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| Board member and editor David Lichtenstein starts off our Open Forum with this question:
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Henry M. Seiden
Secretary
Are psychoanalysis and psychology different disciplines?
The discipline that is concerned with the formations of subjective identity, with its rigidities and its fragilities, its illusions and its functions, seems to be a discipline that is particularly susceptible to the vagaries of its own collective identity. This has been the story of psychoanalysis. We all know the history of excommunications, of debates on the one true way, of wrangles about membership played out, and still playing out, in our professional organizations as well as outside of them in the legal domain.
How should psychoanalysts view the history of their own confused identification? Can we analyze our self as a field, treating our confused self identity as a symptom, or is this an invalid category error, confusing the collective with the individual? In order to better frame this question, let me expand on what I mean by our confused identity.
Every professional discipline must either implicitly or explicitly address two questions about its identity:
Does the discipline have a distinct and separate domain?
What is the relation between its domain and that of the other professions?
From its birth, psychoanalysis has addressed both of these and although it seems to have done a little better with the first, neither are truly settled. It may seem clear that there are distinct psychoanalytic questions in both theory and clinical practice yet there has always been a tendency and it is still very active to fold our discourse into a generic clinical field, such that we become simply another treatment option, even an option that can be mixed into an eclectic model.
The second question follows from the first. If we don't constitute a distinct and separate discourse, then perhaps we are a sub-discipline of another: psychiatry, psychology, the tri-disciplines of mental health, etc. It remains an unsettled question. There are experienced and well-regarded psychoanalysts who argue strongly on each side of this issue, for and against the proposition that psychoanalysis should be regarded as a separate independent clinical discipline. Indeed the official position of our organization, Division 39, is that psychoanalysis is a subspecialty of the traditional mental health disciplines. Many of us question this view.
Why can't we resolve this dilemma? Like the enigmas encountered in treatment, is there a kernel of truth hidden within this impasse? And like those inhibitions, would speaking this truth expand our field of possibility? My hunch is that this is so: a question that repeats itself marks the place of an unrecognized truth. My hunch is that there is something about our independence that is threatening to our collective status and that the nature of this threat is related to the unrecognized truth. Furthermore, I think it is more than that as a fledgling profession, psychoanalysis has had a healthy fear of annihilation and hence tries to prop itself up by leaning against older and stronger fields.
I think the hidden truth that speaks through our confused identity is the fear of our own distinct and radical ideas. We recoil from declaring our separate identity and instead try to blend in so as to be less threatening to the collective resistance to our ideas themselves. Converting our identification from a noun to an adjective softens our position, not psychoanalysis but psychoanalytic. We are not other, we are the familiar therapist/psychologist/psychiatrist/social worker, just with a bit of a psychoanalytic interest. Nothing too challenging. Nothing to fear. However, the distinct and radical nature of psychoanalysis is robust. It will keep insisting on being heard as long as psychoanalysis is practiced. Just as will the efforts to tame that nature by bringing it under the roof of a more familiar dwelling.
David Lichtenstein
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David writes: "A question that repeats itself marks the place of an unrecognized truth." I love that formulation--and can't help thinking (ruefully) that I have such recurrent questions about every group I've ever been a member of. I won't bore everyone with the list, but I include not just psychoanalysis but also psychology!
It's harder and harder--as a psychoanalyst--to read mainstream clinical psychology journals these days with any sense of identification at all. The empirical "findings" there seem trivial or easily or better explained psychoanalytically. The theoretical formulations have no majesty or reach. They seem to depend on concepts that can be conveniently expressed in a couple of initials--giving them a scientific wash--but providing no advancement of understanding at all. My state license says "psychology" but I do feel myself more and more to be "other".
Henry Seiden
David's question reminds me that I am glad of being a psychologist who became a psychoanalyst. There are those who use our background in designing and evaluating research and even some knowledge of the senses and the nervous system to lean toward manualized therapy on the one hand or reliance on psychotropic chemicals on the other. I find our background valuable in evaluating the literature, both when that reinforces my understanding of psychoanalysis and when it helps me to appreciate psychoanalysis as against other bases for understanding human behavior.
I agree with David and Henry, however, that psychoanalysis is so distinct an approach to understanding human behavior that those of us who base our practices on it are a distinct group. I believe this even though many important concepts developed by Freud and evolved further since his time have trickled their way into common usage.
Johanna Krout Tabin
I find David's description of the discipline of psychoanalysis (and here I'm paraphrasing a little) as one that is concerned with the formation of subjective identities, their rigidities and their fragilities, their illusions and their functions to be extraordinarily apt. And it is this particular focus that distinguishes psychoanalysis from other mental health mental health practices. To the extent that we can and do encourage our patients to be one while being many, to quote Philip Bromberg, we liberate ourselves and our patients from narrow empirical findings, 'truths' that restrict rather than open up subjective possibilities.
Although I agree with Johanna that having been trained as a psychologist has given me an advantage in evaluating mental health literature in general, being trained as a relational psychoanalyst has freed me from relying on narrow interpretations and the 'scientific wash', as Henry puts it, as the sole criterion for understanding human behavior.
Ghislaine Boulanger
The question "Are psychology and psychoanalysis different fields?' is much too broad. If psychology is the study of the mind then psychoanalysis is a psychology. As psychoanalysts we are interested in a mind containing affects, representations of self, a dynamic unconscious. For me the trickier issue is does one have to be a mental health professional to be a psychoanalyst? Is our aim to cure a patient's illness emanating from individual psychopathology or are we treating the vicissitudes of the human condtion within both ourselves and our patients? If we are doing the former, then I feel a responsibility to have mastered a body of knowledge about what constitutes the average and expectable and what constitutes the psychopathological; if we are doing the latter then a theory of mind is sufficient. I would prefer that an analyst treating a psychotic patient understand the disease more than existentially.
Jaine Darwin
Jaine goes to the heart of the matter in discussing psychopathology. I agree that psychoanalysis is a clinical discipline dealing with psychopathology; however, it does not seem to me that in this regard it shares much with the views currently taken by the 'tri-disciplines'. The biological model that dominates psychiatry, the assortment of behavioral, biological, or social learning theories that dominate clinical psychology, and to a large extent clinical social work, are based upon fundamentally different principles than those of psychoanalysis. I couldn't agree more with the view that a well trained psychoanalyst should be knowledgeable about the field of psychopathology including psychosis as Jaine asserts and obviously there is no harm in the psychoanalyst knowing about these other paradigms; however, the distinctly psychoanalytic approaches to psychopathology (and certainly there are a number of competing approaches around within our field itself) will not generally be well represented by schools in any of the tri-disciplines. A psychoanalyst should be well grounded in psychoanalytic thinking about psychopathology which is itself a complex field based upon fundamentally different ideas than the dominant views in clinical mental health.
I think that, as a practical matter, it might behoove us to make the choice that is most likely to increase our chances of survival, given how tenuous our survival has started to seem in recent years. If we view the choice from the perspective of survival, I think we will see it somewhat differently. Thinking in terms of survival, the danger in defining psychoanalysis as a part of the tri-disciplines is that a change in fashion in these disciplines could eliminate psychoanalysis entirely. In connection with David Lichtenstein's remarks, let us recall the fate of medical psychoanalysis. It is widely held that the American Psychoanalytic Association would be on the verge of extinction if not for having been forced to train candidates from nonmedical disciplines. If, in other words, the American had continued to define psychoanalysis purely as a subdiscipline of psychiatry, the biological trend in psychiatry might well have swept the entire organization into the dustbin of history. The same risk is run by defining psychoanalysis as a subdiscipline of the other mental health professions. If the survival of psychoanalysis is dependent on its popularity in social work, psychology, and psychiatry, we are on shaky ground indeed. If, on the other hand, we are able to reposition psychoanalysis as a discipline relatively independent of these fields, we will be in a much better position to weather the shifting winds of fashion of the other mental health professions. If we cannot do that, the competence of psychoanalytic clinicians will be irrelevant, because none will exist.
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