The PANY Bulletin

Psychoanalytic Association of New York
Volume 43, #1 Spring 2005

Scientific Meeting
What Is Psychoanalysis?

39th Freud Anniversary Lecture
May 17, 2004
by Lawrence Friedman, MD
reporter: Stephen Malach, M.D.

Dr. Friedman began the evening by questioning his title. Is this a worn out, useless question he asked? What difference does it make? One might say that what really counts is that we like what we are doing and for each of our likes within psychoanalysis there is a theory that can be found to match. One might say, “We stay compatible with science as it moves forward without worshipping the past.” But, Dr. Friedman suggested that it would be a shame if the old psychoanalysis, which is so different from other human doings, disappeared before we understood what it meant and what it could do.

So while many analysts are remodeling treatment from the ground up, Dr. Friedman suggested that we try to find what was special in the old psychoanalysis, to look at what was strange, unique, and weird in it, and not try to make it more reasonable but figure out what sensibility can be wrung from the original weirdness. In order to elucidate this thinking, Dr. Friedman suggested that he and the audience look backwards in time, to watch the “unnatural monster” of the old psychoanalysis form from reasonable procedure, rise up, and contort itself into bizarre rules and then watch it relax and unwind, sinking back into the peacefulness of common sense. Dr. Friedman decided to describe this phenomenon using four amateur “monster movies” to describe four aspects of the old analysis that had gone through this transformation. He explained that all four movies share a “common plot” since they are all really four aspects of the same “monster.”

Dr. Friedman's first “movie” began with the medical triad of examination, diagnosis, and treatment. Psychoanalysis emerged from this three stage medical procedure in which the patient was examined via interrogation, diagnosed via the discovery of a traumatic memory, and treated via manipulation (e.g. by inserting the memory into the patient's awareness). So far this is not strange, but then the strangeness began, as psychoanalysis took shape the three components of the medical triad became a single entity and were indistinguishable; examining collapsed into diagnosis (a disorder was defined by treatment reactions) and diagnosing was identified with the treatment (as the treatment consisted of tracing causes and connections).
But what about the manipulation, where did that component go? Dr. Friedman suggested that where manipulation used to be, references to transference and regression could now be found. Labels such as transference and regression conceal the analyst's own seductive procedure, including the freedom allowed and the selfless attention given (which we would call love). The analyst no longer became responsible for the manipulation (it could be attributed to the analytic structure) since the analyst would not be an analyst if he/she intended the manipulative effect (in fact the treatment depends on not intending the manipulation). Analysts were asked to think that the only proper manipulation was what the patient did to himself (though as Dr. Friedman suggested Freud knew better than this) and as a result became responsible for something that they didn't think they were doing (“I only analyze” one might say). This was a lot weirder than the original form, as patient's became confused about the treatment aspect of psychoanalysis, “now that I know what is wrong with me, how does that help?”
The first element of the medical triad to break free was manipulation, which came out of “hiding” in the form of after-parenting (a word first used by Freud himself). Manipulation has taken on numerous forms within analytic circles; after-parenting has been inspired by new infant observation and legitimized by the neurophysiology of implicit and procedural knowledge; while at the fringe of manipulation one will find professional extractors of memories of abuse. Dr. Friedman reminded the audience that whatever one thinks of procedures which use manipulation, they are procedures, and that is what is ordinarily expected from a “treater.”

The next of the triad to fall away was diagnosing. In current analytic times diagnosing in the form of understanding has been freed to run its own treatment. As the act of understanding is a mutual activity between analyst and patient, it reduces the inequality between analyst and patient (which is onerous for today's practitioners). Both the analyst and the patient welcome the work of understanding, as it is a concrete activity that counterbalances the nebulousness of what type of relationship is being experienced in the room. Therefore, the natural and most welcome path to normalcy is the simple act of understanding, without the elements of examination and manipulation attached to it. Many have selected understanding from the original strange triad, as there is nothing strange about trying hard to understand someone by whatever means necessary. Dr. Friedman reasoned that this relapse into normalcy is a normal phenomenon as “quirkiness is hard to sustain, especially when it carries a whiff of deviousness,” (in the form of manipulation). We all want normalcy as Dr. Friedman said, “What psychoanalyst isn't happiest saying 'I don't believe in technique: I just try to understand my patients?'”

Dr. Friedman then began discussing the second of his four “movies,” whose plot concerns the analyst's vision. In the beginning analysts were meant to be “straight-thinking catharsis technicians,” who would locate and extract noxious memories, bits and pieces of the mind which made trouble. However, psychoanalysis then took a turn, it turned out that the bits and pieces of the mind weren't bits and pieces after all, they were the whole mind itself, “a person, not something stuck in a person.” Two examples of these bits and pieces are Resistance, the whole patient in a particular act, and the Ego, a way of considering the whole person in his/her aspect of adaptation. Whereas the whole world sees a person either as performing acts that are meaningful and intentional or as a “blind organism” (whose parts act with deterministic and causal force), analysts see human beings as both. Dr. Friedman reminded the audience that this is a weird way to look at people and weirdness is hard to sustain. In the contemporary analytic world some analysts have shaken off this “weird” double vision to see patients either in a hermenuetic way (hermeneuticists or intersubjectivists) or in a natural science way (integrative neuropsychoanalysts or empirical developmentalists). These views allow some analysts to “shake off” this old burden of the analyst's double vision. These analysts see Freud's hybrid theory of the mind as either too mechanistic (hermeneuticists) or too unscientific (observational scientists). Thus, the analyst's vision is another example of how two ideas that became strangely fused have tended to diverge again towards normalcy.
Dr. Friedman now introduced his third “movie.” In the first “movie” he spoke of analysis in terms of acts and in the second “movie” in terms of pictures. Now Dr. Friedman wanted the audience to consider psychoanalysis in terms of roles.

The original “protoanalyst” was a physician, a neurologist, a hypnotist, and a suggestionist. These roles were embraced by the “protoanalyst” since they were socially acceptable. Freud then changed what the characteristics of an analyst should be; an analyst was to be an ambiguous figure. In this set-up, the nature of the relationship between analyst and analysand was to remain in doubt, the analyst was not to disclose any special interest or confirm that he wanted anything in particular. This ambiguity was certainly “weird” and Dr. Friedman suggested that this original “weirdness” was bound to wear thin, and it quickly did. Some analysts settled into nurturing postures, others became vessels, others were tempted to imagine themselves as parental figures (with reinforcement from infant observation data). Many analysts seem to feel comfortable in the role of a kindly person trying to understand a partner, though this role has its own uncomfortable moments (an analyst may be reluctant to match confidences with the patient or to encourage reciprocity as others in this role might). Even some anonymous analysts apologize for their anonymity by saying that self-disclosure distracts attention from the patient. Few analysts still defend ambiguity for ambiguity's sake, which is designed to keep the patient and analyst uncomfortable. Ambiguity for ambiguity's sake was bound to be rejected by patients, analysts, and society.

In order to introduce the fourth “monster movie,” Dr. Friedman took the audience on a quick detour through Freud's Papers on Technique of 1911-1915, as Dr. Friedman suggested that in order to best understand the fourth monster we would need to see it through innocent eyes. Freud begins these papers by obsessing over why the transference is the main instrument of the resistance. Dr. Friedman posed two questions; why was Freud surprised that patients would want something from him instead of wanting to remember something for themselves? And second, after he acknowledged that this is after all what one would expect, why did Freud insist on thinking of patient's doings as remembering?

Freud had already developed a theory that could explain what he was finding. Freud had already written to Fliess in 1895 that he felt that psychic structures affected by repression were not reality memories but impulses derived from primal scenes. And, in 1912 Freud recognized that an unconscious memory isn't what we usually think of as a memory at all. So why was Freud so perplexed by the idea that patients wanted to love him in an old way instead of calling up scenes from their childhood? Dr. Friedman suggested that Freud nevertheless had a difficult time placing the transference in the context of the new treatment, and in the last pages of Dynamics of Transference Freud warned his students (in Dr. Friedman's words) “Never mind what I just said about patients hiding; what you have to worry about … is their seeking.”

If the transference is not an actual memory then why call the action remembering? Dr. Friedman answered the question in the following way: Patients do not live in clock time. Patient's live in the past, the present, and future all at once. The most glaring evidence of this is the transference love. Freud realized that he was observing a mind and a relationship that was neither past nor present. Freud had tried to remain a therapist of the present (which, Dr. Friedman reminded the audience, is what an abreaction specialist is) but found himself in a “never-never land” with his patient when faced with transference, as it was neither past nor present. Dr. Friedman described Freud as “bold” enough not to run away from this difficulty and declare love a charade, as Freud understood that “transference love is real—and unreal—as any other love.” In addition, Freud understood that all love is virtual, since all social reality is transference. What makes this love virtual is not only that it is a paradox, since that is part of our every day reality, but that it is exposed as a paradox. In regular everyday conversation between two people, one person confirms the other's contemporaneousness. This is precisely what the analyst does not do; thereby exposing the noncontemporaneousness of the patient and making the contemporary portion of the interaction feel virtual.

With the detour through Papers on Technique complete, Dr. Friedman was now prepared to present the fourth monster sighting. He described how analysis began circa Studies in Hysteria; as a normal, joint effort between analyst and patient to recover memory. After this beginning, analysis took a weird turn with the analyst telling the patient to try not to remember and the analyst being told by Freud to not try for anything. Now the analyst is no longer a contemporary target, as he/she makes no identifiable request. In fact what distinguishes psychoanalysis from other therapies is that there is an active attempt to interfere with purposes (i.e. wishes, efforts, and intentions). Nevertheless, analysis is able to proceed as an inquiry rather than an assault on the patient. So, with this transformation, the term psychoanalysis would have two connotations: a chemical or breaking down process, and a logical or contemplative process. Dr. Friedman then pointed out that both of these focus on desire and they do it by a confusion of time.

Dr. Friedman then noted that this particular way of dealing with someone as past and present with time rolled up into each moment is a “humanly unrecognizable activity.” In addition, this way of doing things is painful to patient and analyst (who has no way to deal with this activity in a straightforward manner). Over the years analysts have tried to normalize this aspect of psychoanalysis via numerous methods: by remaining on a consistent level of contemporary reality (e.g. reparenting, hermeneutcists, narrotologists, and didacticians), by stating that everything is past (e.g. Object Relations and Kleinian theory, considered in abstraction). As for new physiological theories (e.g. implicit or procedural memory and neurophysiology), they view only a present person, albeit one who has a past.

Dr. Friedman concluded his fourth monster sighting by stating that what makes Freudian treatment weird is that it does not view an action as imprinted by the past, but that what is alive in the present “is” the past effort itself and not just the effects of the past effort.

Dr. Friedman concluded by clarifying that he had oversimplified the subject manner, as there is large gap between theoretical models and clinical procedure. Most analysts who “follow” one model count on others as well (e.g. self-disclosing analysts really disclose very little and mostly follow orthodox protocols of treatment). He suggested that perhaps the Freudian model is mainly useful as a reference diagram to keep clear what is being changed and what is being sacrificed for that change when innovation is necessary. Dr. Friedman then defended his caricatures on two grounds; what analysts actually do is not the whole story, since what analysts are seen to be trying to do is extremely important, and that in mixed treatments the proportions of the ingredients are crucial. Dr. Friedman also suggested that though his presentation may have made it seem that the only reason for change in analytic models was embarrassment or strain on the analyst, that another incentive for change or procedure would be the finding of a more successful procedure. He also urged the audience to ponder the success of Freudian analysis against its specific objectives, to think about what its peculiarities were designed to accomplish and whether they can be accomplished otherwise. Dr. Friedman reminded the audience not to forget that the set-up for Freudian analysis is “a weirdly distorted sociality, designed to disrupt a continuum of will and perception and the illusion of presentness,” and since this may not be achievable in more common sense ways, the Freudian monster may rise again.

Stephen Malach M.D. is a second year candidate in the adult psychoanalytic training program at the NYU Psychoanalytic Institute and a third year resident in psychiatry at the Zucker Hillside Hospital. He received his Bachelor's degree from the Johns Hopkins University and attended Sarah Lawrence College for a post-baccalaureate pre-medical program before going on to SUNY Downstate for medical school.