Psychoanalysis: In Search of Its Soul

SINCE the Second World War, some 35 years after they were imported from Europe, Freudian theory and analysis have ruled the field of psychiatry in the U.S. Today many observers believe that their long domination is at an end. A vastly different and more anxious time has bred problems--and demanded solutions--that Freud never envisioned and that analysis was not designed to treat. The field of nonanalytic psychiatry has grown enormously in recent years--a fact that does not so much mean that psychoanalysis has lost ground as that its competitors have gained. Many younger psychiatrists, moreover, are displaying an increasing skepticism about the doctrines and techniques of orthodox analysis. Says British Psychologist H. J. Eysenck: "It has nothing to say to us, and there is nothing we can do for it except ensure a decent burial."

Out of Style. Even Freud's daughter Anna, 73, the founder and director of the Hampstead Child Therapy Clinic in London and one of his school's most progressive heirs, sadly acknowledges that psychoanalysis seems to be going out of style. "Young people now are not interested in man's struggle against himself, but in man's struggle against society," she said last year in Manhattan. "They see that what psychoanalysis may lead to is adaptation to society. That's the last thing they have in mind."

Some of the charges put to Freudianism are thoroughly familiar: that it is an expensive, timeconsuming, highly selective form of therapy, which admits only those patients who suffer from the relatively mild ailments that analysis has a plausible chance of curing. To therapists concerned with the vast volume of mental illness that needs to be treated, write Psychologists Hans H. Strupp and Allen E. Bergin in a study for the National Institute of Mental Health, "a little, but significant, change for a lot of people is seen as preferable to protracted efforts to produce large-scale changes in a few members of the upper social classes."

Dark Urges. A more telling critique challenges the limitations of Freudianism as a theory of mental processes. A biologist himself, Freud was aware of the impact of environment on man; yet orthodox analysis traces mankind's emotional problems to the first formative years of life, minimizing most subsequent influences on the psyche. Moreover, some critics consider analysis defective because of its emphasis on pathology. By churning the invisible wellsprings of maladjustment, Freud sought to discover normality--which is somewhat like describing the law-abiding citizen through the reprehensible habits of the underworld. He focused on what he called the id--man's dark, powerful and basic animal urges--at the expense of the ego, even while recognizing the ego as the vital mediator between instinct and environment. Thus he missed, or scanted, some very basic questions. What is a normal--healthy--emotional climate? Cannot human unhappiness be conditioned as much by the present as by the past?

Whole new schools of psychotherapy have been built to find answers, and they are pushing the boundaries of psychiatry far beyond Freud. Existential analysis (TIME, Dec. 29, 1958) draws upon the insights of such modern philosophers as Kierkegaard and Heidegger and strives in therapy to help the patient discover the essential humanity of his experience. In Britain and South America, orthodox analysis is being challenged by the followers of Melanie Klein, a classically trained analyst who died in 1960 and whose theories, in contrast to those of Freud, emphasize the supreme significance of the child's first few months of life, long before the oedipal period begins.

Redundant Emetic. A far more influential competitor of Freudianism is behaviorist psychology, which borrows generously from physical medicine and the theories of Harvard's B. F. Skinner. The behaviorists concentrate on the symptoms of mental disorder rather than on their origins, on the provocative--but unprovable--theory that the symptom is the disease. The only trouble with the fat man is that he eats too much; ration his calories and he is cured. Aversion therapy, used by some behaviorists, proceeds on the assumption that if a patient is forced into repellence against his neurotic behavior, he will abandon it and thereby become emotionally hale. In this treatment, the male homosexual, for example, may be dosed with an emetic while examining pictures of naked men; in time, the emetic becomes redundant and the patient is declared normal.

The most serious challenge to Freudian orthodoxy comes from the many advocates of group and community-wide therapy, who questioned the rugged individualism of analysis's 1-to-l ratio between patient and physician. Analysis has never been for the many--on either side of the equation. Its rigorous training program, which seldom qualifies a man for practice much before his 40th year, severely limits the number of practitioners. Fewer than 1,300 U.S. physicians are qualified Freudian analysts, and among them they share one of the tiniest practices in medicine: about 11,000 patients, or fewer than .5% of all Americans seeking professional help for emotional disorders.

Analyzing Analysis. In the hope of expanding therapy's scope, enthusiasts for mental treatment in the mass have spawned an astounding variety of techniques, ranging from the feelie T-groups (training groups) of California's sensitivity-oriented Esalen Institute to community mental-health services, which operate on the principles of short-term treatment and fast-acting relief.

Nearly all of these new approaches begin by defining human unhappiness not as something forever fixed in the amber of childhood but as the product of an endless procession of social and environmental interactions that occur all along the human course. Therapy today is less concerned with the etiology of the patient's emotional problem than with tiding him over today's stormy weather. Apart from orthodox analysts, the majority of psychiatric therapists are now eclectic, distrustful both of schoolism and dogma and willing to try any technique, if it seems likely to help the patient.

In loosening analysis's dominion of psychiatry, the new therapies have encouraged analysis to analyze itself. Many Freudians realize that, however significant the lessons of the past, education does not stop there--either for the patient or for the therapy. In the hands of its more imaginative heirs, Freudian analysis has made a consistent, conscientious and for the most part effective effort to draw abreast of the 20th century. The entire field of child psychiatry, for example, pays an important debt to Anna Freud, who as a lay analyst of 31 in Vienna was already specializing in child analysis, a field of which her father knew little. Any course in child psychology today, and any practitioner, begins with her pioneer work on the subject.

The fact that society is a net in which individual man is unavoidably involved every moment of his life was long ago recognized by such Freudian disciples as Heinz Hartmann and Erik Erikson. Rene Spitz focused on early human development without discounting the effect of man's ever-changing milieu; his work indirectly led psychoanalysis to develop a close relationship with such seemingly unrelated fields as urban planning and population control. Erikson, still an active member of Harvard's faculty, was a charter founder of the community-wide approach to mental health.

Beyond the Couch. If anything, psychoanalysis is probably overrepresented in the community mass mental-health movement. Only 20% of the members of the American Psychoanalytic Association confine themselves to the practice of classical analysis; many have gone beyond the couch into the broader, if less remunerative area of community mental-health programs. Just as significant, Freud's emphasis on the id, or man's instincts, has yielded to what the present-day therapists call ego psychology: man's relationship with his environment, a field pioneered by Anna Freud and by Hartmann.

In a score of new directions, today's analysts, impelled in part by pressure from the new therapies, are expanding Freudian doctrine. Since 1966, an interdisciplinary group, led by Psychoanalyst Erikson, has been prospecting ways in which analytical theory can be applied to the study of political figures. At Yale, analytically oriented Psychiatrist Albert Rothenberg uses Freudian insights to illuminate that elusive human quality called creativity. There is even a school of applied analysis that seems to measure theater, music, literature and the arts with the same gauges by which Freud measured the performers.

Quantum Leap. Indeed, scarcely any serious critic denied Freud's enormous contribution to psychiatric theory and treatment. His was a quantum leap into the mind that, however much it may have failed of being an exact science, has informed man's understanding of man for 70 years. Still, psychoanalysis was never the panacea for all mental ills. Although Freud never claimed that it was, the new therapies insistently underline the point. Freud had much to teach psychiatry; today his successors have much to learn.

Among other things, they are learning the value of a group approach to what is emphatically a group problem. "Only small numbers of the emotionally ill can be reached by any one method," says Manhattan Psychotherapist S. (for Samuel) R. Slavson, who is not an analyst but whose orientation is Freudian. Analysis is one such method, but it is only one. This is a lesson that, by chastening the defensive heirs of Freud who would admit no one else to their club, and by vastly expanding the quest for peace of mind, can only benefit psychiatry's ultimate consumer: the man who is out of harmony with himself and with life.

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