It is no secret that psychoanalysts today harbor considerable malaise about the future of our profession. Predicting its future invites speculation that is divided between optimism, perhaps influenced to some degree by wishful thinking, and pessimism, consequent to certain economic, demographic, and cultural trends that contribute to our current concern. In trying to divine what lies in store for us, it will be advantageous to consider the legacy of Freud's revolutionary thinking separately from the subject of the continuing evolution of psychoanalytic theory, as well as from the prospects of psychoanalysis as a therapy, although these three topics are obviously interconnected.
It is perhaps an article of faith from one whose intellectual development and professional life have, in large measure, been determined by the compelling power of Freud's great discoveries, but it is extremely hard for me to imagine that the insights into childhood psychological development and the understanding of adult mental life, especially its motivations and mechanisms, that he presented to the world will ever fade into obscurity. Indeed, any student of history, mythology, literature, or anthropology cannot fail to be impressed by the explanatory value of his fundamental contributions to our knowledge of human psychology and behavior, that is, unless he or she has personal reasons to deny their importance. In fact, one of Freud's most significant contributions was his appreciation of the source and nature of the rejection of his findings by many of his contemporaries, and that is still evident today, both inside and outside our profession. This resistance, as he would have called it, takes the form of either outright rejection of its precepts, or, more subtly, as a partial acceptance qualified by emendations, omissions, or additions that distort or obscure its essential core.
This is not to suggest that Freud had the last word to say about everything psychoanalytic. To be sure, he was sometimes incorrect or incomplete, and many of his successors worked hard to refine his contributions, just as others offered alterations of a more profound nature. Nevertheless, the essence of Freud's grasp of human psychology has been absorbed into our intellectual life and culture, not to mention into our understanding of development and psychopathology, even in the face of the strong appeal engendered by resistance. It is also noteworthy that the interest in Freud's ideas in countries in Asia and the Middle East, where psychoanalysis is growing in popularity, strongly suggests that his crucial discoveries are not so constrained by fin-de-siècle European cultural norms as has been maintained by some critics of Freudian psychoanalysis.
This leads me to a consideration of the second topic, the ongoing exploration and elaboration of psychoanalytic theory, or theories. Every psychoanalyst and student of psychoanalysis is aware that our profession's theoretical edifice has evolved in an atmosphere of controversy, sometimes civilized, often competitive to the point of outright hostility. Personal rivalries, passionate loyalties, and near-religious fervor have engendered splits, and given birth to entire schools of thought and practice, all claiming a place under the mantle of psychoanalysis. I believe that in our present state of knowledge it is not possible for us to arrive at an objective, much less definitive, comparative evaluation of the differences in approach, emphasis, and belief that characterize the various psychoanalytic theories that confront us today. Other analysts express their preferences on the basis of their own education, convictions, and clinical experience, just as I do. As I have suggested, even modifications to the historical core of Freud's work can be seen either as useful refinements and necessary development of Freudian psychoanalytic theory, or as subtle or frank challenges to fundamental ideas and opinions which other analysts still believe to be correct, or even crucial to the psychoanalytic enterprise. Still other alternative psychoanalytic thinkers take much more profound exception to the Freudian corpus and set forth substantially different approaches to the understanding of development, of psychopathology, and normal behavior, and to the practice of psychoanalytic therapy itself. Sotto voce dismissals of opposing theories and theorists as misguided, or as inspired by resistance, or on the other hand as hopelessly and blindly outmoded, are as familiar in our profession's history as is our record of clamorous debate. Some schisms, such as the celebrated struggle between the followers of Melanie Klein and those of the Freuds, have progressed from contentious rivalry to tolerant co-existence within the house of international psychoanalysis. Other differences have been less compatible and more bitterly divisive, as is well known.
Sander M. Abend, M.D., is training and supervising analyst at the New York Psychoanalytic Institute, past editor-in-chief of the Psychoanalytic Quarterly, past chair of APsaA's Committee on Psychoanalytic Education, and a member of the Board of Representatives and Education Committee of the International Psychoanalytic Association.
The past two decades or so have been marked by a dramatic shift in the atmosphere of psychoanalytic debate. Interchanges between proponents of differing views, theories, and technical precepts have become much more frequent and better publicized. Competition remains, to be sure, but genuine efforts to clarify and demonstrate these differences, and to expound the assumptions and observations on which they are based, are everywhere evident in our conferences and our professional literature. Some analysts in all camps remain unmoved and unchanged in their views by these interactive efforts, while others may seek at least a partial inclusion of other approaches and ideas into their own intellectual and technical arsenals.
It is difficult to assess the impact of this changing climate on present day students of psychoanalysis. Some must be stimulated, others confused, and most, if not all, primarily influenced by the attitudes and atmospheres of their own institutes and teachers. Passion and misunderstandings surely persist, and are likely to continue to do so for the foreseeable future.
All the same, it is impossible to overlook the intellectual ferment of our times, and I believe it is fair to think of this change as a normal and healthy developmental step in our field. At least in some quarters, psychoanalytic education is far less parochial than was true in the past.
Other recent trends also deserve notice. New ideas about early childhood development have entered our discussions of theory and practice, and this emerging modification of traditional thinking promises to expand the intellectual controversy we are experiencing. It is too early to say whether radically different views of development, pathology, and treatment will become schismatic influences or will be absorbed into the fabric of our professional culture. Certainly there are a number of figures among our important thinkers and teachers who seem to be devoted to grasping and embracing even quite diverse ideas about psychoanalytic theory and practice. Others are more concerned with promoting adherence to and refinement of the point of view they deem to be most correct and useful. The safest prediction would appear to be that divisions and controversies will be with us going forward, despite the efforts toward understanding and assimilating provocative new ideas that we see all around us today.
One rapidly accelerating field of research which is certain to provide data that pose many interesting challenges for our theories, and which will present us with new knowledge that inevitably will require integration into our psychoanalytic point of view, is that of neuroscience. Despite the preference of those who would see psychoanalysis as strictly a social science, informed by a philosophical, linguistic, or literary tradition, my own background in medicine leads me to assert with conviction that the psychological realm is an expression of brain function, and that brain function in turn is unavoidably affected by psychological factors and forces. We will not long be in a position to ignore the findings of the neuroscientists, nor is it a useful enterprise for analysts to be concerned with measuring the emerging data against Freud's century-old neurological speculations. Our task will be to learn from one another, that is, for analysts to understand what neuroscience can teach us about the coherence, aptness, and utility of our theories, beliefs, and tactics, or, more important still, confront us with the deficiencies and inaccuracy of our hypotheses and practices. We in turn can lend our special expertise to the biological observers in order to help them frame better, more useful questions and theories of their own. One cannot with confidence predict a time frame, but this frontier is sure to constitute the most vital integrative challenge that faces the next generation, or generations, of psychoanalysts.
Despite the preference of those who would see psychoanalysis as strictly a social science, informed by a philosophical, linguistic, or literary tradition, my own background in medicine leads me to assert with conviction that the psychological realm is an expression of brain function, and that brain function in turn is unavoidably affected by psychological factors and forces.
As for the practice of psychoanalytic therapy proper, the one thing we can be sure of is that the salubrious environment that prevailed in the heyday of psychoanalytic popularity following the end of World War II will not be seen again. Psychoanalysis actually inadvertently contributed to the erosion of its predominance by giving birth to derivative forms of psychotherapy which demand less of patients and practitioners alike, but which are beneficial to many individuals who might otherwise seek psychoanalytic treatment. This competitive environment has become even more problematic for psychoanalysis as a result of the introduction of effective psychopharmacological agents, and, later, of behavioral therapies focused on rapid symptom relief that does not depend on investigating unconscious factors and underlying causes. The appeal of these alternatives is certainly based on economic factors, no matter who pays the costs of treatment, but it also rests in no small measure on the promise of providing relief without requiring people to come to grips with the disturbing content of their unconscious minds. Adding to the problem was the
traditional reluctance of psychoanalytic organizations to proselytize, or even to seek favorable publicity for what we have to offer, but the sense of crisis regarding training and practice, of which many speak these days, has mobilized a new attitude towards those endeavors.
It is hard to predict what our efforts to reach out to academia, to influence mental health delivery systems, and to present our ideas and results in the forum of public opinion will be able to achieve. It can only be helpful that more and more thoughtful and articulate psychoanalysts want to teach students at all levels and are willing to speak and write about our knowledge and achievements to those who need to know more about what psychoanalysis has to offer.
My own appraisal is a guarded one. I believe the high water mark psychoanalytic treatment reached some years ago was an artifact of its time. Effective alternative treatments did not exist, and our competition in those days was mainly among ourselves. That is no longer the case and will never be again. However, I expect psychoanalytic therapy, and its psychotherapeutic offspring, will actually gain in popularity in areas of the world where it is relatively new, a phenomenon I have observed at first hand through the activities of the International Psychoanalytical Association, even as it may contract in other loci.
Furthermore, despite the problems we face in this country and elsewhere, I am absolutely convinced that psychoanalytic therapy will survive and continue to develop. It will never be a treatment form suitable for and available to the majority of people with emotional problems. Surely we can agree that in the past it was attempted in many cases where it proved ineffective because in those days nothing better was on the scene. I do believe it will continue to flourish as a specialized approach appealing to a knowledgeable minority who can appreciate its unique potential to help them with their lives and their troubles. Among them will be many mental health practitioners who realize that personal analysis and training will enable them to render more effective treatment, whether it is psychoanalysis proper or psychoanalytic psychotherapy. Others will be those educated individuals who are willing and able to invest in the best available treatment for their emotional problems. In consequence, a cadre of dedicated practitioners will continue to work, and to teach those interested to learn our arcane specialty, in its various evolving forms.
The door Sigmund Freud opened into our understanding of our mental life and its vicissitudes can never be closed again, and the helping profession that his discoveries created will endure, in spite of its internal disputes and external obstacles.