Reflections on the roundtable discussion of the division practice survey
By Frank Summers
In the last issue of DIVISION/Review, several active members gave their comments on the division practice survey conducted by Steve Axelrod. The results of the survey showed that our average member has a very limited psychoanalytic practice. The mean number of individual patients seen is about 18 per week almost exclusively on a once per week basis. On average, only 2.8 patients are seen twice per week and 1.3 for three or more weekly therapeutic hours. While most respondents to the survey valued their analytic training, they do little analysis or even analytic therapy.
The very small number of patients seen more than once per week is clearly a major source of concern for the participants in the roundtable discussion, and they proposed a variety of factors that may be at play, all of them undoubtedly important in the shrinking of analytic practice to an almost nonexistent level among our members. Suggested reasons included: a clash of generations, our failure to recognize the importance of culture, derisive and unfounded attacks on analytic therapy from undergraduate professors, insurance cutbacks, myths about psychoanalytic therapy as lacking in evidential basis, and the belief that we practice an outmoded and ineffective form of therapy. These prejudices affect not only potential patients, but also young people interested in pursuing clinical careers. Students hear at both the undergraduate and graduate levels that psychoanalytic therapy is a relic of the past that has been found to be expensive and lacking in beneficial results. There can be no question that analysis and analytic therapy have lost status and no longer appear to be a viable way to make a living to many young clinicians.
These reasons are all undoubtedly contributing to the deterioration of analytic practice, but I wonder if we cannot take the discussion to a different level by asking why these factors are so powerful. For example, we might wonder why even clinically active undergraduate and graduate psychology professors have adopted a hostile, demeaning view of analysis.
One need only peruse any introductory psychology text to find a clue. Psychology is defined as “the behavior of living organisms” because “that is what can be observed” (Zalat, 2007). These simple statements are the entirety of the epistemological explanation given for defining psychology as “behavior,” a view that excludes psychoanalytic theory from the field. This epistemological position, if it may be called that, is erroneous in a number of ways, as I have shown elsewhere (Summers, 2011). Here I wish to note only that this textbook definition of psychology, rather than formulating a method that befits the subject matter, defines the field by a preconceived method. No argument is given, because none is thought necessary, that the presupposed method is appropriate for the study of the psyche.
When such transparently flawed reasoning about the very nature of an entire discipline goes unquestioned, the error is not simply an intellectual mistake, but a cultural phenomenon. “Scientism,” flawed as it is, has long dominated the culture of American social science. Accordingly, academic psychology has made “behavior” its subject matter because studying the measureable allows psychology to regard itself as a “science.” And to be included among the sciences is the highest compliment any discipline can be given in the culture of scientism. Because psychoanalysis does not meet the criterion of measurability, it is not regarded as a science, and so within the culture of scientism it is delegitimized.
Given the cultural context of American social science, I find it somewhat surprising that psychoanalytic thinking has survived as long as it has in some psychology departments. Psychodynamic scholars who continue to have influence in clinical psychology programs are fighting a brave struggle against a belief system that stands in staunch opposition to the psychoanalytic way of knowing. The wonder is that there are psychoanalytic scholars who manage to keep functioning and in some instances play leadership roles despite their apostasy. The existence of analytic influence in some graduate programs may be testimony to the intrinsic value of analytic thought and its hold on those who possess intellectual curiosity about the depths of human experience.
Psychology’s imitation of the natural sciences only answers the inquiry at the academic level. One wonders: why is the culture of academic psychology dominated by the need to be regarded on a par with the natural sciences? Universities are embedded in a society that tends to define reality by the material and the quantifiable. What can be given a number is accorded more credibility than quality of experience. That is why natural science has always had much higher prestige than social science in the United States. And today the wonders of contemporary technology serve to intensify the passion for material production and achievement that pre-existed the current computer revolution.
E. L. Thorndike made perhaps the most egregious ontological error in the history of ideas when he said, “If it exists, it can be measured.” Those who claim consistency as one of their inviolable scientific principles conveniently overlook the immeasurability of Dr. Thorndike’s statement. The fact that Thorndike’s woefully mistaken statement is the unchallenged credo of American academic psychology shows that his contention reflects a value system deeply embedded in the dominant culture, a cultural “unthought known.” And to that culture of quantification, materialism, and objectification psychoanalysis does not belong.
So, the deligitimization of psychoanalysis cannot be left at the door of a university value system that represents the society it serves. If one defines materialism in the broadest sense of seeing the material as the criterion for truth and reality, the hegemonic American culture is steeped in a materialistic value system. The culture clash is not a narrow academic theoretical debate. It is a fundamental conflict between a culture that valorizes the material and quantifiable, on the one hand, and a discipline that engages human subjectivity, on the other. It serves psychoanalysis to see that the reasons for its fragile status go beyond today’s circumstances, such as insurance cutbacks and ethnic insularity. Seeing that the battle line is drawn at a confrontation of different cultures, of conflicting value systems, provides a clear vision of the strength of the force opposing the growth of psychoanalysis and of the battle in which it is engaged.
Ultimately, my argument is that the crisis of psychoanalysis is nothing short of a confrontation with mainstream American culture. Pessimism understandably abounds because there is little sign that the hegemonic culture will somehow find analytic thought a valued addition to society. If analysis looks to mainstream culture for recognition, it is, if I may paraphrase an old song, “Looking for love in all the wrong places.” That fact has led analysts to the pessimism that permeated the roundtable discussion.
But, the fact that the culture shows little respect for analysis, while a major problem at the level of concrete everyday practice, is ironically a reflection of the unique contribution and strength of the analytic process in its battle with the wider society. The value system of the culture that rejects analysis is not serving its citizenry well, as attested by the staggering amount of depression, anxiety disorders, substance abuse, and eating disorders, among other forms of pathology that pervade American society. In one typical study, approximately half of Americans surveyed reported at least one episode of serious emotional disorder during their lifetime, and 30 percent were afflicted with emotional distress during the previous 12 months (e.g., Kessler, 1994). Dissatisfaction with daily living in the United States is endemic.
This cultural dis-ease shows that many people, perhaps the majority of Americans, feel their lives are unsatisfying and a sizable portion are miserable. The culture of quantification and measurability has little to offer them. If the purpose of life is to produce numbers, of whatever type, the experience of individual can be of little import. No matter how carefully depression is measured, the individual is still depressed. Affect disorder, substance abuse, and characterological dissatisfaction are all a product of a culture that pays all too little attention to the experiences of its members. The citizens are expected to produce, and those who do not suffer the consequences. The “manic society,” as Peltz (2005) has called it, offers no succor to the abused child, the depressed adolescent, or the adult suffering from low self esteem.
Psychoanalysis has the opportunity to step into this breach by offering an experience and approach to human suffering that stands in rare and clear contrast to the culture of objectification. The very fact that psychoanalysis eschews measurement and behavior in favor of listening to the overt and covert meanings of the individual and engages that experience makes it a unique offering in today’s world. Psychoanalysis need not emulate the hegemonic culture by trying to prove our “scientific” worth in conventional terms, for the strength of analytic thinking lies precisely in its opposition to the reduction of human experience to behavioral patterns.
For the same reason that analysis is excoriated by mainstream culture, it provides a unique perspective on both the individual and the culture. Not only despite of, but because of, the inherent opposition of analysis to the dominant culture, one can find hope for more than survival. The possibility is there for a potentially powerful impact of analytic ideas not just on individuals, but also on the culture itself. The transformation of children, adolescents, and adults into natural objects of production has led to a silent opposition in the form of widespread dissatisfaction, even desperation, and a virtual epidemic of psychic symptoms in large portions of the American citizenry. Only a field outside of the mainstream can take a good look at that morass of despair and offer something fresh. It is up to psychoanalysis to take advantage of that opportunity. But to do that the analytic community has to conceive of itself as offering a perspective that stands in proud opposition to the mainstream culture. The battle of opposing cultures has to be engaged head to head.
For the same reason psychoanalysis finds a welcome reception among some in the humanities. Contemporary literary criticism often uses psychoanalytic ideas, and some philosophers find psychoanalytic thought a useful perspective in their efforts to understand the human condition. And here lies a ray of hope: psychoanalysis is warmly received and utilized among some scholars in the humanities, most notably in literary criticism, to a far greater extent than is the case in psychology.
“Marketing” psychoanalysis might well be helpful, but if the marketing campaign is built on the efficacy of analytic work, its effect is likely to be limited because such a campaign will be confined to a battle over statistics and outcome studies. For those hungry for recognition, understanding, and engagement with their experience, statistics are not going to be decisive. What matters to them is to have their hunger for a human experience sated, and that is the market for psychoanalytic therapy. What must be “marketed” is not statistics, but a human experience, a willingness to listen and understand without reducing experience to behavior or measuring it against an external norm.
That is why psychoanalysis as an alternative that proposes to focus on human experience rather than behavior is best introduced by direct human contact: giving talks to community groups, joining discussions of existing groups and culture, such as religious and social organizations. Psychoanalysis more than any treatment is built on a human relationship, and it is in direct human interaction that it is best understood. Moreover, it is imperative that minority populations are central to this effort. The growing ethnic “minority” population cries more loudly than those in the majority culture to have its experience heard. What psychoanalysis offers is the enrichment of human experience, and that need is great at all levels of today’s world.
The value of analytic work is felt most immediately early on in the treatment, often long before any symptomatic improvement occurs, as patients realize their behavior and communication is taken seriously. As one of my patients told me, “You are the first therapist who has ever listened to me!” Most people see the value of depth psychotherapy when they realize that their experience is the focus. Precious few Americans are getting that opportunity in today’s world, but many want it, and psychoanalytic therapists, perhaps uniquely, can provide it.
Kessler, RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of Gen Psychiatry. 51(1), pp.8-19.
Peltz, R. (2005) The Manic Society. Psychoanalytic Dialogues 15 (3): pp.347-366. Summers, F. (2012). The Tyranny of Objectivism, Psychoanalysis, and the Rebellion of the Subjective. International Journal of Applied Psychoanalytic Studies, 9 (1), pp.35-47.
Zalat, J. (2007). Introduction to psychology. 9th edition. New York, NY: Wadsworth
About the Author
Frank Summers, PhD, ABPP, is president of Division 39 (January 2013), clinical professor at the Feinberg School of Medicine, Northwestern University, a supervising and training analyst at the Chicago Institute for Psychoanalysis, and a faculty member of the Chicago Center for Psychoanalysis and several other psychoanalytic institutes. Winner of several teaching awards and more than 40 papers in professional journals, his fourth book, The Psychoanalytic Vision, is due out in early 2013. Dr. Summers maintains a private practice of psychoanalysis and psychoanalytic psychotherapy in Chicago, Ill.