Abstract
Youth, as Bernard Shaw famously remarked, is a wonderful thing. It's a pity it is wasted on the young. Douglas Kirsner might also say that psychoanalysis is a fascinating and crucial field of enquiry. A pity to waste it on psychoanalysts.
This volume details Kirsner's investigations, over more than a decade, into the politics of American psychoanalysis. More than 100 analysts were interviewed, and their personal openness contrasted with the secrecy of the professional bodies. Part of Kirsner's motivation, as he stated elsewhere, was, ‘I believed that psychoanalysis was too important a perspective to be left to the institutes which have stymied its development’ [1].
Although Kirsner claims that there is a problem with psychoanalytic institutes worldwide, this enquiry is focused on the American Psychoanalytic Association and four of its component bodies: the New York Psychoanalytic Institute, the Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute. Each of these has undergone organizational crises. In Boston this actually led to a rupture, with a group of dissidents leaving to form the Psychoanalytic Institute of New England. The Los Angeles Institute underwent several splits and near splits over the years and at one point was almost closed down by the American Psychoanalytic Association.
Such events are hardly unique to psychoanalytic institutes, but are part and parcel of institutional life. As I write, the Sydney University Department of Philosophy is only now moving to repair a schism that has lasted several decades. Many university departments of psychiatry could provide vivid examples of the same process. But psychoanalysts lay claim to a special understanding of human nature in depth, and have all undergone personal analysis with a view to working through their own internal conflicts. Yet Kirsner argues persuasively that the very structure of psychoanalytic training, far from enabling analysts to deal with these group processes effectively, often serves to entrench the problem more deeply.
The current President of the International Psychoanalytic Association, Otto Kernberg, has proposed four models of psychoanalytic education (p.4 of reviewed text): (i) an art academy training expert craftspeople and bringing artistic talents to fruition; (ii) a technical trade school based on learning a clearly defined skill with no emphasis on artistic creativity; (iii) a seminary that treats psychoanalysis as a religious system; and (iv) a university college model that aims at the transmission, exploration and generation of knowledge and methodological tools for the creation of new knowledge. In Kernberg's view, psychoanalytic institutes should be modelled somewhere between an art academy and a university, but are more commonly conceived of as a trade school mixed with a religious system on the seminary model.
Kirsner believes that conflicts within analytic institutes usually centre around the question of who has the authority to train. Institutes confer great prestige, unrealistic prestige Kirsner maintains, on those with the status of training analyst, people authorized to conduct the analysis or supervision of the next generation of candidates. Even in the Chicago Institute, where the restrictions on training analyst status were less severe, this liberality was ultimately meaningless as only a minority of training analysts near the centre of Institute power actually had candidates sent to them. Until more recently, candidates were not permitted to choose their own analysts or supervisors.
Within such a closed system, authority was passed on by a process of ‘anointment’. The superior expertise of those in power was not to be questioned. Each of the four training institutes described in this book had a different organizational structure and a different relationship to the local society of analytic practitioners. Yet they all had in common an authoritarian structure that was inimical to independent thought and irresistibly corrupting to those in power. In this atmosphere, a training analysis entrenched rather than resolved transference, so that candidates graduated from training identified with their analysts and were liable to perpetuate the same professional feuds.
Kirsner's book recounts in fascinating detail how each of these four institutes, and the American Psychoanalytic Association itself, was forced to adapt and become more democratic and open to conflicting ideas. He maintains that the structures remain flawed. He suggests that the position of training analyst be dropped, which would remove the structural flaw that maintains power based on hierarchy, patronage and anointment. Rather, candidates should be with an analyst of their own choosing who has no part in the assessment process. Assessment should be solely on the basis of the candidate's seminar papers and presentations and on supervised clinical work. It is fair to point out that, more recently, most training institutes have become ‘non-reporting’, that is, the confidentiality of the candidate's analysis is respected and the training analyst plays no part in that assessment. Nonetheless, the issue of training analyst status remains contentious in many institutes.
Underlying these institutional conflicts, however, remain questions about the nature of psychoanalysis itself. Freud, who made the first probing discoveries, was himself uncertain whether it was a branch of medicine close to neurology, a method of therapy or purely a means of investigating the human mind. More recent writers have called it a hermeneutic discipline, while the psychoanalyst Heinz Kohut and the school of Self Psychology have called it ‘a science of subjectivity’.
The early leaders of the American Psychoanalytic Association insisted that it was a branch of medicine and, indeed, successfully set out to capture American psychiatry, so that until the 1970s most heads of departments of psychiatry were analysts. No one could be accepted for analytic training in America without first being medically qualified, a situation that, during his lifetime, Freud openly deplored. But such political power within psychiatry as a whole depended on claims for the scientific validity of Freudian theory that ultimately could not be sustained.
Freud's greatest discovery lay not in any of his theories of the mind, which like all theories were incomplete and fallible, but in his method of investigation, of free association within a two-person field, which continues to yield new data inviting more comprehensive theories. Psychoanalysis overlaps with neurophysiology, psychiatry, attachment theory, sociology and philosophy, but, in itself, it could indeed be described as a science of subjectivity, with profound therapeutic implications. It may inform many therapeutic approaches, without claiming itself always to provide the best therapeutic method. Kirsner puts it succinctly when he declares that psychoanalysis is a field of enquiry and is owned by no one any more than physics is.