Reforming Psychoanalysis Again

Four years after its publication, Revolution in Mind has developed a life of its own. While I have my ideas about the lessons to be learned from this history, my view is one among the over fifty book reviews and commentaries that the book provoked. Nonetheless, let me add my thoughts to that chorus, since I think the present turmoil on the psychoanalytic list-servs and inside the American Psychoanalytic Association could benefit from the perspectives offered from that history.

Over the last century, psychoanalysis as a field defined itself in several, strikingly different ways. In Revolution in Mind, I argued this community—like any intellectual community—could be characterized by its border commitments (the way it distinguished those in from those out, the "price" of admission) as well as the level of autonomy afforded to those inside that boundary. In the book, I described how the first Freudian community had porous boundaries and allowed anyone who was a partial Freudian entrance.

Once in, this community—as exemplified by the rollicking meetings of the Wednesday Society in Vienna - allowed extensive freedom of inquiry. This model offered the best possibility for growth. It welcomed cultural critics, doctors, writers and reformers and allowed for the movement to gather steam. However, the cost of this strategy was that there was no legitimate, rule-based manner to exclude individuals who might do harm to the community, including psychotics, sociopaths and misogynists. Anyone who wanted to could call themselves a psychoanalyst, including hucksters and rapists. The whole movement could be high-jacked by sensational actions of these outliers. There was no structure in place to protect patients from such people.

In response to a number of events in 1910, Freud, Jung and Ferenczi formed the I.P.A and changed the borders of this movement over night. Now the price of entry was full acceptance of Freudian psycho-sexuality. Partial adherence would no longer be good enough. The boundary was a clear, very demanding theoretical one that left little intellectual freedom for those who became part of this community. The benefit was that crazed theorists would be denied entrance to the I.P.A thanks to this criterion. They would not discredit the movement or harm its patients. However, any theoretician with significantly contrary ideas to Freud would also be denied entrance. Thus, the schisms began. By 1914, they resulted in a number of small groups dominated by charismatic leaders (i.e.the Adlerians, Jungians, and Freudians).

After World War I, the field of psychoanalysis sought to stabilize itself by placing increased emphasis on shared technique and a bureaucratized system for training which emerged in Berlin, with its psychoanalytic institute and the tripartite training system. Again this came with advantages and disadvantages. Firstly, this process of creating analytic bureaucracies made the rules of entry and the freedom of inquiry rule-based and a matter of disseminated, dispersed authority. Training was not just based on the opinions of one's analyst, but numerous factors. Bureaucratization diminished the power of charismatic leaders who sought to indoctrinate students and create theoretical clones, though it did not fully rid the field of this tendency. Nonetheless, the wilder analysts of the early years, some of whom injected innovation and challenged orthodoxies, were excluded. The field would not have to answer for the drugged-out activities of Otto Gross, but it also would not benefit from the challenges of thinkers like Eugen Bleuler.

For a number of decades, bureaucratization was a great success. It stabilized the field and coincided with great growth. However with time, this success has created its own kind of trouble. We may have protected our patients from wild analysts, but we have done so at the expense of making psychoanalysis as an intellectual movement too removed from other fields, too predictable and too tame. The field badly needs to be reinvigorated. We need infusions of new ideas from new people. The cost of becoming an analyst needs to go down, literally and metaphorically. With our past in mind, there should be ways to protect our patients while loosening some of the rules that suffocate psychoanalysis today. We need not return to the wild days of the past, need not throw out all standards, to lower the bar for those who seek admission. And we need not get into idealized discussions of freedom and repression. All intellectual communities have boundaries that dictate who is in and who is out. The question for us now is to redraw those lines in a way that takes into account our present challenges and the lessons of our tumultuous past.