Does Psychoanalysis Have a Future? No

Abstract

The answer the question posed in this debate is both simple and complex. The simple answer is, Of course it does. In an era of quick-fix cures, biological reductionism, and alarming invasions of privacy by electronic data banks that store medical records, a consumer backlash has emerged. Psychoanalysts today are consulted by people who want make meaning out of their lives. They want a setting where their unique sense of personhood can be recognized, listened to, and validated. They want tell their own story at a pace that allows the complexity, conflict, and ambivalence of the human psyche unfold in their own time and in their own idiosyncratic way. Moreover, in the US, many patients pay for psychoanalysis out of their pockets avoid the compromises of confidentiality that accompany monitoring of treatment by third parties who work for insurance companies. In this regard, psychoanalysis can be considered the last bastion of true privacy (outside the confessional). One can say whatever conies mind without concerns about political correctness, adverse consequences one's relationships, or the shameful humiliation that often accompanies the revelation of one's most egregious transgressions. The power of empathie understanding when one anticipates judgmental condemnation cannot be overstated. What analysts know-and patients soon learn-is that the verbal narrative unfolding in the course of analysis is only part of the clinical picture. What the patient cannot remember and verbalize in the consulting room will be unconsciously enacted in the relationship with the analyst again and again, providing a source of data that will be of considerable value in the eventual understanding of the patient's problems. The how to of relatedness is encoded in procedural memory, and the patient unconsciously recreates the internal world of relationships in front of the analyst's eyes. Data about the patient's desires, hopes, fears, and conflicts that are outside of conscious awareness become manifest in the day in, day out repetitions of analytic work. Patients who come analysis seek a level of understanding that they know will not be available in briefer or more consciously directed treatments. These patients often bristle at the categorization of their struggles as a discrete diagnostic entity, and they may balk at a symptomtailored treatment that bypasses who they are as a person. The complex answer the question posed by this debate is something like the following, Yes, but the exact shape of that future is unclear. Applications of psychoanalysis are thriving. Psychoanalytic theory informs many departments in the academy, including literature, film, and studies of society and culture. Basic premises of psychoanalytic thought are receiving confirmation from neuroscience. The idea that much of mental life is unconscious has been well established by extensive research (1), and the fundamental psychoanalytic notion that people actively try forget unwanted past experiences has been confirmed by a recent functional magnetic resonance imaging study (2). To be sure, the field of psychoanalysis has made a series of historical errors. Among these were the concept of the schizophrenogenic mother in the case of schizophrenia and the refrigerator mother in the case of early infantile autism. These are egregious examples of the privileging of psychoanalytic developmental theory over empirical research. Indeed, many psychoanalysts have been guilty of arrogance and complacency that has led them a contemptuous attitude toward rigorous scientific investigation that can only be described as Don't bother me with the facts-I've already made up my mind. This historical smugness hampered the development of systematic psychoanalytic research. While there is no doubt that psychoanalysis is badly in need of scientific evidence demonstrating its effectiveness as a treatment, there are also significant incompatibilities between the methods of science and psychoanalysis. …