Psychoanalysis is Marginalized because It Lacks a Center

The Problem of Theoretical Ecumenicism

It is not unusual when I meet someone for the first time and asked what I do for a living that I say I am a psychoanalyst. Often, I am then asked if I am a “Freudian or a Jungian.” I then find myself feeling bemused by that question, thinking “Well, at least they know something about psychoanalytic divisions and schisms that took place more than a century ago.”

My stock response is to explain that my psychiatric residency training was mostly in Freudian psychoanalysis with a sprinkling of British object relations theory. My later psychoanalytic training was in “interpersonal psychoanalysis.” However, if I had to put myself in a theoretical box, I’d probably be classified as a relational analyst as I find Interpersonalists like Harry Stack Sullivan and object relational theorist like Donald Winnicott helpful in my clinical work.

At this point in the conversation, what started out as a “small talk” question may lead to empty stares and a change of subject; most people have no idea what I am talking about. Fortunately, I know enough not to bore them any further with explaining how many psychoanalysts don’t consider Jungians to be analysts at all (Jung, after all, rebranded his version of psychoanalysis as Analytic Psychology).

Nor are many people aware that psychoanalysts now identify with an array of theories. How many? I can’t say for sure, however the ones I know of, in alphabetical order include Bionians, Intersubjectivists, Kleinians, Lacanians, LaPlancheans, Modern and Self Psychologists.

Complicating matters further, each of these groups’ theories come with their own jargon. This can make it difficult to those trained in one psychoanalytic model to understand the literature of another. It is not unusual to watch analysts from different “schools” responding with blank stares or even eye-rolling in response to the work of an unfamiliar analytic approach.

Some consequences of this fragmentation are skillfully elaborated upon in Paul Stepansky’s Psychoanalysis at the Margins. A Yale-trained historian of ideas, he was the managing editor of The Analytic Press (formerly an imprint of Lawrence Erlbaum, now part of Routledge/Taylor & Francis) from 1984 to 2006. He was also the publisher of my first book Psychoanalytic Therapy & the Gay Man.

In his book, Stepansky writes about psychoanalysis’ “near-demise” from a unique perspective—that of a publisher and editor of psychoanalytic books who is knowledgeable about the field. He wrote:

“What do I mean when I speak of near-demise? To the extent that psychoanalysis is a mental health profession, it may be reasonably expected to possess the kind of knowledge shared by the members of any profession. And like the knowledge of other culturally authorized caregivers, psychoanalytic knowledge may be reasonably expected to increase as the shared possession of the entire community of psychoanalysts.

“But in America this has simply not happened. The profession to which American psychoanalysts belong—the profession that nurtured and trained them and bestowed on them special therapeutic identities—has long fractured into various subcommunities of analysts allied with one or another psychoanalytic school of thought.

“What we are left with is less a cohesive profession than a loose federation of psychoanalytic communities—what I will term psychoanalytic part-fields—whose proponents see the world in different and often incommensurable ways.” [p. xi]

Stepansky, who published books by analysts from different “schools,” offers insights into what he refers to as the “decomposition” and “fragmentation” of the field. In this regard, he brings a unique perspective to psychoanalytic history and culture.

[Parenthetically, the book offers an amusing account of a publisher massaging the bruised egos of analytic writers who were chronically distressed about their dismal amazon.com ratings.]

Chapter One of Psychoanalysis at the Margins is entitled “Psychoanalysis and Its Crises, Publishing or Otherwise.” There he summarizes major events he believes led to the field’s marginalization from the mental health mainstream, including:

· Critiques and challenges to psychoanalysis’ two decades of post-war hegemony both from within and outside the field;

· The eventual exclusion of psychoanalytic approaches from government-funded studies;

· The 1980 DSM-III rejection of psychoanalytic models of illness;

· The 1987 settlement of the Osheroff case against Chestnut Lodge; and

· The arrival of Prozac to the US market in 1987.

He lays out some factors, beginning in the 1980s, leading to a decline in psychoanalytic publishing houses and psychoanalytic books sales:

“By 1948, three-quarters of all committee posts in the American Psychiatric Association were held by analysts, and by 1962, 13 of the 17 most recommended psychiatric texts were psychoanalytic in orientation. In the 1980s and 1990s, a single generation later, those few analysts who occupied leadership roles in academic and research establishments—Herbert Pardes, Shervert Frazier, Gerald Klerman, and John Gunderson among them—had sequestered their analytic identities and achieved eminence as nonanalytic, biologically oriented researchers” (p. 17).

Chapter Two describes “The Rise and Fall of Psychoanalytic Book Publishing in America.” It begins with the “glory era” following World War II, a time when a psychoanalytic textbook like Otto Fenichel’s The Psychoanalytic Theory of Neurosis (1945) could sell 80,000 copies and trade books like Erich Fromm’s The Art of Loving (1956) could sell millions. I was told when my book was released in 1998 that a psychoanalytic book selling 2,000 copies would be considered successful.

Stepansky goes on to chronicle some of the post-war psychoanalytic schisms leading to the field’s current fragmentation. Consequently, where there was once a thriving audience for psychoanalytic books extending well beyond analytic practitioners, “the very idea of a big psychoanalytic book no longer exists, for the simple reason that the field is neither big enough nor cohesive enough nor influential enough to yield indigenously big books” (p. 67).

The next two chapters deal with “Psychoanalytic Journals and the Road to Fractionation.” Chapter Three is subtitled “The Case of JAPA” [Journal of the American Psychoanalytic Association]. It is a chronicle of how guild issues and “in-group and out-group tensions” created separate publishing spaces where psychoanalytic part-fields flourished. In other words, JAPA would rarely if ever publish articles submitted by analysts who were not part of the guild of the American Psychoanalytic Association (APsA). This is not the case today [disclosure: I am on the present editorial board of JAPA]

Chapter Four, subtitled “The Road to Pluralism,” details how, starting in the 1980s, previously insular, theoretical editorial policies were belatedly liberalized and began to juxtapose contributions by diverse psychoanalytic schools of thought.

This chapter offers a tour de force critique as it contrasts psychoanalysis with the history of medical specialty publishing since the 19^th century. Stepansky explains why there are no “schools” of cardiology; instead, it is a field in which differing theories have to be tested against each other to produce data that can lead to consensus within the field’s mainstream about what constitutes a medical fact.

In contrast, he describes “theoretical pluralism as used by psychoanalysts as linguistically muddled and epistemologically incoherent” (p. 108) asserting that “theoretical pluralism,” rather than moving the field forward, did little to prevent fragmentation.

Reading this, I recall several psychoanalytic conferences in New York City during the 1980s and 1990s that hosted a range of analysts from different schools, purportedly trying to talk to each other about their theoretical differences. I often refer to these as conferences on theoretical ecumenicism.

One vivid, repeated experience was that of the Freudian analysts’ performances on these panels. Almost all of them started out with the assumption that the only reason anyone disagreed with their theoretical approach is because they did not truly understand Freudian theory. Then they would then proceed to explain it—again and again!

Chapter Five, “Theoretical Pluralism and Its Discontents,” further takes up the limitations and problems of theoretical pluralism. Stepansky’s views on the analyst’s unconscious as an “analytic instrument” should be required reading for candidates at all psychoanalytic institutes. The chapter contrasts Freud’s repudiation of his early seduction theory with how mainstream medical theories usually evolve.

Stepansky describes Freud’s abandonment of his early seduction theory of neurosis as “a prototypical example of psychoanalytic theory change, there is no consensual baseline of clinically salient ‘real conclusions’ and expectant ‘complete success’ attendant to the clinical approach Freud is employing with the particular patients he is treating . . . There are simply no public criteria for adjudging notions of clinical success and failure” (p. 138). Instead, there is “theory change by fiat” (p. 139).

In Chapter Six, “Whence Progress?”, Stepansky notes that even when using empirical data from other fields, it is difficult for a fragmented field to progress as psychoanalytic theorists do not share starting assumptions. As he puts it:

“For when all is said and done, we are left with a plethora of integrative strategies, each of which has its own proponents and critics. There are surprisingly few lines of communication among the integrators, much less a profession-wide consensus about how to prioritize the various integrative projects in the interest of promoting common ground” (p. 181).

“Science Matters” (Chapter Seven) asks, “Will psychoanalysts, individually or collectively, choose to pursue the path of one or another variant of normal science, in which case they will likely become less psychoanalytic and more eclectically psychotherapeutic?” (p. 217). Based on the field’s history, Stepansky was doubtful. There are efforts, however, by contemporary analysts like Mark Solms to move the field in a more scientific direction.

Chapter Eight, “Varieties of Healing, Conventional or Otherwise,” unfavorably compares psychoanalytic theories regarding modern psychopharmacology with “alternative medical providers” (naturopaths, homeopaths, osteopaths, chiropractors) of the late nineteenth and early twentieth centuries who “had to provide alternative accounts of bacteriology . . . that conveyed acceptance of the scientific findings that underlay the new discipline but pulled these findings into a conceptual orbit consistent with their idiosyncratic theories of etiology and therapeutic action” (p. 271).

Psychoanalysts should heed Stepansky’s observation that “Not all alternative therapies are eventually absorbed by normal science in the manner of osteopathy, but all of them eventually link up with normal science in meaningful ways or retreat to permanent cult status” (pp. 278-279).

Chapter Nine, “Life at the Margins,” lays out some past lessons and future suggestions for psychoanalysts wishing to move their profession into the mental health mainstream: “various strategies of medical and clinical outreach, pedagogical input, and conflict resolution” (p. 312) must be woven into analysts’ professional identities if analysts are to convince the public and health care policymakers that they bring something of merit to the healing process. Today, there are groups like the Psychotherapy Action Network (PSIAN) which are trying to do just that.

Psychoanalysis at the Margins should be required reading for analysts in leadership roles in psychoanalytic institutes and organizations, regardless of their theoretical orientation. It is also a cautionary guide for students and psychoanalytic candidates to avoid the errors of their professional forbears. Non-analysts interested in the history of the progression of scientific ideas in general and of medical theories in particular will find the book a rewarding read.

REFERENCES

Drescher, J. (1998). Psychoanalytic Therapy and the Gay Man. New York & London: Routledge.

Drescher, J. (2013). Jay Greenberg and Steve Mitchell: Interviews from the White Society Voice (1993-1994). Contemporary Psychoanalysis, 49(1):35-50.

Fenichel, O. (1945). The Psychoanalytic Theory of Neurosis. New York: W.W. Norton & Company.

Freud, S. (1914). On the history of the psycho-analytic movement. Standard Edition, 14:7-66. London, Hogarth Press, 1957.

Fromm, E. (1956). The Art of Loving. New York: Harper and Row.

Greenberg, J. & Mitchell, S.A. (1983). Object Relations in Psychoanalytic Theory. Cambridge, MA: Harvard University Press.

Klerman, G.L. (1990). The psychiatric patient’s right to effective treatment: Implications of Osheroff v. Chestnut Lodge. American J Psychiatry, 147(4):409–418.

Solms, M. (2021). The Hidden Spring: A Journey to the Source of Consciousness. New York: WW Norton & Company.

Stepansky, P.E. (2009). Psychoanalysis at the Margins. New York: Other Press.

Stone, A.A. (1990). Law, science, and psychiatric malpractice: A response to Klerman’s indictment of psychoanalytic psychiatry. American J Psychiatry, 147(4), 419–427.

Sullivan, H.S. (1953). The Interpersonal Theory of Psychiatry. New York: Norton.

Winnicott, D.W. (1986). Holding and Interpretation. New York: Grove Press.