Psychoanalysis, Psychotherapy, and the End of an Era

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{This posting will be in four parts: Introduction, The Deterioration of Psychoanalytic Psychotherapy, The Uncomfortable Duo of Psychoanalysis and Psychotherapy, The Demise of the Profession of Psychoanalytic Psychotherapy}.

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1.    A Very Banal Introduction.

Every time the difficulties psychoanalysis is facing are raised the issue of psychotherapy- in general-comes to mind. The reason is that the birth of psychoanalysis forced sort of a symbiotic link between a theory and its application and the term ‘psychoanalysis’ signified both aspects. This linkage created and still creates may unresolved problems. However, over the years, psychotherapy reached a certain degree of independence of psychoanalysis and seemed to have chartered a course of its own, while psychoanalysis remained undecided about its place in that duo.

Psychoanalysis started as an attempt to marry the French discoveries of the split of consciousness, and of hypnotism as a means to paralyze the active one to reveal the split other. This attempt was meant- at the beginning- to explore hysteria. The attempt, with Freud’s insights and intuitions, led him to the notion that the process of exploring could be turned into a method of psychotherapy. This turning point came from realizing that the split of consciousness could be explained as repression of morbid ideas that conflicts with regular consciousness. In better terms: Freud realized that psychoneuroses could be functions of some psychical mechanism that separate (splits) the unacceptable conscious material from regular consciousness. Those discoveries resulted in creating a new vocabulary to express the findings, which were viewed more as a branch of mental health. Psychoanalysis became a new field within the mental health profession. The most important feature in this new theory was the desperate attempts by Freud and his disciples to come up with a comprehensive “functional” theory of psychoneuroses their psychotherapy (how repression causes the neurosis and removing it results in cure). They were looking for a theory of causes and effects. Discoveries were getting more comprehensive, more extensive, mistakes were corrected, new ways of looking into the nature of the ‘psychical’ were coming from gifted psychoanalysis who came from different cultural and philosophical backgrounds.

Yet, something remained illusive: what is the link within the dual nature of psychoanalysis as discoveries about the subject ant the psychotherapy of the neurotics: is it a theory of something (its subject matter!) that is applied as psychotherapy. The question had another formation: is psychotherapy (profession) that generates new discoveries that require new terminology and theoretical formulation? This question could be dismissed as superfluous if the answer is: the link between theory and practice is dialectical. However, the link between theory and practice psychotherapy did not display a dialectical quality because neither the theory of psychoanalysis got improved by accumulated experiences in practice, nor practices got any better by the “new” modifications in the theory of psychoanalysis (will come to that in part three of this posting). Dialectical links are supposed to create a more advance understandings of that link and create better links. The dilemma of theory and practice is still as complex as it was raised sometime ago and remains as it was before, and we will see later it got worse.

To avoid deviating from our objective by discussing those issues further now I will underline two pairs of concepts that affected the progress of psychoanalysis in manner that put psychotherapy-analytic and none analytic- in focus. They are reflection of a halted progress.

Functionalism and Structuralism.       

Until the thirties of last century, the only way of thinking that was considered scientific or aspiring for factual results, was ‘functional thinking’, i.e., finding the plausible ‘causes’ of phenomena ‘effects’. In the humanities, like psychoanalysis, thinkers and scientists had tremendous difficulties in getting to those functional formulation. They did not know-till Freud showed- that all human phenomena contained an unconscious aspect that interferes in the relationship between the causes and the effects. In the interpretation of the Irma dream the cause of the dream was the implicit criticism Freud read in Otto’s remarks on his patient’s suffering. Hence, he interpreted the scene (in the dream) of the confusion of the ‘great’ physicians about the patient’s diagnosis and the patient’s behaviour itself to be exonerating him from poor practice. The dream fulfilled his wish to deny that the patient’s lack of response to his treatment was because of him. But this rule ‘formula’ does not say anything about dreamers who are seldom aware of a fulfilled wish in their dreams (will get to that a little later). All the unconscious factors involved in creating a Freudian megalomaniac scene of debasing the adversaries were not considered in the interpretation of the dream. In fact, dreams-unconsciously- fulfill the antithesis wish of the ‘day residue’. The wish was to get praised for his good work, while the wish in the dream was to debase the adversaries for blaming him.

In Sociology, marriage was explained as a system to control sexual relations for the sake of normalizing the family unite. However, it was not possible to make sense of this understanding with the wide range of differences between societies in that regard. Sociology missed that whatever are the rules of marriage in the societies they all agree on one shared rule: avoid and prevent incest. Marriage- “unconsciously”- is to control incest, thus prevents interfamilial parricide. Dreams are not wish fulfillment; they are statements of wishing.    

It is very important to emphasize, even to over emphasize, that every time Freud came close to announcing his latest functional theory as the final theory of psychoanalysis, he stopped short of shutting the door behind him. He always sensed that his functional theories were inadequate. He knew what is not before knowing what is. After the theory of infantile sexuality Freud reversed the functional relation between the cause and effect between sexuality and psychoneurosis: the neurosis causes deviations in the sexual urge not that psychoneuroses are the effect of distorted sexuality. Twenty years later (Freud,1926d) reversed the cause\effect of the state of anxiety and psychoneurosis. Anxiety has become the sign for psychical processes to start to activate (unconsciously off course) instead of the old view that anxiety is the manifestation of a psychical process that went wrong.  

A different way of thinking was implicit in his major works. It seems that something similar existed in the best works of the human thinkers of the time. In the early thirties F. De-Saussure (a linguist) introduce structuralism as a distinct way of thinking in the humanities. The implicit became explicit. The jest of the structural way of thinking is to understand (interpret), then rebuild the phenomena based on what your understanding revealed of its internal structure. The ‘unconscious evolution of psychoanalysis coincided with the birth of the structural theory to give us a different psychoanalysis from the cause\effect understanding of the psyche.

The Intrapsychic and Interpersonal.

The second pair of the two concepts is the relational vs. the intrapsychic conception of the subject. As mentioned above we should keep in mind that Freud avoided several premature functional foreclosures on his theoretical endeavours. He ‘sensed’ that functional formulations are void of proper consideration of the unconscious and its participation in the final formulation. A scholarly examination of Freud’s various theoretical formulations revealed to thinkers, philosophers, and the intellectual community in general the presence of a structural component lurking in the background in all his previous functional attempts at theorizing psychoanalysis.

Freud’s finding about infantile sexuality did not stop at that, but he advanced the discovery to make sexuality a Trieb (a pressure put on the mind to work) and not Instinkt. This choice of terms did not stop him completely from trying to name other Trieb (s) but he immediately got to the process of representation (thing and word representations), which is the core structure of the Trieb activity. This means that Freud was a closet structuralist while his disciples, with very few exceptions, were functional theorists.  

Although the term ‘intrapsychic’ was not in use at that time Freud realized that the patient (subject) has his own way of responding to the pressure of the Trieb and realized that what we now call intrapsychic is the core structure of any psychical phenomena. Freud understood infantile sexuality and its relation to adult sexuality and sexual deviation as a process that starts and matures, and in its way to maturation it succumbs to modifications that changes the nature of its pressure on the mind and the response is always individual and subjective. He realized and acknowledged that sexuality is a process not an entity- thing.

 The proof that Freud’s psychoanalysis was ‘basically’ a structural theory is in its impact on the cultural and the philosophical communities. Psychoanalysis caught the attention of thinkers and philosophers quite early in its history. In 1926 Politzer (a Marxist philosopher who should have known the nature of structural thinking well) gave psychoanalysis a great amount of attention. He considered psychoanalysis a different psychology and that its understanding of the human subject (the psyche) is distinct from the other common psychologies, like Wundt’s psychology. Ludwig Binswanger (1881-1960), even suggested a psychotherapeutic approach based on his understanding of psychanalysis. He could be considered the spark that set on fire the attention of phenomenologists, existentialists, and arts and literature masters to psychoanalysis which, was isolated in its psychotherapy camp. Psychoanalysis promised the best of in those in fields an extension to their search for the nature of the subject. Psychoanalysis identified the missing item in the novel structural epistemology: the systemic and none repressed unconscious.  This early recognition of the psychoanalytic conception of the subject was a blessing and also a curse in disguise.

The blessing was extending the boundaries of psychoanalysis beyond its limited beginning as a clinical branch of psychiatry. The advancements in the discoveries about the subject, which made Freud extend psychoanalysis beyond psychopathology [his last creative work was Moses and Monotheism] was influenced by the thinkers, philosophers, and the intellectual in general. Hence psychoanalysis was a blessing in the disguise of what the concept of ‘application’ sometimes offers. None of those giants of the culture considered psychotherapy an application of psychoanalysis. It was also a curse because psychoanalysts felt threatened, surpassed in their knowledge of the subject, and became relentless in refusing none analysts to speak for psychoanalysis. They closed the field of learning, training, and practicing psychoanalysis to be their own field of being.

The serious thinkers and philosophers -mainly in Europe- continued integrating the psychoanalytic discovery of the subject’s psyche in their own philosophical works. The works of Heidegger, Habermas, Merleau-Ponty, Ricoeur, Foucault, etc. and the existential movement and many others in the associated branches of the humanities (anthropology, mythology, etc.) demonstrated a very significant fact: psychoanalysis can survive, even flourish without the practice of psychotherapy. However, psychoanalysts kept their belief that psychoanalysis is a clinical discipline. The faulty understanding of the link between theory and practice led the psychoanalysts to a basic blunder: they believed they can derive a theory of psychoanalysis from practicing it as psychotherapy and anything that does not come from the clinical filed is not psychoanalysis. The fundamental and definitive mistake in that blunder is the fact that psychotherapy is a closed field and it could only survive if there are none clinical sources that could keep it going and growing (imagine the general practitioners in medicine not accepting the discoveries in the other specialties or even in the field of medical instruments). Practicing psychoanalysts could either improve the technique or at best find in the theory of psychoanalysis, as the thinkers have advances it, some clinical aspects that could make psychotherapy more effective.

The distinction between functional psychoanalysis and structural psychoanalysis extends to distinguish between intrapsychic and relational theories of therapy, and between psychoanalysis as a different and separate psychotherapeutic work that does not share much with other psychotherapies. Psychoanalysis of causes and effects (trauma, poor mothering, unresolved Oedipus, etc.) is limited to dealing with relational issues. Relational issues, and their participation in the psychoneuroses dictate using explanations as the means to cure. Explanations do not affect the psychoneuroses that have been established in the patient before any understanding was possible, i.e., understanding them ‘now’ does not obviate the unconscious changes they already done to the intrapsychic psychodynamics when they happened. Functional psychoanalysis is psychotherapy, or we could say psychotherapy came about when psychoanalysis was still in the phase of functional thinking

The beginning of Freud’s attention to structuralism could be seen in the case of the Wolf Man and more so in his understanding of the Schreiber memoirs. In those two cases-though they were not pure clinical example- Freud talks about the person, the individual, the human subject, not about mechanisms or what confirms his theory. Structural psychoanalysis interprets what the patient says to get to its internal structure to reconstruct it with the patient and effect the desirable insights to continue self- analysis and changing the intrapsychic construct. Psychoanalysis aims at changing not improving the intrapsychic nature of the patient. WE are not healers, we are psychoanalysts.     

 Confusing a theory of psychoanalysis with presumably a theory of clinical practice had a very negative and serious result. In a very short period of time analysts started ‘improvising’ theories of practice (for reasons to be presented in part three of the posting) believing that they were advancing psychoanalysis. Some even created fictional new psychotherapeutic techniques and superimposed them on the philosophies of known philosophers of the new age of the human ‘subject’. The coexistence of functional concepts (relational, interpersonal, intersubjective….)  along side the structural understanding of psychoanalysis (identity, transference, narcissism) created two camps of practicing psychoanalysts: relational psychoanalysis and intrapsychic psychoanalysis.

This division has been by some analysts as schools of analysis. Those are not schools; they are deviations from psychoanalysis and caused it to deteriorate since the sixties of the last century.