New Horizons for Clinical Psychoanalysis

Introduction

Clinical Psychoanalysis was the engine that started the psychoanalytic movement moving. It remained for decades the power behind all the discoveries in psychoanalysis. Clinical practice, from its onset up until the sixties of last century, was a field of search and discoveries. Those were decades of burgeoning exploration that expanded from hysteria to deal with the rest of neuroses, extended to hypothesize about the psychoses, reached out to new categories of psychopathology like the psychosomatics and aggression and crime, and eventually to the borderline conditions and the narcissistic disorders. It was mainly busy with the field of psychopathology, using the early conceptions to give the new findings some meaning. There were three main theoretical frameworks, not theories, to organize the new findings: the cathartic theory (an economical point of view), conflict and defense theory (a dynamic point of view) and the structural theory (topographic point of view). Those three frameworks happened to be called by Freud metapsychology. Nowadays, it is not clear what is the major subject of clinical practice because there doesn’t seem to be new psychopathological conditions to explore, or clinicians prefer to just apply what the school they follow say about their cases. Notwithstanding, all that time there was no major mention of the technique of practice. Classically the technique was: listen-interpret-reconstruct. 

The expansion of clinical work, after the golden days of delving into new unchartered fields, led to new pathological conditions (psychopathologies) that started to appear in the offices of the psychoanalysts, and were not considered before as of psychological nature (Anorexia, body mutilation, sexual deviations, etc.). The expansion and the absence of any reference to their psychopathology in the old or the new literature, obliged the analysts to carry on using the main three schools of psychopathology to get by. But a new question arose: are all cases analysable. The free association\interpretation technique was not very workable in several of the new psychopathologies. Some attempts were made to explain that phenomenon using the existing theory of psychopathology but they were mostly hypothetical and marginally successful. There was a need for a theory about the patient, not only about the psychopathology of the patient. Although that theory would have led to a theory of psychoanalysis that could have explained the patient too, there was resistance to trying anything unfamiliar or looks different from the common prevailing ‘psychoanalysis’.

 Analysts were not cognisant of the difficulty and the danger of neglecting the difference between psychoanalysis and psychopathology, which is- in fact- the distinction between theory and practice. An early example was in the area of the psychosomatics. Those patients were exhibiting non- affective transference relationships with their psychoanalysts. The question arose: is the lack of affective transference part of the basic character- structure of the patient or is it a result of the psychopathology that inhibit the expression of affect. Is it the patient or his pathological condition? The French school handled the lack of affect in the psychosomatic condition as a specific aspect of the condition itself, i.e., transference of early poor affective experiences. The Anglo-American school considered the pathological condition the cause of the affectless transference. The question was basically of technique: interpret the psychosomatic condition to clear the way for an affective transference, or deal with the transference to reach the patient’s condition.  Only a theory of psychoanalysis could have put psychopathology in its appropriate context and gave a solid solution to the technique to be used with those patients.

Psychoanalysis did not have a theory to apply outside the field of psychopathology. Some analysts dabbled in other fields that were not directly related to psychopathology but only as they were seen from the psychopathological perspective. There were also eager efforts from non-clinical intellectuals to explore their fields in the psychoanalysis way. This was the beginning of the split between the clinicians and the none clinicians. Yet, it has to be said that psychoanalysts did not have a theory of psychoanalysis to seriously decide who is and who is not a psychoanalyst: they only had the criterion of being a graduate of an accredited institute of psychoanalysis. However, because all trained analysts had clinical licences, previously obtained from their initial professional training, they were the ones who claimed ownership of psychoanalysis and were able to continue exploring the field of psychopathology. Thus, the psychoanalytic training system deprived psychoanalysis from having the input of those thinkers in building a more comprehensive theory. With time and with other developments in psychoanalysis, analysts faced the exhaustion of the original theory and the need to rejuvenate it. They resorted to improvising what they considered ‘theories’, which did not have their matching techniques. Hence, the discoveries in the clinical field seized to progress in the same direction it was taking before (psychopathology), and the clinical analysts treated their novel theories as if they were clinical discoveries.

Clinical psychoanalysis almost stopped exploring psychopathology and got more and more engulfed in theoretical arguments and competitions. From the early sixties, a strong eagerness to follow Freud’s continual attempts to configure ‘a final’ theory of psychoanalysis began to occupy the center of attention and to play a role in the politics of the organization of psychoanalysis. It looked as if clinical psychoanalysis has done its work and solved all the problems of psychopathology and can now work on that illusive theory of psychoanalysis.  At this juncture, it is very important to highlight a fact: whatever was Freud’s position from that final theory he never changed his position regarding the technique of practice. He opposed all attempts at shorting it, or adding or using any ‘artificial flavours’ to free association (just listening to the patient’s choice of the subject and following him in his own pace). In other terms, psychoanalysts were aspiring to find a theory of psychoanalysis that is more comprehensive than being merely a theory of psychopathology, yet they did not free themselves from the attachment to the past of psychoanalysis: concepts, literature, training system and professional identity. I must say that when I, in my own struggles with the shortcomings of psychoanalysis, realised that it has to change to survive I was very ambivalent and mostly sad to plea for giving up the old to let the new emerge. To let go of a dream I had of becoming a psychoanalyst since my early twenties and being able to fulfill the dream after unusual twists and turns in my life was a fight between a past that I should let go of and a past that doesn’t want to let go of me.

Clinical psychoanalysis, even now- seems to be founded on confusing the theory of psychoanalysis (a theory of the individual) and a theory of psychopathology (a theory of pathological conditions). The confusion came natural because Freud started with an already firm idea about the links between the manifest human phenomena and their possible latent meaning (in dreams and parapraxes) and a hope to formulate a functional theory of hysteria, or the psychoneuroses, based on cause-effect principles. The two helices intertwined and did not distinguish between the patient with his psychoneurosis, and a person who has a character of his own. Classically, an  analyst would have said a person is of an anal character would  developed a compulsive neurosis, because without the compulsion this personl would be just “one of us!!”.  The human subject has a patient lurking within him, exactly as the patient has within him a suffering human subject. This confusion is still dominant in clinical psychoanalysis and is manifested more in the proliferation of the schools of psychoanalysis, which added nothing to the field of clinical psychoanalysis. What is more serious is that there is nothing concrete in those schools that could make us, clinician, settle on one of them or the other, let alone the looseness  of their improvised terminology.

Because I have witnessed and lived most of the transformations of clinical psychoanalysis that I am describing, and I am a product of that past, I have to say that I did not think of those events then the way I am describing them now. I lived them like all my colleagues and took stands from them as we all did, which were at the time biased and influenced by political leanings and preferences. However, two things distanced me from my past and allowed a better understanding of our present unstable position. The first thing was the almost sudden birth of the crisis of psychoanalysis. It is intolerable to an old timer, who lived the glorious years of psychoanalysis, to just watch it vanishing and leaving behind the terrible mess we are in now. The second is the meaninglessness of the non-stoppable proliferation of the schools that did not solve any of the problems they claimed to be the reason for their creation. I am bitter and critical of our mess, hopeful that moving psychoanalysis to academia would turn it into a Phoenix that will renew itself. But something more has to be said so this hope would not appear as a silly wish of a condescending old psychoanalyst.

Why did clinical psychoanalysis seize its search and research and discovering more about the human subject; instead turned into a machine of generating useless schools of what is presumably psychoanalysis?