Psychoanalysis: Between Improving and Changing

5. The Deterioration of Psychoanalysis and its Crisis

The anxious and sometimes desperate ways psychoanalysts are dealing with their crisis does not, for sure, show a clear distinction between the body of knowledge that denote psychoanalysis as a theory and psychoanalysis as clinical practice. The obvious concern in their approach till now relates mostly to the deteriorating status of their practice. However, although analysts do not like to consider the distinction between theory and practice in their attitude toward the crisis, the IPA’s point of view, which shows in the recent mode of activity and vitality, meetings, and optimism, is leaning toward considering the crisis to be in the clinical meaning of psychoanalysis. The IPA is ignoring the other side of the coin which is the status of psychoanalysis itself; the dog that has a tail called clinical psychoanalysis. The proof to that leaning is a sudden burst of activities to promote psychoanalysis to regain the interest of people, staying away from examining the analysts’ own interest in real psychoanalysis.

We still have to decide which of the two meanings of the term psychoanalysis that is the one that is actually in crisis? Could it be that psychoanalysis as a body of knowledge (science !!) is losing the interest of people lately? For sure this is not the case, because psychoanalytic thinking is ‘now’ weaved in the fabric of daily human life. The interest in contemporary psychoanalyses is the main issue that the IPA is avoiding to tackle. In my opinion, the reason is that IPA is not capable of doing that due to limiting itself to the function of training, i.e., to psychoanalysis as a clinical practice. I might get beck to this point later, but for now the IPA is not equipped or should be expected to evaluate psychoanalysis, as a body of knowledge, thus is not mandated neither to approve the plurality of psychoanalysis nor the credibility of the current theoretical formulations of psychoanalysis.

Although the concern about the drop of interest in contemporary psychoanalysis is global, the degree of that drop depends on what part of the world we are talking about. However, there is no region of the IPA claiming exemption of that drop. The local and the international organizations are all approaching this issue from the angle of the public and the need to remind it of the ‘goodness’ of psychoanalysis. This idea attests to the need to examine the state of clinical practice of psychoanalysis as part of our responsibility toward the public; not as consumers but as honest and concerned professionals.  Psychoanalysis is not owned by the psychoanalysts; it is part of our human heritage, therefore we should participate in dealing with the crisis with objective and ethical evaluation of its efficacy.

Let us look at the modality of medicine to create a baseline for a fruitful discussion. The changes and improvements in the treatment of cancer in the last four decades is a natural outcome and extension of the advancements in medicine as a whole, which came as part of the major scientific leap of the ninetieth century. The scientific leap was only possible when the West Europeans overcame their religious irrationality, which was the code of their existence for the previous five centuries. They advanced their life and aspired for more advancements and stepped waring and started thinking. In other terms: the evolution of a science or a body of knowledge stems from a larger and more encompassing human endeavour. The question then: could we identify the roots that psychoanalysis sprouted from and allows us to refer to, as the starting point in its progress and evolution? Psychoanalysis is not an extension of medicine or derives much of its nature directly from other human sciences. The most we can say, as Freud used to say, is that psychoanalysis is a psychology of sorts. Yet, its evolution and the progress it achieved did not relate to the psychology of its time; not even of today. Therefore, what we have now as a crisis in the practice of psychoanalysis is coming from an undefined body of knowledge, which we psychoanalysts know very little about. Better, the IPA training institutes train new analyst to practice an unidentified body of knowledge.  In the most classical training programs in psychoanalysis the reading of Freud’s text (and the texts of other gifted analysts) with the most scholarly training analysts would not teach a clinical method of psychoanalysis. No analyst- who is sincere in examining the crisis of psychoanalysis -could identify the body of knowledge that he learned in training which taught him how to practice it as a profession.

The reason, surprisingly is in the nature of psychotherapy itself. Psychotherapy, in particular psychoanalytic psychotherapy, has no theory or even an identifiable recognized technique. If the therapist has an idea about therapy in the back of his mind, he still has to follow the patient’s speech and not his own theoretical bias. In psychoanalysis, the situation is even more strict: the analyst and the patient together should avoid any predetermined notions, theories, or systematic rhetoric.  The analyst is expected to catch himself breaking that rule to avoid it influencing his listening to the patient.

Historically, the practice of hypnosis was not initiated to do therapy but to discover the nature of the splitting of consciousness. The discovery of the repressed through hypnosis, started the idea of therapy. Uncovering the repressed as a means of psychotherapy proved that knowing the unconscious could be done without hypnotism. The next step was discovering the linkage between consciousness to the unconsciousness, and the mechanisms that bridged them. Thus, in principle, psychotherapy evolved to be an act of interpretation; interpreting the unconscious to consciousness, interpreting the patient’s rhetoric to become meaningful events, etc. [Lately, I attended two lectures by Mark Solms. One was on the new translation of the Standard Edition. He brilliantly showed that interpretation is a core in psychoanalytic knowledge in more than one meaning of the word].  The dialectical advancement of therapeutic psychoanalysis reveals that each finding leads to a better, but unexpected understanding of psychopathology. However, because there is no theory of interpretation and there is no way to teach and train in interpreting, the concept of training got to be revisited and re-examined. This is a continuous obligation because as psychoanalytic work changes while working with the patient, psychoanalysis in general must have changed and is still changing over the years.

We still have two other issues to deal with. (1). Psychoanalysis is not a theory of practice but a theory of what practice reveals to both the patient and the analyst. This is the opposite of the prevailing belief in the psychoanalytic community, which looks at the practice as applying a theory to the patient’s material. We thus need to answer this question: what do we then practice if not a theory?  The practice of psychotherapy (analytic or not) relies on learning the psychological functions of the subject that are subjects to fixation, deviation, frustration, maturation, relating etc.). Therefore, training in psychoanalysis (in IPA institutes) is worthless if the candidates do not learn more about what will they do therapy for. This notion is not the simplistic notion of correcting mistakes in the psychical system of the patient; it means knowing what gets sick in the patient’s psyche and how it gets sick in order to be able to understand and interpret. (2). Individual psychotherapy follows the same rules of psychoanalysis in general. We listen, notice, understand, discover links between the conscious and the unconscious, from the patient’s speech, and interpret them (reveal the unconscious core of the speech). This kind of work brings us to reconstruct a theory of the subject we are analyzing. What we do in practice is a replica of how psychoanalysis -as whole- evolved (or should have) and progressed: analysts listened, noticed, understood, discovered more links in the psychopathological conditions, all that is supposed to have provided psychoanalysts with more to work with. The work with patients did not rely on a theory of the psyche or a technique of practice; on the contrary, it led to new notions about the psyche and technique. We realize now that the workings of the primary process are what was called repression or ego-weakness fifty years ago. Listening to the speech of the patients as equivocal statements of the speaking subject (Ricoeur,1970) led Freud and the early analysts (and recent gifted analysts) to eventually restructure meaningful conceptions of the dynamics of the intrapsychic nature of the human subject. This is how Freud noticed transference as an implicit content in the patient’s rhetoric, and how we should deal with it. This same find is still active in nowadays patient but in the form of character formation. A very senior analyst- presenting a psychoanalytic case lately- kept calling the patient’s relationship with him: “in her transference”. When one of the audiences asked what he meant by transference he replied that every relationship with the analyst is transferiantial. The right way to say it: transference is what of past relations that could coexist in present relationships, including the one in the analytic relation. There is no transference but there are matters in the past that gets transferred to the present, i.e., transference is not a psychical thing, it is one of the ways the past influences the present.

It is imperative to acknowledge that a hundred years of psychoanalytic work has unveiled a great deal of the nature of the human subject, and that knowledge has become now common knowledge to the society, particularly to parents and educators. The human subject is no more unknown and has assimilated most of what psychoanalysis has revealed. Therefore, we do not treat the same patient of fifty years ago. The present subject knows most of what was our cherished secrets few decades ago. We need to look carefully at what we are offering the public as psychoanalysis.

The psychoanalysis we still teach, train to practice and consider the basis of our specialty is ‘mostly’ what has been the core of analysis several decades ago. I am not sure what the new schools of psychoanalysis have done to the curricula of analysis in the traditional training institutes of the IPA and the training system in them. Nevertheless, there is good reasons to suspect that psychoanalysis of nowadays is a deteriorated form of the traditional one. Traditional psychoanalysis (we can go back to any preferred point in its history) had a clear identified relation to the theory of psychoanalysis at that time.  If the theory was indicating that psychopathology is caused by repression psychoanalysis was the act of revealing the repressed, and so forth. Up till Kohut’s self-psychology there was that kind of respectable psychoanalysis. The ease by which analysts suggest new schools has dissipated this necessary link which preserves the potential for change without making psychoanalysis lose its respectability. Analysis, like any thought could deteriorates when it loses its bearings. If some institutes -mainly in Europe- still follow that rule their training psychoanalysis still could  suffer some deterioration, because psychoanalysis has to change to make sense of all the discoveries made in regard to the human subject (not the presumed modifications in the technique). Moreover, it would be ridiculous to think that the IPA training model is still enough to qualify psychoanalysts. Reviewing three training programs of psychotherapy in European universities, it became totally unfair to compare their intensity, their detailed curricula, and the time needed to complete one of the three levels of degrees to training in IPA institutes.  Moreover, getting someone fresh to learn psychotherapy is far more better than getting a mental health provider who is not inclined to learn psychoanalysis but seek only its clinical aspect.

The next and last posting of this topic will be: Give me a university or give me death (Psychoanalysis).