The San Francisco Psychoanalytic Society was founded toward the end of what could be called, with modest exaggeration, the American psychoanalytic Civil War. The disputes in this conflict represented the other side of the welcome to immigrant analysts and the consolidation of psychoanalysis as a profession in the years from 1930 to 1942. The issues were orthodoxy vs. neo-Freudianism, lay vs. medical analysis, and, at times, friction between immigrant and native American analysts. The conflicts were exacerbated by economic depression, Freud's exile and death, and the opening of World War II. The resolution of these issues by 1942, in which San Francisco played an important role, determined the texture of mainstream American psychoanalysis. This version of San Francisco's history will describe its early beginnings, including its unique attempt to secure status for lay analysts, its changing demographic mix, and the evolution of what candidates have been taught there.
Shortly after his arrival in San Francisco in 1937, Siegfried Bernfeld was made acutely aware of some of the issues then creating conflict in American psychoanalysis. In a vivid letter written to Anna Freud on November 23, he described the surprising local popularity of psychoanalysis. The yellow pages of the telephone book listed numerous psychoanalysts, while the drugstore literature was full of references, including such typically California titles as “Personality, Food therapy and Psychoanalysis by the World's Greatest Psychologist.” Psychoanalysis locally was a lay affair. At A. A. Brill's suggestion, Bernfeld had visited Joseph Thompson, an eccentric physician hostile to the medical profession, whose house was lined with cages of Siamese cats. His membership in the American Psychoanalytic Association had become void when it was reorganized as a union of local societies. He had developed a “large and poor practice” and had set up two former patients as analysts. There was also a serious interest in psychoanalysis among psychologists, social workers, criminologists, anthropologists, “and sometimes, even educators,” as well as at the local Jewish Hospital, Mt. Zion, with its child guidance clinic, and at the University of California's Child Study Center in Berkeley, where Bernfeld and Erik Erikson would soon be doing research.
The widespread interest among laymen and the existence of largely untrained practitioners were among the motives that led a new generation of chiefly European-trained analysts to establish rigorous professional standards. But America's two training institutes, in New York and Chicago, were but five years old in 1937, and New York was the scene of ongoing internal disputes which shortly would grow worse. The American Psychoanalytic Association, reiterating an old American stance and possibly fearing competition from emigre analysts, forbad in 1938 the training of laymen and accepted for membership only those lay analysts whose training had been completed or who belonged to a recognized American psychoanalytic society.
In the professional consolidation of these years, science, rigorous training, and orthodoxy became linked. Conditions in California, in both Los Angeles and San Francisco, exaggerated the national issues, particularly the delicate problem of lay analysis. No strong medical figure, such as A. A. Brill in New York, had shepherded psychoanalysis in California. Los Angeles had a coterie of untrained and self-proclaimed lay practitioners. California's first
trained analyst happened to be a layman, David Brunswick, a Johns Hopkins Ph.D. in psychology who had been analyzed by Freud. He had organized the first Los Angeles Psychoanalytic Study group and in 1934 invited the physician Ernst Simmel to direct it. Leaving Berlin after Hitler's rise to power, Simmel had been waiting in Brussels to emigrate to America. California's licensing laws made it unusually difficult for foreign physician to practice, requiring not only an examination but a year's internship, far stricter requirements than those in New York, where a number of emigre physician analysts had been accredited.
Into this problematic professional scene in California came the emigres. They included not only a relatively numerous and often distinguished contingent of lay analysts but also physicians who did not meet the California requirements, among them Simmel and Otto Fenichel, both distinguished members of the archetypal psychoanalytic institute in Berlin. At first the medical authorities seemed willing to let laymen practice, presumably under the supervision of a physician. It happened that the lay immigrants—Bernfeld, Frances Deri, Erik Erikson—together with Simmel and Fenichel, played crucial roles in psychoanalytic training in California, having had more psychoanalytic experience than most of the California physician analysts. Then, in 1941, the Board of Medical Examiners asked State Attorney General Earl Warren for an opinion. Warren, later California Governor and U.S. Supreme Court chief justice, ruled that psychoanalysis was a medical treatment and as such its practice by non-physicians violated the state's Business and Professions Code.
However, with occasional exceptions, there seems not to have been any serious prosecution of medically unlicensed analysts, although there were threats of that possibility in 1941 and later. Nevertheless, the number and prominence of lay analysts compromised the attempt to organize a California Psychoanalytic Society in 1941 and 1942 under the aegis of the Topeka Society. At the time Simmel feared that Thompson's group would set up its own lay organization. Simmel had hoped to include the psychoanalytically trained lay analysts in a special “accredited” membership category, without the right to vote or hold office, and with their practices medically supervised. But even this failed to satisfy three medical analysts in Los Angeles who said they feared the possible wrath of the Medical Licensing Board. In 1941 Simmel and Fenichel also withdrew from the attempt.
The result was the formation at Mount Zion Hospital, on March 8, 1942, of the San Francisco Psychoanalytic Society by a group of ten physician analysts, among them Bernhard Berliner and Emanuel Windholz, emigres who had fulfilled the state requirements, as well as Fenichel and Simmel. Simmel, who was elected president, insisted on the scientific status of Freudian psychoanalysis and on the rigor of its organized training. He hoped to draw a clear distinction between legitimate psychoanalysts and the untrained lay practitioners and thus impress the State Board of Medical Examiners. Simmel hoped to include lay analysts in the new San Francisco Society as accredited members on the same terms proposed for the failed California Society: no offices, no vote.
This modest proposal was rejected at the national level because it was contrary to the recent policies of The American. The May 1942 meetings of The American in Boston posed the San Francisco Society a dilemma: either renounce the special category for laymen and be accepted as a constituent society, or retain the category and renounce membership in The American. The San Francisco group chose the former. But the Society also voted to keep a list of “competent psychoanalysts” who had completed their training prior to 1938 and who would have “full participation in the scientific work of the society on an equal footing with regular members.” The American's policy seemed to become increasingly rigid and in 1946 Fenichel, by then convinced that only with medical qualifications could he significantly influence the policies of The American, died during the year's internship he had undertaken at the age of 46. The San Francisco Society continued to advocate the training of laymen and later proposed for membership in The American a group of distinguished lay analysts.
Having failed in 1942 to achieve special membership for lay analysts already trained, San Francisco succeeded in blocking for a time the recognition of multiple institutes in the same locality. Here the issue was what loyalists regarded as keeping intact the essentials of Freudian psychoanalysis and what neo-Freudians referred to as preserving orthodoxy. For some years, the European emigres, especially the Viennese, but also some of the Berliners, had been unhappy with what they regarded as the growing deviations of Karen Horney and Sandor Rado, and particularly resented their criticisms of Freud. Fenichel, engaged in his encyclopedic reviews in the Rundbriefe, was caught up increasingly in these ideological and organizational controversies. He had taken pains to denounce Horney's views in letters and reviews, but, influenced by Marxism, he also wished to avoid the “psychologism” of the “ultra orthodox,” who attributed everything to the Oedipus complex. He feared that the “advanced people,” some of whose criticisms were correct, were rejecting “the dynamic viewpoint, the unconscious, the libido theory” and undoubtedly would “abandon psychoanalysis and Freud altogether.” Moreover, he regarded the “suppression” of lay analysts in California as a symptom of Americas “progressive degradation of psychoanalysis into a psychiatric method…” He even entertained the possibility of a “Freudian” secession within The American but believed the multiple institute plan would make it impossible, as then it would consist only of “newcomers and Germans.” He began the last of his Rundbriefe with the announcement that it was more important to fight for “the very existence of Freudian psychoanalysis” than for “the correct application of psychoanalysis to sociology.”
But not everyone believed psychoanalysis was so imperiled. Jacob Kasanin, chief of psychiatry at Mount Zion and an important figure in the new San Francisco society, defended presenting the “new developments” at a meeting of the Society at which it was clear Fenichel would take the “conservative” position. “I see nothing dangerous in it, and I am sure that analysis is secure enough and strong enough to be able to withstand the criticism and attitude of some of its radical members,” Kasanin wrote to Simmel; “It would be unfortunate if we were to become a completely reactionary organization. Some of the younger men in the organization resent the arbitrariness of the older members. It is such a situation which led to the split in the New York Society and the formation of a Horney group, something which I feel is very unfortunate.”
To Rado's and Horney's opponents, Rado's projected institute and the possibility of several institutes in the same city seemed only to guarantee unacceptable training in the new “advanced” views, as Fenichel ironically called them. The New York Institute, which Horney and some of her students had left in April 1941 to set up their own organization, argued that multiple institutes would create “self-perpetuating educational autocracies, training candidates in a single point of view.” The Boston Society agreed with New York, Helene Deutsch arguing that the separation of dissident groups into separate institutes would lose “for teaching purposes the exchange of ideas and opinions, mutual corrections…”
Finally a proposal to authorize more than
one institute was sent to local societies for a vote. Karl Menninger, who at first had opposed the measure, now believed multiple institutes were inevitable in view of the hard feelings on all sides in New York; he pressed for its passage to prevent an additional split. “By very careful steering,” he wrote to Fenichel, “we can keep psychoanalysis from becoming a cult with orthodox tenets on the one hand, or a loose, all-embracing psychological medicine on the other, the conflicting concepts and theories of which will dissipate and destroy it.”
But here the opposition of the San Francisco Society, led by Simmel and Fenichel, along with Boston and New York was decisive, and the proposal was defeated after a tangled procedural dispute. As a result, recognition for the new Columbia Institute hung fire for several years. The difficulty of resolving controversies through the cumbersome procedures of The American, with each local society ratifying or rejecting constitutional issues and determining training policies, led to a highly centralized reorganization in 1946.
All these disputes were fought out in the growing shadow of World War II. The May meetings of The American included symposia on war neuroses, and those who attended the second meeting of the San Francisco Society in 1942 had heard Erik Erikson deliver a brilliant analysis of Hitler's Mein Kampf.
The subsequent development of the San Francisco Psychoanalytic Society and Institute went more smoothly. During the war years, many of the medical members served as psychiatrists in the military, sometimes in important positions. Physician analysts who stayed in Los Angeles and San Francisco were asked to work in local public psychiatric hospitals and clinics. Norman Reider, one of Fenichel's candidates, headed the Army's training program for psychiatrists in the New York area and after the war succeeded Kasanin as chief of psychiatry at Mount Zion. Papers on war-related topics were conspicuous at Society meetings.
The lay analysis issue surfaced again in 1947, when San Francisco reinstated the category of accredited membership and included Bernfeld and his wife Suzanne, Anna Maenchen, and Nevitt Sanford. Orthodoxy also surfaced when three members influenced by Frieda Fromm-Reichmann were kept off the training committee.
The San Francisco Institute, like others across the country, was flooded with applicants after the war, most of them veteran psychiatrists or residents, and a period of rapid growth began. By 1950 there were 29 active members of the Society and six affiliate members, including one Ph.D. psychologist and three women; in 1960, 72 active members, including two Ph.D.s and eight women; in 1970, 111 active members, including nine women. Although the rate of growth has slowed, there have been steady increases, with a total of 160 members in 1990. That year, the Society, reflecting the American psychiatric profession, was still largely male and medical, with 21 women members or about 13 percent of the total. Non-physicians made up about 8 percent.
However, the demographics are changing fast; among 71 candidates in 1990, 45 are physicians, 18 are non-medical, and nearly one-third are women. Indeed, half of all applicants for training are now Ph.D.s in psychology, with a small percentage of social workers and Doctors of Medical Psychology—and half are also women. Candidates are also older and often are already experienced therapists; today the median age is forty, while earlier most candidates were in their twenties or early thirties.
Some of the most important changes have occurred in educational policy. A crucial issue in the disputes of the 1940s was whether Freud should be taught to candidates before other views were presented. And, indeed, for years the Institute presented psychoanalysis historically, beginning with Freud. For example, 28 sessions in the first year were devoted to dreams and to Freud's Interpretation, while technique was studied through his classic papers. In the 1960s ego psychology also was taught, beginning with Freud's late works and continuing with Anna Freud, Hartmann, Kris, and Loewenstein, and David Rapaport. There were also courses on the psychoses and on character analysis. Gradually, the curriculum has shifted from an historical to a more “cross-sectional” approach dealing with issues as currently conceived. Arlow and Brenner's updating of ego psychology has become central, including their views on compromise formations arising from all the components of the mind. Also important have been the preoedipal developmental theories of Margaret Mahler and her students, as well as object relations theory and, to some extent, recent work on narcissistic and borderline personality.
The most novel undertaking has been the introduction of courses on psychotherapy and its relation to psychoanalysis, acknowledgement that a candidate's future practice is unlikely ever to be entirely psychoanalytic. Students have expressed a hunger for views which differ from those of the prevailing ego psychology—those of Melanie Klein and her followers as well as of Lacan and the French. Accordingly, the Institute is developing a visiting professor program that will bring leading lights from around the world to spend a week with candidates and graduate analysts to explain their views of theory and technique.
The San Francisco Institute has long been distinguished by the research carried out by its members. Today, at a time when psychoanalysis is challenged as never before to demonstrate its therapeutic effectiveness, their research in psychotherapeutic conceptualization, methods, and outcome is of particular importance. Its thrust has been twofold: the creation of new and more comprehensive models bridging disciplines and theories; and attempts to measure long-term therapeutic outcome. At times the San Francisco research has aroused passionate controversy within the Society. In arguments reminiscent of those of the 1940s, some have denounced at least part of it as a defection from Freud's psychoanalysis. Others accept parts of it, while still others view it as embodying important theoretical and practical advances. Fifty-two years after Freud's death, and fifty after the founding of the San Francisco Society, it would be astonishing, indeed appalling, if psychoanalysis were to remain static and barren of controversy.
(Documentation is available from the author.)
Nathan Hale, Ph.D. is Professor of History Emeritus at the University of California, Riverside and an Interdisciplinary Member of the San Francisco Psychoanalytic Institute.