Flora E. Lazar, PhD LCSW
Last year, part way through a case presentation in a very stimulating class at one of the local psychoanalytic institutes, the instructor launched into his transference interpretation of an analytic patient’s passive longings for the analyst and went on to characterize them as homosexual. Taken aback by this characterization in view of the American Psychoanalytic Association’s (APsaA) recent apology to the LGBTQ community for the damage its theories and institutions had done to this community, I raised my hand and asked who had characterized passive longings as homosexual, the patient or the analyst. The instructor thought for a moment and replied simply, “The patient.” Feeling a little shaky on my Freud—the reason I was taking the class in the first place—I didn’t think too much about it until the same instructor pulled me aside about six months later and reminded me of my question. He told me the same question had arisen in another class and thanked me for beginning a process of helping him reconsider this central tenet of Freud’s theory of sexual development.
This acknowledgement prompted me to wonder about the glacial process of theory change and what price patients pay for outdated theories that not only guide our practice but cyclically reinforce themselves by making our educational institutions inhospitable to many of those who might challenge them. It had been a long slow process that culminated in APsaA’s apology, which came as the country celebrated the 50th anniversary of the Stonewall uprising in New York City, a watershed moment in mobilizing opposition to anti-LGBTQ prejudice, hatred, and oppression. Calling the apology for “views that pathologized homosexuality and transgender identities” long past due, ApsaA’s then president Lee Jaffe admitted that it was “time to recognize and apologize for our role in the discrimination and trauma caused by our profession.” In the apology, ApsaA acknowledged that its theories had contributed to widespread discrimination and prejudice in housing, employment, healthcare, and in society at large.
But how did this apology, which appeared in news outlets around the world, ultimately find its way into what we were learning in classrooms, especially in an educational system presided over by voluntary faculty largely insulated from the peer scrutiny of the university system. Even as we today admit the painful impact of this legacy, other similarly-pernicious theory and language has not been fully scrubbed from our daily vocabulary or our curricula. I remember studying Arnold Goldberg’s book, The Problem of Perversions: The View from Self Psychology in a class a few years back (Goldberg, 1995). Surprised by our instructor’s unreflective use of the term “perversion,” I waited until the end of an exceptionally lucid summary on the origins of so-called perversions before thinking back to what I knew from my fellowship year at Live Oak, one of Chicago’s pioneering LGBTQ affirmative training programs. Feeling a little uncomfortable with my own grounding in psychoanalytic theories of sexuality, I nonetheless raised my hand and asked this eminent psychoanalytic educator whether he thought there was clinical value in use of the term “perversion.” He thought for a moment, and gave a candid reply. “There is none,” he said and continued in a more self psychological idiom focused on needs rather than labels. Equal parts analyst and student of history, the instructor implicitly recognized the legacy of history embedded in language as well as the contribution of history and other academic disciplines in the ongoing testing of our theories.
This episode reminded me of a closed-door student gathering some years ago with one of ApsaA’s presidents. After the institute director excused herself to allow for greater candor, the ApsaA president invited students to share their perspectives on their educational experience there. Initially there was an awkward silence, but eventually one candidate—an academic-turned clinician—began to speak. In a quiet, almost deferential voice, she said she was perplexed by the curriculum and why it still contained discredited material. What she found especially perplexing, she said, was how instructors typically explained this anomaly, which she said they often justified somewhat dismissively with the retort that no one still believes the material students are often asked to read. But the inversion of what we know and how we came to know it is peculiarly psychoanalytic. It was a bit like teaching creationism as a science of equal weight with evolution and never addressing its anachronisms until asked.
The persistence of outdated theories in psychoanalysis and the slow percolation of more accurate ideas into the classroom no doubt stems from many sources, including the insularity of the community, its isolation from the university, and the reliance on voluntary faculty not engaged primarily in the advancement of knowledge. Throughout his life, Freud lamented his own rejection from the university and during the early establishment of the American system of psychoanalytic education, leaders in that field often transformed this rejection into a rallying cry, rejecting universities as inhospitable climates for the development and application of psychoanalytic ideas and setting up independent training institutes reliant on part-time poorly-paid practicing analysts. It is probably no surprise that these days, when psychoanalysis is taught within the university, it is more often than not outside the clinical arena in fields such as English, history, and art (New York Times, November 25, 2007).
The Chicago Psychoanalytic Institute was historically unique in trying to establish itself on a university model as an endowed research institute with full-time salaried faculty dedicated, like universities and institutions, to research (Wallerstein, 2011). However, only relatively recently in the United States have serious efforts been made to address the isolation of clinical work from university culture expressed by such eminent psychoanalytic leaders as Robert Wallerstein — isolation that has become ever more acute in a period when psychiatry department chairs are no longer graduates of analytic training institutes as they were in the 1950s and 1960s. But the profession has a long way to go before the educational process can benefit from the challenging, if at times contentious, intellectual climate of an educational system erected on tenure and academic freedom over originalism and reverence for founding texts (Geiger, 1986)(Geiger, 1993)(Schrecker, 1986)(Brown, 1980).
I saw this problem in action several years ago when I began a “basics of psychoanalysis” course created to introduce clinicians and others interested in clinical psychoanalysis. I was excited to see psychoanalytic institutes continuing to relax the restrictions that, throughout most of the 20th century, had kept the centers for advanced training in psychoanalysis bolted shut to all but the medical profession, and was pleased that our class included academics as well as clinicians. I was even more excited that the instructor assigned for the class was one of the institute’s thought leaders, a departure from much of my educational experience, where junior faculty were routinely assigned to introductory courses.
But as the lights dimmed and the outline of the instructor’s PowerPoint deck appeared, I began to worry. In the short hour and a quarter for which the class was schedule, the instructor planned to use some seventy slides, most devoted to the development of Freud’s theories. Suddenly it struck me—institutes are much like the iconoclastic St. John’s College, which still teaches geometry trough Euclid and chemistry through Lavoisier. It is a tradition equipoised awkwardly against the field’s aspiration to be seen as empirically valid.
The discomfort with challenging basic texts that is a fundamental part of university culture was driven home to me by the dean of a psychoanalytic institute when I sought advice on pursuing psychoanalytic training there rather at a university-based program. The attraction of the institute, I confessed, was that it would open the possibility of teaching. Then before checking myself, I went on, thinking a bit out loud, musing about a system that largely prevents one from teaching if one is not an alumnus. Sticking my foot in my mouth even deeper, I confessed my perplexity at a system that privileged whether you are an alumnus rather than what you might contribute.
Little in my experience has shaken my belief that in failing to find a home in university culture, as the founders of the Chicago Institute attempted to do in the 1920s and 1930s, the psychoanalytic system of education lost a valuable opportunity to more easily rid itself of unfounded and harmful theories in the way that university-based discourse helped root out theories such as the culture of poverty and Hernstein’s and Murray’s The Bell Curve. (Gorski, 2008)(Rodman, 1977)(Gould & Gold, 1996)(Hernstein & Murray, 1994). The field has without question made progress. Members of the LGBTQ community are routinely welcomed in institutes’ education programs and some institutes are actually led by members of this community. The literature on relevant issues such, as the transgender experience, is being enriched at a healthy pace (Saketopoulou, 2014)(Saketopoulou, 2011). The same is true for questions of racial identity once taken up by university-based psychoanalytic scholars like John Dollard, but largely left to languish for the better part of the 20th century(Dollard, 1937). The literature now contains the corrective work of scholar-clinicians such as Gregory Rizzolo and Celia Brickman, who have challenged notions of primitivity and regression that have been used to cast Blacks as unanalyzable and thus unable to participate in the field’s educational systems. There is also a bourgeoning body of literature by Black analysts addressing theoretical, clinical, and educational issues (Powell, 2018)(D. E. Holmes, 1992)(D. E. Holmes, 1999) (Brickman, 2003)(Rizzolo, 2017).
The psychoanalytic community is now facing another important reckoning with how outdated theory is addressed. The newly-appointed Holmes Commission, building on the pioneering work of Black Psychoanalysts Speak, has begun its wide-ranging examination of race in psychoanalysis. ApsaA’s leadership has laid out an ambitious agenda. As our community summons the political will to address the issue of race as comprehensively as the Commission’s mandate requires, it will be essential to look in the rear view mirror, not just at the community’s educational failures with regard to race, but at the deeper institutional and intellectual mechanisms that have historically insulated our community and to think from the broader intellectual discourse that has more readily helped us benefit from science and discard discredited ways of thinking. There is a broad consensus in our field that psychoanalysis has far more to offer in terms of public discourse than it historically has delivered. However, to be a credible voice in the public arena, we will need to build on our nascent efforts to give real meaning to our public statements and more systematically eradicate the still far too prevalent vestiges of historic errors that have been costly to our field and costly to the public.
Fortunately, but also sadly, there is no shortage of low-hanging fruit. A more fluid relationship with outside instructors and a wholesale re-examination on non-alums as instructors would be a positive first step in opening up the instructional culture with its reverence for historic texts. It is not enough to locate offices and classrooms on a university campus. Long-term change and the continuous pressure to offer psychoanalytic students the best thinking on the internal experience of race and other identities, will require more fluid interactions among clinical faculty and university researchers, such as those that occurred at the University of Chicago and Yale’s Institute of Human Relations a century ago. Ultimately, this opening up will and should affect the field’s professional associations and their stratified systems of membership. If the field is serious about invigorating its educational offerings with the newest thinking about its various forms of identity, it will need to devise ways to dismantle its top-heavy classification of membership, which limits membership access to a small and economically-privileged group able to undertake the arduous process of “full” analytic training. Also, its teaching academies will need to be led by a broader faculty and reach a broader audience with a broader curriculum encompassing issues such as identity, which psychoanalysis has historically resisted as social psychology. During this time of declining membership in our national associations but great interest in what psychoanalysis can contribute to an understanding of oppression and othering, failing to enfranchise those who have at best sat on the sidelines as limited members, not even privy to the organization’s listserv discussions, and watched the main stage, would be a lost opportunity.
Brickman, C. (2003). Aboriginal populations in the mind: Race and primitivity in psychoanalysis. Columbia University Press.
Brown, E. R. (1980). Rockefeller medicine men: Medicine and capitalism in America. Univ of California Press.
Dollard, J. (1937). Caste and class in a southern town. Yale University Press.
Geiger, R. L. (1986). To advance knowledge: The growth of American research universities, 1900-1940. Oxford University Press. https://books.google.com/books?hl=en&lr=&id=2PhnqzZR5HIC&oi=fnd&pg=PA1&dq=Roger+Geiger+University&ots=a7v0GbSD7L&sig=23XPk-ECbhftWt8-JKRKESip0C0
Geiger, R. L. (1993). Research and relevant knowledge: American research universities since World War II. Oxford University Press. https://books.google.com/books?hl=en&lr=&id=b67PDPCcPIEC&oi=fnd&pg=PR15&dq=Roger+Geiger+University&ots=paZvdm7wM5&sig=CmgvJmxgNLKVK0XZcykKu7WalQs
Goldberg, A. (1995). The problem of perversion: The view from self psychology. Yale University Press.
Gorski, P. (2008). The myth of the “culture of poverty.” Educational Leadership, 65(7), 32.
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Rodman, H. (1977). Culture of poverty: The rise and fall of a concept. The Sociological Review, 25(4), 867–876.
Schrecker, E. W. (1986). No ivory tower: McCarthyism and the universities. ERIC.
Wallerstein, R. S. (2011). Psychoanalysis in the university: The natural home for education and research. The International Journal Of Psycho-Analysis, 92(3), 623–639. https://doi.org/10.1111/j.1745-8315.2011.00459.x