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The convergence of psychoanalysis with the U.S. medical system is marked by two main epochs relevant to this current review: the post-war period (1950 to late 1960s) when psychiatry dominated mental health treatment and the current post-pandemic period that has resulted in the expansion of virtual, Telehealth services alongside a medical insurance system that has aggressively limited the number of treatments allowed (as well as limits on the length of treatment).
Following World War II, newly arrived psychoanalytic clinicians and theoreticians arriving in the U.S. aspired to continue developing pre-war European psychoanalysis within a North American context. The influx of non-physician lay analysts were confronted by a uniquely American interpretation of Freudian psychoanalysis. Between 1950 and the late 1960s, psychiatry emerged as the medium for transmission and the unofficial regulatory body that determined how psychoanalysis should be taught and practiced.
Non-physician psychoanalysts, who had previously thrived in the pre-war “lay analysis” period outside of North America, were experiencing a compromising transition when emigrating into what might be described as the U.S. “neo-Freudian medical model of psychoanalysis.” Within this model, psychiatry ascended even more powerfully as the gatekeeper of psychoanalysis.
Psychoanalysis in psychiatric hospitals became the model for what occurred in the analyst's office. Within the postwar model, rigidity in theoretical and clinical scope manifested by dogmatic adherence to what U.S. clinicians envisioned as the only authority on interpreting Freud. While Freud himself had wrestled with the ideal vision of the psychoanalyst, he believed that artists, and more broadly, the creative class, embodied a certain animating spirit of the psychoanalytic practitioner. Contrasting Freud, the post-war U.S. Freudians argued that the proper psychoanalyst was the physician, specifically the psychiatrist.
In this post-war period, Otto