Twice President of the American Psychoanalytic Association and twice President of the International Psychoanalytic Association, Dr. Rangell maintains his position as a respected and active contributor to the field.
Being invited to contribute this article as a send-off early in Estelle Shane's editorship of the Newsletter has for me a special, poignant pleasure. It brings to mind my writing the President's greeting in 1967 to Volume 1, No. 1, of “a new medium, a new vehicle of communication” which our administration started, with David Kairys as its first editor. This informative publication, looked forward to with pleasure by the membership, has flourished and served us well in the 20 years since then.
I was asked to write about my view of psychoanalysis, its past, present and future. While such an assignment is always timely, it has a special relevance having just celebrated our 75th anniversary. Many of us present and active today will not be here at the 100th.
The open-endedness of this invitation is both a challenge and an opportunity. Since I must limit myself to what I consider most crucial, as a starting point, I am reminded of a story: Babe Ruth was asked how he did his job when the crowd yelled and hollered and stamped every time he came up to bat. “That's easy,” the mighty Babe replied, “I just keep my eye on the ball.” The ball, to every psychoanalyst around whom debates and opinions are also always being loudly proclaimed is the anxiety of the patient. The patient comes to treatment because of what he suffers, not because of what he is. This is what differentiates psychoanalysis from existential psychiatry; whatever else happens in and around the hour, “keep your eye on the anxiety.” That is what the patient and the analyst are there for. That is the best guide in practice and the best advice to every young analyst in supervision.
As our discussions, communications and literature are increasingly filled with issues of third party payments, peer review, insurance problems, legal questions, licensing and the like, I think time and again that we would do well to pay more attention to clinical and theoretical issues, which are our raison d'etre. Without wishing to minimize the importance of practical and realistic issues, or the social issue of the delivery of health care, I would have us turn back, as of more central and vital interest to the subject of understanding, to the theory and science of our professional activities.
We have as a legacy of this past three-quarters of a century a tool which, in my opinion, is the most valid yet devised for studying scientifically the complex behavior of man. With all its weaknesses, challenges and methodological problems, it is ours to preserve and utilize while perfecting and expanding it by continuous studies. The theory, our intellectual armamentarium, combines a means of obtaining valuable data, a method to maximize the informational yield, and subjecting the accumulated facts to our system of understanding. For us that is the theory of psychoanalysis arrived at, with whatever dissension, by consensus and by endurance over time.
From the patient there is free association. While Eissler, writing in the 50th Anniversary Number of the International Journal of Psychoanalysis, expressed what he felt were the limits of free associations toward further contributions to the science of psychoanalysis, I believe, as does he, that no more direct approach has supplanted it as a source of data. From the analyst, there is the analytic attitude, as the theoretical and practical fulcrum of the analytic approach, combining neutrality and kindness, objectivity and caring, so difficult to achieve, so common and ubiquitous and yet so individualistic.
The method endures. Research by psychoanalysis still has a long way to go to exhaust its sources of data or its potential. Clinical research is to be encouraged and facilitated, as has been emphasized recently by the Council on Research of the American Psychiatric Association, who point out the danger of such vital research becoming a vanishing interest.
At the same time, the method and the contents it studies invite the most intense and continuous doubts, controversies and debates. For explanations of the rise and fall of psychoanalytic popularity from the ′50s to the present, I suggest we look not only, to changing trends and fashions in the culture, nor to disillusionment of patients—psychoanalytic results were the same before and after that period—but to faltering inspiration. The main stimulus to the excitement our discipline evoked during the '50s and early '60s was the inspiration it elicited not in the sense of idealization or even worship which some fear acceptance and appreciation of Freud must mean, but the quiet satisfaction which comes with understanding. It was never mainly therapeutic results upon which respect for psychoanalysis stood but the ability to understand the plateaus, resistances and failures as well as positive treatment effects.
Psychoanalysis is a rational treatment; its application is via the rational ego. In
these references to rationality, I hasten to grant the subjectivity of “rational”, and the ready invitation this provides to debate. I am speaking, however, of criteria for logic and rationality which are generally accepted, and upon which we can all reasonably agree. At the risk of arousing an avalanche of objections, but in the spirit of self-assessment and the introspective confrontation with inner negative forces characteristic of the psychoanalyst's approach, I offer the observation that our field harbors within it a weakness or failure of a consistently rational evolutionary approach.
An irrational base, or an irrational method of arriving at or testing theory, frequently invades the theory of understanding itself. This is so despite the fact that the opposite is also true, that psychoanalytic theory and practice, and psychoanalytic group and professional life, progress at the same time in a rational evolutionary path. It is intrinsic to psychoanalytic theory, and life in general, that both trends co-exist.
The theoretical multiplicity from the ′60s to the present, considered by some a healthy scientific ferment, has seemed to others an intellectual bedlam, or at least confusion. Many difficulties in our relations with the public, with contiguous disciplines, and within our own field have followed from this ferment. It is not the conceptualization of alternative theories which introduces concern and dissension, or loss of confidence or conviction, but the presence of fallacies, and spurious and devisive methods of thinking, which erodes the centrality of rationality in the newly offered systems of understanding.
A tradition of the irrational invading explanatory formulations has existed from the beginning. The mysticism and overt supernatural qualities of Jungian theory early rivaled Freud's explanations. Primary process thinking was introduced into, and supplanted, secondary process assessment, with rivalry and opposition becoming more important than additive development. Since then such qualities have been accepted in more covert fashion. Intrapsychic conflict, hard-won as an insight, was replaced by interpersonal conflict with no concern for what was given up. Many alternative theories led to positions which were one-sided, exaggerated, irrational, even absurd, both in observations and explanations. I do not mean differences of opinion, or even the espousal of theories which may, though contradictory, exist side by side, but theories which are incompatible and mutually exclusive.
Newly offered theoretical systems can provide insight or new ways of thinking which can be additive and helpful. The early pioneers could have added to the total evolving theoretical lode; Adler was a forerunner of ego psychology, Rank anticipated early psychic trauma; and Ferenczi laid the groundwork for active treatment, empathy and the understanding of countertransference. The same applies to most of the new theories offered in modern times. Total theory (I prefer this term to “classical”, which contains a built-in ambivalent connotation) is better served and preserved by accretion than by replacement.
But almost all alternative theories, then and since, stand upon fallacies which undermine the presumably accepted rational goal. Two such common conceptual errors are pars pro toto, or its opposite, attention to the whole alone, to the exclusion of the parts of which it is composed. It is not necessary, in order to understand the workings of the whole, to abandon what has been achieved in explanatory depth by understanding the interactions among its internal parts. The internal parts do not detract from a thorough knowledge of the self or the person. Both configurations, the whole and its parts, are important for an integrated scientific encompassing of the total functioning human entity. Each has relevance at different times to different searches and interests.
New theories based upon such fallacies become the fulcrum for the formation of groups, a development which deters, rather than advances, further scientific development. Psychoanalytic theory and psychoanalytic group life are reciprocally interactive, cohesiveness or fragmentation in one spawning the same in the other. Rationality or its absence involves both simultaneously.
The same rational body of theory serves to understand both individual and group psychopathology, including those groups of which we are members. Just as psychoanalytic theory is directed toward conflicting forces among psychic agencies within the individual, so does it equally provide guidelines to understanding conflicts among individuals. These include relationships between analysts and their surrounding world and among analysts themselves.
Within our profession, the affects we study in others influence our own and encroach on the instrument we use to understand. This takes the form of countertransference within the diadic therapeutic relationship and other irrational phenomena in wider group relations. We live and practice daily at the border between clarity and realism on one hand, and defense and distortion on the other, observing and interpreting behavioral phenomena traversing in either direction. Yet in our organizational and professional lives, rationality has not been prominent or consistent; moreover, this phenomenon has not received sustained attention.
From minor institutional dissension to major organizational splits, divisions or disruptions in our professional ambience have often become our way of life. Neither splits nor non-splits are always effected on a rational basis. Nor have post-split repprochements of societies or institutes repaired former breaches in an open, rational or acknowledged way.
Such problems are visible in the daily lives of institutes from the oldest and largest to the smallest and youngest. At the first meeting of a newly-accredited society in another country, I stated that I could already see the form of their future split. This came to pass three or four years later! In such developments, the mechanisms we study are allowed to invade the instrument of investigation itself. The movement to validate and promulgate a theory becomes directed more by group than by individual psychology. Affects color objective assessment, id supplants ego, ambiguity is more valued than clarity, the irrational invades explanatory rationality. While such characteristics are routine in the data of psychoanalysis, they should not be sought or encouraged in systems of understanding.
There is no lack of appropriate scientific debate on such issues, but there has been, in my opinion, a singular deficiency in the responsibility of applying what is brought forth intellectually.
Irrational mechanisms intruding into scientific discourse are not specific to one type of theory, and are not limited to new or unfamiliar theories or concepts, but are equally employed in defense of the old and established. On a theoretical level, I have shown that compromises of the superego take place as commonly as of the id. This applies not only to the psychopathology of patients but to the characteristics of group life. While analysts have accepted the empirical fact that they have no corner on realistic actions or neurosis-free living, I would like to offer a view from the other side, typically neglected or even avoided: they may have too easily abrogated the need, or even the responsibility, for opposing, insofar as possible, irrationality within their own professional ranks and activities.
What is the role and the responsibility of the American in the face of these forces?
(The second, concluding installment of this article will appear in a subsequent issue of the Newsletter.)