Psychoanalysis and Psychotherapy

Free Associations

LIFE AMONG THE ANALYSTS

‘The impossible profession is on the ropes. And Freud’s reputation has never been so battered’, the cover story of New York Magazine recently declared. ‘The art-science he founded, once a kind of secular religion in America with a cultural force Freud compared with the Copernican and Darwinian revolutions, is now a national afterthought, a discipline in financial peril and internal tumult’ (Kaplan, 1997, p. 28). Yet, as any visitor will attest, New Yorkers are every bit as neurotic as ever. They stand in just as much need of therapy and, as the number of cover stories in notable magazines suggests — The New Yorker has recently published another story in its ‘Annals of Psychoanalysis‘ series (Gopnik, 1998) — at least interest in the fate of psychoanalysis has not abated. Perhaps the accounts of the death have been exaggerated once again.

Still, the heyday of psychoanalysis has long passed in New York, once the Mecca of American psychoanalysis,. But it has taken quite some time for the fortunes of psychoanalysis to become so desperate and dire. Questionable a decade ago, such a statement would have been unthinkable two, certainly three, decades ago. Until the late 1960s, psychoanalysts chaired half the departments of psychiatry, psychoanalytic institutes were still finishing schools for psychiatric training, and Freud was an unquestioned part of the zeitgeist. Psychiatrists clamoured to sit at the feet of the New York psychoanalytic Giants. Full couches could be guaranteed on graduation.

Under attack from many quarters, psychoanalysis has been overtaken both by other psychodynamic approaches and by biological psychiatry. As a therapy, few can afford the time or the money — around $500 lying on the couch four or five times a week. In any case, Managed Care has all but taken over. Managed Care is a health insurance arrangement whereby patients insure their medical needs with Health Maintenance Organisations (HMOs) which decide on what treatment is appropriate with their own accredited practitioners. They allow only a few sessions with a psychologist or psychiatrist who must justify longer periods of treatment with the HMO. Most often, such health decisions are made by non-medically qualified clerks in the HMOs rather than by physicians. Under this regime, the open-ended treatment required by psychoanalysis and psychoanalytic therapy is not allowed. Short-term, behavioural and drug-based treatments have become the dominant mental health treatments. As an intellectual discipline, there is relatively little productivity, especially as compared with the early days. As a movement, it has generally lost its éclat, except in a few university humanities departments. ‘Freud-bashers‘ seem to be everywhere.

This is not simply a New York or even a US phenomenon. With few exceptions, psychoanalysis has been declining world-wide. Even were this not so, it is wise to recall that when the US sneezes, the rest of the world eventually catches cold. In any case, this is not purely a US phenomenon but goes to the heart of the problems of psychoanalysis and its institutions.

While the recent criticisms by Frederick Crews et al have helped psychoanalysis fall from grace among the general public and many professions, they are misplaced. Freud made major contributions to our understanding of what the mind is, of human nature, of how and why we mistakenly seem to centre our selves in our egos. But, despite what Freud sometimes said himself, his discovery was not in the scientific realm but in the humanistic one. Like literature and philosophy, psychoanalysis asks big questions about human existence. Freud’s theory of mind was, as Lionel Trilling suggested in his essay, ‘Freud and Philosophy’, ‘the only systematic account of the human mind which, in point of subtlety and complexity, of interest and tragic power, deserves to stand beside the mass of psychological insights which literature has accumulated through the centuries‘ (Trilling, 1951, p. 34). Like the Delphic Oracle, ‘Know thyself’ is a central aim of Freud’s essentially humanistic and critical discipline based on human agency and language rather than mechanisms. As New York psychoanalyst Edgar Levenson argues, Freud’s discovery lay in using language as a therapeutic instrument. But he was more right than he knew in focussing on language — he wrongly attributed his success to what was talked about instead of the semiotic act itself. The important discovery of this semiotic act, common to all psychotherapies, became derailed by this fundamental mistake. Freud and later analysts mistakenly concluded that it was the content of the conversation rather than the process of conversing that brought about change. According to Levenson,

psychoanalysts of every persuasion use the same algorithm in their praxis, framing what the patient says, putting it in some kind of order, and elucidating that order in terms of the patient-therapist relationship. Good psychoanalysts of all schools share an ability to elucidate more data by shining a broad beam that further illuminates the patient’s particular world (Levenson, 1983; 1991).

As Lear recently argued (1998), Freud continued the open investigation into the nature of mind that was so central to Plato and Artistotle. Freud has become part of the zeitgeist that even his critics assume and live. At the end of the century, our culture presupposes concepts such as repression, ambivalence, conflict, anxiety, the unconscious. the suggestion that dreams, ‘Freudian slips’, even neurosis can be seen as meaningful and open to interpretation. Words are magical, they are powerful instruments of change, as Freud clearly saw. In many ways, words are far more powerful than drugs. For Freud, an understanding of our ubiquitous transferences can help us come to terms with suggestion, and the influence words have had and continue to have in mystifying our lives. Society and the individual cannot be understood without understanding something that outer and inner worlds are in constant interaction and cannot be understood without one another. This is so because the human world is made up of agents, not mechanisms, who are, however, not masters in their own houses. This entails an open-minded approach, what Freud aptly called ‘benevolent scepticism’ (1916-17, p. 244), to the phenomena of our intra-personal and interpersonal worlds. Freud continued the philosophical, literary, even religious, conversation that has taken place since our beginnings. Psychoanalysis should be understood as providing an open and critical focus on relating our desires to the details of our lives.

However, insofar as psychoanalysts have often treated their discipline as a positivist or even medical-like science and have created institutions that behave more like seminaries than academies, the critics of psychoanalysis are not wrong. Claims for a higher and different knowledge base than is warranted has been counter-productive. Doctrinaire, uncritical approaches in psychoanalysis have led to its development being stymied. In this sense, I don’t think that the escalating descent of psychoanalysis in the US and elsewhere can be attributed chiefly to external factors. External factors have, of course, played their part but they are scarcely the whole story. Psychoanalysts have generally blamed the outside world for their misfortunes. Yet they would interpret such behaviour in their patients as projection. The first duty of psychoanalytic inquiry is to analyse one’s own part in producing the problems which overwhelm us. But just because some of the criticisms from the outside world may turn out to be valid does not mean that psychoanalysts need to pack up their couches! There is more to psychoanalysis than that. It is important to ask: what is the role played by psychoanalysts and their institutions in helping to bring about their present parlous state?

Substantial issues to be addressed include the clarification and development of the nature and adequacy of psychoanalytic concepts, the history and sociology of their institutional implementation, and the creation of institutions which will bring about rather than discourage creativity. While the hallmark of psychoanalytic technique is free association, psychoanalytic institutes seem to have been organised on the opposite principle, unfree association. They have been unfree associations of psychoanalysts which have promoted identification instead of questioning it, often stymied thought rather than fostering creativity, assumed the certainty of a dogmatic body of knowledge instead of viewing psychoanalysis as a method of inquiry. Rather than assuming a sceptical approach, psychoanalysts often relied on a closed, authoritarian approach that relies more on revealed truth than on the examination of evidence. Too often, psychoanalytic institutes, central to the creation and transmission of psychoanalytic knowledge, have behaved like religious sects. Otto Kernberg, the current president of the International Psychoanalytic Association, began an incisive, rich and perceptive article on institutional problems in psychoanalytic education with the following statement:

Psychoanalytic education today is all too often conducted in an atmosphere of indoctrination rather than of open scientific exploration. Candidates as well as graduates and even faculty are prone to study and quote their teachers, often ignoring alternative psychoanalytic approaches. The disproportionate amount of time and energy given to Freud, in contrast to the brief and superficial review of other theorists, including contemporary psychoanalytic contributions (other than those of dominant local authorities), and the rigid presentation and uncritical discussion of Freud’s work and theories in the light of contemporary knowledge give the educational process a sense of flatness (Kernberg, 1986, p. 799).

Kernberg asked what model psychoanalysis assumes and ought to assume. Is it based on the model of a seminary, a trade school, an art academy or a university? Kernberg argues that present-day American psychoanalysis finds itself between a seminary and a trade school, whereas it ought to occupy the terrain somewhere between a university and an art academy. In my view, the problems of psychoanalysis are those of a humanistic discipline that has conceived and touted itself as a positivist science, especially in the US, but has been organised as a religion.

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My book, Unfree associations: inside psychoanalytic institutes, set out to explore some of these issues through detailing the socio-political histories of the four most important institutes in the US affiliated with the American Psychoanalytic Association — The APsaA — the New York, Boston, Chicago and Los Angeles Psychoanalytic Institutes. The New York Psychoanalytic Institute was the first and, for decades, the prestigious institute which set the model for many others. It became pre-eminent on a world scale with the immigration of leading European analysts fleeing the Nazis. My examination of the detailed political history of the New York Psychoanalytic Institute provides a quintessential example of analytic anointment in practice, together with its pitfalls. I next examine a split that occurred in the Boston Psychoanalytic Society and Institute in the 1970s. This demonstrates some of the tensions and ambiguities that seem inherent in psychoanalytic organisations, especially where society and institute are part of the same institution. Then I move on to investigate the Chicago Psychoanalytic Institute which is quite differently organised: in Chicago, the institute with a lay Board of Trustees is quite separate from the society, and for most of its history has been headed by a powerful director. Then I look at the very complex history of the Los Angeles Psychoanalytic Society and Institute which the APsaA nearly closed down in the 1970s. The Los Angeles history is especially colourful and informative, and includes the introduction of Kleinian and object relations ideas into the institute and the reactions to them. I move from the earliest psychoanalytic society in the US to the more recent, which, like the history of European settlement of the US, traced a westward path. The Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute are quite varied in their organisation and histories.

I wondered whether the culture of each institute represented something unique about the culture of the city in which it was situated. Did the operations and structure of the Chicago Institute reflect aspects of Chicago (such as the machine politics of Mayor Daley Senior], and did members of the Boston Institute treat each other more as the equals befitting the culture of a university town? Did the New York Institute focus on clubbishness in a city where networking is paramount? Or did the Los Angeles Institute represent Hollywood and Southern California in its quick and ready acceptance of new and unorthodox ways of thinking? The cultures are often different, yet many of the problems will be found to be quite similar at base.

I also wondered whether a major aspect of the problems of institutes rested on the central importance of training and the status of training analysts. In his 1953 Presidential Address to the American Psychoanalytic Association, Robert Knight lamented the typical themes of difficulty in institutes:

The spectacle of a national association of physicians and scientists feuding with each other over training standards and practices, and calling each other orthodox and conservative or deviant and dissident, is not an attractive one, to say the least. Such terms belong to religions, or to fanatical political movements and not to science and medicine. Psychoanalysis should be neither a 'doctrine' nor a 'party line’.

In Knight’s view, ‘the most pressing issue and the one charged with the greatest emotion has always been that of training’ (Knight, 1953, p. 218). I was interested in investigating the training processes at institutes as the central sites for transmission of psychoanalytic knowledge and the qualification of analysts in the theory and practice of this knowledge. One of the conclusions from my studies on conflict and splits in psychoanalytic institutes is that ideological splits and conflicts often surrounded the issue of who appoints whom and who is a training analyst. My studies agreed with Jacob Arlow’s observation in 1972:

It is disturbing but true that most of the conflicts have originated over who shall have the right to train, that is, who shall be training analyst. The tensions emanating from the division of colleagues into two categories of analysts, training analysts and just plain analysts, intrude themselves into the organizational and scientific life of the institutes. This is an ever-present problem, and its impact is accentuated by the aura of special status which surrounds the position of training analyst, a position endowed with charismatic implications. The training analyst is regarded as possessing the psychoanalytic equivalent of omniscience. It is from the training analyst that candidates claim their descent. In many places the professional career of an individual may be determined by who his training analyst was. Greenacre referred to some of this in her study of the so-called ‘convoy’ phenomenon, that is, the situation of the analytic candidate who is safely guided through his professional training under the protection of some influential training analyst (Arlow, 1972, p. 559).

Issues concerning the right to train are crucial determinants in psychoanalytic controversies. An excellent heuristic device for understanding trouble in psychoanalytic institutes I have found could be: ‘Search for the training analyst problem!’ I found that the training analyst issue was paramount in all the institutes I studied.

In order to be accredited for training, a candidate’s analysis needs to be undertaken with a training analyst within the Institute. A training analyst is an analyst who is qualified to carry on the personal analyses of candidates for training in analysis. In the USA, training analyst status is achieved by being selected at least five years after graduation by the institute as a training analyst. The new training analyst must also be a member of the American Psychoanalytic Association, actively participate in the teaching and administrative functions of the institute, and have spent at least five years following graduation during which the analyst’s major professional activity has been the consistent independent practice of therapeutic psychoanalysis. These requirements make it clear that the training analyst is seen to be primarily a practitioner; teachers and researchers would normally not be able to achieve that status as their major professional activity would not be therapeutic analysis. This status, which privileges the therapy over the intellectual discipline, is the most prestigious one within analysis. It is the domain of people often fantasised to be ‘genuine’ analysts, the real experts. It has brought with it the largest analytic practice. Moreover, the training analysis is where the real business of analysis is seen to be done and transmitted; as Kernberg observed, there is ‘the implicit assumption that ‘the "real" psychoanalytic education is the training analysis, that supervision is secondary, and courses only tertiary aspects of that training’ (1986, p. 802). Not only is the training analysis what is seen to be unique to analysis but furthermore carries with it many ‘sacred’, quasi-mystical meanings that are also related to its religious structure. The truth is seen as mainly already revealed and analytic work is normally treated as a matter of applying tried and trusted techniques. This is achieved by transmission principally via the training analysis and is not regarded as publicly available. This is somewhat mystical in that the transmission is private and secret between one person and another and carries with it special meanings and privileged access to knowledge. So influential is the training analysis in terms of the transmission of psychoanalytic ideology that analysands tend to follow their training analyst’s theoretical orientation. Arlow reported Anna Freud as having told the faculty of the New York Psychoanalytic Institute that her experience of British Psychoanalytic Institute showed

how regularly and unfailingly this identification can be anticipated. The London Institute at that time was not a tripartite organization but a bipartite one composed of Freudians and Kleinians. The first part of the didactic curriculum was the same for all candidates. After a period of analysis, perhaps two years, the candidate was free to choose either a Freudian or a Kleinian course of instruction. Without fail the candidate chose the course with which his analyst was identified. Miss Freud was convinced that the final choice was determined less by insight and mostly by the process of identification with the training analyst (Arlow, 1972, p. 560).

In Germany since World War II, there have been no Kleinians because there were no Kleinian training analysts.

The history of the psychoanalytic profession is rife with schisms, as Joyce McDougall aptly illustrates in an article entitled "Beyond Psychoanalytic Sects," from her book, The many faces of Eros. (McDougall, 1995). Moreover, in line with my contentions concerning the doctrinaire training practices of institutes, McDougall has recently stated:

I think our greatest perversion is to believe we hold the key to the truth... Any analytic school who thinks this way has turned its doctrine into a religion... when we make our particular psychoanalytic theories into the tenets of a faith, then we're restricting our whole capacity for thinking and developing... But what is our insecurity? Perhaps it's partly determined by the transmission of a psychoanalytic education which is largely based on transference: the attachment to one's analyst, as well as to supervisors and teachers, is permeated with strong transference affects. This may result in the idealization of thinkers and theories as well as leading to the opposite — the wish to denigrate them. But I guess this is part and parcel of the history of psychoanalysis and something we must strive to understand (McDougall, 1997, p. 91).

The profession's penchant for idealisation originates, unequivocally, with its very founding, as psychoanalysis has always been synonymous with the figure of Freud — who identified himself with psychoanalysis and psychoanalysis with him (Freud, 1914, p. 7). In a feedback system of sorts, whereby Freud's own sense of being destined for greatness was enhanced by the quasi-mystical power that is inevitably conferred on those of courageous vision and unflagging determination, he exercised a commanding appeal over those around him. And while the scope of his explorations and insights have yielded one of the most far-reaching and systematic understandings of the human condition ever propounded, it is Freud's role as a codifier that has driven psychoanalytic training and psychoanalysis as a movement. His own patriarchal and charismatic example — in a field where no single paradigm of achieved knowledge has ever generated assent — has served as a model throughout much of the history of psychoanalytic training. Suffice it to think of the power and influence exerted by the figure of Jacques Lacan in recent decades, or of the contentiousness that still animates, after nearly fifty years, relations between Kleinians and Freudians in Britain. As McDougall suggests, however, the model of idealisation/denigration is a pervasive and, indeed, a structural one. It is by no means limited to the loftier and more influential stages of psychoanalytic politics world-wide, but finds a correlate in the day-to-day life and management of even the smallest and most inconspicuous of institutes or training centres. Training issues are everywhere and routinely resolved by fiat. Passionate power struggles, on the model of those between Freud and Jung, or between Anna Freud and Melanie Klein, or between Lacan and the IPA, have always been ubiquitous, and can elicit a zeal that rivals forms of the most uncompromising fundamentalisms.

Today, where training is concerned, most psychoanalytic disputes involve mythological 'standards' based more on passed down versions of the truth than on the examination of evidence. Psychoanalytic concepts are not univocally defined, and in consequence of this are the source of often raucous debate. Even members of the same schools are often deeply divided about their approaches. What is the nature of the body of knowledge to be transmitted in the training? Given that there are no agreed-upon definitions and approaches, no agreed-upon ‘unit of measurement’ in psychoanalysis or agreed way of measuring it, its status as a developed science is questionable. As Christopher Bollas and David Sundelson suggest in their book The New Informants: "It will take a long, long time indeed for psychoanalysis to come to anything like a convincing definition of itself." At the same time, however, there is, as Bollas and Sundelson assert, the creation of a 'false expertise' among psychoanalysts. "By assembling colleagues who agree with them and with whom perhaps, they can write books on a clinical topic, psychoanalysts can create the illusion that true science has taken place. But technical papers, conference appearances, and statistics about patients presumably suffering from a given syndrome are the trappings of expertise, not the substance."⁽Bollas and Sundelson, 1995, pp. 136-37).

The histories I have written are unique detailed political chronicles that provide a basis for understanding the nature of psychoanalytic institutions as they develop. They provide a foundation for a critique of what has gone wrong with psychoanalysis and its institutions and for the larger conclusions I reach about why psychoanalytic institutions behave the way they do. These histories provide dramatic insights into what psychoanalysts and their institutions have contributed to what has gone wrong with psychoanalysis. I draw some conclusions from my research about the causes of the ubiquitous problems in psychoanalytic institutes with some suggestions for change. It is entirely appropriate that this article, written in response to an invitation from the editor to reflect on the development and main conclusions of my book, entitled. Unfree Associations, should be published in Free associations! (Kirsner, in press; currently online on Human-Nature.com website).

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How did I come to write this book? In the 1960s I was a politically active New Leftist against the Vietnam War and, like many others, was interested in being interested in the intellectual fields of Marxism and critical theory on the one hand and in Sartre and existentialism on the other. I thought it vital to understand the individual in social context. Influenced by Sartre and Marxism, R. D. Laing and David Cooper were concerned with the politics of the individual in a group and in society. I was also more influenced by the object relations theorists, Guntrip, Fairbairn and Winnicott than I was by Freud. My book,The Schizoid World of Jean-Paul Sartre and R. D. Laing (Kirsner, 1977), reflected such concerns. Through object relations theory, I became interested in Freud in the late 1970s, started teaching Freud at the university where I work, and founded the annual Deakin University Freud Conference in 1977, which I directed for the next 20 years. I became intrigued in the work of Michel Foucault, particularly on the relationship between knowledge and power (see Foucault, 1981; Gutting, 1994). I was becoming increasingly aware of the influence of power upon knowledge and wondered to what extent such issues influenced the modern psychoanalytic movement at its epicentre in the USA. Freud deplored the Americanisation of psychoanalysis, wondering whether it would become just a technical therapeutic system. I wanted to know which factors — cultural, professional, political, ideological, theoretical and psychological — made American psychoanalysis what it has become. I was inspired by Sherry Turkle’s book, Psychoanalytic Politics, a detailed history of the rise of Lacan and the Lacanian movement in France (Turkle, 1978. I thought it might be valuable to map the career of institutions to see what impact they had on the way people thought. I believed that psychoanalysis was too important a perspective to be left to the institutions which have stymied its development. I wondered whether the method of psychoanalysis was subverted by institutional imperialism. I thus became interested in writing an ethnography of the American Psychoanalytic Association, looking at American analysts as a tribe and trying to discover what the central belief systems were, the rites of passage, sacred cows, what it took to be promoted or banished within the psychoanalytic culture. The more I investigated, the more I realised that there wasn’t really only one culture among the analysts. While there were issues in common, there were also significant differences. The primary involvement of analysts was to their local institutes. Thus, to be true to what was really happening, it was necessary to examine the detailed histories of individual institutes. In line with the view that knowledge and power were intimately related, I believed that organisation could promote or thwart the development of psychoanalytic education and ideas. I wondered whether there was point to Lacan’s maxim: ‘Psychoanalysis is in one place and psychoanalysts are in another’. It was time to begin what the German sixties student activist Rudi Dutschke might have called ’the long march through psychoanalytic institutions’!

So in the 1980s I began to study American psychoanalytic institutions with the assumption that any closure was probably related with the medicalisation of psychoaanalysis with all the bureaucratic consequences involved. However, I soon found that the dynamics of institutional life in psychoanalytic institutions seemed to have nothing much to do with whether they were medical or nonmedical, with whether they were eclectic, Freudian, Kleinian or Lacanian, with whether they were in New York, London, Los Angeles, Melbourne or Paris. While there were obvious and important differences, there were uncanny similarities. One need only read Elizabeth Roudinesco Jacques Lacan and Co. (1990) or her devastating biography of Lacan that shows the limiting role of patronage politics (Roudinesco, 1997). One might examine François Roustang’s important work on discipleship from Freud to Lacan examined how institutes often make their leaders into the owners of knowledge whom the students owe allegiance to in an unquestioning way. Through didactic analyses where the transferences are entrenched rather than examined, the candidate is cemented into the institute as a disciple. Roustang’s work extends much further than Lacan on to the orthodoxies through which many institutes function (Roustang, 1982). Or consider Roustang’s work on Lacan (Roustang, 1990) or the revised edition of Sherry Turkle’s Psychoanalytic Politics (Turkle, 1992) to get a picture of the schism-ridden feuding Lacanian institutes in Paris. Or read The Freud-Klein controversies, 1941-45 (King and Steiner, eds., 1991; see also Roazen, 1992) or the symposium on the controversial discussions in The International Journal of Psycho-Analysis in 1994 (King, Hayman, Schafer, Baudry, Yorke, Sandler, J. and A-M., Segal, 1994) to get a flavour of the Anna Freud-Melanie Klein enmities that continue to bedevil the British Psychoanalytic Society. Readers of this journal will be familiar with Bob Young’s formidable work on the culture of British psychoanalysis (see Young, on line), Sandor Rado’s experiences of heresy and authoritarianism (see Roazen and Swerdloff, 1995) as well as the more well splits with Horney, Fromm, and others in the US make for fascinating reading. Paul Roazen’s independent, pioneering work on Freud’s political history and its impact on psychoanalytic institutions, such as Freud and his Followers (1975) provided important evidence that the problems went back to the beginning and are generic to psychoanalytic institutions as such. In all, group psychology supervenes, the issues of orthodoxy and dissidence seem overwhelming, and questions of power and prestige through control of training are paramount. In his 1973 Presidential Address to the International Psychoanalytic Association, Leo Rangell observed that in the field of psychoanalysis ‘rational argument and scientific discourse do not generally prevail, lost in the face of group psychology’ (1974, p. 6). Eisold has argued that the base anxieties evinced in psychoanalytic life, work and culture tend to bring about the intolerance and schismatic activities so endemic to psychoanalytic institutions, because these anxieties are not contained (Eisold, 1994).

Institutional structures and problems surrounding training are not fundamentally different around the world. Cremerius has argued plausibly that, historically, training, especially the training analysis, became transformed into an instrument of power that promoted conformity, isolation and stagnation in psychoanalytic institutes (Cremerius, 1990). Psychoanalytic institutions are normally organised as guilds which, in my view, are really internally focused cliques. They aim at the perpetuation of their ways of thinking (what they assume to be their body of knowledge that they pass on to their students) and tend to foreclose approaches that challenge their assumptions. They are not part of a wider university culture which, despite its many faults, at least rests on some wider protocols and accountability structures.

These guilds are the free-standing institutes that offer training, intellectual and clinical seminars and forums, and referrals providing a total professional environment without any checks and balances. Who analyses whom provides analytic pedigree. Critical questioning is subservient to issues of graduating, being promoted to training analyst, and getting referrals. Making oneself unpopular with the local analytic establishment is an unwise career move. In addition to his article on the failings of psychoanalytic institutes (1986), Kernberg recently outlined thirty methods used by institutes to destroy the creativity of psychoanalytic candidates (Kernberg, 1996). With the field’s focus on the subjective in a field with no external regulation or validation, psychoanalytic institutes are especially prone as institutions to cliques infighting for power. Where members obtain their professional identities through their institutes and their professional livelihoods through referrals, conformity, obedience and not rocking the boat are almost mandatory. These internally focussed institutions whose standards are set by those in charge make for an esoteric ‘pipeline’ view of truth conveyed to candidates through the agency of the mandatory training analysis, which is generally regarded as far more important than the seminars and supervision in psychoanalytic training. A significant feature of the structure of psychoanalytic subcultures and institutions is that members’ livelihoods are exquisitely dependent on referrals, normally from senior colleagues since they do not receive a salary but are generally in private practice. Power, patronage, referrals and income are intertwined with the question of succession, of being anointed with legitimacy and money through referrals. Debates in psychoanalytic institutes are often moderate as members may be loath to say anything that might cost them a referral. Anointment to the status of training analyst provides candidates which brings greater legitimacy and allows more practice with four or five times per week patients. It also brings supervisees, who are likely to become proteges and may join one’s clinical seminar. This is particularly important when there is a scarcity of lay patients. In Britain this problem goes beyond the strictly psychoanalytic subculture. All of the elite psychotherapy trainings insist that the trainees be in analysis with Institute analysts. This has the peculiar consequence that graduates of these psychotherapy trainings can never become training therapists. The analysts get the trainees as patients and supervisees and also do most of the teaching. In order for a training to get into the prestigious British Confederation of Psychotherapists, they have to agree to this rule. Although there is a loophole which says that analysts who can be shown to be of equivalent training and experience can become training therapists, not surprisingly, this has not occurred (Young, on line). A delicate system of referrals and patronage is structured into these free-standing institutes and make for ingrown views to be increasingly amplified by deference and lack of intellectual challenge. In universities, hospitals and clinics, where academics and therapists/analysts have salaries, patients do not come only from patronage. If proof were needed, we need only compare the amount of intellectually creative work in the early days of psychoanalysis when there were far fewer analysts than now with what has been produced in the recent past. While anointment clearly played an important role in the early days, there was little else about training that was set in stone at that time. Freud was alive and served as referent, model and mentor. Just as importantly, he was also known to change and revise his ideas constantly, in a search for truths that precluded premature ossifications of theory. Moreover, analyses were short, and there was, as yet, no fixed body of knowledge that was passed down as absolute truth. Despite its many flaws, the early life of psychoanalytic societies was not as mystified and oppressive to its students and members. It encouraged — indeed, presupposed — a shared commitment to the energetic and enthusiastic development of the field, a field of inquiry which went well beyond the therapy.

Psychoanalysis is far more than a field of academic exploration — it is a movement and therapeutic endeavour. These aspects feed back to the intellectual discipline. Psychoanalysts make claims to therapeutic knowledge and their institutions qualify practitioners. But what is the basis of these qualifications? Given the nature of the discipline and the level of knowledge within it, I would argue that the claim to knowledge implied by qualification is far greater than the real level of knowledge. Instead of facing this central issue, analysts often substantiate the knowledge implied by qualification in terms of something akin to the biblical gesture of anointment (which I discuss below). Writ large in the history of the New York Psychoanalytic Institute, anointment is present in all other institutes as significant factors in their development.

Why do such training issues seem to lie at the heart of so many analytic problems? I believe that in many other disciplines, it is easier to find more public and objective data to settle issues. However, psychoanalysis is different, partly because of the kinds of deep philosophical and religious questions raised by the psychoanalytic search and metaphor. Answers to questions about the nature of the self, the mind, emotions, relationships, and human nature are not quantifiable, or easily classified and standardised. They are often experiential, subjective, uniquely individual, interpersonal and philosophical. The nature of this complex field is suffused with uncertainty and ambiguity. I reached the conclusion that the nub of the problem is reflected in the existence of presumed truth on a level that is unwarranted prevails to afford the stamp of qualification on graduates. The consequences of the institution of ‘false expertise’ in psychoanalytic institutes is the aura of anointment where training analyst passes down the received truth through an esoteric analytic pipeline. As the level of real knowledge is far below the level of claimed knowledge, a vital and universal problem supervenes. In my view, the religious quality of anointment fills the gap between the level of claimed knowledge on which qualification rests and the far lower level of real knowledge.

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In all I interviewed over 150 analysts belonging to the American Psychoanalytic Association who experienced the events they described at their institutes. I conducted a number of interviews with many of the same analysts over a number of years. Many of the analysts I interviewed were prominent in psychoanalysis as established leaders, and were quite often protagonists in the stories of their institutes. I transcribed a mass of oral history, about a million words from interviews. I consulted a mountain of material in libraries and archives, attended institute meetings and conferences, and became conversant with the complexities of the field. A major obstacle was that institutes were less than forthcoming in releasing historical documents.

In fact, my studies seemed to reveal an immutable rule: individual analysts’ preparedness to talk is inversely proportional to their institutes’ preparedness to help and provide documents. It seems that analysts are institutionally paranoid but individually trusting. Institutes are run by committees, which refuse to take risks of any sort. One member of a committee might balk even at the most harmless request. Kafka’s castle would have been easier to navigate than institutes and their committees. Institutionally, psychoanalysts were not exactly forthcoming. I envied the researchers in the new Russia who were thrown the keys to the KGB archives. I took full advantage of such hard won documents. They were difficult to find requiring much persistence and creativity to locate and study. I came to realise that, so far as the institutes were concerned, history ended normally with the 1940s, sometimes the 50s, and in a few cases, the 1960s. It was all very well to speculate about all sorts of things about Freud and his circle, even about splits and problems before the War. But anything after that was not considered safe to investigate. After all, there were living analysts and their wounds. Only fit to find out after they were dead, which, unfortunately, is too late. Sometimes it wasn’t Kafka that came to mind when I was seeking documents but Umberto Eco’s The name of the rose where the monk-detective finds himself threading an increasingly labyrinthine set of interconnected plots.

So how did I get what documentation I could get? It was really a combination of persistence and luck. Some happened to be in newsletters that were not classified as archives, probably because nobody looked through them. Quite a few fell off the backs of passing couches. Some were parts of self-published appeals or arguments. Some just appeared through the luck of the search.

However, in contradistinction to such a researcher’s nightmare, individual analysts could not have been kinder or more helpful. I have found most individual analysts open, generous, candid, welcoming and encouraging. Perhaps people who spend so much time listening to others’ worries are delighted at the opportunity to talk about their own — their concerns and recollections about their field, their profession and their institute. For they were always individual and passionate about what had happened to something so close not only to their livelihoods but to their hearts. Enthusiastic, despairing or a combination of both, scarcely any analysts I met were indifferent to the state or fate of analysis. Most were very decent, many personally warm and welcoming. Analysts from many different schools and persuasions were happy to speak about their institutional experiences with me in a variety of venues — offices, conferences, dinners, letters, telephone, email — on most points between the informal to the formal. Maybe the fact that I was an academic from Australia with no axe to grind, far from the madding crowd of potentially competitive colleagues from the same or other institutes, made me a neutral person to talk to. Moreover, I was engaged in a unique and serious work of scholarship that nobody else had attempted or was likely to attempt. In terms of institutional histories significantly based on oral accounts, perhaps they sensed a unique opportunity to have their stories told. Many of my informants were older, senior analysts who were past the fire of the immediate political concerns. They were at a stage of their lives and careers when it was time to reflect about what they had experienced, contributed and learned. Moreover, the fact that most trained and worked through the period from when psychoanalysis dominated psychiatry through to the exponential decline of psychoanalysis has not been without emotional and intellectual consequences. Whatever the reasons, I am pleased to say that I made many friends among the analysts I met, and have very much valued and enjoyed the experience of sharing work with them.

My book records how conflicts, problems and even scandals damaged the psychoanalytic institutes I studied. That said, it is true that many of the conflicts ultimately found some form of resolution. The New York Psychoanalytic Institute became far more open, democratic and pluralist. The Boston Psychoanalytic Society and Institute managed constructive relationships with its breakaway institute and both have prospered. The Chicago Psychoanalytic Institute became much more democratic and open. The Los Angeles Psychoanalytic Society and Institute and the American Psychoanalytic Association came to live with theoretical differences which for a time, locked them in seemingly irreconcilable conflict The American Psychoanalytic Association has itself become considerably liberalised and, while the structures remain the same, somewhat more open to questioning certain assumptions. In the face of urgent pressures both from the outside world and from within the institutes, many analysts persisted and ultimately achieved considerable reforms. However, in my view, these changes were achieved despite intrinsic problems that remain at the heart of psychoanalysis and its institutions. The detailed histories of the institutes differ in many ways: the region, personalities, institutional structure, local flavour, and other factors make for the considerable variety that I have explored in each instance. In the conclusion of Unfree Associations , I explore the fundamental themes around which I believe these various histories all revolve. I argue that despite the reforms that have taken place, the underlying problems have not changed. This applies, not only to the institutes I have studied, not only to the American Psychoanalytic Association, but to psychoanalytic institutes in general, whatever their orientation. Many adopt the same kinds of training programs and organisational principles as the institutes I have investigated and tend to produce many common problems. What has happened in the institutes I have studied can be seen as manifestations of past, present and future problems for the whole psychoanalytic world.

What is to be done? It is important to understand the nature of psychoanalytic institutionalisation and its regressive consequences, which I have explored in detail in Unfree Associations. The consequences of the institutionalisation of psychoanalytic ideas through the psychoanalytic movement have been largely regressive. Rather than being resolved, many faults and problems in the psychoanalytic approaches have been perpetuated. It is probably too late for psychoanalytic institutions to become part of universities — that train has long left the station. But a university culture within institutes may be possible if such an approach can come to reflect the will of their members. In my view, the position of training analyst should be dropped, which would remove a structural flaw that maintains power based on hierarchical, patronage and anointment. Candidates should be in analysis with an analyst of their choosing who has no part of the assessment process. Assessment at institutes carried out solely in terms of what the candidate produces in terms of seminar papers and presentations, and clinically through supervised cases. As ‘the proof of the pudding‘ would be in the eating, public protocols would prevail instead of anointment of certain people with avowedly esoteric gifts. I believe that the basic fault in psychoanalytic institutes is qualification on the basis of an unwarranted claim to knowledge. One way out is a radical deinstitutionalisation of psychoanalysis more in line with the kind of philosophical Delphi exploration into human nature that constitutes psychoanalysis. Concomitantly, more open scepticism about psychoanalytic ideas needs to be accepted where the chips will fall where they may. Open-minded interdisciplinary research (philosophy, neuroscience, literature, sociology, genetics, biology, etc.) needs to be carried out, including much more definition of psychoanalytic so that analysts are using the same words to mean the same things. Even the concept of what is psychoanalytic needs to be broadened and at the same time more clearly specified. Psychoanalysis should not be seen as its trappings (number of times a week on the couch by an accredited member of the International Psychoanalytic Association). Psychoanalysis is a field of inquiry and is owned by no-one any more than physics is. The truth is that spiralling costs and changes in insurance are pricing classical psychoanalysis out of the market and the intellectual attraction of psychoanalysis is no longer pivotal in so many areas. Perhaps this condition where psychoanalytic approaches have once more achieved underdog status will allow the space for the imperialism that has so characterised the psychoanalytic movement to be replaced. The time may now be upon psychoanalysis to revive, instead, the once-defining spirit of open, sceptical questioning of all concepts and teachings, including those most dear to the profession. In this sense, it is time, perhaps, for psychoanalysis to be reminded of the wisdom of an Eastern maxim: ‘We seek not to imitate the masters, rather we seek what they sought‘.

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Address for correspondence: kirsner@mail.onthe.net.au