May 29, 2004

Calling All Ids: Freudians at War

By D. D GUTTENPLAN

LONDON, May 28 — Who owns psychoanalysis? That question is at the center of the most recent battle here in the Freud Wars, the epic (or as the man himself might say, interminable) struggle over the legacy of Sigmund Freud, pioneer psychotherapist, cartographer of the unconscious and former resident of Hampstead, the leafy corner of Northwest London where the concentration of therapeutic couches per square mile may be even higher than on the Upper West Side of Manhattan.

Late last year a new group calling itself the College of Psychoanalysts sent out a letter inviting British therapists who met certain qualifications to list themselves on the organization's "register of practitioners." The British Psychoanalytical Society, headquarters of classical Freudian analysis, responded with a statement accusing college members of "misleading the public about their training and qualifications." And then the fireworks really started. One founder of the college — which is a professional organization rather than a training institution — countered with a letter describing the society's action as "a phobic response to growth as symbolized in the Oedipal myth." An opponent of the college, on the other hand, described the new group as "an association of wannabes and poseurs."

More recently, the society's Web site included a disclaimer describing the college as a device for allowing therapists "to pass themselves off to the public as though they were trained psychoanalysts." In British law, "passing off" is a form of fraud; this was a declaration of war.

Susie Orbach, a therapist, an active member of the college and the author of the best-selling "Fat Is a Feminist Issue" and other books, says the dispute has already had "a chilling effect" on British intellectual life. To her, the society's argument that the title psychoanalyst "refers not to what the practitioner does, but what they have been trained to do" is nonsensical, a spurious restraint on trade.

"I do the work," she said. "My contributions are contributions to psychoanalysis, its theory and clinical practice, not to some other field."

On the surface, this is a parochial argument about labels and credentials, a tempest in a Viennese teacup — or at most, a professional turf war. But you don't have to probe the protagonists too deeply to discover that this is also a battle over the nature of therapy itself — what it is, what it does, how it works. And it quickly becomes apparent that alongside the intellectual controversy is a bare knuckles fight over money, power and prestige. These people, after all, are professionals of the ego.

The roots of this battle are in some ways peculiar to Britain. Unlike American psychotherapy, which is regulated by states (with some states, including New York starting next year, licensing psychoanalysts as a separate category), British psychotherapy is completely unregulated by the government. Also, until recently, most psychoanalysts in the United States were required to have medical degrees. The British analysts, however, like others in Europe, follow Freud's view in his essay "On Lay Analysis" and have never required medical training or graduate study in psychology. And because almost all psychotherapy in Britain takes place outside the National Health Service, the government has remained neutral. Legally, anyone with sufficient chutzpah can call himself a psychoanalyst here.

Still, the arguments and effects of the dispute are likely to reverberate on both sides of the Atlantic.

"The same conflict exists in the United States," says Jaine Darwin, president of the American Psychological Association's division of psychoanalysis. "There are the same arguments about standards within the profession," she added, having to do with licensing, training requirements and government registration.

Some of these battles have been raging for years. In 1989 the American Psychoanalytic Association — which had required members to have a medical degree — agreed to settle an antitrust lawsuit and allow psychologists, social workers, nurses and other mental health professionals to enter analytic training. That opening to the outside, however grudgingly done, probably saved American psychoanalysis from extinction. (In Britain the members of the British Psychoanalytical Society have an average age of 65.)

The flow of new analysts, though, raised a new set of problems. New candidates had to agree to the traditional training regime: a personal analysis four or five times a week lasting several years, and a number of supervised training analyses where the candidate saw patients, again four or five times a week, under supervision. What is so magical, some wanted to know, about four-times-a-week analysis? Why not three times a week, or two? Is there a real difference between analytic psychotherapy and psychoanalysis?

These questions are now being asked in Britain, along with some others. What began, said Joseph Schwartz, as "a simple jurisdictional dispute — like a fight between rival unions" — has the potential to become something far more interesting. An American transplant to Britain and the author of "Cassandra's Daughter: A History of Psychoanalysis" (Penguin, 2001), Mr. Schwartz is a Berkeley-trained physicist as well as a therapist on the register of the College of Psychoanalysis.

Ever since the day in 1911 when Alfred Adler and his followers left the Vienna Psychoanalytic Society, the history of psychoanalysis has been notoriously divided. Even so, all psychoanalysts share certain beliefs: the importance of the unconscious, for example. And Freud's own legacy is still central. His sense of mistreatment by Viennese academics is one reason psychoanalytic training still goes on mostly in private institutes rather than in university departments.

Shaped partly by their divergent histories and partly by differing national cultures, British and American psychoanalysis became quite different enterprises. In Britain, the encouragement of lay analysis and the influence of Bloomsbury figures like Virginia Woolf, who published Freud's writings in English, and whose brother Adrian Stephen actually trained as an analyst, gave psychoanalysis a distinctly literary flavor. The Hungarian refugee Melanie Klein, with her emphasis on internal experiences, envy and aggression, became the dominant figure in postwar British psychoanalysis.

During the same period in the United States the vast majority of psychoanalysts were also medical doctors. One consequence of this was that much more psychoanalysis in the United States took place in institutional settings like hospitals or asylums. Another was a gradual loss of prestige as psychiatry, with its growing armory of antidepressant and antipsychotic drugs, turned toward the pharmacy and away from the talking cure.

Both sides of the current dispute in Britain put clinical practice at the heart of psychoanalysis. Here the differences are as much political as theoretical. Analysts today are already free to discount Freud's focus on instinct. And though the requirement of analysis four or five times a week for candidates does guarantee steady work for the training analysts, their trainees are going to have to compete for patients in a world enthralled by quick fixes, whether out of a bottle or in a behavioral therapist's office, and where the superiority of psychoanalysis — once commonly described as the "gold standard" of therapy — is no longer taken for granted.

Julia Fabricius, incoming president of the British Psychoanalytical Society, says, "Psychoanalysis as an academic discipline is open to anybody," but she defends the society's qualifications for membership. She adds that she does not regard psychotherapists who aren't analysts as "second-class citizens."

Robert Maxwell Young, a Yale-educated British-trained psychoanalytic psychotherapist and former Cambridge historian of science, is outside both camps. Though he points out that he held the first chair of psychoanalytic studies in Europe, at the University of Sheffield in England, he is not a member of the society. And he has no desire to join the college. "I don't go to parties where I'm not invited," he said of the college's claim on the label psychoanalyst. "Even so, I have nightmares," he confesses, about not being allowed into psychoanalytic meetings.

What gives the dispute over the College of Psychoanalysts even more urgency is the sense that, in the next few years, psychoanalysis in Britain will soon be regulated. Lists and standards are going to be drawn up. Battle lines are forming over who who sets the standards and who keeps the lists.