Previous News Items from 1999A Recanting Psychoanalyst - USA September 1999Here are extracts from an address to the American Academy of Psychoanalysis. It was given by Alan A. Stone, who in 1990 defended psychoanalysis in 'American Journal of Psychiatry' in relation to Dr Raphael Osheroff's lawsuit for malpractice against Chestnut Lodge. He now expresses his disillusionment with psychoanalysis and encourages therapists to deal with the 'here and now'. "Early in my career as a psychiatrist and a psychoanalyst I believed that every form of mental illness be it psychosis, neurosis or personality disorder, could be understood in terms of psychoanalytic developmental stages. If one wanted to understand psychopathology better one had to learn more about infant and child development. This idea was basic and it was unquestioned, the secrets to understanding psychopathology were to be found in studying infant and child development. That is what Anna Freud, Ernst Kris, Beata Rank, Margaret Mahler and other's devoted themselves to. And other analysts tried to improve psychoanalytic theory based on these observations. Ideas about the relationship between child development and psychopathology were never questioned, although there was always of course the matter of genetic predisposition. "Our problem is that based on the scientific evidence now available to us, these basic premises may all be incorrect. Our critics may be right. Developmental experience may have very little to do with most forms of psychopathology, and we have no reason to assume that a careful historical reconstruction of those developmental events will have a therapeutic effect. I know that it is difficult to assimilate this idea; it certainly is for me. Recently in reviewing a new psychoanalytic textbook on affect I read, 'There is growing consensus that adult psychopathology can be understood with reference to normal child development.' I nodded inwardly in agreement, but then I stopped in my tracks and thought about those words more carefully as I ask you to do. There is certainly no longer any consensus that schizophrenia, bipolar disorder, depressive disorders or substance abuse can be understood with reference to normal child development. In fact most research psycho pathologists would say that child development explains very little about most so-called Axis 1 disorders. There is of course one very important exception--post-traumatic stress disorder; but the trauma is not crucially related to childhood development. Let me delineate the exact parameters of what I am trying to say. Psychoanalysts can no longer assert that what they learn about their patient's childhood will help them to explain the etiology of the patient's psychopathology, or even of the patient's sexual orientation... "Everything we have learned in recent years about memory has emphasized its plasticity, the ease with which it can be distorted, and the difficulties of reaching a hypothetical veridical memory. Much of what psychoanalysis considered infantile amnesia may be a function of the reorganizing brain rather than the repressing mind. All of this makes the task of constructing meaningful histories of desire in the individual more daunting. This is the post modern world where everything is paradox and hermeneutic uncertainty. "If there is no important connection between childhood events and adult psychopathology, then Freudian theories lose much of their explanatory power. If memory cannot be trusted to construct a self description, what does one do in therapy? Each of you has to solve these problems in your own different ways; there is no unifying paradigm. I can tell you briefly what I do. "I certainly have not given up on psychotherapy but my focus is almost entirely on the here and now, on problem solving, and on helping patients find new strategies and new ways of interacting with the important people in their lives. I still believe that a traditional psychoanalytic experience is the best way to explore the mysterious otherness of one's self. But I do not think psychoanalysis is an adequate form of treatment. There is certainly no reason for psychoanalysts to withhold medication from their patients. "If I can call on Freud after criticizing him so harshly as a moral authority. I would suggest that he would have welcomed Prozac, Ativan, and all the rest. Despite his disclaimer, he himself tried to find such substances that would relieve human suffering. "Now it will not be too much of a leap for those of you who are analysts if I were to say that we analysts idealize our own analysts and that this is an element in our institutional politics and divisiveness. For most of my life I have had some sort of idealized transference to Sigmund Freud. I have read and reread the collected works for 45 years and taught them for almost as long. As one might feel toward an idealized psychoanalyst I was able to overlook the negative things I learned along the way including Freud's own boundary violations. Long ago on reading that Freud had himself analyzed Anna Freud--I somehow dismissed it as necessary under the circumstances. What somehow broke through this idealization was my discovery of the Horace Frink affair. "The details of the Horace Frink affair have been authenticated by Professor Gay of Yale, the author of the definitive biography of Freud. Frink had trained in psychiatry under Adolph Meyer at Johns Hopkins. He later settled with his wife and children in New York, where he began to practice psychoanalysis without any real training as was the custom at the time. Among his patients was a woman who was a New York socialite married to a fabulously wealthy man. Frink began to have an affair with her which he interrupted to go to Vienna for an analysis with Freud. Frink had one distinction of importance among analysts in New York at the time--he was not Jewish. Reminiscent of his early elevation of Carl Jung, Freud had the idea of installing Frink as the head of the New York/American Psychoanalytic Association, much to the chagrin of analysts like Abraham Brill who had much better credentials. After several months of Frink's training analysis in Vienna, Freud instructed him to send for the patient with whom Frink had been having the affair. Freud told this woman that unless she divorced her husband and married Frink, Frink would most certainly become a homosexual. The woman agreed to Freud's drastic remedy and over her husband's bitter objection was divorced and married Frink, her analyst; The exchange of letters between this husband and Freud I found appalling. Frink's wife also accepted Freud's verdict. Unfortunately Frink subsequently began to display unmistakable symptoms of serious bipolar disorder, his socialite wife abandoned him, and he eventually returned to Johns Hopkins as a patient. All of this was revealed a few years ago when one of Frink's daughters found her mother's correspondence. "You might say that my reading about the Frink affair was to some extent a mutative experience. It certainly made me question Freud's moral authority. Am I alone in feeling this sense of disillusionment, or am I correct in thinking that others do as well and that is part of our current predicament. "Everywhere I go and talk to other analysts there is the scent of scandal hanging over our idealized leaders." Extracts from 'Where will psychoanalysis survive?'by Alan A. Stone Harvard Review. Jan-Feb. 1997, 34-9 Original (longer) address to American Academy of psychoanalysis, 9 Dec 1995 http://www.harvard-magazine.com/jf97/original.html |