Toward the end of the sixties and the middle of the seventies, a pessimistic mood regarding the future of psychoanalysis seemed to settle over the psychoanalytic community, at least in North America. Anna Freud expressed herself in this vein in a 1968 address to a large audience of North American psychoanalysts gathered in New York. Her pessimistic mood was stirred up chiefly by what she considered the anti-historical, anti-introspective stance of the rebelling youth of that decade, to whom “history and past” and “law and order” were “irrelevant,” if not a downright obstacle, to emotional freedom and humane progress. In 1969, in the International Journal of Psychoanalysis, Kurt Eissler articulated a similar pessimism with regard to pure, orthodox psychoanalysis: “Although the therapeutic applicability of this method has been extended during the last decades, psychoanalysis as a therapy does not have a bright future.” He concluded from this that “all that can be learned by the way of the couch Freud has already learned.”
In 1974 The American's Program Committee addressed this mood by scheduling two panel discussions. The first, entitled “A Critical Assessment of the Future of Psychoanalysis: A View from Within,” took place in the spring of that year. The second, “A Critical Assessment of the Future of Psychoanalysis: A View from Without,” was convened that fall. The spring panel was composed exclusively of members of The American, while the other had a number of panelists from other disciplines. It is to this second panel's deliberations that I address myself. But first a bit of history.
The late twenties and early thirties had seen a considerable widening of psychoanalytic perspectives, both theoretical and clinical. The origins and energies of the “superego” were being sorted out, and Anna Freud's publication of The Ego and the Mechanisms of Defense threw considerable light on the ego's functioning. At about the same time, Hartmann published Ego Psychology and the Problem of Adaptation, thereby introducing a teleological dimension to the study of ego function.
As a result of this expansion in psychoanalytic thought, psychoanalysts quickly became the leading figures in military psychiatry when the start of World War II produced mental casualties everywhere. Clinical views of an analytic cast supplanted, at least among the Allies, the psychiatric preconceptions of World War I — malingering, male hysteria, and similar diagnostic categories. Punishment and useless electrical treatments were replaced by psychotherapeutic treatment. The rationality and positivity of psychoanalytic thinking attracted a great number of young medical officers to psychoanalysis.
Thus, the postwar period was entered with great optimism among the swelling ranks of psychoanalysts, an optimism that transmitted itself to the population at large. Increasing numbers of symptom-laden patients now sought psychoanalytic treatment, while a change took place also in the range of pathology for which such treatment was recommended.
The “scope of psychoanalysis” indeed seemed to be widened. In general, with the growth of the democratic spirit worldwide, greater numbers felt entitled to seek medical care, which included treatment for mental stresses. The resulting pressure for treatment, which during the war had already led to new variants of psychoanalytically inspired group therapy for soldiers, now brought these modifications to the population at large. Nonetheless, psychoanalysis proper—i.e., one-to-one treatment — remained the preserve of a relatively restricted number of patients.
Gradually, psychoanalysts reached out to treat patients whose pathology was bound intimately to their character structure or who stood at the borderline between neurosis and psychosis. This expansion, however, despite its successes, led also to curative disappointments. These, combined with the social disillusion expressed in the proclamations of sixties youth, brought on the pessimistic mood of which I have spoken.
In the 1974 fall panel, Ilya Wachs, professor of comparative literature at Sarah Lawrence College, found in the student body there the same resistance to learning that in her 1968 speech Anna Freud had lamented in psychoanalysis. His students, Wachs maintained, were alienated and passive; they treated their bodies as if they were external to themselves, mechanical objects to be “turned off or on.” They were enormously preoccupied, he found, with food intake and fecal output. The finding and preparing of special foods took up an enormous amount of their time. They fled from the feeling of being an integrated human being and hence from self-confrontation in psychoanalytic treatment. The dissolution of many of their parents' marriages deprived them of the guidance of a reassuring home environment. Wachs interpreted their regressive behavior as a defense against an overwhelming anxiety connected fundamentally to a fear of human annihilation, through either nuclear war or ecological disaster. He challenged psychoanalysis to stand up to this panic, recognize the social problematic it poses, and see it as a profound source of resistance to its own operation. Simply lamenting this opposition, he argued, is not sufficient.
Carl E. Schorske, professor of history at Princeton University, a man particularly versed in the intellectual history of fin-de-siècle Vienna, began his “reflections on the future of psychoanalysis” by noting that the three great thinkers of the nineteenth century—Hegel, Marx, and Freud'—were hopeful that rationalism ultimately would conquer human irrationality. Yet, he concluded, each of the three had failed in bringing us closer to a rational world.
Hegel thought that humanity would recover from the irrationality of the French Revolution, Marx argued that the individuality-oppressing industrial revolution could be overcome through class struggle, and Freud hoped his discoveries could help people enjoy sexual life and individual freedom. At present, however, Schorske noted, psychoanalysis had failed to achieve this goal because of the escalating breakup of the nuclear family—“ the Oedipus complex being replaced by the dominance of Narcissus.” In light of this, the rationalism of psychoanalytic technique and treatment goals would have to change if psychoanalytic treatment was to remain successful. More empathy and intuition, Schorske argued, was needed to help the narcissistically suffering individual.
Beyond that, he held, concern for the individual, that hallmark of nineteenth-century humanism, was coming into question. This was particularly true in Eastern Europe and Asia, China and Vietnam particularly, where a majority of humanity lived under Communist rule. There even Kohut's appeal for a new, more empathic approach had no chance to blossom. What counted there was improvement of the state for the masses, not for the individual. In short, Schorske gave psychoanalysis only a bare chance of surviving, and this only if it minimized its rationalistic, scientific ways and inclined to more irrational, mystical, and intuitive linkages between analyst and patient.
Discussant Robert L. Heilbroner, the noted economist, joined Schorske and Wachs in viewing the future pessimistically. Like Schorske, Heilbroner saw civilization moving in the direction of a Chinese-led peasant communism. In that light, he thought that eventually all humanity would be living under a monastic-like order—uniform in its beliefs, task-oriented in its behavior, with no room for the individualistic orientation the psychoanalytic situation needs and fosters. He doubted that psychoanalysis could adapt to or survive in such an atmosphere or could contribute to making it more humane. However, to a degree psychoanalysis for him shared much in common with Marxist dialectical thinking. Yet, while communism posits a faith in the positive plasticity of mankind, psychoanalysis uncovers an unchanging, intransigent, noncultural, biologically conditioned reality. The two theories both counsel tolerance of ambiguity — in
contrast to a “monastic authoritative order” that demands uniformity and unambiguity. The merits of psychoanalysis lie in the fact that it has been a laboratory investigating human nature.
In lending themselves to this purpose, the privileged few who can afford to undergo analysis pay their debt to humanity. Heilbroner would consider it a crowning achievement if psychoanalysis could discover and promote a “universally shared conception of right behavior,” a standard of behavior that all cultures could adopt. Psychoanalysis, he argued, should enlighten us about the core of what he ultimately called “the moral commandments” for all.
It is striking that both Heilbronner and Schorske, these pessimistic prognosticators of the future of psychoanalysis, held out nonetheless, as a goal and a hope, the possibility that psychoanalysis will be the wellspring of rational existence, that it will show the way to the core of a “universal morality.” And, in a way, the pessimist among the analysts, Kurt Eissler, joined these critics.
Ironically, as matters stand now, clinical psychoanalysis is faced in the capitalist world with a mix of political and economic currents that seriously interfere with its free functioning. While Western capitalism seemingly champions individualism, while “privatization” has become a buzzword, psychoanalytic treatment and dynamically oriented psychotherapy are being put beyond the financial reach of the average citizen. The need to have an insurance company contribute to the cost of psychotherapeutic treatment—the “third-party payer” — has led to interference by this payer in the very basics necessary to the maintenance of a confidential, open, and continuous relationship between psychotherapist and patient.
In the U.S. at present, the health maintenance organizations, to which employed patients increasingly must belong, dictate how often and for how long a patient can be seen in psychotherapy. Reports about the diagnosis, the progress of the illness, and the healing process must be made to these anonymous organizations, thereby violating the essential rule of confidentiality regarding doctor-patient communication.
Setting aside for the moment the question whether the great variety of psychodynamic treatments the spread of psychoanalytic knowledge has spawned might be damaging to progress in psychoanalytic knowledge, we see that the principal threat today comes from a materialistic, capitalistic source. A psychoanalysis, properly speaking, cannot be conducted — its “experimental specimen,” the patient, cannot pay for it, and insurers, public or private, are unwilling to subsidize it adequately. The optimal situation, one-to-one treatment, cannot be sustained under these conditions, and psychoanalytic research is thus sent back to its initial years, when the total number of patients was quite small. In such a situation, psychoanalytic insights can be gleaned only from the treatment of an elite group, either of very wealthy clients or of very dedicated, financially self-sacrificing patients and analysts.
But, we may ask ourselves, must these circumstances in fact spell the end of psychoanalytic research, the doom of psychoanalysis and its search to understand, by means of the relatively purified method of treatment within the analytic situation, how the human mind functions? That situation must remain free of external interference, confidentiality must be preserved, a regular frequency must be maintained, and free associations must be allowed to flow, with no external inhibitions.
In his 1969 article Eissler implied that the achievements of psychoanalysis with regard to insights obtained within the analytic situation had reached their limit. I disagree. Apart from a deepening knowledge of human mental growth attained through direct observation of mother-infant interaction and brain function studies, ever more precise observations of transference and countertransference offer a continuous yield of new knowledge. Further, the various therapies that are the offspring of psychoanalysis — group therapy, family therapy, etc. — are feeding back knowledge applicable to the one-to-one therapy of psychoanalysis itself. The process is reciprocal: pure psychoanalysis teaches its offspring therapies, which in turn provide a sharpening of our perception of what a patient reports in the one-to-one situation of his day-to-day contacts and family conflicts. Beyond that, both patient and analyst are affected by strains in the social, political world.
But negative consequences as well arise from the burgeoning of these new therapies. They draw off a large number of patients who might have been apt subjects for intensive analytic treatment. Additionally, the widespread use of psychotropic drugs for mental disorders further drains the pool of such patients. The most damaging effect of these treatment variants manifests in the field of analytic education. Because of the scarcity of psychoanalytic patients, the acquisition of experience through practice has become increasingly more difficult for analytic candidates.
Despite these handicaps, however, the teaching of psychoanalysis flourishes, as today psychoanalytic teachers are available in a growing number of localities. It must be admitted, though, that the number of students, particularly those medically trained, is getting smaller every year. Because today psychoanalysis is being taught in an increasing number of localities and because channels of communication worldwide are ever more open, with journals printed in a multitude of languages, it may be said that a stable balance of growth is in fact maintained. Considering the increase of populations now in contact with Western thought, the number of persons who potentially might seek psychoanalytic treatment is not outstripped proportionally by the overall increase in the human population. If in earlier years analysands represented a select group of “experimental animals,” matters today remain more or less the same.
Considering the economic pressures of which I have spoken, and the spread of alternative psychotherapies and psychopharmacology, psychoanalysis as a treatment modality cannot expect to emerge from its elite status in the near future. This, however, does not mean that psychoanalysis, as a science and as a treatment method, has reached its limits.
Psychoanalytic institutes, their students, and analytic researchers are to be considered like the persons and institutions involved in research and development in industry. To this status psychoanalysis must lay claim, at least in those societies that can afford it.
What psychoanalytic research has to offer are finer and finer observations on the functioning of the mind, and of the soul (i.e., the mind plus its affectivity), on the somatic responses to mental and physical stimuli, on the formation and transmission of morality, on ethnological peculiarities, and on many other facets of human capacity. We must learn how to register and describe many more phenomena than we have up to now. This can already be accomplished with the aid of auxiliary technologies that can widen our perceptual capacities. These of course cost money. If research in psychoanalysis is to be funded, it must be presented like any other R and D proposal. Psychoanalysis must keep itself at the forefront of public awareness and must promote itself with public agencies and research foundations; it cannot afford to play the wallflower.
Anna Freud, in an address read in her name at the inauguration of the Sigmund Freud Chair at the Hebrew University in Jerusalem in 1977, and I myself on the same occasion, have spoken of the need to combine the efforts of all the social and biological sciences, including psychoanalysis, in what Kurt Eissler called an Academy of Man. Such a joining of efforts is necessary if ways are to be found to keep human aggression in check. The human thanatic drive is at the verge of destroying the terrestrial biosphere itself and with it, of course, human existence. This drive is unconscious, and to date only psychoanalysis has offered the means to identify the factors that enhance its actualization and the avenues that must be kept open if it is to be curbed. To protect the very existence of humanity against this self-destructive tendency, an increased understanding of unconscious human motivation is of the essence. We do know that within human libidinal potential lie forces that may counter Thanatos. To free these forces, this sublimatory creativity, from what unconsciously inhibits their blossoming is an urgent task. The question then is not simply, Has psychoanalysis a future? What ultimately is at stake is the future of humanity itself, and for that to be assured the help of a flourishing psychoanalysis is required.
This article appeared originally in a German version, “Zweifel an der Zukunft der Psychoanalyse,” included in the collection Die Zukunft der Psychoanalyse , publisher Johannes Cremerius, Suhrkamp Taschenbuch Wissenschaft.