INSIDE PSYCHOANALYTIC INSTITUTES

[ Chapter: | 1 | 2 | 3 | 4 | Conclusion | Bibliography ]

Comments, Author's Introduction, Copyright and Acknowledgements

This book provides a detailed and massively well-informed insight into four of the leading psychoanalytic institutes in America: New York, Boston, Chicago and Los Angeles. The author conducted scores of interviews and transcribed a mass of oral history — about a million words. Many of the analysts interviewed were prominent in psychoanalysis as established leaders, and were quite often protagonists in the stories of their institutes. He also consulted a mountain of material in libraries and archives and attended institute meetings and conferences.

The result is a uniquely textured set of pictures of free-standing institutions - their organisations, their cultures, their conflicts and their ways of mediating conflict and surviving, sometimes after splits which led to the founding of new institutes.

Each of his four case studies focuses on basic problems - the role of immigrant analysts; dubious links between senior analysts and patients and ex-patients who become trustees; the vexed question of succession and choosing training analysts by merit rather than personal patronage and even nepotism; doctrinal disputes which, in the case of the Los Angeles institute, nearly led to the American Psychoanalytic Association closing them down if they did not purge Kleinians and Kleinianism from their programme.

The book also sheds light on the question of why psychoanalysis is in such crisis and decline today. While external factors have played their part, psychoanalysts have generally disregarded their own crucial role. Their politics have, on the whole, been inward-looking, while their attitudes toward theoretical differences and innovation have too often been deeply conservative. Another perspective which the author investigates is the problems of a basically humanistic discipline that has conceived and touted itself as a positivist science while organising itself institutionally as a religion.

One can view these issues and conflicts as scandals, which, in some cases, they clearly were. But there is another perspective which Douglas Kirsner is careful to stress. Each of these disputes was resolved, and the institutions have carried on and have done so with constructive relationships with the breakaway institutes and with the theoretical orientations with which they were, for a time, locked in seemingly irresolvable conflict. However, in the author's view, these changes were achieved despite intrinsic problems that remain at the heart of psychoanalysis and its institutions. Through these histories the author identifies fundamental, underlying problems that need to be addressed if the field is to advance from its parlous state.

Interest in this study should not be confined to psychoanalysts. It is also a rich set of case studies in group relations — the psychological and social dynamics of independent professional organisations, with the ironic twist that the members of these organisations profess to have special insight into human nature and how people can and should get along with one another

Douglas Kirsner is Senior Lecturer in Philosophy and History of Ideas at Deakin University, Australia. He has taught and researched in the areas of psychoanalysis and social institutions for nearly thirty years. In 1977 he founded the annual Deakin University Freud Conference, which he directed for twenty years. He is the author of 'The Schizoid World of Jean-Paul Sartre and R. D. Laing, edited collections, and numerous articles and book chapters, mainly concerned with psychoanalysis. Unfree Associations is the result of a decade's work, including many trips to the United States to conduct interviews and archival research.

Some comments on Unfree Associations:

’Douglas Kirsner has produced a pioneering study of the operations of psychoanalytic Institutes. Unfree Associations traces the consequences of various organisational arrangements on their vital functions. It also presents a veritable nosology of the ills that beset analytic education. Kirsner’s case studies are focused on four of the most influential Institutes in North America. The data base he has collected is both convincing and astonishing. His conclusions transcend the problems of psychoanalytic education, for they are equally relevant to the fate of psychoanalysis as a body of knowledge.’

— John E. Gedo MD, Visiting Professor of Psychoanalytic Thought, University of Chicago, author of Psychoanalysis and Its Discontents and co-editor of Psychoanalysis: The Vital Issues.

’A brilliant & original feat of historical reconstruction, synthesizing innumerable details, from dozens of interviews and mountains of documentation, to create a scholarly & yet intensely readable chronicle of "splits" in American psychoanalytic institutes. Each institute had different characteristics, but these differences contribute to an understanding of the general phenomenon.

’As a survivor of a paradigmatic split (Boston 1973), I can attest to Prof Kirsner's sensitivity & precision, in collecting many accounts of these traumatic events. He has recorded dozens of sympathetic interviews, in which each informant reports his or her own version of what happened, & he has reviewed hundreds of documents. From these conflicting & complex details, he has woven a seamless web that is both scholarly & extremely readable.

’From this brilliant historical reconstruction, the general as well as the scholarly reader will learn how complex & easily forgotten are the details of relatively recent events. As a sympathetic interviewer of the analysts who survived these traumatic experiences, each with a different view of what happened, Prof Kirsner has created a unified narrative that makes lively & dramatic reading. Historians of psychoanalysis will also be grateful for the wealth of factual detail he has preserved.’

— Sanford Gifford MD, Chair of the History and Archives Division of the American Psychoanalytic Association.

Introduction to Unfree Associations by Douglas Kirsner

In an age of managed care and biological therapies for mental illness, psychoanalysis is generally seen as a ‘profession on the ropes’ whose hour is up. The numbers of analytic patients have been in constant decline since the 1970s when four or five times a week psychoanalysis began to disappear rapidly. Psychoanalysis became less attractive as a mode of treatment as new, less expensive and less time-consuming therapies and modern medications began to sweep the US. Analytic patient numbers declined further with the recession and changes in third party insurance—especially managed care which supports only brief therapy and medication. Psychoanalysis is no longer popular with the general public, and humanities departments have largely abandoned psychoanalysis in favour of postmodernism. Ongoing conceptual critiques of Freud and psychoanalysis have made psychoanalysis less popular as a methodology and treatment. ^1.

What went wrong? External factors have certainly played their part in the fall of psychoanalysis. However, in blaming the outside world, psychoanalysts have disregarded their own crucial role in creating this crisis. Freud’s question to his patient Dora is an important one here, ‘What is your part in this?’ In Dora’s case, Freud could say, ‘A string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content.’ ^2.

This book examines the role played by psychoanalysts themselves in the formation of the current decline and crisis. This has been played out through their own institutions, the free-standing psychoanalytic institutes. Theoretical developments are only part of the story which is about the institutional context within which developments take place, are transmitted or impeded. ^3. The body of this book does not examine all the factors that have led to the parlous state of psychoanalysis in the US but rather how some of the problems of psychoanalysis have been manifested, reproduced and amplified in psychoanalytic institutions.

Psychoanalytic institutes have been notable as closed shops. Their solid walls have kept them sealed off and mysterious to the outside world, including the mental health professions and the academy. Authoritarian cliques, power struggles and intrigues have predominated inside the institutes. Institute life has been secret, the subject of rumour rather than knowledge. Insiders often know little about other institutes (unless they are involved in site visits to particular institutes). Sometimes, insiders have a limited view of their own institutions because they stay within their own coteries and see the institute through the vantage points of their own experience and that of some close colleagues. What goes on behind the closed doors of institutes has not been examined in detail. I have been privileged to interview a wide variety of participants in the often dramatic histories of some central psychoanalytic institutes in the US. For the first time, this book recounts the intricate inside history of these organisations, the secret life of institutes.

The book‘s detailed investigation reveals some of the ways that psychoanalytic institutes have arrested free inquiry. It describes the group psychologies so endemic to psychoanalysis. Leading psychoanalyst Leo Rangell has observed that in the psychoanalytic field ‘rational argument and scientific discourse do not generally prevail’ as they are ‘lost in the face of group psychology’. ^4. Further, he has argued that if the history of psychoanalysis does not examine sociological, political, and interpersonal elements, ‘we leave out half the history of every institute in the country’. ^5.

Psychoanalytic institutes have always been troubled everywhere. Whether they are medical, nonmedical, Freudian, Jungian, Kleinian, Kohutian or Lacanian, whether they are in New York, Chicago, Paris, London or Sydney, psychoanalytic institutes behave in strikingly similar ways. Even recently formed institutes in Moscow have similar problems: two of the three psychoanalytic institutes in Moscow call themselves ‘The Russian Psychoanalytic Association’! ^6. In his 1953 Presidential Address to the American Psychoanalytic Association, Robert Knight lamented the typical themes of difficulty in institutes:

The spectacle of a national association of physicians and scientists feuding with each other over training standards and practices, and calling each other orthodox and conservative or deviant and dissident, is not an attractive one, to say the least. Such terms belong to religions, or to fanatical political movements and not to science and medicine. Psychoanalysis should be neither a 'doctrine' nor a 'party line’.

In Knight’s view, ‘the most pressing issue and the one charged with the greatest emotion has always been that of training’. ^7.

As sites for transmitting psychoanalytic ideas to the next generation, institutes are the lifeblood of the psychoanalytic movement. They are central to issues of power, prestige and knowledge. The ‘private club’ nature of free-standing institutes has made it close to impossible to gain access to detailed information about their functioning and history. When social institutions are not organised so as to induce confidence and trust, they become suffused with suspicion and mistrust. ^8. There is no redress outside psychoanalytic institutes which claim a special expertise function for training practitioners in the therapy.

Freud hoped that the therapeutic practice of psychoanalysis would not destroy the ‘science‘—the field of intellectual inquiry—of psychoanalysis. But in the main, the spirit of open inquiry has been replaced by training in a therapeutic endeavour. Unlike psychology and psychiatry, psychoanalytic training does not take place in universities but in its own institutions which are supposed to serve not only training but also research functions. From the outset psychoanalysis has been organised around its own free-standing institutions, perhaps deriving from Freud’s own unhappy experiences with the University of Vienna. Psychoanalytic ideas are often perceived as being owned by Freud and his heirs enshrined in psychoanalytic institutions that have served vital gatekeeping and other political functions.

In an important article considering the nature of psychoanalytic institutions, the current president of the International Psychoanalytic Association, Otto Kernberg asserted,

Psychoanalytic education today is all too often conducted in an atmosphere of indoctrination rather than of open scientific exploration. Candidates as well as graduates and even faculty are prone to study and quote their teachers, often ignoring alternative psychoanalytic approaches. ^9.

As Robert Holt observed, ‘American psychoanalysis has lived for so long within a snug cocoon of myth that it seems unable to go through the predictable pains of metamorphosis into a viably progressive discipline. The protective threads it has wound around itself include warding off all criticism as resistance, idolatry of Freud, and faithful internalisation of all his faults as a scientist and writer‘. ^10.

Kernberg proposed four models for understanding psychoanalytic education, each corresponding to aims that have been seen to be primary tasks of institutes. The models, each having a related organisational structure, were: (1) an art academy training expert craftspeople and bringing artistic talents to fruition; (2) a technical trade school focused on learning a ‘clearly defined skill or trade, with no emphasis on artistic creativity‘; (3) a monastery or seminary model that treats psychoanalysis as a religious system; and (4) a university college model that aims at the transmission, exploration and generation of knowledge and methodological tools for the creation of new knowledge. In Kernberg’s view, psychoanalytic institutes are often conceived of as a trade school mixed with a religious system on the seminary model, whereas they should be modelled somewhere between an art academy and a university. ^11.

Psychoanalysis can be seen as a method for understanding the unconscious mind as well as a psychotherapy and body of knowledge based upon the findings of this method. Institutes have generally seen their central task as training practitioners in the therapy. Of the tripartite division in analytic education that most institutes adopt—training analysis, seminars and supervision—the training analysis is normally regarded as the most important. ^12. Through the medium of the training analysis, the transmission of important aspects of psychoanalysis often takes the form of an esoteric pipeline of sorts through which analytic truth is transmitted, from Freud on down, from analyst to analyst. This involves the process of the anointment of those analysts—training analysts—deemed good enough to be the ‘real’ psychoanalysts. Training analysts, in turn, anoint their candidates through the medium of the training analysis. Because of this, the persistence of anointment has played a significant role in most institutes. Who an analyst’s analyst was signifies how good an analyst a person is; not so much whether there are good analytic results. One does not think of asking who one’s heart surgeon was after an operation, at least it is secondary as to whether the operation was successful! What other profession asks for exact genealogy? As Helmut Thomä wrote, "That the genealogical tree and the descent—legitimate when it can somehow be traced back to Freud—should count more than one's own personal achievement is a peculiarity of institutionalised psychoanalysis." ^13.

A training analyst has the right to conduct psychoanalyses with candidates as part of their training. Because this position normally brings such power, who is or is not appointed as a training analyst is often at the heart of psychoanalytic ideological and political disputes. As Jacob Arlow observed,

The tensions emanating from the division of colleagues into two categories of analysts, training analysts and just plain analysts, intrude themselves into the organisational and scientific life of the institutes. This is an ever-present problem, and its impact is accentuated by the aura of special status which surrounds the position of training analyst, a position endowed with charismatic implications. The training analyst is regarded as possessing the psychoanalytic equivalent of omniscience. It is from the training analyst that candidates claim their descent. In many places the professional career of an individual may be determined by who his training analyst was. ^14.

Why have psychoanalytic institutions been so closed, sectarian and seminarian? Reasons can be found in personal, cultural and historical aspects of Freud and the development of the psychoanalytic movement. However, a more fundamental explanation may lie in the psychoanalytic metaphor itself. Freud wanted psychoanalysis to be ‘a profession of lay curers of souls who need not be doctors and should not be priests‘. ^15. Despite many differences, psychoanalysis shares many humanistic concerns with religion and philosophy, such as the big questions of ethics, human relationships, emotions and experience. But, in addition, psychoanalysis focuses in detail on a person’s life and experience. Psychoanalysis can be seen as not so much a scientific search for causes as a humanistic search for meaning and interpretation. ^16. Moreover, it must be remembered that Freud was so enthusiastic about psychoanalysis that he often treated psychoanalysis as an all-inclusive world-view that, like religion, could ultimately explain everything about human reality. Perhaps Freud’s antipathy to religion lay not so much in seeing it as wrongheaded, as in its occupation of some of the ground that Freud wanted psychoanalysis to be able to have explanatory power.

This book examines the problems of a humanistic discipline that has been touted as a science on the model of the medical or natural sciences and has been organised institutionally as a religion. Freud saw psychoanalysis as based on psychology and not medicine and was implacably opposed to excluding lay analysts as the Americans did. ^17. However, the expertise of psychoanalysts lies in an entirely different direction from that of medical science, that of trying to understand the language, context and communications of the neurotic as a ‘stranger in a strange land’. It can be seen as a special probe of the everyday experience, using the interactions of the patient with the analyst as ways of framing and transcending it. The psychoanalytic field began with the discovery of the ‘talking cure’ in the conversation between Breuer and his patient, ‘Anna O’. Change could come about through a special way of talking, free association. The special skills or ‘know-how’ psychoanalysts use lie in the domain of language, literature, sociology, philosophy, anthropology and art far more than in medicine or science. ^18. As New York psychoanalyst Edgar Levenson has argued, Freud’s discovery lay in using language as a therapeutic instrument, but he mistakenly attributed his success to what was talked about instead of the semiotic act. The important discovery of this semiotic act, common to all psychotherapies, became derailed by a fundamental mistake. Freud and later analysts mistakenly concluded that it was the content of the conversation rather than the process of conversing that brought about change. ^19.

This discovery of a new method for focussing on understanding the patient’s communications and experience had institutional ramifications. Psychoanalysts believed they had found a new way of understanding that was sufficiently different from other approaches to be a special discipline of its own. While some wisdom about the human mind, behaviour, communications and experience accumulated over decades of psychoanalytic inquiry, shutting off the outside world of other disciplines, approaches and data stymied development and reinforced prejudices. Different schools developed different emphases on content. Freudian patients had sexual dreams, Jungian patients dreamt of mandalas while Kleinian patients could only dream of escaping from the bad breast. The illuminating insights of gifted founders were transmuted into doctrine by far less talented followers who disseminated psychoanalysis and ran its institutions. Psychoanalysis became stagnant as dogma replaced method.

****

There are currently about 20,000 analytic practitioners in the US most of whom have trained through and remain members of psychoanalytic institutes. The major national umbrella organisations are the American Psychoanalytic Association (3,200 members), the American Academy of Psychoanalysis, the American Psychological Association’s Division 39 on psychoanalysis (the number of psychologists indicating their specialty area as psychoanalysis is 4,109 in 1998), and the National Association for the Advancement of Psychoanalysis (1,700 members including 17 accredited institutes).

The largest, oldest, most prestigious and historically the most important national psychoanalytic organisation is the American Psychoanalytic Association (APsaA) with 3,200 members. It is affiliated with the world-wide accrediting organisation founded by Sigmund Freud, the International Psychoanalytic Association. The APsaA was founded in 1911 and currently has 29 accredited training institutes, 41 affiliate societies and four affiliate study groups throughout the US. The APsaA has always provided an important forum for the exchange of psychoanalytic ideas and publishes the major American psychoanalytic journal, The Journal of the American Psychoanalytic Association. However, its principal function has been the accreditation and maintenance of professional standards in psychoanalysis. To this end, institutes are reviewed and evaluated through regular site visits, and individual analysts are evaluated for certification as analysts belonging to the APsaA. However, the powerful and prestigious APsaA is an umbrella organisation that plays little part in the regular educational, clinical or intellectual activities of institutes.

In order to understand psychoanalytic institutional life, it is essential to examine individual institutes where training and other psychoanalytic activities are based. Institutes vary widely with their different structures, unique histories and cultures. While all institutes train candidates to become psychoanalysts, there is considerable variation in curriculum, requirements, standards, approaches, openness and flexibility. So too do the methods vary for appointment to the prestigious position of training analyst.

Psychoanalytic institutions are divided into two. First, the psychoanalytic society which consists of the graduates of the analytic training program and any other practitioners who are accepted into the organisation. This acts essentially as a forum, although it may conduct some extramural educational activities as well. Second, the institute, the training arm, consists of the faculty and candidates. The institute is often governed by an Education Committee often consisting of training analysts, sometimes with some others. While the institute and society are often connected in some way, the structure of the relationship varies from the institutions being totally separate to being completely unified. Institutes are often run by a Board of Trustees or a Board of Directors, mostly elected from the membership or, in the case of the Chicago Psychoanalytic Institute, consisting of lay people as well as analysts. Methods of governance vary. Although most are free-standing, others have more or less close relations with universities. (For example, the Columbia Institute in New York forms part of the Department of Psychiatry at Columbia University).

Therefore, a complex picture of institutional governance emerges, even within the APsaA. When the cultures and histories are factored in, each institute can be seen as quite different. In these difficult times for psychoanalysis, although there are many similarities in institutional behaviour, each is perhaps unhappy in its own particular way.

Psychoanalytic institutions are based on the transmission and advancement of psychoanalytic ideas, ideas that are not easily defined and understood in the same way by the actors in these dramas. Psychoanalysis is unmoored; it is not a science, nor a religion, not a medical specialty nor simply an art. Freud was an explorer but he also codified his ideas. His work has been taken as an inspiration to explore without presuppositions. and also as Holy Writ. Psychoanalysis deals with emotions and excites passions. Like religion, psychoanalysis asks big questions, and, like religion, is easily influenced and seduced by dogmatic answers to these difficult questions.

The early days of psychoanalysis were imbued with Freud’s inspiration and the excitement of new ideas. Neither ideas nor institutions were set in stone. The new discoveries were the result of an open spirit enshrined in free association. However, the technique of psychoanalytic practice assumed a somewhat mystical status. Institutes, which trained analysts in their new discipline, became less critical and increasingly dogmatic as psychoanalysis became professionalized and more socially acceptable. Training institutes seemed to carry conviction, certainty and knowledge with them through their teachers and graduates. Qualifying as a psychoanalyst increasingly required obsessional devotion to the trappings of analysis (five times a week on the couch, etc) and surviving the ordeal of local, and often wider, psychoanalytic politics. The training became the transmission of dogmas and received truths in the seductive illusion of knowledge rather than a method based on ambiguity, unknowing and uncertainty. Orthodoxy was rewarded as psychoanalysts became more devotional.

A distinction can be made here between what I term critical psychoanalysis and what I term professionalized psychoanalysis. Critical psychoanalysis focuses on an open investigation of the field of the unconscious using the psychoanalytic investigative procedure while professionalized psychoanalysis treats the derivatives of this procedure—the therapy and the collection of information—as primary. Critical psychoanalysis takes truth to be its only goal; Freud regarded the analytic relation as 'based on a love of truth'. ^20. 'During my whole life,' Freud said, 'I have endeavored to uncover truths.' He added, perhaps somewhat disingenuously, 'I had no other intention and everything else was completely a matter of indifference to me. My single motive was the love of truth'. ^21. Critical psychoanalysis investigates why this goal, the love of truth, meets with most powerful often successful resistances that result in mental, theoretical and institutional formations that are based on our need to avoid the truth. The very object and tool of psychoanalytic investigation, the human mind, often produces obstacles to understanding it. Freud never wanted the therapy to stand in the way of an open perspective and was critical of what he saw as the American approach:

'Therapeutic ambition is only halfway useful for science, for it is too tendentious. Free investigation is tremendously hampered by it. Therapeutic ambition leads to a kind of pragmatism, as in America, where everything is judged by its dollar value. As a scientific investigator, one should not take therapy into consideration'. ^22.

He even maintained: 'I have always been of the opinion that the extramedical applications of psychoanalysis are as significant as the medical ones, indeed that the former might perhaps have a greater influence on the mental orientation of humanity‘. ²³

However, professionalized psychoanalysis, which relies on ‘false expertise’, concentrates on the therapy as an end in itself and does not normally deeply question its theoretical underpinnings, regarding them as established truths. Thus, while sometimes superficially appearing empiricist and using quasi-scientific jargon, in reality psychoanalysis resembles an institutionalised secular religion. Qualified psychoanalysts, trained in a restrictive and neurotic approach, were perhaps restricted in their capacity to treat ordinary neurotics.

Most psychoanalytic institutes are unfree associations of psychoanalysts where the spirit of free inquiry has been replaced by the inculcation of received truth and the anointment of those who are supposed to possess knowledge. Through their institutions, psychoanalysts become blind to the spirit of sceptical inquiry on which psychoanalysis was based. This method is rarely applied to their institutions, which are mostly unfree oligarchies, and which rewarded conformity and punished difference. The story of psychoanalytic institutions is central to psychoanalytic history, and to what has gone so wrong with psychoanalysis.

Institutions are often inimical to ideas, yet they are essential for their transmission and application. In part, organisations have their own separate dynamics apart from what they are manifestly about. Once psychoanalytic institutes were established to take on the business of the administration and training of practitioners, inevitably certain dynamics, such as the corruptive influences of power, were set in motion. Yet, they traced a path conditioned by the social, economic and historical context, the nature of the field and task, as well as the personalities involved. They have been centrally influenced by factors such as systematically mistaking the substance of the psychoanalytic metaphor, the psychology of anointment, and the nature of psychoanalytic professional life. How historical, social and special psychoanalytic cultural factors were played out and bolstered in the specific organisation of the institutes forms the substance of the chapters on the individual institutes.

This book reveals the inner political histories of arguably the four most important and varied psychoanalytic institutes affiliated with the APsaA. The New York Psychoanalytic Institute was the first and, for decades, the prestigious institute which set the model for many others. It became pre-eminent on a world scale with the immigration of leading European analysts fleeing the Nazis. I move from the earliest psychoanalytic society in the US to the more recent, which, like the history of European settlement of the US, traced a westward path. I describe the Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute are quite varied in their organisation and histories. The cultures are often different, yet many of the problems will be found to be similar at base.

My examination of the detailed political history of the New York Psychoanalytic Institute provides a quintessential example of analytic anointment in practice, together with its pitfalls. I then examine a split that occurred in the Boston Psychoanalytic Society and Institute. This demonstrates some of the tensions and ambiguities that seem inherent in psychoanalytic organisations, especially where society and institute are part of the same institution. Then I move on to investigate the Chicago Psychoanalytic Institute which is quite differently organised: in Chicago, the institute with a lay Board of Trustees is quite separate from the society, and for most of its history has been headed by a powerful director. Then I look at the very complex history of the Los Angeles Psychoanalytic Society and Institute which the APsaA nearly closed down in the 1970s. The Los Angeles history is especially colourful and informative, and includes the introduction of Kleinian and object relations ideas into the institute and the reactions to them. Finally, I draw some conclusions from my research about the causes of the ubiquitous problems in psychoanalytic institutes with some suggestions for change.

This research is based on my extensive interviews with 150 psychoanalysts belonging to the APsaA who experienced the events they described at their institutes. I conducted a number of interviews with many of the same analysts over a number of years. Many of the analysts I interviewed were prominent in psychoanalysis as established leaders, and were quite often protagonists in the stories of their institutes. I transcribed a mass of oral history, about a million words from interviews. I consulted a mountain of material in libraries and archives, attended institute meetings and conferences, and became conversant with the complexities of the field. A major obstacle was that institutes were less than forthcoming in releasing historical documents.

These histories are unique detailed political chronicles that provide a basis for understanding the nature of psychoanalytic institutions as they develop. They provide a foundation for a critique of what has gone wrong with psychoanalysis and its institutions and for the larger conclusions I reach about why psychoanalytic institutions behave the way they do. These histories provide dramatic insights into what psychoanalysts and their institutions have contributed to what has gone wrong with psychoanalysis.

NOTES

1. J. Kaplan, ‘The final analysis’, New York Magazine, October 20, 1997, pp. 26-33., p. 28; Jamie Talan, ‘Is the hour up? In an age of managed care and miracle drugs, the value of traditional long-term psychotherapy is being, well, re-analyzed’. Newsday, January 31, 1995, p. B23; Gale Scott, ‘Pills are replacing psychiatrists in era of HMOs‘. The Plain Dealer, May 13, 1997; Edelson, 1988; J. Gedo, The biology of clinical encounters: Psychoanalysis as a science of mind, The Analytic Press, Hillsdale, 1991; N. Hale, The rise and crisis of psychoanalysis in the United States: Freud and the Americans 1917-1985, Oxford University Press, New York, 1995;. R. Holt, ‘The contemporary crises of psychoanalysis’, Psychoanalysis and contemporary thought, 15, 2, 1992: 375-403; P. Holzman, 'Psychoanalysis: is the therapy destroying the science?' J. Amer. Psychoanal. Assn., 33, 4, 1985: 725- 770. There has been a steady annual decline of one per cent in psychoanalytic cases treated by members of The American Psychoanalytic Association since 1976 (L. Brauer, ‘1996 survey of practice highlights’, The American Psychoanalyst, 32, 2, 1998, p. 24). By 1976, analytic practice had already markedly declined from the 1960s.

2. S. Freud, Fragment of an analysis of a case of hysteria (1905), S. E. VII, p. 35. As Freud wrote to Jung on December 5, 1912, ‘Let each of us pay more attention to his own than to his neighbor’s neurosis’ (In S. Freud,The Freud/Jung letters; the correspondence between Sigmund Freud and C. G. Jung. Edited by William McGuire, ed., Princeton University Press, Princeton, N.J., 1974, p. 529.

3. See L. Rangell, 'A look around', Los Angeles Psychoanalytic Bulletin, Special issue honoring Leo Rangell, M.D., Winter 1988, p. 60.

4. L. Rangell, ‘A psychoanalytic perspective leading currently to the syndrome of the compromise of integrity’, Int. J. Psycho-Anal., p. 6.

5. S. Wilson, ‘A conversation with Leo Rangell’. The American Psychoanalyst, 27/2, p. 15. Nathan Hale has documented the rise and decline of psychoanalysis in the USA in two invaluable volumes (N. Hale, Freud and the Americans: The beginnings of psychoanalysis in the United States, 1876-1917, Oxford University Press, New York, 1971; The rise and crisis of psychoanalysis in the United States: Freud and the Americans 1917-1985, Oxford University Press, New York, 1995). Important general studies of psychoanalysis within the APsaA are Lewin and Ross, Psychoanalytic education in the United States, Norton, New York, 1960, and Goodman, Psychoanalytic education and research: the current situation and future possibilities, International Universities Press, New York, 1977. R. Fine, A history of psychoanalysis, Columbia University Press, New York, 1979, offers a survey of psychoanalysis in the US and world-wide as does Kurtzweil, Kurtzweil, E., ‘USA’ in P. Kutter ed., Psychoanalysis international: a guide to psychoanalysis around the world, Vol. 2, frommann-holzboog, 1995, pp. 186-234.

6. The New York Times, December 11, 1996.

7. 'The present status of organized psychoanalysis in the United States’, J. Amer. Psychoanal. Assn., 1, 1953, p 218.

8. See E, Jaques, A general theory of bureaucracy, Heinemann, London 1976., p. 34.

9. O. Kernberg, 'Institutional problems of psychoanalytic education', J. Amer. Psychoanal. Assn., 34, 4, 1986, p. 799.

10. R. Holt, Freud reappraised: a fresh look at psychoanalytic theory, The Guilford Press, New York, 1989, p. 341.

11. O. Kernberg, 'Institutional problems of psychoanalytic education', pp. 809-10. The field has been so undermined that Kernberg recently outlined thirty methods used by institutes to destroy the creativity of psychoanalytic candidates. (Kernberg, 'Thirty methods to destroy the creativity of psychoanalytic candidates', International Journal of Psycho-Analysis, 77, 5, 1996: 1031-40).

12. The curriculum consisting of lectures, seminars and case presentations, concentrates on theory including Freud’s writings, clinical applications and technique. Supervised analytic work consists of three cases seen four or five times a week which demonstrate the development of the patient’s transference neurosis, genetic factors and principal conflicts. (American Psychoanalytic Association, American Psychoanalytic Association, Standards for training in psychoanalysis, New York, 1984, pp. 5-7).

13. H. Thomä, ‘Training analysis and psychoanalytic education: proposals for reform’, Annual of Psychoanalysis, XXI, 1993, p. 50.

14. Arlow, 'Ten years of COPE: perspectives on psychoanalytic education'. J. Amer. Psychoanal. Assn. 20, 1972, p. 559.

15. Freud-Pfister in Freud, S., in Freud, psychoanalysis and faith: Letters of Freud and Pfister(1928), Basic Books, New York, 1963.

16. Kernberg noted the role of emotion in why the religious model is applicable to psychoanalytic education. This was because of the ‘sense of conviction about the truth of psychoanalytic theory, particularly about the unconscious. The sense of conviction is usually traced to an emotional experience connected with the discovery of the unconscious in oneself, and the experience of psychological change following this discovery’. Kernberg added that this ‘deeply transforming emotional experience’ occurred in an intense relation to another person, the training analyst, who is ‘idealized and experienced as a spiritual guide’. According to Kernberg, the genealogical retracing of psychoanalytic training back to their training analyst’s analyst, to an original disciple and finally to Freud reflected ‘an extraordinary emotional investment in the original founder and his beliefs, quite similar to religious practice’. (Kernberg, 'Institutional problems of psychoanalytic education', p. 810).

17. Freud thought that a medical background could even be harmful to prospective analysts and even discouraged would-be analysts from studying medicine (E. Jones, Sigmund Freud: life and work, The Hogarth Press, London, 1953, Volume 3, p. 293). Clarence Oberndorf recorded a meeting with Freud which exemplified Freud's views on the subject:

'After a few friendly words of initial greeting, Freud's first question to me was, "And tell me, what do you really have against lay analysis?" in a tone of annoyance and impatience. I tried to explain to him that the laws of New York State forbade it, that the members in America thought a knowledge of the physical manifestations of organic illness necessary so that the physician might compare them with those due to psychological disturbance, that especially in America quacks and impostors, extremely ignorant of the elements of psychoanalysis, presumed to hold themselves out as analysts. Freud waved aside my replies with an abrupt "I know all that." turned, and walked very slowly towards the house. (C. Oberndorf, Sigmund Freud: life and work, 3 volumes, The Hogarth Press, London, 1953, p. 182).

Freud maintained these views to the end of his life. In a letter dated July 5, 1938 written in English to someone who had written him asking if there was any truth in the rumour circulating in the US that he had given up his views on lay analysis.

"I cannot imagine how that silly rumor of my having changed my view about the problem of Lay Analysis may have originated. The fact is, I have never repudiated these views and I insist on them even more intensely than before, in the face of the obvious American tendency to turn psycho-analysis into a mere housemaid of Psychiatry' (Jones, Volume 3, pp. 300-301). See also Freud, 'On Psychoanalysis‘, S. E. XII: 207-11, p. 210; Introductory lectures on psychoanalysis, (Parts 1 & 2) (1915-16), p. 21; The future of an illusion. S.E. XXI (1927): 5-56., p. 252; Freud to Hendrik de Man Dec 13, 1925 quoted in Gay, Freud: a life for our time, Norton, New York, 1988, p. 310 n.

18. Freud was vehemently against seeing psychoanalysis as medical. He proposed that the curriculum of his ideal institute ‘must include elements from the mental sciences, from psychology, the history of civilization and sociology, as well as from anatomy, biology and the study of evolution’ (Freud, 'Postscript' to The question of lay analysis. S.E. XX [1927], p. 252).

19. E. Levenson, The ambiguity of change, an inquiry into the nature of psychoanalytic reality, Basic Books, New York, 1983, especially pp. 8, 55; The purloined self: interpersonal perspectives in psychoanalysis, Contemporary Psychoanalysis Books, New York, 1991, especially p. 198.

20. Freud, S., 'Analysis terminable and interminable', (1937), S.E. XXIII, p. 248.

21. R. Sterba, Reminiscences of a Viennese psychoanalyst, Wayne State University Press, Detroit, 1982, p. 115.

22. Ibid., p. 111.

23. Freud to Hendrik de Man Dec 13, 1925 quoted in Gay, Freud: a life for our time, p. 310 n.

I am very grateful to Jacob Arlow, Charles Brenner, Ken Calder, Elliott Jaques, Albert Mason, Arnold Goldberg, George Moraitis, Bob Gardner, Sanford Gifford, Elizabeth Knoll, David McDonald, Anthony Molino, Leo Rangell, Arnold Richards, and Christine Ware. I want to thank them all for their support, useful comments and suggestions. Special mention should be made of John Gedo who has offered sagely advice and invaluable comments about the entire manuscript. Michael Guy Thompson has been unfailing with ideas and encouragement. Marion Lustig has been a constant source of help, encouragement, and constructive suggestions. I am also very grateful to my parents, Sadie and Gordon Kirsner, for their encouragement and invaluable support.

I want to thank the people I interviewed or otherwise responded in other ways. They made this work possible. Almost all of them were psychoanalysts and most of them again were members of the APsaA. They often spoke freely of often painful events and some chose to remain anonymous. Those I want to thank are listed below.

Robert Akeret

The late Sol Altschul

Norman Atkins

Jacob Arlow

Gerald Aronson

Rolf Arvidson

The late Samuel Atkin

Bernard Bail

The late Michael Basch

Irwin Bieber

Bernard Brandchaft

Charles Brenner

Kenneth Calder

Sandra Cohen

Arnold Cooper

Hartvig Dahl

Robert Dorn

Marvin Drellich

The late Rueben Fine

Susan Fisher

Leonard Friedman

M. Robert Gardner

John Gedo

Ingrid Gifford

Sanford Gifford

The late Merton Gill

Peter Giovacchini

Arnold Goldberg

Leo Goldberger

The late Roy Grinker

James Grotstein

Elizabeth Hegeman

Axel Hoffer

Philip Holzman

Elliott Jaques

The late Edward Joseph

Ralph Kahana

Jerome Kavka

Otto Kernberg

Edwin Kleinman

The late Charles Kligerman

The late Heinz Kohut

Maimon Leavitt

Edgar Levenson

Robert Jay Lifton

Roy Lilleskov

The late Samuel Lipton

Zvi Lothane

Peter Loewenberg

Ivan McGuire

Roger McKinnon

James McLaughlin

Charles Magraw

The late Margaret Mahler

Melvin Mandel

The late James Mann

Don Marcus

Albert Mason

The late Rollo May

Phyllis Meadow

William Meissner

Robert Michels

George Moraitis

Arnold Modell

Grace Mushrush

William Offenkrantz

Arthur Ourieff

Thomas Pappadis

The late Andrew Peto

George Pollock

Robert Pyles

Leo Rangell

Joseph Reppen

David Riesman

Arnold Richards

M. Barrie Richmond

Anna-Maria Rizzuto

Arnold Rogow

Hilda Rollman-Branch

The late Leonard Rosengarten

Creighton Rowe

The late Henry Rosett

Geoffrey Rubin

Roy Schafer

Jorge Schneider

Hanna Segal

Morton Shane

Daniel Shapiro

Martin Schulman

Evelyn Schwaber

Lee Shershow

Jonathan Slavin

The late David Slight

The late Alfred Stanton

Martin Stein

The late Leo Stone

Robert Stolorow

Charles Strozier

Blumer Swerdloff

Thomas Szasz

Arnold Tobin

Sherry Turkle

Heiman van Dam

Arthur Valenstein

Robert Wallerstein

Lotte Weil

Edward Weinshel

Lisa Weinstein

Bryant Welch

Robert Westfall

The late Otto Will

Jerome Winer

Earl Wittenberg

Ernest Wolf

Victor Wolfenstein