Psychoanalysis: Education, Research, Science, and Profession (Book Review)

Author:  Wallerstein, Robert S.
Publisher: Universities Press, 2004
Reviewed By: Martin A. Schulman, PhD, Vol. 26 (3), pp. 66-67

The eleven papers published in this third volume of Wallerstein’s collected papers date from the mid 70s to the mid 90s. They focus on two aspects of psychoanalytic inquiry in which Wallerstein has established himself as one of the American psychoanalytic movement’s experts: psychoanalytic education and research, and psychoanalysis as science and profession. While, from necessity, some of the papers may at first appear dated, and there is the inevitable unevenness that one finds in any collection of papers, they are all of value in understanding the historical development of the contemporary psychoanalytic scene.

What differentiates Wallerstein from many other major figures in American psychoanalysis is his commitment, not only to the clinical and theoretical aspects of the field, but to the necessity for solid research as foundational to psychoanalysis as a science. This aspect of Wallerstein’s career should be appreciated, particularly by psychologists, because that is the tradition in which we were schooled. What also should be appreciated and commended is the role Wallerstein played during his tenure as president of the International Psychoanalytical Association, ushering the end of decades of medical exclusivity within “official” psychoanalysis as finally resolved by the GAPPP lawsuit.

While I will not summarize all of the chapters, I will spend the rest of this review highlighting some of those chapters that stand out and have relevance to the readership of this newsletter. The lead article from 1976, “Perspectives on Psychoanalytic Training Around the World,” reports the results of a questionnaire sent to IPA training institutes in regard to three basic questions: 1) How, if at all, does the training for the profession of psychoanalysis coordinate with the advancement of our knowledge of the science of psychoanalysis; 2) What kind and degree of personality alteration is expected as a result of the training process; and 3) How does the training sequence foster the goals of questions # 1 and 2. Without getting into specifics, the results indicate what is germane, and in retrospect shatters the historical argument from the American Psychoanalytic Association that the admission of nonmedical candidates and the acceptance of nonmedical analysts would deteriorate standards. Wallerstein’s research shows that standards varied tremendously throughout the world and that there was no uniform baseline, regarding admissions criteria, expectations of change, or final completion requirements. For example, preselection varied from none at all to rigorous screening, while Kleinian institutes have “freer admission processes with a willingness to take gambles on candidates who might be deemed too disturbed by other institutes, [and] count on achieving more far-reaching personality changes” (p. 51). Wallerstein concludes that “there are, in short, major differences amongst us on vital aspects of the training experience, with their wide ramifications into the total structural fabric and the total psychological climate within which the training is conducted” (p. 52.). At another point, in a later article but germane to this topic, Wallerstein states,

Until the rise of Kohut’s self psychology, institutes in the United States had been almost monolithically within the ego psychology paradigm. Until recent years, institutes in Latin America have been equally single-mindedly Kleinian and/or Bionian. Aside from the shared beginnings in reading Freud, there have been almost no points of correspondence in what is read and integrated into one’s psychoanalytic understanding and identity between those trained in the North American and in the Latin American contexts. (p. 253)

These findings shatter the myth espoused by critics that psychoanalysis is a uniform cult or a closed discipline. However, it does raise other self-evident problems at times dwarfing the Tower of Babel (and let us not forget that Wallerstein does not cover the Lacanian influence, or vocabulary). Needless to say on all the dimensions studied, with some notable exceptions, the American institutes fell on the more conservative side of the gradient.

The second article, “The Mental Health Professions: Conceptualization and Reconceptualization of a New Discipline,” outlines the effort to create, in line with Freud’s thinking in “The Question of Lay Analysis” (1927), a new psychoanalytically oriented profession: the Doctor of Mental Health (DMH), established through the University of California, San Francisco Medical School and the Mt. Zion Hospital Psychiatry Department in 1973 and lasting until 1986. The desire underlying the formation of this program and its unfortunate demise should be kept as a background factor for future changing times, when perhaps some form of the program can be reinitiated.

The next three chapters deal with a topic that has been a passion of Wallerstein’s during his involvement in organizational psychoanalysis for more than 50 years: research into the effectiveness of psychoanalysis and psychoanalytic (supportive) psychotherapy. These chapters cover the research program at the Menninger Foundation, providing a summary of the empirical outcome studies by various institutes from 1917 until the mid 90s, as well as the assessment of structural changes resulting from analytic treatment. These chapters are a goldmine for future researchers and a fine overview of our present empirical knowledge in this area. Of interest is one of Wallerstein’s tentative conclusions that “concomitant and proportionate structural change accompanied whatever degree of symptomatic and behavioral change was achieved in just about every instance in the more expressive and more purely psychoanalytic treatments. But equivalent structural change also accompanied the achieved symptomatic and behavioral changes in almost half the patients treated with a more ego-supportive and conflict-suppressive (and non-insight-aiming) therapeutic mode” (p. 114). I would like to see an updating of this research, perhaps with more refined statistical tools, as well as incorporation of some of the “newer” models of psychoanalysis that have emerged since the 90s.

Part 2 of the book is more philosophically oriented and deals with the nature of psychoanalysis as a science, the relationship to academic psychiatry the future of psychoanalysis as well as psychotherapy and the question of lay analysis and the identity of psychoanalysis. The debate over the question of metapsychology and whether psychoanalysis is a hermeneutic discipline or a part of the natural sciences is ably summarized by Wallerstein, indicating the depth of his familiarity with not only the analytic literature, but also with philosophical discourse. The question is posed, as it was in the 80s, whether psychoanalysis should delete from its canon the metapsychologies and follow the model of cybernetics and information theory as a natural science or, on the other hand, give up any semblance of scientific identification and see itself as a humanistic, interpretive discipline. Wallerstein, astutely points out the problems with both of these perspectives, as well as their limitations for our rather “unique” discipline. Wallerstein effectively rebuts the argument of Adolf Grünbaum as to the nature of analytic inquiry. His desire in doing such was to

[reclaim]... a viable, albeit developmentally still early scientific status for psychoanalysis, with the continuing ongoing opportunities for the growth of an empirical psychoanalytic enterprise, via both the case study method innovated by Freud, and also via formal and systematic research that is consonant both with the subtlety and complexity of the subjective phenomena under scrutiny, and yet loyal to the reality principle as embodied in the canons of science. (p.155)

Here too, I’d like to see an extension of Wallerstein’s argument emanating from newer developments in psychoanalysis, particularly the postmodern critique of science, and the limitations of the natural science model.

In an overview of the relationship between psychoanalysis and psychiatry, as well as the general academic world, Wallerstein presents a mixed picture, yet leaves the reader with a sense of optimism for the future. I only wish this was so. It seems in the decades since this was written, the academic and psychiatric worlds have moved further from the analytic model. In spite of research into neuropsychology and brain patterns, which seem to give indications that Freud was not as off base as previously thought, the official psychiatric establishment, as well as organizational psychology have not caught up with these new indications. I see the gulf widening, but hopefully, I am wrong. Whether one agrees with Wallerstein or not, this section is an excellent summary of historical trends and developments and sets the ground for the contemporary scene, and is therefore worth reading.

The chapter on lay analysis titled “The Identity of Psychoanalysis,” summarizes some of the main themes of Wallerstein’s 1998 book, “Lay Analysis: Life Within the Controversy.” While covering the now well-known history of this “controversy” from (needless so say) the role of a major participant, what is of interest is the context in which this paper was delivered. It was the keynote address in 1994 at the Winter Meeting of the American Academy of Psychoanalysis, the one major organization that still operates under a policy that regards psychoanalysis as a subspecialty of psychiatry and thus, of medicine. Therefore, in taking a principled stand, Wallerstein confronted the last remnant of medical exclusiveness in its own backyard. (As an aside, breaking with tradition, the paper was not published in that organization’s journal because it was deemed irrelevant to the Academy, and because it covered the experiences of the American Psychoanalytic Association, a separate organization.) It is of interest, historically, how the old concept of “change of function” operates, in that the Academy, which had its origins in the rejection of the homogeneity and oppressiveness of the American, now has become even more “conservative” than its parent organization. But that is a topic for some historian of psychoanalysis or a future paper.

In conclusion, I think the book is worth reading not just for historical information, not simply out of respect for Wallerstein and his dedication to psychoanalysis, but for the possibility of the generation of new ideas and follow-ups to the research and topics discussed.

Reviewer Note

Martin A. Schulman

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