What is the role, and the responsibility, of the American Psychoanalytic Association in the face of the irrational forces within our own professional ranks and activities I elaborated in the first installment of this essay? [Newsletter, Winter, 1987.]
The American has always embraced as a major function the charge to maintain and preserve standards. These involve not only standards of training but also of our scientific heritage. In the only split on the national level—in the early 50's, from which the Academy was formed—comparable to those which took place at local levels around the same time, the American stood for the preservation of standards, and the identity of its members as psychoanalysts in accordance with what it considered the sine qua nons of psychoanalytic theory and principles (without ever claiming an exclusive right as to who could call themselves psychoanalysts).
Crises in administrative life repeatedly call for tests of theoretical issues and scientific clarity. Each president of the American has typically been confronted in his turn with an issue which tests the mettle of the science, and the strength of the scientific credo of the administration and membership of the Association. In the 50's there was a threat of engulfment by medicine; then there was a suggestion that we become part of the American Board of Neurology and Psychiatry; subsequently there arose the question of relations to medical schools and Universities. Each issue called for a clarification of the place of psychoanalysis in the family of science. During the 60's, in one of my terms as President, the issue I was confronted with, which brought forth the same necessity for theoretical clarification, revolved around the problem of the tax deductibility of the training analysis, based on whether the latter was to be considered therapy or training for a new profession. We established that it was both, and that if one or the multiple functions qualified it, the deductibility applied.
It was through the maintenance of scientific clarity and consistency that the American attained the prestigious position it enjoys today. In the recent past, a legal difficulty facing one component institute was overcome by a firm and clear scientific position on the nature of transference. Previous conflicts led to a defense on our parts against an exclusive alliance with medicine and biology at the expense of psychological and cultural disciplines. Since then, after long and subtle discussions, and a delicate working balance having recently been achieved, suddenly an opposite situation prevails. A current lawsuit by psychologists challenges our Association, under external pressure to possibly loosen its ties to biology by altering its evolved mix of medicine and the psychosocial disciplines, arrived at in our own way by decades of experience and scientific discussions.
The American has historically approached such issues on the basis of the merits of their scientific principles, while resisting pressures and coercion based on political or legal grounds. An able psychoanalyst can come from one of many different paths or directions. The scientific principle, however, of an equal theoretical linkage to the psycho-socio-cultural and to the biological must be maintained and applied. The hermeneutic emphasis is compatible with a more abstract explanatory level based on neurophysiological accompaniments.
Psychoanalytic theory retains an interface toward neuroscience and biological advances (although not without careful delineation of the areas of each; indiscriminate mixing of the two at the border between them is not the answer, or even a scientific advance). The future of psychoanalytic science will in fact come from an advance of both fields and their relationship to each other, consonant with the opinion expressed by Freud a number of times during his life. Ironically, total composite theory, as I conceptualize it, provides an interface with wider interdisciplinary fields than does the sum of the individual alternative theoretical systems.
The American has always stood for the objective, scientific and enduring. This firm central position needs to be retained in its organizational relations as much as within its internal scientific structure. This applies, for example, to its relations to the International Psychoanalytic Association, where the stability it can introduce and maintain is valuable for analysis universally. It is not only tradition which defines the relationship between the two, and has given the American the only status of a Regional Association within the International, but the reasons originally behind such a hard-won move. A threat to this established relationship, brought about by external pressure, would in my opinion, alter the stability and balance provided to the remainder of world psychoanalysis by the principles under which the American operates. In the years during which this understanding has been in effect, the influence of the American toward stability of theory and practice has often been appreciated in other countries during periods of more adverse and precarious conditions.
Whatever new administrative arrangements are entered into, for realistic reasons
of law and necessity, as well as considerations of changing social and intellectual conditions, retention of the Regional status achieved by this geographic area, in the sense of retaining autonomy and being responsible for its own standards and criteria, continues to be indicated as in the past. In the face of the increase of analysts which might be anticipated, and from diverse paths, in addition to the dubious methods of proliferation of new theories, it is even more essential to retain what has been gained, the independence of the American Psychoanalytic Association to determine its own standards of training, and, I add, the criteria for what it considers the essential elements of the psychoanalytic theory of understanding.
Psychoanalysis has a root in biology as well as in the psychosocial disciplines. Freud's metapsychology linked analysis to biology. A relationship to both biology and the psychosocial disciplines is the present scientific orientation of psychoanalysis in the United States. While we resisted engulfment, we should not invite alienation. Any arrangement which might in effect loosen the link to medicine and psychiatry, or diminish the interest of residents in psychiatry as a source of candidates for psychoanalytic training, would not only affect the practice of psychoanalysis, but could also significantly alter the outlook for the future of psychoanalysis as a science of man. While literary figures, artists, philosophers and educators, as well as psychologists and the spectrum of the humanistic sciences, have made indispensable contributions to understanding the human mind, it is important for analysts to have a link to the biological, and for biologists to have a knowledge of the dynamics of mental functioning. This is particularly so at this time of burgeoning research and bursting knowledge at the border between mind and body, and of the psychosomatic synapse in both directions.
Kubie has described the ideal position of psychoanalysis within the family of science, and Anna Freud the ideal Institute, both more idealistic than practical, but each providing a goal to aim at. Whatever the educational paths under new, evolving arrangements, a basic building block of the analyst revolves around the nature of the training analysis. This should be a “real” analysis, which so many admit, and even accept, may not always be the case today. Superego analysis needs to be as strong and relentless as that of the id. This area has a long way to go in research and development. Upon its effects and results will depend the capacity of the future analyst to live, behave and exercise judgment as an individual while surrounded by and related to the group.
The educational process in its spirit and content should provide for better intergenerational succession, and greater satisfaction in living the life of an analyst in the new derivative version of the family. Toward this end, there would be less envy, lack of gratitude, character assassination, unconscious plagiarism, rule by cliques, and begrudging bestowal of praise, and a more ready acknowledgement of achievement, and simple, mutual respect. Followership would be less and less automatic. Psychoanalytic research might become the goal of a larger number as the creativity of the individual becomes more routine.
I remember in the 50's when Erikson, not without trepidation, was inserting the roles of such homey concepts as trust and hope into the language of ego psychology. I add sincerity, and have written about this scientifically, as has Trilling, as well as the character traits of integrity, courage and frankness, necessary not only in psychoanalytic work but also as guidelines for group behavior and decisions. Individual choice and responsibility, as an extension of the concept of ego autonomy, is a subject of my most recent scientific concern. The relentless pursuit of truth, however difficult its vagaries, has always held out a more enduring promise than therapeutic zeal.
Over 30 years ago, Waelder, writing on the functions and pitfalls of psychoanalytic societies, noted the frequency with which the original aim for which the societies came into being, to further psychoanalysis, becomes superseded by secondary aims. The organization develops a life of its own, to further social and economic goals and the human needs of the psychoanalysts themselves. Periodically, it is necessary to reverse ourselves to re-establish the original goals. Administrative decisions should take their direction from scientific psychoanalytic principles and the practical applications which derive from them.
The course which will determine the role of psychoanalysis as it moves toward the completion of its first century, in its influence over both individual and group behavior, is whether its insights will lead to the rational extending its domain over the irrational, or the reverse, whether irrational forces, of drives and affects, will encroach upon the psychoanalytic instrument of understanding to a sufficient degree to blunt or mitigate its potential effects. Both processes have been in conflict with each other since the inception of psychoanalysis.
With our eye on anxiety, and trying to understand it all, under the umbrella of total, integrated psychoanalytic theory, there is unity in diversity, encompassing the complete range of human behavior. The root word of integration is integrity. Oedipal and pre-oedipal, internal and external, drives and objects, trauma and fantasies, regressions and progressions, structural neuroses and deficits, transference and reconstruction, not either alone, action theory within ego psychology, the clinical hermeneutic fused with the metapsychologic explanatory, all exist in synergistic harmony, making for the unique blend of science and humanism which is psychoanalysis. With total, composite psychoanalytic theory, rather than competing, fragmented theoretical parts, inspiration may begin to find its place again, both within the field, and for those who look to it for stimulation and direction.