Book Review
Psychotherapy
Unfree Associations: Inside Psychoanalytic Institutes.
Douglas Kirsner. London (UK): Process Press; 2000. 324 p. US$27.20.
Reviewer
rating*: Good
Review by Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
This book comprises 4 initial chapters—each devoted to the
psychoanalytic institutes in New York, Boston, Chicago, and Los
Angeles—and a concluding chapter entitled “The Trouble
with Psychoanalytic Institutes.” In its account of hostile
and irrational functioning within groups of presumably intelligent,
highly educated, and psychologically insightful individuals, this
text provides ample data for anyone who needs to be disillusioned.
A common problem described is the power struggle, with training
analysts attempting to maintain control and withhold power from
most psychoanalytic society members. Of the 4 institutes discussed,
3 were controlled by an elite group—a few individuals who actually
ran the institute. It would have been interesting had the author
compared the pathological functioning of these institutes—apparently
so dominated by narcissistic characters—with the functioning
of other institutions, such as business and government-run institutions,
including hospitals. Such a comparison might have taken some of
the sting out of the descriptions. One analyst was quoted as saying
that the members of the faculty needed to “learn how to listen,”
that “once you get out of your office you don’t have to
do that. You can just get in there, fight, and do anything, you
don’t have to listen any more.” (Page 137) The author
appears to be aware of the positive qualities demonstrated by the
central characters in these dramas, but tends to focus on activities
that highlight their irredeemable narcissism, even paranoia. As
interesting as group politics can be, the detail offered here is
so voluminous as to become tedious at times; it likely will discourage
many otherwise interested readers. As well, because of the nature
of the subject, the material is quite repetitious. The exhaustive
chapter on the Los Angeles institute is especially lengthy—almost
as long as the combined chapters on the other 3 institutes. There
is just too much information, except for a reader with a burning
interest in a blow-by-blow account of each institute’s vicissitudes.
While the contents of this volume might represent the truth, the
whole truth, and nothing but the truth regarding these institutions,
another sad truth is that the audience for whom this is of sufficient
interest is likely to be quite limited.
Conversely, and to be fair, this is a very good book for what it
is. It offers an extremely well-documented history of 4 major American
psychoanalytic institutes. It is very carefully and comprehensively
organized, with 34 pages of notes, a bibliography, lists of interviewees,
and cited personal communications. The reporting appears balanced,
fair, and objective, and it is certainly comprehensive. This is
a well-written history of a rather circumscribed area of interest.
Turning to the content itself, the description of the Chicago Institute
makes little mention of Heinz Kohut’s considerable influence
(1). The author has focused on the politics of institutes rather
than on the ideas being generated within them (ideas that in themselves
have generated considerable political controversy). As a result,
individuals like Kohut, Kernberg, and Gedo, widely published and
influential writers in the last quarter of the 20th century, receive
passing mention only, although Kirsner interviewed Gedo 4 times
(2).
Discussing the institutions’ dysfunction, Kirsner makes the
interesting point that
a major aspect of the problem is that a basically humanistic
discipline has conceived and touted itself as a positivist science
while organizing itself institutionally as a religion (Page 233)
He continues, “psychoanalysis bears a structural resemblance
to a political movement or a religion, a parallel Freud encouraged”(Page
234), adding that Freud’s making adherence to his principles
especially important meant in consequence that psychoanalytic education
“became over the years akin to a process of anointment”
(Page 234) Kirsner argues that “psychoanalysis is not an established
science or a unified body of information from which derives a unified
practice that can be readily and empirically tested.” (Page
235) However, that contention is to some extent contradicted in
the literature on psychoanalytic research (3). Kirsner concludes
that
psychoanalytic education has come to depend on the justification
of its truth claims through authoritarian approaches reminiscent
of some organized religions, rather than through the kind of open
critical inquiry which can take place in universities. Historically,
then, it has been a hallmark of much psychoanalytic education
for mystification to transform illegitimate power into a rational
authority. Secrecy and lack of detailed public evidence have long
fostered opportunistic practices of anointment . . . the model
of idealization/denigration is a pervasive and structural one
finding a correlate in the day to day life and management of even
the smallest institutes . . . Training issues are everywhere and
routinely resolved by fiat. Passionate power struggles are ubiquitous
and can elicit a zeal that rivals forms of the most uncompromising
fundamentalisms” (Page 237)
Kirsner believes that the atmosphere of anointment has persisted
through the medium of the training analysis and the appointment
of those who have the right to train. These, he feels, have always
lain at the heart of all analytic disputes.
Kirsner really comes into his own in the concluding chapter, especially
in the final passages offering his cogent opinion about how psychoanalytic
institutions need to change. The conclusion begins positively, describing
changes achieved “despite intrinsic problems which remain at
the heart of psychoanalysis and its institutes”(Page 232) One
may understand the childishness, internal focus, phenomenon of anointment,
and fratricidal behaviour thus: “Issues concerning the right
to train are crucial determinants in psychoanalytic controversies”
(Page 239) According to Kirsner, the claimed knowledge implied by
qualifications is far greater than its real level. Analysts do not
face this but substantiate the knowledge implied by qualification
in terms of anointment. He concludes that, despite reforms, the
underlying problems in these institutes remain. This final chapter
is far more gripping reading than the minutely detailed accounts
of each institute that precede it. The final chapter should, I think,
be required reading for all psychoanalysts and psychoanalytic candidates.
Perhaps, in fact, it would have been better to write a shorter book
of 2 chapters, the first being a summary of the difficulties within
all the institutes instead of a repetitious rendering of each institute’s
problems. Kirsner’s reasonable and seemingly inevitable conclusions
are important for psychoanalysis as an institution to consider.
Including the history of the Toronto and Montreal psychoanalytic
institutes would have increased interest for Canadian psychiatrists
and psychoanalysts, but this is clearly an American text. I found
several ungrammatical and incomplete sentences and occasional nonstandard
English in the text, which appears to reflect some carelessness
in the editing.
References
1. Strozier C. Heinz Kohut: The making of a psychoanalyst.
New York: Farrar, Strauss, and Giroux; 2001.
2. Gedo J. Spleen and nostalgia: a life and work in
psychoanalysis. Northvale (NJ): Jason Aronson; 1997.
3. Doidge N. Empirical basis for the core clinical
concepts and efficacy of the psychoanalytic psychotherapies: an
overview. In: Cameron P, Ennis J, Deadman D, editors. Standards
and guidelines for the psychotherapies. Toronto: University of Toronto
Press; 1998.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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