Fault Lines, Blind Spots, & Otherness

The impact of the coronavirus pandemic has been seismic in its exposure of systemic cracks and flaws across the spectrum. Assumptions about what once felt relatively predictable in terms of health and economic safety, job and educational security, and expectations for the future have been upended by the destructive course of the virus. And at the national level, in the equally unpredictable convergence of events that determine historical moments, the fault lines of foundational and transgenerational racism that undergird our country have been highlighted.

Roused by widespread support for Black Lives Matter, institutions of every kind, psychoanalytic institutes among them, have decried institutional racism and the myopia of white privilege, and pledged to address them. Psychoanalytic institutes have taken steps to welcome Black faculty and fellows and to intensify diversity awareness and training. But overdue and critical as this focus on racial bias and blindness within institutional psychoanalysis undoubtedly is, might it also be obscuring other longstanding fault lines in the contemporary psychoanalytic system that intersect with it and may be equally difficult to reckon with? For a large number of clinicians, the private practice of psychoanalysis and psychotherapy is dependent on a supply of high-income patients, a reality that reflects the prevailing and established steep socioeconomic divide and system of wealth inequity. The luxury status of private practice treatment affects patients of color disproportionately, and Black patients in particular, many of whom lack insurance coverage and are unable to pay moderate or even low out-of-pocket fees or copays. The racial problem is equally a socioeconomic one and accounts in no small measure for the paucity of Black patients in psychoanalytic clinics, as well as in private practice.

From its inception, psychoanalytic treatment was inflected with class privilege and opportunity, notable as early a