If psychoanalysis proved globally to be one of the greatest intellectual and ethical events of the twentieth century, crossing and scrambling the divisions between the sciences and arts, medicine and morality, the technical and the everyday, it perhaps had its most outrageous popular and institutional success in the mid-century United States. There, it not only enjoyed an almost-incredible triumph in its rapid and near-total takeover of psychiatric institutions across the country, but infiltrated the field of cultural production to the point where the shrink cartoon became a genre in its own right. As Lawrence R. Samuel puts it in Shrink, ‘an inordinate percentage of newspaper and magazine cartoon panels, particularly in the New Yorker and Punch, featured a psychoanalyst and patient, sometimes with couch, sometimes without’ (Samuel, 2013: 90). The world of capitalist marketing also quickly recognized that the power of psychoanalysis could be deployed for selling product: the role of Edward Bernays, ‘Freud’s Nephew,’ in forging the meme of the ‘smoking babe’ is now well known thanks to Adam Curtis’ brilliant BBC TV documentary titled The Century of the Self.

The success of psychoanalysis in the US is matched only by the rapidity of its eclipse. In Joseph Schwartz’s words: ‘By the 1960s, it was not possible to become chair of a department of psychiatry in US medical schools unless one was a psychoanalyst. Twenty years later, it was not possible to become the chair of a department of psychiatry in US medical schools if one were a psychoanalyst.’ (Schwartz, 1999: 278). Since at least the 1970s, then — the evidence of Woody Allen movies and The Sopranos notwithstanding — the dominance of analysis has been thoroughly supplanted by a new psychopharmacological paradigm. Indeed, we now occupy what David Healey has denominated ‘the psychopharmacological era,’ (See, inter alia Healy, 1997) that is, a time in which the dream of technological solutions to mental disorders dominates the governmental-corporate-medical provision of services. Hence the ubiquity of psychopharmacological treatments for an enormous range of disorders, dispensed by a range of state ratified medical officials (from general practitioners to high-end psychiatrists), and supported by a wide and powerful range of institutions, from private research bodies and universities to governments, the mass-media and the ‘Big Pharma’ industry itself. Drug treatments are pragmatic, not exploratory; biotechnical, not personal or sociological; they are above all directed at neutralizing sets of psychophysical symptoms, not towards illuminating and transforming analytic structures. So-called ‘Evidence Based Medicine’ (EBM) has trumped the qualitative narratives of psychotherapy; automated management tools take over the burden of diagnosis and prescription for the ever shorter face-to-face sessions available to practitioners; commandments issuing from the insurance industry determine the micro-practices of psychiatrists and psychologists. Given their clear and present supremacy in the treatment of all sorts of alleged disorders, the new-generation management strategies for mental illness have utterly overrun psychoanalytic methods of diagnosis, treatment and theory. The latter now appear protracted, expensive, unstable, untestable — if not downright noxious.

The consequences for psychoanalysis, that is, for psychoanalysts, their theories, practices and institutions, have naturally been experienced as close to catastrophic. If very many studies have attempted to take up this situation from a variety of perspectives (philosophical, sociological, medical, etc.) and with a range of affective tenors (triumphal, elegiac, pragmatic, etc.), only a few have taken up the challenge of undertaking on-the-ground ethnographic research into the impacts upon the persons and practices of psychoanalytic professionals themselves. It is precisely this challenge that Kate Schechter proposes to meet in her fascinating, if flawed and sometimes frustrating, book Illusions of a Future: Psychoanalysis and the Biopolitics of Desire.

Schechter’s title alludes to Sigmund Freud’s 1927 diatribe against religion, The Future of an Illusion, in which he makes an important distinction between ‘illusion’ and ‘delusion.’ For Freud, ‘An illusion is not the same thing as an error; nor is it necessarily an error’ (Freud, 1961: 30). Yet he quickly continues: ‘In the case of delusions, we emphasize as essential their being in contradiction with reality. Illusions need not necessarily be false — that is to say, unrealizable or in contradiction to reality. For instance, a middle-class girl may have the illusion that a prince will come and marry her. This is possible; and a few such cases have occurred. That the Messiah will come and found a golden age is much less likely’ (Freud, 1961, page 31). Insusceptible to proof although not necessarily to falsification, illusions themselves can easily enter into a zone of indistinction with those very delusions that deny the claims of reality tout court. Note in Schechter’s titular inversion of Freud’s the supplantation of the definite article by an indefinite, and a singular by a plural. There will always be a future for illusions — even if it’s an illusory one.

For Schechter’s book deals with personages whose raison d’être is supposedly a cure for delusion and a treatment for illusion: psychoanalysts themselves; or, more precisely, contemporary Chicago psychoanalysts and their personal and institutional vicissitudes. Schechter herself should probably count as a kind of participant observer in this affair, as she is ‘Assistant Professor in the Department of Psychiatry at Rush Medical College, Chair of Conceptual Foundations at the Institute for Clinical Social Work, and faculty at the Chicago Institute for Psychoanalysis. She is in the private practice of psychoanalysis and psychotherapy in Chicago.’ Phew. That sounds like a lot of work. Indeed, the proliferation of Schechter’s professional titles itself proves symptomatic of the situation she describes; her book, unsurprisingly, thereby also conveys some of the flavor of a de facto profession de foi, the public declaration of one’s adherence to a faith.

Yet hers is literally a profession of divided faith, to say the least. Schechter concludes her ‘Acknowledgements’ with the note that ‘I will never forget how one of the most senior “classical” psychoanalysts I interviewed told me (psychoanalyzing the anthropologist, to be sure!) that eventually I would have to choose between psychoanalysis and anthropology. If that is the case, I have not yet reached that point’ (viii). So this is a book founded on an indecision-that-may-not-even-require-a-decision-in-the-first-place: anthropology v. psychoanalysis.

Thereafter, the undecided divisions proliferate — and this is, on balance, a good thing. As Schechter herself says of her case studies, we are confronted by ‘the intensification of a systemic predicament of indeterminacy in the psychoanalytic collegium’ (page 52). The book is divided into three parts, each comprised of two chapters. The titles are suggestive without being clearly defined: ‘The Slippery Object and the Sticky Libido,’ ‘The Problem of Psychoanalytic Authority,’ ‘Psychoanalysis and the Declensions of Verisimilitude,’ etc. Despite the announced organization that such a division suggests, it doesn’t quite follow the lines of object and libido, authorization crises, or reality-claims that those headings imply. Of course, the situation Schechter describes is itself marked by such referential unclarities and confusions, due to the fact that US analysts have ‘lost control of the exclusive educational institutes and professional organizations with which they affiliate, the pace and quality of their daily work routines, their career trajectories and satisfactions, and, not least, their status in American society’(page 4). Charting the historical institutional preconditions of these deleterious eventualities — some already invoked above — Schechter identifies the rise of medical managerialism, the dominance of the insurance industry, the decoupling of psychoanalysis from the ‘scientific’ and ‘medical’ fields, and the establishment of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as the mandatory options (sic.) for all.

This is a general or global context which Schechter nominates ‘biopolitical,’ after the work of Michel Foucault, whereby ‘life’ itself becomes the key object for management by a variety of governmental experts. Schechter proceeds to refigure the current predicament of psychoanalysis in these terms. Rather than simply fighting a losing oppositional battle against emergent governmental forces, psychoanalysis has already capitulated to a kind of biopolitical neoliberalism. Despite its own heroic, elegiac self-images in terms of battling a ‘crisis,’ psychoanalysis is an agent of the crisis itself. However, Schechter also differentiates psychoanalysis from other traditional disciplines caught up in the biopolitical tumult, precisely because of its own constitutive attentiveness towards paradoxical forms of negation (such as the uncanny or death-drive).

Schechter supplements her global framing with the analyses provided by Jacques Derrida concerning psychoanalysis’ difficulties regarding the concept of ‘resistance.’ This concept, which is at the very origins and centre of psychoanalytic innovations from Sigmund Freud himself, acquires ever more complexity as it goes. ‘Resistance’ in psychoanalysis began as an account of the resistance of the patient to his or her own truth, yet both analyzable and dissolvable (one can know resistances and change them, indeed, change them through knowing them). Yet some psychic phenomena soon turn out to be unanalyzable, if still resolvable (i.e., what one doesn’t know can still be changed). Then again, there are also presentations that proffer the horror of being both unanalyzable and irresolvable (one can’t know them and can’t change them). Moreover, resistances can emerge not just at the level of the personal or interpersonal, but at the levels of genesis and structure: psychoanalysis as itself a practice crippled by a self-resistance it refuses to address… Schechter takes up such self-analyses of self-non-analyses and applies them to the utterances of Chicago analysts, an application all the more pertinent and paradoxical because Chicago has been ‘prominent as the home of several homegrown schools of psychoanalysis that problematized the therapeutic relationship per se’ (page 7). Schechter tracks the consequences of the history of such problematizations for the heirs of the problematizers themselves. Psychoanalysis has always been interested in how the sins of the fathers have unintended consequences for their descendants, and this book provides compelling instances of such ambiguous legacies in an institutional-ethnographic frame.

Schechter’s investigations take her through various kinds of evidence: interviews with prominent contemporary analysts; a brief genealogy of ego-psychology; the notorious 1989 lawsuit that saw the psychoanalytic link to the medical institution severed; the founding historical antagonisms between Lionel Blitzsten, doyen of the Chicago Psychoanalytic Society (and fearsome adept of the so-called ‘Blitzstenskrieg’), and Franz Alexander, master of the Chicago Institute for Psychoanalysis; the shifting conceptual, professional and demographic frameworks of American psychoanalysis, from militants promulgating psychoanalysis-as-paradigm-of-psychiatry to residual protestations regarding its demedicalized present…. as well as a sometimes-preposterous parade of princelings of psychoanalysis, from Kurt Eissler through Gitelson and Grinker to Heinz Kohut and beyond. The narrative sweep moves from struggles over the treatment of neurosis to the support-structures of narcissism, from egos to selves, from domination to subjugation, to conclude with ‘several baroque new imbrications of intimacy and commerce in the transformed proprietary/disciplinary space of knowledge production that is current psychoanalysis’ (page 180). Current psychoanalysis in the US, that is.

The book is very North American in every way. Not that there’s anything wrong with that, as Jerry Seinfeld used to say, but its attitudes are almost entirely shaped by its peculiar milieu, with certain conceptual and practical consequences. As might be expected in psychoanalysis, it’s usually in the passing remarks or marginal details that some of these limits emerge. For example, when Schechter writes ‘unlike Theodore [sic.] Adorno or Jacques Lacan, who were developing their post-Freudian critiques of the ego in the same period, neither of these Americans had any nostalgia for the prebourgeois subject’ (page 119). While we could also dispute the attribution of Theodor’s putative ‘nostalgia’ here, I can’t let the implied slight against Jacques go unanswered. It’s not just that Lacan had no discernible nostalgia whatsoever for any alleged prebourgeois subject, but that Lacan’s own analysis of the situation Schechter is interpreting would see no psychoanalysis anywhere, only the automated false squabbles of its perversion. Lacan, first, thought that any affirmative targeting of the ego was strictly anti-psychoanalytic in its essence; second, that American ‘psychoanalysis,’ in its very suture to the medical phantasy, had become precisely a profession, turned towards its own institutional (abuses of) power, and careless of the exigencies of thought. For instance, the ego-psychological conviction that interpretation was a skill that could expose intra-psychical conflict from a position of (relative) exteriority couldn’t be more foreign to Lacan. My point here is not to rebroach the fractious polemic between different schools of psychoanalysis, but to engage a kind of fundamental psychoanalytic principle: it is an unmotivated (and here inaccurate) comparison that opens onto local fissures of revelatory import.

In this vein, Lacan considered psychoanalysis to be — as Freud himself said — literally impossible, that it can’t and shouldn’t win in any public or professional stakes. As such, the postures of aggression, prostration and lamentation so rigorously catalogued by Schechter are foreign to such an account of psychoanalytic thinking. Lacan thought US psychoanalysis was never really psychoanalysis at all, precisely because of its medical obsessions, its ego-focus, and its overweening professional obligations. One doesn’t have to agree with Lacan’s sometimes outrageous and unjustifiable claims in order to affirm their probative value: in the present case, they allow us to adjudge how the persons Schechter cites throughout this book are precisely mostly saying things that are not specifically analytic. There’s no reason why they should, as they’re speaking of broadly professional losses after all, of threats to their livelihood.

Schechter is often a brilliant analyst of the symptoms of the local effects of neoliberal profession shock: take her account of the transformation of the transference as the primary operation and condition for analysis into the value of the patient-doctor relationship itself, where she recognizes that, ‘in seeking to resolve a conundrum that is central to their practice, in seeking to maintain themselves as psychoanalysts when they cannot practice what they define as psychoanalysis, they trade the real relationship against disciplinary failure’ (page 2). But because, unlike Lacan, the persons and institutions she’s dealing with never generated any really strong psychoanalytical theory of institutionality per se, they end up cycling round the generic gardens of anticipated loss.

Moreover, this state of affairs skews some of her local interpretations. It is hard not to be impressed by the care and detail in Schechter’s sketches of the personal and professional aporias that her analysts find themselves in, the choices they feel that they have to make between bad or worse, between giving up on the essence of psychoanalysis or disappearing, between blurring themselves into a generalized psychotherapy or spinning their wares on an severely-constrained market. Schechter analyses these symptoms of personal-professional contradictions as evident in the rhetoric of ‘crisis’ becoming ‘a systemic artifact’ — which seems a true and useful thing to say — but which could just as well have been said of a wide range of other professions, including law, medicine more broadly, academia, etc. This is why she can just as well quote Edward Sapir from 1949 regarding the ‘perils in the business as getting a living’ (page 69) as Derrida, or Pierre Bourdieu, or indeed any number of sociologically- or ethnographically-oriented theoreticians.

So the lack of Lacan (more precisely: of the sorts of questions he raises) also has methodological implications. In the US, it seems he’s basically a ‘Theory’ guy, treated much like Foucault or Derrida insofar as he provides a set of propositions to be asserted or techniques to be applied to a variety of phenomena, but basically less appealing than the others. He is hardly present at all as an analyst — certainly not one to be taken seriously outside a few suspicious outliers, such as Bruce Fink or Josefina Ayerza — and the major Lacanian analysts in the US seem especially marginal to this now-marginal semi-profession. But Lacan was above all a psychoanalyst, concerned with specifically psychoanalytic issues, with training matters, and the treatment of patients. In being so, however, he became one of the most important influences upon precisely Foucault and Derrida themselves; and his impact upon them is evident in their various inabilities to deal with some of his more radical propositions regarding the structures of the insertion of subjects into institutions, let alone the creation and dissolution of different kinds of institution. If Foucault and Derrida found some new things, it’s in part because they lost some radical psychoanalytic things — and those lost things bear upon questions irreducible and even counter to the motifs of biopolitics or resistance that orient Schechter’s account.

To raise these issues is not to doubt the value of this book. For anybody interested in psychoanalysis, its institutions, history, theory, practices and personnel, this book makes a significant contribution that should have some (possibly even beneficial!) effects upon, and for, contemporary practitioners themselves. More generally, the book also contains incisive and interesting interpretations that bespeak the ongoing impact of biopolitical domination upon the mental health professions more generally — and should therefore also attract the attention of a wider audience. 

References

Freud S (1961) The Future of an Illusion. In J Strachey et al. (eds) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XXI (1927-1931). London: The Hogarth Press and the Institute of Psycho-analysis.

Healy D (1997) The Antidepressant Era. Cambridge, MA: Harvard University Press.

Samuel LR (2013) Shrink: A Cultural History of Psychoanalysis in America. Lincoln: University of Nebraska Press.

Schwartz J (1999) Cassandra’s Daughter: A History of Psychoanalysis. New York: Viking.