1
.)1002(The First Hundred Years of Psychoanalysis: A Century of Internal Resistance.
Free Associations 8D: (4) 576-590
Saul S. Haimovich
My aim in this paper is to show the strong resistance to the empirical application of
Freudian research principles, especially of the ‘fundamental rule’ for the discovery of
the unconscious, that marks the first hundred years of psychoanalysis. Research by
means of free association is deeply rooted in Freud's concept of the unconscious as a
realm in which logical rules are not valid. Though it is not possible to reach a full
reconstruction of the unconscious by conscious means, free association allows the
nearest approximation.
Below I offer a comparative analysis of the main aspects of traditional psychoanalysis
- social, educational, theoretical and technical - as they developed in the hundred
years after the publication of The Interpretation of Dreams (Freud, 1901) and the
beginnings of the psychoanalytic movement (1902). I will examine these to find out
if, in their present form, they allow the application of the analytical method. My
assumption is that if such application is impossible and free association processes in
personal analysis are even obstructed, then psychoanalysis as it is being practiced now
is driven by defensive needs.
)2The Social and Educational Aspects of Psychoanalysis
I examine these two aspects jointly because psychoanalysts' education determines the
social structure and dynamics of psychoanalytic
- 675 institutes. These educational and social aspects have been fully described in literature
elsewhere (Kirsner, 1998; Rustin, 1991; Young, 1990, 1996). Kirsner studied the
structure, dynamic and development of American societies and institutes and we can
generalize his findings to all societies belonging to the International Psychoanalytic
Association as they all have the same structure. Psychoanalytic organizations are
divided into two, the psychoanalytic association and the institute. One part, the
psychoanalytic association, is composed mainly of those who completed the
educational program. Teachers and candidates, on the other hand, make up the
institute, the educational part. An educational committee consisting of didactic
psychoanalysts directs the institute: they are in charge of education and nomination of
new analysts. The association functions as a stage for lectures and it does not have
any control over education.
Rustin and Kirsner agree that psychoanalytic education is the central element to be
considered if we want to understand the structure, dynamics, politics and changes that
characterize these organizations. According to the psychoanalytic educational model,
a candidate must participate in seminars, and take supervision and didactic analysis.
Psychoanalysts who are educated by means of another type of programme are not
considered as qualified (Bergmann, 1997, p. 81.)
Kirsner argued that these organizations suffer from endemic problems (see also
Bergmann, 1997; Eisold, 1994; Kernberg, 1986, 1996; Stelzer, 1986; Wallerstein,
1993). Besides sectarianism, dogmatism and the schools' phenomena, didactic
analysts' have disproportionate power, originating in their right to analyze candidates
and to decide who will qualify as an analyst. Kirsner described phenomena like
nepotism, favouritism, and candidates' fear to express uncommon opinions or new
ideas. Political and ideological struggles and rivalries are fought around issues like,
who will be appointed as supervisor, and who has the right to train? (Arlow, 1972, p.
559; Kirsner, 2000, pp. 13-71.)
2
Kirsner concluded that most psychoanalytic institutes are unfree associations of
psychoanalysts that have lost the spirit of free inquiry. They teach the truth of the
‘anointed’, conformity is awarded and those who ask questions and expose
differences are rejected (Kirsner, 2000, p. 10.)
Rustin interpreted similar findings differently. He argued that the oligarchic,
authoritarian and arbitrary nature
- 677 of the International Psychoanalytical Association is not only understandable but even
indispensable to psychoanalytic work. Since psychoanalysis crucially involves the
sharing of secrets, he argued, this requires of these organizations, much like other
secret societies, to have a hierarchic, secret, ceremonial structure (Rustin, 1991, p. 4.)
While not denying the importance of Kirsner's research, I think that his ethical and
political criticism does not fully refute Rustin's argument. Though these ethical and
internal political problems are serious, they are not psychoanalysis' main trouble.
Psychoanalysis' big problem is a scientific one, namely the inappropriateness of its
social-educational structure to the kind of scientific work psychoanalysts must do.
Though historical and sociological academic studies, like Kirsner's, are important to
expose collective defences against the application of psychoanalysis, much work
could be saved through an early examination of the way in which psychoanalysis is
practiced. This early examination would consist in a simple comparison and
evaluation of any theoretical, social, technical and educational feature of the work of
psychoanalysts in terms of how they accord with psychoanalytic principles. As said,
psychoanalysis demands the study of our free associations: the work of
psychoanalysis is not accomplished when this crucial condition is ignored. In order to
make psychoanalysis possible, both as a praxis and as a theoretical-scientific model,
organizations should not obstruct free association.
The examination of psychoanalytic organizations and their educational model shows
that they cannot do proper psychoanalytic work. The way in which didactic analysts
teach and evaluate candidates obstructs any true psychoanalytic process of free
association. When the analysand must agree with his analyst's and supervisor's
opinions and theories true psychoanalysis is impossible. When psychoanalysts and
supervisors also evaluate they become representatives of the superego; they cannot
consequently analyze their own ambition for power, authority and prestige. Free
association is abandoned as a central research principle when the analyst who teaches
the method must serve other lords. Therefore, paradoxically, it is not possible to
educate psychoanalysts at ‘psychoanalytic’ institutes, simply due to their basic
institutional-educational structure.
This leaves us with a disturbing question: can we imagine any social organization that
will fit the demands of free
- 675 association? And if the answer to this question is no, then is true psychoanalysis
grounded on free association possible at all?
I shall not attempt to answer these questions here. I would only like to point out that
the typical structure of current psychoanalytic organizations does not reflect a
sufficiently profound consideration of their own implementation of the principles of
Freud's new science. That is to say, psychoanalysts have not bothered to examine the
relationship between their institutions and Freudian working methods. As a result they
contribute to a distorted public and academic conception of psychoanalysis. It must be
said that Freud himself was not fully aware of the fact that he built the foundations for
a movement that would, to a significant extent, contradict his science. I believe that
3
psychoanalysts committed to free association will be able to create social
organizations fitted to it.
)1The Theoretical Aspect
The theoretical aspect is an important element of the collective defensive structure
that has developed among psychoanalysts. Barratt stated that psychoanalysts ‘only
rarely’ explore their own ‘rationalities’ and their resistance to the psychoanalytic
process as they become expressed in their theoretical activity (Barratt, 1994, pp. 6978). This state of affairs becomes even more serious when analysts adopt a theory or
concept because it is accepted in their professional milieu without questioning its
fitness to their associative world. To my best knowledge only Barratt proposed to
study analysts' theoretical activity by trying to classify different kinds of defensive
attitudes. In addition to this I believe it is of special importance to analyze the
defensive theoretical foundations of psychoanalysis as it is practiced. What I will do
below is exactly that.
Before setting out on this I shall offer some clarification about psychoanalysts'
theoretical activity. Freud's statement that free association is the ‘fundamental rule’
for the study of the unconscious created a new scientific situation which has until now
not fully been understood, either by psychoanalysts or by anyone else dealing with
psychoanalysis. What has been especially ignored is that with the foundation of this
principle the concept of theory as foundation of science changed radically, at least in
the field of psychoanalysis. In Freudian science, the theory that
- 675 analysts use is part of the empirical phenomena that they must study. Its social
character, that is, the fact that a large group accepts a theory, cannot be used as a
justification for not analyzing and considering it as external to associative phenomena.
But psychoanalysts do not scrutinize their theories and concepts in analysis. In this
they follow scientific method as it is practiced in physics and philosophy. This
adoption by psychoanalysis of the theoretical foundation of other empirical sciences,
according to which theory and empirics are distinguished, has greatly affected the
nature of psychoanalysis. The theory-empirics dichotomy may be sustainable when
the objects of study are physical but it fails in the study of human phenomena because
here theories themselves are part of the matter under observation. This situation is
well demonstrated in clinical presentations, when empirical material is always
misleadingly exposed to exemplify a concept or a theory.
A possible objection against my argument is that the analysis of theories itself will
always again be informed by some other theory or concept. I fully accept this but
claim that it does not contradict the view previously presented. An important element
of Freudian analytical method is the assumption that the researcher cannot be aware of
everything: analysts must decide when they stop their analysis of foundations and
establish the most convenient working principles for themselves, while being aware
that these principles will at some point be the object of further analysis. What matters
is not that they are influenced by this or that theory but rather if they take their
theoretical decisions after careful reflection on the appropriateness of these decisions
to their own associative world, so as to avoid inconsistency between what they do in
their work and what they say they do.
Theoretical decisions should not be a result of blind adoption and internalization of
theories merely because they are accepted in the professional milieu. At this stage in
the history of psychoanalysis it is especially important to analyze the concepts and
theories considered essential to psychoanalysis because they tend to function as
4
defensive mechanisms. The scope of this paper forces me to postpone the treatment of
the subject of how to develop good psychoanalytic theories and concepts, i.e. theories
and concepts that suit analytic work.
As said, in this part of my paper I will show only how we can investigate the
suitability of theories, concepts, theoretical
- 650 mechanisms and theoretical activity (in general, what analysts say they do) to work by
means of free association (that is, what analysts should be doing). I propose that the
analytical process should always include such an examination so as to avoid defensive
fixation of concepts and theories and the consequent failure of free associative
activity. To exemplify the procedure I have in mind, I will look at psychiatric
concepts that form the basis of psychoanalytic work.
An Analysis of Psychiatric Psychoanalysis
Psychopathological concepts and descriptions of illnesses in Freudian terms constitute
a considerable part of psychoanalytic thought. It is one of the strongest social
defences against a fuller application of Freudian scientific principles. Freud's attitude
towards the relation between psychoanalysis and psychiatry was complex and
contradictory.
On the one hand, Freud himself warned us on many occasions against turning
psychoanalysis into a branch of psychiatry. He was convinced that the adoption of
psychoanalysis by psychiatry was no more than disguised resistance and hostility
(Freud, 1926b, p. 183). He stated clearly that his science was to be considered part of
neither medicine, nor medical psychology and psychopathology, but rather as
constituting the very foundation of any psychology (p. 252). He even thought medical
studies to be unnecessary to psychoanalysts (Jones, 1953-7, vol. 3, p. 289), and
rejected any attempt to draw conclusions about the nature of psychoanalysis from its
medical applications (Freud, 1926b, p. 252-3.)
On the other hand, Freud did not categorically exclude psychiatric conceptions and
kept a strong connection with psychiatric thinking by fitting his theories to psychiatric
nosology. This compromise left its marks on psychoanalytic thought. While
psychiatric thinking defines illnesses according to manifest symptoms and their
combinations (Ackercknecht, 1957, pp. 60-81; Binswanger, 1936; Menninger et al.,
1958, p. 6; Zilboorg and Henry, 1941, 379-478), Freud proposed to refer to what can
be called ‘unconscious symptoms’. For this purpose he used his and Breuer's formula
for the definition of hysteria as distortions of ideo-energetic processes resulting from
different mechanisms of repression of painful thoughts and feelings (see
- 652 Haimovich, 1995, pp. 150-164; 183-202). Freud defined hysteria as the outcome of
the repression to the unconscious of a painful idea and the subsequent displacement of
its energy to the body. Freud named this process of transformation of psychic into
somatic energy ‘conversion’. He then explained obsession as the result of the isolation
of the idea from its energy, with both (idea and energy) remaining conscious. Free
painful energy becomes attached to another, not painful idea which from now on will
appear compulsively. From this it should be clear that Freud abandoned neither
psychiatric terminology and classification, nor the conception of psychic disorders as
illness. This became psychoanalysts' common usage.
Freud's two opposed attitudes towards psychiatry reflect the general contradictory
character of Freudian texts. These contradictions result from the coexistence in
Freud's thought of both revolutionary and conservative conceptions (Haimovich,
1995). On the whole, Freud did not abandon conceptions he adopted at the earliest
5
stages of his work. He rather transformed them while also creating new revolutionary
ones. Frequently he formulated compromise conceptions, as in the case of
psychoanalytic psychiatry.
I have argued that one aspect of Freud's genius was reflected by his struggle with the
basic dichotomies of modern scientific and philosophical thinking about human
phenomena. On the one hand, there is the mind-body, biology-psychology problem,
which he addresses in the early period of his work (1886-1900), and which I call ‘prerevolutionary’. On the other, there is his engagement with the individual-social,
psychology-sociology dichotomy, which characterizes the revolutionary (1900-1905)
and post-revolutionary (1905-onward) periods. When working with these problems,
Freud's views are never one-sided. He often adopted two opposing conceptions. This
leads me to state that we cannot understand Freud without distinguishing between the
revolutionary and the conservative aspects of his complex thinking and without taking
into account these contradictions.
The question then arises: why did Freud firmly and unequivocally assert that
psychoanalysis is not a branch of psychiatry and medicine and simultaneously use
psychopathological terms and classifications? Why, moreover, did he not abandon the
medical concept of illness? How did Freud ground his belief that psychoanalysis does
not pertain to medicine,
- 651 medical psychology, or psychopathology and cannot even be considered part of
psychology, but rather constitutes the latter's foundation?
I argue that Freud chose the wrong approach when trying to establish his differences
with psychiatry. Throughout his work he tended to do this through a theoretical
approach; his attraction to philosophy, to theoretical systems - a tendency which he
himself bitterly criticized (Freud, 1926, p. 96) - did not serve him well in this respect.
Without denying the importance of his theories, I have tried to show (Haimovich,
1995, pp. 6-97) that the essential difference between Freud's conceptions and those of
psychiatry must be looked for in the manner in which he perceived the phenomena he
studied, and not in his explanatory theories.
It is important to emphasize that the abyss between Freud's work and psychiatry
opened up very early in his work, in his book on hysteria (Breuer and Freud, 1895).
Already here, Freud attributed special importance to the stories told by his patients.
This tendency increased gradually from case to case and it was this, more than
anything else, that shaped his work with analysands. The associations, memories and
ideas reported by his patients, embedded in their particular narrative sequence,
became the phenomena that Freud wished to explain.
This was completely alien to the traditional psychiatric approach to empirical
phenomena. Psychiatrists, now as much as then, build up their picture of an illness by
the combination, organization and classification of symptoms. According to this
approach the symptom has no meaning beyond its identification and classification.
The empirical approach that Freud developed in Studies on Hysteria is very different
from this. For Freud a symptom obtains its special identity and significance according
to its position in the patient's story. We can say that for him no symptom will ever be
the same symptom. Elizabeth's paralysis cannot be the paralysis of any other patient.
Freud's approach and the symptomatic approach differ on three main points:
First, instead of trying to localize and classify symptoms in order to diagnose
illnesses, Freud exposed and tried to understand his patient's story.
6
Second, each element in the story derives its identity in relation to other elements
(e.g., in the famous case of Elizabeth, the nature of her paralysis is determined in
relation to other
- 655 narrative components: the walks she used to take, her guilt feelings, etc.). The sign
that there may be a problem is inconsistency in the narrative rather than any abnormal
behaviour.
Third, psychiatry studies abnormal phenomena, with normal phenomena only
featuring as their background. When the research object is the story, every element in
it, regardless of its (ab)normality, can be important. In fact, while the symptomatic
conception will ignore most narrative elements because they are ‘normal’ (e.g., in
Elizabeth's case: sitting near her father's bed, walking with her lover, guilt feelings,
etc.), Freud's early work, by abandoning the distinction between the normal and the
pathological, becomes the study of the normal and quotidian (which now includes
‘abnormal’ phenomena.)
So, though Freud could not furnish a successful explanation, his belief that his science
differed essentially from psychiatry was right. But the difference was not grounded in
any theoretical distinction. Though psychiatry has assimilated Freud's theories and
succeeded to digest even his theory of the unconscious, it has not taken account of this
essential difference in attitudes to human phenomena. Freud's confidence that he had
created a different science originated in his new definition of psychiatric phenomena
and his development of a different way of perceiving these phenomena. Compared
with Freud's new approach, psychiatric perception is a primitive one because it
removes the object of study from its context.
Freud's rejection of the symptomatic view has been considered a result of his
humanistic approach, which led him to focus on the individual (Zilboorg and Henry,
1941, pp. 499-500; 524-5, 1954, pp. 93-4). Zilboorg argued that Freud was ‘a true
disbeliever’ in psychiatric nosology and accused ‘academic scientific psychiatry’ to
be unable to acknowledge the practical importance of ‘individualization’ for a ‘true’
psychopathology. Unlike Zilboorg, I argue that individualism, beyond its humanistic
significance, played a scientific role in Freud's development. Humanism alone cannot
explain why Freud abandoned the symptomatic conception, even if we are convinced
that this ethical factor had a central role. Zilboorg erroneously tried to give an ethical
explanation to a scientific rupture.
The assumption of the categorical, systematic identity of individually different
phenomena is the principle on which any psychopathology and symptomatology are
grounded. This is not so in true psychoanalysis, which makes no compromise
- 655 about the principle of free association. What is important for Freudian
phenomenology is the specificity of each phenomenon and of each individual person,
rather than the commonalities.
The central argument of this section is, indeed, that the use of psychopathological
concepts to refer to psychic phenomena disregards the latter's uniqueness and
individuality. We must, therefore, see the attempt to consider different phenomena in
their similarity as a defensive device directed against a full perception of empirical
phenomena and their meaning. Another aspect of this device is to consider these
phenomena in detachment from their natural context - the life story of a person.
Contrary to the symptomatic approach, the method of free association expounds the
need to consider each phenomenon in its individuality. If this need is not met the
application of the method is incomplete. We can say that any use of
7
psychopathological terms is evidence of the adoption of a pre-Freudian symptomatic
conception and resists the application of psychoanalysis. We can also claim that
psychoanalysis is more scientific than psychiatry because it considers phenomena in
their context. It must, then, be concluded that every ‘psychoanalytic’ psychopathology
is an expression of resistance to a full implementation of the principles of Freudian
science. The fact that the source of this hybrid approach is in Freud himself should not
reduce the force of my argument.
)5The Technical Aspect
According to members of the International Psychoanalytical Association, true
psychoanalysis is possible only when analyst and patient meet five times a week for
fifty-minute sessions. The patient must lie on a couch and the therapist must sit in an
armchair (preferably one similar to Freud's own famous armchair; the style of the
couch allows for more freedom…). These rules are known as the setting of the
analytic treatment and are considered indispensable to it. Traditionally psychoanalysts
must focus on the analysis of the transference and counter-transference and must use
interpretation as its main therapeutic instrument. In addition, psychoanalysts must
take care to be neutral and objective in their relation with patients.
When psychoanalytic theories began to proliferate away from their source, it became
more important to psychoanalysts to
- 656 stress homogeneity in spite of diversity. With the support of a techno-clinical
definition of psychoanalysis, Wallerstein has been able to argue that despite the
multiplicity of psychoanalytic conceptions, psychoanalysis as such is still quite
unitary since psychoanalysts agree on the character of their clinical work (Wallerstein,
1988; also see Esman, 1991, p. 289). Even though there has been criticism from
within psychoanalysis, this has not led to change of the old model:
We may have our doubts about the ideal of the-analyst-as-reflecting-mirror and want
to feel we have left it behind, but we have not yet really replaced it; we have just
made it more user-friendly by not taking it entirely seriously. (Renik, 1995, p. 468)
An important representative of traditional psychoanalysis, Etchegoyen, has admitted
that the technical elements of the model have not undergone any essential change
since Freud formulated them in the first decade of the twentieth century (Etchegoyen,
1986, p. 498). Aware that Freud did not regard all the components of the common
model as imperative and presented them as suggestions which analysts may adopt at
their convenience, Etchegoyen states that Freud's followers nevertheless took them
over, regarding them as indispensable to psychoanalytic work.
So for instance Etchegoyen dwells extensively on the question of whether or not
psychoanalysis is possible when analyst and patient meet only four times a week, and
then states categorically that it is possible only when there are five meetings: ‘The
frequency and duration of the sessions are absolute rather than relative constants’ (p.
512). Why? Etchegoyen's pseudoscientific argument runs as follows: Freud deduced
the defining hypotheses of psychoanalysis from empirical observations, and ‘the rules
that constitute the setting and without which psychoanalysis cannot occur’ derive
from these hypotheses (p. 509). ‘The constants of the setting are, then, empirical rules
dictated by Freud on the basis of his clinical experience, which led him to set up a
definite and strict framework in his relation to the patient, so that the treatment could
develop in the best way possible, with the least possible disturbance’ (p. 511.)
In addition there is the ‘therapeutic argument’: the setting is necessary for the patient's
sake (p. 511), and the ethical
- 655 -
8
argument: he who does not keep the setting is regarded as cither childish or perverse!
(p. 13). And if all this is not enough to intimidate independently-minded candidates,
Etchegoyen offers a religious, even mystic, argument, in which Freud rises to the
level of divinity: ‘In the beginning, as stated in Genesis, there was chaos. There were
only variables. Freud arrives and establishes order: there will be six sessions per
week, one a day; a particular hour belongs to a particular patient, and neither the
patient nor Freud change it, and so forth’ (p. 510.)
Etchegoyen is paradigmatic of the many publications that all aim to prove that
psychoanalysis is possible only if the setting established by Psychoanalytic
Association is kept.
The analysis of psychoanalytic technique and its theory reveals the same fixation and
denial of individualism that I mentioned in earlier sections of this article. As shown
before, these features do not allow work by means of free association.
)5Psychoanalysts' Collective Defences and their Resistance to the Application of
Psychoanalysis
My simple comparison between the conditions that must be fulfilled to work with free
association, on the one hand, and today's psychoanalytic practice, on the other, leads
to two conclusions. First, there is a tendency in the field of psychoanalysis to fixate
behaviours and concepts that impede the free stream of associations and their
observation. Second, there is a marked trend to violate the basic logical and scientific
demand of free association. According to this principle each association must be
considered in its individuality and specificity despite its similarities to other
associations. This does not disqualify classification of associations according to
different criteria, so long as the principle is preserved. What must be rejected is those
approaches that classify associations according to external criteria, that is, criteria that
have not evolved from the observation of associations and their characteristics, as is
the case with psychiatric classifications. Moreover, the logic of free association
precludes fixing the meanings of phenomena.
I argue therefore that disregard for the necessary conditions of free association
constitutes the main feature of twentieth century psychoanalysis. This results from a
powerfully
- 657 defensive process, which has many expressions and plays an important role in the
building of therapists' certainties and sense of security. Those who join
psychoanalytical organizations internalize these defensive social, theoretical and
behavioural structures and attitudes and thereby become part of an historical process
opposed to psychoanalytic work. The insertion of the individual in these structures
occurs through the same type of primitive identifications and idealizations as depicted
by Freud in his book on the ego and mass psychology. In it, Freud indicated that
abstract ideas could fulfil a role similar to that of the Pope or the chief of an army
(Freud, 1921, p. 100). People identify with them and by means of this identification
identify with each other. Jaques (1955) argued that social systems do not only serve
constructive aims and do not express only libidinal drives. According to him one of
the main ties uniting people in organized societies is the defence against psychotic
anxieties.
Finally, I would like to repeat that the aim of the depicted defensive social processes
which characterize psychoanalysis today is to stop the development of Freudian
science through resistance to work according to the principle of free association.
There is no doubt that the full implementation of this principle has a very high anxiety
9
potential. And it is precisely these anxieties that psychoanalysts try to stave off
through the fixation of their educational, institutional, theoretical and technical ideas.
‘Primary’ social structures like the ones referred to here do not allow true
psychoanalytic work because they do not allow free association. To enable true
psychoanalytic work, which is attentive to, and preserves, psychoanalytic scientific
principles, psychoanalysts must study in and belong to institutions with ‘secondary’
mature structures, in which individuality is strictly respected. I believe that careful
application of the scientific conditions of the ‘fundamental rule’ of free association
will also lead to development of mature social processes among psychoanalysts.
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- 650 Article Citation
Haimovich, S. S. (2001). The First Hundred Years of Psychoanalysis: A Century of
Internal Resistance. Free Associations 8D: 576-590