Issues of Psychoanalysis in the 21st Century:
From Some Experiences in Japan
Masahisa Nishizono
1.
Periodical
and
cultural
backgrounds
and
the
universality
of
psychoanalysis—from Freud to post-Freud
The discovery of psychoanalysis by Sigmund Freud is said to be one of the greatest
cultural achievements of the 20th century. Psychoanalysis began as a treatment for
hysteria, which is a type of neurosis. It then developed as a treatment for all types of
neurosis, such as phobias and obsessive-compulsive disorders. Followers of Freud
developed psychoanalysis further and applied it to the treatment of mental illnesses
such as schizophrenia and manic-depressive psychosis (currently diagnosed as
‘bipolar disorder’). In the course of developing these treatment methods, moreover,
Freud evolved psychoanalysis from the study of treatment for mental disorders to a
set of “psychological theories for understanding humans.” Psychoanalysis is regarded
as one of the greatest cultural accomplishments of the 20 th century not only because
of its value in therapeutics but also because of its advocacy of “psychological theories
of understanding humans” which was a completely new concept.
What, then, is psychoanalysis?
Freud himself clarified his definition of psychoanalysis in “On the History of the
Psycho-Analytic Movement” (1914). In his view, psychoanalysis is characterized by
the unconscious origins of human thoughts and behavior, childhood experiences
which are related to those origins, and transference and resistance during treatment.
Moreover, as Freud conceptualized anxiety as the core dynamics of human thought
and behavior in “Inhibition, Symptoms and Anxiety” (1926), the concept of anxiety
was said to have become the fourth condition that defines what psychoanalysis is all
about.
The discovery of psychoanalysis took place with patients who were diagnosed with
hysteria, such as “Anna O.” by Joseph Breuer, “The Case of Dora” by Freud, and other
patients introduced in “The Study of Hysteria” co-authored by Breuer and Freud. It
seemed that hysteria was a mental illness that attracted the interest of many
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scientists in the field of psychiatry and neurology at the time.
Horst-Eberhard Richter (1979) brilliantly described the periodical and cultural
backgrounds of Freud’s discovery of psychoanalysis in his book, “A Study of the God
Complex in Western Man.” A summary of the main points of his book is as follows: God
and the Church had supreme power over the individual and social life of Europeans.
However, with Nietzsche proclaiming that “God is dead,” the power of God and the
Church weakened, and people themselves tried to raise themselves to the position of
gods. The industrial revolution, continuing wars, and political turbulence took place,
and existing authorities and rules broke down. Resistance to the prohibition of sex,
especially to discrimination against women which was common up till then, began to
emerge. It brought about conflicts with the old morals that had remained, and became
the cause of rampant incidence of hysteria. Richter considered that Freud’s
psychoanalysis appeared to deal with crises of civilization such as these.
In those days, intelligence and paternity were esteemed as replacements for the
weakened authority of God and the Church. Freud’s psychoanalysis is very revealing
of the spirit of the times in which he lived: we cannot help perceiving intelligence- and
paternity-dominant traits in the series of therapeutic strategies unique to
psychoanalysis, such as an analyst gaining insights into his patients based on
interpretations made according to the basic rules of free association, which Freud had
contrived, rules of abstinence, and the analyst’s behavioral neutrality. Moreover, the
basic rule of free association (“recall the past honestly”) is closely related to unity with
God in Judaism. It is clear from his conversation with Romaine Rolland, featured in
“Civilization and its Discontents” (1930), that Freud shunned Judaism and religion as
being “neurotic acts.” However, it appears that, by replacing the “desire for unifying
with God” in Judaism with the “desire for seeking the truth” which Freud emphasized
as being the highest level of human desire, he worked out a universally insightful
therapy for all humankind. For the purpose of obtaining universality, Freud’s
psychoanalysis seeks the salvation of the mind only in the psychological dimension
and excludes the dimensions of the soul and spirit from its theory. We can now see,
from his “Project for Scientific Psychology” (1895) that, in the course of establishing
psychoanalysis, Freud, who was a physiologist and a scientist of neurosis, held on to
his attitude of respect for intellect as he tried to relate events in the psychological
dimension with the processing that takes place in the brain. Freud was also sensitive
to the spirit of the times he lived in, as the drive theory of Thanatos is said to be
related to his thoughts on human destructiveness that were based on his experience
of confronting the misery of World War I. Thus, at its starting point, psychoanalysis
2
reflected a sense of the times and culture. However, Freud, with the greatness of a
genius, developed psychoanalysis as a universal intellectual property to all humans.
The first half of the one-hundred-year history of psychoanalysis was mostly led by
Freud’s theories. There were, of course, other pioneers who advocated what may be
referred to as the characteristics of modern psychoanalysis, such as Sandor Ferenczi
and Karl Abraham. Ferenczi asserted the importance of the oral-dependent
relationship, and Abraham, the importance of anal erotism-aggression. They both
pointed out issues that are seen in the pre-Oedipal phase, which was the main theme
of Freud, but did not go as far as integrating their thoughts with Freudian theory.
However, post-Freudian psychoanalytic psychology emerged in the latter half of the
100-year-history of psychoanalysis, or, in other words, after World War II. As is
commonly known, the Kleinians and the Independent group advocating the
object-relations theory of psychoanalysis developed in Britain, while modern conflict
theories (Gray, P., 1994, and Busch, F., 1999) and self psychology developed from the
ego psychology of the United States. A number of common characteristics are seen in
these schools: (1) emphasis on the mother-child relationship as a factor affecting
personality development; (2) changes in perceptions of what form the analyst-patient
relationship should ideally take, from placing emphasis on neutrality (Freud) to
neutrality in intimacy (Schafer, R.), the container and contained (Bion, W.R.), the
holding environment (Winnicott, D. M.), a harmonious mix-up (Balint, M.),
complementarity-emphatic understanding (Kohut, H.), interpersonal subjectiveness
(Ogden, T. and Stolorow, R. D.), and interpersonal relations (Michell, S.); and (3)
theoretical and technical developments were achieved, stating that transference and
counter-transference should be understood in the context of mutual relationships,
and that counter-transference can be utilized as a forum for treatment or as a clue to
understanding a patient. These kinds of therapeutic relationships are said to
emphasize “here and now” relationships, which seem to reflect the zeitgeist of placing
emphasis on attachment and maternity.
Psychoanalysis underwent a transition from intellect to attachment, and from
paternity to maternity, in response to the changing zeitgeist. Objectives of
psychoanalytic treatment today, or mental illnesses of modern people, have, in many
cases, the features of social disorders. The biggest issue in psychoanalysis may be
how to develop itself to support analysands in obtaining psychological growth and
insight.
2. Introduction and development of psychoanalysis in Japan: Psychoanalysis
3
with emphasis on the mother-child relationship
Since the Meiji Restoration of 1868, Japan has followed the path of modernization, and
worked vigorously to absorb Western civilization. The Japanese people typically have
strong curiosity to begin with, and, partly because of this national character, Freud’s
papers were introduced to Japan and translated into Japanese at an early stage.
However, simply reading books does not necessarily guarantee that correct
psychoanalytic treatment can be performed. Psychoanalysis as a form of treatment
began in Japan with Professor Kiyoyasu Marui. While studying neurology at Johns
Hopkins University in the US, Marui audited a course on psychoanalysis and, based on
that understanding, energetically performed treatments at Tohoku University where
he was assigned to work after returning to Japan. However, such practice did not
spread to the rest of Japan. The technique Marui used, although adopting the free
association method, entailed little or no understanding of the therapist-patient
relationship, or, in other words, of transference and counter-transference. It was said
his “treatment” consisted of merely explaining the meaning of the symptoms that
were manifested as symbols, and not much more. The abilities of a therapist in
psychoanalytic
treatment
hinge
upon
his
or
her
understanding
of
the
transference-countertransference concept and its therapeutic application. Training as
a therapist is essential for this. Even if Kosawa had wished to undergo adequate
psychoanalytic training, however, no systematic training setup was in place in those
days, even in the US, so his wish was not granted. It was Heisaku Kosawa, assistant
professor to Marui, who began offering psychoanalytic training in Japan. Kosawa
studied under Freud from 1932 to 1933, received training analysis from Richard
Sterba and supervision from Paul Federn, then returned to Japan and began
performing psychoanalytic treatment in Tokyo. However, Kosawa had to wait until the
end of the Second World War—when social structural changes occurred in Japan as it
changed from being a totalitarian to a democratic nation—to be able to start providing
training in psychoanalysis to his successors, based on his academic knowledge and
learning. Psychoanalysis can be properly accepted and accommodated only if society
allows individuals to determine their own lives according to their own will. In 1955,
with the approval of the International Psychoanalytical Association (IPA), Kosawa
established the Japan Psychoanalytic Society as a branch of the former. This
organization carries out the screening of candidate students, conducts training
analyses, supervisions, and seminars, evaluates and approves candidates’ abilities,
and certifies them as psychoanalysts. All these processes are carried out in
4
compliance with IPA’s international standards. Currently, the Society has about 40
members and about half as many candidates. At the same time, Kosawa established
the Japan Psychoanalytical Association. This is a domestic-oriented organization with
the objective of spreading the concept of psychoanalysis to the psychiatric and clinical
psychology sectors. Members of the Society comprise the Association’s core members
and serve as its leaders. In other words, the two organizations demonstrate a type of
concentric function. Currently, the Association has over 2,500 members. Because the
number of training analysts was insufficient, the needs of students who sought
training could not be adequately met; and, ever since Kosawa received training in
Vienna, overseas training has become the tradition, so quite a number of individuals
receive training in the UK and the US. A characteristic feature, however, is that, even
though students who have undergone training overseas and returned to Japan have
had a variety of experiences and studied a variety of schools and traditions, once they
are certified by the Society in Japan as a psychotherapist, they respect each other’s
standpoints and opinions, and cooperate with one another.
Thus, the Society and the Association were launched in 1955. One academic
characteristic that was seen was the strong interest in orality, or preoedipal
mother-child relationships. This, incidentally, was the theme of a paper which Dr.
Kosawa had presented to Freud while studying in Vienna, entitled, “Two Kinds of Guilt
Consciousness” (1954). The paper stated that, besides the Oedipus complex that
Freud discovered, guilt consciousness included that which was directed toward the
“on,” or a feeling of moral indebtedness, that a person feels towards his or her mother.
This is in contrast to Freud, who emphasized the relationship with the father. Moreover,
whereas Freud’s Oedipus complex used a story in Greek mythology as its source text,
Kosawa sought his source in a Buddhist classic, and named it the Ajase Complex,
taken from the name of a prince who was the leading character in the “Sutra of the
Contemplation of Infinite Life,” or Kanmuryo Jukyo. Both Oedipus and Ajase were the
sons of a king, and both killed their fathers. However, in the case of Ajase, his story
focuses first on (1) Ajase’s rancor toward his mother’s egotism surrounding his birth,
then (2) his anger toward his mother who secretly tried to save his father, whom Ajase
locked up in confinement and starved. Although Ajase tries to kill both his parents, he
is reprimanded by his followers and gives up the idea of killing his mother. After his
father’s death, Ajase suffers a severe skin disease that spreads over his entire body.
Thanks to his mother’s devoted care, and because of his encounter with the Buddha,
Ajase is finally saved. Kosawa understood that the source of this story was not in
Ajase’s lust toward his mother, but in his anger toward his mother, the source of his
5
own life, who had betrayed him. “The Amae Theory—Anatomy of Dependence,” a book
written by Takeo Doi in 1973 that enjoys worldwide acclaim today, was also inspired
by the mother-child relationship that had been transferred to an analytic situation. At
present, the theory of “understanding and technique” is all the rage in psychoanalysis
in Japan. This theory, being advocated mostly by analysts who underwent training in
other countries as well as by individuals who were influenced by these analysts, is
based on post-Freudian psychology, which stresses early-stage mother-child
relationships in personality development. I believe that substantiating its similarities
with, and differences from, past theories that have focused on oral-phase regression,
is important in identifying the universality and cultural nature of psychoanalysis.
What I wish to especially point out here is the reinterpretation of Kosawa’s Ajase
complex by Keigo Okonogi (2001). Okonogi took note of the mother’s egotism
described in this Buddhist scripture story which was her egotism as a woman, and
emphasized the child’s “mishô-on,” or prenatal rancor. Okonogi defined this term as
“an individual’s fundamental rancor toward the en or relationship that had created the
self even before he was able to make the choice himself.” This may also be connected
to the concept of “0,” or “ultimate reality” advocated by Wilfred Bion (1965, 1970) that
is currently drawing strong interest among psychoanalysts throughout the world. In
other words, this is absolute anxiety about one’s existence. It is a challenge that the
psychoanalysis of the 21st century must confront.
3. What is psychoanalysis?—One’s inner parents and dialogue with analysts
The structure of a psychoanalytic scene, as Christopher Bollas pointed out in 1999, is
believed to be this: A patient lies on a couch, engaged in free association, and an
analyst, while listening intently, like a mother listening to her child talk, makes
interventions or interpretations based on “psychoanalytic” logic, like a father. In other
words, psychoanalysis may be said to be an analysts’ bridging of a dialogue with one’s
parents that has been incorporated into one’s psyche. I would now like to present
some pictures that artists all over the world have drawn on the themes of “mother and
child” and “father and child,” and study the dialogues with one’s inner parents,
especially problems that are anticipated to occur in the 21st century.
Figure 1 is Picasso’s “Mother and Child”. Here, we can perceive a mother and her child
“trying to become one,” transcending their distinctions. The mother and her child are
6
trying to come as close to each other as possible through the skin of the entire body.
This mother-child image was a theme that numerous other painters besides Picasso
have used in their pictures. We may say that, in these paintings, the painters drew the
concept of integration or coexistence between a mother and her child. Such
coexistence between a mother and her child may be said to be the source of a child’s
mental security and trust. What is more, such mother-child relationship is believed to
be universal in nature.
Figure 2 is “Bo-Peep” by Eastman Johnson. A baby grows up, and, as depicted in this
painting, discovers the fun of playing peek-a-boo. The child begins to recognize the
distinction between the mother and the self. Peek-a-boo is later taken over by
hide-and-seek, which becomes an attempt to ascertain one’s self through
“disappearing and returning” (Daniel M. Freeman, 1998), a process that continues
throughout one’s life. Verbal communication starts between a mother and her child
during the period from peek-a-boo to toddling. Through mother-child relationships
during this period, a child interacts with the outside world to protect the self, and also
develops functions that differentiate the self from the outside world. As Didier Anziew
(1985) referred to it as the “skin ego,” the skin plays an important role. However, a
shocking report was released recently about childrearing in Japan: of the 839 babies
who were studied, 25% “disliked being held” (2004). The study states that one of the
reasons for this may be the growing number of parents who are unable to hold their
babies well. Fred Levin (1991) and other neuro-psychoanalysts point out that
development disturbance during this period affects not only a child’s personality but
also the development of the brain.
From around the time a child begins toddling, their muscular movements and
exploratory behavior increase dramatically. These activities soon become so vigorous
that the mother can no longer control them, and calls on the father to take part.
Recent studies show, however, that a fetus is able to identify its father’s voice, so it is
incorrect to underestimate the role a father plays and his influence on the child. The
father-child relationship during the pre-Oedipal period is a theme that needs to be
studied.
Figure 3: This is a wood-carved figure of St. Anthony of Padua, a priest known for his
love of children, which the author bought at a souvenir shop behind St. Stephan’s
Cathedral in Vienna. The father’s arms are supporting the child’s legs, and the child,
with his muscles taut, holding his back straight, looks toward the front. In my own
experience, it is difficult to find a picture depicting a father and a child. However,
7
although the number of such paintings and photographs is small, they depict the
interaction of muscles between those of the father and those of the child. In them, I
can perceive courage, joy, and challenge. The father-child relationship during the
pre-Oedipal period is a theme that is presently drawing interest among analysts. It is
thought that the disturbances of the self that are presently spreading among children
and adolescents, including apathy/lethargy, social withdrawal and indecisiveness,
may be related to a lack of father-child relationships.
The 21st century will most likely see the spread of families breaking up, divorce of
parents, and transformations of sexual ethics. As a result, the relationships between
fathers and their children will be compelled to change. Psychoanalysts will be called on
to play increasingly important roles from now on.
4. The so-called crisis in psychoanalysis, as well as its revival and
development
Over the past decade, the IPA has been talking frequently about a “crisis in
psychoanalysis”. As a result of influences such as the spread of pharmacotherapy
associated with the development of biological psychiatry, the development of an array
of simpler and more convenient psychotherapies, and, above all, changes in people’s
preferences in that they increasingly favor convenience and ease, the number of
people who seek psychoanalytic treatment as well as individuals who are seeking to
become analysts has declined. These compounding factors are collectively referred to
as the “crisis in psychoanalysis.” Fortunately, as I have stated earlier, psychoanalysis
is well developed in Japan. And, as this Siberian Conference shows, interest in
psychoanalysis is growing in Russia. Of the Asian countries, South Korea, China and
Taiwan have IPA guest study groups, and appear to have responded favorably to the
IPA’s call for participation in this conference. To resolve the “crisis in psychoanalysis,”
the IPA launched the Developing Psychoanalytic Practice and Training (DPPT) project.
As part of this project, a questionnaire survey was conducted to study the actual
status of therapeutic activities of individuals who have newly qualified as
psychoanalysts during the past five years. The results of this survey were reported at
the Presidents’ Meeting held at the IPA’s Rio de Janeiro Congress. Some of the findings
were as follows.
(1) The survey had a response rate of 31%, with one-half of the respondents coming
from Germany, Argentina, Brazil, the Netherlands, Britain, and Finland.
8
(2) The average age of the respondents was 51.4 years; 70% were females; and 56%
were psychologists and 35% were doctors.
(3) The average number of patients the respondents analyzed was 6.16, and the
number of patients of psychotherapies was more or less the same.
(4) Reasons for undergoing analytic treatment were mood disorders (49%),
personality disorders (36%), and psychosis (5%).
(5) As for frequency of treatment, the largest number of respondents cited twice a
week, followed by four times a week and once a week. Some said they provided
treatment five times a week. The criteria for analytic treatment differed among
various countries, with some requiring 4 times a week, while others designating 3
times a week.
What can be considered from these questionnaire survey results is that, first of all,
people who newly became psychoanalysts are middle-aged or older, and comprise a
large number of females. These may show, therefore, that today’s analysts are
required to have holding or containment capabilities as a professional skill. Next is
that, even today, where pharmacotherapy has made tremendous strides, the largest
number of patients suffer mood disorders, followed by personality disorders which are
pathologies that cause changes in personality structure. These, I believe, validate the
importance and the raison d’être of psychoanalytic treatment. One thing that should
be noted, however, is a “dilemma” seen in psychoanalysis: the tendency for the
targets of psychoanalysis to be increasingly restricted to a limited number of people,
because of today’s complicated contemporary living and the bearing of costs of
psychoanalytic treatment. The objectives of psychoanalysis are to enable patients,
within their relationships with analysts, to observe the self, or check/verify the self
through dialogues with their inner parents, thereby discovering their true self. Thus,
the frequency of treatment is an issue that is related to the very essence of such work
process.
The fact that pharmacotherapy has developed extensively, to the extent that it has
become essential to today’s psychiatric treatment, is good news in terms of alleviating
the symptoms and preventing recurrences. However, pharmacotherapy alone cannot
resolve all patients’ problems. Nobel Prize winner Eric Kandel (1998) elucidated the
fact that psychological experience brings about changes to the structure and function
of the brain synapses and said, “All of nurture is ultimately expressed as nature.”
Kandel also concluded that pharmacotherapy prepares the field for the effective action
of psychotherapy. Indeed, psychoanalysis in the 21st century will find its potential in a
dialogue with neuroscience that continues to develop.
9
Another cause of the so-called “crisis in psychoanalysis” is related to Zeitgeist.
Psychoanalysis as initiated by Freud appeared in an age of darkness, where God was
believed to have died, for use as a tool for dealing with the crisis of civilization by
carrying “expectations for intelligence” with it and incorporating the essence of
Judeo-Christian culture. The confusion that occurred in the wake of the fear and
anxiety of human destruction by the Second World War was dealt with by the
emergence of post-Freudian psychology that focused on “healing by affection.” I
believe that expectations for psychoanalytic theories that understand and try to
resolve the anxieties of today’s human beings who are confronting waves of
globalization—which, in a sense, are about losing one’s solid anchor or foothold—are
embodied, paradoxically, in the form of the so-called “crisis in psychoanalysis.” At
present, the psychoanalysis of Bion, who was born in India, is drawing strong interest;
it seems to me that this, in fact, reflects the circumstances I have just described.
Fig. 1 “Mother and Child”
10
Pablo Picasso: 2004-Succession Pablo Picasso-SPDA(JAPAN)
Fig. 2 “Bo-Peep”
Johnson, E.: Amon Carter Museum, Fort Worth, Texas (In) Langer, C. (ed); Mother
and Child in Art. Crescent Books, New York, 1992
Fig. 3 “Father and Child”
A Wooden Doll of St. Anthony of Padua, a souvenir shop, St. Stephan, Vienna, Austria
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