Abstract
This plenary address was delivered just before learning the successful outcome of a bylaw amendment extending full American Psychoanalytic Association (APsA) membership to psychoanalytic psychotherapists, researchers, scholars, and all who share a commitment to psychoanalysis. This historic change culminated efforts over the previous four decades to rectify exclusionary harms and revitalize psychoanalysis in the United States as a clinical practice and a cultural force. Membership expansion is discussed in the historical and sociological context of psychoanalysis as a profession with a focus on organizational resistance to change. Professionalization established and legitimized psychoanalysis but also contained the seeds of gradual decline as monopoly over training and practice distanced APsA from the wider psychoanalytic community. Expanding membership beyond the profession is a step toward uniting the community and strengthening all applications of psychoanalysis, including the traditional form. These developments at APsA reflect changes in other disciplines that feature inclusion, generosity, situated learning, and distributed subjectivity in epistemic communities of practice.
It is an honor to add my reflections to those of previous American Psychoanalytic Association (APsA) presidents. These presidential addresses are snapshots of our evolution, and mine comes at a particularly dramatic moment, while we are waiting to learn the outcome of the vote on a bylaw amendment extending full APsA membership to psychoanalytic psychotherapists, researchers, scholars, and all who share a commitment to psychoanalysis. This historic change to our membership may appear novel and radical but is the culmination of efforts at APsA over the past four decades to rectify past exclusionary harms and revitalize psychoanalysis as a cultural force and a clinical practice.
Tension between the broad, multifaceted psychoanalytic movement and a narrower, purer profession has existed since the beginning. Psychoanalysis spoke to the 20th century, capturing public imagination and inspiring a sociocultural movement. Psychoanalytic ideas spread rapidly through wide exposure in public media and discourse in the equivalent today of going viral. Freud’s charisma, literary talent, and prolific output catalyzed a movement of psychiatrists, intellectuals, and artists who spread the influence of psychoanalysis in popular culture. The ideas inspired a movement that popularized psychotherapy, making psychoanalysis a major force of modernity.
The institutionalization of psychoanalysis was part of a broader social phenomenon of the times: the professional project to control applications of specialized knowledge, its practitioners, and their marketplace. Law and medicine are the exemplars. Psychoanalysts formed professional associations, the International Psychoanalytic Association (IPA) in 1910 and APsA in 1911, and established training institutes separate from medicine and academia. These professional education and membership organizations limited access to psychoanalytic knowledge and to the profession. The clinical profession claimed jurisdiction over psychoanalysis, relegating other uses to the lesser status of “applied psychoanalysis.” This successful professional project also contained the seeds of its gradual decline, and the diminished standing of organized psychanalysis today mirrors the decline of the professions in general.
The changes to APsA membership over the past four decades, although initiated for varying reasons, have each served to lessen the divide between the preeminent professional association and the broader community, a divide originated by APsA limiting its membership almost exclusively to psychiatrists trained at its own institutes.
The profession provided the structure and leadership essential to establishing and legitimizing the entire field of psychoanalysis, but APsA’s monopolization of training and practice separated and alienated us from the broader analytic community. A fragmented movement was ill prepared to meet the challenges of the latter part of the 20th century. Despite recurring warnings of existential crisis due to our marginalization, decline in practice, and decreasing membership, APsA has been slow to adapt. The invitation extended to the broader psychoanalytic community to join APsA represents a step toward unifying the movement in the United States, thereby strengthening all applications of psychoanalysis, including the traditional form.
Resistance to Change
In reviewing the history of change in APsA, I read Arnold Cooper’s 1982 presidential address, “Psychoanalysis at One Hundred: Beginnings of Maturity”: I suspect that every past president preparing a plenary address did what I have done—read the plenary addresses of past presidents. With few exceptions, the theme has been the same—change and our resistance to it: organizational change, scientific change, social change. Past presidents take from the experience of the presidency an irresistible urge to warn the membership against excessive resistance. (Cooper, 1982, p. 249)
Recently however, the urgency of multiple social and environmental crises has quickened the pace of change at APsA. The coronavirus disease 2019 pandemic, climate change, global violence, and racial, ethnic, and class inequities inspired a return to the social in psychoanalysis and led us to reevaluate political and social neutrality in our theory, practice, and public discourse. Internally, demand for greater democracy, social relevance, and inclusiveness led to transformative actions such as replacing the centralized, hierarchical Board of Professional Standards with the decentralized, consultative Department of Psychoanalytic Education; revising our educational standards; sponsoring the Holmes Commission on Racial Equality in American Psychoanalysis; and bringing the expanded membership amendment to a vote.
The series of expansions of APsA membership since Cooper’s address more than 40 years ago includes welcoming lay analysts, women analysts, analysts trained outside APsA, and openly LGBTQ members. Guided by the Holmes Commission on Racial Equality in American Psychoanalysis, we are addressing our glaring lack of racial, ethnic, and class diversity. Each step has lessened the exclusivity of APsA but has not altered our fundamental structure. The expanded membership bylaw goes further by clearly locating the profession within the broader analytic community rather than as a superordinate elite.
Change brings fear of loss and resistance. For example, even though many members had long wanted to loosen the medical monopoly on training, it took a lawsuit to open our doors to other clinical disciplines. This opening saved APsA from a downward spiral.
What makes our resistance to change so strong? How can we sustain our newfound momentum? Can we revitalize the transformative influence of psychoanalysis in society?
A major source of our resistance to change is the insularity that began with the myth of Freud’s “splendid isolation” in founding psychoanalysis. The idealization of the individualism that Freud modeled has continued on in our profession’s isolation and self-centeredness. We have an intense, rich dialogue among ourselves but neglect what other disciplines have to offer. Discussion of organizational life is conspicuously absent from our literature, with notable exceptions, such as the writings of my mentor, Ken Eisold (1994, 2003).
When psychoanalysis emerged at the turn of the 20th century, medicine was unregulated chaos, and wild analysis flourished. Freud and his followers were eager to distinguish psychoanalysis as a respected science and treatment and did so by defining it as a specialized, exclusive profession. Establishing the profession regulated and legitimized psychoanalytic treatment and speeded public acceptance of its ideas.
The strengths of a profession, however, can become liabilities. The professionalization of psychoanalysis also fostered exclusion, hierarchy, and an orthodoxy that resisted change and led to stagnation and decline. As the profession matured, this self-imposed closure and isolation deprived us of the contributions of outsiders and cross-pollination with other disciplines. Stepansky (2009) noted the “cautionary tale of the inevitable marginalization of any profession that resists integration into the scientific mainstream of its time and place” (p. 7).
Zaretsky (2015) observed that psychoanalysis found itself at a crossroads: whether to be absorbed by mainstream institutions or to become insular and sectarian to protect its identity. Psychoanalysis has followed both roads. As the late Lee Jaffe (2021) pointed out in his presidential address, psychoanalysis is the foundation of all the talk therapies, but many of its insights have become common sense today. Paradoxically, psychoanalysis does not receive credit for establishing the basic constructs for understanding the mind. Psychoanalytic ideas have been appropriated by society, leaving the public’s perception of psychoanalysis as an outmoded, if not discredited, therapy. Meanwhile, the profession has been preoccupied with sectarian conflicts. Our closed ranks and internecine struggles limit the production and dissemination of knowledge necessary to retain the public’s confidence.
The tension between the broader movement and the narrower profession is already evident in two articles of Freud’s bracketing World War I, “The History of the Psycho-Analytic Movement” in 1914 and “Lines of Advance in Psycho-Analytic Therapy” in 1918. These two arrticles show Freud’s oscillation between broader and narrower definitions of the psychoanalytic movement.
“The History of the Psycho-Analytic Movement”
Freud’s (1914) history is the proclamation of a profession. He narrates an origin story: “. . . psychoanalysis is my creation. For ten years I was the only person who concerned himself with it . . . even today no one can know better than I what psychoanalysis is” (p. 7).
This is Freud as the founding genius, the hero who alone created psychoanalysis. Historians of psychoanalysis, however, point out that Freud was hardly so isolated. Psychoanalytic ideas were in the air of the times: in the philosophy of Schopenhauer and Nietzsche and in the intuitions of artists and writers about unconscious subjectivity. In medicine, Freud acknowledged the influence of Mesmer, Charcot, Janet, and others. Freud’s ambition, however, was always to be the pioneer. He reports that during his decade of isolation developing psychoanalysis, he did not read contemporary literature because he feared it might distract him from making his own discoveries. We know that the claim of discovery is used to justify possession and authority—a topic I will return to.
Freud sets out his theory and its principles, dismissing the ideas of Adler and Jung as totally incompatible with psychoanalysis. James Strachey’s (1914) editorial note in the Standard Edition finds “Freud adopting a more belligerent tone than in any of his other writings” (p. 4). Freud’s aggression is usually understood as due to the break with Carl Jung, his heir apparent. Cooper and Zaretsky, however, suggested that the simultaneous loss of Eugen Bleuler, head of the Burghölzli clinic in Zurich, the foremost psychiatric hospital in the world, was equally significant. Bleuler was one of the few international figures in psychiatry who supported Freud’s ideas. He contributed the concepts of ambivalence and schizophrenia. Bleuler originally joined the IPA but later resigned in disagreement with what he felt was its closed scientific attitude.
Cooper (1982) cited the correspondence in which Freud tries to convince Bleuler to stay with “our cause.” Here is Bleuler’s reply from the Freud-Bleuler correspondence (Alexander & Selesnick, 1965): “There was a difference between us. . . . For me, the theory is only one new truth among other truths. . . . I am therefore less tempted than you to sacrifice my whole personality for the advancement of the cause of psychoanalysis” (p. 5). How many others have distanced themselves from organized psychoanalysis over the years for similar reasons?
Cooper concluded that Freud’s insistence on establishing psychoanalysis as a movement centered around his ideas was strategically correct, even if it led to isolation from other disciplines. The price paid for this isolation was a diminished connection to the academic community and other sciences, a cost Bleuler had anticipated. However, the consequences of this isolation are more profound than foreseen by Bleuler or Cooper.
By “beginnings of maturity,” Cooper meant that psychoanalysis was outgrowing its childish discipleship to Freud and becoming a mature science. He quoted from an earlier presidential address, by Robert Knight in 1952, published in the inaugural issue of this journal (Knight, 1953): “Perhaps we are still standing too much in the shadow of a giant to view psychoanalysis as a science of the mind, rather than as the doctrine of a founder” (p. 211).
The observations of Knight and Cooper from 70 and 40 years ago are relevant today. The myth of the founding hero persists in psychoanalysis more than in any other scientific or intellectual field. However, it is not just idealization of the leader we need to outgrow; we also need to outgrow the exclusionary, hierarchical profession that constricts us today. Eisold (1994) spoke to this dual problem in his influential article “The Intolerance of Diversity in Psychoanalytic Institutes,” tracing the conservative nature of institutes to two factors in group cohesion identified by Freud (1921) in “Group Psychology and the Analysis of the Ego.” Initially the group members invest their ego ideals in a common leader, followed by an identification with each other as his followers. Individuation works to offset such bonds; group life reinforces them. APsA is in the process of outgrowing our focus on professional monopoly and developing the open scientific exchange that Bleuler wished for. The irony of taking pains to show that the changes proposed are consistent with some of his views, all the while advocating for outgrowing him, illustrates Freud’s enduring authority.
Zaretsky (2015) characterized the Wednesday study group at Freud’s home that began psychoanalysis’s organizational life as a Mannerbund: a male bond, originally a band of warrior brothers following a charismatic leader. Freud’s correspondence with Buehler and his attitude to Jung, Adler, and other dissidents shows the loyalty and conformity he expected to “our cause”: his vision of psychoanalysis. Freud’s fear of his theories’ being contaminated by other versions of psychoanalysis led to purging those who deviated.
It is unique to call a science or a form of psychotherapy a movement. Neil Smelser (1962), a sociologist with psychoanalytic training, studied collective behavior and identified social movements as large, enduring groups loosely drawn together in support of a shared social or cultural cause. Leadership usually includes charismatic figures and one or more organizations that give identity and coordination to members with varying degrees of commitment.
Smelser, however, noted that membership in a movement is not coterminous with following a particular leader or joining any specific organization. A movement is greater than any of its parts, encompassing multiple strands. By contrast, Freud condensed the psychoanalytic movement into a profession, conflating a part, albeit a central one, with the whole. The success of a movement is often partial, with some of its ideas assimilated by society while the movement itself dissolves or fragments. As the professional project and its institutions became the public face of psychoanalysis, psychoanalytic ideas were absorbed by society, the broader movement fragmented, and the cultural influence of psychoanalysis dispersed.
Although Freud was a fierce entrepreneur, his vision extended beyond the profession. He saw psychoanalysis as a new, comprehensive understanding of humanity, and wrote extensively on society and culture as well as individual psychology, highlighting the tension between the professionalization of psychoanalysis and its broader social and cultural aspirations.
“Lines of Advance in Psycho-Analytic Therapy”
Freud’s strongest statement of psychoanalysis as a social movement is the second article I mentioned, “Lines of Advance in Psycho-Analytic Therapy” (Freud, 1918), presented at the fifth congress of the IPA in Budapest shortly before the establishment of the short-lived Socialist Republic of Hungary. In this article, Freud called for a “psychoanalysis of the people,” envisioning a time when society would recognize “that the poor man should have just as much right to assistance for his mind, as he now has to the life-saving help offered by surgery” (p. 167).
From communist Budapest, Freud heralded the postwar expansion of psychoanalysis in Red Vienna and Weimar Berlin, where free training clinics were established (Danto, 2005). Many early analysts, including Freud, were social democrats or communists, and some were activists.
The rise of Nazism led to the mass migration of continental European analysts. They hid their socialist inclinations as they began new lives in countries, such as the United States, where anticommunist sentiment was strong. A leftist tradition persisted, as with Otto Fenichel (1998) and his Rundbriefe, and vestiges of free clinics continued, but analysts by and large avoided activism in order to secure their livelihoods. The revolutionary promise of a psychoanalysis for the people lapsed in adaptation to the liberal and neoliberal orders. Importantly, the vision of psychoanalysis for the people was sustained by a number of intrepid analysts and is reviving.
Despite its humanitarian ethos and liberatory potential, psychoanalysis has mirrored societal inequities. Prioritizing the individual over the group has aligned with capitalist ideology, contributing to perpetuating inequality and implicating psychoanalysis in colonialism and racism. Weber (1922/1978) maintained that virtually any group attribute—race, language, social origin, religion—can be used for “the monopolization of specific, usually economic, opportunities.” Psychoanalysis, like liberalism, espouses racial equality but has been content to benefit from its privileged status. The philosopher Charles Mills (2017) framed the contemporary discussion of race by identifying liberalism as historically a racial liberalism based on an implicit “racial contract” that denies equal personhood to people of color. Psychoanalysis has been complicit in upholding this contract and is only now reckoning with its legacy of racial inequality and discrimination.
Freud gave priority to establishing the profession over the larger social implications of psychoanalysis. The IPA developed from a small Mannerbund into a standard-setting and credentialing body that franchised psychoanalytic institutes around the world.
The Sociology of the Professions
In the same era the psychoanalytic profession was forming, sociology was greatly impressed by the professions, considering them essential to the understanding of social structure. Parsons (1938) called the professional complex the most important single component in the structure of modern societies. Professions require specialized knowledge, advanced education, and legal and/or public sanction. They are partly self-regulating, relying on professional standards and ethical codes to protect the public.
Two traditions dominated the study of professions: first came the functional approach, followed by a focus on power dynamics. The functionalist or “naive” tradition of Spencer, Parsons, and other positivists viewed professions as nobly motivated and crucial to the evolution of society. Professions are occupations that profess to work for the common good and were seen as protecting social values by providing a brake on unbridled capitalism. This exuberant statement by the sociologist T. H. Marshall (1938) captures their idealism: The professional man . . . does not work in order to be paid, he is paid in order to work. Every decision he takes in the course of his career is based on his sense of what is right, not on his estimate of what is profitable. (p. 17)
The second, “cynical” tradition initiated by Max Weber () focuses on power dynamics and how professions achieve their status. Weber’s concept of social closure theorizes how professional power is derived from exclusion: “the process by which social collectives seek to maximize rewards by restricting access to resources and opportunities to a limited circle of eligibles” (p. 638).
Modern professions sought the powers of medieval guilds: control over membership, the skills of the trade, and the market. Part of their status and power derive from lingering associations with the noble and the divine. Theology, law, and medicine were the learned professions, distinguished by aristocratic patronage and altruistic commitment to the common good. Residues of the scared aura connecting nobility with the divine carry over into the professions. Serving the aristocracy provided upward mobility for practitioners to join the upper classes. The combination of expert knowledge and transcendent values justified professional autonomy and privilege.
The struggle over lay analysis illustrates the association of a profession with divinity to elevate its status. Profession derives from profess, taking vows in a religious order. The word lay comes from layman, a nonordained male member of a church, and has come to mean anyone without specialized knowledge in a subject or occupation. Layman implies a lower status, while higher professional status is linked to nobility, implying divine superiority. Psychoanalysis is criticized as based on belief more than evidence and is often compared with religion. Freud’s splendid isolation could be seen as a retreat leading to divine revelation. Exhortations to join the cause emphasize conversion and faith.
As an illustration of the success of this labeling, an example from the Oxford Learner’s Dictionary of the use of the word layman in a sentence is “A layman is someone who cannot understand mental illness” (Oxford University Press, 2022). This professional noblesse oblige justifies making money by doing good but ignores the implication of professionals in economic and political systems that exploit and oppress. Ironically, the hierarchy of candidates, graduate analysts, and training analysts of a 20th-century profession mirrored the medieval trade guilds with their apprentices, journeymen, and master craftsmen. For psychoanalysis, training analyst status implies an aristocratic genealogy tracing back to Freud.
Professions present their jurisdiction over a domain of knowledge (e.g., law, medicine) as a natural, unquestioned fact. Bourdieu (1977) observed that “every established order tends to produce the naturalization of its own arbitrariness” (p. 115).
The sociologist Andrew Abbott (1988), in his classic study The System of Professions, described “professions growing, splitting, joining, adapting, and dying.” He observed that professions compete for jurisdiction in three ways: before the state, in the workplace, and before the public.
Parkin (1979) elaborated the concept of social closure through a Marxist lens: This monopolization is directed against competitors and its purpose is always the closure of social and economic opportunities to outsiders. The nature of these exclusionary practices, and the completeness of social closure, determine the general character of the distributive system. (p. 119)
According to Parkin, private practice is an ideal distributive system for a profession because it concentrates professional expertise in a closed group of self-regulating practitioners who profess to be the ones who know. APsA, holding the exclusive IPA franchise, effectively monopolized the psychoanalytic profession in the United States for decades.
Among Freud’s talents were what today we call branding and marketing. Marketing thrives on charismatic heroes, and Freud provided one: the solitary genius behind a groundbreaking discovery that inspired a movement. His essays, drawing on Greek mythology and intriguing case studies, introduced the public to compelling theories of infantile sexuality and unconscious wishes.
Freud’s talent for branding is illustrated by the famous metaphor of psychoanalysis as pure gold that he introduced in discussing psychotherapy for the people in “Lines of Advance”: It is very probable that the large-scale application of our therapy will compel us to alloy the pure gold of psychoanalysis freely with the copper of direct suggestion; . . . But whatever form this psychotherapy for the people may take, whatever the elements out of which it is compounded, its most effective and most important ingredients will assuredly remain those borrowed from strict and untendentious psychoanalysis. (Freud, 1918, p. 165)
This passage is usually understood as a warning against diluting psychoanalysis into psychotherapy, branding psychoanalysis as the gold standard. We now recognize, however, that all applications of psychoanalysis are alloys. This conflation of pure knowledge with a clinical application is marketing, not science. There is a difference between science and applied science. A science is a set of evolving theories that may be applied to specific problems, as in theoretical physics and its applications. Psychoanalysis as a profession elevates one application to the status of pure knowledge usually reserved for theory: promoting clinical psychoanalysis while relegating other applications to a lesser status. An alternative interpretation is that by “pure gold,” Freud meant the theoretical principles of psychoanalysis rather than a specific application.
In “The History of the Psycho-Analytic Movement,” Freud (1914) marked his territory by asserting intellectual property rights over psychoanalysis. The concept of intellectual property emerged in tandem with the rise of modern professions, who claim monopolies on the basis of possessing the highest knowledge in their field. Production of knowledge is a hallmark of the professions, supporting their claims of jurisdiction over practice on the basis of that knowledge. Intellectual property is justified to protect and encourage creativity in the intangible products of the mind, guarding them from unauthorized use. The downside, however, is that these rights can also hinder innovation and marginalize others from the field of intellectual activity. The proprietary claim can impede the production of knowledge by isolating the profession from new and threatening ideas. Furthermore, anything considered property becomes a market for capitalism—a petite bourgeois capitalism for psychoanalysis so far, but vulnerable to the predation of corporate capitalism.
Freud began as a neurological researcher but put aside those ambitions to pioneer psychoanalysis as a science of the mind, using his case studies to develop and illustrate his theories. Freud (1927) envisioned a Junktim, an “insoluble bond between practice and theory,” with clinical observations informing theory, which in turn guides practice. This conjunction of research and practice has been widely criticized for its lack of empirical validity. Case studies illustrated theory and made great stories that popularized the new therapy. Neglecting empirical research, however, left psychoanalysis on shaky scientific ground.
Fortunately, APsA also has a tradition of rigorous research that is growing stronger. APsA features research programs at its meetings and sponsors the College of Research Fellows. The new bylaw amendment invites all psychoanalytic researchers to join us as full members.
Professional Success—and Regression
The psychoanalytic profession enjoyed a great run in the United States, spearheaded by APsA, peaking in the 1950s and 1960s and extending on into the 1980s. The profession had all it could wish for: hegemony over mental health treatment, analysts’ commanding thriving practices and leading psychiatry departments, and favorable press. Even Hollywood was on the couch. At my home institute in San Francisco, old-timers reminisce about those days as a “Camelot,” when psychiatric residents, psychologists, and social workers trained at Mt. Zion Hospital under psychoanalysts, with the best and brightest residents going on to “the institute” to become psychoanalysts in private practice themselves, while the other trainees accepted subordinate roles. Today, however, the landscape of private practice in psychoanalysis has become increasingly challenging.
Flush with success, psychoanalysis oversold itself as a universal treatment for almost the entire spectrum of mental illnesses. The heyday of the profession passed as competition from psychopharmacology and other psychotherapies increased. The advent of managed health care introduced corporate capitalism into the therapy market, marginalizing psychoanalysis within medicine, psychology, and public perception. APsA’s resistance to change did not help.
Psychoanalysis experienced what Abbott (1988) called professional regression. A profession is organized around the knowledge system it uses, and the more one’s professional work uses that knowledge alone, the more status one gains. Status among one’s peers counts the most, and in its pursuit, professions tend to withdraw into themselves, becoming inbred.
Bourdieu’s (1993) concept of cultural fields as social arenas in which actors vie for different forms of capital—economic, symbolic, social, and cultural—aptly applies to psychoanalysis and its waning legitimacy. Analysts pursue social and symbolic capital alongside economic success. As psychoanalysis becomes marginalized, its reliance on symbolic capital intensifies, while direct economic and social benefits dwindle. The highest status within psychoanalysis is conferred upon training analysts, who wield extensive knowledge and control over candidate analysis, supervision, and instruction. Training analysts are more likely to see patients who allow them to use their psychoanalytic knowledge in its ideal form. They are less likely to see the naive and cost-conscious patients seen by journeyman analysts and candidates who must balance their professional knowledge with client reality. By targeting the most motivated and/or well-to-do patients, the profession neglects the broader population.
Professional success is measured by becoming a sought-after training analyst, supervisor, and teacher within a shrinking profession. Analysts publish mainly for the analytic audience and are largely absent from public discourse. Another symptom of professional regression is seeing fewer patients overall but in longer analyses. These are critical factors in psychoanalysis’s diminishing jurisdiction before the people.
Sociologists’ idealization of professions waned at the turn of this century, and they began to ask, What do professionals actually do? We know the answer for analysts but ignore its implications. Although some do a lot of analysis, most analysts do more psychotherapy or apply their psychoanalytic knowledge in other ways. For decades, surveys of practice have found that the modal number of analysands per analyst is less than one. Sociology informs us that the motivation to belong to an internally stratified profession lessens for those on the lower rungs when the benefits don’t match the cost. Not meeting the idealized goal of analytic practice frequently leads to member disappointment, shame, and withdrawal. A professional association whose members often don’t actually practice the profession is in trouble. Membership needs to mean active engagement, not merely a credential with waning prestige.
A turning point was the successful lawsuit brought by psychologists and other mental health disciplines in the 1980s claiming restraint of trade for being denied training at APsA institutes. APsA settled the suit, giving up its exclusive IPA franchise in the United States, allowing clinicians from nonmedical disciplines to train at its institutes and institutes outside of APsA to join the IPA. However, APsA retained its unique status as the only autonomous regional association within the IPA, a matter of controversy today.
After rejecting lay analysis for decades, many APsA members regarded the lawsuit as the best thing that could have happened, saving APsA from itself by forcing it to accept other clinical disciplines and thereby revitalizing the organization. Personally, the lawsuit enabled me to join APsA. Preceded by Mark Smaller and Lee Jaffe, I became the third president with a PhD rather than a medical degree.
New Directions: Inclusion, Distributed Subjectivity, Generosity
The opening of APsA membership to the wider analytic community reflects transformations in the social structure of other disciplines and professions. New directions in sociology, education, and science and technology studies offer perspectives that apply to psychoanalysis. It is not a coincidence that the decline in psychoanalytic prominence aligns with a decline in scholarly interest in the professions as a whole; modern sociology no longer views them as an overarching mechanism of social structure, and today’s cutting edge is the study of knowledge, expertise, and epistemic communities.
Sociologists such as Gil Eyal and Nicholas Rose argue that generosity offsets the monopolistic tendencies of professionals in the realm of expertise. Eyal (2019) contended that generosity . . . means that a form of expertise, as distinct from the experts, can become more powerful and influential by virtue of its capacity to craft and package its concepts, its discourse, its modes of seeing, doing, and judging so that they could be grafted onto what others—whether experts or the laity—are doing. (p. 83)
Likewise, Jean Lave and Etienne Wenger’s (1991) educational theory of situated learning emphasizes participation in social practice over the mere transmission of information. Their concept of “legitimate peripheral participation” views learning as not merely a condition for membership but is itself an evolving form of membership. We conceive of identities as long-term, living relations between persons and their place and participation in communities of practice. Thus identity, knowing, and social membership entail one another. (p. 64)
Wenger (1998) identified “communities of practice” throughout organizational life that transcend traditional disciplinary and professional boundaries, encouraging dialogue between internal and external perspectives. This dynamic rhythm generates the excitement, relevance, and value that attracts and engages members. Although many factors can inspire a community, nothing substitutes for this sense of aliveness. APsA’s commitment to expanding membership allows us to share its vitality with the broader analytic community.
Contemporary thinkers in science and technology studies have developed theories of actor networks and distributed cognition, seeing knowledge as the production of collectives rather than solitary minds. These ideas challenge the image of the heroic, solitary genius, viewing geniuses such as Stephen Hawking as distributed subjects, acting as a hub within collectives.
Hawking is commonly regarded as the epitome of the solitary genius producing science with only his mind. The philosopher and ethnographer Hélène Mialet (2022), however, observed that Hawking’s physical limitations made visible a collective that functioned on multiple levels, intellectual as well as physical, enabling him to think and communicate. Hawking, instead of a solitary mind, exemplified what Mialet (2015) called the “distributed-centered subject”: because his intellectual competences, his identity, and even his own body, are more distributed, collectivized and materialized than those of anyone else, he is the most singular of all. In other words, the more powerful you become, the more infrastructure you need, and the more infrastructure you get, the more you seem to stand alone. This is the paradox of the “distributed-centered subject.
The collective functioning of others considered to be geniuses is less obvious than with Hawking but just as present. This view redefines Freud’s role within psychoanalysis and challenges the profession’s individualistic bias.
Concepts such as situated learning, peripheral participation, distributed-centered subjectivity, and communities of practice may seem unfamiliar to us but find resonance within APsA. These trends work to counteract our professional regression and facilitate integration with the broader community. Some examples are as follows:
Our meetings combine cutting-edge programs with traditional offerings.
JAPA publishes new voices.
When coronavirus disease 2019 struck, we mobilized crash courses for working online, peer consultation groups, and regular town halls. From the outset, we invited the whole psychoanalytic community to attend, and the enthusiastic participation of both insiders and outsiders showed the value of peripheral participation and expanding membership.
Two of the popular international clinical working parties, clinical observation and end of training, held workshops before this meeting using uniquely psychoanalytic research methods in which each participant’s contribution is valued. The distributed expertise in these groups brings a fresh approach to the traditional case study method.
The Department of Psychoanalytic Education provides consultation and resources to our institutes, and our newly revised educational standards recognize the wide range of training at our approved institutes.
Most APsA institutes have psychotherapy training programs, and some offer integrated curricula for the first 2 years of training, with those seeking psychoanalytic training continuing on.
We have new organizational alliances with the Psychotherapy Action Network, a highly effective grassroots organization dedicated to advocating for psychotherapies of depth, insight, and relationship and with the Foundation for Social Psychoanalysis, with its new journal, Parapraxis, which features stimulating contributions by young scholars, clinicians, and activists.
These activities create epistemic communities in which generosity enriches APsA. Of course, our members have always volunteered pro bono services to our institutes and in the community. This generosity is laudable, but charity is not the systemic change necessary to alter our legacy of exclusion, elitism, and systemic racism. Expanding membership brings structural change that invites diversity and, together with the leveling of status hierarchies, facilitates generous exchanges within communities of practice.
Psychoanalysis has always been more than a profession. APsA is adapting to the changing world in the ways I’ve outlined and even beyond that, but our institutional identity, how we organize ourselves, and how the public perceives us lag behind. Although new ideas and movements spread rapidly, once established, their institutional image is difficult to change. APsA is widely perceived as representing an elitist, outmoded profession rooted more in received wisdom and privilege than in scientific knowledge and social relevance.
Our own resistance to change, aimed at preserving a professional mythology and monopoly, hinders progress, jeopardizing the production of knowledge, entrenching division, and discouraging newcomers from joining. The social closure that consolidated and set our profession apart has become an enclosure stifling the creativity and the generosity that make psychoanalysis a beacon of sanity and care in an increasingly mad and violent world.
Some members fear that opening membership to the entire psychoanalytic community will dilute or even undermine psychoanalysis. If traditional psychoanalysis is as valuable as we think it is, it will stand on its own merits, not because it is propped up by a professional guild. The consulting room, coupled with the burgeoning contributions of psychoanalytic research, remains a psychoanalytic laboratory in which advances in theory and technique originate and then radiate into the various applications of psychoanalysis.
I want to emphasize that these changes do not mean erasing psychoanalytic identity or the differences among APsA members. The identity of groups within the association, on the basis of their specific competencies and functional responsibilities, is respected. The specificity of psychoanalytic training and identity continues.
I advocate for a stronger, more relevant profession within a united psychoanalytic movement. Clinical psychoanalysis will prosper more as part of an inclusive community than as an isolated, vulnerable profession. Reimagining APsA by expanding membership, incorporating social psychoanalysis, striving for racial equity, embracing research, and valuing all the applications of psychoanalysis: these are what will secure the future of psychoanalysis and the profession within society.
Reflecting on Cooper’s (1982) address from four decades ago, he took the largest possible view of the contribution psychoanalysis can make to society and human welfare: “One might say that psychoanalysis is too important to be left only to psychoanalysts, and it is certainly too important to be confined solely to the conduct of psychoanalytic treatment” (p. 264).
Postscript, April 2023
Pandemonium broke loose at APsA soon after my address. We quickly plunged from the high of passing the bylaw amendment to a low point in a fight between the Executive Committee and the Program Committee over inviting a prominent Arab woman scholar and APsA member, Lara Sheehi, to present at the next meeting. Members were sharply divided. Some considered Dr. Sheehi too controversial because of alleged antisemitism, while others felt that opposition to her speaking indicated systemic racism within the association.
I won’t repeat the details here, but suffice it to say that the controversy shook the association to its core. Some members, including Dr. Sheehi, resigned in protest. The Board of Directors did not support the decisions of the president, Dr. Kerry Sulkowicz, and he chose to resign his office, feeling unable to lead the organization any longer.
It is no coincidence that this institutional trauma occurred right after the expansion of APsA membership. Although we expected resistance to change, we had not anticipated such a perfect storm. We were not prepared for the transformation we invited. Fault lines in the structure and coordination of our governance were exposed. America’s culture wars were enacted at APsA. The intractable conflicts between Israel and Palestine and racism in the United States were evoked. Old fights resurfaced, adding fuel to the fire. It has been difficult to listen to one another. Collegial posts on the members’ list server are outweighed by ones that talk at or past each other. Regrettably, some of the groups we hoped to welcome by expanding membership were alienated, either resigning or turning away in protest.
This is a soul-defining moment for APsA. If we are to truly become a psychoanalytic community that fully embraces diversity, our actions must match our aspirations for racial equality and recognizing the social. If there is a silver lining in this crisis, it is the passionate engagement of so many members. All of us, both active participants and bystanders, are implicated in this institutional enactment. Enactments are mutually constructed, and we must all reflect on our part. Although the Holmes Commission’s final report and recommendations are a guide, the responsibility for repair rests with all of us.
The APsA Board of Directors is proactively leading a collective process of healing and renewal. It is my fervent hope that we can emerge from this crisis with a stronger sense of unity, a deeper commitment to diversity and inclusion, and a renewed dedication to the principles of psychoanalysis in our evolving world.