For approaching 50 years, both as an insider—Training and Supervising Analyst in four Institutes, member of the late BoPS and two of its committee—and as an outsider—dissident and, more recently, as an Analyst who continues to practice and write but has retired from participation in Psychoanalytic Organizations—I have observed (Leffert, 2010, in press) how Power and Politics play out in these organizations. By doing so, I do not pretend to be offering an account of some overarching Truth about these organizations but rather a narrative, weaving together a number of at times conflicting strands (a différance) that I hope you will find compelling. In a Postmodern sense, what I am offering is a text, a reading of events; there are others.
Although there has been significant writing (e.g. Hale Jr., 1971/1995, 1995; Kirsner, 2009; Richards, 2003, to name three prominant works) on psychoanalytic organizations and their politics, little notice has been taken of the fact that there is a considerable body of Postmodern and Political Science literature on Power and its dispositions in social groups. I plan here to briefly review that literature and to comment on what I see as the decline of Psychoanalytic Power over the past decade. I will posit that we are living through an era of fundamental change in this Power and the organizations that wield it, both in the United States and the wider World.
Power has two meanings here: the strength and energy and the skill, talent and ability to accomplish some particular tasks; and the ability of a ruling elite to force or coerce some individuals or groups, hence a dominated class, into thinking or acting in particular ways. I have posited (Leffert, 2010, chapter 7) that this kind of Power has been wielded in
The Postmodern and Political Science arguments presented in the first half of this paper follow those first presented in Leffert, 2010, chapter 7.
Psychoanalytic Organizations since their origins and, to a lesser extent, is still being wielded today.
McGowan (1991) locates Marx (Marx & Engels, 1845/1998) along an axis of social conflict: power versus freedom. In this conflict Capital shapes Power. McGowan, in the late 20th century, defines Neo-Marxism as involving the concept that social relationships are economic relationships; he substitutes cultural process for physical capital in the expression of power. Foreshadowing the concept of social embedding, Marx posited that Class shapes the realities of its members and that the ruling material class is also the ruling intellectual class. There is a connection between Knowledge and Power. Ideology is an attempt by a ruling intellectual class to legitimize the social circumstances of its Power Relations.
Moving from the theoretical to the practical, what might this look like in one of APsaA's Institutes a half century ago? As I write this in 2020 it sounds harsh but, having lived through it, this is what the dynamics of power looked like. Power was mostly never thought about. At the pinnacle of an institute was an Education Committee (or some such) composed of Training and Supervising Analysts who passed around leadership positions and referrals amongst themselves, perhaps surrounded by a circle of TAs who were not and would rarely become EC members. TA appointments were at least partly political, sometimes competence was not so important; then there were the non-TA graduate analysts who would aspire to and sometimes achieve these higher positions. “Certification” by the parent body was a mark of status necessary for referrals and advancement. Below them were the Institute's students, called Candidates or Clinical Associates. Paired with the Institute was always a Society, a degraded powerless organization where Scientific Papers were presented; in some Institutes, TAs did not, as a matter of principle, attend Society Meetings. The Institute ran on Power and Money. The most prized referrals came from the top; students needing a training analysis usually consulted the officers of the EC for a referral; patients from the wider world suitable for analysis were sent to “deserving” TAs and GAs; Students needed training cases and these too were apportioned. Institute teaching assignments were plums much sought after and, once obtained,
rigorously defended. Income, Career Advancement, and Narcissistic Gratification were the rewards that kept an Institute running.
Foucault (1980, 2000) was interested in the relations of knowledge and power. He studied the Archaeology and Genealogy of Knowledge, the history of ideas. He did not undertake this to understand the past but rather to understand how the present is shaped, constrained and distorted by it and to deconstruct, that is to free, present from past. To have a power relationship, Foucault posited (this is a contested point), both partners must freely enter into it and have some range of action and resistance open to them. Thus, a slave in chains cannot be the subject of a power relationship because he lacks the freedom to act in any way. Power does not exist in the abstract; it can be possessed, but, in the absence of a relationship, it has an uncertain shelf life. Power relations constitute an aspect of holistic social systems from which an individual cannot, or feels he cannot, hold himself apart.
Power-Knowledge (Foucault, 1979/1995) embodies the concept that the creation, maintenance, and deployment of knowledge cannot be separated from a simultaneous power transaction. Examples of these transactions abound in Psychoanalysis. The acceptance of scientific papers for publication by analytic journals was only partly determined by their quality and originality; their theoretical basis and the political standing of the author had much to do with it as well. But more pressing still was the role of choice of particular psychoanalytic theories held by competing factions in individual institutes overseen by the then ruling body of APsaA: The Board on Professional Standards. I have referred (Leffert, 2010) to these as metapsychology wars and, beginning with Freud, they have been fought since the very earliest times of psychoanalytic organizations. The Klein Wars that took place in and nearly destroyed the Los Angeles Psychoanalytic Institute in the 1970s were an example of this but some power struggles between factions were purely personal. More subtly, the point Foucault is making here is that the particular Power Relations structure of a social group determines just what Knowledges that group is able to formulate and accumulate.
Rouse (2003) argues for a second meaning of Power-Knowledge in the power structure of an organization: the knowledge of the subjects
obtained through surveillance. (The original French title of Foucault's (1979/1995) Discipline and Punish is actually Surveiller et Punir.) The extreme version of this is Jeremy Bentham's Panopticon (Foucault, 1979/1995, pp. 200-217), a prison or asylum with its cells so situated that the inmates can be observed by a single superintendent. The inmates know, much like through the monitors in Orwell's (1949/1961) 1984, that they can be observed but not whether they are being observed. The observer is unknown. It takes but a moment's reflection to see how surveillance plays out in a Psychoanalytic Institute. Students are surveilled by their analysts who, at least into the 1970s, often could report on the students to the Education Committee. They were (and are) reported on by their supervisors and seminar leaders. Advancement within an institute required individuals to present their work in various ways, with politics and power sometimes entering into these decisions. Training Analysts in some institutes had cadres of loyal students and graduates who did their bidding, fought their enemies, and who, in exchange, were convoyed through the power structure by the TA for their advancement. In these institutes (and I have been involved in two of them) students often remained a TA's partisans throughout his career.
Lukes (2005) is a social and political theorist who writes on Power in social relationships and how language is used in its operations. He begins by asking two fundamental questions concerning the existence of “dominating” and “dominated” within a holistic social system (von Bertalanffy, 1968) such as a psychoanalytic institute. The first is how a ruling elite and its presence can be identified in a social system. To answer this question Lukes cites Dahl (1958, p. 466) who offers three tests that prove the existence of such an elite: First, it must exist as a well-defined group; then its preferences must run counter to those of another well-defined group or groups; finally, it must consistently prevail in realizing its preferences. Lukes' second question is why dominated or subordinated groups accept the dominance of ruling elites in the first place. He answers this question by offering Tilly's (1991) checklist of possible reasons for their submission:
This premise is false: Subordinated groups are actually resisting and rebelling continuously, only choosing to do so in covert ways.
Subordinates get something from the ruling elite for their submission, something of sufficient value to them to get them to acquiesce most of the time.
Through the pursuit of valued ends, social status or admission to an esteemed class, members of subordinated classes become enmeshed in the very social system that oppresses or exploits them.
As a result of a variety of processes deployed by a ruling elite—repression, mystification, and the absence of any other frame of reference for understanding the system and their role in it—members of the dominated class remain ignorant of their true interests.
Subordinates are held in place by threats, force, and/or inertia.
Resistance or rebellion is often costly and dominated individuals lack the means, the capital, to engage in them.
All of the above (Tilly, , p. )
Lukes posits that choice 7 is correct. (We have to, I think, agree.) They are accomplished by the application of material or organizational gain or the use of force.
Lukes' (2005) major contribution to our understanding of power lies in what he calls a three-dimensional view of power. Dahl (1957) offers a one-dimensional view dealing with the exercise of power; it is entirely behavioral. It evaluates power relations in a group by asking the questions: How often is A successful in getting B to do what he wants: how many attempts does it require to get him to do so? This account limits the necessary inquiry to describing behavior in decision-making in the presence of conflict. In it, A is allowed to use threats and force. Conflict must be present in any situation to be tested for dominance and submission and the conflict must be between readily observable and conscious preferences. There has to be a conflict of interest between the contesting parties.
Bachrach and Baratz (1970) while accepting the one-dimensional view of power suggest another possible form that Power Relations can take (this is Lukes', 2005, second dimension). A can also assert his power over B if he is able to limit public discourse in a social system to only
those subjects or conflicts that A finds to be innocuous. In this second dimension, A can assert power through successfully creating or reinforcing barriers to social discourse. A does so by claiming the right to set agendas (the control of the United States Senate offers a ready example of such powers) and by appealing to putative social and political values. An important third tool that they do not consider is the creation or modification of language so as to deny the existence of a particular conflict. Calling an institution that incarcerates the mentally ill against their will an asylum (a place of protection) or a prison a “correctional facility” are examples of this as is naming an unconstitutional piece of federal legislation authorizing surveillance the “Patriot Act”. These techniques serve to mobilize bias and act through coercing decision-making or the absence of decision making.
Lukes (2005) mounts a critique of Bachrach and Baratz's (1970) position on behaviorism as still too mild and offers in its place a three-dimensional view of Power. He denies that the presence of an actual and observable conflict is required to find the presence of power and submission in a given relationship and disagrees with Bachrach and Baratz's view that, in the absence of independently observed grievances, there is no power relationship. Because of these arguments, Lukes goes on to posit his third dimension of power relations: “A may exercise power over B by getting him to do what he does not want to do, but he also exercises power over him by influencing, shaping or determining his very wants” (Lukes, p. 27, italics added). In other words, power elites can exert power by shaping tastes and preferences. They can do this through social media but language is an even more powerful tool: A can give some credential an appealing name that can seem to offer economic or social advantage and standing. In our little world of psychoanalysis until the end of the last century (and to a lesser extent today), Certification and Training Analyst were (and, to a much lesser degree) still are such terms.2 Another way of doing this is for A to confer titles on himself that he creates as a show of power.
A colleague at a Midwestern institute was appointed a Training and Supervising Analyst around forty years ago. After a decade or so when he had received referrals for neither a training analysis or a supervision he brought this to the attention of a member of the EC. He was told that the title was an “honorific” and should be treated as such.
A growing body of neuroscience evidence now shows that the use of particular emotionally laden language can change the brain (Doidge, 2007), changing what it perceives, what its values are, and what it can think about. Experience in groups organized along Power Relations lines changes the Self (Leffert, 2018). These processes shape the thinking and wants of the Power Elites themselves just as they do the Dominated Classes. They bestow a conviction of legitimacy on the whole system; there is nothing disingenuous here, and members of both classes believe that they are acting altruistically, often at great personal cost, to preserve the system of which they are a part. Psychoanalytic power systems often act to explain deviation by attributing psychopathology to rebelling members. Although character pathologies can be found in Psychoanalytic Organizations, among elites, rank-and-file, and rebels alike, as they can in other systems, they do not offer sufficient explanations for their behaviors. They do, however, serve a power function when they are wielded as pseudo-interpretations that assert power over rebellious or non-compliant members. Processes such as regression, repression, projection, introjection and identification as they pertain to group psychology, can play the same role in analytic organizations as they do in others. Stockholm Syndrome is a prime example of this, a term ironically applied by a colleague in the 1990s to the Certification process. In it, the hostages regress and side with their captors; their behavior then reinforces the captors' experiences of legitimacy.
There is an aspect of the functions of organizations shaped around the wielding of power, particularly relevant to the history of psychoanalytic organizations, that Lukes (2005) does not consider. It has to do with the organization's use of power to deny membership; it forces the disenfranchised to remain powerless, low-status outsiders. The glaring example in American Psychoanalysis was the virtual exclusion of non-medical clinicians from training and membership in its organizations. (This has changed so much since that it requires an act of will to remember it.)
I have posited (Leffert, 2010, 2013), as have many colleagues lacking the Postmodern and Political Science formulations, that, up until the mid-1980s, The American Psychoanalytic Association, ruled by its Board on Professional Standards and its component Psychoanalytic Institutes constituted such a power relations organization. It made use of graduation, Certification and TA appointments to control the members that were
rewarded with national committee assignments, seminar teaching and referrals, particularly referrals of mental health workers and of members' families (in Los Angeles, referrals of people in the Entertainment Industry were much sought after). Withholding these things as a means of punishment and control was also a tool of covert control.
So, what happened to this gentleman's agreement and when did it happen? A number of changes, Social and Scientific, inside and outside of Psychoanalysis, began to occur in the last half of the 20th century and massively accelerated in the 1980s. One factor that was much denied was a decrease in interest in Psychoanalysis among potential patients that was worsened by rising numbers of analysts and students in analytic communities. Demand for a three to five times a week analysis using a couch declined except among mental health professionals for whom, in addition to fulfilling therapeutic needs, it served to convey (Lukes, 2005) status and standing. This dramatic decrease in the numbers of potential patients brought with it a decline in referrals to be used as power rewards and great difficulties for students seeking out training (“control”) cases: The national average of analytic patients per graduate analyst declined to a bit more than one.
The second thing to occur was the gradual appearance of effective psychotropic drugs, beginning with the tricyclic antidepressants in 1962 and peeking with the appearance of the game-changing SSRI, Prozac, in 1985. It offered dramatic therapeutic results3 for depression but also for social phobia, both of which could change character. The initial response of (many/most?) psychoanalysts, particularly the members of ruling elites, was to dismiss4 these drugs as ineffective, anti-analytic patient-gratifying agents. The fact that this position was so at odds with society's experience made psychoanalysis seem even more arcane and irrelevant in the therapeutic marketplace.
This is not to say that the prescription and efficacy of psychotropic medications are not complex subjects—as are the prescription and efficacy of Psychoanalysis and Psychotherapy—but rather that they produced massive change in the social world of psychopathology and its treatment.
The fact that a severe depression, responsive to an antidepressant, could include cognitive slowing that would render analysis impossible (the patient couldn't think) did not affect their dismissal.
The final event of this sort of dark annus mirabilis of 1985 for Psychoanalysis was what came to be known as (and now largely forgotten) “The Lawsuit.” APsaA had, from its beginnings asserted the claim that Psychoanalysis could only effectively be practiced by physicians and, with rare exceptions, only physician-psychiatrists could be admitted for training. This was in fact a status-power relations claim masquerading as scientific knowledge. It is important to remember, following Lukes (2005), that this was not a consciously fraudulent practice: In 1985 we (myself then included) believed this to be the case. So, in 1985 four psychologists sued APsaA, not challenging the scientific merits of the case but (correctly) alleging it to be an illegal combination in restraint of trade—an anti-trust claim. The lawsuit proved successful and, I believe, ultimately saved us all from disaster. As a result, the power elites of APsaA suffered an enormous loss of face (and power) making further changes possible.
Psychoanalysis, the brand, has continued to age and to lose value and cachet. The public mostly associates it with seeing an analyst multiple times a week (something that has become much harder as society exerts more complex pressures on patients' availability for such a procedure) at great expense and, weirdly, has the patient lie on a couch where they could not see the analyst. Mention you're an analyst anywhere except at a Manhattan cocktail party and you will see this. People will ask if you're reading their minds, tell you about people who have “gone for years” and haven't gotten better, or tell you about some analyst's bizarre behavior. They want results much more quickly with less frequent sessions that they can fit it into their busy lives. This brand decay can't be unrelated to the fact that the average analyst has a bit more than one patient in analysis. In an implicit response to this trend more and more psychoanalysts have begun referring to themselves publicly and on their websites as psychotherapists (I do) instead of psychoanalysts; people are much more comfortable seeking one out for treatment.
What has the new millennium brought us?5 Broadly speaking, these
I am now moving into the final part of this paper that is covering events that will be well known to my readers. The alternative narrative I am presenting, drawing on power relations dynamics is not so well known and is bound to be controversial, but that, after all, is what The International Journal of Controversial Discussions in Psychoanalysis is supposed to be all about.
trends have continued and gathered momentum. The covert rebellion that Tilly (1991) described became overt, growingly powerful and, to a considerable extent successful. Analysts without analytic patients exist and strive to maintain an analytic identity in spite of it. Certification has dramatically lost its cachet and standing. It remains only an admissions ticket necessary at some APsaA institutes to train candidates and there are relatively few of these nowadays. It has become irrelevant for holding any administrative or teaching positions at APsaA and at least some of its institutes (I do not know if this is universal).
What about BoPS? The short answer is that, through an APsaA bylaws amendment, the rebellion killed it. Its ruling elites performed a strategic withdrawal. Some returned to positions of power in a few of the most conservative institutes. Others created a new certifying body, an American Board of Psychoanalysis and appointed themselves to membership in it. Neither their qualifications nor that of the “Board” were externally determined in any way. The first thing they did, in an attempt to claim power, was to offer to grandfather in any psychoanalyst previously certified by BoPS who was also prepared to pay them an annual fee of $100. I don't know how successful this has proved to be; I certainly did not take advantage of this “opportunity,” and I know nothing about their success in attracting new business.
What happened to Power and its Elites? Did they disappear? Alas, no. Power structures, while still present, became much more informal and covert. The old Power Elites as discreet groups disappeared with some members remaining active in APsaA, whereas advancing age caused others to retire from politics to a greater or lesser extent. (For myself, at 75, I simply don't have the time for it.) What we have locally, and I expect the same is true nationally, is that there is a group of psychoanalysts who get to participate in what they want (administration, teaching, and “scientific” participation) and a larger group who don't. “Credentials,” like certification or TA appointment, are no longer membership tickets in these new power structures. Motivation is, of course, a factor but it is not sufficient. Journals are organized in much the same way. If one looks at JAPA one finds that the members of its Editorial Board do much of its writing. We are still organizations in flux and it will be interesting to see what we look like down the pike in 25 years or so.