THE FUTURE OF PSYCHOANALYSIS
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VANN SPRUIELL, M.D.
ABSTRACT:
The field of psychoanalysis can be delineated as a discipline, an entity, a system. Utilizing formal rule theory, it is possible to delineate its boundaries and distinguish its internal elements. Each part is, in my opinion, integrated with each other. While it is impossible to predict the processes of complex systems very far in advance, one can examine the prospects of individual parts. Providing there is not further erosion of democratic values, the future of psychoanalysis will be a bright one because it already has a head-start over rivals. This paper examines in some detail three of these parts: the morale of psychoanalysts, professional standards, and the possibilities of increasing research in the future. It then allows free speculations which not only express my beliefs but my personal wishes. Better a shameless speculator than a trafficker in doom.
"Ideas without facts are empty; facts without ideas are blind."
Robert Waelder (1967, p. 26)
INTRODUCTION
What happens within complex systems can't be predicted far in advance. Psychoanalysis is such a complex system. But thinking about it's future can be a useful game. There are times when speculation is appropriate. We need our imaginations about the future, if only because they add to the sense of vigor and life in the present.
When we examine our field in terms of its coherence, its existence as an entity, we can compare it to other entities. For example, a house has an "inner identity," composed of all its interior structures and all the human happenings that have occurred within it -- constancy in the midst of change. And a house has an "exterior identity," its street address and all the things that have taken place in relation to other buildings and the larger surround and its history (Greenacre, 1958). Only when we examine all of its major components, keeping in mind that each influences and is influenced by each of the others, should we go on to think about, not one, but a number -- a range -- of possible futures, whether of a house or of an entity like psychoanalysis. Some futures are more possible than others. Some are beyond our capacities to affect. Others can be influenced one way or another. As professionals in a discipline to which we are vitally committed, we want to do what we can to help along some futures and tilt against others we know would be harmful.
We ought to be chastened by memories of old predictions about the future of psychoanalysis. Fifty years ago, as Freud lay dying, enough was known about the immediate past of the civilized world to make the near, grim future seem quite expectable -- although not many people seemed to anticipate the sheer extremes of the horrors which followed. But by the end of the war in Europe, although the immediate future of the world seemed uncertain, at least there were grounds for hope. But the more mundane prospects of making a living in the private practice of psychoanalysis still appeared to be gloomy. Without Freud's authority, who could have guessed what would happen to psychoanalysis? Few would have dared hope for the way it in fact flourished not many years later.
On the other hand, should the future in 1939 have seemed as good as it turned out to be in the United States, still later, in 1953 or 1963? Looking back, we can see that the rosy predictions often made then, in those optimistic days, were flawed by overly simplified understandings of the brain and mind which were characteristic. The predictions that might have been made at those times were also defective because of a lack of appreciation of the weight of shifting social, academic, insurance and governmental forces.1
What about predictions in 1997? I believe that the pendulums of larger forces may be swinging toward psychoanalysis again; that we can be certain of our capacity to distinguish good theoretical and therapeutic analysis from bad analysis; that there is overwhelming evidence that good clinical analysts create more good new analysts, and that bad analysis fouls our own nest.
THE AIMS OF THIS ESSAY
Psychoanalysis will survive. But before supporting that statement, it is important to ask a primary question. What is meant by the word, "psychoanalysis"? We could give the usual answer: it is something that is therapy, a theory, and it has applications to other fields. Or, we could say it is a label applied, for some reason or another, to individuals and their ideas and certain special things they do. Or, the term could refer to formal organizations, presumably made up of these same individuals. But the two categories, individuals and organizations, are not exactly congruent, or even two sides of the same coin.
There is third way of looking at psychoanalysis: as a body of knowledge, a set of techniques and characteristic work, held together by a professional group defined by and committed to this body. Psychoanalysis, in this sense, is a particular kind of non-material entity which binds a professional group. It goes beyond mere labels of persons and organizations.
But if psychoanalysis includes a body of knowledge, is that knowledge merely a conglomerate of ideas? Perhaps even riddled with fundamental contradictions? If one adds up an the individual, apparently separate ideas known as "psychoanalytic," then that is the way it sometimes seems -- a conglomerate. Looked at more carefully, however, there can be discerned, framed within reasonably definite boundaries, a very small number of coherent, compatible, fundamental assumptions, basic concepts, and guiding principles. And together with the theoretical guiding principles there exists a set of explicitly shared techniques. These are delineated succinctly in a paper by Samuel Guttman (1985). Within the frame defined in such a way, theory and praxis are ideally indivisible.
This psychoanalysis is a system, a process in a slow rate of change with consolidations, corrections and elaborations. It can be both applied to and be influenced by other intellectual fields which are also entities -- other disciplines. Depending on definitions of science, psychoanalysis is either a genuine science in early stages of its development or a protoscience.2 It has capacities to generate and test hypotheses, discover provisional truths, some of which turn out to exist independently of the human discoverer, and connect and integrate verified facts on different levels of abstraction. Thus, psychoanalysis has content from which predictions can be made, and this content is independent of particular persons -- psychoanalysts -- who make the predictions.
Committed psychoanalysts are as surely professionals as chemists are professionals committed to chemistry. And there are criteria for distinguishing these disciplines and professionals from other disciplines and professionals. To think of the future of psychoanalysis, we need to examine this system in more detail, Just as we might examine the system (or systems) known as biology. We need to look not only for the possible futures of the whole, but variations in the futures of its parts.
Of the interrelated variables of the discipline of psychoanalysis, which I summarize in this paper, three are selected for special attention concerning the future. These three are: the morale of psychoanalysts; the preservation and improvement of professional standards; and the development of scientific research, vital for psychoanalysis in the long run.
WHAT IS A DISCIPLINE?
For convenience of discussion, I will draw upon the later work of a physicist and historian of science, Thomas Kuhn (1977). This work immensely sharpens his earlier concept of revolutions in science -- the substitution of new paradigms for old ones (1962). For purposes of the present discussion I will not examine Kuhn's work systematically,3, 4. but instead partly paraphrase his points and even alter their contexts in minor respects for the purpose of delineating our own field. In other words, I won't address Kuhn's primary interest, which is the philosophy of science, with its need to define more accurately just what is meant by the word, science.
There are divisions of the functions of elaborated scientific disciplines. A coherent discipline has: fundamental, shared assumptions; preferred models, and shared techniques of investigation and validation. It has inner organizational modes to provide coherence and continuation: schools, literature, and particularly meetings in which technical and theoretical matters can be organized, presented and debated. And it also has modes to deal with the external world within which the discipline exists. Each discipline has special modes of looking after its interests -- which are primarily to do two things, make a living and do the kind of work that the members want to do.
Standards, particularly minimal standards, are created out of these modes of organization together with the group experiences of work. Closely associated are social and intellectual values. All these play into the complex reputational systems, which make or break the prestige of scientific, intellectual and political authorities within the group. These reputational systems are in themselves neither good nor bad; they are necessary to maintain the discipline's cohesion and such authority its leaders have. There are also traditions. Among the most important of traditions are those sets which favor conservatism opposed by those sets which favor change.
On one side are recommendations for a very strict implementation of standards; they run the risks of dogma and cultish degeneration. On the other side are traditions which favor an "ecumenicism" of standards; at the extreme, they risk a mindless eclecticism and egalitarianism of values. If an intellectual discipline copes with conflict by demolishing it through becoming frozen in authoritarianism it loses its intellectual status and becomes a mere ideology preached by a group of believers. If it abandons the apprehension of conflict by assuming that all points of view are equally valid and that no differences exist among them, it becomes a mob. In either case, there is promise of extinction and replacement by other more intellectually legitimate disciplines, or at least more practical ones. A final dimension, dependent upon all the others, is the question of the morale of the group.
Freud insisted that clinical data and theoretical abstractions are -- or should be -- indivisible. One of Kant's most famous remarks was, "Thoughts without content are empty, intuitions without concepts are blind (1787; p. 931). It was paraphrased by Waelder (1967), "ldeas without facts are empty; facts without ideas are blind." Without its laboratory of clinical experience that which is called psychoanalysis all too easily becomes intellectualized -- and then any particular version of psychoanalysis is no more convincing than any number of other philosophical speculations about the workings of the mind.
It is true that there are outstanding individuals within the core of the discipline of psychoanalysis who do not practice clinically, and yet make valuable theoretical contributions. And it is also true that some major clinicians have contributed no research at all, and have never added to theoretical knowledge, yet become influential through direct teaching. It nevertheless holds that the vigor of the collective is a result of the appreciation of the indivisibility of the core assumptions from each other and the indivisibility of theory and clinical practice, ideas from the "facts," -- their regular acquisition, exchange, and refinement (Spruiell, 1988, vs88); Weinshel, 1988). However, although the primary source of the "facts" of psychoanalysis comes from the clinical practice of psychoanalysis, there are also secondary sources of facts -- other ways to "do" psychoanalysis. Both the accretions of experience and the acquisition of knowledge from non-psychoanalytical forms of research, e.g., the neural sciences, may add to the information bank from which we may derive new ideas.
Psychoanalysis began as an individual enterprise of Freud's. Eventually, it made what Freud called the greatest progress a group can achieve: the "decisive step," the replacement of the power of the individual Leader with the power of the community (1927, p. 95). When others first joined Freud, psychoanalysis became a group activity. There came into being a group of individuals called psychoanalysts. Freud set the criteria for who could belong and who couldn't (1914). It became possible to do psychoanalysts in ways beyond the self-analytical and the two-person relationship between analyst and analysand or supervisor and supervisee. It became possible to "do" it in the context of professional groups in a way comparable to mathematicians who "do" mathematics and physicists who "do" physics. During the early years, the small number of these new professionals made themselves identifiable, and distinguishable from, for examples, the followers of Jung and Adler. However, during the past fifty years it has become harder to draw distinctions between the discipline of psychoanalysis and the ideas and practices of those who merely label themselves psychoanalysts.
If we think of ourselves as constituting a special entity, or involved with one, we must think of boundaries. Whitley (1984), a sociologist, examines and compares scientific disciplines by applying similar criteria to a variety of fields, setting aside valuations of the end products, even the validity of their "scientific" status. Then their types, their structural similarities and differences, can be more profitably surveyed. A sociology of intellectual disciplines, insofar as they are disciplines, can exist, and Whitley's work demonstrates that such a sociological enterprise is possible and desirable. Thus, not only can a psychoanalytic sociology be imagined (as Freud did), a sociology of psychoanalysis is also imaginable and desirable.
FORMAL RULE THEORY
In another place (1983a), I have used formal rule theory as a conceptual tool to examine the analytic situation. Here, I wish to apply it to an organizational system. Rule, as used here, means "an established guide or regulation for act on, conduct. method. arrangement. etc., (Webster's Unabridged Dictionary). In other words, rule theory applies to attempts to discern regularities in events, and to put the resulting "rules" in symbolic form.
The general concept of rules can be useful, but they are very loose. Under their shelter fall many kinds of rules: rules concerning electromagnetic actions; grammatical rules; rules of games; moral rules; rules of law; the logical rules of Boolean algebra. However, I am confining myself here to shared rules of ordinary behavior in groups of people. As such, they are almost always obeyed without thought or awareness that there are rules. They are made evident when they are broken -- when everybody knows that a particular piece of human behavior seems highly unexpected, or deviant, or inappropriate, or psychopathological.
For these purposes, there are three categories of socially evolved or invented rules. One prescribes what one must do in given circumstances. Another describes what one must not do -- the limits of permissible behavior in specific social situations. The third category refers to mixtures of the two, or conditions in which there are, say, two choices which are merely two sides of a coin: one rule would say what a person has to do; another, applying to the other choice, would say what he may not.
Why should we bother to classify rules in this way? The limits of permissible behavior, or proscriptive rules, set boundaries. If they are silently agreed to, and most viable rules are, one may do anything within the boundary but one may not go over it. As far as such rules are concerned, one has total freedom within the boundaries. Of course, if the boundaries are very tightly drawn, one is confronted with a taboo concerning a forbidden act, like incest or murder. If proscriptive rules are very closely defined, there is much freedom -- even to break them. However, if the rules are viable -- that is, enforceable -- the society applies sanctions to the rule-breakers. In contrast, prescriptive rules, if they are specific, are completely limiting; sharply drawn, they leave no room for freedom at all within their domain. (Of course, if they are vaguely drawn they too can be meaningless -- amounting only to manners; for example, one should always be courteous. If either set of rules, the prescriptive or the proscriptive, is rigidly defined and tightly drawn, there is no freedom of any sort, we then say that such a system is "rule-bound."
In terms of psychoanalytic theory, prescriptive rules apply only to fundamental assumptions and guiding principles; in terms of technique, for instance, to all that is implied by the "fundamental rule" and its counterpart in the analytic stance. In terms of theory, our prescriptive rules are loose. For examples: It is assumed within the group that there exists in individuals a truly dynamic unconscious which influences conscious phenomena; there is no consensus within the group that one sharply specific view of it is "correct" and that others are "wrong." Or, it is assumed that man is a historical creature; it is not agreed that one developmental view is necessarily correct and others are necessarily in error. Or, it is assumed that it is in the nature of mind to be ubiquitously involved in inner conflicts; it is not agreed that necessarily all psychic phenomena are products of conflict.
At the same time, each of the truly fundamental assumptions and basic concepts must be included; no one of the small number can be Jettisoned without altering the whole and turning it qualitatively into a "something else" (as Rangell has stressed in a number of papers, see especially 1985). Similarly, the addition of qualitatively quite different fundamental assumptions, e.g. Jung's belief in a central theoretical and clinical place for a concept of the racial unconscious, also turns that discipline into some other system, not psychoanalysis. To the small number of essential concepts, several technical prescriptions are intimately related. If some other fundamental prescription is offered, say that infantile needs of analysands should usually be gratified directly, or that all patients must re-experience a birth trauma to complete their therapeutic work, some other therapy is being described, not psychoanalysis.
No dogmatic, unexamined, judgement is implied, however, about whether these other theoretical or technical systems are better or worse than psychoanalysis. Quality or "truth" should not be dictated by dogma or some form of logic. Such issues, if determinable, must be settled in other ways.
Together, the proscriptive and prescriptive rules set the boundaries and encourage certain activities within the frame -- for example the observance of limitations of the analysand's motor behavior and the injunction to analyze inner constraints to the analysand's psychic freedom. They distinguish psychoanalysis from apparently similar disciplines, e.g. interpersonal psychiatry, Jung's or Adler's systems, group or family therapies, and from those not similar at all, e.g. vocational guidance or anthropology.
Nevertheless, psychoanalysis has had quite useful interdisciplinary interchanges relationships with some of these other forms of psychotherapy, and with disciplines even more distant, e.g. anthropology, physiology, neurophysiology, sociology. But this holds only if the essential differences of the disciplines are respected. Psychoanalysis is absolutely distinguished from occupations which have no enunciated theory at all, like Rogerian or behavioral treatments, and from "disciplines" of psychotherapy which have no technical rules at all, like nude group therapy. When chasms are too great to be bridged, the consequence of trying to bridge one anyhow is to fall in.
I hope not to be misunderstood. A field such as ours should have reliable rules, but not internal injunctions and abstract boundaries which are frozen and specific. For example, a metaphor of a box, or boxes within boxes, would be inappropriate if applied to a living system. Boxes seem too hard, too fixed. A better metaphor for the disciplinary boundary would be that of a membrane of a living creature: expandable, contractible, with some variations in its permeability. Furthermore, the boundaries I am describing are generously loose. If they are too constrained, we would be describing a belief system, not a scientific enterprise.
What this organismic model can help describe is a system of an evolving disciplinary entity. Flexible but necessary rules allow great freedom within the system for constructive disagreements. But without boundaries which can be at least relatively clearly discerned, and without fundamental assumptions, psychoanalysis is only a label without an entity.
INDIVIDUALS CALLED PSYCHOANALYSTS
In terms of this systems model, three groups of individual psychoanalysts can be discerned:
A) Analysts whose major professional commitment is to psychoanalysis, as described above, do understand that it is in fact a well-defined entity. These analysts make up the core workers within a true professional discipline. In the United States, the large majority belongs to the American Psychoanalytic Association. But there are some notable exceptions, which even include people who have had no formal analytic training at all, or people who have been trained in institutes not accredited by the American. This core group of American psychoanalysts shares a strong consensus about the frame described above, and the happenings within it. In fact they are the core of the only cohesive disciplinary group in the United States which possesses a general theory of mind. Peripheral to this core, but necessary for it, are those psychoanalysts in the United States, usually members of the American Psychoanalytic Association, who are primarily committed to psychoanalysis as a special therapy. Many of them, for conscious or unconscious reasons, are not interested in theoretical matters. However, some of the members of this sub-group may later in life move into the disciplinary core of scientists. Others may drop away. But the majority supports the theoretical and clinical propositions of the core group.
B) There are still other colleagues in the United States, nobody knows just how many, who may also be members of the American Psychoanalytic Association, but who do not agree with the fundamental assumptions mentioned above, or the corresponding technical maxims which flow from them. Some of the same colleagues have more or less coherent and cohesive theoretical and technical systems which vary from the "established" science in the mainstream. If groups ever form around "alternative schools" in sufficient numbers -- probably nobody can define what number would be sufficient -- one or two of them may eventually become a rival scientific discipline. There are a few worthy alternative theories which are self-consistent and which, as such theories have in the past, may force alterations of mainstream or "core" theory. One hears of rival "paradigms" (Kuhn, 1962). But at this point, the numbers constituting these groups are not large enough to constitute separate scientific disciplines. I am not convinced of the lasting qualities of any of the dissident groups known to me. I think, as Rangell does (1985), that most of them modify essential theories or techniques of the mainstream discipline, for instance, alter in major ways techniques having to do with transference, or make markedly different fundamental assumptions, e.g. establishing theories which are mostly or entirely cognitive in nature. It is the justification for making these alterations which so far have failed to be convincing. Quite often, in polemics against the mainstream framework ("Freudian" or "orthodox", said with a sneer), begin with rhetorically dehumanized set of statements about it, then triumphantly believe they have destroyed that evil. The alterations are apt to be expressed on a theoretical level but most of them arise in the realm of therapy.
Or the alterations are not enunciated at all; there is a synecdochical emphasis on one part of Freudian theory and covert de-emphasis or outright denial of other parts. It is quite possible that some day a truly new discipline may emerge which will eventually displace the scientific discipline of psychoanalysis, or compete with it on equal terms. If that happens, we can hope that the new discipline, with its truly new paradigm in Kuhn's (1962) sense, will be given another name. There are still other colleagues who also have a primary commitment to what they call psychoanalysis, but who have no enunciated theories at all and/or no coherent corresponding techniques. Some of these "loners" actually do have implicit order but aren't able to write or talk about it except in very private relationships. They may have very important things to say to us and about us -- if only they could find ways to do it. Again, it is important to keep the distinctions clear between individuals and organizations. It has already been mentioned that there are individuals who are outside the formal and informal organizations, yet who very much belong to the discipline. And there are psychoanalytic institutes which are not part of the American Psychoanalytic Association which produce at least some graduates who certainly would be included within the discipline of psychoanalysis. I am in no position to judge the relative quality of these institutes. And there are graduates of institutes accredited by the American, and who are inside the dominant organizations, but who oppose the central aims of the discipline. But within this sizable second group, Group B, there is great diversity; lines of communication are anything but clear. Group B is an entity mostly in terms of what individuals think they are against. The people -- one hesitates to say members -- in this group do not constitute an entity like Group A. They constitute a squabbling conglomerate.
C) A very large number of people in the United States, larger than the entire membership of Groups A and B, identify themselves as psychoanalysts, yet cannot properly be considered psychoanalysts at all because they have not adequate training and never acquire it "one the job," so to speak. Most are primarily psychotherapists. Whatever theoretical and clinical beliefs they have are not important to them. They want mainly to call themselves psychoanalysts. Most are not certified by recognized national organizations. Some of them have not had even pseudo-training. In the United States, there is no formal organization which is identical with the first group, Group A, the scientific discipline of psychoanalysis. And that is probably as it should be. In my opinion political and scientific motives should be distinguished as clearly as they can be. I am only familiar with the American Psychoanalytic Association and the institutes accredited by it. One can find a concentration of the individuals who make up Group A in the Board on Professional Standards of the A.P.A., in central positions within the majority of its institutes, in groups of analysts like those who constitute the Center for Advanced Psychoanalytic Study In Princeton, and on some editorial boards of psychoanalytic journals.
THE FUTURES OF ALL OF THE PARTS OF A SYSTEM
To secure its best futures, psychoanalysis needs to strengthen its core as a scientific discipline in each of the components set forth above. Each is integrated with every other: 1) Assumptions, 2) Models, 3) Technical procedures, 4) Schools, 5) Publications, 6) Values, 7) Reputational systems, 8) Morale, 9) Professional standards, 10) Scientific research -- and, 11) External relations. All are interrelated variables within the discipline.
PSYCHOANALYTIC MORALE
Among the most serious of the threats to psychoanalysis are pressures to lower standards and cheapen analysis through ecumenical and eclectic attempts to encompass all or most of the people who call themselves psychoanalysts. Some of the pressures are closely associated with problems of morale. Contributing to the negative interactions are manifestations of self-destructiveness among analysts themselves. For example, it is amazing how often analysts engage in pessimistic indulgences. Let any philosopher attack the central ideas of Freud and psychoanalysis and he finds himself invited to our podiums, quoted in our journals, and praised as an expert. There are people -- even analysts -- who regularly lecture us about the scientific inadequacies of our clinical evidence and our research methods -- and they do so, not on the basis of experience, but on the basis of obsolete, positivistic, reductionistic, idealistic, perfectionistic, "scientific" standards of "proof" which are unapproachable in our discipline and perhaps illusory in any other. There is a great market for what is supposed to be bad or questionable about mainstream or Freudian psychoanalysis -- and willingness to listen to preposterous indictments. The worst enemies of the scientific discipline of psychoanalysis are some psychoanalysts.
It is not clear to me why this is so. It is simply stating the same thing in another way to ascribe it to a failure of resolve, or a need to pacify aggressors by self-immolations. The isolated nature of the work, and its consuming interest in the deepest conflicts of the mind, undoubtedly favors the expression of unresolved transference conflicts, sometimes displaced to the organization itself or its parts. Certainly the frustrations involved with the necessary abstentions must also play a part. Finally, there are unavoidable disappointments.
But I have to point out something that should be obvious: the despair of some contemporary analysts is not a realistic reaction to danger. Only compare the present realities with those in Austria and Germany during the 1930's! Without criticizing those who found themselves truly in helpless positions, if the reaction of all analysts had been despair about the Nazis -- perhaps with the hope that it would be dissipated by submission, compliance and expiation --the vigorous post-war development of our discipline would probably not have occurred.
There is no genuine relief from our burdens to be had in the external world. I do believe psychoanalysts should look outward to other disciplines for stimulation and collegiality; I do not believe, however, that psychoanalysts should look to behavioral scientists or philosophers or literary critics or other experts in any other field for confirmations. Turning away from our own field of competence guarantees disappointment.
If psychoanalysts want to do something about themselves, recover their courage and commitment, re-discover their resolve, they should look inward, to what they know about themselves, what they learned about themselves in their careers as analysands and analysts, what they learned in many thousands of hours of being supervised, of supervising, of group discussions, of arguments with friends -- the whole immersion in the collective lore of the discipline itself. We need to return to understandings that tend to get lost in our other preoccupations, especially those insights we sometimes painfully had to learn about ourselves. And we need to preserve plain commonsense.
Nowadays, in my opinion, there are some external dangers. They are real, but they do not seem overwhelming -- yet. These include: consequences of governmental and social changes; a lowered perception of the value of psychoanalytic treatment by some potential patients; economic pressures on medical schools (which have a myriad of effects, particularly on psychiatry, residents, and analysts on their faculties); reduced opportunities for psychoanalytic teaching and research within departments of psychiatry; removal of insurance benefits for therapeutic analyses; the dangers of deprofessionalization -- the freedom for large numbers of hardly trained or untrained individuals to represent themselves as therapeutic psychoanalysts; the interaction with all of these factors with the internal one of a lowered group self-esteem; theoretical propositions which offer simple ways out for complex human problems; easier and supposedly surer methods of treatment because they are purportedly easier for therapist and patient alike; and external belief systems in place of the inner necessity to live in a real world of uncertainty and ambiguity.
THE MAINTENANCE OF MINIMAL PROFESSIONAL STANDARDS
We must be responsible for our own care, and our public resources are small. The collected institutes recognized by the American Psychoanalytic Association still make up only a tiny national organization. Nevertheless, it has been remarkably effective, in spite of having been among other things, its lack of efficiency and an allegedly bumbling systems of governance. Better, some say, to merge with universities. But the majority of psychoanalysts think it is better to be free -- even at the price of retaining what seems inefficient to outsiders. As Lawrence Friedman (1988) says, psychoanalysis does not thrive within larger academic or governmental organizations.
Our best safeguards and remedies have to do with maintaining and improving psychoanalytic standards. Although the American Psychoanalytic Association is often thought by non-members to be dogmatic, awesomely powerful, and ideologically conservative, the facts do not bear out these assumptions. In fact, the A.P.A. is relatively weak, compared to similar organizations. Its Board on Professional Standards, is the only group monitoring standards. It needs to be strengthened, not weakened. Without doubt, the International Psychoanalytic Association will set up organizational modes similar to those of the Board when new, autonomous institutes come to be evaluated.
It will be to the advantage of both organizations to aid and encourage new institutes which come to be recognized by the International Psychoanalytic Association but not accredited by the American. If there are tendencies -- from any accredited quarter -- to lower these standards by trying to train untrainable people, all psychoanalysts and all potential psychoanalysts will be the losers.
SCIENTIFIC INFORMATION AND RESEARCH
The long-range future of psychoanalysis also depends upon how rapidly and how well it can move from the verbal tradition of natural scientific observations by individuals to a maturity which adds more impersonalized studies by groups.
Astonishing amounts of data have to be accumulated if any living system, such as a person, or a mind, is to be properly investigated. The study of the mind in depth is comparable to a study of an ecological system. After their own eras of individual, empirical observations, other sciences began to study isolated variables in large numbers of subjects. This was easier in sciences which dealt with inorganic phenomena -- and, indeed, this method became idealized as the scientific method. It was much more difficult for biologists to use reductionistic and statistical systems in work with living subjects.
During this century it has come to be feasible to objectively study much large numbers of variables and their interactions simultaneously in systems than was possible previously (Spruiell, 1993, vs93ai, 93aii.). We can be certain that this trend will continue, and will even lead to the establishment of new criteria for what is to be called, science. New surprises will certainly swim into view if we are able to exploit the technologies of computer science. New formulations will occur if we are able to devise new methodologies.
Of course, psychoanalysts have always studied complex systems. They utilize their own brains' computational abilities -- and the brain is still incomparably more capable than any presently imaginable computer. However, it is not as precise as some scientists wish -- it is not even as precise as an adding machine. But it can cope with relating parts with each other and to wholes. To do this, analysts must move back and forth between free processes of their own associations and rational analyses -- as other scientists actually do, although they hardly ever admit to it in their reports.
Given the awesome and unique therapeutic potentialities of psychoanalysis for suitable people who are interested in their own minds and fates, there will always be a need for clinical psychoanalysis. As long as there are relatively free societies, the traditional psychoanalytic forms of putting forward new ideas, testing them, challenging, refining, and shaping the developing body of theory will continue. But something new was added forty years ago to the study of individual psychoanalytic cases: team research.
In what follows, I will make no effort to survey the range of psychoanalytic scientific investigations, past, present and future. Much more has and is being done than is commonly believed. I will confine specific remarks to the research I know something about. I will begin with a few general questions, then discuss past and present together, and conclude by making some speculations about the future.
What do we hope more organized research by groups of analysts can tell us that we do not already know from our traditional activities? What can we expect to learn from the investigations of scientists in other fields that would be actually relevant to ours? I think the correct response to both questions is that we don't know. It is simply important to keep repeating the questions. However, we do know some of the things we have little to do with validations for outsiders).
First, we need to continue our traditional forms of psychoanalytic investigation. And here are some examples of additional needs: to test those of our concepts which can be tested; to develop a psychoanalytic epidemiology; to acquire modern archives which are easily accessible -- that is, computerized archives; to perform prospective, comparative, and longitudinal studies; to study the operations of case conferences -- and predictions made during them. More generally, we need to advance the epistemological problem of studying small numbers of subjects while taking into account large numbers of variables. Psychoanalysis began by the investigation of single minds. It was a great good fortune that these investigations turned out to have unprecedented therapeutic value. Thus psychoanalytic research originally came from some members of the group of individual clinicians. To my knowledge, there are no general scientific disciplines made up only of full-time researchers. Only a fraction of chemists spend a significant amount of time doing research, if they do any at all. Most anthropologists, biologists, physicists, astronomers and sociologists teach. Traditionally, most psychoanalysts have analysands, teach, and work in other ways as psychiatric clinicians.
Nevertheless, most analysts look upon their clinical analytic settings as potential laboratories for naturalistic scientific observations. For many of us that is one of the reasons the profession is so fascinating. Unfortunately, it is inherently difficult to share and test these insights in the way an ecologist, for example, might share and discuss his observations and ideas. Even the ecologist would communicate mostly with other biologists. It should be interjected here that it is a myth that academic psychologists, philosophers, and historians of science often visit the laboratories of other disciplines. Unless one were a trained geneticist, a non-geneticist would have little or no idea from laboratory observations about either the work or the competence of the geneticist. Geneticists have their own ways to examine the veridicality of results and the competence of their colleagues. So do psychoanalysts.
Despite all the limitations, a huge collective "information bank" has come into existence among psychoanalysts. It contains data at every level of validity, from the effectively proven to the extremely speculative. But it is largely private and informal in nature. Communication remains, for the most part, in the oral tradition, rather in the written, symbolic tradition. It is in the murmuring marketplace of ideas that pragmatic tests of new insights, formulations and re-formulations occur. It is likely that psychoanalysis will remain for a long time relatively inaccessible to "outsiders." This is true for two reasons. At the existing level of theories, stringent proofs are hard to establish. Rather, we deal with a very small number of basic assumptions and a series of likelihoods. And our exchanges are enormously constrained by the fact that the data of psychoanalysis has to do with intimate details about potentially identifiable people.
Only a minority of analysts now publish clinical material. When they do, their aims are more to demonstrate rather than to document what they believe to be true. Few analytic papers are scientific reports intended to prove something. Rather, they are intended to demonstrate that the analyst-writer observed something, or inferred something, in the way other natural scientists observe and infer phenomena in nature, and ultimately make more abstract generalizations from them.
This is not the tidy way research is done in fields claiming modern methodologies. But even if, say, one of the neural sciences can be thought to be more advanced, its research is tidy only in certain ways. The neural scientist may have beautifully documented results about the brain, but his findings are useless if combined with trivial conceptions of mind.
Nevertheless, ways can be found for psychoanalysis to move toward more organized information which can be disseminated more publicly. In fact, during the fifties, sixties, and into the seventies, psychoanalysts were involved in many organized scientific investigations, some specifically having to do with psychoanalysis, some interdisciplinary in nature. I had the opportunity to do research work with two of these groups. In the 'fifties and 'sixties, there were great hopes that linguistic, sociological, anthropological, biochemical, genetic, developmental, cognitive, physiological, and neurophysiological fields would produce information which would inform psychoanalysis and in turn be informed by psychoanalysis. An important instance was developmental research which helped shape and correct reconstructions made from adult and child analytic work -- and in turn was influenced by the analytic point of view. However, excepting the developmental studies, the results of the major psychoanalytic research efforts in the past have been largely disappointing. The reason massive research projects have not been more successful has to do with our underestimation of the extraordinary complexity of our fields of study. We did not recognize the translation problems between separate disciplines with differing epistemologies. We have not, as yet, been able to devise scientific methodologies which can cope with the extraordinarily large and complex sets of variables involved. Looking back, it was not even possible, no matter how much funding might have been available, to cope with such complexity by processing coded data statistically by hand. Finally, the social, governmental and educational forces during the last ten or fifteen years have operated against the older, large-scale research projects. On the other hand, a large amount of valid scientific information was derived from them and has simply been forgotten -- much research in psychosomatic medicine, for example.
Some of the most interesting (and frustrating) projects have focused on recorded individual analyses. But studies which use audio and video recordings (and often the use of computers as tools) of analytic sessions and observations made by independent observers are extraordinarily labor intensive. Think of simply listening to the recordings of one analysis: aside from processing what the analyst heard and later evaluated, he would consume at least 10% of his working time simply listening. The wonder is that any such studies at all have been undertaken and even completed. And it is not to be forgotten that even elaborate observational studies such as these can reveal only one part of the analytic process -- almost entirely the productions of the analysand's mind, not the analyst's, observed from outside the field. Only in a supervisory or self-analytic situation can valid information -- limited at that -- be derived about the happenings inside the field. But to go beyond the limitations of studies of both the analyst's and analysand's minds in communion raises concerns that the research itself will contaminate (and perhaps even destroy) its own field of vision.
Not only have psychoanalysts been involved in large-scale scientific enterprises, many have worked on a smaller scale. Very useful projects have been devoted to what happens to analysands post-analytically, the fate of transferences, the validity of psychoanalytic clinic predictions, "micro-analytic" investigations of recorded material utilizing the computer, individual case studies, the massive, 30-year Menninger psychotherapy research which culminated in Wallerstein's 1986 book -- these and many more. These ventures need to continued when more enlightened funding policies makes them possible -- or without them to whatever extent that is necessary and yet possible.
Of several such locally engendered and mostly locally funded research projects, two can be cited. One is the series of Kris Study Groups of the New York Psychoanalytic Institute. The last published report of a Kris Study Group, on so-called borderline states in analyzable patients (Abend, et al, 1983), is a model for this kind of psychoanalytic research. The second is the study of adolescent psychoanalyses at London's Brent House. I had the opportunity to take part, as a year-long visitor, beginning in 1972. At that time (1972-73), Moses Laufer led 23 analysts of adolescents in research. Not only were good records kept, but the several groups worked in teams on special research problems -- while utilizing these same teams in weekly, round-robin, peer supervision. The work of the Kris and Laufer groups continues; each is proof in itself of the possibilities of cooperative research.
These examples could be extended. Study groups with research purposes have worked under the auspices of the American Psychoanalytic Association, individual institutes, and simply privately. For example, a nationally dispersed set of analysts -- also self-funded, ran a pilot study on a computer bulletin board; it's purpose was to follow the results of discussions carried on anonymously of actual, on-going case material presented to the (privately accessible) bulletin board by an analyst who was also unknown to the discussants. Pilot studies are exploratory; it is hoped that more such studies, which more or less systematically limit some variables in ordinary case discussions, will be conducted. Again, the list could be enormously expanded. My point is that analysts can and do carry on largely or totally self-funded investigations beyond individual case studies. They have demonstrated a remarkable willingness to give their time. And this applies not only to research itself, but the information management which must accompany it.
One group made a strong beginning toward assembling the psychoanalytic bibliographical archives in computerized form. The work was done personally by groups of analysts from three widely separated institutes. They entered the bibliographical references of the five major English-language literatures in computerized, searchable databases. The results of the work, very inexpensively stored on diskettes, are available at cost. Anyone with a computer can have access at home to these references, be able to search almost instantly for words in titles, authors, specific journals -- anything in the database. The same was done with book reviews. Now, the smaller journals are being added.
Some analysts work better alone. Two examples follow: Two years ago, Paul Mosher, M.D., of Albany, New York, spent his free time for an entire year working out a program which allowed the database on journal articles to be printed in the fashion of the monumental Psychoanalytic Concordance (Guttman, 1980). The result is a book (Mosher, 1987) which the American Psychoanalytic Association sells at near cost. It allows the computer illiterates much of the same convenience their more modern friends enjoy.
The Concordance itself is another fine example of individual initiative. Incidentally, both of these projects, Mosher's and Guttman's, were funded by the analysts themselves.
One of the unexpected consequences of cooperative work was the recognition that there are many analysts who want to play a part individually, in groups, within and among institutes. There are vital social implications to be drawn: in the nationwide village of psychoanalysts it is still possible for us to do our own research, to make a cottage industry of it. Just as single individuals can often produce far more than committees, small groups of analysts united by common aims can often produce more than some heavily funded organizational programs.
At present, more and more departments of psychiatry recognize that there are advantages in reconstructing relations with psychoanalysis. After all, there is no adequate rival theory of mind. Psychiatric residents desperately need to learn rational approaches to psychotherapy. And, except for specific projects, the flood of grants for so-called "biological psychiatry" has slowed. At the same time, there is a revival of interest in at least small-scale investigations of subjects of interest to psychoanalysis.5
Whether we can entertain the same hopes in the more distant future that were had in 1950 is uncertain. But it is more certain that whatever happens, psychoanalytic theories will become much more sophisticated. Psychoanalysis will be able to extend relations to the newer knowledge in molecular genetics, neuropsychology, psycho-endocrinology, and artificial intelligence. For example, it should be possible to imagine that in some cases it will be possible to actually create the alterations in what Freud called constitution, which seemed so unalterable in his own time.
A greater sophistication implies that we need to keep perfectionistic standards from stymieing us at the outset. The output of problem solutions also will be complex; we will have a range of likely "truths" or probabilities. Real attention will have to be paid to "hierarchies of validities." "Artificial intelligence," a possible tool of the future, was copied from human cognitive functioning: it utilizes what information is available, acknowledges what is known to be unavailable, and then attempts to make those inferences which seem most likely. It operates in terms of probabilities rather than perfectionistic certainties.
Even with the computer as a tool, large-scale studies are usually not possible without large grants from private or public agencies. However we should be patient. Funds are useless or wasted if there are not sophisticated investigators to use them well. The sort of renaissance envisioned would be a long-term affair. In the meantime psychoanalysts should get ready for it.
For research purposes, we certainly ought to have coded records -perhaps with ratings from validated rating scales. We need a collective and impersonalized memory bank -- archives which be easily searched. The Hampstead Child-Therapy Clinic (now the Anna Freud Clinic) assembled such a bank in the 1960's in the form of a huge number of indexed cards. The technology was not advanced enough at the time for It to be as useful as it might have been in a computer -- but the work of assembling it was, and the idea becomes truly feasible in the future.
Some archival scientific tasks can only be done by experienced psychoanalysts. The bibliographical database is such an example, and it is only a beginning. Now that there is a core of reliable data -- the names, addresses, titles, dates, etc. -- the next phase will be to pull in references hidden in volumes of collected papers and in smaller journals. The hope will be to add search words to text not contained in the titles; after that, abstracts will be made more seachable; after, cross-references; later still shifting opinions. If archives like this are constructed, it can be seen that around the center of absolutely verifiable information are successive bands of increasingly subjective data. At the periphery would be the shifting preliminary reports and commentary. But also, at successive levels away from the center, editorial discretion would be increasingly involved. Each institute within a few years will be financially able to maintain a large part of such a database -- and some central, national organization can serve as integrator. If it comes into being, it will join with the other factors of the disciplinary matrix, and influence and be influenced by them all.
I have no doubt that this particular complex electronic library, or one like it, will be made. In whatever form, it will allow for a kind of browsing known as hypertext -- which in cognitive ways parallels free association. There is no doubt that the psychoanalytic literature will change rapidly within a few years. As suggested, it may even change materially away from print on paper toward electronic communication, in both formal and spontaneous forms.
Beyond electronic libraries will be additional functions of the computers of the future, some now known, others not. The development of optical circuits, parallel distributed processing (the use of cohorts of separate but integrated computers to study parts of a complex problem simultaneously rather than single computers which have to scan so extensively), neural networking, all these and others, will create futures which pass predictability. No one knows the lengths that artificial intelligence, for example, will go, or its limits. It is known, however, that extremely complicated programs must run their course on particular problems before their inventors and the associated scientific workers can have any idea what the results will be. It is known that small inputs into complex systems can, in a short period of time, result in absolutely unpredictable consequences.
SUMMARY: A FULL CIRCLE
If a consensus can ever develop among funding agencies that human minds, at least as much as brains, ought to be studied -- that the individual human is worth it -- what is predictable is that the most thrilling revolution ever known will accelerate again. We are part of it. But with or without help from funding agencies, we will continue it. The psychoanalytic revolution, begun by a lonely and brave conquistador, became a group activity transcending the man and the myths about the man. At its best, psychoanalysis offers the only reliable opportunity to allow a person to change himself on the levels of deep structure. It is invaluable for those who can engage in it, and within a free society there will always be people like Freud -- conquistadors of inner space. In a free society, therapeutic psychoanalysts, if they are well-trained, will survive.
And there will always be a place for psychoanalytic theory, however much it is sure to be altered in the future. It has influenced every educated person in our culture, whether a given individual knows it or not. It will continue to influence the culture in terms of all that is best in humans. The reason? It rests upon a reliable base, relies upon rationality -- which includes the recognition of the limits of rationality and the functions of imagination. And it allows us to apprehend pseudo-rationality in terms of the recognition of conflicts, of self-deceptions, of perversions of thought. That is the reason the psychoanalytic movement became a discipline, a proto-science. And that is the reason it will survive in some ways that are known, in others that are quite unpredictable.
END NOTES
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