A Psychotherapy for the People

Toward a Progressive Psychoanalysis

Lewis Aron, Karen Starr

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136225246
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

How did psychoanalysis come to define itself as being different from psychotherapy? How have racism, homophobia, misogyny and anti-Semitism converged in the creation of psychotherapy and psychoanalysis? Is psychoanalysis psychotherapy? Is psychoanalysis a "Jewish science"?

Inspired by the progressive and humanistic origins of psychoanalysis, Lewis Aron and Karen Starr pursue Freud's call for psychoanalysis to be a "psychotherapy for the people." They present a cultural history focusing on how psychoanalysis has always defined itself in relation to an "other." At first, that other was hypnosis and suggestion; later it was psychotherapy. The authors trace a series of binary oppositions, each defined hierarchically, which have plagued the history of psychoanalysis. Tracing reverberations of racism, anti-Semitism, misogyny, and homophobia, they show that psychoanalysis, associated with phallic masculinity, penetration, heterosexuality, autonomy, and culture, was defined in opposition to suggestion and psychotherapy, which were seen as promoting dependence, feminine passivity, and relationality. Aron and Starr deconstruct these dichotomies, leading the way for a return to Freud's progressive vision, in which psychoanalysis, defined broadly and flexibly, is revitalized for a new era.

A Psychotherapy for the People will be of interest to psychotherapists, psychoanalysts, clinical psychologists, psychiatrists--and their patients--and to those studying feminism, cultural studies and Judaism.

Chapter 1

Introduction

A Psychotherapy for the People

In this book we argue for a progressive and humanistic vision of psychoanalysis. We will show that to its detriment, American psychoanalysis has historically defined itself by contrasting itself with its other—psychotherapy—thereby limiting its own range and scope. We call for a broader and more flexible definition, one that has practical implications for how psychoanalysis and psychoanalytic therapy are theorized, taught, and practiced, and that includes psychoanalysis as a social and humanistic enterprise. When asked by Anthony Molino whether psychoanalysis was a dinosaur, close to extinction, Christopher Bollas wittily remarked, “Psychoanalysis just has to survive ‘the psychoanalytic movement’” (Molino, 1997, p. 59). In its efforts to preserve the purity of its methods and protect the status of its practitioners, the psychoanalytic movement has threatened itself with its own extinction. As Stephen Mitchell cautioned,

It is tempting to preserve the purity of one’s practice and work only with patients—generally other mental health practitioners—(or else the very wealthy) who will play it the traditional way—four times a week, the couch, free association and interpretation, and so on, but that is not feasible for most practitioners. Even if it were, it would be hard to avoid a sense of bad faith, that one is preserving one’s purity at the price of turning away people seeking help.

(1991, pp. 150–151)

This book is about how psychoanalysis has historically been defined and how it might be understood in the 21st century. We present a cultural and intellectual history that supports our thesis that psychoanalysis has always defined itself in opposition to something else, something it viewed as “other.” In its early years, that “other” was suggestion. Psychoanalysis was not hypnosis and its results were not based on suggestion. In the years following World War II and through the 1950s, the psychoanalytic establishment officially defined psychoanalysis as a sub-specialty of psychiatry and as distinct from psychotherapy. These were “the halcyon years” of psychoanalysis in America, the era of consensus (Wallerstein, 1995), “the golden age” (Coser, 1984, p. 47). Viewed as the most scientific form of psychological treatment, psychoanalysis rose to the height of its prestige and popularity. Analysts had lengthy waiting lists and few free hours, and psychoanalysis was one of the highest paid medical specialties in the country (Hale, 1995).

Leo Rangell memorably articulated the consensus leading to these definitions:

The two disciplines [psychoanalysis proper and psychoanalytic psychotherapy], at far ends of a spectrum, are qualitatively different from each other, though there is a borderland of cases between them. An analogous comparison can be made to the fact that conscious is different from unconscious. Day is different from night, though there is dusk; and black from white, though there is gray.

(Quoted by Wallerstein, 1995, p. 81; see Rangell, 1954, p. 737,
emphasis added)

This masterful piece of rhetoric illustrates how analysts of this era chose to emphasize the differences between psychoanalytically-oriented psychotherapy, sometimes referred to as psychodynamic psychotherapy, in contrast to “standard,” “classical,” or “proper” psychoanalysis. These analysts knew there were many areas of overlap between the two modes. They knew that elements of psychotherapy were always implicated in psychoanalysis proper, and that psychoanalytic psychotherapists used many aspects of standard psychoanalysis. And yet, “day is different from night, though there is dusk.” They chose to emphasize the differences rather than highlight the similarities and gray areas. Psychotherapy and psychoanalysis were not just differentiated—they were polarized. Defining psychoanalysis in opposition to psychotherapy set up two poles “at far ends of a spectrum,” creating two disciplines, rather than one discipline with a variety of applications. This polarization has been detrimental to all aspects of psychoanalytic theory, practice, and education.

Following World War II and through the 1950s, these postulates dovetailed with the American valuation of self-reliance and the heroic image of the lone cowboy riding off into the sunset. Psychoanalytic values were aligned with polarized notions of masculinity versus femininity and heterosexuality versus homosexuality. Homosexuality was treated as psychopathology and homosexuals were not admitted to psychoanalytic institutes. The cowboy riding off into the sunset was not yet envisioned as being on Brokeback Mountain (Ang Lee, 2005). Analysis was defined as superior to psychotherapy as masculinity was to femininity, autonomy to dependence, heterosexual to homosexual, and phallic to castrated. Psychoanalysis led to internal structural change, creating a strong agent, while psychotherapeutic change was devalued as being due only to relational factors, leaving the patient with structural deficits.

Historically, suggestibility was associated with primitivity, degeneracy, women, hysterics, neurotics, and Jews (Brickman, 2003). Considered the product of advanced European civilization, the autonomous individual required renunciation and hence, abstinence (Van Herik, 1982). The issue of suggestion raised serious problems for Freud. He needed to eliminate suggestion in order to make his findings objective, scientific, and universal, rather than idiosyncratically Jewish (Gilman, 1993a, b; Frosh, 2005). In America, suggestion and suggestibility were associated with interpersonal influence and dependence. If you improved because of interpersonal influence or reliance on your relationship with your therapist, you were not helped to be as autonomous as you might be. Under the domination of ego psychology, the principle of ego autonomy became the rationale for determining which interventions defined psychoanalysis. Heinz Hartmann’s championing of ego autonomy was in keeping with American values and the European idealization of the autonomous individual. It was believed that the analyst should rely almost exclusively on interpretation so the patient would do as much of the analytic work as possible: the patient’s exercise of his own ego muscles would lead to structural change. An analyzable patient was one who could tolerate the analyst’s doing very little; an analysis was complete when the patient could analyze himself with the analyst no longer necessary. In short, self-reliance, independence, and autonomy constituted the requisite conditions for analyzability, the analytic process, and the goals of analysis. In contrast, everything involving suggestion was viewed as dependence; all relational factors were reduced to suggestion. If a patient seemed to get better because of reliance on the therapist, a transference cure, it was considered superficial, external behavioral change, rather than deep, internal structural change, because the patient remained dependent rather than becoming autonomous.

Binaries proliferate. Psychoanalysis was historically associated with deep change, psychotherapy with superficial change; psychoanalysis with internal change, psychotherapy with external change; psychoanalysis with insight, psychotherapy with support. Psychoanalysis was for more psychologically developed, analyzable patients, while psychotherapy was for less developed, un-analyzable patients. Psychoanalysis was civilized, psychotherapy primitive. Psychoanalysis required frustration tolerance, impulse control, long-term planning, and postponement of gratification. These were all functions associated with white, middle class values, and so psychoanalysis was White and wealthy in contrast to psychotherapy, which was for those without such values or finances—Blacks, minorities, and the poor. Altman wrote,

Since … the definition of ego strength occurs in a cultural context, the culturally or socioeconomically different patient, if accepted into analytic work at all, is not likely to get the elite version of the treatment. The elite status of psychoanalysis as a treatment modality is thus protected by reserving the “pure gold” for elite patients. The hierarchical class structure of society is thereby replicated in the analytic subculture.

(1995, p. 45)

This gives troublesome new meaning to the phrase “Day is different from night, though there is dusk; and black from white, though there is gray.”

Psychoanalysis proper was viewed as pure, while all other uses were considered applied. Of course, psychoanalysis proper was just as much the application of a theory and method as was psychoanalytic art criticism, child analysis, or analytic group therapy. But it was as if the analytic community accepted the fiction that the original method was uncontaminated, an application of a pure practice. Psychoanalysis was defined as pure gold, while psychotherapy was tainted with copper. This polarization aligned with the traditional splits between pure and applied science, theory and practice, abstract and concrete. All of these binaries lined up with masculine versus feminine, civilized versus primitive, and in anti-Semitic Europe, with Christian or Aryan versus Jew (Jews were thought too concrete to be good scientists). Internal and intrapsychic, psychoanalysis was about understanding one’s own mind, whereas psychotherapy was about solving external problems. Psychiatric medicine, which dominated psychoanalysis in “the golden years,” was largely male, whereas the “salvation army” of women social workers was left to solve concrete problems. Danto (2009) has documented this split between psychoanalysis and social work in terms of the division of labor between men and women, as well as the tendency for psychoanalysts in America to be less radical and eschew social and political action. Cushman (2009) has argued that this unbridgeable chasm between the individual and the social resulted from the Cartesian split between spirit and matter, mind and body. In post-World War II America, psychoanalysis valorized depth, inner life, internalization, and the bounded individual self.

We add the following to this argument: the dichotomy between psychoanalysis proper and psychotherapy is one of a series of polarities built into the structure of psychoanalytic thought. That which is social, cultural, political, interactional, and interpersonal, because they set limits on the individual’s autonomy and self-contained independence, leave us vulnerable. These factors are culturally marked as feminine, and so were split off and projected onto psychotherapy. From the point of view of the mainstream psychoanalysis of that classic era, they were “not-me” phenomena. These polarities are based on the split between civilized and primitive, mature and immature, Oedipal and pre-Oedipal, conflict and deficit, guilt and shame, science and magic, cure and care. We will show that psychoanalysis is situated in the midst of a hierarchical division of binaries into male/female, heterosexual/homosexual, white/black, and gentile/Jew. This is why we find racism, misogyny, anti-Semitism, and homophobia to be surprisingly relevant to the fundamentals of psychoanalysis.

Treatment versus Care

In the modern era, treatment and cure have been associated with science, progress, intervention, and accountability, whereas care has been relegated to the intangibles of relationship, morale, support, and palliative gestures. Consistent with an era that emphasizes fast, pragmatic results, empirical support, cost-effectiveness, and measurable outcomes, treatment is assigned the status of science, subject to metrics, whereas care is devalued as being personal and relational, unmeasurable and intangible. Rooted in a long history of gender discrimination and misogyny, especially within medicine, which for centuries was an all male profession, treatment is cast as scientific, assertive, penetrative, and essentially male, while care, associated with resignation and passivity, is marked as female. Common gender stereotypes and gender bias, as well as their related aspects—misogyny, homophobia, racism, and anti-Semitism—continue to haunt psychological theory and practice, with adverse effects.

Since its inception, professional medicine was almost exclusively the province of men; this remained true in America until the 1960s. With the modernization of medicine, doctors became intent on presenting themselves as providing effective treatment, in contrast to nurses, who provided only care. Care was primarily what the male physician had to offer before the invention of modern medical science. But as the doctor came to see himself as a member of a new elite—a scientific, progressive, and highly educated profession—he diagnosed, prescribed, and treated using modern medical interventions and instrumentation, becoming uninterested in wasting his time simply providing care or support. Feminist historians Ehrenreich and English wrote,

Healing, in its fullest sense, consists of both curing and caring, doctoring and nursing. The old lady healers of an earlier time had combined both functions, and were valued for both. (For example, midwives not only presided at the delivery, but lived in until the new mother was ready to resume care of her children.) But with the development of scientific medicine, and the modern medical profession, the two functions were split irrevocably. Curing became the exclusive province of the doctor; caring was relegated to the nurse.

(1973, p. 651)

We will show that psychoanalysis aligned itself with the masculine-oriented medical model of treatment, relegating care and all that was associated with the feminine to the purview of psychotherapy.

Autonomy versus Relationality

Taking into consideration the above binaries, the very idea of “relational psychoanalysis” was historically quite literally an oxymoron. To the extent that a treatment relied on relational factors, it was by definition psychotherapy and not psychoanalysis. Let us be clear: we do not envision a simple reversal, in which contemporary psychoanalysis should value relationality over autonomy. Rather, in our view, psychoanalysis must be dialectical, valuing relationality and autonomy, agency and communion. The very name “relational” psychoanalysis can be misleading if it is thought to exclude agency or individuality. Stephen Mitchell’s understanding of relational psychoanalysis was dialectical, transcending the one-sided usage of the term relational. He never intended a relational psychoanalysis to omit consideration of individual subjectivity. In clarifying what he meant by a “two-person psychology,” Mitchell and Aron (1999) wrote, “These emergent properties of the dyad exist in dialectical relation to the individual subjectivities of the patient and the analyst” (p. xv). An excellent example of Mitchell’s (1997) usage of this dialectic notion of autonomy and relationality is his statement, “Personal autonomy is not something that antedates interaction with others, but an emergent property of interactive processes, not something that can be sheltered from influence, but something that grows through influence” (p. 21). Relational psychoanalysis is an attempt to move beyond simple binary reversals, to find freeing options when faced with immobilizing deadlocks, both in theory construction and clinical practice. However, our call for a progressive psychoanalysis is not a brief on behalf of relational psychoanalysis or any other school of psychoanalysis. Mitchell’s comparative, integrative, and dialectic sensibility remains his most enduring and inspiring legacy (Aron, 2003, 2005).

Years ago, one of us had an experience worth relating directly in the first person: I (Lewis Aron) had just completed my psychoanalytic training at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. I was with my mentor, Donald Kaplan, a highly regarded Freudian analyst from New York. At the time, I was not yet on faculty. A young graduate of the program, I had thrown my hat in with the relationalists. Don, with whom I continued to have a wonderful relationship, never stopped teasing me about my becoming more relational in my thinking. We were with a group of the Freudian faculty and were all getting into an elevator; it was very casual and jovial. We were in the elevator, and I don’t exactly remember what led to the remark, but Don was talking to me about “you relationalists,” in front of the faculty, who were all men. He said (laughing), “You relationalists, come on, you just want to hold hands, you don’t wanna fuck.” At the time, I didn’t have the presence of mind or the maturity to respond quickly, but this joke captures everything that was wrong with the way psychoanalysis was defined. Psychoanalysis was a masculine phallic thing, in contrast to psychotherapy, which included everything that was degraded, castrated, and devalued, because of its emphasis on the relationship. For the Freudian faculty at that time, relational psychoanalysis and other “deviations” such as “neo-Freudian revisionism” or Kohutian self-psychology were “perversions” of psychoanalysis. Their practitioners were viewed as doing psychotherapy rather than psychoanalysis.

We write as clinicians and educators of clinical psychologists and psychoanalytic therapists. Our goal is not to trace history for its own sake or to make an intellectual contribution suitable only for academic purposes. We believe the future of our profession hangs in the balance. The binaries we have identified continue to haunt contemporary psychoanalysis. On a practical demographic level, psychoanalysis has changed from being an almost exclusively male to a predominantly female profession. Gender and the women’s movement have played a significant role in the theoretical shift from the dominance of classical theory to the ascendance of relational and other revisionist theory. Yet underlying prejudices remain deeply embedded in our fundamental concepts. They must be exposed and subjected to radical critique.

In the golden age of psychoanalysis, there was a good deal of consensus about what psychoanalysis was and how it should be defined. But in 1985, as psychoanalysis was breaking up into multiple schools, Roy Schafer introduced the methodology of comparative psychoanalysis, which had not before been necessary. As long as psychoanalysts were able to say that an alternative theory was “not psychoanalysis” but a deviation, there was no need for comparative psychoanalysis. Considering what might be meant in a contemporary age about “wild analysis,” Schafer recognized that with the shift to multiple perspectives, what it meant to be wild had become relative to one’s orientation. He emphasized, “our ideas of sound technique and appropriate lines of interpretation are necessarily defined by contrast with what is not acceptable” (Schafer, 1985, pp. 275–276). With the proliferation of multiple theoretical models, psychoanalysis can only be defined in the context of a comparative methodology. We suggest that rather than teaching the either/or approach of psychoanalysis or “not psychoanalysis,” or psychoanalysis versus psychotherapy, or psychoanalysis versus “wild analysis,” all psychoanalysis be taught comparatively.

We are not alone in arguing that psychoanalysis and psychoanalytic education should be more inclusive. But no one has systematically shown how psychoanalysis was defined in contrast to psychotherapy, or why the two have been viewed as incompatible and contradictory. The implications are profound. By stressing the similarities among its various applications, we can make psychoanalysis much more amenable to integration, attracting clinicians who think psychoanalytically even though they do not conduct psychoanalysis “proper” (four or five times per week, using the couch). In this regard, we are pursuing suggestions made by Emanuel Berman (2004a) who argued, “the core of psychoanalytic training is not the teaching of any specific technique or any specific theoretical model but the development of a unique state of mind and of particular sensitivities …” (p. 228). While we may differ from Roy Schafer (1983) in precisely what constitutes the “analytic attitude,” we would still argue that psychoanalytic education must transmit the analytic attitude to new generations of analysts. As Berman contends, while exploration of the differences between psychoanalysis and psychotherapy is of interest, at a time when all psychodynamic approaches are under attack, “an overemphasis on such inner dividing lines may serve the narcissism of small differences while neglecting the crucial contemporary debate about legitimacy and value of psychoanalytic treatment as a whole” (p. 228). We have often felt that the bickering among psychoanalysts about what “counts” as psychoanalysis, what theory, how many times per week, whether or not the couch is used, what school of thought is included or excluded, is nothing more than rearranging the chairs on the Titanic as the ship is sinking. Ours is not one more effort to shift the chairs. We believe the ship needs to turn in a very different direction.

We argue for a broad definition of psychoanalysis that encompasses the full range of its theories, applications, and methodologies. This includes “psychoanalysis proper” and “psychoanalytic therapy,” as well as what has generally been thought of as “applied psychoanalysis;” not only the several times per week clinical analysis of private practice but also the full range of clinical, educational, and social applications in the community and inner cities of America.

The Dialectics of Marginality

In his intellectual history of psychoanalysis in America, Paul Stepansky (2009) refers to Psychoanaly...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgments
• 1 Introduction: A Psychotherapy for the People
• 2 Binaries, Polarities, and Thirds
• 3 Guilt and Shame
• 4 Treatment versus Care: Psychoanalysis and American Medicine
• 5 Psychoanalysis in Uniform
• 6 Psychoanalysis as War Hero
• 7 Psychoanalysis as Holocaust Survivor
• 8 Psychoanalysis versus Psychotherapy: Definition via Binary Opposition
• 9 Comic Book Crusaders: Psychoanalysis as Superhero
• 10 Charcot and Bernheim: Origins of Intrapsychic and Relational Models of Mind
• 11 Women on the Couch: Genital Stimulation and the Birth of Psychoanalysis
• 12 Freud’s Anti-Semitic Surround
• 13 The Right to Pass: Psychoanalysis’ Jewish Identity
• 14 Universalizing the Jewish Problem
• 15 Freud, Ferenczi, and Schreber: Wandering Jews
• 16 Ethics, Universalism, and the “Jewish Science”
• 17 What is Psychoanalysis? Can you say “Shibboleth”?
• 18 Monsters, Ghosts, and Undecidables
• References
• Index