Is Psychoanalysis Dead Or Alive? Part One
How psychoanalysis is coming back to life in 2014
Posted Jan 23, 2014
Fifty years ago in the United States, psychoanalysis was the treatment of choice for a whole range of people and their difficulties: from the worried well to the very ill. It was trendy; it was respected; and it was the gold standard treatment for what ailed us.
But times have changed—and, in some ways, to good account. Since the 1950’s, the scientific study of mental illness has yielded discoveries that have made monumental advances in the effective treatment of psychological disorders. Most notably, researchers discovered that certain forms of mental illness—from schizophrenia to depression to bipolar disorder to autism—are linked to brain chemistry. As a result of this discovery, medications were developed that were far more effective than the woeful treatments available before. We said a fond farewell to lobotomies, straightjackets, and ice baths. We welcomed psychotropic medications that offered relief for the most severe psychiatric symptoms and helped people find their way back to reality.
But with such advances, our whole mindset as a culture began to shift. The medical model got the upper hand, both in how we think about our psychological troubles and how we go about treating them. Biological explanations, psychopharmacological treatments, and evidence-based therapies became king. We grew suspicious of anything that could not be measured in a lab, on a 5-point Likert scale, or as a cost-benefit analysis. We became the Prozac generation and expected that ten sessions of cognitive behavioral therapy or behavior modification would do the trick.
Not only did we become a fast-food nation, we became a fast-therapy nation, too.
With this cultural shift, many people lost confidence in psychoanalytic therapies. They took too long, cost too much, and lacked the focus on immediate, measurable outcomes. Given the changing atmosphere, these criticisms were understandable and needed to be addressed. But for many years, psychoanalysts mostly kept quiet, ironically resistant to change. Some stuck their heads in the sand, too tied to their theories and their heroes. Others dug in, reluctant to submit to the microscope of research, claiming that the sacred analytic endeavor could not and should not be reduced to laboratory study. Most had difficulty waking up to the need to make their discipline user-friendly, relevant, and more practical. Fewer and fewer mental health professionals went into training to become psychoanalysts, and fewer and fewer patients sought their help.
Quietly, behind the scenes, a makeover has been underway in psychoanalysis. Freud is taking less of center stage and is now viewed more as Newton is to physics: a pioneer but not a god. New strands of psychoanalysis have taken root. British object relations, attachment theory, intersubjectivity, and relational approaches are bringing the outdated modes of psychoanalysis into the 21st century. Freud’s unconscious still has its place, but now there is also consideration for the place of inborn temperament, early life experiences, and the impact of another’s psyche in the development of one’s own. Psychoanalysts understand now more than ever how we are shaped by the psychological reality we co-create with another person: first with mom and then dad, siblings, and others in our intimate circle, including our psychoanalyst if we have the courage to find one. They haven’t thrown Freud’s baby out with the bathwater, but they have gotten to know the psychological complexity of that baby much, much better.
I hope that I am making some small contribution to this outreach effort by writing my blog for Psychology Today as well as through my forthcoming book (shameless plug), Wisdom from the Couch: Knowing and Growing Yourself from the Inside Out. I am heartened by outgoing President Charles Hanly who, at the big meeting of the International Psychoanalytic Association in Prague last summer, spurred his fellow psychoanalysts by saying: “One good outreach project is worth more than any new article in a journal.”
In essence, psychoanalysis is transforming itself from a mechanistic to a more human model, from a hierarchical to a more egalitarian process, from the purist pursuit of insight to a more clinically-focused model as an agent of change. It is emerging from its isolation and elitism to take its place as a legitimate treatment among other legitimate treatments. Hopefully, it is becoming more approachable and user-friendly, too.
To be sure, not all psychoanalysts have changed in these ways and not all psychoanalysts welcome such change. Nevertheless, there is a growing recognition that psychoanalysis needs to become more relevant in today’s world, both in order to survive and in its fundamental purpose to be helpful to the patients who entrust themselves to its care.
Copyright 2014 by Jennifer Kunst, Ph.D.
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To learn more about the ideas introduced in this short post, check out the more thorough, brilliant, and award-winning piece by journalist Wendy Dennis, Why Psychoanalysis Matters.
For previous posts in my series about the basics of psychoanalysis, check out, What Is Psychoanalysis.