Let me congratulate you, first of all, graduates of the class of 1990 of the San Francisco Psychoanalytic Institute. You have just successfully completed one of the most arduous and expensive courses of training in any profession. Your accomplishment is a measure not only of your capacity for hard work, but also of your dedication to psychoanalysis as a science and as a profession.
Graduations are in the nature of initiation rites—you have now entered into the Council of Elders. The future of the profession and its educational procedures will inevitably become your responsibility. You will have to face the task of bringing psychoanalytic training and education, which in my opinion is woefully antiquated, into consonance with the realities of the 21st century. Accordingly, I would like to direct my remarks this afternoon to the question of revising the psychoanalytic curriculum.
My remarks evolve from a meeting I had with the Curriculum Committee of the New York Psychoanalytic Institute. I made some suggestions about teaching psychoanalysis as a natural science and adopting a more historical and critical perspective on what is taught. Such observations, I felt, applied particularly to the way in which Freud's early works were usually presented in the psychoanalytic curriculum. To place my suggestions in proper perspective, I decided to write the following aide-memoire to jog the memories of some of our educators concerning the origin of the psychoanalytic curriculum.
Some 30 years ago, before I was Chairman of the Board on Professional Standards and before I served for five years as Chairman of the Committee on Psychoanalytic Education (I include these to establish my credentials as a psychoanalytic educator), I was President of the American Psychoanalytic Association. As one of the prerogatives and responsibilities of my office, I used to visit the various committees of the Board and Council to observe how their members were fulfilling their duties to the Association. One such visit was to the Membership Committee, a body then serving the function that has since been assigned to the Committee on Certification. The Membership Committee's mode of functioning was roughly identical to that of the Committee on Certification, and their decisions, then as now, were based primarily on the examination and evaluation of case reports of patients treated by the applicant.
One applicant remains indelibly in my memory. He was clearly a most talented man, with an extraordinary gift for lucid presentation. In his covering letter to the Membership Committee, he expressed himself in part as follows: “When it comes to evaluating my case writeups, I would like to direct the attention of the Membership Committee to the following considerations. I am a beginner in the field, and I live and work in a city where very few people have ever heard of psychoanalysis. Those who do know about it are mostly hostile to it. Under the circumstances, as you can well imagine, it has been difficult for me to get a good analytic case, although I feel confident that, properly applied, psychoanalysis would be of benefit to most patients.”
The first case that I am presenting is that of a young woman still in her teens. She was caught up in the family intrigues all too common in our upper middle class suburban society, but she was not easily fooled and, not surprisingly, was bent on revenge against those who had wronged her. In my description of the case, I have focused on a particular dream and its implications for the transference, implications that dawned on me only slowly. It was for me, however, a most illuminating experience, and I trust the committee will agree.
The second case is that of a young man with artistic leanings who suffered from severe obsessive-compulsive symptoms centering primarily on religious themes. He was the scion of a well-to-do family whose fortunes in recent years had taken a sharp decline. The understanding of this case, which, as I have indicated in my report, I have followed for a very long time, also centered on the interpretation of a crucial dream. On the basis of my understanding of this dream, we were led in the analysis to the unraveling of the patient's infantile neurosis and the recovery of a traumatic event from his earliest years. As you will see, I have taken great pains in my description of this case to supply the necessary process details, which serve to validate the preoedipal reconstruction.
My next two cases may perhaps be regarded as problematic. In both instances, I have used the psychoanalytic approach meticulously. The former derives from the realm of child analysis. I understand that at the present time there is considerable controversy among analysts and in the Board on Professional Standards itself concerning the admissibility of experience from child analysis for qualification for membership in the American Psychoanalytic Association. I do appreciate that the method of treatment diverges in large measure from standard psychoanalytic procedure, inasmuch as children are unable to associate freely and also because they cannot form a real transference, inasmuch as they are still in a relationship with their primary objects. Nonetheless, I feel that the material that I have to present is so revealing about the nature of childhood sexuality and is so illustrative of the genesis of anxiety that the case warrants presentation for purposes of admission to the American Psychoanalytic Association.
The fourth case represents a venture that is rarely undertaken even by more experienced analysts, to say nothing of a beginner. It is a meticulous psychoanalytic investigation of the productions of an undeniable case of psychosis. The patient was a highly successful man, married, with no children. He appears to have suffered several breakdowns of a paranoid nature. Although I admit that this was a rather daring undertaking, I have reached the conclusion that my analysis of this patient's productions enabled me to elucidate, in a way that probably has not been done before, the psychodynamics of certain types of psychoses. I trust that the members of the committee will not find this last assertion too brash and immodest but will take it in the spirit of honest inquiry with which I approach the material of this fascinating individual.”
Intrigued as the members of the committee were by the exemplary case reports the applicant had submitted, after much debate and controversy, they voted to reject his request for admission to membership in our association. The reasons for rejection were given to the applicant in a letter from the Chairman of the
Committee on Membership, a straight-forward and, I would say, rather hard-nosed person. He said in part: “The Committee on Membership read your case reports with great interest. You are unquestionably an unusually perceptive observer, with a most enviable capacity for lucid and convincing exposition. There are, however, a number of difficulties with each of the cases you presented for consideration. While Case No. 1 holds together in a most remarkable fashion and is as engrossing as a novel, the fact remains that the patient was in treatment only a very short period of time. It is not clear from your report whether she was in analysis nine weeks or eleven weeks. In any event, the treatment ended abruptly and onesidedly when the patient decided to discontinue. Apparently the transference implications of much of her behavior, as you yourself admit, had been missed by you until it was too late. The fact that you refused to take her back into treatment some time later, when she appealed to you, puzzled several members of our committee. Could this refusal have been the residue of some hostile countertransference feeling? Perhaps you felt frustrated that she had left just at the point where you thought you had solved the problem of her neurosis.
This brings up some issues in connection with Case No. 2 as well. Did the patient really enter a termination phase? The rules of the Board on Professional Standards do not require that the patient go through a successful termination, but the drastic method of imposing a deadline onesidedly seemed to some of the members of the committee to be ill conceived. Perhaps the patient was sicker than you appreciated. Unfortunately, we do not have a supervisor's report on this case. Some members of the committee felt that the patient could be characterized as suffering from a borderline disturbance with a potential for paranoid decompensation. Others thought that the therapeutic achievements of this case may have reflected an idealizing transference. As you can appreciate, there are differences of approach to theory and technique among the members of the committee as well. Accordingly, there was some disagreement about the validity of the reconstruction of the preoedipal trauma, but, by and large, the majority of the committee sustained your interpretation. Many of them considered it to be quite brilliant. In sum, however, there was sufficient uncertainty about the severity of the pathological process and the prognosis for the patient to invalidate the case for purposes of membership.
Your observations on the case of the five year old patient with the phobia were striking indeed and your interaction with him impressed especially those members of our committee who have some experience with child analysis. Leaving aside the controversy about admissibility of child analysis experience for purposes of membership certification, this case could hardly be called one of child analysis. You saw the patient very infrequently, two or three times perhaps. Most of the work was done by the father under your guidance. We assume that he is either a colleague or someone with previous experience in analysis. In any event, in spite of the splendid outcome for the patient, we could not accept that case either.
The final case that you presented could not be considered a case. Your report constitutes a brilliant application of psychoanalytic concepts to the phenomenology of the paranoid psychosis, but what you have given the committee is an exercise, albeit a brilliant one, in psychoanalysis applied to data not obtained within the standard psychoanalytic situation. While conceivably this might be the kind of material obtainable in direct working with the patient, the fact is that no such involvement ever took place. Some of your interpretations were felt to be rather dogmatic, not taking into account the possibility of alternative explanations. Accordingly, we had to conclude that, brilliant though your analysis was, it could not be considered a case study for purposes of membership.
“This scientific spirit of free inquiry, of readiness to change, should be the center of our professional heritage, and psychoanalytic education….”
All the members of the committee were greatly impressed by your insights and exposition. You are the kind of person that the Association eagerly seeks but never finds. So we ask you in the meantime to continue with your analysis. Your analyst seems to be doing an excellent job. He has helped you clear up the crippling symptoms that appeared in consequence of your father's death. We are sure that further self-exploration will help you overcome certain countertransference difficulties that we have detected in some of the case reports. Please let us hear from you very soon.
In the meantime, my committee and I have a very unusual and delicate request to make of you. We have found your exposition of psychoanalytic process and interpretation so lucid and convincing that we would like to use this case material for purposes of teaching candidates in psychoanalytic training. We realize that this raises certain issues of confidentiality vis-a-vis the identity of the patients, but there are ways in which these difficulties, we are sure, may be circumvented. The most difficult situation would arise in connection with your first case, the patient whom you called Dora. She seems willful and angry and has already caused enough grief and trouble to her parents and others. The case of the charming little Hans with the horse phobia should present no problem. You achieved an exemplary result, and his family is well disposed to you on that score. The third case, whom you labeled the Wolf Man, also seems to present no problem. We gather that he is quite an exhibitionist. He is, after all, an artist. He struck us as the kind of man who would revel in having his case published to the entire world. It might even make him a celebrity. Finally, of course, the memoirs of Senats President Schreber, published by him, are part of the public domain. Our lawyers state that we would hardly even have to ask his permission, although it might be the better part of wisdom to get in touch with him.
We hope, Dr. Freud, we have not been too disappointing to you. We look forward to accepting you into membership the next time, and we hope that you will consider our request to use your case material for purposes of student indoctrination as the compliment it is intended to be.”
Classically, Freud's case histories have served and continue to serve as the introductory texts to the teaching of psychoanalysis. We are perhaps the only profession that uses textbooks almost 100 years old. Furthermore, these texts have been subject to seemingly endless extension, elaboration, improvement, and reinterpretation. No detail seems so insignificant that it would not merit a contribution to the literature. In the mid-1950s, when I was a member of the Editorial Board of the Journal of the American Psychoanalytic Association, I reacted to the avalanche of the studies of this type and wrote to the editor of the Journal: “The time has come for the willful Dora, the charming and engaging little Hans, and the august Senats President Schreber and their companions to
take a well deserved rest between the hard covers of the Standard Edition of the Complete Psychological Works of Sigmund Freud. They are our youthful friends, and they served us well; but the time has come for us to get on to other things.” Freud's early papers and his case histories are milestones on the road to great discoveries made by a genius. They are major historical documents, but they do not represent modern psychoanalytic thought and practice. Is there really any need to continue studying them as if they were the holy writ of psychoanalytic science?
This trend is part and parcel of a transference idealization and mythologizing of the image of Freud, but, as we know, transference idealization very frequently is the other side of the coin of derogation. On one hand, there are those who rush to defend Freud against any implication of imperfection. On the other, there are analysts who cannot resist the temptation to analyze the primordial analyst. As a result, there has come into being a literature of overwhelming proportions, in which analysts reinterpret Freud's dreams, examine every slip of the pen and tongue, point out what he missed, why he fainted, where he had countertransference, and on and on and on. It is a seemingly unending preoccupation growing geometrically and showing no signs of abating. In the end, all such studies are speculations, appealing perhaps to literary scholars but hardly serving psychoanalysis as a science. Psychoanalysis was central in Freud's life, but Freud's life is not central to psychoanalysis as a science. The validity of psychoanalytic findings is quite independent of what happened to Freud the man. What we should emulate is his open-minded, endless curiosity, the priority he accorded the facts of clinical observation in formulating his theories, and his readiness to change or abandon theories when confronted with evidence that refused to conform with established preconceptions.
This scientific spirit of free inquiry, of readiness to change, should be the center of our professional heritage, and psychoanalytic education in general and the nature of the curriculum in particular should be brought up to date in keeping with that spirit. We must have a better historical perspective on the evolution of psychoanalytic theory and practice, on where we stand now and what the prospects are for the future. It is in this spirit that the psychoanalytic curriculum should be revised, and that is a task that will remain for you, members of this graduating class. At some point in the future, you will have to make decisions crucial for the future of psychoanalysis. I trust you will do so with the open-minded objectivity and quest for truth that is our principal legacy from Sigmund Freud.