A Time of Questioning: The Severely Disturbed Patient Within Classical Analysis

The last few years have seen psychoanalysis slip into a deep malaise, a crisis about its identity and its standing in a health care system that demands ever greater accountability and scientific methods of verification of process and outcome. It is finding itself more and more pushed to the wall in medical schools and shaken by the massive curtailments of insurance benefits. Yet in response to this situation we have also witnessed an opening up of psychoanalysis to a spirit of questioning. It has become acceptable to rattle the cages of dogmatic beliefs, of rigid attitudes in treatment and training, and of overly schematic classifications. The latter refer in general terms to those judgmental attitudes toward patients and colleagues that have proven so pernicious to the creativity and health of the field. This new freedom of thought parallels the astonishing processes in the political world: the old immovable fronts are beginning to break up, new vistas are opening up.

I really see a double crisis in psychoanalysis, one from without, and a more important one from within. First the outer challenge:

One form of this outer challenge is organizational, systemic. Methods of superficial manipulation and confrontation, of exhorting patients to accept reality and adapt to it, to be “willing” and “motivated,” thus dismissing the profound problem of compulsion and lack of inner freedom, have persuaded health care providers that they can validly supersede the system whereby they listen to the patient for uncounted hours of psychoanalysis. On the other side, neurophysiology demands of the psychiatrist that he or