“Bare ruined choirs, where late the sweet birds sang,” this line from Shakespeare's Sonnet 73 captures the zeitgeist of anxiety that suffuses much of psychoanalysis at this point early in the 21st century. The “bare ruined choirs” of our present time refers, of course, to the paucity of analytic patients, particularly the ideal analyzable neurotic. It also refers to the difficulty in finding candidates for training, so institute faculties have someone to teach. “Where late the sweet birds sang,” speaks of nostalgia for a lost golden time in psychoanalysis when psychoanalysts had full practices, waiting lists even, and comfortable incomes. Also implied, but not spoken aloud, is that a return to the pinnacle of mental health practice is what we deserve; and our excellence and exceptional clinical capability is being devalued, and we are eager, perhaps desperate, to restore ourselves to our rightful place. The conclusion many of us draw is that psychoanalysis as a science, a field of practice, and a profession is in danger and we are suffering a crisis.
Because of this zeitgeist of frustration and longing, our professional association, APsaA, has been riven with conflict, which has fostered its own atmosphere of crisis. I think we are suffering from Weltschmerz, which means “world pain” in German. It is the sadness in our hearts for the world we can never have.
Kate Schechter, in her excellent book, Illusions of a Future: Psychoanalysis and the Biopolitics of Desire, offers some analysis for this current condition I am calling our Weltschmerz. Using ethnographic methodology, she describes the profession of psychoanalysis as ensnared in the current neoliberal climate of evidence-based medicine, in which the ethos of the audit defines the value of any practice, and all practice can be reduced to a cost-benefit analysis. She says in her introduction: “Evidence-based medicine (EBM), embraced by the insurance and pharmaceutical industries and by health economists and policy makers alike, stands in sharp contrast to psychoanalysis in matters of ontology, authority, and value.” She goes on to argue that we have unwittingly responded to this pressure by constructing a parallel, fetishistic claustrum wherein we fight about the “real relationship.”
She argues there has been a modification in our psychoanalytic technique from the original model of interpretation of transference and retrieval of memory to neutralize transference, to a newer definition of technique where the measure of the psychoanalyst is in her ability to form a relationship with a patient, and “to experience, process, and contain affective intensity in that relationship.” But Schechter's point is the containment of affect is too weak an edifice for our profession. So we falter under the pressure. She finds evidence for the collapse of the edifice in our disputes with one another about whether something is or is not psychoanalytic. By concerning ourselves with whether the clinical actions of others fit our standards of psychoanalysis, we governmentalize our profession and occupy ourselves with measurements, all to achieve control of others, and of ourselves. The conflict about clinical technique imbues the conflicts that are internal to APsaA.
In this brief column I can do little more than sketch the shifting tectonics within our organization. But I have a couple of points I would like to make about the current times. One of the points Schechter is making, by situating us within a larger biomedical environment, is that we in psychoanalysis are being shaped by forces external to ourselves. The prevailing neoliberal ethos, where everything can be measured and monetized, and the essential value of any activity can be reduced to, and determined by, a cost-benefit analysis, is pervasive, as is the over-valuation of reason. Data triumphs in this scenario.
The second point is about psychoanalytic education. I think those of us who enter into psychoanalytic training at this time are doing so because we reject neoliberal values. We study psychoanalysis because we are interested in the complexity of the mind and human interaction, and do not want to simplify and reduce human activity, and certainly not clinical activity, to measurable units subject to reimbursement. But it is awfully hard to fight this current. Candidates enter into psychoanalytic training because they believe it is something of genuine value, which will enhance their clinical skills. Because of this commitment on the part of candidates, it is crucial that our organization ensure excellence in our clinical and theoretical education—however that can be achieved.
Phoebe A. Cirio, M.S.W., LCSW, is president of the Candidates' Council.