21 Nov The Weariness of the self – A sociohistorical Perspective on Depression
Den 29. oktober 2010 afholdt den franske sociolog og forfatter Alain Ehrenberg en forelæsning i Den Femte Salon . Omdrejningspunktet var depression, og hvordan og hvorfor depression har gjort sig gældende som vor tids vigtigste psykiske problem.
Turbulens.net bringer i samarbejde med DPU Ehrenbergs engelske manuskript fra forelæsningen.
In the nineteen forties, depression was mainly a syndrome recognizable in most mental illnesses, and society paid it no particular attention. In the 1970, during a conference hold in New York, psychiatrists claimed, statistics in hand, that depression was the most widespread mental disorder in the world. Psychoanalysts and other psychological practitioners noted a significant increase of depressed people among their patients. Today, this disorder has captured the attention of psychiatry, just as psychosis did fifty years ago. This is the medical success of depression. But it has also recently captured a huge social attention. Depression has been transformed into a practical tool for defining various kinds of unhappiness and alleviating them by multiple means. This is the social success of depression.
The aim of this speech is to explain this double success, the medical one being embedded in the social.
Hypothesis and Approach of the Issues of Depression
The invention of antidepressants counts a lot in this history. It has given to psychiatrist and, above all, to general practitioners the pharmacological means to treat the problem. These fascinating medicines are effective on such a variety of symptoms that some pharmacologists contested the label “antidepressant”. Contrary to minor tranquillizers, which often have been considered as anti symptomatic medicines, antidepressants have always been highly valued by psychiatrists. Nevertheless, sociological conditions were necessary for depression to occupy a central position not only in medicine, but also in psychoanalysis, in the world of psychotherapies and, more generally, in society.
I also have to underscore two points about “sociological conditions”. First, I don’t approach depression as one of the social constructs sociology invents regularly to explain domination, power, etc., since the social sciences have adopted what Francis Zimmerman, a French anthropologist, called the “mourning paradigm“F. Zimmerman, “The Love-Lorn Consuptive: South Asian Ethnography and the Psychosomatic Paradigm”, Anthropology and Medicine, 7, 1991. in an article published in 1991. Second, depression has to be considered not as a personal unhappiness caused by modern society, and notably by a slackening of social links, but as belonging to an attitude, a general mindset, which permeates increasing numbers social practices in a society where values of autonomy have been generalized―I’ll discuss this point in the fourth and last part of this talk.
Depression certainly is a public health issue, because it is a disabling and costly illness. But it also has an anthropological interest. By anthropological interest, I mean that its medical and social success is linked to a global change in the representation man has of himself. In their famous Saturn and Melancholia, Klibanski, Panovski, and Saxl wrote that the history of melancholy overlaps with the history of modern sensibility. Why? Because melancholy is an exacerbation of self-consciousness of an individual, who is the owner and the responsible of himself. In the 16th century, it was considered as the elective sickness of the exceptional man―from genius to noblemen. “My joy is melancholy,” said Leonardo di Vinci. In the 19th century, during the Romantic Era, melancholy was at the crossroads of creation or genius and unreason. It is now the situation of everyone, because contemporary individualism consists of having democratized the idea that anybody could be exceptional. Depression is a pathology of greatness, this is the point, and this is why I have organized my book to answer two intertwined questions: Firstly, how has depression imposed itself as our main form of personal unhappiness? Secondly, to what extent and in what way does depression reveal the transformations of individuality or society at the end of the 20th century?
The twofold medical and social success of depression has accompanied the anchoring of new social ideals for action which were instituted during the last three or four decades of the twentieth century. That is, the progressive shift of a society based on discipline, mechanical obedience, to one which refers to autonomy, that is, personal choice and individual initiative. Depression is the main clinical entity, which has led us to a new language game, that is, to a means of expressing problems, conflicts, and dilemmas, which have accompanied this process of generalization of the values of autonomy which now permeates the whole of social life. If neurosis, according to Freud, is an illness of guilt, depression appears as an illness of responsibility, one where guilt expresses itself in terms of insufficiency.
Before presenting what I consider to be the two ages of contemporary depression, I will quickly mention the two contrasting concepts of the two founders of the notion of neurosis at the end of the nineteenth century, the Austrian Sigmund Freud and the Frenchman Pierre Janet, one of his main opponent. Freud bases his approach on guilt and conflict, and Janet to insufficiency. I have used this contrast as a framework to explain the shift from neurosis to depression.
Freud considers neurosis from the perspective of conflict: unconscious guilt arising from repressed psychic conflict coming from the infancy of the subject characterizes the psychoneurosis of defense. Janet refers to a deficit or, more precisely, to an insufficiency, a weakness he called depressive: the difficulty to act is the fundamental disorder. Whereas the neurotic for Freud is the subject of his own conflicts, for the logical reason that the patient is simultaneously the agent of his own change (the patients does the work), this is not the case with Janet’s concept. In terms of philosophy of action, the patient is the principal agent for Freud, and the immediate agent for Janet.
This implies a different idea of recovery. For Freud, there is a truth for the subject himself in neurotic symptoms and recovery is the freedom “to decide for this or for that”, as he wrote in “The Ego and the Id” in 1923. For Janet, the goal is to make the traumatizing recollection, which causes the illness, disappear from the memory, as if it had never happened. Janet’s idea is a “mental disinfection”. It is the doctor who does the work. He is the principal agent of the recovery of the patient.
Since the invention of electroshock therapy in 1938, I have distinguished two periods in the contemporary history of depression. From the nineteen-forties to the beginning of the seventies, there were complementarities between the two models of illness, and depression was considered a subfield of neurosis. The disconnection between the two models during the seventies and the autonomization of the depression disorder has led to the domination of the insufficiency model over the guilt model, and neurosis has been embedded in depression.
Depression as a subfield of neurosis
The contemporary history of depression doesn’t start with the invention of antidepressants in 1957, but with electroshock therapy in 1938. Why? Because this technical innovation gave birth to a type of controversy which gave a certain form to depression which lasted until the seventies. Those controversies emerged in a social context where families had to be respectable, individuals disciplined, and ambitions modest. In the offices of general practitioners, the complaints expressed seem numerous, according to what I have read in psychiatric articles published during the thirties and the forties, but patient’s ills were often considered as imaginary, as simulators or individuals observing themselves too much. In other words, they weren’t taken seriously. In such a context, the problem for psychiatrists was to make those complaints recognizable to doctors as genuine pathologies.
The central controversy was about the role and place of affect or mood in the diagnosis of non-melancholic depressions. Keep in mind that melancholic depression was a psychosis characterized by a delirium of guilt, and it is on this type of depression that electroshock therapy has been acting with efficacy. To “situate” mood was the pivotal issue, because it conditionned the choice of therapy.
In the French context, psychiatrists believed it wasn’t possible to treat the affective part of the disorder without understanding the place of the conflicts to which the patient is subjected. This was the consensus, which included the most organicist psychiatrists.
The diagnostic question was: to which underlying pathology must the depressive disorder be linked? The answer implies focusing on the etiology and pathogenesis of the illness, on its motive and its causal mechanism. During that period, depression was generally considered not as a clinical entity, but as a crossroads entity that one could find both in neurosis and psychosis, which were considered genuine pathologies.
Around the concept of “personality”, a tripartition was formed which dominated the nosography and the diagnosis of depression until the end of the seventies: endogenic depression, exogenic depression, psychogenic depression ― in the American context, the two latter types of depression were often assimilated with each other. Globally, there were two contrasting models, the specific and the non specific. The first one is the melancholic-electroshock model: electroshock therapy is specifically for a sharply delineated illness. The second is non-specific: electroshock therapy has a positive, though less effective, effect on any depression, notably neurotic. This debate continued with the invention of antidepressants at the end of the fifties, in the niche of controversies elaborated during the forties. For instance, it is striking at reading two articles published in 1970 in the same book by the two discoverers of antidepressants.In F. J. Ayd and B. Blackwell (eds), Discoveries in Biological Psychiatry, Philadelphia, Lippincot, 1970.
For the Swiss Roland Kuhn, the antidepressant is mainly effective on endogenic depression, which is caused by biological factors; for the American Nathan Kline, it’s effective on every type of depression, because they all have a biological substrate. Kuhn thinks he has discovered a specific therapy, and Kline a non-specific, “a psychic energizer”N. Kline, From Sad to Glad, New York, Ballantine Book, 1974.
, as he put it.
In the second period of the history of depression, Kline’s vision of depression would predominate over Kuhn’s one.
On the social level, a new horizon appeared during the fifties in Europe: freedom for everyone to have a genuine private life with the establishment of well-being as a highly political value. Economic growth, the development of the welfare state, changes in educational systems, new possibilities of social mobility, transformations of the family, housing policies (which increased space for intimacy), etc., all of these elements had a decisive consequence: they triggered a collective process of material and moral emancipation where constraints were reduced to the benefit of freedom of choice and decent private life for everyone. The possibility of having a more individual life increased, and attention to privacy was modified.
The main therapeutic strategy of that period was the following: by acting on depressive syndromes, the molecule prepared the patients to address their own psychic conflicts. For instance, in France you could find papers by psychoanalysts stating that antidepressant use is necessary in cases of heavy obsessional neurosis (OCD), because the reduction of the symptoms allows the patients to undertake a talk therapy. Antidepressants were relational substances. They were a part of a general shift of attention among physicians to emotions, feelings, affect, and psychic conflicts. Even at the end of the fifties, magazines and popular books reassured readers: depression was not a mental illness ―a psychosis―, it could happen to anyone, included healthy people. For instance, Pierre Daninos, one of the most famous French humorists in the sixties, published a book on his own depression in 1965, and Elle, the famous French weekly magazine, published excerpts of the book in six consecutive issues. These mediations stopped people from feeling guilty about being interested in their personal problems. How? By giving common labels to what everybody is personally susceptible to feeling indistinctly. All these elements contributed to giving a social place to psychic life. To recover, including with a medicine, it is indispensable for the patient to think about it. He must not be reduced to an object of his illness, an immediate agent; he must be the subject of his conflicts, a principal agent: he was living the modern adventure of individual guilt
Note that the discovery of antidepressants led medical doctors to pay a new attention to emotions and psychic conflicts. In the first period of modern depression, antidepressants stimulated their listening to their patients.
Yet, a diagnostic problem, largely undermined in psychiatric literature as in articles for general practitioners, led to the decline of this approach: the problem was that endogenic depression can resemble neurotic depression, especially for the untrained eyes of general practitioners. As Jacques Lacan, the most famous French psychoanalyst, put it in 1962, “Anxiety doesn’t mislead”. Depression is exactly the contrary: it’s the misleading illness. The heterogeneity of symptoms and thus the difficulty of diagnosing depression was a common preoccupation among psychiatrists, notably because they thought general practitioners were unable to recognize it. And during the 1960s, psychiatrists invented the notion of “hidden depression” to help GP’s make better diagnoses.
The autonomization of the depressive syndrome
In discussions among psychiatrists, the type of depression under discussion was neurotic depression, the most widespread one. Neurosis was the key word: psychic conflict manifested itself in depressive symptoms, and it was this conflict that was the object of the therapeutic action.
Two main solutions were adopted to make diagnoses more coherent. In a totally different ways, each one has contributed to the decline of neurosis. The first solution was centered on the notion of the depressive personality: the depressive symptom is not a symptom of neurosis, but of a narcissistic pathology in which either the patient is unable to bring his conflicts to consciousness, or, if he is able to do this, it doesn’t help him to heal ―an old and recurrent issue in psychoanalysis about the reasons of therapeutic resistance. The patient feels empty, fragile, and has difficulties bearing frustrations, hence, his tendency toward compulsive behaviors and sensation seeking, which attenuates the conflicts. The individual is subjected to a feeling of insufficiency.
The second solution eliminates the notion of personality and of the clinical skill of the psychiatrist for diagnosis, thanks to the use of a model of syndromic cutting up: since psychiatrists couldn’t reach consensus on causes and, consequently, on underlying pathologies, the solution was to get rid of the etiological problem. That is, to get rid of the question: to which underlying pathology does a set of symptoms belong? The technical means consisted of the elaboration of standardized diagnosis criteria, which described the symptoms clearly, and thus could be accurate guides for the diagnosis of depression. This is the famous DSM, the Diagnosis and Statistical Manual for Mental Disorders, the third version of which was elaborated by American psychiatry during the seventies and published in 1980. The medical aspect was intended to treat a patient who no longer needed to tackle his conflicts to be treated pharmacologically. The consequence: neurosis as a category became pointless. Its decline has been facilitated by a new question: which antidepressant should the doctor prescribe for which type of depression? This question was also engendered by the growing diversity of antidepressants after 1975, when new molecules which were less toxic and easier to handle for general practitioners were launched. Psychiatric papers started advising psychiatrists and GP’s less and less to look for the underlying pathology of depressive symptoms, that is, to look for what affects an individual in so far as he is more than a body. The figures of conflicts declined to the benefit of figures which pose deficit or insufficiency as the problem, and well-being as a the solution. Therapy was conceived of in a similar way to Pierre Janet’s idea of the mental disinfection.
In the medical version , the insufficient individual is no longer the principal agent of his healing; he is reduced to the proper status of patient, the status of immediate agent of his illness. Depressed people don’t need to address their own conflicts anymore. In the psychoanalytical version, the patient doesn’t succeed in being the subject of his conflicts, because he suffers from “flaws of the Ego”, from narcissistic deficiencies or borderline pathologies.
This transformation of the notion of depression occurred in a context of normative and value changes, which became obvious during the sixties. Traditional rules of framing individual behaviors were no longer accepted, and the right to choose the life one wanted to live started entering mores. Following a substantial amelioration of material conditions in Europe and in the US, there were simultaneously new opportunities for social mobility for the working class and a new attention to oneself promoted everywhere in society and which is now our commonsense. The perception of intimacy was changing: the idea that everybody could escape from his destiny or social origins, could make his way on his own, and become someone by himself was democratizing and becoming our supreme value. Hence, of course, new hopes, but also new worries.
This period was characterized by a dynamic whose two facets were: psychic liberation (that is, hopes) and personal insecurity (that is, worries). In the foreground, the emancipation of mores was taking off. For instance, in 1966, the techniques the American essayist Philip Rieff called “releasing therapies”P. Rieff, The Triumph of Therapeutic. Use of Faith after Freud, Chicago, London, University of Chicago Press, 1966, paperback with a new preface1987. offered practical means for building one’s own path in life, independent of any constraint and personal price. New therapies (Primal Scream, The Human Potential Movement, etc.) engendered the feeling that anyone could master a life of choices without having to pay the price: therapists used a deficit model to increase human potential; their ideal was an individual without any conflict. In the background, numerous psychoanalysts and psychotherapists worried about narcissistic-type mental pathologies which seemed much more numerous than before. Their patients were dominated by personal insecurity and feelings of having lost their self-esteem. Psychoanalysts insisted on a neo-traumatology where problematics centered on desire lost ground to problematics centered on object loss and subjective identity (narcissistic pathology and/or borderlines). It seems it is less desire which was at stake, than a need for being, expressing itself through permanent insecurity. The new typical patient no longer seemed to be neurotic. Actually, this decline of neurosis was widely discussed, notably in France: for instance, Daniel Wildlöcher, who recently was president the International Psychoanalytic Association, wrote in 1975 that hysterics mostly presented symptoms of depression, fatigue, and pain, and they non longer went on to psychoanalyst’s couch, but to the GP’s or neurologist’s offices. But today, the issue of narcissism is clearly a strong preoccupation among psychoanalysts who deem that most patients are subjected to such neurosis.
Parallel to this increasing preoccupation with depression, was a parallel increase preoccupation with addiction. Clinicians emphasized the auto-therapeutic use of drugs or addictive behaviors. Addictive intake seemed to be the other side of the depressive void. Instead of having symptoms, the patient attenuates conflicts through compulsive behaviors (addiction) and impulsive behaviors, with violent or suicidal acting out.
To summarize , the decline of reference to neurosis overlaps with the decline of a form of a social life, which used to express itself in terms of subjection to discipline and of supposedly cut and dry conflicts. Depression, whose main trait is the loss of self-esteem, can be considered as a pathology of greatness: instead of the old bourgeois guilt and the conflict between what is allowed and what is forbidden (Œdipus), there was now the fear of not living up to ones own ideals and the impotence resulting from that fear (Narcissus). Then, depression is part of the democratization of the exceptional, of this quest to be only oneself, which is the primary vector of the redefinition of contemporary individuality.
If personal choice is the first vector, the second one is the rise of personal initiative norms and values, which has developed since 1980 circa, notably in the workplace. At the same time, psychiatrists were giving more and more credence to the idea that the fundamental disorder of depression was inhibition, which has become the cardinal concept of depression. It doesn’t mean people are more inhibited today than yesterday, but that inhibition is more visible and more disabling in a society of generalized autonomy than in a society of mechanical discipline.
It is in this context that a new class of medicines was launched on the market: ISSR, of which Prozac is the first kind. In raising hopes of getting over any type of psychic suffering, whether one is sick or not, the new class of antidepressants personifies, rightly or wrongly, the unlimited possibility of manufacturing ones own mind without the dangers of illegal drugs. Previous kinds of antidepressants couldn’t help with that task. In a pill-taking society, no one would be able to distinguish between therapeutic goals and performing goals.
Two remarks . First, at the time when these new medicines were put on the market, depression was redefined as a recurring and chronic illness, and psychiatrists estimated most patients didn’t recover completely. During the sixties, psychiatrists used to say that recovery was quite certain. There is no mystery here, because it is the definition of depression itself that has been enlarged: the main reason for this transformation of a curable illness into a chronic one resulted from the integration of neurosis, a notable long-term illness, into depression. The notion of dysthymia, which designates this type of depression, has replaced the notion of neurosis, and is treatable with antidepressants. The antidepressant has become a medicine for neurosis. The quality of life with comfortable and harmless medicines has replaced the idea of recovery, whatever was that idea. The mastering of the human mind is not going to happen anytime soon.
Second remark, Prozac and all similar antidepressants are part of a general shift in the field of medicine which is no longer only a medicine of disease, but also a medicine of health and a medicine of enhancement, as more and more illnesses are becoming chronic. But the case of psychotropic drugs addresses moral issues in Western society, because it is the mind which is at stake, that is, what western societies consider to be the essence of human. Too many sociologists or philosophers, when they talk about topics such as mental health, psychotropic drugs, psychotherapies, depression, psychic suffering, etc. generally they think that there is a psychiatrization, a psychologization or a pathologization of society―today this belief dominates medical anthropology. If the use of these notions is descriptive, it is of course true, because there is more psychiatry, more psychology, etc. It is true, but pointless. In fact, they are used in a normative meaning. This is wrong, because these claims mean genuine society is what used to be. Certainly, today, depression, and more generally mental health and psychic suffering are public health issues, but the point is that these terms don’t designate only a precise reality, but also an atmosphere, a state of mind of our common sensibility in Western society. And this transformation is related to the values of autonomy, values for which the question of personal responsibility is a major issue.
I’ll end up this talk with this question.
Is Autonomy a weakening of social links or a transformation of the spirit of action?
The issue we are confronting is not a psychologization of social life resulting from a weakening of social links, but a general redefinition of the concept of illness, of the relationship between the normal and the pathological according to the current supreme value of individual autonomy. This is why the topic of disability is a major issue in psychiatry today: disability means the impossibility to act as an autonomous agent in social life. In the case of mental pathology, that is in the case of pathologies of emotions and moral feelings, which come from and affect relational life, “normal” functioning is both a sign of good health and a sign of balanced socialization. In the new world of mental health, health and sociality are intertwined.
The transformation of the relationship between the normal and the pathological has accompanied the subsuming of the values of discipline by the values of autonomy, which now permeates the whole of social life. This means everyone is supposed to decide and act in every sphere of life as the actor of … his own work, his own education, his own health, his own illness, etc. Discipline hasn’t disappeared, of course. There has been a change in the hierarchy of values: values of discipline are subordinated to values of autonomy, which are more efficient, have more prestige, and engender more respect. Mechanical obedience is embedded by and subordinated by autonomous obedience.
The democratization of the idea that everybody can be exceptional has put everyone in the situation of the melancholic of the sixteenth century, as described by the authors of Saturn and Melancholy: Through its two facets of personal choice and personal initiative, the demand for autonomy has given rise to the idea that the self is belabored by multiple responsabilities. The values of autonomy bring out a personal aspect in every social relationship. The trap is to consider this aspect as meaning we are confronted with a process of psychologization that compensates for a weakening of social life, a decline of the idea of society. Actually, it is an old and recurring topic in the history of individualistic societies. Contrary to the intertwined ideas of the weakening and the psychologization of social links we are confronted with a transformation of the concept of social links, a change in our hierarchy of values, a change of the mindset of social training. To emphazise that it is an old topic, I’ll mention an article by Emile Durkheim, who wrote in 1906: “Analyze the empirical constitution of man, and you will find nothing of the sacred trait of which he is invested today. This trait has been added by society. It is society, which has considered him to be sacred; it is society, which has made him the respectable thing. So, the progressive emancipation of the individual doesn’t imply a weakening of social links, but a transformation”É. Durkheim, « La détermination du fait moral » (1906), Sociologie et anthropologie, presentation by B. Karsenti, Foreword by C. Bouglé, Paris, PUF, 1994 (1924), coll. « Quadrige », p. 109..
One century later, numerous sociologists, anthropologists and social philosophers think we are confronted with a decline of the institution, a decline of social obligation. Therefore, Durkheim’s assertion is still true. It isn’t because things seem more personal today that they are less political, less social or less institutional. Supporters of this theory don’t see we have been undergone with a general change in our conception of action: today, one obeys by undertaking a task, including by means of constraint, instead of executing an order. This is the major difference between mechanical obedience and autonomous obedience. In disciplinarian systems, workers are the objects of the action conceived of by management professionals, who are the agents of the action. In terms of philosophy of action, it means the manager is the principal agent and the worker the immediate agent. The sociality of autonomy is based on the idea that the object of the action is simultaneously the agent. In other words, he is the principal agent of his own action, the agent of his own change.
We have been faced with new life trajectories and new ways of living affecting the family, employment, education, relationships between generations, etc., whereas we have witnessed the end of the welfare state of the twentieth century. I characterize the change as a progressive shift from the protected and disciplined individual to the capable and autonomous individual. This is a change in the spirit of action in the sense thateverything which is about individual behavior, the mobilization of personal dispositions or capacities, the ability to change, in other words agency, are major preoccupations in a world where personal choice and autonomous action are our supreme values, and where cognitive and relational skills are essential ingredients of socialization.
This change indicates we are living in a type of sociality in which we all have to invest ourselves personally in numerous and heterogeneous social situations. Individual capacity to act as an autonomous self has become a major reference. It incarnates our ideals of personal accomplishment. In this sociality, individual subjectivity has become a major issue, a common question, because it emphasizes problems of self-structuring. Without this self-structuring, it is difficult to act by oneself in an appropriate manner. It was not a central concern in a society of disciplinarian obedience. The issue of self-structuring and that of agency are intertwined.
The sociality of autonomy, that is, the changes in our conception of action, means our institutions are now organized according to the ideal that each citizen has to be in an environment which leads him to be the agent of his own action. This concretely implies the combination of three intertwined social schemes omnipresent in society, but which have to be analyzed differently according to their respective contexts. Those three schemes are: first, the permanent transformation of oneself, second, the development of social or relational skills, and third, the accompaniment of life trajectories. To put it briefly, this accompaniment helps increasing the ability of individuals to change and transform themselves on their own, to find motivation on their own, to have projects, to improve their social skills, in short, to acquire skills to act on their own in increasing numbers of social situations, be they schizophrenic, deviant teen-agers or banks employees. How could, for example, a person with schizophrenia live outside the hospital without a minimum of social skills?
In such a society, at the level of ideology one finds the subjectivist rhetoric, at the level of the reality of individualistic society, the development of social schemes whose practices consist of fostering conditions to train people in manifold ways to be the principal agent of their own actions. It is this shift in our collective conception of action which makes the personal aspect in social relationships stand out, aspect which didn’t exist in a disciplinarian society.
A society of generalized individual initiative and of personal choice renders visible the difficulties of structuring oneself (indispensable to be able to act) that drew no particular attention in a society of discipline. These difficulties have been expressed through the notion of depression, the psychiatric category which includes the widest variety of symptoms and whose main problematic is self-esteem, without which it is impossible to act.
That is in that way than one can claim that depressive insufficiency is to autonomy what neurotic conflict was to discipline. In a way of life organized by discipline, the question was: am I allowed to do it? When reference to autonomy dominates the concept of society, the question is: am I able to do it? Depression is a means of expressing and resolving the problems inherent to the latter question.
Being the agent of one’s own change was at the core of Freud’s thought―it’s the patient who interprets his dreams, not the doctor. As he put it with Joseph Breuer at the end of their Studies on Hysteria (1894), a psychoanalysis is only a means to transform hysterical misery into an ordinary misfortune. In this transformation, it gives tools to the patient for coping on his own. Some thirty years later, he wrote the psychoanalyst, like the educator and the politician, are three “impossible professions”. He didn’t mean they were very difficult professions, but professions where autonomy is the means and the goal of their practices. During the last three or four decades of the 20th century, we have witnessed the generalization of such professions and regulations whose practices aim to make of those involved in them, clients, customers or patients the agents of their own change, rather to a slackening and a psychologization of social links. We have attended to the generalization of the impossible professions.