Unlike the conflicted and often bitter splits that occurred within the New York Psychoanalytic Institute in 1941, when the Karen Horney group left to form the American Institute of Psychoanalysis, and in 1942, when the Sandor Rado group left to form the Association for Psychoanalytic Medicine at Columbia (see TAP 26/4), the founding of the Downstate Institute, later to become the Psychoanalytic Institute at New York University Medical Center, was accomplished with relatively little acrimony.
Howard W. Potter became chair of the Department of Psychiatry of Brooklyn's Long Island College of Medicine in 1947. Although not himself a psychoanalyst, he wanted trained analysts on staff to teach psychiatric residents and valued the concept of a psychoanalytic institute within a university setting. To achieve these ends, Potter invited Richard Frank, an analyst from the Columbia Institute, to organize and direct the psychiatric residency training program. Together they brought a number of well-known analysts—George Goldman and Henriette Klein from Columbia, Mark Kanzer from the New York Institute—to assist in the fledgling program.
Once the residency program was in place, Potter turned his efforts to developing a three-year course in psychoanalytic medicine. It was at about this time that Sandor Lorand, from the New York Institute, failed in an abortive attempt to found a psychoanalytic training program at Manhattan's Bellevue Hospital. In the spring of 1948 he accepted Potter's invitation to chair a Psychoanalytic Section within the Department of Psychiatry at Long Island College. From the New York Institute Lorand recruited a group of young analysts eager to be the founders of a new psychoanalytic program. In 1949 the first class, consisting of eight candidates, began meeting in the private offices of the faculty.
In 1950 the new program was accepted as a provisional institute by The American, which had concerns about the autonomy of an institute operating within a university. In particular, it worried whether the institute would accept the final authority of the Board on Professional Standards. Potter, a gifted administrator, was content with his achievements and never attempted to influence either the internal development of the Institute or the content of its courses. That same year the Long Island College of Medicine became the Downstate Medical Center of the State University of New York, and the Institute took the name Division of Psychoanalytic Education. Classes were conducted Saturday mornings at Kings County Hospital, and initially candidates were required to see analysands there. In addition, candidates were required to treat patients in psychotherapy. Austin Silber, in recounting this early period, has voiced the belief that some of the analytic teachers felt psychotherapy training was counterproductive, confusing candidates about proper analytic technique. Personally, however, he considered the exposure to psychoanalysts as psychotherapy supervisors to be educationally rewarding.
In 1954 Downstate became a fully approved institute of The American and saw the graduation of its first three candidates. The need for a psychoanalytic society for Downstate graduates soon became evident, and in 1955 the Psychoanalytic Association of New York came into existence as an affiliate society of The American. Also in 1954, John Romano, chair of the Department of Psychiatry at the University of Rochester School of Medicine, and his colleague, Sandor Feldman, worked with Potter to establish a geographic training facility at Rochester under the aegis of Downstate. The program was small, but by 1965 ten candidates had been accepted.
Lorand, like Horney and Rado, was an emigré from Europe who had escaped the devastation of fascism (see TAP 23/2–3). However, organizational psychoanalysis was not the only area influenced by the Europeans. Helen Meyers, commenting on the evolution of psychoanalytic theory, notes that by the mid-fifties ego psychology was fully established in New York. Emigrés at the New York Institute, such as Heinz Hartmann, Rudolf Loewenstein, Ernst Kris, Hans Loewald, and Edith Jacobson, were major contributors to this theoretical development and influenced a rising generation that included Leo Stone, Charles Brenner, and Jacob Arlow. New ideas concerning childhood blossomed, as René Spitz, Peter Blos, and Kris, along with Anna Freud in England, made important contributions.
Rado, the major force in developing the Columbia Institute, realized, as had Potter, the advantages of a department of psychoanalysis in a university setting. Discarding libido theory and substituting a theory of motivation based on the emotions, Rado stressed the integrative and adaptive functions of the ego. Thus, while in some ways a maverick, he took a theoretical position rather similar to the adaptive ego psychology then emerging at the New York Institute. This is hardly surprising, as Rado had once taught there. Rado also attempted to reform analytic language, translating jargon into ordinary English (e.g., he called the “superego” the “conscience”). The Columbia curriculum, reflecting Rado's influence, included medical courses such as neurology, biochemistry, and genetics.
In 1955 Rado was succeeded by Abram Kardiner, who in turn was succeeded by George Daniels. Both were members of the original Columbia group that had left the New York Institute with Rado. However, over the years Rado's influence decreased, and in the 1960s his terminology, along with the medical courses, was dropped, as Freud, dreams, and structural theory took an increasingly prominent place in the curriculum.
Lorand remained director of Downstate until 1959. His successor, Sylvan Keiser, established the policy that directors would be limited to a three-year term in order to reduce the frustration and rivalries that in the past had occasioned splits. In 1960 Maurice Friend organized the Child Analytic Program, which he then directed. The tradition of two teachers—one senior and one junior—assigned to each course was established. Kanzer, upon succeeding Keiser, established a newsletter and the candidate advisor system. An attempt to develop a new training institute in New Jersey was begun at this time, but in 1969 it was discontinued for lack of applicants.
Arlow and Brenner's classic monograph, Psychoanalytic Concepts and the Structural Theory, published in 1964, was the high water mark of ego
This article is based on the Oral History Workshop held at the Fall Meeting of the American Psychoanalytic Association on December 19, 1991, in New York. Robert S. Grayson chaired.
psychology. Already, alternative theories were beginning to make themselves felt in New York. The British influence increased as New York analysts became familiar not only with the writings of Anna Freud, but with those of Winnicott, Bowlby, and Sandler. In the 1970s the theories of the British object relations theorists—Melanie Klein, Fairbairn, Balint, and Rosenfeld—made further inroads.
1972 was a milestone year for Downstate, as Alan Eisnitz became the first of its graduates to direct the Institute. But even as a four-volume collection of papers written by the faculty in celebration of Downstate's twenty-fifth anniversary began to appear, conditions were changing. The Division's offices at Kings County were located in an increasingly impoverished area of central Brooklyn, and national trends in psychiatry found their reflection in the Department of Psychiatry, where analysis was viewed to be of decreasing importance. The department made demands on Institute faculty to become involved in teaching and supervising in the psychiatric program. Faculty members felt that the Institute's autonomy was endangered, and under the directorship of Roy Lilleskov the Institute was moved to New York University School of Medicine. Robert Cancro, chair of the Department of Psychiatry there, had been a psychiatric resident at Kings County and a colleague of many on the faculty. He welcomed the move, which took place in July 1979.
In the letter of agreement with NYU, the name of the Institute officially became The Psychoanalytic Institute at the Department of Psychiatry of the New York University Medical Center. Use of the proposition at was intended to honor the Institute's longstanding tradition of independence from the host university. However, in Silber's opinion, the relationship with the NYU Department of Psychiatry has been of mutual benefit. Members of the faculty are actively involved in teaching, supervision, and interviewing prospective residents. The Institute is involved in both medical student education and the child psychiatry fellowship. With analysts intensively involved in the NYU residency program for over a decade, many residents have chosen to become candidates at the Institute. An analytic/psychiatric track has been created, with beginning psychiatric residents jointly accepted as candidates in the Institute.
In 1972 the new director at Columbia, Aaron Karush, and the chair of the curriculum committee, Arnold Cooper, effected major changes by establishing a core curriculum supplemented by a wide range of electives to accommodate both classical theory and various alternatives. In 1973 child and adolescent studies began. Work with children and with sicker patients led then to an interest in early intrapsychic development, self- /and object representations, and early object relations. The Columbia Institute, Meyers recalls, was more receptive to the newer theories, as is attested by a list of guest speakers and new faculty that reads like a bibliography of modern analytic theory.
Archives Medical Research Library of Brooldyn
Margaret Mahler's work exemplified the growing interest in early development. Although associated with the New York Institute, she taught and supervised in the Columbia program along with Peter Blos. Nineteen seventy-three also marked the arrival of Otto Kernberg, who continued to develop object relations theory using the concepts of Jacobson, Mahler, and Melanie Klein to understand and treat narcissistic and borderline pathology. Five years later, Roy Schafer came to Columbia, where his dereification of metapsychology, hermeneutic concepts of narrative, and work on the analytic attitude have been influential. Less so was his advocacy of action language. In the same decade Heinz Kohut, working in Chicago, developed theories of self psychology that found favor in some institutes but never became central at the three in New York.
Nineteen eighty-one saw another major revision in the curriculum at Columbia. During the directorship of Ethel Person, and with Helen Meyers as curriculum chair, the curriculum was reorganized along historical-longitudinal and conceptual-horizontal lines in order to include the various models of the mind and to accommodate the integration and differentiation of both classical and contemporary theories, as well as to establish the relation between theory and technique.
In recent years the two major forces in the development of New York psychoanalysis—theoretical battles and intrasociety conflict—have faded, while new factors have appeared that affect the practice of psychoanalysis. One of these, cited by Kenneth Calder, is the trend of The American (and the three New York institutes) toward a dwindling representation within the International Psychoanalytic Association. In 1952, members of The American accounted for 64% of the International's membership; today that figure has declined to approximately 30%. In the meantime Latin America has taken up some of the slack, today accounting for 20% of IPA membership. Calder wonders if the situation might not reflect a marketing failure on the part of American psychoanalysis.
In 1956 there were 5.06 cases per analyst nationwide; by 1990 this figure had dropped to 4.78—in New York City, an even lower 4.32. Calder credits the decline to a shift in attitude from long-term to short-term goals: the “general orientation of something-for-little-or-nothing,” he reflects, “is anathema to psychoanalysis.” The use of medication, psychotherapy, the trend toward three-times-a-week analysis, and the societal acceptance of neurotic enactments all contribute to this decline in analytic patients.
Robert Michels points out that the decline is relative. Because of a large increase in the number of practicing analysts, the data actually show that the number of analytic patients has more than doubled. Michels agrees, however, that analysis has grown less than other areas of psychiatry. In addition, New York has analytic competition not found elsewhere; a few years ago there were some 32 “psychoanalytic training institutes” in the area. The recent acceptance into the IPA of two institutes not affiliated with The American—the Freudian Institute and the Institute for Psychoanalytic Training and Research (IPTAR)—poses additional challenges.
Harold Blum views the current theoretical issues in Freudian analysis as both challenging and exciting. They have occasioned a salutary reexamination of theory and a shift to discourse closer to clinical experience. Blum cites in particular the issues of theoretical development and technical utilization of structural theory; preoedipal and adolescent influences; the adaptive and constructive use of regression; different levels of object relationship; character analysis; the stability and organization of the ego and its representational world; and movements toward higher levels of object relationship, self-representation, and ego integration. Other important theoretical issues include the actual meaning of the analyst, of the analytic relationship, and of the object to the patient. Blum worries a bit that the genetic viewpoint is being discarded. A “pessimistic optimist,” he views psychoanalysis as continuing to flourish, but fears that problems of clinical practice, especially the paucity of analytic cases, could ultimately retard its scientific development and negatively affect psychoanalytic education. He notes the importance of the ambience of institutes, of changing attitudes and updated curriculum and electives.
Michels sees a shift from theoretical issues to an interest in the analytic relationship, which along with the growing pluralism of American psychoanalysis has made it easier for the three institutes to discuss issues. But comparing The American's institutes in New York is difficult, he thinks, since no one is that well informed about all of them. While Michels considers all three quite excellent in preserving the body of psychoanalytic knowledge and in training practitioners, he faults them all when it comes to providing research convincing to the scientific world outside. In his estimation, they also do poorly in educating other health professionals and influencing the broader New York community.