morning and trusting that they will emerge unscathed at the end of the day.

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