“Heroic Indications” for Psychoanalysis Reconsidered

The concept of “heroic indications” for psychoanalysis was most clearly articulated (though not by that name) in Glover's 1954 article “The Indications for Psychoanalysis.” After delineating very simply (and elegantly) the definitional parameters of psychoanalysis as a treatment, and then sketching out a developmental approach to the classification, diagnosis, and prognosis for mental disorders, Glover approached the indications for analysis in terms of three main groupings: those prospective patients accessible to that treatment, those only moderately accessible, and those called alternately “only slightly accessible” or “intractable” (p. 399). The third or intractable group, Glover said, “includes cases which would ordinarily come in the earlier groups but for evidence of deeper or wider ego disorder” (pp. 399-400). Among these, he listed certain types of alcoholics (who “cover either an endogenous depression or a paranoid predisposition”), patients with anxiety hysteria with a “psychotic sub-structure,” those with severe monosymptomatic phobias, those with pure psychoses, those with psychotic characters, those with severe cases of psychopathy, and those with “sexual perversions and inhibitions of an equivalent order” (all on p. 400). Quite aside from the fact that Glover has thrown this net of possibilities too widely for most of us (few would include patients with “pure psychoses” unless Glover meant something else by this category than is usually understood), few would disagree with his careful cautionary statement:

In the third group certainty of cure or even of major improvement cannot be expected and should never be promised. It is true that well-selected cases taken from this third group may from time to time give surprisingly good results, but it would be absurd to pretend that on the average more than a mild degree of betterment can be expected. No organic physician would refuse to treat a case of rheumatism because it was