For decades psychoanalysis dominated professional approaches to mental health in the United States and had an influential impact on our culture. Starting in the late 1960s, however, psychoanalysis has become increasingly marginalized. Here, I will argue that psychoanalysis has always contained both subversive and conservative threads. As the historian Nathan Hale argued, Americans modified psychoanalysis to solve a conflict between the more radical implications of Freud’s views and the conformist pulls of American culture. This process of domestication enabled Americans to enthusiastically embrace psychoanalysis for a period of time. But they did so at the cost of transforming psychoanalysis in ways that ultimately contributed to its decline. Yet, ironically, the current marginalizaton of psychoanalysis may contain the seeds of a more radical psychoanalysis that serve as a healthy and constructive counter-cultural force moving forward.

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There are many reasons for the decline of psychoanalysis in America. During its heyday in the 1940s until the late 1960s, psychoanalysis earned a reputation as a conservative cultural force with a tendency towards orthodoxy, insularity, and elitism. Over time, it became widely perceived as a somewhat esoteric discipline with limited interest in grappling with the concrete problems afflicting people in their everyday lives and in understanding the social and political factors contributing to poor mental health. Thus, some dismissed psychoanalysis as a self-indulgent pastime for the well to do.

The fact that psychoanalysis came to be seen this way is ironic. Although Freud initially began developing psychoanalysis as a treatment for patients other physicians had been unable to heal, his ambitions quickly extended beyond therapy and into the realms of social theory and cultural critique. Though he and other early analysts came from medical backgrounds, Freud welcomed the contributions of those with diverse, non-medical training to the evolving discipline. Moreover, many of the early analysts, including Freud, were members of an emerging, educated Jewish professional class, whose upward mobility was enabled by the open, politically progressive policies of the Austro-Hungarian empire at the turn of the century.

Western European Jews at the turn of the century formed a unique group of marginal intellectuals. Alienated from traditional Judaism while not fully accepted into European society, they developed a skeptical point of view, which critiqued, but also contributed in constructive ways, to the very culture from which they were partially estranged. The early analysts thus tended to be members of a liberal, progressive intelligentsia. They sought social acceptability, but at the same time tended to question prevailing cultural assumptions. Their critical and in some respects subversive stance went hand in hand with a broader vision of progressive social transformation.

Psychoanalysis began in part as a radical critique of the illness-producing effects of social suppression and, most especially, the psychological repression of sexuality. Freud was deeply interested in broad social and cultural concerns. He was also critical of the trappings of the physician’s privilege, supporting, until the end of his life, free psychoanalytic clinics, payment on a sliding scale, and the ability of those without medical training to practice psychoanalysis. Many of the early analysts were indeed activists. Sandor Ferenczi, one of Freud’s closest colleagues, founded a free clinic in Budapest and passionately defended the rights of women and homosexuals. Karl Abraham, Ernst Simmel and Max Etington set up a public psychoanalytic clinic in Berlin in the 1920s that became a bastion of social and political progressiveness, influenced by left wing, socialist thinking. Prominent analysts such as Wilhelm Reich, Erich Fromm, and Otto Fenichel became well known for their socialist or Marxist commitments and their fusion of psychoanalysis with a politics of social emancipation.

Another example of this longstanding tradition of the intersection between psychoanalysis and social, political and cultural concerns, is the productive collaboration that took place among psychoanalytic thinkers such as Erich Fromm and Herbert Marcuse, and the tradition of critical theory emerging out of The Institute for Social Research in Frankfurt. Marcuse in particular continued to synthesize Marxist thinking, critical theory and psychoanalysis in his writing throughout his career. Both Adorno and Horkheimer synthesized psychoanalytic thinking with critical theory in their analyses of the way in which American consumerism, popular culture, and the mass media manufacture false needs that perpetuate the capitalist system. They drew attention to the way we are socialized into believing that if we drink the right beer or wine, drive the right car or wear the right clothes, we will find love, happiness and contentment.

In contrast to writers such as Fromm and Marcuse, many of the European émigrés who became most influential in the development of American psychoanalysis as a therapeutic modality, downplayed their progressive and socialist leanings so as not to arouse suspicion among their American hosts, fearful of ideologically dangerous foreigners. The intense anti-communism of the McCarthy era further created pressure on these emigres to decouple psychoanalysis from Marxism and downplay their politics more generally so as not to jeopardize the future of psychoanalysis in North America. (Herbert Marcuse, integrating psychoanalysis into critical theory, was a notable exception.) They thus kept their political views to themselves and focused on establishing psychoanalysis as a profession.

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The professionalization of psychoanalysis within the United States, starting before the émigré phenomenon, in many ways succeeded. During the early 1920’s, when psychoanalysis was beginning to take root in the United States, the American medical profession was struggling to upgrade and standardize medical training. The American physicians who played a dominant role in developing psychoanalysis were concerned about jeopardizing the future of the profession by training candidates who did not have a background in medicine. In 1938, the American Psychoanalytic Association made the fateful decision to restrict formal psychoanalytic training to physicians. The concern with protecting the professionalism of psychoanalysis contributed to its elitist character, privileged scientific respectability, and discouraged innovation. Over time, as medicine consolidated its elevated status within the healthcare professions, and psychoanalysis became established as a subspecialty of medicine, the social prestige of the psychoanalytic profession grew as well. For residents training as psychiatrists, the rigorous, time consuming process involved of psychoanalytic training, also fed the sense that psychoanalysis was an elite subspecialty within psychiatry. Chairs in most major psychiatry departments were psychoanalysts and most psychiatry residency training programs provided at least some training in psychoanalytically oriented treatment.

The United States became the center of the psychoanalytic world and massive effort and resources went into psychoanalytic training and the development of the field. Psychoanalysis thus emerged as a lucrative, high prestige, and socially conservative profession, attracting candidates who most often had greater interest in becoming respected members of the establishment than in challenging it. Psychoanalytic practice itself adopted a narrow, technical approach, with rather inflexible ideas about correct and incorrect technique. Psychoanalysis as a whole became a purveyor of conservative American middle class values rather than a culturally subversive force. Mental health, by extension, tended to be defined in terms of conformity to those values.

With the rise of biological psychiatry in the late 1970s, and the explosion in the development of new psychotropic medications, psychoanalysis grew less fashionable within American psychiatry. Over time, training curricula within psychiatry residencies shifted away from introducing residents to the basics of psychoanalytic theory and practice. Concurrently, the number of psychiatry residents applying for training in psychoanalytic institutes dramatically decreased. In 1979 the American Psychological Association formally established a division of psychoanalysis – Division 39. In the mid-1980s Division 39 filed a class action suit against the American Psychoanalytic Association, arguing that the refusal to admit psychologists as candidates within psychoanalytic training institutes was a violation of the antitrust regulations since, by establishing a monopoly of the field of psychoanalysis by physicians, they were preventing fair competition for clients by psychologists and depriving them of their livelihood. Ironically, by the time the lawsuit was settled, market forces were already opening the doors of psychoanalytic training institutes to psychologists, since as the number of candidates seeking psychoanalytic training continued to dwindle, traditional institutes became eager to recruit psychologists.

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In the last twenty years many of the more significant and innovative contributors to the development of American psychoanalytic theory have been psychologists. This new breed of psychoanalytic theorists and researchers has played a vital role in transforming psychoanalysis into a less insular and more intellectually vital discipline, grounded in an appreciation of contemporary developments in a broad range of social sciences including psychology, sociology, philosophy, political science and philosophy. But ironically, they function on the margins of mainstream American psychology and have little influence in academia.

Because pursuing formal psychoanalytic training in today’s culture is less likely to be a pathway to professional prestige or financial success, the typical candidate is more likely to be drawn to the field for intrinsic reasons. Especially given the increasingly marginal status of psychoanalysis within the general culture, and within mainstream clinical psychology, those attracted to the field are less likely to buy into prevailing cultural and professional values and assumptions and are more likely to approach things from a critical perspective. Thus ironically, the marginalization of psychoanalysis provides a potential catalyst for innovative thinking. In this respect, important aspects of the emerging sensibility in contemporary American psychoanalysis may be closer in nature to the sensibility of the early psychoanalysts than that of American psychoanalysis during its heyday from the 1940s to the early 1960s.

Given the current marginalization of psychoanalysis, it is not surprising that the general public tends to have a limited and often caricatured understanding of it. Psychology undergraduates typically receive very little exposure to psychoanalytic thinking, and when they do it is not unusual for them to be taught to think of it as a discredited pseudoscience. Psychoanalysis is more likely to be taught in the humanities than in psychology. And when it is taught it tends to be done so in a purely academic fashion, disconnected from therapeutic considerations, clinical practice, and lived experience. There is a tendency, moreover, for the media and entertainment world to equate psychoanalysis with Freud, and to assume that the value of psychoanalysis is inextricably linked to the validity of all of Freud’s ideas.

Freud was one person writing in a particular historical era in a specific culture. Some of his ideas were more valid in their original historical and cultural context. There are dramatic differences between the psychoanalysis of Freud’s time and that of today, in North American and elsewhere. For example, contemporary American psychoanalysis has a greater emphasis on the mutuality and intersubjective nature of the therapeutic relationship, as well as the role of flexibility, creativity and spontaneity in the therapeutic process. And, contrary to the common misconception, there is actually a substantial and growing evidence base for the effectiveness of psychoanalytically oriented treatments.

In the United States, psychoanalysis has evolved under the influence of a number of characteristic American attitudes, including a tendency towards optimism and an ethos of egalitarianism. Important as well, many of today’s leading analysts came of age during the 1960s, when traditional social norms and sources of authority were routinely challenged. In addition, prominent feminist psychoanalytic thinkers have challenged many of the patriarchal assumptions implicit in traditional psychoanalytic theory, raised important questions about the dynamics of power in the therapeutic relationship, and reformulated psychoanalytic thinking about gender. Another influence has been a postmodern sensibility that challenges the assumption that we can ever come to know reality objectively, maintains a skeptical attitude towards universalizing truth claims, and emphasizes the importance of theoretical pluralism.

Unfortunately, many people in the broader mental health field and the general public are unaware of these changes. While there are many valid critiques of psychoanalysis in both its past and current forms, its decline is also attributable to the fact that important aspects of the psychoanalysis sensibility go against the grain of a number of American cultural biases. These include an emphasis on speed, pragmatism, instrumentality, and an intolerance of ambiguity. While these emphases certainly have their value, they can also be associated with a naïveté that underestimates the complexity of human experience and the difficulty of change.

American culture, moreover, tends to gloss over the more tragic dimensions of life and espouse the belief that we can all be happy if we only try hard enough or adopt the right “quick fix.” This leads to the pathologization the inevitable anxieties and sorrows of everyday life. A therapeutic culture has emerged that employs techniques and medications for the purpose of manipulating one’s internal experience in order to produce a sense of well-being. But this therapeutic culture is disconnected from broader ethical and philosophical questions regarding what actually constitutes the “good life.” And it is also disconnected from broader social and political contexts. In our American “can do” culture, the failure to be happy is a moral failing. If we are all equally free to pursue “the American dream” then differences in opportunity available to different social classes are irrelevant.

Psychoanalysis originated in a continental Europe that had experienced centuries of poverty, class oppression, political and religious persecution, and international conflict and civil conflict, culminating in two calamitous world wars and genocidal violence. Freud once maintained that the goal of psychoanalysis is to transform neurotic misery into ordinary unhappiness. While some have argued that this statement is a reflection of the fact that Freud was not a particular cheery fellow, I think this is a profound misreading, Essentially Freud believed that therapeutic change involves coming to terms with and accepting the existential suffering that is an inevitable part of life.

Although American psychoanalysis tends to be more optimistic and pragmatic than its European counterpart, it still retains many of the traditional psychoanalytic values such as the appreciation of human complexity, a recognition that fulfillment is not necessarily the same as a superficial version of “happiness,” and an appreciation that change is not always easy or quick. At a time when mainstream psychology and psychiatry are promoting the beliefs that short term cognitive therapy or the latest psychiatric medication can cure whatever ails you, the reminder that things are not quite so simple can be a welcome antidote to our cultural narcissism.