Wednesday, June 1, 2011

The Report of My Death: A Short Course in American Psychoanalysis

Psychoanalysis has been pronounced dead more times than Francisco Franco. “The mental illness it purports to cure,” in Karl Krauss’s infelicitous definition, has been variously lampooned as ludicrous or condemned as the cause of all our 20th century’s maladies. Frederick Crews was able to trash psychoanalysis as equally responsible for covering up the reality of child abuse as well as causing the false memory scandals of the 1980s. A neat trick all told.

For all its repeated obituaries, replete with Time cover stories, psychoanalysis has waxed and waned in the popular imagination, as well as in scientific circles, throughout the old century and now into the new. Its death has been lamented and celebrated as its return to life has been touted and scorned, yet psychoanalysis never lets go, at least completely, its hold on our imagination, our conceptions of man and society, and our efforts at healing human ills.

In this article I want to offer my own, slightly potted, ideas about how and why psychoanalysis has (and has not) thrived in the last 60 or so years. I contend that the time when psychoanalysis has been most respected and respectable was also paradoxically the time of its greatest crisis and intellectual decline. As psychoanalytic theory and practice have come under increased attack (or more to the point, scorn), our theories, practices, and science have become increasingly vibrant, life affirming and challenging to our culture and society.

It has long been a commonplace that psychoanalysis thrived in this country in the 1950s, when it was seen as the only game in town for the treatment of the severely mentally ill as well as the Park Avenue doyennes beloved by New Yorker cartoonists. It is certainly true that psychoanalysis achieved a largely unchallenged prestige in medical schools and throughout all of psychiatry. Securing a niche as a training analyst at a prestigious American Psychoanalytic Association (APsaA) institute more or less guaranteed a comfortable income and enviable social propriety.

For many of us, however, this era does not shine so brightly in memory. While the tendency to cast past paragons into exterior darkness is an endemic defect in the psychoanalytic character, there is some truth in the proposition that American psychoanalysis had to be rescued from itself. The slough of despond within our profession has been ably documented by Douglas Kirschner in Free Associations and perceptively described by Jacqueline Rose in On Not Being Able to Sleep. The shabby treatment of psychoanalyst émigrés, including Annie Reich and Otto Fenichel, has been reported by Russell Jacoby in The Political Freudians. Psychoanalysis in this country was, with rare exceptions, an all-male bastion of physician privilege. While there were many “islands” of psychoanalytic heresiarchs, from Menninger’s to William Alanson White, official psychoanalysis was overwhelmingly conformist and self-satisfied with its accomplishments. It is certainly not true that every ambitious woman was told she suffered from penis envy or that every gay male was told he had he suffered from a mental (albeit curable) disorder; but it is “true enough” that the psychoanalytic paradigm did not include the possibility that these constructions themselves were subject to analysis. It is certainly true that an adolescent boy’s report of masturbating, recounted in the Psychoanalytic Study of the Child, was described as “soiling;” and his wearing jeans and sporting long hair was interpreted as examples of disturbingly regressive acting out. You could look it up!

The intellectual ferment within psychoanalysis could not remain long muted and the work of reviving psychoanalytic theory and practice can be ascribed to many, although any list would have to include Heinz Kohut, Stephen Mitchell, and Jessica Benjamin. More important, I think, was the “entrance” on the scene of the interpersonalists, Kleinians and Middle Group thinkers that had been largely marginalized in the 1950s and 1960s. Equally important, are those ideas and individuals from outside psychoanalysis, beginning with feminist critics of psychoanalysis, through the Stone Center writers, and eventually to queer theory thinkers and others who brought to psychoanalysis passion, anger, and provocative determination to make psychoanalysis rethink itself.

While the Division can claim only a distant glory in honoring the emergence of self psychology, relational psychoanalysis, etc., it can certainly take considerable credit for opening a space for new ideas and approaches within psychoanalysis. By its self-creation over 30 years ago, the Division claimed the right to speak for psychoanalytic psychology both within and without APA, as well as carrying out Freud’s goal of recognizing that medical training was the least desirable route to becoming a psychoanalyst and that psychoanalytic thought was a sub-discipline of psychology, not medicine. By initiating and supporting the GAPPP lawsuit against APsaA (resulting in opening up their institutes to offer training to non-physicians on a basis of equality), the Division radically altered the psychoanalytic landscape. By initiating the diplomate in psychoanalysis (ABPsaP), the Division established the only current independent organization for the certification of psychoanalysts. By working with other psychoanalytic organizations, the Division also helped establish the Accreditation Council for Psychoanalytic Education (ACPE) as an independent accrediting body for psychoanalytic education.

I think it is important to emphasize, then, that psychoanalysis in America underwent a sea change in the 1980s and 1990s, revitalized by new (and some not so new) ideas about theory, technique, and the notion of change and cure, as well as the establishment of new (and some not so new) education opportunities for psychologists. Of course, this was the very same era when psychoanalysis came under increasing attack within the “talk therapy” movement, as more and more treatment approaches encroached on the claims of psychoanalysis, while psychiatry refashioned itself, with a little help from their pharmaceutical company friends, as the new “pill doctors,” dispensing relief from what ails you without all that messy business of actually changing, thinking, or having to talk to a human being.  DBT and Prozac, CBT and Risperdal, held out the promise that change could come quickly and cheaply (and, eventually, delivered by “highly trained” paraprofessionals), whereas psychoanalysis came to be viewed as out of touch with both science and the culture.

To continue with our theme of the death of psychoanalysis, in this new century the increasing accusation against our work (and indeed the work of any who espouse some variant of relational psychotherapy) has been that we fail to meet the scientific sniff test. With the rise of increasingly sophisticated research paradigms and the ideological triumph of Randomized Control Trials (RCTs) and manualized treatment protocols as the “gold standard” for determining efficacy of treatments, the “evidence-based” mantra, curiously emerging at the same time as corporate takeover of mental health care, has promised to cast into shade any treatment that is not symptom-specific, culturally sensitive, and, of course, quick and inexpensive. In the last year or so, the emergence of the Association for Psychological Science, with its attempts to supplant APA’s role in credentialing clinical psychology programs, has clearly been a knife blade aimed at discrediting our work and casting derision on our craft by comparing it to “dolphin-assisted therapy” or worse.

But psychoanalysis has not died. In fact, many researchers have taken up the challenge and produced more and compelling evidence that psychoanalytic treatments work, that they work for diverse populations, that they work for disparate symptoms/diagnoses, and so on. There remains much ill will on both sides of the clinician-researcher divide; but there is increasing evidence that we not only need one another but may actually like one another. APsaA has been hugely supportive of researchers in recent years and some increasingly powerful psychoanalytic research organizations have emerged.  While the Division still has a way to go in this area, we have formed a Research Committee with the goal of keeping psychological research at the core of our publications, programs and educational efforts.

So, once again, has psychoanalysis been resuscitated? I would argue that it has and that the opportunities to learn psychoanalysis have been greatly expanded, the ability to think critically and broadly about our work has been increasingly accepted, our ability to work with diverse populations has increased, and the value of our work has been effectively demonstrated in multiple ways. Certainly much needs to be done and we must work harder than ever to have our profession look increasingly like our society with its diversity in ethnicity, sexually identity and culture. And we ain’t getting any younger, either.

So what are our challenges? There is one major challenge: we need more people in psychoanalysis and psychoanalytic psychotherapy. To accomplish this we need to figure out how therapists can be paid for their work at a level commensurate with their education and training. To accomplish this, we need other professionals, policymakers and the general public to learn about the value, efficacy, and indeed the efficiency of psychoanalytic work.

This is work for all of us, but the Division has a new Committee on Public Relations and Psychoanalysis (please check out their information on our web site) and the Psychoanalytic Consortium has agreed to make public relations/public information a common agenda we will address in the next few years to determine ways we can work together to inform the public of our work.

What can you do? Each of us can take on the job of educating the public about psychoanalysis. While writing critiques of articles that propound incorrect information about psychoanalysis may help, a more proactive stand is to inform the public what psychoanalysis is. A member of our Division, Ruth Neubauer, has been involved for a number of years in teaching psychoanalytic ideas (using Judith Viorst’s book, Necessary Losses, among other things) in adult education seminars. Many members have web sites where they could post short articles on psychoanalytic understanding of diverse topics. A number of our members blog on Psychology Today and other sites, including our InSight editor Tamara McClintock Greenberg, and identify themselves as psychoanalysts or psychoanalytic therapists. We need to build strong psychoanalytic communities through our institutes and local chapters in order to support and mentor younger colleagues, as well as participate in our national organization, its Sections and committees.

It is unfortunately true that Freud never said to Carl Jung, as they arrived in America in 1909, “We bring them the plague.” It could more accurately be said, however, that it was psychoanalysis that caught the plague from America’s “mental illness” of conformism, consumerism, and philistinism. The early success of psychoanalysis in this country was at least partly due to a misunderstanding of the nature and purpose of psychoanalytic thought. Perhaps psychoanalysis has now cured itself of the American plague, but it will take some hard work to truly bring them the plague  . .  and its cure.