Projects for the coming years: a presidential speech in 2009

On 1st of August 2009 - on the end of the International IPA Congress 2009 in Chicago - Charles Hanly made the following final speech as new IPA President:

For a good part of the 20th century Freud captured the interest and imagination of the enlightened world. The Oxford philosopher Gilbert Ryle accurately described him as “the one genius psychology has produced”. And it is this genius, together with the difficult truths out of which he constructed psychoanalysis that allowed Freud to locate his discoveries, without pretension and risk of ridicule, in the great tradition of Copernicus and Darwin. All share in the offense their discoveries gave to human narcissism. The interest that Freud aroused was motivated by various and conflicting emotions: sometimes it was indignant hostility, sometimes idealizing enthusiasm and sometimes curiosity, gratitude and informed admiration. But the important thing is that there was plenty of lively interest to go around. Freud’s genius took psychoanalysis into the consulting rooms, the universities, the publications and the cultural productions of the entire world. Unfortunately, for at least the last two decades, psychoanalysis has been increasingly confined to the consulting rooms of analysts. There are exceptions. Psychoanalysis may not thrive now in medical faculties as it once did, but it continues to thrive intellectually and in various forms in the seminars and lectures of arts and science faculties. However, the fountainhead of psychoanalysis remains clinical practice.

For this reason, the retreat to the consulting room (as I have called it) is not problematic in itself. The analytic consulting rooms of analysts, the seminars of our institutes and the scientific meetings of our societies are the proper habitats of psychoanalysis. Those analysts who have prosperous practices, conduct successful treatments, teach in our institutes and contribute to our scientific meetings and journals earn our respect and merit our imitation. But the trouble now is that relatively few analysts have as many analytic patients as they would like and the decrease in the number of patients is certainly not to be credited to the general improvement of the mental health of our fellow contemporaries. Too many analysts have to supplement their income with the practice of psychoanalytic psychotherapy or of their pre-psychoanalytic professions. Analysts need more analytic patients and the community needs more analysts. Our institutes need more young candidates. Our profession needs to bridge these disparities of need. Psychoanalysis is a clinical discipline; psychoanalytic knowledge is sustained and advanced by clinical observation. A threat to clinical practice is a threat to psychoanalysis itself.

Some may say that this picture is too pessimistic. Let us hope that it is. When more analysts are getting more referrals, when more young health professionals are beating a path to our institutes, then our efforts will have borne fruit. But even if this is true, the initiatives I shall describe in a few moments will be useful as they build on our existing strengths and efforts.

To be sure various courses of action lie before us. We may choose to remain on the path we now appear to be following. It is always possible and assuredly easier for us to carry on with stoic dignity, eased on our way by nostalgia and the hope that benign socio-economic and cultural accidents might restore psychoanalysis to the pride of place that used to be hers in science, culture and the healing arts during the last mid-century. Or we can gather up the considerable strengths we have and set out along a more promising path leading to renewal, one which should make us, as Auden said when paying homage to Freud, “able to approach the Future as a friend.”

Our present difficulty comes down to the following question: “to whom will the next generation of analysts throw the torch?” They will throw it to our current candidates, more and more of whom are already in their fifties. Not long ago our institutes refused to accept for training anyone who was older than forty. If we continue thus, only Zeno’s paradoxes could save us from extinction. Let me be very clear: candidates in their fifties are not our problem. On the contrary, they enrich psychoanalysis with the experience and maturity they bring to it. Here, necessity has been a good teacher. But however much these older candidates have to offer, they do not make up for the relative lack of young candidates. We need the enthusiastic vistas of youthful inexperience no less than we need the mature wisdom of experience. Perhaps, necessity has something to teach us here as well.

I hope to set in motion processes that will reduce the average age of psychoanalysts by a decade. In the pursuit of this aim, it is essential not to compromise our three model training requirements, or our professional and ethical standards. Anything we do to strengthen our profession must satisfy these requirements. For, in the final analysis, psychoanalysis, as a clinical discipline, will live or die with our success or failure in easing the neurotic suffering of our patients and in improving their quality of life.

To meet the challenges I have just mentioned, I propose to establish three committees: a Project Committee on Conceptual Integration of Theory, a Project Committee on Clinical Observation and Testing and a Committee on Outreach.

Psychoanalysis has long been characterized by conflicting theories, a situation that has both advantages and disadvantages. The advantage has been that psychoanalysis has had alternative hypotheses to explore and test. The disadvantage has been that psychoanalytic theorizing has tended more towards school debates than towards enquiries that might settle them. We have too often replaced enquiry with gladiatorial combats of schools, exciting narcissistically and intellectually as they may be. To explore theoretical possibilities by promulgating new hypotheses is essential to the growth of a science. If these hypotheses are not submitted to the test of fact and clinical confirmation or rejection, we end up with the formation of new schools. Contradictory theories, theories that cannot both be true at the same time of the same thing, are advocated with sublime indifference to logic. Clarity, simplicity, coherence and verifiability get lost in the obscurity of ill defined, vague ideas that escape testing.

This problem has long been identified and analyzed by Rangell. This issue was at the scientific heart of Wallerstein’s Rome and Montreal congresses and it is again at the Chicago congress on convergences and divergences in psychoanalytic practice. The lead article and discussion of the most recent IJP is an exercise in conceptual and technical clarification of compatibilities and incompatibilities in current psychoanalytic theorizing and clinical technique. It is fitting that a renewed effort to tackle the problem of conceptual ambiguity and chronic theoretical proliferation should follow upon the inspiration provided by the Chicago congress, for which we thank the scientific programme committee.

The Project Committee on Conceptual Integration will address these issues, but its aim is not to establish either orthodoxy or consensus. Orthodoxies stifle new ideas and new discoveries; consensus does not protect us from a blind reliance on experience. Consider for instance how long our species mistakenly believed the testimony of its senses concerning the motion of the sun, or the evolution of species, how long it believed the testimony of introspection concerning consciousness as the essential attribute of the psychic and the will as the sole author of our actions. The aim of the project committee is to encourage and facilitate explorations of the following question: “Is it possible to construct a more comprehensive, coherent psychoanalytic theory out of the competing theories that we now have?” It is not the aim of the project committee to construct on its own such a comprehensive theory. Its work is to encourage the search for answers to this question and to the component questions into which it divides; it is to encourage in this direction our scientific committees when planning congresses, conferences and meetings at every level of our community, our journal editors and editorial boards, our individual colleagues who contribute to our scientific and clinical literature, our colleagues who teach in our institutes in their struggle with questions of curriculum and our working groups of colleagues at international, regional, national and component society levels. The unification of psychoanalytic theory cannot be legislated by a committee of twelve wise men. It is a perpetual task for the community of psychoanalysts.

However, as Freud’s favourite quote from Charcot reminds us, “la théorie est bonne mais ça n’empêche pas d’exister”. The coherence of a theory, while necessary, is not enough: it does not establish its application to reality. Euclid’s geometry is a paradigm of coherence and completeness, but it applies only as an adequate approximation to small rectilinear portions of the earth’s surface and not, as we now know, to the vast reaches of the curved space of nature. Freud thought of theory as a scaffolding we construct to better observe a building or, in our case, the psychic reality of individual lives. He cautioned against mistaking the scaffolding for the building. Only the observations we make of psychic reality with the aid of our theories and technique can reveal its nature to us and, thereby, enable us to evaluate our ideas of it.

Clinical observations played a crucial role in Freud’s development of psychoanalytic theory. Freud modified his seduction theory, formulated the hypothesis of infantile sexuality and adopted his dual aetiological theory because of the clinical observations he was making. The foundations of psychoanalytic knowledge are not to be found in the theories about psychic life we construct, but in the clinical observations on which these theories are based. If clinical observation enabled Freud to discover psychoanalysis, why should it not be sufficient to continue the work of discovery, conservation and renewal?

The spirit of Freud’s methodological and epistemological thinking about the acquisition of knowledge shines through in the following passage in which he compares scientific with clinical work:

Progress in scientific work is just as it is in an analysis. We bring expectations with us into the work, but they must be forcibly held back. By observation, now at one point and now at another, we come upon something new; but to begin with the pieces do not fit together. We put forward conjectures, we construct hypotheses, which we withdraw if they are not confirmed, we need much patience and readiness for any eventuality, we renounce early convictions so as not to be led by them into overlooking unexpected factors, and in the end our whole expenditure of effort is rewarded, the scattered findings fit themselves together, we get an insight into a whole section of mental events … (S.E. 22: 174).

Clinical observation is essential for theory testing. It is no less essential to good clinical work. We estimate the worth of interpretations over time by observing how they are taken up in the transference, and by observing what changes in the associative process, what improvements in ego functioning and what improvements in extra-clinical relations, if any, follow them. Analysts proceed in this way when they search for the causes of an impasse or when, at the end of an analysis, they sum up the nature and extent of these changes by comparison with the patient’s functioning at the beginning of the work. This clinical testing of interpretations that all analysts do provides the groundwork for the evaluation of explanations and of the hypotheses we build up on them – for the evaluation of the scaffolding that enables us to make yet further observations. The further development of psychoanalytic theory is a task to which individual analysts will contribute but it is also one in which the community of psychoanalysis must be constantly engaged.

Accordingly, the Project Committee on Clinical Observation and the Project Committee on Conceptual Integration complement each other: together they embody Kant’s famous aphorism that ideas without observations are empty and observations without ideas are blind.

The mandate of the Project Committee on Clinical Observation has a double purpose: first, to explore how clinical observations are being used, can be used and can best be used to test interpretations and theories; second, to experiment with testing hypotheses and theories by means of the methods of observation available to clinical psychoanalysis and seek to improve these methods and our use of them. Taken together, these project committees are intended to stimulate and organize enquiry into the construction of a coherent clinically tested theory and technique made up of the most probable knowledge now available to us. This work is open to new ideas and discoveries; it is essentially open ended.

An important instrument of these project committees will be IPA Work Groups modeled on the EPF working parties now being developed in South and North America. The EPF working parties have the following significant features:

• They are not from the outset methodologically committed to any one metapsychology or clinical theory; their task is not to advance a theory or technique but to explore how and how well theories and practices work,

• They are methodologically committed to enquiry rather than to debate,

• They engage colleagues from different societies, orientations, etc. in enquiry aimed at improving psychoanalytic knowledge and, in doing so, they advance the knowledge of the participants. They contribute to professional development.

The Project Committee IPA Work Groups will have projects and methods of their own but they will seek to incorporate these highly desirable features of the EPF working parties. CAPSA, our IPA Analytic Practice and Scientific Activities Committee, has already been supporting the development of EPF working parties in North and South America as part of their funding of inter-regional clinical and scientific exchanges. I want to continue CAPSA for the near future, at least for supporting regional efforts to further develop working parties in cooperation and cost sharing with the regional organizations: NAPSAC, FEPAL and EPF. As stated above, IPA Work Groups will be similar to working parties in their aims but, of necessity, they will develop their own methods of working. I hope to create a New Initiatives Funding Committee to financially support the IPA Work Groups.

I admit to hoping that the Project Committees with the support of the New Initiatives Funding Committee will move us toward a more unified theory made up of our most probable knowledge and that this knowledge, stated clearly, simply yet profoundly can be conveyed, in at least some of its essentials, to the public and especially to young people and students. We live in a world in which most people, even well educated people, are still unsure about the differences between psychiatry and psychology, let alone the differences between psychoanalysis and psychotherapy. Who we are and what we do needs better public definition. This greater clarity of definition is the foundation on which effective outreach can be built. As clinicians we have to lay claim to knowledge of the human psyche with a therapeutic method that helps patients overcome real difficulties. For this reason the work of the two Project Committees I have just described is strongly connected with the Committee on Outreach.

There are already numerous and effective out-reach projects of component societies. Some are individual such as psychoanalysts who hold university appointments; others are societal such as low fee clinics. The work of the Committee on Outreach will be to support and multiply these initiatives in various ways:

• It will maintain an inventory of existing programmes and make it available to all component societies,

• It will facilitate communication and co-operation among societies that need certain kinds of outreach programmes and those that already have them in place,

• It will provide consultations when requested,

• It will publicize successful out-reach projects at congresses, in the Newsletter and on the website,

• In cooperation with interested component societies it will design and explore the efficacy of new outreach projects.

In these and other ways, the Committee on Outreach will help societies to develop or strengthen strategies aimed at increasing the number of patients seeking psychoanalytic treatment. By exploring new approaches to recruitment and education compatible with the requirements of the three IPA training models, the Committee will help societies to attract more and younger candidates to our Institutes.

These policies and the new committees that embody them seek to keep the promises I made to you during the election. I am encouraged by the knowledge that I share a commitment with each one of you to advance psychoanalysis as a science and as a clinical practice. Working together in these and other projects for the advancement of psychoanalysis as science and as profession, we will be better able to serve our patients, our communities and our profession.