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Fumbling in the Dark

10/08/2015 10:25 AM | Deleted user
In the spring of 2013, Thomas Insel, medical director of the National Institute of Mental Health (NIMH), announced that all grant funding by this, the most important and prestigious mental health research center in the country, would be limited to studies attempting to elucidate the biological basis of mental illness—NIMH was not going to fund any research having to do with the mind or the environmental context of mental activity. The announcement (Belluck & Carey, 2013) was unequivocal: Insel “said in an interview … that his goal was to reshape the direction of psychiatric research to focus on biology, genetics, and neuroscience so that scientists can define disorders by their causes, rather than their symptoms,” as they are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

This announcement was surprising because, in a very real way, the search for biological underpinnings of mental illness had been a complete and utter failure after decades of effort and billions of dollars of expense. In a recent article in the New York Times (Carey, 2014) devoted to Dr. Insel, he says as much himself, “the previous generation of biological research in psychiatry has been largely a disappointment, both in advancing basic science and in improving lives.”

In the article, it is claimed that the “overall impact of this drug revolution on public health has been mixed,” but that could be understood as a euphemism; in fact, there are no biological markers for the overwhelming majority of mental illnesses as a result of the current biological research. No genetic explanations for any of the diseases in the DSM came out of the unraveling of the human genome in the 1990s. No linking of the etiology of a mental disorder and the clinical effects of a biological therapy have been found, such as exists for insulin and diabetes or penicillin and pneumonia.

Of course, psychopharmacology is everywhere, and it has had a positive impact on the reduction of emotional suffering for many people, but, as the journalist Robert Whitaker has pointed out, with the advent of biological psychiatry as the standard of care for the treatment of mental illness, there has also come an exponential growth in the number of people on disability because of mental illness (Whitaker, 2010).The newer, relatively side-effect free antidepressants are so widely used now that trace amounts of Prozac have been found in the drinking water in the United Kingdom (Hurley, 2004), yet the suicide rate remains at least as high as it ever was and continues to change in response to the same variables as always (such as the economy).

So, what made Insel so unequivocal, so certain about the right direction for psychiatric research? Why is it that decades of work would be put into something that was so unproductive, yet still so believed in and hoped for? Why is the research leadership in psychiatry so committed to a focus that has been so unsuccessful? We can give a cynical answer: biological psychiatry has made some people very wealthy. This might answer part of the question, but I don’t think the answer is complete. Even if the ideological discourse of biological psychiatry were less insistent, it could still be a very lucrative enterprise—drugs that make people calm down would be big business anyway. In other words, do we need a theory of the biological origins of mental illness to justify using psychotropic drugs?

This is the question that came into focus from Insel’s announcement last spring. I believe it is a question about seeking knowledge and what drives us to do that—it is a question about desire.

The myth of Cupid and Psyche is ancient and Greek, but our oldest surviving account of it is from the Metamorphoses of Apuleius, a text best known today as The Golden Ass, the only novel of classical antiquity to survive in its entirety (Apuleius lived between 125 and 180 CE) (Kenney, 2004). According to the myth, Psyche was a human princess who was deemed the most beautiful woman in the world. In time, her beauty was praised as greater than that of Venus. This infuriated the goddess of love, who ordered her son, Cupid, to make her fall in love with someone so degraded that she would be humiliated by the match and her beauty would be forgotten.

As it happens, Psyche’s parents, trying to determine who could marry her, are advised by an oracle that she be prepared for “funeral wedlock”—“place the girl on a high mountain, king” (“Montis in excelsi scopulo, rex, siste puellam”).


“No human son-in-law (hope not) is thine,

But something cruel and fierce and serpentine,

That plagues the world as, borne aloft on wings,

With fire and steel it persecutes all things,

That Jove himself, he whom the gods revere,

That Styx’s darkling stream regards with fear.”

(Apuleius, Bk. 4, ll. 33ff.; Kenney, p. 74)


Assuming she was going to her death, Psyche insisted that her parents carry out the oracle’s orders. In part, she realized it was envy that was leading her to this fate, but at the same time, we learn that “for all her striking beauty, [Psyche] had no joy of it” (iv, 32; Kenney p. 73). This is because “everyone feasted their eyes on her, everyone praised her, but no one, king, prince, or even commoner, came as a suitor to ask her in marriage. Though all admired her divine loveliness, they did so merely as one admires a statue finished to perfection”(ibid.) Thus, “Psyche stayed at home an unmarried virgin mourning her abandoned and lonely state, sick in body and mind, hating this beauty of hers which had enchanted the whole world”(ibid.). What was the most beautiful girl in the world to do about this, but to go willingly to her death? She is bitter, but accepts her fate: “Why should I shirk my meeting with him who is born for the ruin of the whole world?”(ibid.).

So it was a great surprise when, left on the hilltop and expecting to be eaten by a monster, Psyche is instead carried by gentle Zephyr to a magical palace. The first night in the palace she was frightened; she “quailed and trembled, dreading, more than any possible harm, the unknown” (V. iv, p. 78). In the night, she was visited by a being she could not see. As it turned out, the unknown wasn’t bad at all. Before he left her, her mysterious lover told her everything she saw was hers and she would be visited nightly by him, but there was one rule: she must never try to see him. For a long time, this arrangement worked for Psyche: by day, she had the run of the palace; at night, she slept with someone she could never see but from whose company she derived pleasure.

To make a long story short, Psyche’s curiosity, provoked by her sisters’ envy, eventually got the best of her—after all, she had been told by the oracle that her lover would be something monstrous and why wouldn’t she want to verify this was not the case? One night, while he slept, she lit a lamp and saw that he was none other than Cupid, Desire himself. When he awoke and realized Psyche had seen him, he fled, angry at her for how foolish she had been. “Simple-minded” (V. xxiv, p. 89) is what he called her. Psyche was crushed.

We will finish the story later.

The myth of Cupid and Psyche is focused around a very specific problem: the nature of desire. In each part of the myth, a different facet of this problem is presented. In the beginning, there is the growing adoration of Psyche, which ends up being a source of heartbreak for the princess and her parents. Then there is the oracle’s prophecy, telling Psyche’s parents that her only partner would be something inhuman—a monster who “persecutes all things” and whom even Jove feared. There is also the discovery of Psyche’s unhappiness—she is so beautiful, so perfect in the eyes of those around her that no one feels competent to woo her—she is no more approached than a leper would be, and she is miserable as a result. Finally, there is the mystery of the castle and Psyche’s lover, whom she can never see, but only encounter by fumbling in the dark.

It was the importance of the element of darkness and the unknown that struck me. Apuleius writes how Psyche dreaded the unknown more than any possible harm. Walking in a procession to the hilltop where she expected to be devoured by a monster, she was bitter, but not afraid. We do not see her frightened until she is in a place where she does not know what to expect, even though things are working out better than she had expected. Her desire is for knowledge—even when everything is going well for her and even though her lover insists nothing good will come of her trying to see him.

The motif of fumbling in the dark, I was interested to learn, is a significant one in myth. In Hindu Vedic literature, the story of King Pururavas and the Apsara (a kind of demigod), Urvashi (Masson-Oursel & Morin, 1968). Most of the details of the story are different from the Psyche myth, but one element is similar: the female, Urvashi, was forbidden to see the king naked and when she did, the relationship was brought to a sudden end. This myth also is resolved in a way very similar to the myth of Psyche—which I will get to later. The other myth I will mention only briefly is the story of Jacob wrestling the angel. Jacob had, up to this moment in his story, been sneaking his way around his older brother Esau and his father Isaac, trying to get as much power and wealth as he could until, feeling guilty about all this, he tried to make peace with his brother. When night fell, Genesis tells us (Genesis, 32:22–32),  Jacob, alone, finds himself fighting with something totally mysterious that he cannot identify or name, but from which he demands a blessing before he will let go.

In all three of these stories, there is a similar detail: the inability of the subject of the myth—Psyche, Urvashi, and Jacob—to see the object of his or her desire combined with a wish for knowledge. These characters are not just in the dark, they are in the dark trying to find something related to their desire. For Psyche and Urvashi, the desire is to know/see their lover; for Jacob, it is to receive a blessing from the mysterious stranger.

For the anthropologist Claude Levi-Strauss, recurrent elements in myth, like Psyche and Jacob’s encounters with someone they cannot see, are central to an understanding of how myth works (Levi-Strauss, 1963). These elements “provide a logical model capable of overcoming a contradiction” (1963, p. 229) in thinking about the problem the myth is addressing. These are the building blocks of myth, the elements that point to the underlying concerns that led to the construction of the myth in the first place. And it is important to note that those concerns are not entirely consistent with what we would today call science, at least, in some ways of thinking about science. The point is not to explain desire in this case, but to clarify how it is problematic. Thus, the myth of Cupid and Psyche is not some primitive attempt to explain why desire happens; rather, it is a marker of something that cannot be reduced to a simpler explanation.

And that is a description that fits desire well. As it is worked out in human life, desire often seems to make no sense. In the Psyche myth, the most desirable person in the world finds herself completely alone. In the account of the myth we have, the oracle’s description of her lover suggests a fearsome monster. The fact that this monster turns out to be Desire himself, as he is described in the text, is ironic and unexpected but does not change the fact that he is a monster, that he is feared by the gods. In both the Greco-Roman and Hindu myths, the knowledge of the desired object is actually forbidden; in the Hebrew myth, Jacob doesn’t even know what he is doing and his unknown antagonist finally causes him an irresolvable groin injury (he will have a crooked gait the rest of his life from it).

It would not be hard to come to the conclusion that nothing is worse than desire itself. It causes no end of trouble, even though satisfying desire is what we are all trying to do, all the time. And, the myths suggest, we are always fumbling in the dark when we are doing it.

The fumbling happens because there is something missing, something we cannot see or grasp. We can never say exactly what it is that we desire. We do not know beforehand exactly what it is that we want, and even when we get something that seems to be our dream, we are still not so satisfied.

In the opening speech of Shakespeare’s Twelfth Night (Shakespeare, 1993),  Orsino interrupts his praise of the music he is hearing, music that he associates with his love for the countess Olivia, after only 6 lines:

“Enough; no more./ Tis not so sweet now as it was before.

O spirit of love, how quick and fresh art thou,

That, not withstanding thy capacity

Receiveth as the sea, naught enters there,

Of what validity and pitch soe’er,

But falls into abatement and low price

Even in a minute.”

(1.1. 7–14)


No desire can be satisfied—nothing can be enough. As soon as a satisfaction is touched on, it is over. Orsino ends this speech, “So full of shapes is fancy/That it alone is high fantastical” (Shakespeare, 1993). It is only the pursuit of new fancies, new desires, that moves the human subject. How crazy is this?

Psyche, when she is still in the dark, would seem to be doing a whole lot better than she had any reason to expect before she got there, yet, like Orsino, she cannot be satisfied with the satisfaction of any desire: she must move on to the next thing.

So, if desire is so important to our psyches, what role does it play in psychological medicine? Can it be reduced to the product of certain biological processes? In the age of neuroscience, is it less problematic than in the age of Apuleius?

Throughout my years at the medical center where I trained and worked, I had always been aware of concerns about the placebo effect in antidepressants, especially the type that came on the market for the first time while I was doing my internship—the serotonin reuptake inhibitors, or SSRIs. It seemed very likely to me that, at least some of the time, the benefit of the medications was the result of something that could be called suggestion. For example, the fact that a doctor was prescribing a medication for one’s mood could, in itself, relieve some people: they felt bad because they had a disease, not because they were “bad” in whatever way they felt themselves to be so, and they knew they had a disease because a doctor had given them a pill for it.

But during the more than two years I worked at a student health center, my skepticism mushroomed. I could prescribe the same antidepressant to different people on the same day, for the same symptoms, and inevitably get radically different responses from each person. This was most striking in this context, I believe, because the population I was working with was relatively homogeneous: all were in their late teens to mid-twenties; all were ambitious; most came from fairly prosperous middle-class backgrounds; there were few cultural differences to take into account; nobody was trying to get disability; and so forth. But after the first dose, while one person would declare that the antidepressant had changed his or her life, another would insist that he or she would never take that medicine again, though both of these people had presented with the same symptoms at roughly the same time. Most people were somewhere between these extremes, but no matter how similar their stories, symptoms, or treatments, no two had the same treatment response. I found it very hard to believe that I was doing anything more significant than distributing snake oil.

Shortly before I left this job, I found myself wondering about this problem in a different way: was there was anything that serotonin reuptake inhibitors do that could be described as consistent across patients? Was there any reason to think these were not just placebos and bromides?

To my surprise, I found that there were some things these drugs did fairly consistently. First, I noticed that anyone who said they cried when they were depressed reported that they stopped crying when they took an SSRI. What was noteworthy was how people responded to this fact: some were relieved that they weren’t crying anymore, while others stopped taking the medication because it prevented them from shedding tears. And then there was the one person who cried only when she talked about how wonderful Prozac was because before she started taking it she cried all the time.

But there was another effect of SSRIs that was truly universal and not at all dependent on the patient’s symptoms: the loss of interest in sex. Again, I had seen this side effect before, but now I was working with a population of young, physically healthy people and every one of them who took one of these medications noted the loss of libido. For some, that was a deal-breaker, they preferred feeling depressed; for others, it was just the price they had to pay.

What I believe I learned from these observations was that loss of libido and of emotional intensity were not side effects of the medication: dampening energetic investment was how the SSRIs worked. In other words, even though the effect was a biological one—the manipulation of serotonin levels in the brain to decrease emotional intensity—this wasn’t really a disease-specific effect, as one would see with antibiotics for bacterial infections or insulin for diabetes. Instead, the effect of taking these antidepressants was to blunt the expression of libido, with the consequence that they sometimes (often) palliated symptoms. A more proper analogy for how they worked, it seemed to me, would be the predictable effects of drinking alcohol. The biological effect of alcohol would be to disinhibit the drinker, which might make it easier for one person to talk to strangers but might make somebody else look for a fight and somebody else take a nap.

What is of secondary importance for our discussion, but what excited me the most about all this at the time, was the way it supported Freud’s understanding of what a neurotic symptom is: a substitute for sexual satisfaction. This seemed clear to me from the way that both libido and the symptom of depression or anxiety were removed by the use of the drug. As it happens, a few years after I left the student health service, a French psychiatrist and analyst, Gerard Pommier, published a book on “how neuroscience demonstrates psychoanalysis” (Pommier, 2004). The relation of SSRIs to libido was one example of that demonstration.

After all, the discovery that there was some connection between serotonin and mood was made entirely by accident and not in an obviously psychiatric context. It happened when a new drug for tuberculosis (TB) was studied at an asylum for TB patients and it was observed that the patients were less emotionally upset while taking this drug than any of the others. When the drug was analyzed for its chemical effects, it was found that this particular anti-TB drug, Iproniazid, enhanced serotonin levels in the blood (Lopez-Munoz and Alamo, p.1566). But those who responded to the drug were not an obviously psychiatric patient population. They were unhappy for a reason, as we say—diagnosed with tuberculosis, they had been forced to leave their homes and take up residence in a treatment center with other sufferers so that they wouldn’t infect others with the disease. Nobody, at that point, would have argued that there was a biological basis for their low moods; they were just in a bad place. Similarly, the first antipsychotic medicines were just anesthetic agents, major tranquilizers, which had the effect of calming down severely agitated people. There was no necessary relation between the effects of these drugs and assumptions about the fundamentally biological basis of psychotic agitation. How did psychiatry get from these rudimentary observations about the effects of some drugs on some emotional states to the NIMH’s decision to only fund research into the biological origins of psychopathology?

In the first session of a teaching seminar he gave in 1967–1968 (Lacan, 1967–1968), Jacques Lacan asked the same question of a famous experiment in behavioral science—Pavlov’s work with classical conditioning. Pavlov tested the hypothesis that one could induce physical reactions in animals by conditioned responses to artificial stimuli, as opposed to the natural responses to appropriate stimuli. Most famously, he linked the sounding of a trumpet to the presentation of food, then, after a certain number of repetitions, he sounded the trumpet without presenting the food. As is well known, the animals responded to the sound of the trumpet at this point in the same way they would have responded to the presentation of food—by generating an increase in the secretion of gastric juices. Pavlov was able to observe this because he had surgically created a gastric fistula in the animal, allowing him to measure the secretions.

Lacan’s view of this experiment is that it involves a certain sleight of hand. As with the examples of biological psychiatry mentioned above, Pavlov’s experiments suggest that there is something “in the brain” (1967–1968, 15 November, 1967) of the animal in the experiment that leads to the outcome. But this completely overlooks the fact that, if someone had not wanted to do the experiment, it would never have happened. There is nothing natural about what Pavlov did here. In the words of the psychoanalyst Alan Rowan, “what is silently eliminated from this experiment is the prior act of the experimenter who … actively introduces the very sign that he or she wants, indeed obliges the animal to respond to” (Rowan, 2012). In other words, what is left out of the experiment is the fact that a subject, Pavlov, is essentially forcing an outcome in a study that could never occur in nature and for which there could be no earthly use, except for the experimenter’s desire.

The value of Lacan’s discussion of Pavlov is that he points out that there is a subject who desires to push things in a certain direction. This is equally true for the examples of psychopharmacology I mention above. There was, and is, nothing in the evidence for the drugs that increases the amount of serotonin in the bloodstream to necessitate a claim that the symptoms of depression a patient experiences are due to a chemical imbalance, even if that correlation is empirically valid. The same can be said of the relation between dopamine blockades and psychosis. It is only the desire of the researchers to put things together in this way that results in this line of research being the most used. As one recent critic of this kind of scientific assumption notes, referencing the 19th century German philosopher Schelling, empiricism is flawed from the beginning because it fails to take seriously the fact that the things it observes require an observer (White, 2013).

Thus, I must insist, desire is alive and well, if not in the depressed patient on Prozac, certainly in the psychiatric researcher who is developing models of mental illness and health. The only problem with this is that it is, after all, another example of fumbling in the dark, but unlike Psyche, in this case, the desiring subject is often unaware of the darkness.

Consider the case of one of the most famous descriptive psychiatrists, Emil Kraepelin. Kraepelin once told his students not to indulge in “the poetic interpretation of the patient’s mental process, [which] we call empathy. Trying to understand another human being’s emotional life is fraught with potential error…. It can lead to gross self-deception in research” (Kraepelin, 1992). He practiced what he preached his entire career. As a young researcher, he decided to study the behavior of the insane in an asylum for the chronically institutionalized in Estonia. It was as a consequence of this that he developed his theory of mental illness, wherein he set out to determine the course of illness for the psychiatric disorders he studied. According to one source, he chose this country for his research because he did not speak the local language and would be less prone to poetic interpretations (Greenberg, 2013). But even if he had spoken the language, the decision to study the outcome of a disease from people who are already chronically institutionalized is surely worth commenting on. Again, as in the case of Pavlov, what is left out of these decisions is “the prior act,” in Rowan’s words, of a subject’s choice, in this case, to eliminate any consideration of empathy or even verbal meaning in studying psychopathology.

Or consider the creation of the DSM-III, as described by Christopher Lane, from his review of the written record (Lane, 2007). It was absolutely central to the psychiatrists working on this text that psychiatric diagnoses be based on a listing of symptoms, which would be both unambiguous and clearly demarcated from normalcy. Again, this speaks more to the desire of the researcher than to anything that occurs in the nature of psychiatric difficulties. It assumes that such a clear demarcation exists and that it can be found, even if that basis, decades on, remains as elusive as the holy grail.

Both these examples stand in marked contrast to another fumbler in the dark of the psyche—Freud. Unlike Kraepelin and the creators of the DSM-III, Freud made the question of desire central to his own theory of mental illness. In fact, his own desires were a major focus of his first great book, The Interpretation of Dreams, a book described by at least one scholar as the first great autobiography of modernity (Davis, 1990). I would also point out that Freud was, in at least one sense, far more attentive to empirical reality than any of the other researchers I have mentioned here and, arguably, more than many analysts after him. He was acutely aware of the fact that he was fumbling in the dark and reminds us of this fact again and again in his work.

But whether we are talking about Kraepelin or the DSM or Freud, there is no question that there is an active desire in play, a fact, as Lacan notes in his discussion of Pavlov, “that is not… the first thing that foolish people may think about”(Lacan 1967-68, 15 November 1967) when looking at the results of all this research. “Foolish people” brings to mind—at least to my mind—“simple-minded” Psyche. Let’s finish the story.

Because of the oracle and her sisters’ gossip, Psyche had anticipated that her lover would be a horrible monster and so had planned to kill him. She is so surprised by what she finds when she does see him that she cuts her finger on one of Cupid’s arrows and spills oil from her lamp on his shoulder. He wakes up and discovers her disobedience only after he feels the burn of the oil. As Apuleius tells it, the agent of vision, the lamp that allows Psyche to see her lover, is also the agent of betrayal.

Cupid flies away immediately, but Psyche is able to hold on to him for a little while before her strength gives out. When she has fallen, he explains what has happened: after Venus told him to humiliate Psyche, he fell in love with her on sight. Disobeying his mother, he arranged that he could have Psyche as his wife; therefore, out of his mother’s hair with nobody the wiser. This is why it was so important for Psyche to not know who he was. Saying farewell, he told her that her only punishment would be his absence.

It will be noted that, up to this point in the story, nothing Psyche does could be called wise. Nothing that happens in the rest of the story will change this state of affairs. Psyche tries to kill herself several times out of regret and longing, but her beauty saves her because everything with which she tries to kill herself is struck by her beauty. Learning that Venus is trying to find her, she actually surrenders to her mother-in-law, who gives her impossible tasks to perform. Two more suicide attempts and help from gods, ants, water, a rock, an eagle, and a tower ensue. Finally, she performs the last of the tasks she has been given, to bring back from the underworld Prosperine’s divine beauty in a box.

Throughout these tasks, we could say that the only attribute Psyche brings to her adventures is her desire and the fact that everybody and everything that encounters her, except her mother-in-law, finds her eminently attractive. At the very end of her very last task—bringing the boxed beauty of Prosperine back to Venus, a box she has been told she must never open—she tells herself, “What a fool I am, to be carrying divine beauty and not to help myself even to a tiny bit of it, so as perhaps to please my beautiful lover.”(Kenney, p. 104) She opens the box, which does not reveal a goddess’ beauty to her, only a deep sleep. Even to the end, Psyche’s curiosity is her undoing.

My point is not that she should be smarter. Rather, the story conveys how the mind—the psyche—really works. It is driven to satisfy desire, not to achieve a normative state of health or a state of greater insight or understanding, whatever that may be. This is the case even as desire continues to not be capable of achieving satisfaction.  This is not just how Apuleius sees things—it is how psychoanalysis came to be as well.

I have already mentioned how Freud’s desire was so important to his own research. The analyst Colette Soler has observed that “Freud would not have invented psychoanalysis without the gracious cooperation of hysterics” (Soler, 2006). It was the efforts of hysterical patients to come to terms with desire that led Freud to psychoanalysis. The myth of Psyche is also the myth of the hysteric, who is always trying to bring desire into focus, to determine what it is that her lover desires and to bring her own desire to a state of rest. But her efforts in this direction create problem after problem. This is true to experience: the only way we can produce something really new is by fumbling, like Psyche and Anna O., in the dark.

In the story, Psyche does succeed in making something happen. After she has fallen asleep, Cupid, who never stopped pining for her, appears to wake her up from the sleep induced by Proserpine’s box. He has been convalescing at his mother’s from the burn from the lamp oil, but has resolved to disobey Venus and take back his wife. To achieve this, he does the only reasonable thing: he asks Jove to make Psyche a goddess. This is a great resolution to the problem of desire and knowledge because now Psyche is immortal and is spared the dialectical struggles of mere mortals. Jove agrees and everything ends happily; even Venus is nice. In the end, Psyche has a child by Cupid named Voluptas, Pleasure.

In the myth, Psyche’s searches do not end until she is taken out of the realm of human discourse, when she becomes a god. Since neither psychoanalysis nor Prozac nor Haldol (or CBT or EMDR or resilience training or whatever) can raise us above the level of discourse—that is, since none of these can make us gods—it is at least arguable that enriching the discourse is a more valid goal than trying to bring it to whatever we might define as a satisfactory conclusion.

Another way to say this is, desire can never be pre-empted by data and stories are at least as important as neurotransmitters. In fact, whatever discoveries neuroscientists make in carrying out the NIMH’s mandate in the coming years, they will certainly be caught up in stories in a way that stories are not caught up in scientific findings. In a very real way, it is the mind—the psyche—that creates the world and not the other way around.



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