Life among the analysts

‘The Impossible Profession is on the ropes. And Freud's reputation has never been so battered’, the cover story of New York Magazine recently declared. ‘The art-science he founded, once a kind of secular religion in America with a cultural force Freud compared with the Copernican and Darwinian revolutions, is now a national afterthought, a discipline in financial peril and internal tumult’ (Kaplan 1997: 28). Yet, as any visitor will attest, New Yorkers are every bit as neurotic as ever. They stand in just as much need of therapy and, as the number of cover stories in notable magazines suggests — The New Yorker has recently published another story in its ‘Annals of Psychoanalysis’ series (Gopnik 1998) — at least interest in the fate of psychoanalysis has not abated. Perhaps the accounts of the death have been exaggerated once again.

Still, the heyday of psychoanalysis has long passed in New York, once the Mecca of American psychoanalysis. But it has taken quite some time for the fortunes of psychoanalysis to become so desperate and dire. Questionable a decade ago, such a statement would have been unthinkable two, certainly three, decades ago. Until the late 1960s, psychoanalysts chaired half the departments of psychiatry, psychoanalytic institutes were still finishing schools for psychiatric training, and Freud was an unquestioned part of the zeitgeist. Psychiatrists clamoured to sit at the feet of the New York psychoanalytic Giants. Full couches could be guaranteed on graduation.

Under attack from many quarters, psychoanalysis has been overtaken both by other psychodynamic approaches and by biological psychiatry. As a therapy, few can afford the time or the money — around $500 lying on the couch four or five times a week. In any case, Managed Care has all but taken over. Managed Care is a health insurance arrangement whereby patients insure their medical needs with Health Maintenance Organizations (HMOs)