Future of Psychoanalysis Put on the Couch

Sometime around 1900 there arose a promising new craft to help people in mental distress. It was Sigmund Freud’s psychoanalysis, of course. With one of his early patients, a teen named Dora, Freud actually listened to her—something quite amazing for an authoritarian “Victorian” physician to do. By the 1930s and 1940s, psychoanalysis was being widely practiced not just in Europe, but also in the United States.

By the 1950s, however, psychotropic medications started to become available, and in the next several decades, even more effective “meds” came along, opening the door to new treatments for mental illness. Other types of psychotherapy also arrived on the scene, and beginning in the early 1990s, managed care reared its ugly head, helping to marginalize analysis further.

As if these factors haven’t deflated American analysis enough, some others have been conspiring against it as well. For instance, verbal skills are essential for a successful analysis, yet Americans are not as verbal as they used to be. That is an observation that a Los Angeles literature professor voiced at the American Psychoanalytic Association meeting in New York City in January in a session called “On Becoming and Being a Psychoanalyst in the 21st Century.” Interactions with college students have made it clear to her, she explained, that people are less interested in talking and expressing their feelings than they used to be. “Language is being reduced more and more to grunts,” she lamented.

Nor are Americans generally willing to take time for reflection these days, let alone take time to be put on the couch four times a week, an analyst who has been analyzing patients since 1949 pointed out at the session. “Americans are terrified of death,” he said. “That’s why they are always exercising instead of reflecting.”

Also, being analyzed isn’t something that Americans are willing to talk about, much less promote, a corporate tax lawyer and analyst candidate pointed out at the session.

“I don’t think a lawyer would ever admit to seeing an analyst four times a week,” he said. “He would be afraid that the information would be used against him in his job.”

In fact, probably most people in analysis want to keep it a secret, Judith Chertoff, M.D., of Rockville, Md., and Todd Mitchell, M.D., of San Francisco agreed at the session. The reason? Stigma, of course.

Nonetheless, a few thousand analysts are still providing their services in the United States. (The American Psychoanalytic Association has some 3,500 members.)

So what kinds of people are undergoing analysis these days? Is it only those who can afford to pay for it themselves? “No,” Kerry Sulkowicz, M.D., a New York City analyst and chair of the American Psychoanalytic Association’s Committee on Public Information, told Psychiatric News and several other publications during a press briefing held at the association meeting. The people in analysis, he explained, include those who experience anxiety, depression, relationship difficulties; those who keep getting fired from their jobs; and those who are stuck in an impasse in their creativity. Some have tried other forms of psychotherapy or psychotropic medications but haven’t been helped. In nearly all cases, they are highly motivated and want to change.

While American analysts will continue to analyze a select number of patients, Erik Gann, M.D., the San Francisco analyst who headed the session, pointed out that “the future of psychoanalysis is not going to be in treatment per se, but in the extension of psychoanalytic thinking into 21st-century culture.”

Analysts, he declared, are going to reach out to people in the neurosciences, arts, education, business, and industry.

Indeed, they already appear to be doing so. For example, as Sulkowicz reported at the meeting press conference, he recently served as a consultant to a biotechnology company that was having personnel problems. The chief executive officer wanted to fire the company’s major scientist because of “insubordination.” After talking with various members of the company, however, Sulkowicz discovered that the problem was the CEO, not the scientist; in fact, the scientist was very much beloved by people in the company. Sulkowicz imparted his findings to the company’s board, and it fired the CEO.

In a meeting session on aggression, Phyllis Cath, M.D., a San Francisco analyst, reported that in the past few years she has been consulting to teachers about mental health concepts. “I have found that good educators, like good analysts, tend to be very intuitive,” she said. “However, their experiences with children are very different from ours.” In other words, some teachers may not have a conceptual framework to help children, and that is where analysts can be of assistance.

“We have veins of rich things to offer,” the analyst practicing since 1949 declared. ▪