… of all the objects treated by medical thought, healing is the one that doctors have considered least often.

Georges Canguilhem

One must not forget, it is not the doctor but the patient who reaches the end of the illness.  The sick person cures himself using his own power, just as he walks, eats, thinks, breathes, and sleeps under his own power.

Georg Groddeck

  1. Unlike Freud, I don’t have a problem accepting that there are unknowable experiences, that sometimes our experiences exceed the possibility of knowing, or even that we are constitutively more than we can know. Moreover, I don’t believe that imagining this to be the case is a sign of regression to an infantile or atavistic (a.k.a., “animistic”) mode of thinking, although I’m not especially bothered if it does. These days I only half-jokingly describe myself as a pan-psychic, neo-vitalist, which might just be animism in modern drag.  However, I wasn’t born thinking this way.  In fact, as the oldest son of a physical chemist and a vulgar Marxist, both rabidly-atheistic, cultural Jews, I was raised to believe–much as Freud did–in a thoroughly secular, scientific, rationalist worldview.  Only after suffering with an acute autoimmune illness for more than a decade, from which I almost died, and then undergoing a seemingly “miraculous” healing experience, during which I spontaneously started going into trances, did it begin to dawn on me that the medical model, to which I owed my life, could not explain either why I had gotten so sick in the first place, or how I had gotten better so quickly.  Needless to say, this realization came as something of a shock to my secular scientific assumptions, if only because I now understood that I had been staking my life on somewhat suspicious suppositions.  Moreover, I started to wonder why none of my many doctors had ever mentioned the possibility of healing to me, or why—as Canguilhem notes—they seemed to have so little consideration for it.

This lack of interest, it turns out, was not just an idiosyncratic failing on the part of the many physicians I’d come into contact with at the many medical centers at which I’d been treated (including two of the U.S.’s most famous teaching hospitals).  Rather, since the end of the nineteenth century, exactly at the time Freud did his medical training, it has provided the criteria—or perhaps the shibboleth–that distinguished scientific medicine from its “non-scientific” competitors.   Until then Western medicine, like almost all therapeutic systems ever conceived by human beings, held that doctors could (at best) support and encourage the natural power of healing, which, following in the Hippocratic/Galenic tradition, it called the Vis Medicatrix Naturae.  Today, if you look up “healing” on Medline, the U.S. National Library of Medicine’s comprehensive database, you will find only four categories: faith healing, fracture healing, mental healing, and wound healing.  Not healing as a possibility, as a tendency, as a vital function, or as that upon which all of medicine’s most prized bioscientific interventions depend if not importune, as Groddick reminds us.   In this regard, Freud was a consummately modern physician: if you search for “healing” in Freud’s writings you will find very few instances, and none of them refer to psychoanalysis (although he does once refer to the “healing power of love”—however, not without irony).

My hunch is that the absence of healing in Freud is uncanny, in part because healing is uncanny, not in a psychoanalytic sense, but etymologically and literally:  i.e., unknown if not unknowable.  Healing is a known unknown; it’s familiarly unfamiliar.  We all “know” it in very material ways or we wouldn’t be here–we’d be dead–yet our “knowledge” is not usually conceptual, but experiential, undertaken by the savoir faire of our cells, molecules, and subatomic particles.  However, within the medical perspective that underpinned Freud’s (not to mention my own doctors’) practice, knowledge alone represents the royal road to care, as it has done for the last two and a half millennia, ever since Hippocrates differentiated medicine as such from other forms of healing (shamanistic, temple, cultic, etc.).  So, while Freud could admit that the navel of the dream might elude total knowability at any given moment (giving rise to the famous question: analysis, terminable or interminable?) he held fast to his Enlightenment faith that knowledge alone provides the best therapy–a sentiment that underwrites his famous declaration, in The New Introductory Lectures: “where the it was, the I shall be.”  Nevertheless, despite his avowed scientific secularism, psychoanalytic practice continually brought Freud up against the limits of his motto.  Indeed, the very existence of hysteria and the other conversion neuroses, from whose treatment psychoanalysis derives, if not the potential efficacy of the “talking cure” as one such treatment, troubled the premises of determinate causality upon which Freud’s scientific aspirations rested.  The failure of his “Project for a Scientific Psychology” provides the first intimation of this trouble, and seemingly, it got harder and harder for Freud to reconcile his theory and his practice, until in 1919, at the end of the first world war, and just before he revised his psychic topology in The Ego and the Id, he published his strange essay, “The Uncanny.”

As numerous commentator have noticed, “The Uncanny” represents an anomalous work in Freud’s opus.  Freud himself tells us this in the essay’s opening sentence, where he offers an explanation for taking up a topic more suited to aesthetics.  Furthermore, the essay’s style of argumentation, its circuitous development, its extensive reliance on literary readings, all suggest that something uncanny is going on in “The Uncanny.”  My hypothesis is that both Freud’s essay and his concept (unheimlich/uncanny) only make sense within the horizon of a modern secular, scientific, evolutionary, and medical point of view.  Furthermore, unheimlich/uncanny constitutes Freud’s attempt to shore up “the truth” of this point of view in the face of his own analytic practice, which revealed the limits of determinism to encompass all forms of causality.  The uncanny thus seeks to account conceptually for the affects engendered by experiences that appear to exceed our rational understanding.  By designating these affects as the unconscious eruptions of repressed infantile or “primitive” material, Freud cannily tries to capture the unknown and unfamiliar within the knowledge project of psychoanalysis.  Yet, despite his best intentions, Freud’s efforts have their limits.  For, much as Freud might desire us to keep faith with the Enlightenment, we are (I believe) more than we can ever know, and healing is just one of the uncanny ways that we can become familiar with the unknown-that-we-cannot-not-know.

* * * * *

  1. I had an uncanny healing. That’s a medical fact. I’ve had many, many other uncanny experiences, but none of those were medically affirmed.  I was 23 at the time and had been living with acute Crohn’s disease for more than a decade—I’ll spare you the gory details—when I had a critical episode in which I almost “bled out,” as they say.  The near-death, out of body experience that this event precipitated could certainly be considered uncanny, as might the moment of waking up in the ICU, reaching for a beloved friend’s hand, and feeling the spark of life returning, not to mention the trances I spontaneously began falling into during the months I remained tethered by IV lines to my hospital bed.  Alas, I don’t any have medical confirmation for those particulars.  However, I do have it for the entire arc of the experience, for what Canguihem called the “ordeal of healing” itself.  In my exit interview with the young and sexy surgeon, on whom I had a major “therapeutic” crush, he uttered words that sent chills down my spine, although that was the least of it.  He said: “You were the sickest person I’ve operated on in 5 years who is still alive, and I have no idea how you got better so quickly.”  Now that was probably uncanny in both the psychoanalytic and the etymological senses of the term.

James Stratchey’s decision to translate Freud’s unheimlich as “uncanny” was a somewhat odd one. Of course, it makes sense because like the original, the translation involves a word that is the negative of a substantive adjective, and the tension between the two tends towards indecidability (i.e., heimlich tends towards unheimlich much as canny tends towards uncanny).  Yet, the two antithetical couplets don’t resonate in exactly the same ways.   On the one hand, heimlich/unheimlich in Freud’s exposition mostly pertains to the defamiliarization of what once felt familiar—albeit either in infancy, in utero, or in “primitive” hominid development.  It’s primarily affective, rooted as Freud tells us in “emotional impulses.”  Canny/uncanny, on the other hand, doesn’t signify in the same way.  Canny, from the Scots root can/ken, meaning “to know how, to be able,” refers to a kind of knowingness, a kind of cunning (a word that shares the same root), that verges on being “too knowing” (as you probably know all too well, since it is sometimes derogatorily applied to Scots people).  Uncanny thus discloses a relation to the unknown, which may or may not be familiar (in both its both its literal and figural senses), and it doesn’t necessarily have the same affect attached as unheimlich.  This is why long before it took on the valence “associated with supernatural arts or powers” or “partaking of a supernatural character; mysterious, weird, uncomfortably strange, or unfamiliar” (which the O.E.D. reminds us was only “common from 1850”), uncanny primarily meant: mischievous, malicious; careless, incautious; unreliable, not to be trusted; not quite safe to trust, or have dealings with.  Thus, the uncanniness of the uncanny in the Standard Edition does not render the familiar unfamiliar in quite the same ways as unheimlich would seem to do for Freud.  Nevertheless, the friction between the original and its standard translation does disclose something that might otherwise remain latent in Freud’s idiom, since it underscores the extent to which the question not only of knowing, but of knowing how, of knowing if one can, underwrites the work of the uncanny/unheimlich.  In other words, Strachey’s rending of unheimlich as “uncanny” alludes to the epistemological role that the unheimlich performs in Freud’s text where Freud deployed it—at least in part–in order to finesse the ontological paradoxes that psychoanalysis introduced.

In order to grasp what the uncanny does for Freud, it’s important to remember that from the outset Freud declares himself to have “a special obtuseness” when it comes to his sensitivity to uncanny experiences.  (Similarly, at the beginning of Civilization and its Discontents, he professes ignorance of what Romaine Rolland described as a feeling of “oceanic oneness,” before proceeding to explain it away.)  Indeed, in the essay Freud admits to only 3 uncanny experiences: finding a short story in an English magazine during the war; unwittingly misrecognizing his reflection on a train (although he equivocates as to whether this was truly uncanny or not); and, most tellingly, stumbling into a red-light district in a “provincial town in Italy,” where the first three times he seeks to escape “the painted women … at the windows of the small houses,” he instead returns to the scene of seduction, before at last breaking free from his uncanny promenade.  Apart from these limited instances, the last of which certainly bears more consideration than Freud gives it, Freud represents himself as largely immune to the uncanny, except in its literary or aesthetic manifestations.

Personally, I don’t have this problem.  I’m happy to admit that many of the most important moments in my life have been both uncanny and unheimlich.  To give you another example, when I was diagnosed with Crohn’s disease at the age of 13, I was told I had an autoimmune illness.  Now, as you may know, according to prevailing biomedical theories, autoimmunity is actually uncanny.  Paul Ehrlich, the first person to even entertain the possibility, called it the horror autoxicus, in order to name it as an impossible possibility, which unfortunately is not only all too possible, but increasingly common.  Immunologically speaking, autoimmunity represents what happens when “the self” mistakes itself for another, so that that which should be most heimlich (“the self”) instead becomes unheimlich, often leading to deleterious pathological manifestations, and sometimes even death.  Although it hadn’t been invented yet, it’s almost as if Freud had autoimmunity in mind when he wrote apropos “the double”: “the subject identifies himself with someone else, so that he is in doubt as to which his self is, or substitutes the extraneous self for his own.  In other words, there is a doubling, dividing, and interchanging of the self.”  At the cellular and molecular levels, this characterization of the uncanny pretty closely resembles the ways bioscience has framed autoimmunity ever since Macfarlane Burnett declared immunology the science of “self/not-self discrimination.”  However, since I was an adolescent at the time, my doctors didn’t offer me this scientific explanation, and instead tried to communicate the concept using what they imagined were more heimlich metaphors: first they told me I was rejecting myself; then, that I was allergic to myself; and finally, that I was eating myself alive.  Now that was another fairly unheimlich moment.  Needless to say, after this (in)auspicious start, over the more than four and a half decades that I’ve lived with Crohn’s disease, I’ve become quite familiar with the unheimlich, if not in fact fast friends.

Not surprisingly, then, unlike Freud, I don’t disavow my sensitivities towards the uncanny.  Nor do I disdain the “animistic standpoint,” which Freud believes the uncanny recapitulates, dismissing it as atavistic, primitive, or infantile, that is, as “belonging to the prehistory of the individual or the race.”  Of course, that’s in part because, unlike Freud, who steadfastly held to a “secular” perspective (in “On Lay Analysis,” he refers to analysts as “secular pastoral workers”), I’m more eclectic when it comes to healing.  Hence, I don’t share all the assumptions that underlie Freud’s famous assertion: “[A]n uncanny effect is often and easily produced when the distinction between imagination and reality is effaced, as when something we have hitherto regarded as imaginary appears before us in reality.” Here Freud affirms the bifurcation between imaginary/real as the ontological and epistemological foundation of his thinking.  He embraces the Occidental onto-theology that began with Plato and, while he recognizes that this conceptual opposition has not always and everywhere obtained, he asserts that its emergence constitutes a phylogenic milestone.  Indeed, as a good Enlightenment thinker, he holds that “civilized” humans have—or should have–“surmounted” the confusion between the real and the imaginary, and that they certainly shouldn’t ever imagine that the imagination is real:

We, or our primitive forefathers—once believed that these possibilities were realities, and were convinced that they actually happened.  Nowadays we no longer believe in them, we have surmounted these modes of thought; but we do not feel quite so sure of our new beliefs, and the old ones still exist within us ready to seize upon any confirmation.  As soon as something actually happens in our lives which seems to confirm the old discarded beliefs, we get a feeling of the uncanny….  Conversely, anyone who has completely and finally rid himself of animistic beliefs will be insensible to this type of the uncanny.

No doubt Freud is thinking of his own “special obtuseness” here–this from the man who taught us that psychical reality is real.  Nevertheless, as his text in fact confirms, emphatically employing the first-person plural so that we’re sure to feel included in his argument, our “new beliefs” are actually still beliefs, not facts, and certainly not truths, and therefore as subject to uncertainty as any other.

Be that as it may, we who appreciate the uncanny—or whatever the uncanny gestures towards or tries to contain–we who hold that the uncanny happens in the way that shit happens, or in the way that Derrida says that “deconstruction happens,” might find something uncanny about Freud’s use of the uncanny—uncanny not in the psychoanalytic sense, but in the older etymological sense of “too knowing,” “not quite trustworthy,” “unreliable.”  For, as many readers have noticed, “the uncanny,” as both a concept and an essay, begs as many questions as it answers.  In part, this conceptual instability betrays, I would argue, a contradiction that emerges within Freud’s thinking between his training as a doctor-neurologist and his practice as a psychoanalyst.  Caught between the deterministic causality that defines the “scientificity” of scientific medicine, and the indeterminate, or indeed overdetermined, causalities that psychoanalysis investigates, Freud falters.  “The Uncanny” (as both concept and essay) marks this fault, even as it seeks to rectify it by making it accord with the “reality principle”: “The whole thing is purely an affair of ‘reality-testing,’ a question of the material reality of phenomena.”  To put this another way, the uncanny serves as a supplément—in the Derridean sense—that shores up the bio-logic of scientific medicine for Freud, even as psychoanalytic practice itself suggests that “the material reality of phenomena” do not and cannot exhaust the dimensions of the real.  Thus, the uncanny seeks to uphold the distinction real/imaginary, or in fact presupposes this distinction, even while recognizing not only its instability, but perhaps its untenability.

In saying this, I don’t just want to “deconstruct” Freud’s uncanny, but rather to offer an opening onto that which the uncanny has served as a constant deferral, i.e., the known unknown-that-we-cannot-not-know that psychoanalysis seeks to contain—which may include something like healing.  Indeed, it seems rather uncanny to me, given his therapeutic commitment to ameliorating psychic and physical suffering that medicine could not assuage, not to mention his own long healing ordeal with cancer, that Freud almost never uses the word “healing” in his work, and when he does use it, it never refers to psychoanalysis.  One of the few places Freud even mentions healing occurs in the decidedly pre-psychoanalytic essay “Psychic (or Mental) Healing” (1890) in which he embraces the therapeutic resources afforded by the charged relation between doctor and patient (prefiguring his later theorization of transference) in order to argue for the positive value of hypnosis for medicine.  Needless to say, he soon abandons this position, throwing the baby out with the bathwater, in part because he feared that the association with hypnosis would undermine his credibility as a scientist and a physician.  Healing too easily gives rise to uncanny effects, which is why when it happens in medical contexts it can easily be rendered invisible or dismissed as “merely anecdotal.”  Yet it goes on happening, in both remarkable and unremarked ways.  And, personally speaking, I’d say we’re very lucky that it does.

* * * * *

  1. If I had time I’d take you through some of the key moments in the development of scientific medicine that led to the downgrading of the Vis Medicatrix Naturae during the century preceding Freud’s medical training, including: the French Royal Commission Report of 1784 debunking Mesmerism, which introduced the distinction between “real” and “imaginary” cures; Claude Bernard’s break with the Hippocratic tradition by separating milieu intérieur from milieu extérieur; and Charcot’s attribution of hysterical symptoms to undetectable and yet supposedly real “dynamic lesions”—but unfortunately I don’t, so I won’t. Instead, let me just remind you of the paradox that draws Freud to the entanglement of heimlich/unheimlich as a psychoanalytic doublet in the first place: “Thus heimlich is a word the meaning of which develops in the direction of ambivalence, until it finally coincides with its opposite, unheimlich.” Freud’s interest in heimlich/unheimlich bespeaks his attraction to antithetical concepts, to the tensions sustained by and through ambivalence.  Yet, since such a coincidence of contraries necessarily violates the “laws of logic” which Aristotle first posited (i.e., identity, non-contradiction, and the excluded middle), it must in Freud’s mind manifest the unconscious where such laws do not apply.  Nevertheless, despite the insistence of the unconscious, these laws are “real” for Freud, insofar as they describe the epistemological and ontological conditions for true knowledge.  Hence, in his estimation, the unconscious upsurges of the uncanny return us to a time before we realized the “true nature” of the real, as his characterization of Hoffmann’s literary techniques underscores: “They are a harking-back to particular phases in the evolution of the self-regarding feeling, a regression to a time when the ego had not yet marked itself off sharply from the external world and from other people.” Freud’s assumption here is that we could—or should—be marked off sharply from the world and from other people, since this is the condition of possibility not only for the bourgeois individualism within which Freud operates, but also for the medical epistemology within which he thinks, if not practices. Therefore, in his estimation, when we have (or think we have) uncanny experiences that seem to suggest otherwise, we must in fact be regressing to an infantile or primitive mode of being.

Given my own experiences of illness and healing, I find this interpretation somewhat reductive.  We are never actually separate from the world or from other people, or if we are it’s only in the sense that independence is another form of dependence, as the analyst Adam Phillips admonishes us.  Indeed, such paradoxicality might constitute the very basis for our going-on-living, as the theoretical biologist Francisco Varela suggests when he describes: ‘‘the intriguing paradoxicality proper to an autonomous identity: the living system must distinguish itself from its environment, while at the same time maintaining its coupling; this linkage cannot be detached since it is against this very environment from which the organism arises [that it] comes forth.’’  The paradoxicality of living systems, which includes humans, is proper to us, if for no other reason than as living beings we are all vulnerable (which etymologically just means woundable) and hence moral.  Healing represents the reparative potential that all organisms have conserved since the first cell managed to survive its vulnerability long enough to extend itself in time and space by way of other cells.  In this sense it partakes of another paradox, the paradox that healing is always only partial and temporary, since in the end death comes to us all.

George Canguilhem defines this paradoxical possibility as the very ground of healing: “To learn to heal is to learn to become familiar with the contradiction between today’s hope and the failure that comes at the end–without saying no to today’s hope.”  Or, to put this another way, healing represents what Henri Bergson calls a “tendency.”  It’s not a certainty, not a steady state, not a telos, but a direction in which the elan vital can unfold, even as it composes with other vital tendencies that may run athwart or conflict with it.  Healing therefore calls for support, encouragement, and appreciation, and fortunately when we care about healing it matters.  At some level, certainly at the level of a practitioner, Freud knows this; however, as a theorist and a writer, his commitment to the bio-logics of scientific medicine and of Enlightenment philosophy requires him to contain the perturbations that healing’s indeterminant, or over-determined, causalities entail.  “The uncanny,” then, seems to offer Freud an opportunity to try to have his cake and eat it too.  Yet the trail of crumbs that he leaves behind might allow us to discern some of the uncanny traces of healing on which psychoanalysis probably depends, but that it cannot allow itself to openly acknowledge.  Indeed, in order to appreciate the uncanniness of healing, we might need to recognize something that Freud, given his medical training and his “special obtuseness” could not: i.e., that both healing and the uncanny do happen, and when they do they remind us that despite our fondest beliefs, we are always more than we can know.  Thus, rather than affirming Kant’s motto for the Enlightenment: Sapere Aude: Dare to Know, to which Freud religiously adhered; we might consider a new more, uncanny motto: Curare Aude: Dare to Care.

 

“To learn to heal is to learn to become familiar with the contradiction between today’s hope and the failure that comes at the end.  Without saying no to today’s hope. Is this intelligence or simplicity?”

Georges Canguilhem, “Is a Pedagogy of Healing Possible?” UMBR(a) no. 1 2006. 9-21.  (19)

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