Looking back on the December meeting, I suspect that a flurry of first impressions about the setting needs to be dispensed with before seriously free-associating to more substantive issues.
To one for whom “the May meeting” had meant the Moscone Center in San Francisco, my arrival at the Waldorf-Astoria— already dubbed the “Walled-off Hysteria” at our first Fellows meeting—was an eye-opening experience. Visually, the Waldorf tended to confirm my belief that psychoanalysis indeed provides the most elegant model of the mind (would analytic elegance, like the Waldorf's, embrace tradition and the well-to-do?). I walked past huge tables in the lobby, iron gargoyles leaping from their legs, and a ten-foot bronze clock—primary process gatekeepers to the labyrinthine tiers of stately dining rooms, meeting rooms, and guest rooms that even banks of elevators could not connect in any linear, coherent fashion. (In such a place it is easy to convince the gullible Fellow—as my wily roommate and I briefly succeeded in doing after the Fellows dinner that evening—that our room came replete with servants, a masseuse, and a small courtyard with a fountain.)
This conference was different. Here was no carnival of pharmaceutical reps, light-box salesmen, and locum tenens recruiters, only a quiet room where erudite booksellers read as you browsed. The most frivolous gifts—nearly the only gifts, in fact, that I could find—were a pair of Freudian Slippers and a Freud Watch that displayed a fifty-minute hour. They were not exactly selling like hotcakes. As for the discussion groups and panels, I know of no other professional organization whose members are capable of listening attentively, for two to three hours, without the help of slides or video. Before a word was spoken, though, the setting itself conveyed that here it was okay to be a serious person, a shunner of superficies, a mensch.
Thanks to the work of Elise Snyder, Resident Fellows could sample any of the discussion groups and clinical workshops, and could attend any or all of the four outstanding Special Programs for Students organized by Glen Gabbard. We were graciously welcomed to The American through meetings with Dr. Snyder, our individual mentors, the Executive Committee, the Fellowship Subcommittee, former Fellows, and—not least—through lively dinner conversation with our fellow Fellows.
The psychoanalytic smorgasbord we encountered was too rich and varied for me to capture in a narrative account, but a large number of the sessions we sampled appeared to focus on significant areas of controversy in psychoanalytic thought. I'd like first to share a few insights that helped this newcomer frame these areas of controversy, and then briefly grind an axe of my own.
The intricacies of the research controversy were addressed in Howard Shevrin's plenary address, “Is Psychoanalysis One Science, Two Sciences, or No Science at All?” As if to provide commentary on the proper role of research, George Engel had appeared earlier on a rare videotape shown in the Oral History Workshop. Characterized by colleagues as “pragmatic, skeptical, empirical,” Engel described his lifelong passion “to render as reliable as possible whatever claims you make.” Yet, elaborating on his biopsychosocial model (currently at risk, as Otto Thaler noted, of regression to the biomedical model), Engel observed that “the human part of medicine cannot be approached scientifically.” (In a similar vein, a panelist quoted child psychoanalytic researcher René Spitz as saying, “I was a human being first, a physician second, and a psychoanalyst third.”)
Two of the Special Programs for Students particularly challenged traditional psychoanalytic views. Prior to an excellent case presentation by Resident Fellow Justin Richardson, Richard Isay spoke on the topic “Psychoanalytic Therapy with Gay Men: Developmental and Clinical Considerations.” Dr. Isay argued that the preponderance of evidence favors a “constitutional, biological, probably heritable” etiology for homosexuality, and that he therefore prefers the term “sexual orientation” to the common misnomer “sexual preference” (He also cited evidence that in adolescence sexual orientation is not malleable.) Clinically, he finds that profound injury to selfesteem can occur consequent to a father's rejection or absence—a frequent effect, not a cause, of the son's gender-atypical behavior—and that gay men whose fathers were not rejecting are more capable of loving relationships.
In “The Child and His/Her Environment: Analysis and Advocacy,” child analyst Don Cohen described the trajectory of juvenile delinquency, “a conveyor belt to social dysfunction” onto which we “throw away 20 to 25% of our people.” Beginning with poor prenatal care for the women at highest risk (18% of women in Connecticut receive no prenatal care at all, compared to 0.1% in Israel), we then spend $5,000 a day to keep low-weight/drug/HIV infants alive (“equality in the neonatal nursery, then no follow-up for the rest of their lives”). They fall far behind cognitively and linguistically—“50% of New Haven kids fail the Kindergarten Readiness Test”—and ultimately a full 50% of inner city kids drop out of high school. Once out of school, they're out of work, and then the girls get pregnant and the boys get arrested (“one-half of inner city boys of color are arrested by age 18”). Societal responses—do away with truant officers, create a foster care system with 400,000 kids, 90% of whom drop out of high school—are themselves often dysfunctional. “The problem,” says Cohen, “is what the culture does with kids.” Resident Fellow Louis Kraus's case presentation drew from his work at Joliet Prison's juvenile offenders unit; he voiced the frustration of those working within a legal system that mandates hundreds of hours for investigation and evaluation, but precious few for providing care. Cohen invited analysts to take leadership roles in advocacy on many fronts, including working with judges to minimize legal impediments to care; helping parents, teachers, and principals to understand developmental issues; working with legislators to humanize social policy; studying the influence of social class, poverty, and multi-generational behavior on psychological vulnerability; and doing training consultations with community policing teams. “You can't do this work alone,” Cohen warns. He recommends that analysts ally themselves with mental health teams and work with professionals in other fields to use “contextualized developmental concepts to humanize the multigenerational transmission of vulnerability.”
On this theme of social advocacy and, more broadly, of controversy, I would like to confess one area of personal disappointment in the December meeting. Having read Russell Jacoby's Social Amnesia and The Repression of Psychoanalysis, I had hoped to see the glowing embers—perhaps even some newly fanned flames—of that radical zeal of classical psychoanalysis as a social critique, the legacy of Otto Fenichel, Annie Reich, Edith Jacobson, and others associated with the Freudian Left. I found many wonderfully humane, intelligent, and articulate analysts at the December meeting, but few programs touching on the great socioeconomic crises of our times. (Notable exceptions were Dr. Cohen's program for students and the discussion group “Psychoanalytic Perspectives on Prejudice and Beyond,” coordinated by Afaf Mahfouz.) My sampling was admittedly small, but nowhere did I encounter anything like Fenichel's view that “neuroses are social diseases,” that “not because primitive instincts are still effective within us do we have wars, misery and neurosis; rather, because we have not yet learned to avoid wars and misery by a more reasonable and less contradictory regulation of social relations, our instincts are still kept in an unfavorable form.”
The times seem ripe for rejuvenating and extending the roots of psychoanalysis in social theory. Freud, as I understand, called the American resolutions against lay analysis “an attempt at repression,” largely because he feared that monopolization
by medical doctors would degrade psychoanalysis into a treatment specialty that would no longer contribute to general knowledge and culture. With the coming of “glasnost” in The American, as well as in Russia, the twin demons of medicalization and Cold War anticommunism are shrinking just as social crises loom ever larger. Among the few Americans not theory-phobic, psychoanalysts would seem to offer a uniquely distanced yet sympathetic perspective on such cherished (but largely dysfunctional) mainstream notions as the autonomous individual, and other cultural constructs in which individual psychic conflict appears as a microcosm of unreasonable social relations. I enter here, I suppose, a plea for “de-repression.”
I think my enthusiasm about psychoanalysts as social critics was fostered by the priority I observed, throughout the December meeting, that analysts gave to the patients clinical material. Fundamental controversy in theory (as dealt with, for instance, in the panel on the transference neurosis) appeared to elicit a phenomenal richness in the clinical material (as in Owen Renik's case presentation). Should not our social diagnosticians value such fidelity to, such affection for, individual lives? Jacob Jacobson's engaging talk in the Psychoanalytic Forum, “Signal Affects and Our Psychoanalytic Confusion of Tongues,” endorsed a radical clinical empiricism even as it posited an overarching “bridging theory” in which signal affects might be the “hub” through which structural theorists talk with Mahlerians, Kohutians with Winnicottians. Noting the tendency to “talk theory” while secretly practicing something else that may work better for the patient, Dr. Jacobson endorsed occasionally “throwing away the book as a beginning to clinical moments of truth.” He espoused a “willingness to follow” what we think our patients need, a willingness to adapt theory to practice. In this spirit, can psychoanalysis construct bridging theories that once again recognize in the suffering individual the lineaments of social and historical forces?
In these times of social crisis, not to do so may be to risk irrelevance. Dr. Jacobson concluded with the tale of Tittlebaum, who went to be fitted for a suit, one that required the greatest contortions for him to wear. “So with a hand here, a twist there,” the tailor said, “and you'll look like a new man.” Uncertain, crimped, bent over halfway to the pavement, Tittlebaum emerged looking like the Hunchback of Notre Dame, just as two acquaintances happened by. “What's wrong with Tittlebaum?” asked the first. “I don't know,” the other replied, “but would you look at the cut of that suit!”