What the hell is “the unconscious”?

If my question sounds rude, well, I can deal with that. It is a fairly legitimate question, I think. I inevitably had to stumble across this problem when I pondered what I wrote in my last post. I had talked about Dr. Crazy´s claim that the anxiety patient dominates all of his relationships. It made me sufficiently angry and I argued that I don´t feel like I´m dominating anything at all. Now, a first possible reply could be that while I might neither feel like I dominate anything, nor even intend to do so, it is nonetheless a fact that I, due to my anxiety issues, have a strong (detrimental) influence on my interpersonal activities and relationships. It is because of these issues, and because of me, that certain choices are made – like going home early – whether I like it or not.

This is a fact, sure. But it is the kind of fact that makes you go “Duh!” Of course a person´s illness affects his relationships. If Dr. Crazy just meant to state this “objective fact”, then why should “looking at the patient´s relationships” play any role in curing the illness, though?  Cure the illness, and the relationship problems will disappear. His statement only makes sense if he thinks that a patient´s relationship might contribute to keeping him ill. And given what else he said – that the patient dominates his relationships – the reason why the relationship keeps the patient ill is that by dominating the relationship the patient gets some secondary gain out of his illness.

Now – after nearly two years of panic attacks in bar restrooms, I´m a little miffed in the face of such an insinuation. But I bet that just proves it is true, doesn´t it? *rolls eyes* My anger aside, though, I think there is a huge gap between Dr. Crazy´s insinuation and the patients´ experience of their illness (and suffering!). What could bridge such a gap? The unconscious, of course. “On a conscious level,” the argument goes, “the patient is suffering from his illness and he wants to restore his health; but subconsciously, he keeps himself ill because that way he can dominate his relationships.”  Of course I could shower this argument with scorn. When all attempts at therapy fail, you can still claim that, without even knowing it, the patient wants to remain ill! How very convenient!

But if we assume that the unconscious is not just a failed therapist´s emergency exit, what, then, is meant by it? What is the unconscious? Let´s stick to the example of subconscious secondary gain for a moment. “Subconscious” seems to imply that the patient is not aware that he gains anything from his illness. How can either therapist or patient ever determine, then, if the patient really derives some secondary gain? And even more importantly, how can a patient ever refute such an insinuation?! Or, to ask in a phenomenological way: What is the experience of subconsciously deriving secondary gain from a mental illness like? As opposed to, for example, subconsciously wanting to murder one´s father?

It seems that if the patient is completely unaware of his subconscious psychological motivations, then both the experience of subconsciously deriving secondary gain from a mental illness and the experience of subconsciously wanting to murder one´s father are alike: They are experiences of not being aware of any hidden motivations. That´s problematic, though, because then there seems to be no way to determine if a patient has subconscious motivation A, subconscious motivation B, or no subconscious motivations at all.

But – isn´t that the precise point of psychotherapy: To make people aware of their subconscious motivations and feelings? It certainly is one of the main points. But how is it possible, if, for the patient himself, all subconscious motivations are equally inaccessible through his subjective experience? Even if we should accept that the psychotherapist, through long years of learning and researching, has the wisdom and legitimate authority to judge what subconscious motivations a patient has – how can he make the patient aware of them? He can tell a patient how he interprets his behavior, the patient might swallow it – but is that the same as awareness? Does the patient ever see, intuitively know, feel a therapist´s interpretation is true? And if so: How is that possible?



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