- John Milton Bunch
- 4 days ago
- 9 min read
Psychoanalysis, Science and Depression: A Response to Hook & Vanheule
John M. Bunch
15 April 2025
At the outset, let me state that I am not attempting to cast the “biological/cognitive” theories mentioned by Hook & Vanheule as competitors to Lacanian perspectives on depression. In fact, quite the opposite – I strongly believe that no one has an intellectual handle on what we call depression, and that the most honest and humane approach we can take is to admit that fact up front. Once we’ve mastered the intellectual humility required to take that initial step, we realize that, just maybe, the other guy has some meaningful things to say. It’s ultimately an integration of current thinking rather than a dogmatic adherence to one perspective over the other that will provide for a more enlightened understanding of depression in the future.
From a personal perspective, and as, essentially, an old man who’s been fighting depression his whole life, I’ve heard it all and done most of it. The only thing I know for certain is that no one, and I mean no one, has enough of a genuine and valid understanding of the phenomenon to reject someone else’s perspective out of hand. In other words, the validity of any theory, and the efficacy of any treatment it produces, is weak at best, harmful at worst, but most likely simply off-base and benign.
It's from this perspective that I make the following comments on the introductory chapter by Hook & Vanheule to their edited volume Lacan on Depression and Melancholia. Hook & Vanheule attempt to provide a rationale for Lacanian psychoanalytic approaches to depression as an alternative to contemporary biological and cognitive models, and I certainly agree that comparative investigations of different models of depression are critical to our understanding of it. Lacanian approaches to depression may very well have important insights to share, and become all the more capable of doing so when prodded toward an accurate assessment of other models.
However, Hook & Vanheule fall into an all-to-common pattern of argument used by psychoanalysts when critiquing scientific approaches to the understanding of mental health in general and depression in particular – what gets critiqued are largely straw men built upon the conflation of pop-culture notions of depression and market-driven treatment options with scientific models. In this case, rather than a realistic assessment of the weaknesses of “biological and cognitive models”, Hook & VanHeule do little more than couch the entire discussion in a series of straw-man arguments seemingly designed to promote Lacanian psychoanalysis as the only valid approach to understanding and dealing with depression. It should be noted that I am making the assumption here that the “biological and cognitive” models referred to by Hook & Vanheule are intended by the authors to refer to scientific models of depression built upon a biological and/or cognitive substrate.
The authors could have easily avoided this criticism with references to the biological and cognitive models they have in mind, but surprisingly not a single paper, study or theory is cited. This makes it impossible to discern how, exactly, cognitive and biological models fail while Lacanian psychoanalysis succeeds. Further, while not directly addressed, the biological models which became the genesis of Lacan’s own thinking seem to be taken as a priori assumption about the nature of man and immune from criticism.
Straw-manning Biological and Cognitive Models
Hook & Vanheule begin their introductory chapter by referencing empirical evidence of the high prevalence of depression in the global population and note its omnipresent nature in the culture. However, we soon run into trouble when the claim is made that, as the prevalence of depression has only increased over time, the relevance of “…particularly biological and cognitive psychological models..” is called into question.
This seemingly logical conclusion is problematic as it ignores a couple of issues. First, it ignores the possibility that biological and cognitive models may be gaining validity but have not yet advanced to the point of offering effective treatment options. As the authors give us no examples of biological or cognitive models, we have no way to evaluate this issue. Second, and certainly plausible, is the possibility that a valid biological or cognitive model simply will not offer a workable intervention, and thus validity cannot be assessed by improved treatment outcomes.
One issue that perhaps complicates Hook & Vanheule is a misunderstanding of the epistemology of psychological science. Researchers in this area generally work from a post-positivist perspective. In other words, what they are doing is not making truth claims about how the world works but rather attempting to provide the most likely, testable explanation for things that we see, including but not limited to the results of experiments. For example, when a functional MRI study demonstrates differences in brain activity between depressed and non-depressed patients, the goal of the scientist is to explain why - not to prove a truth, but to put forth the most logical and likely explanation in the form of a theory or model. Even when the sum total of scientific research fails to shed much light on a subject (in other words, when its models are weak) it can still be good science as long as it’s honest and transparent in its model-building.
This is where we currently find scientific inquiry regarding depression. Which is to say, science hasn’t produced a causal model capable of explaining much of what we see related to depression, and it certainly hasn’t helped lower the prevalence of depression, as Hook and Vanheule state. However, to put forth the idea, as Hook & Vanheule do, that inadequate “treatments” for depression argue against biological and cognitive models of it is to sincerely misunderstand scientific models, and to conflate post-positivist model-building with both pronouncements of truth and market-driven health care delivery.
Science gives us repeatable observations, such as the observation that differences in brain activity exist between depressed and non-depressed patients and proposes models of depression that attempt to explain such observations. However, a robust model capable of informing practical interventions that significantly change the phenomenological experience of depression across a wide variety of sufferers and circumstances still eludes it. At the same time, I would challenge the most evangelical of Lacanian acolytes to produce a Lacanian model that fares any better.
At best, treatment efficacy studies show no difference between psychodynamic treatments and, for example, cognitive behavior therapy (e.g. Smith & Hewitt, 2024). Smith & Hewitt (2004) use the term psychodynamic in the common way - to refer to models of mind that posit internal, unconscious forces or entities that interact and/or conflict with one another. Psychoanalysis, then, is an attempt to identify and resolve this internal conflict via talk therapy. While it’s difficult to parse out strictly Lacanian analysis from other forms of psychoanalysis in this study, it seems incumbent upon anyone making an argument for the superiority of Lacanian psychoanalysis to provide evidence of its superior treatment efficacy over both other forms of psychoanalysis and non-psychodynamic approaches. Hook & Vanheule do not do this, and I would argue that such evidence does not exist in the clinical literature. Thus, it seems hypocritical if not perverse to use poor treatment outcomes to promote Lacanian theory over biological and cognitive models.
Of course, having said the above, many Lacanian purists will insist that psychoanalysis isn’t psychotherapy and can’t be judged on its practical application. Fair enough, but it seems a bit unreasonable to exempt one’s own preferred model of mind from the burden of clinical efficacy while condemning alternative models for their lack of it. It should be noted that “evidence-based treatments,” such as cognitive behavior therapy, are not themselves science, and are based (or, perhaps more accurately, loosely based) on admittedly weak biological and cognitive models, and poor treatment efficacy does not necessarily refute what is essentially inchoate science.
Interestingly, the authors provide no citations whatsoever for any cognitive or biological model against which their acrimony is hurled. For example, the claim is made that “…depression once approached along the lines of medical and neurochemical interventions, that is, without the accompanying exploration of the patient’s internal life, leads to expectations of a direct solution.” Sounds like a reasonable observation, but why did the authors choose not to provide a single reference to an example of a biological or cognitive model in which the view is espoused that the patient’s internal life is irrelevant? An uncharitable interpretation of this might wonder if the authors aren’t straw-manning.
Another confusing claim that warrants mention: “It is for this reason that the refutation of the popular notion of depression – as a malady to be treated by medications – has become tantamount to an ethical issue for many Lacanians.” What, exactly, are we talking about here – the failure of biological and cognitive models, or the uncontroversially low validity of “popular notions?” If the authors are truly conflating “popular notions” of depression with biological and cognitive models, the reader may reasonably call into question the entire premise of the essay.
The last example of a potential strawman I’ll mention is the criticism that, as opposed to contemporary models of depression, according to Lacanian perspectives “…the notion of depression is considered to be under-defined and too all-encompassing.” Yet even the most biological of biological theorists (e.g. Buch & Liston, 2021, Pizzagalli & Roberts, 2022, and many others a brief Google Scholar search will produce) clearly view the clinical presentation of “depression” as “heterogeneous and etiologically complex” (Buch & Liston, 2021). Again, Hook & Vanheule make their claim without a single citation of a scientific model in which depression is construed as a unitary or overly simplistic construct.
Is Lacanian Psychoanalysis Free of Biology?
Beyond the scope of Hook & Vanheule, yet of critical relevance to it, is the historical evolution of Lacan’s own thinking from biological models. According to Hook & Vanheule, the Lacanian view of depression sees current suffering from, and clinical presentation of, depressive symptoms to result from the specific social and personal history of the depressed person. From this perspective, the idea that biological predispositions, or, God forbid, a biological genesis of depression simply can’t be. For this reason, treatment must focus on a verbal exploration of personal history, an uncovering of internal conflict via language, and, ultimately, a talking cure. The claim seems to be that human biology is either wholly irrelevant, or to the extent that it is relevant, does not differ between individuals with regard to the causes of depression.
Yet as noted by Chien (2006) and Chiesa (2009), Lacan’s core concepts regarding the primacy of language in the structuring of human mental life developed from his reading of biological models in the nascent stage of his own psychodynamic model-building. In Seminar 1, for example, Lacan refers to the impact of a human nervous system “…not complete at birth,” which gives rise to a continuing instability and alienation from the external world, which gives rise to psychodynamic forces. Further, it was the biologist Jakob von Uexküll’s concept of the Umwelt of animals from which Lacan ultimately developed his conception of a split of the human subject into conscious and unconscious discourses. Clearly, Lacan was willing to make assumptions about the role of physiology in the experience of the subject. Hook & Vanheule, however, seem to want to distance or perhaps completely divorce psychoanalysis from any physiological reality.
The Lacanian model of mind can be considered an organism-environment system, in which mind arises via the interaction of the person and the environment. While one can contrast this with more common biological or cognitive models in which mind is rooted inside the individual, the organism-environment system is not without its biological and cognitive acolytes. Psychologist J. J. Gibson’s influential model of visual perception, for example, certainly fits this paradigm. While Gibson’s theory of direct perception is not a cognitive theory, it nonetheless assumes a biological substrate. There is nothing to prevent a biological model of depression from arising within a similar organism-environment framework.
Summary
In summary, it’s difficult to take seriously a Lacanian critique of biological and cognitive models of depression when Lacan himself seems to have wanted to tie his model of mind to some sort of physiological reality within the human organism. It’s even more difficult when Hook & Vanheule appear to conflate contemporary biological and cognitive models of depression with both “popular notions” of depression and available treatment options. Finally, given the difficult and complex nature of what we call depression, and the human toll depression takes, it seems to me that the only humane approach is to acknowledge our extremely limited ability to address it. Regardless of theoretical orientation, we need to develop a willingness to consider, and attempt to integrate, all approaches.
Works Cited
Buch, A. M. & Liston, C. (2021). Dissecting diagnostic heterogeneity in depression by integrating neuroimaging and genetics. Neuropsychopharmacology. 46, 156–175.
Chiesa, L. (2009). The World of Desire: Lacan Between Evolutionary Biology and Psychoanalytic Theory. The Yearbook of Comparative Literature, Volume 55, pp. 200-225.
Chien, J. (2006). From Animals to Humans: Uexküll’s Umwelt as Read by Lacan and Canguilhem. Concentric: Literary and Cultural Studies, 32 (2),45-69.
Hook & Vanheule (2023). Introduction: The failings of depression – A Lacanian orientation. In Lacan on Depression and Melancholia, Hook & Vanheule (Eds), Routledge.
Pizzagalli, D. A. & Roberts, A. C. (2022). Prefrontal cortex and depression. Neuropsychopharmacology, 47:225–246.
Smith, M. & Hewitt, P. (2024). The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review. Journal of Clinical Psychology, 8 (5).
John M. Bunch, PhD is a semi-retired cognitive psychologist and computer scientist who spent the majority of his career providing data analytics training to audiences ranging from Fortune 100 companies to global non-profits and the US military. He is currently the owner of data analytics courseware provider The Cuban Sandwich Press, and writes on a variety of topics he finds interesting.
