Abstract
Paul Stepansky’s Psychoanalysis at the Margins is an impressive, scholarly work that explores the fragmentation of psychoanalytic book publishing as a way to provide a sharp critique of American psychoanalysis, its institutions and its practitioners. The author concludes with a ray of hope, however, for the psychoanalytic future of the USA.
For most of his 30-year tenure at The Analytic Press (TAP), North American psychoanalysts regarded Stepansky as a pre-eminent publisher of analytic books. His expansive knowledge of history and philosophy, as well as psychoanalysis, made him a reliable guide for both writer and reader alike. He shepherded a ‘miniscule publishing enterprise’ (p.1) from its founding in 1982, releasing a list of notable works that achieved at least modest success. What came to constitute ‘modest success’ changed as psychoanalysis changed. Eventually that success was so modest that the Press was no longer financially viable. TAP closed in 2005 with Stepansky still at the helm. The stories of these intertwined trajectories of psychoanalysis and psychoanalytic book publishing provide a view of the condition of the profession today.
Psychoanalysis in the USA was in its heyday in the aftermath of the World Wars, particularly World War II. Psychoanalytically trained physicians were instrumental in treating what Freud called the ‘war neuroses’. Psychiatrists saw an opportunity for a widened application of psychodynamic thinking, something that Karl Menninger had called for in the 1930s (p. 50), eventually launching the new field of psychosomatic medicine. Psychoanalysis sat at the pinnacle of medicine in the USA. Analysts became the doctor’s doctor, bringing a kind of healing that others could not. The general public was immensely interested, eager to learn more. The wide appeal of psychoanalytic thinking led to the publication of many successful psychoanalytic books. For example, Otto Fenichel’s The Psychoanalytic Theory of Neurosis (1945) sold 80,000 copies, and Charles Brenner’s An Elementary Textbook of Psychoanalysis (1955) over 1,000,000 copies. Today, in contrast, most psychoanalytic books sell fewer than 1000 copies.
Stepansky documents the medical hegemony of the classically trained Freudian ‘ego psychologists’ within psychoanalytic institutions in the USA. He goes on to describe the maintenance of that hegemony through the restrictive editorial policy of the premier psychoanalytic journal, The Journal of the American Psychoanalytic Association (JAPA) and others. These publications maintained the party line securely until that line buckled under a multi-pronged assault – cultural, economic, pharmacological and legal.
As sweeping social and technological changes produced an American educated public impatient with painstaking self-exploration, psychoanalysis ceded some of its territory to brief therapies that promised quick relief. The advent of the second and third generation psychopharmacological agents likewise brought assurances of an almost effortless recovery. In the meantime, changes in the economics of health care and the widening income disparity between wealthy and middle-class Americans made any intensive psychodynamic psychotherapy increasingly unaffordable.
These external pressures posed significant adaptational challenges to traditional psychoanalysis. But the test that it was least equipped to withstand was one mounted in the courtroom. By early l985, no longer willing to tolerate their exclusion from the mainstream, the psychologists took legal action. With the support of the newly organized Psychoanalytic Division of the almost century old American Psychological Association, four psychologists filed a class-action suit against the American Psychoanalytic Association, two of its member societies (and secondarily the International Psychoanalytic Association), claiming that their monopoly had interfered with the ability of psychologists to make a living as psychoanalysts. After four years of legal struggle, the psychologists prevailed, forcing what came to be a sea-change in analytic theory and practice. Stepansky’s fledgling press, only two years old at the time, was destined for entrapment in the estuaries of conflicting theoretical currents, bitter rivalries and the almost inevitable marginalization of the field that followed.
Grudgingly, the psychoanalytic fortress dismantled itself stone by stone. Training institutes like the Columbia University Center for Psychoanalytic Training and Research began to admit highly qualified licensed clinical psychologists with doctoral degrees. Those psychologists were granted full membership status in the American Psychoanalytic Association upon completion of training; and psychoanalytic journals like JAPA softened their hard-line editorial policies, occasionally publishing quality articles that avoided real theoretical novelty.
Eventually editorial succession at JAPA brought new attitudes towards the multiple theoretical frameworks that started to take root in the USA, some of them European imports, others more home-grown. Efforts towards greater inclusiveness came to treat a plurality of theories as a value in and of itself. ‘Theoretical pluralism’ became the catchphrase under which systems of ideas with varying epistemologies at different levels of abstraction could be held. Stepansky decries what he calls the ‘fractionation’ of psychoanalytic theory into part theories. He argues that this fractionation accounts for the near demise of the profession of psychoanalysis.
Stepansky’s choice of a word borrowed from chemistry is hardly casual. He wishes to emphasize that psychoanalysis, at least in the USA, had once tried to make its bed with normal science. Indeed, it should have stayed there between the sheets rather than splitting into what Thomas Kuhn called ‘incommensurable paradigms’. The late Charles Brenner agreed with Stepansky, claiming, even in his final publications, that psychoanalysis was part of science; its task was simply to distinguish the wheat from the chaff (Brenner, 2006: iv). Contemporary psychoanalysis has failed at that task. Its new-found inclusiveness opened the door to both diversity and incoherence, pushing it to the margins as a treatment modality.
So what, according to Stepansky, is left for the profession to do? Comparing it to alternative practices such as homeopathy and osteopathy in their ascendance to acceptability, Stepansky argues that psychoanalysts must exploit their new marginality in creative ways. Furthermore he invites analysts to expand their reach into psychiatric residency training, consultation liaison psychiatry in the general hospital, and perhaps even into under-served communities.
Psychoanalysis at the Margins is a far richer book than this brief review can describe. Stepansky’s tone is passionate. He had clearly hoped for a bit more from the psychoanalytic community to which he dedicated his career. His disappointment has brought us a brilliant book, and one that may function as a raft for a professional group in troubled waters.