Unfree associations : inside psychoanalytic institutes

In an age of managed care and new biological therapies for mental illness, psychoanalysis is generally seen as a 'profession on the ropes' whose hour is up. What went wrong? While external factors have played their part in the fall of psychoanalysis, psychoanalysts have generally disregarded their own crucial role in creating this decline. This thesis examines this role as played out through their own institutions, the freestanding psychoanalytic institutes. Freud was an explorer but he also codified his ideas. His work has been taken as an inspiration to explore without presuppositions but also as Holy Writ. Psychoanalysis deals with emotions and excites passions. Like religion, psychoanalysis asks big questions, and, like religion, is easily influenced and seduced by dogmatic answers to these difficult questions. Psychoanalytic institutes have been notable as closed shops. Their solid walls have kept them sealed off and mysterious to the outside world, including the mental health professions and the academy. Authoritarian cliques, power struggles and intrigues have predominated inside the institutes. Institute life has been secret, the subject of rumour rather than knowledge. Insiders often know little about of other institutes (unless they are involved in site visits to particular institutes). Sometimes, insiders have a limited view of their own institutions because they see them through the vantage points of their own experience and that of some close colleagues. I have interviewed central participants of the dramas of the histories of some key psychoanalytic institutes in the US. For the first time, this thesis recounts the intricate inside history of these organizations. The thesis reveals the detailed inner political histories of arguably the four most important and varied psychoanalytic institutes affiliated with the APsaA. The New York Psychoanalytic Institute was the first and for decades the prestigious institute which set the model for many others. It became pre-eminent on a world scale with the immigration of leading European analysts fleeing the Nazis. The Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute are quite varied in their organization and histories. The cultures are often quite different yet many of the problems will be found to be similar at base. I first examine the detailed political history of the New York Psychoanalytic Institute which provides a quintessential example of analytic anointment in practice, together with its pitfalls. I then examine a split that occurred in the Boston Psychoanalytic Society and Institute, which demonstrates some of the tensions and ambiguities that seem inherent in psychoanalytic organizations, especially where society and institute are part of the same institution. I move on to investigate a very different history in the Chicago Psychoanalytic Institute, which is quite differently organized: in Chicago, the institute with a lay Board of Trustees is quite separate from the society, and has for most of its history been headed by a powerful director. Then I look at the very complex history of the Los Angeles Psychoanalytic Society and Institute which in the 1970s came very close to being closed down by the APsaA. The Los Angeles Institute history is especially colourful and informative, given the introduction of Kleinian and object relations ideas into the institute and the reactions to them. These histories provide dramatic insights into what psychoanalysts and their institutions have contributed to what has gone wrong with psychoanalysis from the basis of a critique. A major aspect of the problem, in my view, is that a basically humanistic discipline has conceived and touted itself as a positivist science while organizing itself institutionally as a religion. I argue that psychoanalysts approach psychoanalysis with an inappropriate paradigm, 'as if it were a science. Their systemic misconception of their own discipline, and the resultant, widespread creation of what Christopher Bollas calls a 'false expertise' contributes to their present-day decline. I argue that qualification from an institute assumes the transmission of a body of knowledge which has not really been established as knowledge. This presumed knowledge is then transmitted by means of anointment reminiscent of the Bible. There is no unified body of knowledge within the psychoanalytic field nor is there a unified practice that can be readily empirically tested. Therefore, by default, psychoanalytic education has become a process of anointment, transmission through a subjective process akin to consecration. The large gap between the small knowledge base of psychoanalysis and the high level of 'pretend' knowledge which is inculcated during training and upon which qualification is based entrench conditions which themselves make real knowledge in this complex field more and more difficult to attain. This argument has implications not only for psychoanalysis but for many other professions where knowledge and qualification have unrealistic and inappropriate bases.