Reflections on the Impossible Profession

An Australian academic psychoanalyst, Douglas Kirsner, recently wrote in the New Yorker Magazine, “the Impossible Profession is on the ropes [and] Freud’s reputation has never been so battered.” Furthermore, “the art-science he founded, once a kind of secular religion in America … is now a national afterthought, a discipline in financial peril and internal tumult.”

Although for its entire hundred-year history psychoanalysis has been vigorously and at times viciously attacked from both without and within, the last 20 or so years has seen an escalation in vigor and viciousness. From Jeffrey Masson’s portrait of Freud as a craven careerist denying the reality of child abuse to get more referrals to Peter Swales’ allegations that Freud had an affair with his sister-in-law, a chorus of critics contend that he, and the movement he founded, are morally and intellectually dishonest. A whole new growth industry has been created, which the media has even dignified with a label — “Freud bashing.”

Yet this is only one side of a deeper attack on psychoanalysis along with any other form of depth psychotherapy that takes seriously the examination of the inner life. This aspect of the onslaught is driven by the world of corporate health care and their shills. These “shills” are the brief solution-focused psychotherapy crew allied with the unlikely coalition of biological psychiatry and the latest incarnation of behaviorism, cognitive-behavioral therapy. All of them share the belief that the practice of psychoanalysis and psychoanalytic psychotherapy is at best useless, and at worst, fraudulent.

From the perspective of the practitioner the situation has become quite grim. For the majority of those who want to continue working with patients in the traditional psychodynamic modes there are several unpleasant alternatives. One can accept managed care insurance money at the cost of putting up with the full gamut of managed care horrors which include, but are not limited to, spending large amounts of unpaid time filling out long application and credentialing forms, filling out treatment reports, wading through lengthy telephone and voice mail menus, and having inane conversations with intellectually challenged case manager bureaucrats — all for having, at most, 20 to 30 sessions a year paid for by insurance at substantially reduced fees. Alternately, one can practice managed care free and be faced with the choice of living on a very reduced income or limiting one’s practice to a carriage trade clientele.

But perhaps things are not quite as grim as they seem. Although I have been a practicing clinician for 30 years, my primary interest in psychoanalysis has always been as a way of understanding contemporary political realities and historical trends and events. My introduction to psychoanalysis was in the mid-1960s at the start of the anti-Vietnam War movement and the emergence of the radical politics of the New Left. I felt that psychoanalytic concepts were the most powerful, sophisticated, and satisfying tools for understanding the behavior and motivations of entities larger than the individual: groups, organizations, governments, and nations.

I have always strongly identified with Freud’s claim that he was more interested in understanding than in therapeutic change. In particular, I have always wanted to be able to understand what motivates people, and the groups with which they are affiliated, to do things like drop atomic bombs on cities full of people and commit the atrocities of the Holocaust. I have always been drawn to those psychoanalytic thinkers who have emphasized the importance of the outer world — the stage of history, politics, and current events — in determining who we are and what we do. This, of course, is the essence of psychohistory.

So, perhaps the promise of psychoanalysis lies more in the direction of psychohistory than of psychotherapy: to make use of the discoveries, insights, and theoretical constructions of the discipline and way of thinking developed by Freud, and elaborated by the many branches and schools of

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psychoanalysis which have proliferated over the course of the last 100 years, to help us understand the why of history.

There are several hopeful signs that within psychoanalysis itself there has been some change of focus, shifting from the exclusively clinical to broader concerns about groups and culture. The popularity of Lacanian analysis, with its emphasis on understanding the behavior of groups, the significance of the products of our culture, and the workings of the institutions of our society — rather than on strictly clinical matters — is one sign of this.

Speaking as a psychoanalyst and again looking for silver linings in dark clouds, I would say that we should remember that for most of our hundred-year history, psychoanalysts’ incomes were closer to the bottom than to the top within their profession. The strength of psychoanalysis and Freud’s genius was always to look deeper, behind, around, and underneath what is apparent on the surface; to understand as fully and truthfully as we can about the whys, whether it is about our patients, our selves, or our world and its history. The value of psychoanalysis lies in its ideas, methods, and applications — not in its popularity as a commodity which commands a high price or grants its practitioners an elite status.

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