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The Culture of British Psychoanalysis
Robert M. Young
THE CULTURE OF BRITISH PSYCHOANALYSIS
I want to begin by saying something about the kind of essay this is intended to be. What I hope to do is to catalyse a kind of thinking, rather than to impart any particular body of information (although there is information) or reflections (although I also offer reflections). I am trying to suggest that it is appropriate to think about psychoanalysis in this country as a culture - or, more precisely, as a subculture - and its aspects as cultural phenomena. This offers a broader framework - a space to reflect, as distinct from our habitual comings and goings as practitioners or teachers or intellectuals. I think psychoanalysis would benefit considerably from such a space to reflect on itself. If you are seeking weighty conclusions, you will be disappointed. My aim is to ponder a subculture and to encourage a mode of discourse.
I think - although I'm subject to correction - that this is the first time anyone has tried to encompass the culture of British psychoanalysis, which I use as a broad term including psychotherapy and related psychodynamic perspectives in other professions, including psychiatry, academic work, group relations and counselling (although I do not discuss counselling herein). I say this at the outset, because what I have to offer is an accumulation of things I have acquired from the peculiar position I am in as a teacher, editor, therapist and intellectual. Things tend to come my way, because I am not embedded in any particular psychoanalytic organisation or institution in this highly sectarian subculture, although I am involved in many and in touch with many more. It occurred to me when I was asked to give the talk on which this essay is based, that my position might have some benefits resulting from my unusual perspective, just as I assure you it has some practical, personal and financial liabilities.
A lot of what I have to offer is gossip, but that does not worry me. I read an essay on gossip by John Forrester in his book, The Seductions of Psychoanalysis (1990), in which he says that gossip is the cultural unconscious of psychoanalysis, as it is of any subculture. The trick is to distil gossip in such a way that it isn't merely malicious. I know quite a lot of people who claim not to want to purvey gossip, but it has been my experience that this assertion of moral purity is usually immediately followed by a piece of particularly scurrilous gossip. My own position is that malice is not always misplaced, though one must be vigilant about the depletions which ensue from projective processes. I won't promise to avoid all hint of malice here; indeed, I intend to settle a couple of scores.
In defence of gossip, I offer three thoughts. The first is that it often serves truth at the expense of objectivity. Someone recently accused me of not giving an objective account of a dispute in which we were engaged. I laughed, because I have spent nearly thirty years in an academic discipline - the history, philosophy and social studies of science - which has scrutinised the concept of objectivity and found it a frail vessel for truth, which is usually reached by other paths (Young, 1977, 1977a, 1993b). Second, I think you will recognise the situation where you have read all the official documents and printed sources and meet someone involved with the institution or person involved. and ask with delicious anticipation, 'What is she/he/the place really like?' What you expect in reply is gossipy anecdotes which will illuminate what you want to know as no other source can. Although we all chuckle and feel morally ambiguous about gossip, we use it, rely on it and deeply trust it. Even so, it requires balance, just because it contains unconscious truths at the expense of mere objectivity. What I say below is drawn from my own experience or has been checked with those involved. (A commentator on an early draft quipped that what I do here is not, in any case, really gossip, since I have, on the whole, eschewed naming names.) My third point is that whatever people profess to feel about it, the experts say that 'gossip about relationships accounts for an overwhelming proportion of human conversations' (Dunbar, 1992, p. 29). Indeed, it is thought to be the basic cohesive force in social bonding and to account for the evolution of language and our disproportionately large brains (ibid.).
It will soon become apparent that I draw quite a lot on my own personal experiences. This is inevitable, given the sorts of issues I am exploring. A very good and eminent psychoanalyst friend who has gone to some trouble to help me with revisions, and who feels strongly that this essay should be published, has urged me to say clearly that although personal hurt is certainly involved in some of my examples, a more important motive for my giving them is to say that institutions should not treat their friends badly. If they do, bad consequences will certainly ensue sooner or later. Another well-meaning friend has said that one should not stoop to telling about people's paltry behaviour, lest the telling of it demean oneself. I feel the force of that objection, but I feel more strongly the need to bear witness to standards of decency and civility in the face of the behaviour of people who publicly profess to maintain standards while privately and sneakily behaving meanly. Yet another - who has been in the thick of controversy in the profession in recent years and has, in my opinion, behaved consistently well - has said that what is written here is very painful but nevertheless needs to be published.
In the course of my reflections I want to mention certain notions, for example, a concept of culture. I also want to promote the sociology of knowledge - the idea that knowledge, including clinical knowledge, has a sociology and that there are locations on the map of any account of intellectual discourse or practice, locations which are embedded in values and the interests of particular groups (Mannheim, 1929-31; Berger and Luckman, 1967). I also argue that there are all kinds of ways of representing reality. Different people, viewing the terrain from different perspectives, will draw the map differently. Moreover, ideas, including scientific ideas, have histories, and these exist inside the histories of cultures. It is useful and sometimes essential to be able to locate yourself on a map - to know where you are relative to other positions, values and interest groups, e.g., when you have fallen among thieves or philistines or people who take for granted values which you do not share but assert them as common sense or 'realism'. For example, I have recently been in dispute with people whose clinical skills are admirable but whose notions of democracy were acquired in the culture of white South Africa, from which they emigrated without (as far as I can discover) significantly engaging in anti-Apartheid struggles either there or here. This says something about how they are likely to react in situations where power can be tiered and where issues of representation, appeals, natural justice and truth-telling are being disputed. Such people are very likely to draw a firm line between clinical matters and social or political ones, with which they 'do not want to get involved', yet they will also tend to think that their clinical authority legitimately carries over into matters where it is appropriate that colleagues and students be treated as peers.
As I said, people will draw the map of reality differently and emphasise different features. There are all kinds of distinct, overlapping and mutually interacting networks involved in giving an account of anything. It is a serious matter that relativities in the histories and sociologies of institutional, clinical and scientific matters also apply to psychoanalysis. In my experience, the more people believe themselves to be in possession of the truth, the more likely they are do things in the name of that truth which they would not otherwise find morally defensible. Freud is eloquent about this in Group Psychology and the Analysis of the Ego (Freud, 1921), but he was not assiduous in applying it to psychoanalysis itself, except perhaps with respect to lay analysis (Freud, 1926). As Phyllis Grosskurth has recently shown in her account of Freud's inner circle, The Secret Ring (1991), the pioneers of psychoanalysis fell easily into the habit of pathologising those with whom they disagreed. Accounts of similarly distressing sectarian wrangles, in which deep theoretical issues were entangled with multilayered interpersonal, institutional and international issues, have been provided by Grosskurth (1985) and King and Steiner (1991) with respect to the Freud-Klein controversy in Britain, by Russell Jacoby (1983) with respect to the treatment of Otto Fenichel and the political Freudians in Europe and America, by Sherry Turkle (1992) and Elisabeth Roudinesco (1990) with respect to the work and influence of Jacques Lacan in France and (with mutually disputed reliability) by Janet Malcolm (1984) and Jeffrey Masson (1990) with respect to the higher echelons of those entrusted with the care of and access to Freud's memorabilia. (Masson's account of his own training - even if only a fraction is true - raises huge questions about boundary-maintenance on the part of at least one Canadian training analyst.) Each of these accounts brings to my mind parallels with the Catholic Inquisition, the Stalinist Moscow purge trials and the doctrinal disputes among the Mormons in America. In all such matters, certainty and the rationalisation of murderous impulses seem to go hand in hand.
Returning now to my title, I suppose the words 'The' and 'of' are relatively unequivocal, while 'British', though controversial, is really not my focus, and the terms 'Culture' and 'Psychoanalysis' are minefields. Let's look first at 'culture'. In a recent encyclopaedia of social science there is a useful article, from which I want to offer some extracts: 'Culture is the way of life of a people. It consists of conventional patterns of thought and behaviour, including values, beliefs, rules of conduct, political organization, economic activity, and the like, which are passed on from one generation to the next by learning and not by biological inheritance. The concept of culture is an idea of signal importance, for it provides a set of principles for explaining and understanding human behaviour. It is one of the distinguishing elements of modern social thought, and may be one of the most important achievements of modern social science, and in particular of anthropology' (Hatch, 1985, p. 178). An important features of the concept of culture is that 'The patterns which both guide and define thought are learned'. 'A large component of culture is below the level of conscious awareness; and that 'Cultural patterns structure both thought and perception' (ibid.). 'With the development of the modern culture concept the intellect itself came to be viewed differently: instead of being the guiding principle behind culture, it was now seen to be largely constituted by culture' (p. 179). I think this is an important insight for thinking about ourselves when we believe we are taking up intellectual positions as acts of autonomous choice. We know that in personal matters the roles of social forces, passive learning and the unconscious are usually determinant. But we are less inclined to grant this in group and institutional, much less putatively intellectual, ones.
There is, of course and notoriously, no such thing as the culture of psychoanalysis. There are a number of more or less interacting subcultures, of which many are more like ghettos and at least one is rather like Kafka's The Castle (1926), in the sense that it is very hard to get there, hard to find out what is going on and very easy to be in a paranoid relationship with it, infantilised by it or both (see Rustin, 1991). This mode of thinking is not one-way. I can think of innumerable examples, but one will suffice. Because of the number of books I have published or initiated or both, I was once fêted at a meeting held to celebrate the publication of a member's book as having been 'a good friend to the Independent Group' of the Institute of Psycho-Analysis. Some weeks later, a business school student who was doing a dissertation about psychoanalytic publishing wrote to the Institute and asked for a list of publishers of psychoanalytic books. He got back a list of eight publishers on which the firm which I founded, Free Association Books, did not appear, even though in the last decade we published more psychoanalytic books than all the firms on the list put together and a multiple of the number any other publisher has brought out which are by psychoanalysts. Weird.
Now I want to introduce a series of sub-concepts connected with culture. Cultures and subcultures include of institutions. They also include belief systems. One of the things modern cultural anthropology has pointed out is that when you say 'belief systems' you are not only talking about quaint, exotic tribal beliefs. Western medicine is equally amenable to being thought of in this way; so is psychoanalysis. Its truth claims can be suspended, while its social role is scrutinised and evaluated. The various versions of psychoanalysis share a belief in the unconscious and in the possibility of change produced by therapy. Beyond those general points I cannot think of many sentences which can be uttered which will not fall foul of some line or other which divides various sects. It becomes very complicated.
Cultures also consist of structured social relations both within and between institutions. They also have practices and boundaries within and between themselves. The breaching of those boundaries is a serious matter. There is also the problem of cultural transmission which occurs in some cases via writing, in some by speaking. It is especially true that in psychoanalysis transmission occurs by means of apprenticeship, i.e., supervision, which is the main vehicle after the experience of therapy itself. Therapists and supervisors act powerfully as role models, as well as transmitters of ideas and practices. Finally, cultures have lore, which brings up back to gossip.
People often seek my advice about where to train or what therapist to approach. Until very recently you could not find a convenient and comprehensive list of places to train in psychoanalysis and psychoanalytic psychotherapy. Those which were available missed out several institutions and, of course, gave no clue to that paradise of gossips' fantasies: 'what it's really like'. There was one list, compiled by the United Kingdom Standing Conference for Psychotherapy (UKSCP). It was grandly called 'the Yellow Pages', and I stopped counting the number of people who slipped me a photocopy of it with the utterly unfathomable injunction that it was 'strictly confidential' (It can now be purchased from the UKCP - which has settled down and taken a seat; it's no longer 'Standing'). Thanks to the imagination and industry of Jan Abram, we now have Individual Psychotherapy: A Guide to Trainings (Abram, 1992), which lists and describes fifteen psychoanalytic psychotherapy trainings, along with eleven humanistic ones, and includes evaluations by students of each and the author's own comments.
This valuable volume goes some way toward providing what people want to know, but you would not believe what a diplomatic labyrinth the writing of it proved to be. One institution, upon reading what its students said about who was in charge of its training programme, took grave umbrage and said that person had nothing to do with it. Where did the students get the idea, then? The students (under what prompting?) then asked to be allowed to re-write their comments, which were duly accepted, along with a request that the final proofs be made available, as if the author might maliciously change it all back. This request was politely and reassuringly refused. In fact, the prominent person had been the subject of scandal a few years earlier, and I dare say he was once again visibly involved in the training when the students were interviewed, even though he held no official position. Another organisation, which went into potentially terminal turmoil while the book was being produced, insisted that not a single word or punctuation mark could be changed (even for copy-editing purposes) from the agreed, highly-flattering text. This was also politely refused, and nothing more was heard.
I offer these bits of gossip to give a hint of how touchy psychoanalytic institutions can be when they feel themselves scrutinised and compared to others. One reason for this is the histories which generated those institutions. Jonathan Peddar has drawn up an interesting chart of the genealogies of certain institutions, from which it is obvious that some evolved out of others. The reasons these evolutions occurred are various, but some of them occurred for reasons, of which it can be said, 'thereby hangs a tale', in several cases a tale of doctrinal differences, in others of disagreements over access on the part of patients who could not pay high fees, in some cases a factor was a story of sexual irregularities on the part of the staff which were intolerable to others. Indeed, a single individual was involved in several of the splits, and in each case there were several issues involved in the decision to found a new organisation. The chart is reminiscent of one I once saw tracing the history of splits in Trotskyist revolutionary organisations. I offer this parallel to emphasise how political psychoanalytic sectarianism is, and I would add from lots of personal experience that splits in political groups are at the same time intensely emotional and about personalities, no matter how principled the rhetoric of the splitting sectarians.
It is important to take a broad view of the institutions which make up the culture of psychoanalysis. It is too easy to think that members of that culture include only the Institute of Psycho-analysis and the training organisations listed in Abram's book. There are also a number of closely related institutions, for example, MIND (the country's leading mental health charity), Nafsiyat (a treatment centre specialising in work with black patients), the Cassel Hospital (where whole families can be in-patients and in psychoanalytic therapy), the West London Psychotherapy Clinic, the Ealing Psychotherapy Clinic (both low-fee institutions where there is little National Health provision of psychotherapy), the Women's Therapy Centre, a new Asian centre, the British Association for Counselling (which produced the first publicly-available listing of counsellors and psychotherapists). Then there is the whole world of therapeutic communities, past and present: Villa 21, Kingsley Hall, Philadelphia Association houses, the Arbours Association, New Barnes School (recently closed, amid scandal), the Cotswold Community, Peper Harrow (recently closed).
There is a growing list of places for graduate studies in psychoanalysis: the University of London Psychoanalysis Unit, the Centre for Psychoanalytic Studies at the University of Kent and new programmes which have subsequently come on stream at Middlesex University, University of Essex, University of East London/Tavistock Clinic, Manchester Metropolitan University, Leeds Metropolitan University, University College London, Trinity College Dublin, University College Cork, Brunel University, University of Essex, University of Bristol, University of Sheffield (with over 140 students in six MA programmes) - about a dozen by autumn 1996. The development of university programmes has reached the point where it was thought worthwhile to create a Universities Association for Psychoanalytic Studies and a Universities Psychotherapy Association.
There are also sympathetic programmes and supervisors in many universities, notably Cambridge, where there is an active seminar programme in the university and also a very informal training in the town, which calls itself 'The Outfit', whose main teacher, Peter Lomas (who played an important role in starting various London trainings and then moved on), is wary of institutionalisation. In France this aversion to institutionalisation has been common among Lacanians since Lacan dissolved his school. An apprenticeship programme in Oxford is even less visible, because its main teacher, Donald Meltzer, is fed up with all institutions (Meltzer, 1986, ch. 17; 1992, p. 156).
There is also a growing list of periodicals: The most established are The International Journal of Psycho-Analysis and the International Review, which grew out of it and has recently been merged with it. When the British Journal of Psychotherapy was being established there was talk of joining forces with another new venture, Psychoanalytic Psychotherapy, which was being set up by people holding posts in the National Health Service. The founder of the British Journal wanted to cast his net widely through the profession, something like Mother Jones in the US, which it calls itself 'the magazine for the rest of us'. Those involved with Psychoanalytic Psychotherapy wanted to draw a narrow circle. Instead of cleanly going their separate ways, the Health Service people started accusing the founder of the other journal of avarice, which - I can assure you in my capacity of journal founder and editor - is hilarious. Then there is Free Associations, whose subtitle embraces psychoanalysis, groups, culture and politics. A nascent journal, now on ther world wide web and soon to be in printt, as well, is Psychoanalytic Studies, a scholarly journal associated with the development of academic programmes in this field. Human Relations, Authority and Justice is an electronic journal concerned with social and political issues, in particular, the development of new democracies in Eastern Europe. It is founded on a London-Sofia collaboration. A recently discontinued journal is M/F, which celebrated an ambiguous identity embracing masculine/feminine and Marxism/ Freudianism. Feminist Review, Women: a Cultural Review, New Left Review, the Institute of Contemporary Arts, the French Institute, the Goethe Institute - all focus on psychoanalysis in varying degrees and from time to time. In addition to these public forums, there are house journals of a number of institutions, for example, Winnicott Studies, Journal of the Arbours Association, Lincoln Newsletter, London Centre for Psychotherapy Newsletter.
In the domain of book publishing, the pre-eminent imprint for many decades was the Hogarth Press. Then, after they had published about one hundred and twenty books, a Freudian sectarian (a so-called 'Contemporary Freudian') became editor of their International Library of Psychoanalysis, which was published jointly with the Institute of Psycho-Analysis. After a time it was noticed that not a single living British writer had been published by them for many years. I don't know the ins and outs of this, but it was apparent that you had to be dead or foreign to get published by the official imprint of British psychoanalysis. In this same period, the review editor of the International Journal, a member of the (nominally) tolerant Independent Group, never allowed a review to appear about the writings of another member of the British Institute of Psycho-Analysis, whom he apparently saw as an arch sectarian enemy, a Kleinian.
Into this situation came an energetic and enterprising young analyst who proposed the establishment of a New International Library, ostensibly to bring out books of a different kind and level. But after much wrangling - which so offended the Hogarth Press that it led them to discontinue the International Library - when Routledge brought out the new list, it was remarkably like the old one and included authors whose books had been stuck in the pipeline of the old library. The remnant and right to reprint Hogarth's books passed to Karnac Books, whose Maresfield Library had for some time been bringing out paperback reprints of Hogarth books. Karnac have since become Britain's most prolific publisher of orthodox psychoanalytic writings, while I think it's fair to claim that Free Association Books (FAB) has for some time been the pre-eminent publisher of more adventurous titles, and a new imprint, Process Press, is focussing on meritorious but less commercially promising titles. Rebus is a new iprintwith a Lacanian bias, while a long-established publisher, Duckworth, will be publishing books by authors at the Tavistock Clinic and perhaps oother psychoanalytic writers.
When a collection by Institute authors was brought to Free Association Books, someone closely involved with the plans for the New International Library withdrew his paper from the volume and wrote to the editor that FAB was a direct and serious threat to the plans of the Publications Committee of the Institute, and that person would do nothing to help them. I am reliably told that the editor of the volume stood before the other person's house and vainly called him out to fight.
On another occasion an author wanted to have a party at the Institute to launch his distinguished book, which was being brought out by a publisher other than the Institute's. Discreet enquiries were made, and it was agreed all the way up the hierarchy, including the president, who I'm told said that surely the public rooms of the Institute were there to celebrate the achievements of its members. When the formal approach was made, however, the letter fell onto the wrong desk, and members of the Institute's Publications Committee were able to block permission for the event and sent a discourteous and insolent letter to the publishers, who had believed themselves to be implementing an already-agreed plan. When the author persisted and managed to get his next book launched at the Institute, the President duly appeared but managed to make a speech at toast-making time without mentioning either the author or the book... So much for psychoanalytic civility. Imagine any other academic or professional institution which published books with a particular firm. Is it conceivable that a member who published with another firm would not be allowed to hold a launch party on its premises? I think it very unlikely that such pettiness would be sanctioned.
I turn now to a broader sense of the culture of British psychoanalysis - matters which do not fall within the foibles of individuals embedded in institutions with a haughty relationship with the rest of the subculture. It is part of my serious purpose to convey in the interstices of my stories that those foibles are not qualitatively different from those of other human beings in other institutions, although you might hope - and even expect - that they would be, since people of our world are supposed to have a high degree of self-knowledge and containment. The first thing is that it is highly Balkanised with all of the opportunities for splitting and projective identification that our daily news media distressingly show to follow from Balkanisation. That's another way of saying that it's nasty. I recall advising a woman who wanted help fund-raising to ring up another woman in another training organisation who had been very successful at it. She replied, 'I'm not sure why, but I think we're not supposed to approve of them'. So she had to forego the advice, which I am sure would have been freely given.
It is also very class, race, and London specific and expensive - which is not unrelated to the other three characteristics. It is on the whole anti-intellectual or theoreticist. Between those two approaches lies genuine intellectuality. Most of the trainings are un-academic. As I'll stress below, there would be advantages in greater contact between training organisations and academic institutions, and this is beginning to happen. This has occurred to a number of organisations where accreditation is concerned, but other benefits may follow. There are conventions of civility and collegiality which, for all the nastiness of academic life, are practically absent in the psychoanalytic subculture, and I think we could learn a lot from those norms (Young, 1993a). I have an academic colleague who sought to work with certain papers at the Institute of Psycho-Analysis, only to be told that they were not available, since a certain member might want to work on them. He was not doing so, mind you, but he might. I am a person with much experience of academic life, and for all its faults its level of civility is far above ours in psychoanalysis.
Next, it is very blinkered with respect to other disciplines and the broader context of political, cultural and public policy matters. You may say that there is a rich cultural programme, but I think it is a cultural ornament, reminiscent of the way physicians indulge in history of medicine. When those physicians are faced with the scholarship in the history of medicine which challenges their positivism, they don't like it. I think members of the psychoanalytic subculture are similarly defensive. I am reminded of the role of high culture in Dallas, where I grew up. Practically all the people in the wealthy neighbourhoods attended such events for the wrong reasons and kept it's challenges and implications split off from their professional and private spheres. My impression is that most psychotherapists and psychoanalysts do not want to become involved with the hard edges of culture and politics, because they are keeping their heads down and don't want to do anything which might endanger their referrals or lead them to be considered politically controversial.
I got a letter from someone who has been very generous to Free Association Books which said that she no longer attended the annual 'Psychoanalysis and the Public Sphere' conferences because when she went to one she felt criticised and bullied into thinking about political things from a left perspective. She advised me that if I wanted to get the ears and the support of psychoanalysts I should not upset them, which she implied I was doing by mounting activities which raised the category of the political, never mind what the result of a particular political debate might be. Another person with a similar background described the centre of gravity of that grouping as 'Bloomsbury', which I took to mean just left of centre but unwilling to tolerate radical challenges to their way of life, which largely depends on private practice with affluent patients. A thoughtful American analyst once said that the problem about the radical potential of psychoanalysis is the social location of its practitioners. I think I'm right in saying that the only political issues which have been taken up with enthusiasm by psychoanalysts and psychotherapists are nuclear weapons and the Gulf War. How much agitation is there for psychotherapy on the National Health Service or for a greater black presence among trainees?
I have always found it disturbing that the pecking order of prestige among psychoanalytic and psychotherapeutic organisations in the private sector is, broadly speaking, inversely related to the extent to which their members provide therapy for the less well-off. That is, it is the less highly-regarded institutions which tend to offer low-fee treatment to the broader community. I know that all trainings have low-fee schemes for training cases. My point is about the norm, which is that high prestige tends to go with high fees and low with low. Certain institutions were set up with this matter as important to their reason for being. For example, the West London Psychotherapy Clinic takes referrals primarily from the NHS, as well as GPs and self-referral, and operates a sliding scale. The London Centre for Psychotherapy (LCP), The Association for Group and Individual Psychotherapy (AGIP) and the Institute for Psychotherapy and Social Studies (IPPS) came into existence with the goal of providing greater access to people who were not well-off financially. It is my impression that they see a higher percentage of low-fee patients than some other organisations.
I want to turn next to the United Kingdom Council (formerly the United Kingdom Standing Conference, then the UK Conference) for Psychotherapy, which I take to be the arena where the structured social relations of the profession are considered, debated and maintained. A report was generated in 1971 as a result of fears about brainwashing, fleecing and coercion on the part of L. Ron Hubbard's Scientology. It is less well known that his form of psychotherapy - Dianetics - has many affinities with psychoanalysis and has demonstrably helped a lot of people who wouldn't go near orthodox psychotherapy. It is not easy, in my opinion, to legislate against charlatans, because we are here dealing with matters of the heart and the subjective world. It took a decade for the conference to get going, followed by another one - highly-frustrating and fraught - for it to bear fruit in the form of the register which has, at last, been promolgated (Pokorny, 1984, 1985, 1991).
I am bound to say that I have mixed feelings about the Council. Part of me hears echoes from my childhood of Ceasar Augustus's decree that all the world should be taxed, with the ensuing census which meant that the returnees booked up the inns in Bethlehem. That is, I respond with a frisson against authority and associate it with threats to issue identity cards to the populace. On the other hand, who can be against standards, and who but the most dedicated right-wing libertarian (of the kind who would oppose pure food acts and sewerage plants) is opposed to setting and enforcing standards for practitioners who work with our intimate lives, whether psychically or somatically? The answer is that I know some serious humanistic psychotherapists associated with the Institute for the Development of Human Potential (at one time associated with the University of Guildford), who believe that such regulation is intrinsically reactionary and intolerant, part of the culture of professionalisation which squeezes the life out of alternative therapies in the process of making them respectable. I have some sympathy for that point of view, but I come down, albeit uncomfortably so, on the side of trying to maintain life inside the institutional framework.
When I last looked into the matter, there were seventy-one organisations represented at the conference, with eight sections: Analytical Psychotherapy (that's us - thirty organisations); Humanistic and Integrative Psychotherapy (nineteen organisations); Analytical Psychology (Jungians); Family, Marital and Sexual Therapy; Hypnotherapy; Behavioural Psychotherapy; Psycho-Analytically-Based Therapy with Children; Experiential Constructivist Therapies (neurolinguistic programming; personal construct psychology). There is also a queue of 25 or so organisations which have applied, as well as organisations which have been deemed Special Members, Institutional Members and Friends of the Conference.
You could call this a rich culture and see it as a tribute to human tolerance and cooperativeness that they have continued to work together. I think it is those things, but it has also been hell and hilarious to hear all the shenanigans about who is and is not willing to get into bed with whom. Snobbery, denigration, and slavering sycophancy have co-existed with patience, integrity and remarkable feats of containment. A number of people with extreme good will have stood their ground, while others - whom I perceive as cynical elitists - have sought to wreck and sink the organisation or to subordinate it to the hegemony of the Institute of Psycho-Analysis and other organisations which have already kow-towed to it.
Heroic efforts were made to keep all organisations inside the conference, but a small number eventually withdrew and formed a new organization, The British Confederation of Psychotherapists (BCP). It was particularly ironic that among the objections made by the elitists was that certain procedures in the UKCP were excessively democratic, with full voting rights in the hands of organisations which they thought did not merit them. When it came to withdrawing, the members of one organisation were not consulted, a row ensued, and they had to mark time and postpone withdrawal until a properly-constituted meeting could occur. That is, their representatives ran rough-shod over the constitution of their own institution. The same folks, wearing different hats, withdrew another training organisation without consulting its members at all. In this case there was no constitutional way of stopping them. This same organisation, by the way, is in various sorts of turmoil because of other undemocratic structures and actions.
I have been told on good authority that of the ten groups who set up the BCP, five had to get the permission of their members and failed to get a majority of their members. Five who left the UKCP did not have to get permission. Wrangles continue. In the British Journal of Psychotherapy, the BCP claimed that those of its member organisations who remained in the UKCP wish the BCP - and not (italicised) the UKCP - to speak for them. Unfortunately, one of the signatories had failed to consult her organisation, and this claim was repudiated by the council by all but the one vote of the offending representative - 15-1. There are similar claims and counter-claims with respect to European psychotherapy organisations and to formulating government standards for psychotherapy and counselling, the so-called Lead Body. In all these spheres my perception is that the BCP is making ersatz claims to be representative of the profession when, in fact, they represent a tiny portion of it.
At an earlier stage it was being argued that no one should be a psychotherapist who was not a member of a 'core profession': doctor, nurse, psychologist, social worker (see Peddar, 1989). This move lost out, thank goodness. Some of the best therapists come from the arts or from tough experiences in life, and some of the best trainings reserve the right to admit people with training or experience deemed to be equivalent to a degree. This has been true of psychoanalysis from the beginning, as we know from some of the people from Britain who went to work with Freud, e.g., Alix Strachey, and others who stayed in Britain, partly because America (then, not now) only allowed you to be a psychoanalyst if you were a doctor, e.g., Anna Freud and Melanie Klein. In 'The Question of Lay Analysis' (1926) Freud supported the non-medical analyst, Theodore Reik, when the Americans sought to debar him, and it could be said that Otto Fenichel died of his efforts to become a qualified doctor in America (Jacoby, 1983, pp. 130-33). If that rule was in force in Britain today, the following people could not be therapists or analysts: Marion Milner, Alan Tyson, Adam Phillips, Christopher Bollas, Margot Waddell, Karl Figlio, me.
There are in the world at last census 8197 psychoanalysts, members of thirty-five component societies, with some countries having a number of institutes, two in France, four in Argentina, six in Brazil, thirty-six in the US. The British Psycho-Analytical Society has four hundred members, about three hundred active in the UK, where lay analysis has always been accepted, while 4000 analysts are American and doctors. This hegemony was recently broken by a successful court case on behalf of lay analysts who were professional psychologists (so the broadening of the US membership did not extend beyond the core professions). The lawsuit was mounted because the medical analysts were alleged to be 'in restraint of trade', and they settled out of court and agreed to admit non-medical candidates rather than face the likelihood of an adverse verdict. I should perhaps add that all these statistics are about the International Psychoanalytical Association. There are actually more Lacanians world-wide than IPA members and a multiple more who are psychoanalytical psychotherapists (about ten times more in the UK, for example).
In the wake of this decision a conference was held in Britain on the relations between 'Psychoanalysis and Psychoanalytic Psychotherapy' (see British Journal of Psychotherapy., vol 5, no. 2, 1988, pp. 172-203) I want to relate some illuminating anecdotes about this event. When it occurred I asked one of the organisers, a friend, to get me a press ticket, since I intended to write and publish an account of it. He said he would but rang me back in some embarrassment, saying that to obtain the ticket I'd have to ring the other organiser. I said to forget it, only to be asked to make the phonecall as a favour. I did and was treated to a remarkable conversation. I was first told that I would know why I was asked to ring. I said I didn't and was told that anything I wrote would have to be vetted by him before publication. I pointed out that this is not a country in which censorship operates, that I could buy a ticket and that this was an extraordinary way to speak. The reply was that he had reason to suppose that I was hostile to the Institute of Psycho-Analysis. I said that was odd, given that I was in analysis with a training analyst, was supervised by members and had published innumerable books and articles by members - all of that selfsame institution. I added that I had criticisms of the Institute, as I did of most institutions, but that this was a long way from hostility. I'll spare you the rest, since my point is that he apologised the next day and put his behaviour in the context of his anxiety over the threat from psychotherapists which the court decision had engendered. He even said that 'a back door' would have to be found to admit suitable psychotherapists into the International Psycho-Analytical Association. (I sometimes think I know wherew it is being constructed.) Note the rhetoric, whether it implied the servant's entrance or something more claustrum-like about the back passage (see Meltzer, 1992).
At the conference it emerged that many people had been asked to give the paper which the planners wanted from a psychotherapist, and over twenty had declined, believing themselves to be in an awkward position, since most had applied to the Institute to train as psychoanalysts and their applications had been unsuccessful. The person who finally accepted gave what many thought was the best paper at the conference, in which she contrasted 'the dominant culture' in the analytic world with the work and the atmosphere of at the Tavistock Clinic (Waddell, 1988, esp. pp. 194-5). The author of that paper subsequently became a trainee at the Institute and has qualified as a psychoanalyst.
Throughout the conference there was a recurring imagery in which psychoanalysis was referred to as 'pure', 'pure gold', and so on (echoing Freud) and psychotherapy as 'alloy', 'debased', 'copper'. In the course of the conference someone spoke of his fear that unless they found a way of opening the back door, the shit would come up through the drains. At another point an analyst asserted matter-of-factly that the relationship between psychoanalysis and psychotherapy will always be hierarchical, with theory, therapy and teaching flowing from the analysts on high to the psychotherapists below. I felt that that atmosphere (see comments by participants, ibid., pp. 200-203) and some of the things said at that conference revealed many of the problems in the culture of British psychoanalysis. There was lots of paranoia around.
A more recent event was staged by THERIP (The Higher Education Network for Research and Information in Psychoanalysis, about which more anon), where different people put forward positions with respect to the UK Standing Conference for Psychotherapy, as it then was (Some of these are reprinted in Free Associations no. 29, vol.4, part 1, 1993, introduced by Young, 1993). One important fact about the meeting is that it was the first public venue for discussing the issues raised by the UK Conference. I thought the positions were put very well, and when I complimented the person who was seen by the other speakers to represent the elitist point of view, I was severely criticised. They were adamant that he was dishonest and worse - a lapdog or go-fer for the analyst who, they were convinced, had set out to wreck the conference by insisting that the psychoanalysts should have an effective veto on conference decisions. I got my comeuppance. Having defended him and then having decided to publish the papers, I wrote a brief introductory note, which I sent to him for comment. He said he 'would not rise' to my 'provocation' and said he hoped I would one day do 'something constructive' with respect to these matters. I thought I had, including setting up the debate, complimenting his contribution and publishing his and the others' remarks, accompanied by what was intended as an informative introduction.
On the surface the disagreements within the conference were about two major issues. The first was that organisations were members of the conference which were not engaged in training or were thought to have low standards but nevertheless had full voting rights. Certain training institutions were not prepared to have this. The second was that some wanted to insist that trainees be in therapy at least three times per week and see their training cases that often. This was usually linked to the rule (there are a few exceptions) in certain particularly 'well-regarded' trainings that training therapists and supervisors be psychoanalysts. The consequence of this is that in certain institutions of 'high repute', very few of their own graduates are likely in the forseeable future to be allowed to be supervisors or training therapists. Other institutions took the line that the competence of training therapists should be considered case by case and that the number of sessions per week for trainees and training cases should be less than three or should not be specified. One argument is that most therapy is once or twice per week and that this work should be taught as a discipline in its own right and not seen as a debasement of the 'real/pure' thing, i.e., five times a week analysis. The sharpest divide was that some thought you should not be qualified as an analytic or psychoanalytic psychotherapist unless you met the 'three times per week rule', while others were opposed to this criterion. As far as I can see, this is a legitimate disagreement, but I keep feeling that it is a stalking horse for the question of the hegemony of the Institute of Psycho-Analysis. Indeed, at a crucial point an analyst argued that there should be a 'security council' model, whereby the Institute would have an effective last say (in effect, a veto) about decisions made by the other members of the Conference. Not to grant this, he said (neatly shooting himself in the foot), would be like 'allowing the students to set their own exams'.
This view of the Institute representatives behaving haughtily has been borne out by events, since that organisation and one other 'highly-regarded' training institution whose training officers are all analysts and which requires three times per week analysis and training cases and insists that training therapists and supervisors be analysts, have, amid great acrimony, withdrawn from the UK Conference and, as I said above, have set up a competing body, the British Confederation of Psychotherapists. The Lincoln Centre is the only London psychotherapy training to withdraw and the only one to have refused to be vetted by the visitation scheme set up by their section. The split is not clear-cut, however. With the single exception of the Scottish Institute of Human Relations (which I'm told is likely to change its position and advocate belonging to both organizations), all other training institutions have remained members of the Conference, including an excellent training in an institution of which one of the main protagonists of the elitist split was chairman at the time of these controversies. That is to say, the Tavistock Clinic, whose Adult Department offers a four-year training in psychoanalytic psychotherapy, has elected to remain in the UKSCP, even though the then-chairman of the overall institution is widely regarded to have played a leading part in the campaign for training institutions to withdraw from the UK Conference. Something funny is going on. (I should add that three training institutions have membership in both bodies. Also - and bizarrely - the association of graduates of the Tavistock training has withdrawn, even though the training institution itself remains a member.) The situation is fluid, but I think it is clear that events are flowing the way of the UK Conference, which appears to me to be the way of open debate and democracy.
Some institutions have had extensive internal discussions about these issues (for example, the London Centre for Psychotherapy) and/or have had public meetings to discuss them (for example, the Guild of Psychotherapists). Others have seen their officers act without reference to their own membership, for example, the Lincoln Centre, where a move was afoot for some time to persuade the institution to re-join, and an open meeting of its members - belatedly - debated the issue. No decision was taken Then some members took it upon themselves to conduct a postal ballot, in which 70% of respondents advocated rejoining. Then the Professional Committee called yet another meeting, at which the vote was 27-20 in favour of rejoining, with 2 abstentions. Then (third go) it was decided that a mistake had been made in not including the students in the vote, and the whole ballot had to be taken all over again. The result was 38-32 in favour of rejoining. Even after all this, the Professional Committee is not bound by these votes, which are only advisory. On the other hand, why go to all this trouble if you are not going to feel bound by the vote? Lo and behold! It was announced at the next AGM that that in spite of three separate votes in favour of rejoining, conducted over several months and all carried by substantial majorities of those voting, the Professional Committee had decided not to apply to rejoin the UKCP. It was further announced that no discussion of this decision was to be allowed! Some people won't take 'yes' for an answer. In the face of this lack of respect for its own hard-won, and fledgling democratic atmosphere, it is hard to see how members of this institution can retain any self-respect if its nominally representative government remains so deaf to the thrice-expressed will of the people. Moreover, it is difficult to imagine people with any self-respect aplying to be trained in an institution which treats its own students and graduates with such studied and haughty contempt. I should add that there was later a fourth vote, which went the other way by a substantial majority and led the organization to decide definitively not to rejoin the UKCP. If at first you don't vote the way your betters want, vote, vote and vote again until you get it right! (These later events are discussed in my essay, 'The Psychodynamics of Pschoanalytic Organizations'.)
Looking at these developments more broadly, I have been astonished at the way analysts who have been involved in these debates have been, by turns, contemptuous, devious and secretive and have denied roles which it is clear to all they have played. One threatened me with legal action, saying that he found it personally offensive that I had said that he had played a leading role. I was shaken and made further enquiries and was told that he had begun an agenda item involving a vote to withdraw or not by saying that he would keep the committee there until they reached the right decision. He was outvoted; the institiution stayed in the UK Conference.
As I have said, in the instance of the Institute of Psycho-Analysis, withdrawal was announced and then had to be postponed, since it was pointed out by irate and eminent senior members that their representatives had acted unconstitutionally in not consulting the membership. This was particularly ironic, since the Institute's representatives were claiming to stand for the highest standards - of what? In the event, the membership voted overwhelmingly to withdraw, but it is alleged by people I trust that the vote was not a properly informed one and that it boiled down to a vote of confidence in the well-regarded President. I was also told by senior analysts whom I respect that it was felt by a responsible minority of public-spirited members to be a black day for the profession, and one whose fair-mindedness I particularly esteem said that withdrawal will be taken to be a declaration of war on the rest of the profession. There is no doubt in my mind that the split was a diplomatic disaster, fomented by power-seeking individuals and those who do their bidding and that it would have been better to remain in the UK Conference and argue for their point of view, no matter how long it took.
I feel that I am now deeply immersed in a morass. It feels like quicksand: the more one struggles, the deeper one sinks until overtaken by suffocation. In order to winch my story out of this mire, I want to sketch some of the elements which make psychoanalysis a broad church, not confined to the particular swamp in which my account has just bogged down.
Let me draw breath and start anew. Let's begin by having a look at the size and the coverage of the profession. In an article he was invited to contribute to Free Associations, Bob Hinshelwood has made a stab at this: '1) If we assume as a rough estimate across the country, the various training courses take in some 200 new trainees. 2) If, say, 10% of trainees drop out (my impression is that on the whole the drop-out rate is very low), then something like 180 new therapists are arriving in the profession each year. 3) If we assume that the average professional career of a psychotherapist is 25 years (many trainees start in midlife), then the total number of therapists will level off at 180 x 25. This is a total of 4,500. 4) Assuming that the average number of patients in treatment at any one time with a therapist is 10, then the total number of patients in treatment will reach 45,000 (this may be more if the number of group therapists becomes a significant proportion). 5) If we take the next assumption, that the patient will stay an average of 2 years in therapy, then 22,500 new patients would start treatment every year. 6) If the average age of patients when they leave therapy is mid-thirties, then their life expectancy will be about 35 years, so that the number of people within the population who will have sought and received psychotherapy will rise to 22,500 x 35, which totals 562,500.
'This figure represents about 1% of the British population. But since, say, 90% of therapists live and work in southeast England, it will amount to 4% in the southeast.
'These results estimate the amount of load that the present training in the private sector could eventually handle. It is not an estimate of the need, or of the numbers who would prove suitable. Based on attendances at General Practitioners' surgeries, the number of individuals who have neurotic problems may be some 10-15% of the population' (Hinshelwood, 1985, pp. 14-15).
I find these figures sobering. First, think of the passion generated about and within such a small professional group - a fraction of the number of doctors, lawyers, clergy or psychiatrists. Second, a tiny fraction of the need will be met if and when these figures are ever fulfilled. A good estimate of the present number of people qualified to practice psychotherapy is about 2500, although clinical psychologists, psychiatric and other social workers, psychiatrists, nurses and GPs - none of whom are trained in psychotherapy - carry the bulk of the load. These calculations lead me to have a sense of proportion.
Another dimension of the subculture is the diversity of points of view which are in play and which should be seen as potentially leavening of the institutional wrangles I have sketched. I will only list the tendencies: Contemporary Freudian, Kleinian, neo-Kleinian, Independent Group, consisting of people who may draw heavily on Freudian or Kleinian ideas but who wish to avoid being acolytes in an eponymous school of thought.
Then there are Jungians of several groups, including a particularly active Jung/Klein tendency. There are other groupings which have been highly influenced by the work of particular writers, most notably Jacques Lacan, who has inspired both academic work at Middlesex University (where there is an MA in Psychoanalytic Studies) and clinical work at The Centre for Freudian Analysis and Research (which has its own journal). There is an emerging group of post-Lacanians who are influenced by Jean Laplanche, a leading French analyst who worked with Lacan but has gone his own way (Laplanche, 1987, 1992).
Other inspiring writers have had important influences on individuals and groups. Foremost among these is Donald Winnicott, but there are individuals and groups indebted to W. D. Fairbairn, Robert Langs, Harold Searles, Heinz Kohut, Otto Kernberg, Margaret Mahler, Alice Miller, John Bowlby, R. D. Laing, Wilhelm Reich, Carl Rogers, Fritz Peirls, Paul Goodman. The last few names on that list take us further and further into dissidence from psychoanalysis and into such persuasions as client-centred therapy, existential analysis, transactional analysis, psychosynthesis, body work, neurolinguistic programming and various therapies which are considered esoteric from the point of view of psychoanalysis per se. Yet each can trace at least part of its ancestry back to figures who were at one time psychoanalytic.
I also want to mention the application of psychoanalytic and systemic ideas to the study of groups and institutions. The Institute of Group Analysis (IGA) has grown primarily under the influence of the work of S. H. Foulkes, a psychoanalyst who sought to bring a social perspective to analysis. The IGA has an active and imaginative programme of day schools, courses and conferences. The other main influence on the study of groups and institutions is W. R. Bion, the leading light of post-Kleinian psychoanalysis. Before turning primarily to individual analysis, Bion worked with soldiers during World War Two and then at the Tavistock Clinic, where he and others pioneered the study of group relations (Bion, 1961). Out of this grew the work of the Tavistock Institute of Human Relations, which became the leading centre for the study of the dynamics of groups. The group relations movement has as its central institution the annual fortnightly Leicester Conferences on 'Authority, Leadership and Organisation' as well as other weekend and week-long meetings. The primary task of these conferences is defined as 'to provide opportunities to study the exercise of authority in the context of interpersonal, inter-group and institutional relations within the Conference Institution' (Miller, 1990, p. 169). These are something of a Mecca for similar activities and institutions around the world, notably in Israel, Australia, France, Denmark, the United States and Bulgaria. For example, there was an international conference in Oxford in 1988, and an 'International Group Relations and Scientific Conference: Exploring Global Social Dynamics' under the auspices of the Australian Institute of Social Analysis in 1993. According to the brochure, the conference aim was 'to identify the global social dynamics of an unconscious nature that co-exist with conscious psychic, political and spiritual preoccupations and aspirations. Our working hypothesis is that those who have contributed to the work of the Bion/Tavistock tradition of group relations have a methodology for this form of exploration' (AISA, nd, p. 1). Closely related is the work of the Grubb Institute in London, which concentrates on consultancy work from the same point of view. Jon Stokes and David Armstrong have developed The Tavistock Centre Consultancy Service at the Tavistock Clinic. An outgrowth of these institutions (some of which have their own factions and splits) are the conferences on 'Social Dreaming', inspired by Gordon Lawrence (formerly Tavistock and Grubb) sponsored by Imago East-West (Lawrence, 1991). The School of Advanced Urban Studies at the University of Bristol had an active programme of group relations events and consultancy which focused primarily on public sector workers, and a former member of the staff there, Paul Hoggett, has migrated to the University of the West of England, where he is now a professor and is setting up a similar programme. My impression is that lots of link-ups between clinical and consultancy activities, on the one hand, and universities, on the other, are in the pipeline.
Conferences, seminars, lecture series and day schools on psychoanalytic issues are mounted in ever-increasing numbers by various training organisations, most notably the Institute of Psycho-Analysis, but other regular venues are the annual 'Psychoanalysis and the Public Sphere' conferences at the University of East London (trhe tenth annual event in 1996), as well as events at the Freud Museum and the Institute of Contemporary Arts in London and the Bridge Foundation in Bristol.
A broad definition of the culture of British Psychoanalysis should include the academic programmes at Kent, East London/Tavistock, Sheffield and elsewhere, mentioned above, as well as the ongoing programme of THERIP, the aforementioned Higher Education Network for Research and Information in Psychoanalysis, which publishes The Psychoanalysis Newsletter and an annual THERIP Register and mounts regular lecture series, for example, on psychoanalysis and theatre, on phantasy and 'Sanity and Insanity: Clinical, Conceptual, Historical' (1992-3), 'Dialogues between Klein and Lacan' (1994-5). The aim of this organisation is to act as the hub of a network which facilitates contact among people working in various academic settings, for example in psychoanalytic studies, film studies, literary studies, French studies, critical theory and other disciplines. The Squiggle Foundation mounts a regfular series of seminars and public lectures and publishes a journa, Winnicott Studies.
A feature of the broader psychoanalytic culture is its pluralism. There is a tendency, for example, for academic work to be Lacaniann and there is a Lacanian bias in THERIP, but interest in Winnicott, Klein and Bion is growing and there is no reigning orthodoxy. This sort of pluralism, and in some cases eclecticism, is common in other countries, for example, France, Italy, Latin America, Canada, where there are more than one institute recognised by the International Psycho-Analytic Association. In the United States and Brazil, there are veritable supermarkets of institutions and orientations. But in the United Kingdom, as in Switzerland, there is one recognised institute, whatever its internal tendencies. I think this is a pity.
If we want to understand the sociology and dynamics of the culture of British psychoanalysis, we need to devote attention to the biographical and social history of the various institutions which make it up. There are a small number of articles and books in this sphere. I am thinking, in particular, of essays by Nini Herman (1989), Jonathan Peddar (1989), Jean Scarlett (1991), R. D. Hinshelwood (1989) with respect to psychotherapy trainings, H. V. Dicks (1970), Peter Barham (1984), Isabel Menzies Lyth (1988), Eric Trist and Hugh Murray (1990), and Nikolas Rose (forthcoming) on the Tavistock and Ricardo Steiner (1985), Pearl King (King and Steiner, 1991), Bob Hinshelwood (1991), Malcolm Pines (1991) and Eric Rayner (1991) with respect to the Institute of Psycho-Analysis.
The writing of such histories is a a complex task, full of taboos and gossip. I recall when it was thought bad form to refer to the 'controversial discussions' at the Institute which occurred in the early 1940s, but a number of books and articles on the subject are now available. Some have deplored the personal details recounted in Grosskurth's biography of Melanie Klein (1985). There are no comparably revealing accounts in the psychotherapy world, where the personalities and relationships of two people played central roles. Both Ilse Seglow and Penny Balogh were involved in the founding of the Association of Psychotherapists in 1952, as well as in the beginnings of the London Centre for Psychotherapy (LCP). Penny Balogh went on to found the Association for Group and Individual Psychotherapy (AGIP) with Derek Dyne, while Ilse Seglow was also involved in the founding of the Institute of Group Analysis. Both of these people had complex lives and generated intense passions, both positive and negative. The story of Penny Balogh's relationships and how they interacted with institutional splits has not been publicly told. Nini Herman has provided an insightful account of the role of Ilse Seglow's charismatic and domineering personality and the sad tale of her last period, when those near her should have found a way of helping her to retire before harm was done to people and institutions. There have been similar problems about the timely handing over power from the founding spirit at the Grubb Institute, at the Institute for Psychotherapy and Social Studies and at the Tavistock Institure of Human Relations. I believe that a non-prurient way should be found to tell these intertwined personal and institutional histories. Among the founding members, Pat and Paul de Berker were also involved in the creation of the British Association of Psychotherapists, the LCP and AGIP. There are other names which turn up in the foundations of a variety of institutions: R. D. Laing, Peter Lomas, Haya Oakley, John Heaton, Malcolm Pines, Earl Hopper.
You may think my account has degenerated to lists. My purpose in the above section has been to lay out some groundwork for research and writing that needs to be done and to indicate the materials and some of the personalities involved. I now want to revert to a more abstract mode and return to the concept of culture and add two facets of the definition of culture. The first comes from one of the founders of cultural studies, Raymond Williams, whose book, Keywords (1976), is a rich mine of insight The other is from the social anthropologist Mary Douglas. Among the meanings of 'culture' whose histories Williams traces is one which should be familiar to psychoanalysts who find the concept of containment helpful. He refers to the verb 'to culture', which connotes nurturing, cultivation, husbanding, fostering growth, preserving. I do not think we draw enough on these senses of culture. Mary Douglas makes a point about how we evaluate things, and she stresses that the assignment of values occurs within a cultural framework, so that 'good' and 'bad' get associated with whether or not something conforms to a give social order. Her pithy way of putting this is that 'Dirt is matter out of place', i.e., pollution and taboo are functions of Purity and Danger (the title of her inspiring short study, which appeared in 1966), This idea helps me to understand some of the violent condemnations associated with psychoanalytic subcultures. It is the anthropological equivalent of the use of projective identification in groups and institutions. Raymond Williams' definition seems to me to be integrative and to lie in the depressive position, while Douglas' one draws attention to the splits and outgroupings which are characteristic of the paranoid-schizoid position.
I want to tell a story to illustrate this point. I was for many years being trained by R. D. Hinshelwood in group psychotherapy. Several times a year we met with people who were being trained at the Institute of Group Analysis. Hinshelwood taught me according to his understanding of Kleinian theory, with particular reference to Bion's ideas about groups (see Hinshelwood, 1987). As I have said, Foulkes was the main influence at the IGA (see Foulkes and Anthony, 1957). One evening someone who was trained at the IGA said, rather bluntly, that the transference is to the group. I disputed this and said that it was my experience that the transference is primarily to the therapist. It was soon clear that this was a matter of doctrine, something I had not initially realised. When I did, I suggested that we discuss these differing points of view. This proved not to be possible. The anxiety level in the room shot up, and the meeting ended in disarray. Hinshelwood took me aside afterwards and said that doing therapy was not like a philosophy seminar. It was more like learning surgery where 'mistakes' are - or are experiences as - life and death matters. It was not possible to stand back and reflect. I found this an important moment in my psychotherapeutic education. Having worked as a philosopher and historian for decades before training as a psychotherapist, I had not realised the urgency with which trainees cling to the 'one right way' and find it very difficult indeed to hold ideas up to the light and ponder them. As Bion says, it's hell's own job to think under fire - to cultivate and ponder rather than grab and split and project.
Hinshelwood has expanded on the ideas he shared with me in our group: 'One of the most striking features of the profession is its fragmented state, in which rivalrous groups claim allegiance to different theoretical orientations, and protect themselves by arcane terminologies that restrict the possibility of interchange. Each group prizes its own orientation above all others. Groupings which have no original views of their own to propound often turn to the ennobling idea of eclecticism, which... means more often than not that students are confronted with a spectrum of ideas by different teachers who are not themselves "eclectic", and who leave the students to make the links as best they can.
'The intensely felt siege mentality of different groups seems to me a strong indicator of a collective defensiveness in action. It suggests to me that the mutually enhancing correctness of the members of any one group within itself displays the degree of insecurity (rather denied insecurity) of the members. Insecurity is dealt with in this way by inculcating each other (and new recruits) into a system of mutual confirmation of the group's theoretical ideas, even if it has a competitive style of living up to the same group "ideal".
'This internal competitive culture is often very painful. But it is significantly relieved by identifying another group that holds to a "substandard" theoretical framework. Internal stability is thus bought by the projection of defeat and inadequacy into other groupings. If this is not achieved, then the group may split into two in order to achieve the more personally comfortable inter-group dynamic. Fragmentation is thus maintained by the defensive needs of psychotherapists experiencing insecurity within their own profession. This hypothesis would be enhanced by the frequently expressed views that psychotherapy is an insecure profession; that one needs a background in a "primary profession"; that there is no recognition from some establishing authority, like the National Health Service; that outcome research is inherently impossible; that psychotherapists and psychoanalysts huddle together in north-west London to shelter each other from the stormy world outside; and so on...
'All these factors make for an insecure profession. An insecure profession becomes a defensive (psychologically) profession. The defensiveness incidentally enhances in this case the insecurity of being in a fragmented profession. New recruits are at the outset confronted with a bewildering decision that they are at a loss to make (between the trainings) and are inculcated in the collective defences of the profession to comfort themselves with, thus leading to a prolongation of the fragmentation' (Hinshelwood, 1985, pp 16-17). It is noteworthy that the mechanism described - splitting off unwanted parts and projecting them into another group - is the same as that involved in racism and virulent nationalism (Young, 1994, ch. 6).
You may say that I have by now painted such a bleak picture that it would be inconsistent and unwise to add a section of hopeful and positive suggestions. Even so, I have some to make. The first is that there is a crying need for relatively neutral spaces for thinking about psychoanalysis and the inner world. It would be naïve to suppose that such spaces will remain forever free of the sectarian and other distressing forces I have discussed. Yet it is important to create such spaces from time to time. Obviously, the less such spaces are beholden to the existing power structure, the better. I have in mind from the recent past the enabling roles of the Freud Museum, the various programmes in Psychoanalytic Studies, the activities of THERIP and those generated and supported by Free Associations, Free Association Books and Process Press. These strike me as having in common the fact that they are open, encouraging and beholden to no one (relatively speaking). But since I had that thought, the Freud Museum mounted a conference with dissident psychoanalytic figures, and the director was sacked; the Kent programme has had an awful job getting money for new staff and questions have ben raised about its administration, leading to complaints that students are not well enough looked after; THERIP is chronically short of energy to sustain its interesting programme and is becoming more narrowly Lacanian in its deliberations; and Free Association Books has become a 'strictly business' enterprise, and has withdrawn support from actvities in the wider analytic culture. Process Press is shoirt of money to bring out the books which are in its pipeline. In a world of sectarians, the anti-sectarian soon gets labelled another sect and pressures to do things which are less unusual abound. Yet some soldier on.
Another desideratum is for spaces relatively free from careerism, but such spaces also have a way of getting colonised by what they seek to avoid. I recall my first small group meeting at a Leicester Conference on group relations, where someone mentioned initial distress, since some members had not been successful in getting accepted into the Training Group, which takes people who have been to one or more previous conference. I laughed at the idea that group relations conferences could have a career structure. It was soon abundantly clear to me that I was wrong. The ladder goes from membership to the Training Group to the Staff to prestige here and abroad and on to lucrative and consultancy work. Even so, it is important to try to keep one's eye on learning from experience and not on thinking primarily of advancement.
As I have already said, I believe that stronger links with universities can help people to take thought and gain some of the forms of civility which are (let's not exaggerate this) normal in academic life as compared with commercial and professional circles. Universities are also supposed - though recent government policy has significantly undermined this - to provide an environment for taking thought, for loosening the link between thought and action: for contemplation. I think this is still relatively true and should be nourished and husbanded. Prior to my present psychotherapeutic vocation, I worked in the academic world, in medicine, in political agitation, in television and in Dallas. Psychoanalysis is the worst of these subcultures with respect to civility; for all its faults, Cambridge was the best. (This approach, involving re-situating trainings as graduate degrees, has recently been advocated in a letter from Lea Goldberg to the International Journal of Psycho-Analysis 75: 619, 1994.)
Something similar can be said about links with the community, whether through the National Health Service or other organisations and groupings. This chips away at the inward-looking tendency among analysts and therapists. It is also important to lobby for more psychotherapy and psychotherapists in the public sector. In the catchment area where I initially trained - Southall, Middlesex - there was one consultant psychotherapist for three quarters of a million people. The Number of non-medical consultant psychotherapists in the NHS is paltry. Peddar mentions twenty (1989, p. 211), but I have since been told that there are about 120, some part-time, making the number the equivalent of eighty full-time, a high proportion in the London area. In any case, compared with the need, it is a dramatically low number.
It is consistent with what I have advocated so far that trainings should include more about scholarship, including research papers; teaching about the sociology of psychoanalytic knowledge, the history of ideas and some work in conceptual analysis and the philosophy of human nature and society. Practitioners need to be able to step back and think about the ideas they employ, thus making some effort to overcome the blinkered and tenaciously complacent dogmatism I mentioned in my example about whether the transference is to the group or the therapist. It should be possible to think about the alternatives and discuss the issues involved, whether or not anyone's practice is changed as a result.
Another way of putting my general point is that I sometimes think that nobody cares about psychoanalysis. They only think about their own practice, their referral network, their training organisation, their orientation and their little worlds. If, as Philip Reiff has said, psychoanalysis is 'perhaps the most important body of thought committed to paper in the twentieth century' (Rieff, 1979, p. x), it behoves us to devote some of our energies to thinking about it as a body of thought, not just as a trade which we practice.
As I see it, the culture of psychoanalysis is in perpetual danger of losing out to the professionalism of those who are, in turn, in danger of losing sight of the motive to bring out the best in human nature and serve humanity. Power, patronage and professionalisation are, I submit, the enemies of service. Psychoanalysis is about the understanding and the enhancement of the lives and work of people by means of the understanding and interpretation of unconscious motives in individual, group and institutional settings and in attempts to intervene in the public sphere. Anything which gets in the way of this is bad news - a manifestation of human destructiveness. Much of the existing culture of British psychoanalysis can be so described - envious, spiteful, anti-life. Let's hear it for the ongoing effort to bear and heal splits and take back the projections.
(Place of publication is London unless otherwise specified.)
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Some useful addresses:
United Kingdom Council for Psychotherapy
167-69 Great Portland Street W1N 5FB
British Confederation of Psychotherapists
37 Mapesbury Road
London NW2 4HJ
United Kingdom Universities Psychotherapy Association
Mr S Du Plock
School of Psychotherapy and Counselling
Address for some of the Psychoanalytic Studies programmes in the British Isles:
Mrs Marilyn Ward
Centre for Psychoanalytic Studies
Tel: 01206 873745
Dr Alison Hall
Faculty of Cultural and Educational Studies
Centre for the Arts and Contemporary Studies
Leeds Metropolitan University
Dr Parveen Adams
Department of Human Sciences
The University of West London
Middlesex UB8 3PH
Dr Martin Stanton
Centre for Psychoanalytic Studies
University of Kent
Mr Ross Skelton & Dr David Berman
Department of Philosophy
University of Dublin
Republic of Ireland
Tel: 6172941 ext. 1561 or 1166
Ms Susan Aylwin
Department of Applied Psychology
University College Cork
Republic of Ireland
Dr. John Churcher
Department of Psychology
University of Manchester
Tel: 0161 275 2595
Fax: 0161 275 2588
Dr Barry Richards
Department of Human Relations
University of East London
London E15 2JB
The Tavistock Clinic
120 Belsize Lane
School of Psychotherapy and Counselling
Tel: 0171 487 7406
Dr Bernard Cullen
Programme in Theoretical Psychoanalysis
University College London
The Human Nature Review © Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM