American Socialist, June 1958
[Louis Proyect: One of the defining characteristics of American Socialist was its willingness to subject every aspect of society to a critical Marxist analysis, including in this case psychoanalysis. During the 1950s, ‘neurosis’ was on everybody’s lips as anxious readers of Life Magazine and other mass publications sought to define themselves against an arbitrary notion of ‘mental health’. The most interesting aspect of this article is its scathing deconstruction of the psychoanalyst’s fee.]
A view of psychoanalysis: Its adherents and practitioners ought to follow some of their own basic precepts a little more closely than they do.
THE ideas, whether normal or abnormal, of an individual are understood in Freudian doctrine as being determined by the material conditions of his existence, including the conditions of his body as well as those of his social environment. Qualitative changes in a person’s ideas, for the better or for the worse, depend on significant changes either in the organ-derived impulses impinging on his consciousness from within himself, or in the social relations impinging on his consciousness from without. An idea is incapable of taking hold of the mind and be coming an effective force in behavior except when it is felt in consciousness, as the expression of a need.
The custom of human beings of explaining ‘their actions from their thoughts instead of their needs—which ‘ . . are reflected and come to consciousness in the mind’ is discredited by Freud, as it was by Engels who in those words(1) characterized it as leading to the ‘idealistic outlook on the world.’ The contrary outlook that while ideas are decisive, it is upsurging needs and not ideas which are basic to behavior, distinguishes the Freudian as it does the Marxist doctrine from the common outlook of variegated critics of psychoanalysis, early and late, non-Marxist and would-be Marxist, like Homey, Bartlett, Moxon, Furst, and many others. These critics demand, in the words of Bartlett(2) a ‘rejection of the theory that emotional drives are more basic than ideas.’ They consider that ‘ideas are basic’ to behavior, and alterable by some quite autonomous and disembodied force such as pure will-power, independently of material changes in the body or the objective facts of external relations.
The psychoanalytic approach to mental treatment is thus necessarily distinguished from the approach of such critics by its qualified scientific optimism. The idealists tend to pessimism, as for example Moxon,(3) who in disparaging ‘cure’ as an ‘impossible aim’ only blurts out about anti-Freudianism what has always been, from before Freud, the approach of those who rely on suggestion and appeals to the will-power and reason of the neurotic.
THE psychoanalysts are legion who display interest or even belief in the consistent application objective principles of treatment which the best of their science have evolved into a fine instrument. Analysts of the greatest prominence like Alexander, Lauretta Bender, Bergler, Marie Bonaparte, Ferenczi, Anna Freud, Fromm, Edward Glover, Jones, Klein, Laforgue, Karl Menninger, Theodore Reik, Riviere, Rickman, Sterba, and many others have put forward variations of frankly mystical, religious, suggestive, or pessimistic approaches to treatment. Among them, although not in all of these analysts, are variations adapted to the fraud that it is not greed and conflict the social environment, but a death instinct or an masochistic self-punishment tendency that is the barrier to the normal satisfaction of the needs of individual. This authorized obscurantism, diffusing the literature and the analytic Training Institutes, has perverted the thinking and therapeutic integrity of - times larger numbers of less prominent and analysts.
The purely formal aspects of the slovenliness of the profession (in particular since its having put on in matters of validations and standardizations, were earnestly marshalled by Edward Glover, in l952.(4) There is evidence that Freud himself in his later years was far from a consistent practitioner of the technique which he had so effectively developed. The abusive and wildly interpreted caricature of a psychoanalyst in Wortis’s ‘Fragments of an Analysis with Freud’—but apparently a fair picture for the particular fragments—bears no resemblance whatsoever to the discoverer and master of resistance of the ‘Papers on Technique,’ 1910-1919. Unfortunately, Wortis, who suffered his supposedly ‘didactic analysis’—as it used to be called—in four months of 1934-1935, and published from his daily notes of it twenty later, was entirely unfamiliar with the literature and principles of Freud on technique. He did not see the discrepancy, and still takes for the genuine article, mishmash of exasperated personal insults, reparative reassurances, and undisciplined divagations of the master in his decline.
THE problem of payment is the point of departure for another of the artificial contradictions between theory and practice in the profession. Payment for treatment was seen by Freud as an almost irremissible measure to fight the resistances on the part of the patient to protect the gains of illness. (These include the so-called paranosic gain, or circumstantial satisfactions, the solicitude or attention or exemptions from responsibility which accrue from a conclusive succumbing to strains, and the so-called epinosic gain, or unwholesome actions of needs which are built into the illness as symptoms, in substitution of normal satisfactions which blocked.) Payment is supposed to incite a need for a clearly advantageous return for the sacrifice, which adds incentive and tends to reinforce the harried conscious strivings for health. Of course, the result may be a devaluation or a cynical corruption of the importance to the patient of his payment. In that case, it is theory and not infrequently practice, especially with more well-to-do patients, for the fee to be coolly raised. But the corollary and its practice are adroitly overlooked (although it has been found feasible to provide analytic treatment at nominal or no charge, as through appropriate clinics, to persons of scant means) that when the importance to a private patient of his payment becomes revaluated up as upon a fall in his income or an increase in his family obligations, a lowering of the fee is as readily to be directed. It should not be merely acceded to by the analyst, nor worse, should the patient be dropped or handed down to a less expensive colleague.
Moreover it is overlooked that to the wealthy patient, a raising of the fee can serve as a reinforcement not of strivings for mental health, but by apparent example and identification with the analyst, of the predatory standards and impulses of the patient. That result could be avoided if the added levy were for some unselfish cause. But classical psychoanalysis, immersed in a predatory world, has difficulty in even perceiving as meaningful the conceptions of such standards and impulses, and of their antagonism to civilized impulses and standards as neurosogenic.
Classical analysis casuistically plays down the necessity, which it recognizes in principle, of engaging liberated energies in struggle against the frustrating and deforming agencies of the social environment. Freud points out,(5) ‘When we succeed in dissolving a symptom into its elements, in freeing an instinct from one concatenation, it does not remain in isolation, but immediately enters into combination with something else. . . . There is no truth in the idea that when the patient’s mind is dissolved into its elements it then quietly waits until somebody puts it together again.’ Yet to the last,(6) he could not see actively helping the individual to a realistic social ideology, and supposed that any such assistance was a new ‘crushing of the independence’ of the individual, a ‘disrespect for his individuality,’ and a ‘disloyalty’ of the analyst to his task.
In particular, the classical analyst pusillanimously declines to help the individual even to an awareness of the selfish or greedy external environment which obstructs his cure, and seeks rather to keep his attention diverted from them. The neurotic misuses the reality of the predatory aggressiveness of the capitalist class to evade the reality of the aggressiveness which he has been mistaught to turn inward in hidden ways against himself. In the same way, the classical analyst misuses the reality of the self-directed aggressiveness of the neurotic to evade the reality of the predatory aggressiveness to which capitalist society, indirectly and directly, continually subjects the individual. The classical analyst resists the fact that under an economic system in which the production of the necessities for living is for profit as a merciless precondition of their use, virtually the whole natural and industrial re sources of the nation become concentrated in the effective ownership of a tiny minority whose interests are basically predatory with respect to society. The classical psycho analyst thus, as can hardly be rubbed in too often, wards off the conclusion that this predatory minority forms a powerful ruling class, which gives society an element of irrationality. Without some resistance to these irrationalities, there can be no complete psychological normality.
Actually, by means of its own discoveries, given an unevasive application of them, psychoanalysis is well equipped to investigate the mental processes, and their social causes, which retard the perception of these facts by individuals, both neurotic and without neurosis, and including psychoanalysts. These are mental processes and social pressures which influence some individuals to resist the recognition of such facts even when their attention is called to them, and called to them logically and empirically—and which delay their acting on these facts individually and collectively, to their own and to all society’s best long-range interests.
It is in his laying down of this equipment, and not in his making use of it, that the analyst is disloyal to his task.
Unquestionably many of the failures of classical analytic treatment, and relapses from its cures, are attributable to these deviations from, and unjustifiable limitations, of its own principles.
1 In ‘Dialectics of Nature,’ 1872-1882.
4 ‘Research methods in psychoanalysis,’ Int. J. Psy., 33: 403 409, 1952.
5 In ‘Turnings in the ways of psychoanalytic therapy,’ 1919.
6 E.g., in his ‘Outline of Psychoanalysis,’ 1938.