SACRAMENTO, JUNE 15, 2015: While searching the abandoned headquarters of the California Psychological Association (CPA), noted UC Berkeley Sociologist W.R.D. Klein discovered documents indicating that a disinformation campaign by major insurance companies during the late 20th century led to the destruction of Psychology as an independent discipline. According to these documents, which were buried in a wall while the building was being remodeled during 1996, officials of Hatena and Get Life insurance companies either influenced CPA officials or, more dramatically, may have actually have placed “moles” within its leadership. The profession of Psychology, which had emerged as a distinct discipline during the 1940’s and flourished through the late 1980’s, was formally incorporated into the medical profession during 2005, thereby terminating its status as an independent field.

Dr. Klein, who specializes in the study of professions in American society, is publishing a book on the demise of Psychology. He believes that the disinformation campaign sought to undermine the integrity of psychologists in the eyes of the American public. Two major themes were stressed in the campaign, he said in an interview yesterday.

First, the CPA placed prescription privileges as its top priority for legislative action during the mid-1990’s. This move, which was crushingly defeated by the California State legislature during 1997, drained resources from the professional organization and was an embarrassing, pUblic humiliation for the profession. In seeking these privileges, Psychology placed itself squarely as an inferior child to Medicine. Klein predicted that, if prescription privileges had passed, it would have had such a divisive effect on the field, would have drained much-needed resources for training in the areas that Psychology already served, would have confused the public, and would have also cemented Psychology as a secondary, inferior specialty to Medicine. The profession would have been destroyed anyway, he believes. He said, “Medicine had relinquished psychotherapy beginning in the 1970′ s, and Psychology lost its golden opportunity to seize that opening to focus on providing those specialized services to the public. Psychologists were already respected for their research, assessment, and teaching services. These skills should have been developed further rather than diluted by merging with Medicine.”

Second, and related to the issue of prescription privileges, the CPA failed to aggressively rally its members around a concerted fight against managed mental health care. In Klein’s view, the problem with managed care was a simple one, namely that it destroyed the psychologist’s ability to provide mental health care services in a confidential and private fashion — an absolute requirement for provision of psychotherapy and psychological assessment. Psychologists were viewed as joining the forces that placed profit before human services, thereby compromising their credibility.

Klein’s book, which he hopes will assist in the re-emergence of Psychology as a profession, includes a section outlining the steps he believes could have saved the profession and, indeed, allowed it to flourish into the 21st Century.

First and foremost, Klein writes, the profession needed a strong call for unity, not instigation of a professional civil war through making prescription privileges a priority. While he tends to be rather gentle and calm in tone, Dr. Klein was forceful on this point. In the course of the interview, he stated, “What were they thinking? With attacks on the profession coming from insurance companies, the medical profession, and some patient groups, to make prescription privileges a priority, thereby squandering resources and causing disunity, is unbelievable.” He believes the profession would have been better served by joining with the other mental health professions, from social workers to marriage counselors to psychiatrists, to combat threats to performing competent psychotherapeutic work, mostly threats that came through managed care companies. other weaknesses he points to include the failure to coordinate, in conjunction with the American Psychological Association, uniform standards for training psychologists. The plethora of unaccredited institutions, as well as some institutions which irresponsibly flooded the state of California with psychologists during the late 20th century, also served to weaken the profession. He also emphasizes that educating the public about the value of psychological services would have been most helpful. Such an educational campaign began during 1996, but was “too little too late.”

The steps that Dr. Klein recommended were not adopted. As a result, CPA membership dwindled. The profession increasingly lost credibility. After the overwhelming defeat of the prescription privileges bill during 1997, the profession essentially collapsed and psychologists were relegated to a clearly subservient role to that of physicians. Dr. Klein added, “We can only hope that had members of the professional organization known of the disinformation campaign during the early 1990’s and taken the necessary steps to counteract it, the profession of Psychology could have survived. Consumers of mental health services in this country would have been much better off with their active participation in, if not dominance of, the mental health field but, alas, such was not the case.”

(Dr. Karbelnig, a past Member of the CPA Board of Directors and current Chair of the Ethics Committee of the San Gabriel Valley Psychological Association, practices psychoanalytic psychotherapy and forensic psychology in South Pasadena, California.)

Psychology’s Clouded Vision

February 27, 2008

Instead of directing their sexuality towards a more conventional object, individuals with perversions deflect their desire elsewhere, be it towards special clothing, shoes or. more dangerously. children or even animals. Professional psychology, on a state and nationwide level, displays a similarly perverse distortion of objectives. Rather than focusing on the true threats to applied psychology. attention has instead been paid to educating psychologists to work with managed care companies, to allowing the proliferation of new doctoral programs and expansions in existing doctoral programs (such as CSPP’s rumored-to-be-soon doubling of their enrollment), and to pursuing the gravest perverse aim of professional psychology–the quest for prescription privileges. The real threats to applied psychology lie in its participation in managed care, the (much less widely publicized) plethora of inadequately-trained psychology graduates from accredited and unaccredited graduate schools. and the waste of time and energy spent pursuing prescription privileges.

So why has psychology’s vision become so clouded? The answer lies in its short history. Beginning during World War II, with the need for mental health practitioners to treat psychologically traumatized soldiers, clinical psychology emerged as the bastard child of medicine, essentially unwanted, relegated to a second-class position, but tolerated due to need.

During the ensuing three decades, with much sweat and toil on the part of its leaders, psychology emerged as a distinct discipline. By the 1970s, it had gained considerable respectability. Psychologists’ expertise in provision of psychotherapy, and psychological and neuropsychological assessments, was well-established. Many psychologists practiced independently. Graduate schools excelled in training psychologists in these basic tasks.

Enter the malignant spread of health maintenance organizations, preferred provider organizations, and the like, commonly referred to as the “industrialization of medicine.” The face of psychology gradually changed. In retrospect, it seems that almost overnight psychology as a profession became influenced by economics rather than ethics. Issues of confidentiality and privacy took the back seat to concerns about cost cutting. By the late 19805, some psychologists began seeking prescription privileges as a way of competing with medicine and working within this time-limited, cost-controlled system. It was then only a short trip to the dark collection of various recently published. particularly nauseating articles in the APA Monitor and The California Psychologist such as one gem which described a psychologist’s discovery of how working for a managed care company, which she had previously viewed. as “the enemy,” proved. to be a rewarding, fulfilling experience.

Because it has been responding to market pressures rather than striving to perfect its services, professional psychology now risks complete destruction. The continued capitulation to managed care forces threaten to destroy the privacy which is ultimately the basic foundation of any psychotherapeutic approach. The inevitable failure of the prescription privileges effort will drain limited financial resources for political lobbying and weaken the profession in the eyes of other professional colleagues, not to mention the public. A final issue, which receives far too little attention, concerns the excessive number of psychology graduates being produced, particularly in California, One recent psychology graduate appeared in Playboy magazine. How many more will be driving taxicabs, working as waiters. or functioning in other businesses? These trends will ultimately diminish the credibility of the entire field, For those who find work in psychology, their fees or salary will be greatly reduced, as will respectability. because supply will exceed demand and the many swollen training programs will inadequately screen or train their graduates.

Perversions typically prove difficult to treat because of the gratification individuals find in the distorted object of desire. A compulsive, self-reinforcing pattern usually develops which ensures the continuation of the behavior. This is just the sort of pattern that has emerged in professional psychology. It has become entrenched in certain paths: Lobbying for prescription privileges when many psychologists are inadequately trained in their basic skills; training psychologists to work within a managed care system which destroys the provision of meaningful psychotherapy with its third party intrusions; and allowing graduate training programs in psychology to proliferate when higher standards for screening and training should be developed instead.

In cases of severe perversions, behavioral changes typically only follow major consequences, i.e. arrest or public exposure. If there is any hope for the future of psychology, it sadly lies on a similar path. As the profession’s credibility with the public plummets, the prescription privileges effort fails, and the number of unemployed psychologists reaches into the hundreds or thousands, perhaps only then our profession’s leadership will focus its attention on these three focal tasks: eliminating managed care in professional psychology, relinquishing the absurd push for prescription privileges, and greatly increasing the standards for professional training through better screening, training, and the elimination of unaccredited schooling. And since, as Tolstoy argued in War and Peace. leadership emerges from the will of the people, the responsibility for ensuring such a movement toward ethics and integrity in our field rests with all of us.

(Dr. Karbelnig, a past Member of the CPA Board of Directors and current Chair of the Ethics Committee of the San Gabriel Valley Psychological Association, practices psychoanalytic psychotherapy and forensic psychology in South Pasadena, California.)

Engaging the Complexities of Human Subjectivity

Abstract

The human mind, being the primary focus of psychoanalysis, can be broadly contextualized in terms of four aspects: the subjective (thought-feeling), the inter-subjective (culture), the objective (brain), and the inter-objective (social systems). No psychoanalytic model can comprehensively account for all of the varied and dynamic components of these quadrants. Therefore, any effort by psychoanalysis to constrain itself to any specific model, be it scientific, hermeneutic, or systems, will fail. Because of the infinite complexity of the contextual variables creating mind, psychoanalysts continually balance the subjective and the objective, and they just as continually improvise. Thus psychoanalysts ultimately function more as healing artists than as natural scientists.

If accurately portrayed, a description of a psychoanalytic session would demonstrate what a marginal place scientism or even strict psychoanalytic theory has in psychoanalytic practice. Science and theory are not absent from the consulting room, but they reside on the sidelines. This, many psychoanalysts might fear, would call into question the validity of their endeavors or risk devaluation of their work compared to their medical or other professional colleagues. Yet by identifying psychoanalysis as a healing art, the field not only proclaims its true nature, but stands poised to evolve with more certitude and less conflict.
Indeed, the work of the psychoanalyst parallels the work of the artist more closely than the work of the medical or other health care practitioner. The number of variables present and interacting during the psychoanalytic exchange approaches the infinite. Unlike the relative precision guiding physicians prescribing antibiotics to treat an infection, for example, psychoanalysts wield ambiguous tools, the greatest being their own personhood. Creativity holds a central, primary place in their work. Their interventions, ranging from offering heartfelt empathy to sophisticated interpretations, are made instantaneously within a dynamic, ever-changing interpersonal field.

The basic aim of psychoanalysts – to achieve personal transformation in the patient – differs from the goal of artists primarily in terms of media. Artists seek to transform the viewer of their artwork; psychoanalysts seek to elicit a personal and enduring transformation in their patients. The psychoanalysts’ art work, co-created with their patients, emerges from specific media – the cultural-psycho-sociobiology of the patient, the cultural-psycho-sociobiology of the psychoanalyst, the linguistic, symbolic order in which these entities are embedded, their interwoven social systems, and then any number of difficult-to-define, ephemeral factors such as conditions of weather, foods or substances recently ingested, relative state of physical health, the global political environment (particularly relevant of late), and literally endless additional factors and their infinite variations and interactions. Some are under the control of psychoanalysts and their patients; most are not. If psychoanalysis were unencumbered by such perverse trends as rigid adherence to scientism or strict psychoanalytic theory, it could finally focus on its true area of study and intervention—the infinite complexities of human subjectivity. In doing so, psychoanalysts could claim their true identity as applied healing artists.

Acknowledging Complexity
The psychoanalytic relationship is characterized by one person, identified as the healer or helper, offering a structured relationship in which a type of “mental” help is proffered. Among the phenomena which then emerge from this structured relationship (and other types of relationships) have been described by psychoanalysis as such things as transference, counter-transference and projective identification. When attention is paid to the mind of one of the participants, phenomena such as the internal object world, differing levels of psychological development, and a variety of defenses erected to guard emotional vulnerability, become evident.

Most mental health professionals agree on such fairly well-understood broad diagnostic categorizations as exist between the neuroses, borderline disorders, and psychoses. Certain well established character styles have been identified, likely of psycho-socio-biological origin, such as those styles commonly known as the hysterical, phobic, paranoid and obsessional. These general categories help in organizing sets of mental phenomena. They abjectly fail to comprehensively define the range of possibilities of mental disturbance.

Regarding interventions, similar categorizations have been made which serve as rough guides for most psychoanalytic practitioners. Michael Balint (1994), for example, views all psychoanalytic interventions as a combination of the object relationship, by which he meant the interpersonal relationship between analyst and patient, and the provision of interpretations. Samples of the more classic psychoanalytic interventions include transference interpretations, frustration of infantile wishes, and confrontation of primitive defense mechanisms, all of which allow for a “working through” of the underlying unconscious conflicts which ultimately caused the character/neurotic symptoms. More contemporary interventions would include provision of affective attunement, optimal frustration, and working through impingements resulting from empathic failures, leading to the growth of the deprived self. Again, these basically classify sets of psychoanalytic “intervention” phenomena. They provide a way to organize what psychoanalysts do. Like all psychoanalytic categories, they offer some order out of the potential chaos of the human interpersonal psychoanalytic interaction. They do not even remotely approach comprehensively defining the ways to help someone in emotional distress.

Viewing the human mind from a broader perspective, Ken Wilber (2000), a contemporary American philosopher, offers an organizational system for understanding any number of fields, including psychoanalysis. Wilber’s philosophy, based on a central idea of the “holon,” seeks to integrate widely disparate disciplines, from biology to sociology to politics to psychology. His philosophy offers a fully contextualized view of human subjectivity. He posits that “reality as a whole is not composed of things or processes, but of holons” which consist of parts which compose wholes which in turn are parts of other wholes (p. 313). In other words, holons, which have many characteristics common to one another, are conceptual units of part-whole relationships. For example, the holon of the human brain consists of atoms which are parts of molecules which are parts of cells which are parts of neuronal tissues, etc. All holons have four aspects, or quadrants, which vary in complexity depending on the intricacy of the holon.

When applying this idea to the phenomena of a component of mind, say a specific thought, notice how that thought has components to it, i.e. language, but is also part of a greater whole, i.e. the brain, the organism, the family, the society, and so on. Beginning with the upper left quadrant of the holon (see Appendix), which describes subjective experience, a thought consists of images, symbols, or concepts experienced in the internal world of the individual. In the upper right quadrant, the realm of objectivity, the thought has correlative brain changes, e.g. changes in levels of dopamine or serotonin, types of neuronal nets or patterns, etc. The third quadrant (lower left) consists of the cultural context, i.e., the thought “I need to do some work on my computer” has an obvious cultural context. It would not have been thought prior to the 1980s. The final quadrant (lower right) concerns the social system which similarly shapes thought, i.e. the so-called “digital divide” which results in many financially impoverished individuals lacking access to computers. Acknowledging the contextual and circular nature of mental phenomena, Wilber writes, “… the social system will have a strong influence on the cultural worldview, which will set limits to the individual thoughts that I can have, which will register in the brain physiology.” (p. 73).

The entire left side of the chart concerns variations of the internal world: The top left represents the internal world of the individual (subjectivity) and the lower left the culture (inter-subjectivity). The right side of the grid views the mind from its objective, observable elements. The top right would be the individual “it,” i.e. the brain, and the bottom right would concern itself with a group of its, i.e., a group of brains or a society. The right side of the grid would be most consistent with the so-called “enlightenment paradigm” which, at its worst, suggests that phenomena are only legitimate if they can be seen, measured, or quantified.

Further acknowledging distinctions between the subjective and the objective, Wilber writes:
The brain is a part of nature, but the mind is not part of the brain. The mind, or consciousness, is the interior dimension, the exterior correlate of which is the objective brain. The mind is an I, the brain is an it. So…the brain, like anything else in empirical nature, can be known by the monological gaze, by empiric-analytic investigation, but the mind can only be known by introspection, communication, and interpretation. You can look at a brain, but you must talk to a mind, and that requires not just observation but interpretation (p. 243)

In the course of observing, interpreting, and helping a human mind, psychoanalysts encounter a literally infinite number of variables and their inter-relations. Because of such complexity, psychoanalysts constantly improvise, rendering their work much more artistic than scientific. This need not lead to any type of diminution in the value of psychoanalysis; on the contrary, it allows for an exaltation of the field which can once and for all relinquish its efforts, historical and contemporary, to somehow cram psychoanalytic theory into the right handed side of the grid. Psychoanalytic theory may offer ideas regarding the functioning of the brain, the evolution of culture, and the impact of social systems. Falling under the spell of the enlightenment paradigm, psychoanalysis, particularly early in its development, felt compelled to offer explanations for other parts of the quadrant, namely the right or “objective” side. However, its real point of inquiry lies purely in the realm of the subjective. If it is to transition into this more integrated paradigm, it must of necessity acknowledge its true realm, the left-sided region, that area of pure human subjectivity, which co-exists with ethics, arts, history, literature and other products of human subjectivity.

The Historical Evolution of the Subjective from the Objective in Psychoanalysis
In its earliest stages, psychoanalysis began in the purely objective, empirical-analytic world. It then deviated away when the astonishing complexity of human subjectivity became evident. Despite its initially being touted as the “talking cure,” Freud unequivocally intended to build a science when he single-handedly started the field. The first sentence in one of his earliest works, the Project for Scientific Psychology (1895) reads, “The intention is to furnish a psychology that shall be a natural science…” (p. 295). He and his colleagues, towards the end of the nineteenth century, completed the process (begun in the prior century) of wresting control over treatment of mental conditions from religion. But towards the end of his life, Freud, perhaps wiser from a half-century of trying, veered away from his purely scientific approach. For example, in his book, Analyses Terminable and Interminable, Freud (1937) referred to what he termed the three impossible professions. He wrote: “It almost looks as if [psycho]analysis were the third of those ‘impossible’ professions in which one can be sure beforehand of achieving unsatisfying results. The other two, which have been known much longer, are education and government” (p. 248). These three fields intervene with groups of human subjectivities; they offer certain types of transformation.

However, they also encounter impossible obstacles—biological, cultural, social differences, resistance to change or learning, and lack of support from related institutions and people, to name but a few. Indeed, in education, government as well as in psychoanalysis, the interventions can similarly be viewed as more art than science for the same reasons discussed earlier. But even these fields have clearer, more empirical paths available to them than are available to practicing psychoanalysts.

Thomas Szasz (1988), a contentious critic of the scientific method in psychoanalysis, also centers psychoanalysis more in the realm of the subjective than the objective. He views the psychoanalytic encounter as a uniquely human form of interaction, writing that:
since therapist and patient judge and influence each other and at the same time examine the standards for their judgments and conduct, psychoanalytic therapy is closely related to ethics, politics, and religion. Accordingly, it is fruitless to approach the problems with which psychoanalysis deals and the solutions it offers for them primarily from the point of view of medicine or traditional psychiatry. Psychoanalysis belongs to the history of ideas and to the history of man’s relation to his fellow man (p. 12)

Representing some of the recent efforts to return psychoanalysis to its scientific roots, Grunbaum (1993) highlighted psychoanalysis’ failures in the foundational aspects of science, i.e., its lack of replicability and testability. A contemporary neuroscientist, Solms (2001), wants to return psychoanalysis to its scientific status by calling it neuro-psychoanalysis. He suggests focusing on neurological changes that result from psychoanalytic treatment. Caws (2003), a contemporary philosopher of science, seeks to establish within psycho-analysis the “idiosyncratic science of the subject” (p. 625). He writes, “Every new patient, in other words, is a new world, whose laws it is the task of the analyst to establish and apply” (p. 619) before concluding that psychoanalysis, “if a science at all,” would land somewhere among the “human sciences” which he defines as entities subject to scientific scrutiny which have a distinctly human basis to them, i.e., institutions, humans themselves, literature, and art (p. 619).
In his recent efforts to meld mental phenomena with the neurosciences, Damasio (2003) reaches a conclusion similar to Szasz’. He cited the work of the philosopher Baruch Spinoza who, unlike Descartes, saw mind and body as one (resulting in his ex-communication first from Judaism and later from Christianity). Spinoza considers the mind body split to be the result of “aspect” as opposed to “substance” dualism. Spinoza concludes that mind and body reflect two versions or “aspects” of the same thing (basically capturing two of Wilber’s four quadrants, or perhaps capturing entirely the two sides of the quadrants, the subjective and the objective). Damasio writes, after Spinoza, that mind and body are no longer required to interact and are instead one entity. He notes that mind and body “spring in parallel from the same substance, fully and mutually mimicking each other in their different manifestations” (p. 209).

Yet Damasio ultimately reaches the conclusion, like Spinoza and Wilber, that the human subjective experience cannot be “reduced” to biology (or, by extension, to cultural or social systems). Damasio continues:
I hope a reductionist research strategy eventually will allow us to explain how we get from the ‘neural-map’ level to the ‘mental’ level, although the mental level will not ‘reduce to’ the neural map level because it possesses emergent properties created from [his italics] the neural-map level. There is nothing magic about those emergent properties, but there is a lot that remains mysterious, given our massive ignorance of what they may involve (p. 327)
But does even he believe that mental life will ultimately be reduced to determined features, as he implies by his phrase “nothing magic about those emergent properties”? Distancing himself still further from the possibility of reducing mental life to the biological, Damasio adds:
A simple neurobiological explanation for the rise of ethics, religion, law and justice is hardly viable… in order to comprehend these cultural phenomena satisfactorily we need to factor in ideas from anthropology, sociology, psychoanalysis and evolutionary psychology as well as finding from studies in the fields of ethics, law, and religion (p. 159-60)

As one psychoanalyst put it, there will be an increased neurophysiology of memory, but there will never be a neurophysiology of a memory. Of course the mind has its biological, social, and cultural substrate. The mind can become troubled by any variation of these four sources. It can similarly receive help from any number of sources, basically paralleling the various ways it can be affected. While it appears that psychological approaches can indeed affect brain functioning, psychoanalysis intervenes purely in the realm of unique human subjectivity, a subjectivity that can and will never be reduced to synaptic clefts or neurotransmitters.

The seemingly relentless emphasis on the sciences, or even on the development of strict psychoanalytic theory, constrains the psycho-analytic encounter, artificially limiting its infinitely complex nature. Horner (2003) writes, “Attempts to reduce or simplify processes to neurological or biochemical factors are, in my opinion, a manifestation of the flight from complexities that confound clinicians and non-clinicians” (p. 3). It may indeed be time to be liberated from the reductionistic frenzy that has plagued the west now for several centuries.

Indeed, one wonders if the surprising absence of the word “art,” from Damasio’s or Szasz’ musings, reflects the residuals of this stranglehold of scientism. They fail to acknowledge an additional aspect of this uniquely human, subjective encounter between two individuals participating in the psychoanalytic endeavor: the two individuals are engaged in a creative enterprise.

Of course human creativity also holds a central place in the evolution of ethics, religion, law and justice. It is the most active aspect of the psychoanalytic process, and arguably its single most powerful aspect. Psychological, sociological, biological and cultural forces all act together to create the problematic character styles and symptom patterns that lead individuals to consult psychoanalysts. It takes courage and creativity for the patient, in the close work of the psychoanalytic encounter, to make changes in attitude, feeling and behavior that herald true personal transformation.

But just when it looks like psychoanalysis has freed itself from the prison of scientism, of pure objectivity, contemporary scholars like Caws and Solms continue to so encapsulate it. Caws ended his 2003 paper with the following sentence, “Between the neurosciences and the human sciences we are now in a position to show how his [Freud’s] science can take its place without apology among the other sciences” (p. 633). The continued pursuit of a central place for science in psychoanalysis, even if within some sort of an idiosyncratic science of the subject, keeps psychoanalysis objectifying the human mind.

But actually psychoanalysts lack any purely technical accoutrements, further rendering their work so much like that of the artist. Even their use of the word “technique” suggests objectivity notably absent from the psychoanalytic encounter. Ironically, with their brushes, paints, and canvases, fine artists may well have more objective tools available to them. Psychoanalysts rely on their own being—an entity parallel to the troubled one which the patient brings to them for help–for their “technical” tools. This is consonant with the Lacanian notion that psychoanalysts make three payments in psychoanalytic sessions: they give of their words, they give of their person, and they give of their desire (Harari & Moncayo, 1997). They watch, participate, and observe as phenomena of human subjectivity, named by psychoanalysts as transference, counter-transference, and projective identification, invade their own personhoods. They translate these phenomena into certain theoretical languages, and then they deliver interpretations using the appropriate lexicon. Because of the complex, dynamic nature of human subjectivity, these “interventions” deviate from the type of algorithmic specificity offered by educational curricula, medical treatments, or legal procedures. Psychoanalytic interventions exist in the world of verbs, not in the world of nouns.

Thus psychoanalysts work in the world of the subject, but also dip into the objective world, in a sort of dialectical dance, back and forth, in order to assist their patients. Their variables range from infinity on the “subjective” end of their work to, perhaps, a single theory based interpretation on the “objective” end. They receive the subject in as broad and undefined a fashion as possible; they also set boundaries, offer emotional support, introduce ideas in the form of interpretations, etc., which serve as a sort of container or structure in which the psychoanalytic work then unfolds. When they offer their humanity, and are as open and receptive as possible to the patient’s full subjectivity, they risk missing an aspect of the patient’s psychic structure. It proves difficult to think of organized aspects of the psyche when in the greatest possible mode of reception. When alert to structural or theoretical aspects of the patient’s experience, they might in contrast miss the subtleties of the patient’s experience–a sad look, a change in voice tone, an unusual gesture. Psychoanalysis proceeds, because the brain functions in a serial as opposed to a parallel processing fashion, by this sort of to-and-fro between subjective presence and the more objective ways of observing and structuring mental experience. However much the patient’s experience might fit into a particular model of the mind, of development, or of interaction, the static nature of the model is always overshadowed by dynamic, ever-changing subjectivity. Psychoanalysts who understand their patients perfectly have, by definition, lost contact with them.

Psychoanalytic theory then, in all of its scientific or unscientific glory, provides but one component of the transformative interaction. Other psychoanalytic “tools” include empathy, human presence, ability to receive projective identifications while observing and not reacting to them, capacity for metabolizing painful emotion, skill in emotional engagement, ability to observe, analyze, synthesize, and explain how theoretical ideas apply to their patients’ unique emotional and interpersonal experiences, and so on. Unlike the artist applying paint to a canvas–in which only one creative entity contacts an inert entity–the art of the psychoanalytic engagement consists of one artist offering up their own subjectivity while applying certain techniques, i.e. empathy, interpretations of externalized internal object relations, and applications of information garnered from self-analysis of counter-transference, to another creative entity. As previously noted, the objective world, analyzable through empirical-analytic science, exists within this engagement. It may be possible to tease out aspects of it for scientific analysis, e.g., specific interactional patterns, levels of serotonin in the brain, and effects on degree of “depression” measured through certain psychometric techniques. But the interaction itself is an art form. The applied sciences, such as medicine, are, in contrast, sciences in which some degree of art is present, mostly because their practitioners, like psychoanalysts, are dealing with their fellow, creative human beings.

Why Resistance to the Concept of Applied Art?
Psychoanalysis resists surrendering to the world of the artist, even the healing artist. It instead clings to variations of logical positivism, scientific materialism, or detailed but often competing psychoanalytic theories. Most psychoanalytic institutes continue to feature regular “scientific meetings” as if such a focus provides a stamp of legitimacy on the topics presented. Why has this occurred?

First, as psychoanalysts from beginners to advanced practitioners would attest, the infinite complexities of the human mind elicit anxiety. The variations of causation, presentation, and interaction are overwhelming. Endless complexity breeds anxiety which in term seeks containment. It would appear only natural to seek structure–oftentimes in rigid systems of classification or theory–on which to hang the psychoanalytic experience. Certainly a number of workable structures have evolved, with variations of scientism being among the favorites. Freud, Jung, Adler, Klein, Fairbairn, Winnicott, and innumerable others have offered fairly systematic approaches to the mind; each has had their cadre of followers or other theorists who have conducted integrations of two or more of these primary theorists. The temptation to circle around one or two specific narratives is nearly irresistible.
Even when considering the artistic nature of psychoanalytic work, recent theorists still yield to the temptation to overly constrict through theory. For example, even though her recent work stresses the need for an open-minded approach to psychoanalytic inquiry, Eckhardt (2000) calls for a specifically anthropological orientation which ends up unnecessarily constricting psychoanalysis. She writes, “The need to embrace wholeheartedly an anthropological orientation is central” (p. 264). This would seem to negate a more open, holistically oriented approach. Even in his recent work promoting a thesis quite similar to this one, Bernstein (2001) limits the type of art practiced by the psychotherapist to the dramatic realm, particularly in view of the re-enacting features of the transference. He writes that “the role of the psychotherapist effectively requires at least as much artistry and skill as that involved in a dramatic performance and the utilization of many of the same skills” (p. 186). Bernstein, like Eckhardt, needlessly limits the range of the art of psychoanalysis. Other interventions, highlighted in the work of any number of different theorists, are also part and parcel of the psychoanalytic process. Constriction in theory restrains creativity. The idea of psychoanalysis as “art” fails to provide sufficient bounds, it appears, and therefore threatens the status quo in the field.

The proliferation of dogma and rigidity results as part of the evolution of any of the professions. Samuel Johnson is purported to have said that all professions are conspiracies against the public. Eckhardt, even though ultimately guilty of the same thing, echoes this sentiment when she elaborates on how the professions reduce open-mindedness and heighten the pressure for conformity. She notes that “some disciplines are less vulnerable to this process, but the discipline of philosophy and psychoanalysis are activities that do not fare well when thus confined” (p. 266). In all likelihood, a competent Freudian likely helps patients just as much as a competent Kleinian or Fairbairnian. Along the same lines, a competent impressionist will not necessarily move a viewer any more than a competent cubist.

Second, the major theorists, as is likely common in other disciplines as well, attract followers in part due to their own certainty and enthusiasm. They espouse a particular theory, or their version of a theory, and then (perhaps unwittingly) promote it through their own teaching and writing. The more brilliant and sometimes charismatic psychoanalysts lead the way, offering their theoretical interpretation of the phenomena of human subjectivity; their less charismatic, more anxious colleagues follow. More radical, revolutionary ideas, such as that all dreams represent repressed wishes, or that the mind is comprised of a collection of unconscious fantasies, have garnered the most attention in the history of psychoanalysis. Revolutionaries inspire followers. Such a leader-follower dynamic also constrains the acceptance of psychoanalysis as an art form. Creativity requires courage. It is one thing to creatively improvise with certain theoretical themes; it is another to rigidly adhere to any one theoretical approach. Passive adherence to rigid theory, as noted before, reduces anxiety but also allows less room for creativity. In its most rigid forms, psychoanalysis becomes a process of following a rough protocol rather than creating a transformative experience for the patient.

Third, most psychoanalytic writers–consistent with this thesis that psychoanalysis is first and foremost a healing art–expound upon their own unique subjective (and creative) experiences with their patients. This explains many of the differences in psychoanalytic theory. Some human phenomena are consistent: transference and counter-transference, as they have been called, for example, or stages of human psychological development (even though described in differing ways). Psychoanalysts have some broad idea of what transference is, even though it has never been defined in a universally understood fashion. Yet the manifestation of the transference will differ according to each unique psychoanalytic dyad. Therefore each psychoanalytic theorist offers ideas about transference which tend to be based on their own unique experiences.

Much psychoanalytic theorizing then may be likened to artists writing an artistic critique of their own work. Like art critics, psychoanalysts writing about technique tend to devote much energy and many hours of time analyzing a session, or a series of sessions, after the transient art of each of those sessions has passed. Such critiques must, of necessity, always miss the immediacy of the healing creation of the psychoanalyst and analysand. Those that have read the most “art criticism,” have spent the most time practicing their art, and are also dedicated members of their particular artistic group, grow ongoing, sometimes powerful reputations in the field of psychoanalysis. They develop their own schools and followers. The idea that psychoanalysis may be reduced to an artistic endeavor appears to frighten many psychoanalytic practitioners, particularly those of the old school, who wish to cling to some form of modern respectability. Zaphiropoulos (2001) notes that many psychoanalysts feel “traumatized by… [anti-scientific critiques] to the extent that it has become important to justify what we do in psychoanalysis” (p. 167). Further, psychoanalysts feel bolstered by “the belief that belonging to science will make us honest or true to ourselves or to the rest of the world” (p. 167).

Fourth, closely related to this objection would be concerns surrounding constraints on research. If psychoanalysis is viewed as more art than science, research possibilities become limited. As noted previously, certain psychotherapeutic approaches, like cognitive-behavioral ones, offer highly specific interventions which can then be paired with highly specific outcome measures, say on a particular psychological test. Such pairings can be useful in assessing psychotherapeutic efficacy. Yet their legitimacy is limited by the specificity of their research protocols. They may be able to show reductions in certain specific, measurable parameters, e.g., level of depression on the Beck Depression Inventory. But how could alterations in internal images of self and other, which in turn improve self-esteem and relationships with others, be measured? How could an increased ability to experience pleasure, due to a working through of guilt over exceeding one’s father’s achievements, be assessed? Whenever scientism reigns supreme, the lack of a research program to substantiate a particular treatment approach becomes a liability. This may be falsely perceived as a weakness of the intervention being studied. Instead, the reasons that the psychoanalytic process may not be subjected to empirical-analytic research may be found in the features of its focus of study, the complexities of human subjectivity. To conclude with finality that psychoanalysis concerns art more than science would be to upset those insistent on it being suitable for scientific scrutiny.

Finally, psychoanalysis has, and continues to be, subject to considerable societal pressure to conform to other movements. In Freud’s day, for example, science was the new god. It was the modern period. It had not been so many years since psychologically disturbed individuals would have found themselves confined to insane asylums run by the Church. In embracing a scientific model for psychological disturbances, Freud increased the legitimacy of the mental health professions. Mental problems became the stuff of men of science, of the then-popular culture. During the 1940s and 1950s, ego psychology held sway, particularly in America, and this allowed for a mechanistic, structured understanding of mental disturbances, which paralleled closely with the long-established industrial prominence of the United States. These represent but a few of the societal trends–begging for conformity by the professional community–that shaped and influenced the evolution of psychoanalytic theory. Consideration of psychoanalysis as an art form would be anything but conformist.
In our current era, two societal forces appear to predominate. One is the fantastic increase in understanding of neuropsychological processes, and the concomitant explosion in the use of psychotropic medications. (The recent press suggests that this trend might have hit its zenith with the increasingly severe concerns over side-effects, questions regarding the true effectiveness of these medications, risks associated with long-term usage, and so on.) People want a rapid, easy solution to their mental pain, and if it comes in the concentrated, daily form of a pill to ingest, then so be it.

The second major recent trend relates to the industrialization of medicine and, with it, the mental health professions. Much like the sociological motivation behind the rise and fall of behaviorism, contemporary society wants a quick, economical solution to emotional distress. Most men who feel anxious regarding their sexual performance, for example, would prefer to take a pill, or have a short term course of cognitive behavioral therapy, rather than take the time to explore what may well be the significant but hidden meaning of their potency difficulties.

These current and historical societal forces, as well as certain features of human nature, i.e., tendencies towards seeking leadership or structure in reaction to anxiety, have thus far prevented the more overt surrender to the arts that would most accurately characterize psychoanalysis. The artist wants to affect his or her audience in some way; the psychoanalyst also wants to do so, in the form of help. Given societal pressures for “treatment,” “medical necessity,” “evidence-based treatments” and the like, it has become politically incorrect to advocate anything but a scientific, empirical approach like the “scientist-practitioner” model (the so-called Boulder model) advocated by the American Psychological Association some years ago. The average psychoanalytic practitioner knows full well the fallacy of applying rigid science or even rigid psychoanalytic theory to the practice of psychoanalysis. To do so would be bad psychoanalysis. As Jasnow (1978) writes, “we talk science, but we do art” (p. 318).

The Wisdom of Viewing Psychoanalysis as Art
Clinical psychoanalysis, then, is purely an applied healing art. By extension, psychoanalysts function as something like applied commercial artists. Between scientists and artists, psychoanalysts are more like artists. Between physicians and poets, psychoanalysts are more like poets. Psychoanalysis could even glorify itself as one of the purist of the healing arts due to their lack of applied technology combined with the variety in the type of human pain that they treat, in the points of view of its various different practitioners, and in the unique signature of each analyst-patient relationship (Ingram, 1994).

In an effort to more fully embrace its artistic nature, and given the four quadrants characteristic of all holonic systems described above, the teaching of clinical psychoanalysis would seem in need of revision. Certainly the various schools of psychoanalytic thought, particularly because they offer rough roadmaps to subjectivity, require continual emphasis. However, the quadrants that form the context of such subjectivity require deeper exploration. It would behoove students and practitioners of psychoanalysis alike to learn more of the inter-subjective world–not just in the sense of any specific psychoanalytic school–but in terms of culture, literature, and history. They would benefit from a deeper exposure to sociology and social systems theory. They might benefit from studies in speech, the pragmatics of human communication, acting, and rhetoric because their work is substantially a process of interpersonal engagement and influence. Finally, the study of the empirical, biological aspects of the mind similarly should be included into psychoanalytic training programs. As was suggested earlier, each patient that presents with some form of subjective distress, say depression or chronic low self-esteem, experiences this discomfort in a cultural, social, and biological context. Because of its unique focus on subjectivity, psychoanalysis must continue its emphasis on the interpretive, hermeneutic realm but need not so completely ignore these crucial contextual components of the mind.

In the final analysis, psychoanalysts require this well-rounded educational background, like a painter needs to master color theory and basic figure drawing, but they must then be liberated to creatively apply their craft. The more skilled the psychoanalyst is in the understanding and interpretation of such basic human subjective phenomena as the unconscious, transference, counter-transference, and so on, and the more creative, the better the psychoanalyst. Just as in the arts, successful psychoanalysts cannot necessarily be taught. They require talent, and much creativity, to apply their “techniques” in a fashion that results in the personal transformation of their patients.

Appendix

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Footnotes

1. The psychoanalytic process finds parallels in warfare. Once an armed engagement has begun, the number of variables at play with one another, and their infinite combinations, quickly overwhelm humans’ capacity for understanding. The term “the fog of war,” attributed to Carl von Clausewitz’ text On War, has been used to describe how, in war, things can often appear to be not as they seem, and events, which unfold quickly, may become contradictory, blurred, and confused.
2. Psychoanalysts may theorize in certain technical terms but ideally communicate with their patients in as experience-near a fashion as possible. That is why it is ironic that, among the most humanistic of the modern psychoanalytic theories, self-psychology and inter-subjectivity theory, phrases such as “insecure attachment,” “affect regulation” and “affective attunement,” which reek of logical positivism, enjoy so much popularity. These theories espouse close connection with the patient but nonetheless use language that describes the human as some sort of machine.
3 Ironically for a philosopher seeking the science of psychoanalysis, Caws acknowledges his own doubts in his use of this phrase, “if a science at all.”
4 Certainly psychoanalysts work with individuals with medical conditions, and those conditions are subject to intense scientific scrutiny. Patients with bipolar disorder, or schizophrenia, likely have a neurological disorder, as yet still only loosely defined and understood, but nonetheless impacting the functioning of their brains. While it appears that psychological approaches can indeed affect brain functioning, psychoanalysis intervenes purely in the realm of unique human subjectivity, a subjectivity that can and will never be reduced to synaptic clefts or neurotransmitters.
5 The Oxford English Dictionary (2002) describes the word “technique,” as the “manner of especially artistic execution or performance in relation to mechanical or formal details; the mechanical or formal part of an art” (p. 3197, italics added).
6 Indeed, because of their devotion to helping individuals achieve personal freedom, psychoanalysts would likely be among the first to be executed in any fascist government. It is precisely because they are artists that they stand outside of society, advocating for the internal freedom of the individual, that they risk being perceived as threatening. Psychoanalysts refuse to overuse psychotropic medications, contrary to the wishes of multinational drug companies; they refuse to cram their patient’s problems into an eight-session managed care model; they refuse to reduce these difficulties to a set of identifiable “symptoms” requiring “treatment”; they refuse to conform to societal trends touted by the contemporary media. They instead seek freedom of thought and desire in the individuals they treat.

References
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Freud, S. (1937). Analyses terminable and unterminable. Standard Edition, 23, 216-253.

Wittgenstein, L. (1958). Philosophical Investigations (3rd ed.). Upper Saddle River, NJ: Basil Blackwell & Mott, Ltd.

Jasnow, A. (1978). The psychotherapist – artist and/or scientist? Psychotherapy: Theory, Research and Practice, 15, 318-322.

Szasz, T. (1988). The Ethics of Psychoanalysis. Syracuse: Syracuse University Press.

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Ingram, D. (1994). Poststructuralist interpretation of the psychoanalytic relationship. Journal of the American Academy of Psychoanalysis, 22, 47-62.

Harari, R., & Moncayo, R. (1997). Principles of Lacanian practice. Anamorphosis: The Journal of San Francisco Society for Lacanian Studies and the Lacanian School of Psychoanalysis, 1, 13-28.

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Bernstein, A. (2001). Psychotherapy as a performing art. Modern Psychoanalysis, 26, 183-190.

Solms, M. (2001, November). What is neuropsychoanalysis? Keynote address presented at the meeting of the Association for the Psychoanalysis of Culture and Society, Rutgers University, New Brunswick, NJ.

Zaphiropoulos, M.(2001). Can psychoanalysis be a science? International Forum of Psychoanalysis, 10, 163-169. Shorter Oxford English Dictionary (Fifth Edition). (2002). Oxford,England: Oxford University Press.

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By Alan Karbelnig, Ph.D.

(Dr. Karbelnig, a past Member of the CPA Board of Directors and current Chair of the Ethics Committee of the San Gabriel Valley Psychological Association, practices psychoanalytic psychotherapy and forensic psychology in South Pasadena, California.)

Karbelnig, A. (2005). Psychoanalysis as healing art: Engaging the complexity of human subjectivity. (Scholarly article). [Currently being edited.]