LETTER TO FREUD: On the Plight of Psychoanalysis Dinah M.

Mendes
In the form of a letter, the writer communicates to Freud her appreciation for the incomparable richness and complexity of the psychoanalytic enterprise in its century-long evolution from classical, Freudian origins to new developments in theory and technique. At the same time, concern is expressed about the continuity and survival of psychoanalysis in a cultural milieu that has absorbed its once radical ideas about sexuality and unconscious motivation while resisting its viability as a method of treatment.

Dear Professor Freud, In your lifetime you were a tireless correspondent: We have volumes of exchanges between you and your mentor-confidants, Fliess, Ferenczi, Abraham, and Jones, to name just a fewnot to mention the letters from the rank and file of humanity who turned to you for guidance. You have been dead now for over seventy years, but would the discipline or field that you created (although you probably would be happiest with the designation science) be recognizable to you in its latter-day incarnations? Perhaps that phenomenon is no stranger on the grand scale than is your contemplating on an intimate, familial level a painter-grandson like Lucian Freud or your celebrity fashion designer great-granddaughter, Bella Freud. For better or for worse, we have no say at all in who our parents and ancestors are, and very little, it would seem, about our descendantsand not even you, in your god fatherlike hegemony, were able to oversee the evolution of psychoanalysis. Who knows what you would think if you were to appear, Scroogelike, on the scene today? I think you would be bewildered by, probably indignant about, the many schools of psyPsychoanalytic Review, 98(6), December 2011 2011 N.P.A.P.

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choanalysis, the many hybrids and variations that refer to themselves as psychoanalytic. You were so concerned about defining psychoanalysis, declaring who was or was not a psychoanalyst and expelling the faux or rebel ones, that I think you would be astounded by the runaway development of the movementyour original term, which suggests its cultlike or sectarian quality. By way of introducing and locating myself, I am a clinical psychologist and certified psychoanalyst who works in New York City; my observations about psychoanalysis reflect familiarity and direct contact only with the psychoanalytic milieu of that city. I studied English Literature as an undergraduate, a circumstance that might meet with your approval because, notwithstanding your aspiration to establish psychoanalysis as a science, you also believed that a background in the humanities was the best foundation for the understanding of human nature. (One of the many lessons that psychoanalysis teaches us is that contradiction and paradox are the stuff of life.) The fact that I am a nonphysician psychoanalyst might not displease you either because you were a proponent of lay analysis and did not believe that the practice of psychoanalysis required medical training or the imprimatur of a medical degree. When you wrote The Question of Lay Analysis in 1926, however, you could not have foreseen the battle that would be waged for so long by American lay analysts against the appropriation of psychoanalytic training by the medical establishment, which barred access to analytic institute training to non-M.D. mental health practitioners (the wolf of economics and politics disguised in the sheepskin of ideology that psychoanalysis seems prey to no less than other disciplines). But perhaps you, with your instinctive distrust and dislike of the American way, would not have been very surprised by this particular piece of American psychoanalytic history either. The etymology of psychoanalysis indicates that it refers to a study of the soul (the Greek psyche) or the understanding of human natureand what grander or more ambitious undertaking could there be, cloaked though it is in a term disarmingly scientific in its manifest clarity and precision? This venture, like most heroic journeys, was conceived and undertaken by you alone although you were never without supporters and admirersand

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sustained by your never-ending mental energy and productivity. The magnitude of your single-handed accomplishment has left an indelible impact on the professionjust as all roads lead to Rome, or in your version, the dream is the royal road to the unconsciousvirtually all departures and arrivals in psychoanalysis are measured in terms of their distance from you. It seems that you cannot be lost sight of; your photograph, in one pose or another reflective, with penetrating gaze, or at ease in your garden with the chowsgraces countless consulting rooms and bestows on them the stamp of ancestral legitimacy and affiliation. There is hardly a psychoanalyst, seasoned or novice, celebrated or obscure, who embarks on a psychoanalytic investigation without acknowledging your foundational presence via painstaking references and linkage to your work. Its strange: In The Future of an Illusion and Moses and Monotheism, you were determined to uncover the infantile need for protection by a powerful Other that underlies religious beliefs and rituals. But while so many of your followers adopted your disdain for formal religion, they were not able to eradicate the apparently universal human need for a system that makes sense of the mess and pain of life and, along with that, for human exemplars and guides. For psychoanalysis and its practitioners, you are the touchstone and the wellspring, the eternal superego to be reckoned and reconciled with, a larger than life presence. One way to approach the history of psychoanalysis is to view it before and after your death. While you were alive, it was a oneman show, and although you had some venerable sidekicks Ferenczi, Abraham, and Jonesthere was trouble for anyone who deviated too much from your definition of psychoanalysis (the roster of iconoclasts and the expelled is notorious). While you exercised veto power over the thinking of your adherents, your own mind did not stand still at all, although you were almost insouciant about the dramatic revisions recorded in the flow of your writing, barely pausing to acknowledge them. In the topographic theory, as the first theory of mind that you developed at the beginning of the twentieth century is called, you proposed an innovative but disarmingly simple and straightforward model of psychic functioning. There were three systems or levels of psychic opera-

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tion: conscious, preconscious, and unconscious. Neurotic symptoms were understood as the by-product of repression or relegation to the unconscious realm of thoughts and fantasies (usually of a sexual nature) that threatened the patients conscious, rational functioning. With the encouragement of the analyst and by means of the method of free association, the patients unconscious thoughts and fantasies were eased into consciousness and interpreted by the analyst, and a cure was achieved. Ultimately, making the unconscious conscious did not prove to be the panacea that you had hoped for; in the course of your clinical explorations, you stumbled upon powerful obstacles to the patients motivation to be curedmost notably unconscious guilt and the negative therapeutic reaction (an unanticipated and paradoxical worsening of symptoms)that could not be accounted for by the existing model. Theory and technique have always worked hand in glove in psychoanalysis, and your topographic theory of consciousunconscious operation was superseded by the structural theory, formally introduced in The Ego and the Id in 1923. Your codification of psychic functioning was becoming increasingly complex, with the recognition of an increasing number of variables in interplay. You revised your classification of the drives or instincts that represent the energy that fuels the psychic apparatus from ego-preservative and libido, at first, to object love and narcissistic love, and finally, to Eros (libido) and Thanatos (death), the last interpreted by some as the inborn aggressivedestructive force. The proposed new tripartite structure of id, ego, and superego attempted to account both for the newly recognized role of aggression in psychic functioning, as well as the unconsciousnessconsciousness continuum of the topographic theory. Your death in 1939 coincided with the outbreak of World War II, when the Nazi takeover forced scores of psychoanalysts, the majority of whom were Jewish, out of Western and Central Europe into other parts of the world. Their influx and influence were greatest in England and the United States, where in the vacuum created by the loss of your leadership and tight control, a rapid cross-pollination took hold (attesting to the fecundity of your original ideas), generating new offshoots of Freudian psy-

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choanalysisKleinian, Ego Psychology, Object Relations, Interpersonal, and Self psychology, to name some leading ones. The French psychoanalyst Andre Green has speculated intriguingly what the history of psychoanalysis would look like if you had not cast the Oedipus complex, after identifying it in yourself, as the cornerstone of psychic development. Thanks to advances in psychoanalytic knowledge, we now know that a relatively safe and sound arrival at the oedipal stage signifies a major accomplishment in terms of the childs establishment of a well-defined sense of self and recognition of the separateness and autonomy of others; for many patients this is an achievement rather than a starting point of treatment. Certainly, if you yourself had been less high functioningan oedipal victor in your own rightit is unlikely that you could have sustained the quality and quantity of ideas assembled in the 23 volumes of your Gesammelte Werke. In hindsight, however, many of the patients that you diagnosed as neurotic (the Wolf Man may be the most egregious example) would be reevaluated and diagnosed today as suffering from more severe pathology, such as borderline or narcissistic disorders. It is not that patients are sicker now than they were in your time, but rather that our psychoanalytic lens is more refined and refractive of fissures and shadows in personality that were once obscured. Your deconstruction of the psyche was based on an implicit assumption of a functional or reasonably well-organized self. The greatest post-Freudian discoveries stem from forays into the period of life and experience that predates a more or less whole and integrated self, referred to variously as the preoedipal phase, the stages of separationindividuation, or the two-person, early relationship of mother and child. Many of your most creative colleagues and followersFerenczi, Klein, Fairbairn, Balint, and Winnicottinspired by their work with more disturbed patients, captured and conceptualized the phenomenology of the unwhole or unintegrated mind. As an explorer of the psyches uncharted terrain and its first official cartographer, you proudly viewed yourself as a conquistador. You bequeathed to us those grand psychic edifices of the minds interiorid, ego and superegoand in the decades immediately following your death, mainstream psychoanalysts, spear-

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headed by your daughter Anna, concentrated on the psychology of the egothe arbitrating, compromising, adaptive system that functions to reconcile inner and outer reality. But bold and original as your ideas are, they bear the imprint of the Weltanschauung that you imbibed: the Enlightenment belief in the primacy of reason and rationality, transmuted into the triumph of the ego over the irrational forces of the id and superego that it subdues and mediates. As much as any other hermeneutic discipline, psychoanalysis has been influenced by the postmodern perspective that our window on the world and reality is a subjective one, and that to a large extent what we perceive is relative and contextual, not absolute or objective. Probably the best-known example within psychoanalysis is the feminist challenge to the phallocentrism at the heart of many of your theories and prescriptions about women. While the presumption that the normative, experiential, narrative I is male, white, and heterosexual has been contested, perhaps even more essential for the evolution of psychoanalysis is the challenge to assumptions about the unitary and stable nature of the experience of self. In the treatment of patients with more severe pathology or traumatic backgrounds, the psychoanalytic probe, to borrow the concept of Wilfred Bion, one of your most original followers, has been extended into the nethermost regions of the mind, where atomizationpsychic bits and pieces, split or part-objects, dissociated states (the nomenclature varies with the theorists)prevails. This is the panorama of infancy and early childhood and of psychosis, but also the register of our earliest and most primitive experience that lies buried beneath layers of integrated and sophisticated functioning. Past the earliest stages of development, psychic well-being derives from a sense of self that feels relatively discrete and harmonious, and malfunctions in this experience are the source of great pain and malaise. Paradoxically, however, although a healthy experience of self feels quite stable and unitary, in actuality this is no more than an illusion of cohesion or a phenomenological gestalt. The psychic interior cataloged by your successors is neither neatly demarcated nor unchanging, but rather in a state of flux and transformation. Melanie Klein, a psychoanalytic pioneer who set up a rival

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camp to your daughter Annas in postwar London, took your postulate of a Death instinct (a concept rejected by many psychoanalysts as unscientific or biologically fatalistic) and translated it into the permutations and vicissitudes of human aggression and the obstacles it poses to psychic integration. Klein introduced a fundamentalist and perhaps unwittingly moral perspective into psychoanalytic developmental theory, wherein Good is equated with love, gratitude, and creativity in the broadest sense, and Bad with destructive envy and hate. According to Klein, the forces of love and death present at birth within the infant threaten to overwhelm its capacity to integrate them and therefore its psychic survival. Splitting, a virtual apartheid or radical separation of good and bad feelings and experiences regarding oneself and others is a developmental necessity, and only gradually and optimally does a tolerance for and integration of contradictory feelings come about, an achievement heralded by Klein with the doleful designation of the depressive position. Together with Fairbairn, Klein was one of the draftsmen of the fractionated, microcosmic inner world of object relations or, more accurately, (human) object-self relationsmultiple constellations of aspects and functions of the self in interaction with aspects and functions of the human object-Other. The inner world conjured by the Kleinians, who have been enormously influential in Europe and South America, is a Lilliputian one of homunculi engaged in love, but most often war, with each other. Melanie Klein and her followers emphasized the role of fantasy, colored by the distinctive drive characteristics of the individual, in shaping psychic reality. In Kleinian psychoanalysis, these internal, fluctuating patterns are manifested in their projection onto the person of the analyst and played out between patient and analyst. While the Kleinian lexicon employs the language of splitting to convey fragmentation of emotional experience or lack of psychic integration, there are other competing models of mind that seek to depict the mental landscape of early life and the disfigurations that result from early trauma or overwhelming challenge. Balint, the Hungarian-born student of Ferencziyour contemporary and erstwhile confidantemployed the geographical metaphor of a basic fault to describe the weakness or compromise in

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the psychic foundation of certain patients in whom deficiencies in the original relationship of child and caregiver were registered in their flawed psychic structure. Winnicott, Englands beloved Dr. Spock of emotional development, wrote about the earliest caregiving environment that is not welcoming enough for the true selfthe individuals kernel of personal potentialsto emerge and unfold. In such cases, the true self goes into storage, waiting for the proper conditions (often encountered for the first time in the ameliorative environment of an analysis), while a false self, formed in reaction to an inhospitable environment, takes over and copes as best it can with the exigencies of life. Inevitably, psychoanalytic models tend to favor one side or another of the naturenurture divide in their attribution of developmental requirements and aberrations. Kleinian analysts are portrayed as emphasizing constitutional determinants, such as drive intensities, while neglecting the influence of the human environment. Bion, a British Kleinian disciple, is a notable exception who attempted to bridge both sides of the divide, admittedly in language that is too abstruse and idiosyncratic for popular consumption. On American soil, Kohut, who formulated a Self Psychology that he eventually submitted as an alternative to the Freudian model, was an exponent of the significance of nurture and its deficiencies in determining psychopathology. He elaborated the pathological distortions of functions of the self that characterize patients suffering from narcissistic disorders that evolve, according to his theory, in reaction to parental failure to supply the child with the proper nutriments for healthy self-development. Historically and empirically, psychoanalytic theory and technique emerge from a common matrixthe consulting room, the actual locus of treatment but also shorthand for the clinical process that takes place thereand most theories are accompanied by a model of clinical technique. While ego psychology is associated with the gradual uncovering (surface to depth is the cautionary mantra) of defenses that obscure underlying and largely unconscious conflicts, Kleinian analysts are sometimes caricatured as offering their patients flash communiqus of their deepest conflicts and most primitive wishes. Theories based on formu-

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lations of a self that has been traumatized or stunted in its development, such as those of Balint, Winnicott, and Kohut, are translated into techniques of treatment that are predominantly nonintrusive, in which for much of the time the analyst does not actively interpret but rather holds or contains the material and the patient. In these methods, regression to the arrest or trouble points in early development is encouraged and facilitated, with the goal of a more benign replay and repair in the new analytic relationship. In the United States, the popular Relational School of psychoanalysis is a blend of interpersonal, intersubjective, and object relations theories. As a group, these psychoanalysts are most noted for their emphasis on the unavoidable repercussions of the psychoanalytic encounter as a relationship between two people, whose impact on each other is verbal and nonverbal, conscious and unconscious. Among the Relational analysts who concern themselves with severe psychopathology, dissociation is a term used to refer to the disconnections between self-states or experiences of self that seem to exist in self-contained, noncontiguous segregation from each other. Dissociation, with its roots in the theory of trauma (a return to your original starting point) and its cognitive and emotional fallout, speaks in the contemporary cultural idiom of existential isolation and anomie that exist alongside global access and communicationlike neighbors in a highrise who remain strangers to each other. There seems to have been a perennial struggle in you, Professor Freud, between your yen for classificatory order and the resistance of the inchoate nature of your creation to simple categorization. In Analysis Terminable and Interminable you referred to psychoanalysis as an impossible profession, along with education and government. Why did you link these particular professions, and what did you think confounded them all? Perhaps it is their ambitious, common goal of influencing minds and hearts that are often indifferent or recalcitrant. Another factor that contributes to the impossible nature of psychoanalysis is its hybrid and elastic identity. What is psychoanalysis anywaya science, a Weltanschauung, a philosophy? In a lecture titled The Question of a Weltanschauung, you endeavored yet again to align psy

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choanalysis with a scientific Weltanschauung in its search for empirical truth, as opposed to your view of the wishful, childlike impulses that propelled the illusions that nourish a religious Welt anschauung. As a body of cumulative knowledge and research about psychological functioning and development, psychoanalysis aspires to scientific credibility. Its scientific status, however, at least when applied to the clinical situation, seems destined to remain soft because is it ultimately impossible to convert the multiple and overlapping components of the currents of human interaction (the now universally acknowledged simultaneous subjectivity and intersubjectivity of the clinical encounter) into variables that replicate and quantify aspects of human communication without compromising their complex and layered significance. From its inception, you and your followers regarded psychoanalysis as a movement, an organization of people united by a shared ideology. Early on, the commitment was, first and foremost, to the existence and significance of unconscious mental life, to infantile sexuality, and the centrality of the Oedipus complex. Following your example, many analysts remain atheists or agnostics, but psychoanalysis is a meaning-making enterprise, and it is axiomatic that psychic contents are never random or meaningless: They make sense, if only they are plumbed well enough. Indefatigable intellectual imperialist that you were, your interest shifted from the clinical domain of psychoanalysis to its cultural implications. In The Future of an Illusion you challenged the origin of religious feelings, and in Civilization and Its Discontents you considered the renunciations entailed in the process of civilization. Whether groped for within ones own psyche or applied to the general workings of humankind, psychoanalysis shares air space with philosophy in its search for meaning. In the clinical situation itself it does not seem to matter whether psychoanalysis is a science or a philosophy; here it is indisputably a relationship, although the nature of the psychoanalytic relationship and its role in treatment has been one of the most disputed topics. Not surprisingly, Professor Freud, you were divided on this topic; you both likened the approach of the psychoanalyst to that of the surgeona dispassionate application of a well-honed skilland also reflected that psychoanalysis is ulti-

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mately a cure through love. In your paper On Psychotherapy you related the work of the psychoanalyst to that of the artist when you applied Leonardo da Vincis comparison of painting and sculpture to psychoanalysis, suggesting that the psychoanalyst works not like the painter, who adds on to the canvas, but like the sculptor, who pares away the superfluous to expose the essence of the medium. As you suggest, the art of healing is different from the science of healing and draws on innate aptitude and talent, as well as instruction and skilla matter that informs the question of how one trains to be a psychoanalyst. The French, interestingly, refer to the transmission of psychoanalysis, alluding to its significance as a calling. The analytic institute at which I trained operates on a traditional model of training in which four years of coursework build on one another chronologically and developmentally. In the Freud sequence, your early writings precede later ones, while Infant Development, and its normal and pathological ramifications, precedes Latency and Adolescence. Several classes are devoted to the assessment and treatment of patients across the diagnostic spectrum, representing a range of pathology from neurotic (also referred to as classical, in deference to the origins of psychoanalysis) to narcissistic and borderline (nonclassical). Theorists like Melanie Klein and Winnicott, whose influence extends far and wide in the field, merit a seminar of their own, and a sprinkling of classes reflects current trends and hot topics in the field, such as gender differences and enactment. In addition to coursework, every candidate is required to analyze two control or training casesone for a minimum of three years and the second for a minimum of two yearseach supervised weekly and written up at six-month intervals. The teaching of theory is a much more intellectual and straightforward enterprise than the teaching of technique. Technique is hands on and requires a synthesis of formal method and guidelines with the experiential and with something more personal and creative. Herein lies the importance of the training analysis, the personal analysis of the candidatethe third leg of the training tripod and the one identified by you as the bedrock of analytic training. Unlike the two other components of training, courses and control

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work, the training analysis is neither reported nor evaluated. While this ensures privacy and confidentiality within an institutional setting, it also means that the most personal experience of training is never openly or explicitly integrated with other parts of trainingyet another challenge to the synthesizing capacities of the analyst-in-training. It is difficult to convey the experience of psychoanalysis to another person because at one and the same time channels of communication are opened up within the analysand and between two people, analysand and analyst. The analysand has to convert the psychic material that enters consciousness, much of it fluid, uncontextualized, and imagistic, into the linear vehicle of language, where it then makes intersubjective contact with the personal and idiosyncratic psychic grid of the analyst. The British psychoanalyst Bion enjoined analysts to listen without memory or desire in order to curtail the imposition of the analysts organization and motivation on the clinical data, but inference and meaning-making are inescapable organizers at all levels of communication. The two indispensable and defining tenets of a clinical psychoanalysis that have survived intact since your time, Professor Freud are (1) free association and (2) transference; the role of the third primary tenet, interpretation, has been much more subject to question and modification. With the injunction to say whatever comes to mind, the psychoanalytic initiate is introduced to the psychoanalytic goal of free associationthe verbal conveyance, as spontaneous and forthright as possible, of the contents of the mind. To anyone who has ever attempted to do this, it is far easier said than done, and the challenge of free associationthe analytic conduit to psychic materialis negotiated over and over as hitches, technically referred to as resistances, both conscious and unconscious, to another layer of thoughtfeeling wishfantasy are encountered and surmounted, only to yield to the next stratum. The frequency of analytic sessions (usually a minimum of three a week) and the traditional lying down position facilitate free association, intensification of transference, and the potential for regression. Analyses differ greatly in the degree of unraveling or regression that takes place, sometimes referred

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to as the depth of an analysis. How far can one go in reliving or reconnecting with early experience, and what exactly is encountered? From one perspective, the journey into the interior of the mind, free associations providing a running account of the lay of the land, is like a journey into another world, and it is no accident that a typical photograph or painting in analytic waiting and consulting rooms depicts a road that slowly winds out of sight until it disappears from view. I recall a period from my own analysis with a nostalgia that attends memories of pristine, blissful states of being, during which I lay on the couch and watched myself drift slowly and steadily downstream on a raftlike structure. The image, I thought afterward, may have been derived from a forgotten memory of an illustration in a seventh-grade Huckleberry Finn text, part of the blurring or confusion that often confounds the source of memory: Was it first- or secondhand, did it happen to me or was I told about it? I felt held or buoyed on gently rocking water that reflected glints of suna vast, open expanse that was strangely unthreatening and even welcoming. Was this a replay of an infantile, perhaps even a prenatal, experience, or was it perhaps a recasting in archetypal water imagery of a new experience in the analysis? Boundaries waver in analysis, and what is actual or illusory, real or transference, objective or subjective, and recalled or imagined is called into question. Today, a little more than a century since your creation of the field, the practice of psychoanalysis seems both daunted and daunting. For several decades in this country, from the 1940s through the 1960s, psychoanalysis was embraced by the liberal intelligentsiaMary McCarthy, Diana and Lionel Trilling, David Rieff, Saul Bellow, and Philip Roth were among many enthusiastsas the road to the examined life. There are many explanations for the growing disenchantment with psychoanalysis and its disenfranchisement as a treatment and theory; in some college Introductory Psychology classes today it barely merits an honorable mention. To begin with, there is no professional situation quite comparable to psychoanalysis: a service profession composed of relatively few patients who occupy a considerable chunk of weekly time (three to five sessions a week) and contribute a

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considerable portion of the analysts incomeall this going on over several years. Many analysts in New York City currently charge between $250 to $350 a session (although a New York Times article by Eric Konigsberg in 2008 chronicled the analysts of the super rich, who charged as much as $600 an hour). This makes psychoanalysis, or even a once-weekly psychotherapy session, inconceivable for the majority of people and puts it in the category of luxury items and services, like spa treatments or designer handbags, for the wealthy and privileged. Viewed from another perspective, however, psychoanalysts need to make a living, and as is frequently pointed out, medical specialists can squeeze in several patients in the same time frame of 45 or 50 minutes in which therapists and analysts meet with one patient. In the mental health field in general, the neurobiological reconfiguration of psychiatry, the conversion of psychological problems into brain irregularities and anomalies treatable with medicationsanti-anxiety, anti-depression, and anti-obsessional, to name somecorresponds with the prevailing orientation of the quick fix and evidence-based validation. Managed health care plans cover only a fixed number of psychotherapy sessions or short-term therapy for which concrete and quantifiable results can be demonstrated. Although there are private and hospital outpatient clinics as well as psychoanalytic instituteaffiliated clinics that offer psychotherapy and psychoanalysis on a sliding scale, in which the treatment may be good, it is also true that the therapists are often students and candidates whose changing life circumstances tend to disrupt the possibility of sustained treatment. It is indisputable that the once radical ideas about sexuality and unconscious motivation unveiled by psychoanalysis have been tempered by overfamiliarity and absorbed into the culture at large. But the depreciation of psychoanalysis is also a by-product of a zeitgeist in which the intrinsic and often intangible value of knowledge and education, and of self-knowledge and self-examination, has been supplanted by the appeal of material and pragmatic goals. Over several months, I would regularly pass a bookshop window that featured the ominous title Educations End: Why Our Colleges and Universities Have Given Up on the Meaning of Life; at many Ivy League colleges, where economics is one of the more

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popular majors, students opt for preprofessional training rather than a broad liberal arts education. At psychoanalytic training institutes it is often difficult for candidates to secure control or training casesprospective analysands who sign on with analystsin-training, usually at a low rate (sometimes as low as $10 a session). Here the issue is not the cost of the analysis but the low valuation of the opportunity offeredwhat might be regarded as the gift of self-knowledge. The gratifications of instantaneous communicationtexting, Facebook, and bloggingare immediate and obvious and erode the value of the slow and arduous route to communication and understanding offered by psychoanalysis. We seem to be transfixed in our culture by the allure of performance and public presentation, and a climate in which the exterior signifies the interior, where what you see and hear is what is true and real (no matter how often this fantasy is belied) is not receptive to the ideals of psychoanalysis. Psychoanalytic exploration and research have yielded rich and precise data about psychological development and malformation, but as the range of psychoanalysis has expanded to include previously untreatable pathologies, the length of treatment has expanded as well. Time and money intersect as variables both in training and treatment, and there have been varied attempts to deal both with the length of training entailed in becoming a psychoanalyst, as well as the duration of treatment. All over the city there are programs, often contained within standard training programs, which offer a shorter course to becoming a psychotherapist and psychoanalyst. Training is abbreviated and diluted, as are treatments that attempt to identify and confront the core of the problem without too much dillydallying. Viewers of the popular television series In Treatment, which covered one therapists work with four different patients from Monday to Thursday and then his own Friday supervision, got a somewhat exaggerated version of the popular Relational approach. The therapist, Paul, does not hide behind the standard classical psychoanalytic mask and, in fact, seems very real in his presentation of himself and disclosure to patientsat times confusingly and alarmingly so. We learn from his supervisory sessions about the problems in Pauls own life that color his perception and judgment with his patients (the

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contemporary emphasis on the role of countertransference in the analysts work), but his interpretive method is almost stereotypical as he shifts from empathic listening to a nosedive for the latent conflict or unexpressed wish that hides beneath the patients manifest declaration. In Treatment (which was actually successful in kindling interest in psychotherapy in its original Israeli audience), is a television dramatization of psychodynamic therapy that is based on the psychoanalytic principles that unconscious mental life and conflict produce symptoms, influence feelings and behavior, and infuse the experience of oneself and others. But although psychoanalysis and psychoanalytically based therapy derive from the same matrix, in their application they are very different. For example, Paul, the therapist in the television show, actually sees his patients only once a weeka more practicable situation, admittedly, for most people and insurance companies. How does psychoanalysis differ from psychoanalytically based therapy, and what does each treatment offer and for whom? A broad working definition is that psychoanalysis is an intensive treatment in which an established frequency of sessions creates a setting that facilitates both free association and the emergence of transference patternsthe sine qua non of psychoanalysis. While psychodynamic psychotherapy taps into the entire psychoanalytic database (which is why a thorough psychoanalytic training is necessary), its implementation is more condensed: There are fewer sessions (often just once a week), and the elements of treatment (free association, transference, and regression) are worked with in a more abridged form. Without the luxury of back-to-back sessions that facilitate a kind of organic and rhythmic unfolding, many therapists find that psychotherapy imposes much more of an in the moment challenge. Innumerable conferences and articles have been devoted to the pros and cons of psychoanalysis versus psychotherapy, and one seemingly paradoxical findingsince psychoanalysis was developed for and is still most easily applied to neurotic disordersis that while patients with less severe pathology can gain a great deal from psychotherapy, people with more severe character pathology require the intensity of a psychoanalysis, specifically the personality unraveling and subsequent reintegration that it allows

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for, to make substantial changes in their mental functioning and the quality of their lives. To judge from the mushrooming of new institutes of psychotherapy and shorter training programs within established psychoanalytic institutes, many people are interested in becoming psychotherapists, while there are fewer candidates for traditional psychoanalytic training and for psychoanalysis as a treatment choice. For those who elect full-scale psychoanalytic training, the supply of certified psychoanalysts exceeds the demand in the population, and as psychotherapists they compete with psychotherapists of all stripes and denominations. The analytic institute can feel like a sequestered haven in which psychoanalysis is an in house specialty, tendered by training analysts (who have to earn their institutional stripes) to analytic candidates. Within the institute this situation intensifies the political jockeying for power and position by senior analysts who may represent different orientations, a situation that is matched on the outside by the rivalry between competing institutes. The credo of privacy and secrecy so crucial to the analytic process pervades aspects of analytic training, where it seems less constructive. In my years of training, the contemporary challenges facing the would-be practitioner of psychoanalysis were rarely if ever openly addressed, although many recent graduates find themselves with few and sometimes no analytic cases. A hostile attitude to psychoanalysis in the larger world exacerbates the clubhouse atmosphere of psychoanalytic training and the stance of self-protection that discourages the freedom to question and explore that is integral to the learning process. While winds of uncertainty assail the relevance of psychoanalysis at the beginning of the twenty-first century, I look forward every week to a study group that beckons at weeks end as a bulwark of psychoanalytic tradition and continuity. Every Friday morning, seven psychoanalysts gather around the dining room table of Dr. Martin Bergmann, who at 98 is still a sought-after teacher of the history of psychoanalysis; he conducts a daily study group in addition to his private practice. The ambience of the room is gracefully Old World European, with a nod to both East and West, and a touch of the modern blended with the classical the convergence of cultural and historical layers of civilization

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that you, Professor Freud, so appreciated. At the center of the oblong table, a brass planter with a flowering plant sits on an embroidered Oriental cloth; a watercolor by the Israeli landscape artist, Anna Ticho, hangs on one wall, while from the opposite wall a carved wood Madonnalike figure looks down beneficently from her pedestal at the rooms inhabitants. Dr. Bergmann has what he might term a near apostolic connection to you, Professor Freud, because his teachers were Siegfried Bernheim, Paul Federn, and Theodor Reik, who knew you personally, and he was analyzed by Dr. Edith Jacobson, an important neo-Freudian theorist. In his education Dr. Bergmann exemplifies the humanistclassical tradition that grounded your thinkingknowledge of the great works of philosophy, religion, and literature of Western civilization. He can quote you chapter and verse, and is a part of a generation of psychoanalysts trained in the belief in your absolute, near-infallible authority. In this he is very different from his students, most of whom have been infused with the postmodern influence that almost every idea is relative or contextual. And yet, in the decade that I have been in the study group, in the eyes of his students certainly, Dr. Bergmann seems to have lived up to his own ideal that the aim of psychoanalysis is to make sure that you dont stop growing. By his own admission, he is now more independent of Freud, and although no less admiring of your brilliant feats, he is more inclined to study you in a historical context and to regard psychoanalytic constructs as ideas to evaluate and sometimes critique rather than as articles of faith. Dr. Bergmanns disposition inclines him to the Aristotelian endorsement of moderation: Over decades of clinical practice and teaching of psychoanalysis, he has witnessed the vicissitudes of changing trends and emphases in the field, reinforcing in him an attitude of respect for tradition with an open mind to revision and innovation. In the course of one century there has been a giant expansion in the range and depth of psychoanalytic exploration and knowledge. Viewed from the turn of a new century, psychoanalysis seems to have lost popularity as a treatment choice, but in heartening testament to its theoretical and technical develop-

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ments, there are new populations of prospective analysands who would have been unimaginable in your time, Professor Freud: patients with severe narcissistic pathology, adults in their sixties and seventies, homosexualsmany in committed relationships and raising childrenand people from diverse racial and ethnic backgrounds. Your original goals for psychoanalytic treatmentthe capacity to love and to workremain the same, but it is possible to apply them to a new widening scope of people. Enthusiasm about the talking cure declined in the age of psychopharmacology, with its relatively cheap and quick cures for emotional troubles, but the pendulum is shifting again, with the recognition of the limited and sometimes superficial effects of medication. In an inverse shift, the efficacy of the talking cure is being validated by neuroscience research that continues to demonstrate positive and lasting alterations in brain functioning that occur in a therapy that is experienced as beneficial. A few concluding words, Professor Freud. For the last two years, the Friday study group to which I belong has been dedicated to a close textual reading and analysis of your writings. Often in reading a line or paragraph of yours, I feel a thrill of recognition, as one does at times in encountering a great literary or artistic work that stimulates a stirring of the unthought known, as the psychoanalyst Christopher Bollas calls it, or intimations of the unconscious and unformulated world that burbles within us. Mostly your tone is magisterial in its pronouncements, like that of a grand Victorian paterfamilias who has seen and knows all, whose view is all-encompassing; yet in between, in seemingly casual asides that hint at doubts and questions suppressed or brushed aside, are presentiments and intuitions of other possibilities, detours that might lead elsewhere and arrive at unexpected doors. These signals were not lost on some of your great psychoanalytic followers, many of whom were eager to note that they heard it first in your words, before they embarked in new directions. Hans Loewald, philosopher turned psychoanalyst, traced the resolution or waning of the Oedipus complex and the development of the superego via a pathway that begins with parricide, the abrogation of the original parental authority and power and their eventual reclamation and internalization in the process of individuation.

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What a towering oedipal figure you have been, and small wonder, perhaps, that only a daughter of yours could dare to carry the mantle of succession. The challenge you have posed to your successors is formidable: a father whose inestimable and unsurpassable achievements threaten to induce paralyzing idealization at one extreme or the temptation to overthrow it all and assert absolute independence at the other. Living nearly a century later, we would be incalculably impoverished without the fruits of your enterprise, Professor Freud although like the effect of the infamous plucked fruit in the Garden of Eden, our eyes have been opened to knowledge that we might prefer not to have: that we are not masters in our own houses; that our Paradise on earth is brief at best or even illusory; that we are born warring creaturesbattling opposing forces even within ourselves. Always you were committed to the search for psychic truth, in the belief that in spite of our resistance, we are better equipped as human beings by the knowledge of what lives inside us, conscious and unconscious. The profession of psycho analysis may seem beleaguered today, devalued in some corners, beset within by raucous pluralism and internecine rivalries, and yet you might proudly point to the legions of your descendants and declare that they number the stars (I hope you do not mind the Biblical reference). And captivated by the sighting and naming of psychic life that you first revealed to us, we soldier on. Respectfully yours, Dinah M. Mendes
20 West 86th Street, #1D New York, NY 10024 E-mail: dinahmendes@mac.com
The Psychoanalytic Review Vol. 98, No. 6, December 2011