I have been asking myself lately why has psychoanalysis become so marginalized? Analysts have a morale problem. A large number have withdrawn and have removed themselves from the analytic scene. Fifty years ago our discipline was very much part of the Zeitgeist and an integral part of the cultural scene of North America. At that time, most psychiatry department chairs were analysts. These days there are hardly any left in those positions. Some joke that the situation has gotten so bad that we don’t even rate cartoons in the New Yorker. What has been our responsibility in the way psychoanalysis is viewed by the public? How has CBT been able to dominate the field of therapy to the point that psychoanalysis or psychoanalytically oriented psychotherapy are not even considered as therapeutic options? What has happened that we have ceded the field to CBT? Psychoanalysts have written about short-term interventions but have we taken a thoughtful public health point of view and made our knowledge maximally useful to the public? To make matters worse so many analysts are disenchanted with local, national and international organizations and question whether the time and expense of training was worth the effort and whether organizational membership has a pay-off.
It is always painful to look at one’s shortcomings and it is much easier to blame outsiders. We have all heard theories about the reasons for our decline. That psychoanalysis is too threatening, that Freud reduced everything to sex, that it takes too long etc. To compound the situation, we as analysts have not wanted to engage “mano a mano” with our critics. I have often heard the statement from analysts that if you have not been analyzed you are not qualified to critique psychoanalysis. Psychoanalysts in the past prided themselves for keeping apart from scientific discussions claiming that our discipline is unique and therefore scrutiny from outside scholars is illegitimate.
Why have we not educated the public? We were proud of our isolation and unfortunately the world has passed us by. We have not conveyed to the public that psychoanalysis is not a static discipline and that we have evolved in the last 100 years. CBT does not arouse the same negative reactions in people. What have the CBT people done that we have not been able to do? The received wisdom is that CBT can accomplish results faster than a psychodynamic intervention. Analysts have written about short-term therapy and crisis intervention. Yet in spite of these publications we have not been able to swing the tide of public opinion in our favor. Something else must be at work. What have we done to contribute to our undoing?
Psychoanalysis was set up in a rigid hierarchical way where the elders had the wisdom and were the owners of the truths. Unfortunately, different truths were promoted as the only possible way of viewing the mind. The public mocked our arrogance and candidates were put in a position of having to choose and acquiesce to demands that in any other circumstance would not be countenanced. The role of ideology in the psychoanalytic process poses the danger of analyst indoctrinating his patient with his own beliefs and ideas. The objectivity of the analyst may be disturbed by his own ideological beliefs or by political ambitions within institutions. So why have young analysts participated in this dysfunctional set up?
The compact in these situations revolves around the promise that if the candidate shows loyalty to his or her analyst or to an important figure in the society he/she will be rewarded by advancement in the organization or by the referral of patients. The use of younger people to further the ambition of senior people has permeated many of our societies and led to great ambivalence toward authority that is then projected on to our national and international organizations.
The perception about some of our organizations is that strife in their ranks is essentially endless; people want to stay away and wash their hands of the whole scene. Interestingly, rightly or wrongly CBT is perceived in the mental health field as more democratic without the power struggles that plague psychoanalysis.
It does not have to be that way. Psychoanalysis is thriving in other countries. There is excitement about our discipline along with a lively dialogue with psychiatry, anthropology, epistemology etc.
I am running for the position of North American representative to the IPA Board and I would like to change the negative perceptions about psychoanalysis by promoting both interdisciplinary and interregional dialogues. In the past, I organized several clinical conferences where members of FEPAL and NAPSAC alternated presenting clinical cases in small groups. These conferences had an uplifting effect on all the participants. We need more exchanges with other disciplines. Why don’t we have them with CBT therapists, Jungian analysts or personal change gurus like Brené Brown? They are obviously perceived as having something to offer to the public. Has any psychoanalyst ever given a TED talk? If not, why not? Paradoxically, as our profession struggles, there is evident public thirst for insight into motive, emotion and ways to change and lead a more satisfying life. That’s what we know.
If we talk to the public and people outside our psychoanalytic silo, we might learn something from each other.