Thank you Dr. Fried for giving us another perspective on the changes in psychoanalysis that enriches our understanding of what has happened in psychoanalysis in the United States in the past 70 years. It is a good corrective to our thinking. It substitutes an economic understanding for a more narrowly historical one. In essence, it says that we are now free of psychiatric dominance in American psychoanalysis and are free to understand our patients as the products of their relationships to their parents, early caretakers, and siblings rather than embodied selves wrestling with their desires, fears, moral prohibitions and attempts to defend themselves from conflicts and inhibitions. I agree completely with your suggestion that the two ways of understanding mental pain are complementary and that it increases our therapeutic armamentarium to use both in attempts to understand our patients.
I do not completely agree with the historical account of how this came about. One important issue is that Freud and the medical men in his inner circle welcomed women from early in the 20th century. Another important point is that Karen Horney was able to challenge Freud on the issue of female sexuality and to become a leader in the psychoanalytic world early on. And a third point is that the male hegemony in psychoanalysis allowed in women physicians trained during World War II when medical schools had too few male candidates and allowed women to train as doctors. Women like the founders of IPTAR and the all women education committee of New York Psychoanalytic Institute, as well as such great contributors as Annie Reich and Frieda Fromm Reichman spoke up in favor of understanding psychopathology as including relations with early “objects.” Reading case reports from the mid-century and after, there are many descriptions of relations to early caretakers and how they, and their treatment of the children they raised, influenced patients' lives. Similarly, Anna Freud's exhaustive records of
the early experiences and the fantasies of patients paid much attention to the relationships with parents and caregivers.
What was new in the relational turn was initiated by men, notably Steven Mitchell and Jay Greenberg. Women were not the initiators, but were receptive to the emphasis on relations between patient and analyst as well as patient and early caregivers. So equating the female with the relational is, I think, a bit of a stretch. We have all known warm, nurturing men and many of us have known cold, demanding, authoritative women. I agree with the notion that we do not need another round of “Anatomy is destiny,” but I think we do need a way of understanding the relationship between mind and body that frees us to deal with the current revolution in gender in which the binary is totally rejected and the spectrum first envisioned by Freud has come to mind-bending reality.