Having lived through years of emotional wildfire under a president whom the foreign minister of Luxembourg labelled a “political pyromaniac,” our country faces not only a viral epidemic but an epidemic of dangerous, unchecked emotion. That American citizens marked the presidential transition with violence for the first time since the Civil War by ransacking the U.S. Capitol is only the latest symptom of our country's troubled mental state. Psychoanalysts steeped in rational introspection and emotional self-regulation, are needed now more than ever.
The good news is that recent crises have created, if nothing else, an opportunity for the field of psychoanalysis to reintroduce itself to the world. The defensive political pathology on display demands psychoanalytic explanations and solutions. The spate of news articles about denial published in the last few years, meanwhile, reflects the public's appetite for psychoanalytic help understanding the irrationality in our midst. The current leadership of the American Psychoanalytic Association has risen to the occasion with proposed organizational changes and new communications designed to expand the public presence of psychoanalysis.
If psychoanalysis is to succeed, however, and join the fight against the collective delusions that endanger our planet and our republic, it will also have to confront an old danger that lurks within: the field's longstanding aversion to public engagement and discourse. As I wrote in my 2019 book The Psychoanalyst's Aversion to Proof, crises have not always mobilized psychoanalysis to better public advocacy. On the contrary, World War I and II arguably exacerbated Sigmund Freud's sense of helplessness before the impregnable irrationality of his fellow Europeans. It's critical that this time around, psychoanalysis does not make the same mistakes.
What exactly do I mean by psychoanalysts' aversion to proof and public engagement? My book's thesis is that beginning with Freud, psychoanalysts have generally resisted presenting their ideas to the public due to their own emotional inhibitions and aversions. Freud often complained that psychoanalytic ideas were, by their nature, provocative of disbelief because of repression. He called this phenomenon “intellectual resistance” to psychoanalysis. Anyone who has tried to explain or defend psychoanalysis in public has likely encountered an instance of this sort of irrational skepticism and emotional resistance. Freud underestimated, however, the extent of emotion and irrationality that affects the presenter of psychoanalytic ideas—emotion that arises in no small part because of the unfairness and irrationality of the critics.
Moreover, the unpalatable facts of emotional life burden the keepers of psychoanalytic knowledge with shame. Consider a simple thought experiment: Imagine you're standing in front of a
Austin Ratner, M.D., is author of The Psychoanalyst's Aversion to Proof (IPBooks 2019) and sits on APsaA's Committee on Public Information. He has written widely on psychoanalysis in publications as diverse as USA Today and The Lancet.
group of critics of psychoanalysis and it's your job to persuade them of the significance of infantile sexuality. Do you feel comfortable with this task? Or is it easier to say, as Freud often did, You can't argue with defenses, so why bother? If they want my wisdom, they'll come to me, and if they don't, why waste my time? It's an understandable position, just as it was understandable that Galileo, when threatened by Pope Urban VIII, recanted his Copernicanism.
Reticence, however, played no role in the eventual acceptance of Copernican ideas. Progress came instead from spirited advocacy by disciples like Galileo, prior to his inquisition, and like Giordano Bruno, who struck a mighty blow for heliocentricity but also demonstrated the risks of speaking truth to power; he was burned at the stake for his Copernican views in 1600. Likewise, Charles Darwin's reluctance to publish didn't help establish the theory of evolution. Publishing On the Origin of Species did, and its eventual acceptance depended on public defenders like Thomas Huxley, who became known as “Darwin's Bulldog.” For reasons that are understandable—but not entirely rational—Freudians have been even more shy than the Copernicans and Darwinists once were. And psychoanalysts have paid a price for this reticence over the last half-century as their influence in the mental health field has waned. The country has, in turn, paid for the marginalization of psychoanalysis with deficient mental healthcare.
If the field can recognize its own “proof aversion” or “advocacy aversion” as an emotional obstacle to growth and success, an obstacle that's been unconsciously overlooked, it's my hope that psychoanalysis can unshackle itself from reticence and paralysis, restore its influence, and make an impact on the mental health crises now afflicting our society. Just as understanding defenses eventually frees patients from their grip, a better understanding of psychoanalysts' emotional resistances to the work of public validation and promotion—i.e., to the task of proof—can free psychoanalysis to answer and conquer its critics and to reach out to new constituencies with more confidence and optimism. I've been thrilled that leaders in the field of psychoanalysis like Mark Solms, Arnie Richards, Kerry Sulkowicz, and others have shared in my excitement about the concept of proof aversion and its potential applications.
Having now presented the idea of proof aversion to various groups of psychoanalysts, I've had some opportunities to observe proof aversion in action—in others and in myself. In February 2020, for example, when coronavirus was still theoretical in New York City, I spoke about my book to the psychotherapy faculty at Mt. Sinai Medical School. The Upper East Side neighborhood surrounding the Icahn Institute for Data Science and Genomic Technology, where the psychotherapy group meets, is so familiar to me, I could hardly get lost. I'd had a long and fruitful psychoanalysis just a few blocks away. So, I should have known exactly which way to turn when I reached the corner of 96th Street and Madison. Yet I turned downtown instead of uptown, in the exact opposite direction of the talk I was to give. I had given many talks and was not aware of particularly strong qualms about the presentation. My feet, though, had other ideas and did not bother consulting me before setting their escape plan in motion. It was, in all likelihood, a small example of the sort of defensive aversion I describe in my book. I noticed my error, turned around, and made it up to the fourth-floor conference room, which soon filled up with psychotherapists. I gave my talk as best I could, and attendees' comments indicated that many left the room energized by the idea of proof aversion and its promise of more effective advocacy and research. The generally positive reception to my ideas belied my unconscious fears of rejection which had perhaps led me to turn downtown instead of uptown.
That said, my talk inspired other observable dynamics. Calling attention to a defense for the first time can after all be a tricky business. To identify a thought as a defense is to question the validity of the manifest content of the thought. Since the defensive thought arose in the first place to ward off the patient's anxiety, questioning the validity of the thought is bound to trigger the underlying anxiety, and the eruption of anxiety can, in turn, create resistance to the interpretation and to treatment, and can reinforce the commitment to the defense to make the anxiety go away. (Petraglia J et al. “Ten Principles to Guide Psychodynamic Technique with Defense Mechanisms: An Examination of Theory, Research, and Clinical Implications.”) My book's aim is to analyze a group of defenses that have affected not patients, but analysts. These defensive patterns paralyze psychoanalysis but also, by their very nature, provide psychoanalysts with emotional relief from certain professional anxieties. Questioning these defenses is bound to cause some eruption of that anxiety and to provoke resistance.
Sometimes in presenting my ideas on proof aversion, I've encountered incredulity of the kind Freud so dreaded. Some readers and audience members have asserted that proof aversion is not a new or helpful idea but rather the latest edition of tiresome, old criticisms of psychoanalysis. Others have dismissed the idea as “too speculative,” even though the proportion of empirical versus deductive content in my work far exceeds that in many theory-heavy psychoanalytic communications. As it happened, no one at Mt. Sinai raised these particular objections.
The discussion did, however, provoke observable anxiety mainly, a fear that an advocacy movement would redefine psychoanalysis in a way that favors a particular camp and would therefore leave others behind. When I urge more advocacy and proof for psychoanalytic ideas, which ideas do I mean and what kind of therapy? And what do I mean by “proof”? Do I mean randomized controlled trials? If so, will such evidence-based research invalidate vital psychoanalytic principles derived from clinical experience and case studies?
The factual answers to these questions are short and straightforward. By psychoanalytic ideas, I mean: defenses (or dissociations, as some prefer to call them today), transference, and talking therapy aimed at the modification of emotional defenses and transference through insight or through exercise of the therapist-patient relationship. These are the common denominators of psychoanalytic thought and therapy without which psychoanalysis becomes undifferentiated from other branches of psychology and a psychoanalytic advocacy movement becomes incoherent. By proof I mean any form of public validation; that includes case reports, randomized controlled trials, laboratory experiments, session recording, research into art and literature, or any other credible method of research, and that means public relations efforts to communicate past and new research findings and to argue for the merits of psychoanalysis at every opportunity.
An advocacy movement aimed at bolstering the psychoanalytic field's scientific credentials, public understanding, and institutional authority could potentially benefit every style of psychodynamic psychotherapy.
But even an advocacy movement conducted under a “large tent” may not allay the deep-seated fear of proof and criticism. It may be that as soon as one speaks of proof, the old anxiety returns that critics and their demand for proof will unfairly neglect whatever school of thought one happens to call home. In that February meeting, the therapists in the Mt. Sinai conference room represented a diversity of views. There was a classical four-day-a-week psychoanalyst, a relational practitioner, and a behaviorist. A dropout from the New York Psychoanalytic Institute made a point of contesting the universality of the Oedipus complex. All seemed at least somewhat concerned that an advocacy movement might leave them behind or unfairly invalidate their school of thought.
On the contrary, an advocacy movement aimed at bolstering the psychoanalytic field's scientific credentials, public understanding, and institutional authority could potentially benefit every and any style of psychodynamic psychotherapy. Fear of authoritarianism and dogmatism clearly contributes to the fear of a new advocacy movement, but I consider psychoanalytic authoritarianism and dogmatism old symptoms of proof aversion. Resolving this root problem of proof aversion will create a freer and more diverse society of analysts and will not “dilute” psychoanalytic knowledge. The fear of dilution is more emotional than rational.
I hope to continue the conversation about proof aversion in a way that takes into account the legitimate professional anxieties that psychoanalysts and psychodynamic psychologists face. The theory of psychoanalysis is younger than the theories put forward by Copernicus and Darwin. We are still in the middle of an intellectual revolution. The idea of proof aversion provides much needed aid to that revolution and brightens its prospects. “We shall not be shipwrecked. Instead of the channel we are seeking, we may find oceans,” Freud wrote to Fliess on January 3, 1897, looking ahead to what discoveries the new year would bring. “[I]f we do not prematurely capsize, if our constitutions can stand it, we shall arrive…. When I happen to be without anxiety, I am still ready to take on all the devils.”
At the moment, there are plenty of devils in our midst, causing storms within and without. We need psychoanalysis to navigate them and steer ourselves to steadier waters. As Peter Gay said of Ernest Jones's 1938 effort to save Freud from the Nazis, “One of the most tenacious obstacles to the rescue of Freud was Freud himself.” There is a lesson there. In order to save the world, psychoanalysis must first save itself.