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Kavanaugh - Is Psychoanalysis in Crisis?

Is Psychoanalysis in Crisis?

It All Depends on the Premise of Your (Psycho) Analysis
Looking Inward and Outward for Direction ©

by Patrick B. Kavanaugh, Ph.D.
Copyright, 1996

CONTEXTUAL NARRATIVE

This paper considers the question Is Psychoanalysis in Crisis? from three different perspectives:  1) from the rather narrowed perspective that psychoanalysis is a healthcare profession, or a specialty thereof; 2) from a somewhat broader perspective in which there is a crisis in representation as to which psychoanalytic theory, organization, and educational standards best represent psychoanalysis to congress, the insurance industry, and the public; and, 3) from an even broader perspective, a cultural-historical perspective, that speaks to a different kind of crisis in representation taking place within the very epistemological fabric and design of the westernized cultures.  While organized psychology and psychoanalysis might be in crisis, that does not translate to mean that psychoanalysis is in crisis.  An alternative version of psychoanalysis situated in philosophy, the humanities, and the arts is considered.

The paper I will be presenting this morning is a somewhat elaborated version of a paper presented at the APA convention this past August at a symposium sponsored by Section V of Division 39. 1 would like to preface this morning’s presentation with a brief recounting of the history that led up to the invitation to participate in that symposium.

In January of 1995, the Academy for the Study of the Psychoanalytic Arts was founded as a section of the Michigan Society for Psychoanalytic Psychology (MSPP). A group of five members of the MSPP had formed this new section in response to the industrialization and commercialization of the health care professions. The Academy’s organizing interest and defining project is to be found in the reconsideration, reexamination, and rethinking of the philosophical-theoretical underpinnings of psychoanalysis from within a psychological understanding of the human condition and within a contextual metaphor more closely allied with philosophy, the humanities, and the arts than with biology and medicine. The project of the Academy is to extend the understanding of psychoanalysis beyond existing conceptual boundaries. This new section was formed within MSPP to represent this particular interest in psychoanalysis, to provide a place and space for the like-minded in their pursuit of this scholarly project of rethinking psychoanalysis, and to collectively and vigorously advance this understanding of psychoanalysis in the marketplace of ideas in the professional, lay and academic communities --- activities that the founding members of the Academy had considered to be central and foundational.

Whereas the formation of the Academy had been brought about by a reactive response to the industrialization and commercialization of the health care professions, the project of the Academy was to proceed by proactive design and through the presentation of its project of rethinking psychoanalysis in the marketplace of ideas. In February of 1995, "The Narrowing Scope of Psychoanalysis", an article published in the MSPP News, announced the formation of the Academy within the MSPP, articulated this foundational philosophy, purpose, vision, and project of the academy, and extended an invitation to colleagues to join with like-minded others in its project and effort. (MSPP News, Feb., 1995) This same article was to be later published in the Psychologist-Psychoanalyst, the newsletter of the Division of Psychoanalysis of the APA (Nov-Dec. 1995 vol.5, no. 1).

It was in response to this publication in the Psychologist-Psychoanalyst that a representative from Section V of Division 39, the Psychologist-Psychoanalyst Clinicians, invited the Academy’s participation in a symposium to be held in August of ‘96 in Toronto. Section V’s program theme for 1996 had been organized around the question of the current state of psychoanalysis. Part one of Section V’s two part program took place in April during the Division’s 16th annual Spring Meetings in New York in a symposium titled: "The Death of Psychoanalysis: Murder, Suicide or Rumor Greatly Exaggerated?" Part two of the program took place in August during the Division’s meetings at the APA annual convention in Toronto in a symposium titled: "Is Psychoanalysis in Crisis? Looking Inward and Outward for Direction". Each presenter at this second symposium was asked to address the question "Is psychoanalysis in Crisis?" and, also, to speak to the future directions for psychoanalysis as was seen from each individual’s perspective. Dr. James Barron presented a paper titled Contemporary Psychoanalysis: Crisis and Creativity, Dr. Bertram Karon presented a paper titled The Struggle is Not Yet Over, and the following is a somewhat elaborated version of the paper that I presented titled Is Psychoanalysis in Crisis? It all depends on the Premise for Your (Psycho) Analysis.

The perspective and positions advanced in the following paper is intended to represent a contribution to the study of the psychoanalytic arts.

Introduction: Is psychoanalysis in crisis?... Recent years have witnessed the juggernaut-like onset of the Health Care Reformation. Massive changes in heath care policies and revolutionary transformations in the design of health care delivery systems have impacted most dramatically upon the psychoanalytic community. These have been desperate times. And desperate times have called for desperate measures. Organized psychoanalysis and psychology have responded by directing vast allocations of their meager organizational resources into political-legislative efforts to soften, if not blunt, the impact of the industrialization and commercialization of the health care professions. The question remains, however, "Is psychoanalysis in crisis?" And the question invites the reply, "It all depends......." Crisis and that which might constitute psychoanalysis being in crisis resides in the eye of the beholder and is inextricably linked to one’s particular understanding and version of psychoanalysis. Put in a slightly different way: the determination of crisis in psychoanalysis depends upon one’s understanding of psychoanalysis, itself; and, the premise upon which this understanding proceeds.

As a contribution to the symposium this afternoon, I would like to consider the question before us, "Is psychoanalysis in crisis?", from three different perspectives: (1) First, to consider "Is psychoanalysis in Crisis?" from the rather narrowed perspective that proceeds from the premise that psychoanalysis is a health care profession, or a specialty thereof. And, as such, to consider some of the implications for psychoanalysis as the standards of the health care model and the principles of industrialization and commercialization are applied to psychoanalysis as theory, as practice, and as education; (2) Second, to consider the question "Is psychoanalysis in crisis?" from a somewhat broader perspective that proceeds from the premise that the creative ferment that has been taking place in psychoanalytic conceptualization, theory and technique in recent years has come to result in the development of what could be thought of as a "crisis in representation" within organized psychoanalysis and the psychoanalytic community at large. More specifically, there has been a growing "crisis in conceptualization" as to which theory represents psychoanalysis in terms of purpose and objectives... There has been a developing "crisis in education" as to which set of objectivized standards of training represents the legitimate Psychoanalytic Institute and authorizes the authentic Psychoanalyst... And there has been a divisive political crisis developing amongst various organizational representatives as to which psychoanalytic organization or consortium represents psychoanalysis to the professional, lay, and political communities. And, third (3) to consider the question "Is psychoanalysis in crisis?" from an even broader perspective..... a cultural-historical perspective. From this perspective, the current conceptual and political "crisis in representation" taking place within organized psychoanalysis reflects and contributes to an even more profound and farther reaching "crisis"--- a different kind of "crisis in representation". This "crisis in representation" has been taking place within the very epistemological fabric and design of the westernized cultures during the past quarter of a century with the emergence of the Postmodern Era. The Postmodern Era, as a cultural epoch, provides an historical-perspective and a cultural context in which to consider the question: "Is psychoanalysis in crisis?". It is this emerging and revolutionary epistemological field of the Postmodern Era that provides the opportunity to reexamine, reconsider, and rethink psychoanalysis as theory, as practice, and as education. And it is in this discourse of the postmodern that is to be found the directionality for the future of psychoanalysis.

The Industrial Age of the Modern Era

In the history of people and of ideas, it is possible to discern at least three "Ages" in which civilization was organized in a manner characteristic and distinctive of each of these Ages. In the first Age, the Agricultural Age, civilization was organized around the requirements and tempos of agriculture with the rhythms of the earth and other quasi-mystical explanations inherent in religion, magic, superstition, and folk wisdom coming to constitute the body of knowledge for that Age. In the second Age, the Modern Age, civilization was organized around the Enlightenment with emphasis placed upon rationality and science during the accompanying emergence from the Middle Ages. Within this schema of historification, the Industrial Age of the Modern Era is believed to have had its beginnings sometime in the early 1700’s with civilization organized around the characteristic and inexorable trend toward the industrialization of the westernized cultures.

In the history of people and of ideas, psychoanalysis had its earliest of beginnings within the socio-cultural context of the Industrial Age of the Modern Era. As a child of the Westernized cultures, psychoanalysis was born out of the then emergent and revolutionary epistemological matrix and cultural ideology of the Industrial Age. The episteme of the Industrial Age was to proceed from within a philosophic tradition of objectivism in which objective reality was believed to be self-evident and its essence was to be found in solid matter with each object occupying its own sharply demarcated place in space and time. This "world" was understood to be a predictable and mind-independent world that had an essential state. In its essence, this world was both objective and it was knowable through the discovery of universal and unifying laws that existed "out there". A linearized 1-1 correspondence between the world, these natural laws, and the concepts that represented them was assumed by this classical epistemology. Language, it was believed, was object-based and simply reflected reality as it really was. The "world" of the Industrial Age, however, was more than just "objective and knowable". This world was a Cartesian-Newtonian world, a world based upon a particular way of thinking about institutions, people, and life.

A Cartesian certainty of knowledge about the world was possible only through the application of Newtonian based science, method, and explanation. A central preoccupation of the Modern era was to be the discovery of nomothetic laws that would explain the world and people, make it possible to predict, influence, and control natural events and human behavior, and to eventually to construct a better world through the discovery of such empirically derived knowledge. The applications of this discovered knowledge were to provide for better adaptations by people to the objective realities of everyday life, to contribute to more informed social policies for government, and, in general, to further the development of a better and more civilized world. The scientific method was to occupy a privileged relationship with this Truth discovered. The Industrial Age of the Modern Era was to become the Age of science and technology; the Age of quantification and objectivization. This was to become the Age in which the assembly line of the factory and the component parts of complex machinery were to serve as the mental model for the ordering and thinking about people and events. It was this rational-objectivist view of reality, the world, and of people as being like complex machines that was to be developed during the 17th, 18th, and 19th centuries. The Industrial Age of the Modern Era was, also, to be the Age in which certain principles were to be developed for the mass production, mass distribution, and mass consumption of goods and services. It was to be the Age in which "the producer" and "the consumer" were to become the hyphenated basic unit of society. The Industrial Age of the Modern Era provided the cultural context and ideology, the objectivist epistemological premise and world view, and the historical tradition of industrialization which was to contextualize the development of psychoanalysis. It was to be this Cartesian-Newtonian way of thinking that was to provide the epistemological assumptions, premise, core values, and context for the development of classical psychoanalysis as theory, as practice, and as education. Psychoanalysis has been a child of the Westernized cultures. Psychoanalysis as theory, as practice and as education has been a product of these times. It is this Industrial Age that has provided the cultural context in which healthcare has become the most recently identified and regulated of the major industries in this country --- the Behavioral Care Industry. And, in which industry, the principles of industrialization and commercialization are being systematically applied to psychoanalysis as a health care profession.

"Is Psychoanalysis in Crisis?":
Psychoanalysis as A Health Care Profession

In the United States, the history of the conceptual development, the education and training, and the practice of psychoanalysis has been closely interwoven with medicalized concepts and practices and has been tightly intertwined with the history of the development of the health care professions. Largely unquestioned medicalized conceptual models and unexamined ways of thinking have had a profound impact on the development of psychoanalysis as theory, as practice, and as education ... and, in the minds of many, upon its identity as being a health care profession. As a profession situated within the matrix of health care, psychoanalysis has come to be understood within the contextual metaphor of disease, diagnosis, and treatment. And, people have come to be understood within the conceptual framework of symptomatology, etiology, and pathology. In this country, particularly, this favored conceptual framework of symptomatology, etiology and pathology has come to understand psychodynamics to be evidences signifying of psychopathology. In many respects, it has been this medicalized contextual metaphor and its organizing conceptual framework that has become the strongest weakness of contemporary psychoanalysis.

Redefinition of Professional Standards
As a profession situated within health care, psychoanalysis has become subject to the ongoing Industrialization of the Health Care Professions and the systematic redefinition of professional standards. The psychoanalytic practitioner and the psychoanalytic educator have been captured and imprisoned in the image of themselves as health care professionals. They have become confined in the prison of their contextualizing and defining metaphors. They remain captive in this conceptual prison through the ongoing redefinitions of the standards of practice, standards of care, and standards of education and training. This redefinition of professional standards has extended to include the rewriting of the ethical standards of the profession. This newer version of ethics derives from medicalized conceptualizations of people and psychopathology, core values and attitudes more appropriate for issues of sickness and treatment, and the presumptive responsibilities for people and their lives more consistent with people afflicted with physical disease and illness. The reification of the traditional contextualizing metaphors for psychoanalysis such as psychopathology, mental illness, cure, and curative factors has contributed significantly to redefine that which is to constitute "quality", "integrity", "reliability", and "value" as the healthcare professions become more industrialized. (Register Report, January, 1995) This rewriting of ethics proceeds from the medicalized conceptualizations underlying the professional standards currently being established by various bureaucratic entities, national committees, and other healthcare interest groups. And it is these industrialized and industrializing standards that will determine the psychologist-psychoanalyst’s legal exposure and liability in future malpractice actions.

These institutional(ized bureaucracies, national committees, and various special interest groups have been developing policies and prescribing procedures that have dramatically redefined the professional standards of psychoanalysis and psychology as being more clearly the standards of a health care profession. These professional standards are being articulated, established, and encoded in the maze of new health care rules, regulations, policies and procedures. The redefinition of these professional standards have re-defined the professional functioning and everyday life of each psychologist-psychoanalyst as a health care professional. Succinctly stated: the current identification of psychoanalysis as a specialty of the mental health disciplines has come to define psychoanalysis as a regulated craft to be further subjected to the regulatory constraints imposed by the industrialization and commercialization of the health care professions. The psychoanalytic community has been witness to a massive, systematic and literal dismantling of a psychoanalytic practice and educational "reality" that once was... And the psychoanalytic community is currently witnessing a dynamic system of intersecting, interrelated and interconnected linguistic relations that overlap, define, and proscribe a new professional identity for the psychologist-psychoanalyst as a craftsperson. A new "objective reality" is being created and defined in which to practice and educate. As the psychoanalytic community debates the merits of the postmodern discourse, or of social constructivism, or spends its energies defending the assumptions and premise of classical epistemology, a unique opportunity is being missed to study the interweave of an intricately complex semiotic process of signification by which various governmental entities, legislative bodies, professional organizations, and regulatory agencies continue to redefine and transform the objective reality for psychoanalytic practice and education..

Psychoanalytic Practice

The Industrialization of the Health Care Professions has resulted in the narrowing of the scope of psychoanalysis. As a health care profession, psychoanalysis has been subsumed by this current industrialization and commercialization with far reaching consequences for theory, practice, and education. As the standards of the health care model and the principles of industrialization have been applied to psychoanalysis, the scope of psychoanalysis narrows through the increased centralizations of information, authority, and decision making power in various bureaucracies; through the uniformity of policies and procedures that are coming to define and assure so called quality in psychoanalytic practice and education, and through the templates that indicate the appropriate treatments for specified diagnostic categories and determine the expected outcomes for education. As a medical procedure, psychoanalysis is considered to be appropriate for only certain diagnostic conditions. And, as a method of treatment, psychoanalysis is considered to be amongst the least cost-effective of those medical procedures to be included in the pre-packaged health care product lines marketed by the insurance industry. It is significant to note that neither organized psychology nor organized psychoanalysis has questioned or challenged the framework of healthcare that presumes an integral relationship between healthcare and psychoanalysis as these health care policies are being formulated, standards of practice are being redefined, and revisions to state Mental Health Codes are taking place. The focus and effort of organized psychoanalysis has been to deal with "the managed care threat" through the education and lobbying of legislators, the providing of information to consumers, and the organization of various coalitions in the service of influencing and shaping these health care policies, plans, and delivery systems (Eagle, M., Psychologist-Psychoanalyst, Winter, 1966, vol.XVI, no. 1)

This centralization of information, authority, and decision making power is to be found within the proliferation of a number of national committees and task forces (Practitioner Update, December, 1993). These committees and task forces such as the Utilization Review and Accreditation Committee, the National Committee for Quality Assurance, the National College for Professional Psychology, and the APA’s Board of Professional Affairs Task Force had been formed and charged with the responsibility of setting standards for the profession and practice of the psychologist-psychoanalyst. The establishment of these and other such standard setting entities proceeds from the largely unquestioned premise that the profession and the practice of psychology-psychoanalysis is a craft, that psychology-psychoanalysis is a health care profession, that psychologist-psychoanalysts comprise a "cottage industry" of loosely organized and minimally regulated craftspeople; and, that the next evolutionary step for the profession is to adapt to the health care systems being devised and to practice from within these systems.

Indeed, the centralization of information, authority and power in various bureaucracies includes the overlapping bureaucratic structures of organized psychology and organized psychoanalysis. The stated strategic objective of the APA Practice Directorate, for example, has been to maintain psychology’s stake in American health care (Practitioner Focus., February, 1995) and, more recently, the Practice Directorate’s organizational focus has been to address "...the need for better balance between cost containment and efforts to ensure quality services in the health care delivery system." (Practitioner Focus, February, 1996) Obtaining prescription and hospital privileges are two of the APA’s priority policy objectives for the ‘90s reflective of this strategic objective. Progress in achieving these objectives are regularly updated for the practitioner. The February, 1996 issue of the Practitioner Focus reports on the key victory for psychology in which Congress had extended the Psychopharmacology Demonstration Project (PDP) until June of 1997 at which time Congress will consider making it permanent. And, at the state level, the 3rd Quarter, 1996 News Bulletin of the Michigan Psychological Association (MPA) updates the MPA membership on the progress of a Hospital Practice Bill in the Senate (Senate Bill 962) and the House (HB 5826). The Task Force of the Board of Professional Affairs of the APA had been charged with the responsibility of developing templates for the practitioner which were to meet certain "internal validity criteria", derived from clinical experience and based on research data. "External validity criteria" were to be based on cost factors, feasibility of treatment, and ease with which the practitioner can be trained in its application. The Task Force recently published the "Template for Developing Guidelines: Interventions for Mental Disorders and Psychosocial Aspects of Physical Disorders" (1995) Effective psychotherapeutic techniques are specified for specific diagnostic conditions. These guidelines were approved by the APA Council of Representatives in February of 1995. These "suggested" guidelines carry far reaching consequences for psychoanalytic practice and education, the restrictive implications of which are increasingly being recognized and considered by members of the psychoanalytic community (Walls, G.B. & Scholon4 A.H., Psychologist-Psychoanalyst, Winter, 1995; vol. XV1, No. 1).

Another layering of this centralization of authority, and decision making power is to be found in the State Psychological Associations (SPAs). With the defeat of the Health Security Act of 1994 and the failure to accomplish health care reform through the passage of national legislation, the primary forum for the shaping of health care plans moved to the state legislatures. Currently, health care reform is to be found in state legislative initiatives and state psychological associations have become major players in the shaping of these initiatives. Organized psychology and psychoanalysis have sought to establish or influence through their state psychological associations and local chapters, mental health parity bills, e.g., coverage for mental health benefits on the same basis as coverage for physical conditions, Patient Protection Acts, Points of Service, and Any Willing Provider Laws, and Hospital and Prescription Privileges legislation for psychologists (-psychoanalysts). Thus far, an estimated 30% of the Health Security Act of 1994 has been enacted in one form or another and the groundwork- for the other 70% is being laid in Congress and various state legislatures. (Investor’s Business Daily, Editorials, September 16th, 1996)

Psychoanalytic Education

The same industrializing principles for the mass production, mass distribution, and mass consumption of psychoanalysis as a treatment procedure are now being applied to psychoanalytic education. For example, the APA’s Board of Professional Affairs Task Force had been charged with developing guidelines that were intended to serve as a template for graduate school programs of study in psychology. (Practitioner Update, 1993) Amongst other of the consequences of health care reformation for the psychoanalytic educator has been the increased emphasis upon the development of more standardized programs of study, the predetermination of educational objectives and outcomes to be attained, and a pre-defined and standardized set of core competencies to be mastered by new practitioners. These educational objectives have been adopted by the APA as "priority objectives" for graduate school education in psychology. (APA Monitor, March, 1995; APA Education Directorate News, Summer, 1995) The Industrialization of the Health Care Professions with its emphasis upon outcome based treatment has led to the Industrialization of Education with its emphasis upon outcome based education.

Competency in education has come to be defined as the mastery of certain pre-thought thoughts and ways of thinking. And this standardizing, qualitizing and homogenizing educational philosophy is organized around the rapidly developing trend of increased specializations within the healthcare professions. As reported in "A Legal Update on Provider Credentialing" (The Psychologists’ Legal Update, June, 1995, no.7), provider-specific credentials are becoming the standard by which competency in specific areas of ability are measured: "Since ‘quality’ in health care has proven so difficult to advertise based on outcomes of care, those who assemble networks of providers usually resort to asserting quality based on the inputs i.e. the providers’ credentials." (p.3)(italics added) This emerging trend of proficiency credentialing in designated areas of competence is taking place throughout the health care professions.

This increased emphasis on specialization, standards, and proficiency credentialing is being actively embraced and advanced in organized psychology and organized psychoanalysis. In 1993, the Practitioner Update reported that the National College of Professional Psychology (NCPP) had been proposed as a new structure within the APA to provide guidelines for the education and credentialing of psychologists in "designated proficiency areas". In the February, 1996 issue of the Practitioner Focus, the NCPP announced the availability of its first certification: "The Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders". The increased specialization and credentialing in designated proficiency areas within the profession of psychology-psychoanalysis has kept pace with this larger industrializing trend in the health care professions. For example: The announcement of the awarding of diplomate status by the American Board of Psychoanalysis in Psychology (ABPsaP) (Lane, R., ABPsaP and ABPP Begin to Diplomate Psychologists-Psychoanalysts, Psychologist-Psychoanalyst, Spring, 1995); the establishment of Division 39’s Committee on Specialization and Accreditation of Psychoanalysis which has been working to achieve recognition for psychoanalysis as one of the first postdoctoral specialties in professional psychology; (Kaley, H., Psychoanalytic-Psychologist, Fall, 1995, vol.XV, no. 4) or, in the efforts of the Psychoanalytic Consortium which represents Division 39 on matters of national accreditation, state-level licensing and certification. The Psychoanalytic Consortium, representing itself as the collective and responsible voice for psychoanalysts, advances psychoanalysis as a function and specialty of health care professionals. In response to the Vermont State Legislature passing a psychoanalyst certification law, Division 39’s representative called for the Psychoanalytic Consortium to be the militant standard bearer for well trained psychoanalysts with "well trained" being defined as trained and licensed as mental health professionals; and, being a mental health professional i.e. attainment of a professional degree in a field of mental health service, as being criteria to be included as training standards for defining a "national psychoanalytic association". (Calligor, L., The Psychoanalytic Consortium, The Psychologist-Psychoanalyst, Summer, 1995; Winter, 1996)

This increased emphasis on specialization and credentialing for the psychologist-psychoanalyst follows in the footsteps of the medicalized model of specialization, contributes to the further conceptual fragmentation of people, serves as both the "effect" and the further "cause" of industrialization......... and, as reported in the Legal Update, the expectation is that these credentialing requirements will increase. Such industrializing efforts in psychoanalytic practice and education tacitly advances and endorses the principle and practice of "Economic Credentialing" in which efforts are made to include only those who meet certain levels of "efficiency" in managing the costs of treatment.

As a profession situated within the matrix of health care, psychoanalysis in the United States is quickly becoming a psychoanalysis of conformity and compliance: conforming to the health care standards that contextualize psychoanalytic ethics, practice and education. And, through such conformity and compliance, encouraging of people who seek psychoanalytic consultation or education to conform and comply to the standardized, qualitized, homogenized and idealized normative outcomes. From the rather narrowed perspective that proceeds from the axiomatic premise that psychoanalysis is a health care profession or a specialty thereof ... Yes! it would appear that psychoanalysis is in crisis. The industrialization and commercialization of the health care professions have enveloped the psychoanalytic community and have come to define for the psychoanalytic community how to conceptualize, how to practice, and how to educate....

The defining issue confronting the profession has been rather narrowly defined by organized psychoanalysis as the "the managed care threat". These are desperate times. And desperate measures have come from desperate times. Efforts to redress this so called crisis in psychoanalysis have centered, for the most part, upon attempts to humanize the harshness of the industrializing principles that have come to contextualize psychoanalytic practice and education and to enlighten various legislative, regulatory, and policy making bodies/entities as to the worth of having psychoanalysis included in the health care product lines marketed by the insurance industry. (Eagle, M., Psychologist-Psychoanalyst, Winter, 1966, vol.XV1, no. 1) There is, however, a noteworthy alternative position developing amongst a significant minority of colleagues. This significant minority has re-identified the defining issue as psychoanalysis having located itself in the health care professions in the first instance. Their more radicalized solution, which appears to be gathering support in some sectors of the psychoanalytic community, is to extricate psychoanalysis from the health care professions and to declare psychoanalysis to be an independent and separate profession. Cloaked within the developmental notions of "progress" of the modern era, the establishment of psychoanalysis as being a separate and autonomous profession is presented as taking the next logical and evolutionary step as a profession. The psychologist-psychoanalyst could then practice independently and educate their own, it is advanced, and, in so doing, "the natural destiny" of the psychologist-psychoanalyst could be then fulfilled.

To move in either of these directions in the pursuit of a (re)solution to the so called "crisis in psychoanalysis as a health care profession", however, is to do so at the risk of underappreciating something that has been happening in recent years within psychoanalysis and within the westernized cultures at large. Indeed, as we look inward and outward for directionality in psychoanalysis, we might do well to collectively consider a broader perspective, an historical-cultural perspective, contained within which is to be found several "crises in representation" that bares quite directly upon the future of psychoanalysis as theory, as practice and as education.

"Is Psychoanalysis in Crisis?": Crises in Representation

Within the past quarter of a century, the emergence of a new sociocultural epoch has been making its largely unexpected, if not unwelcomed, appearance. A Third Age in the history of people and of ideas has been emerging. The Information Age of the Postmodern Era has made its rather disturbing and disquieting presence known. Its discourse speaks loudly to an unrelenting questioning of the largely unquestioned and presumed realities of the so-called Truth that had come to constitute science and the body of knowledge of the Industrial Age of the Modern Era. A deconstructive questioning of the modern era notions of history, literature, art, education, physics, science, conceptualizations of the self, the referents of language, logic and reasoning, the nature of reality, and other questions, philosophic in nature, have profoundly shaken if not eroded confidence in the logical-objectivist epistemological premise of the modern era. A profound and far reaching "crisis in representation" has been making its appearance in the westernized cultures as certain fixed, foundational and enduring "rules" that had prescribed "the reality" and the "natural order of things" are being requestioned, reconsidered and reconceptualized. These rules had provided for that which had constituted the discursive rationality and social coherence of the Modern era. And for that which had constituted its Goodness, Beauty, and Truth. The discursive power of the monologic rules of discourse has been shaken. The fundamental and foundational codes as to that which have constituted, authorized, and sanctioned "appropriateness" in perceiving, thinking, and knowing during the Modern Era have been changing dramatically and radically. There have been rather abrupt and ruptured breaks with traditional ways of thinking about, understanding, and conceptualizing people, ideas, life, and the world. The westernized cultures are currently immersed in a turbulent transition from the Industrial Age of the Modern Era to the Information Age of the Postmodern Era. The episteme of the Modern Era, having its origins in the 17th century, is becoming as obsolete and non-functional for the emerging Postmodern Era as the episteme of the Agricultural Era was for the Modern Era. A conceptual revolution has been taking place within the westernized cultures as profound and as far reaching as that which took place in the transition between the Agricultural Age and the Industrial Age of the Modern Era. Uncertainty has been spreading as the unquestioned fundamental assumptions, traditional epistemological premises, and presumed realities of the Industrial Age elusively evaporate and transform into the unexpected, the unfamiliar, and the unknown.

This crisis in representation within the westernized cultures has had a disturbing, disorganizing, and disorienting impact upon institutional structures and individuals alike. A series of so called crises have been developing in organized psychoanalysis as this irreverential discourse of deconstructive questioning gathers synergistic momentum and pragmatic consequence in its reexamination and reconsideration of the once seemingly natural and unquestioned ideology of a monolithic psychoanalysis. Within organized psychoanalysis, these have become times of profound uncertainty as this "crisis in representation" has been making its appearance in theory, practice, and education. A conceptual "crisis in representation" has been making its appearance in psychoanalytic theory as the monolithic view of psychoanalysis of the Modern Era has been disappearing, if not disintegrating, as a plurality of heterogeneous theories have been making their appearance in contemporary psychoanalytic thinking. There has been a proliferation of conceptualizations of what psychoanalysis "is", each version of which has little in common with the others. Theoretical pluralism, at least for the time being, has been accommodated, if not appropriated, through innovations within traditional organizational structures and educational curriculum. The epistemological-philosophical premise of the Industrial Age which had provided a seemingly eternal and unquestioned justification for psychoanalysis in the Newtonian-Cartesian tradition and psychoanalytic education fashioned in the image of the Berlin Model has been disappearing and evaporating beneath our feet. The once axiomatic epistemological premise, assumptions, and core values of that which had come to be defining of a monolithic psychoanalytic theory, practice, and education of the Modern era have been drawn into deconstructive question. There has been a seemingly "natural" and "common sensical" organic bond between psychoanalysis and its largely unquestioned and unexamined medicalized concepts, attitudes, values, and ways of thinking. And, there has been a seemingly "natural" and "common sensical" organic bond between psychoanalytic education and its institutional(ized) structure, educational philosophy, and educational model, methods and objectives of the Modern Era. It is this organic bond that is decaying.

This "crisis in representation" gathers considerable significance as it raises questions of pragmatic, economic, and political consequence as this plurality of heterogeneous theories make their appearance. For example: Who is to be represented as being the authorized Psychoanalyst? as defined by which set of objectivized standards ? or, levels of certifications ? or, tiers of credentialing ?.  And, a competitive "crisis in representation" is developing between groups within organized psychoanalysis centering upon such questions as: Which psychoanalytic organization or consortium is to be the recognized standard bearer for psychoanalysis? or, to represent the standards of psychoanalytic education? or, Which psychoanalytic institute is to be the legitimate guardian and authorized transmitter of psychoanalytic Truth? particularly as there are increasingly different and contradictory Truths of psychoanalysis. This "crisis in representation" extends to such political of questions as: Which psychoanalytic organization is to represent and speak with the authentic voice of psychoanalysis? in the professional community? in congress? to insurance companies? to the public? Such a series of "crises in representation" may be understood and responded to as simply being a part and consequence of the creative ferment and tensions that have defined the tradition of restless and searching inquiry within psychoanalysis. However, it seems to me, as a profession whose basic theoretical constructs, principles of practice, and educational philosophy and model are conceptually situated and located within the epistemological premise and roots of the Modern Era. Yes!... it would appear that mainstream psychoanalysis is in deep .... deep .... crisis! ...

The crises of psychoanalysis as the principles of industrialization and commercialization are applied to the health care professions, or as a consequence of being buffeted about in the throes of a political "crisis in representation" within organized psychoanalysis, or seemingly caught up in the fractured turbulence of an epistemological "crisis in representation" within the westernized cultures is not to be construed to mean, paradoxically, that psychoanalysis is in crisis. Organized psychoanalysis might be in crisis. And organized psychology might be in crisis. However, that does not translate to mean that psychoanalysis is in crisis. Psychoanalysis is neither a healthcare profession nor is it an entity defined or housed in organized psychoanalysis. To the contrary, looking inward to the "crises in representation" in organized psychoanalysis brought about by the recent creative ferment in psychoanalytic theorizing and thinking; and, looking outward to the epistemological "crisis in representation" in the westernized cultures suggests directions for the future of psychoanalytic theory, practice, and education. Indeed, contained within these so called "crises in representations", themselves, is to be found a reexamination, reconsideration and radicalized rethinking of psychoanalysis that has been going on from "within" and from "without" for quite some period of time.

Inward and outward Directions:
Philosophy, the Humanities, and the Arts

As confidence has shattered in the various mythologies that had come to envelop and define the psychoanalysis of the modern era, there has emerged, Phoenix like, a new psychoanalysis of extraordinary power, passion and poetics. This psychoanalysis proceeds from an epistemological premise of radicalized relativism, perspectivism, and phenomenalism and is situated within philosophy, the humanities, and the arts. Its conceptual premise and understandings are to be found within the realm of human experiences. This psychoanalysis speaks from different and unfamiliar ways of thinking about the world, people, and life. As has been noted by the philosopher Vattimo (1988), the world is a "World of Differences" in that there is an infinite interpretability of reality amongst people. The only world that can ever exist and be known is this "World of Difference", i.e., this world of interpretations of the world.

This philosophic premise of an infinite interpretability of reality leads to an understanding of psychoanalysis of a much different purpose, objective, and set of core values for theory, practice and education than have had the various psychologies of psychoanalysis of the modern era. Such a psychoanalysis presumes neither the reparative purposes nor the normalizing objectives of the psychologies of psychoanalysis of the modern era. From this philosophic premise, the center of the universe in psychoanalysis becomes the human experience and the question of the enunciating subject. The focus and purpose of psychoanalysis becomes the understanding of that person’s way of thinking, knowing, perceiving, and constructing "reality", the "world", and the nature of that "world". The quest of discovery in psychoanalysis becomes the quest of the speaking subject. Any essence to this world is the essence as is seen and "is experienced to be" by the individual. This world is a world in which reason and "Truth" are situated in the realm of the human experiences of the subject and are to be found within the ideographic and provisional laws of the perceiver. "Truth" as to the question of "essence" is reduced to the values of the subject. It is the subject who has the privileged relationship to truth; it is the privilege of the action of the analysis to attempt to understand that "Truth".

Situated within philosophy, the humanities, and the arts, the essence of psychoanalysis derives from such sources of knowledge and understanding as literature, poetry, and the theatre. As recently noted by the psychoanalyst Jonathan Lear (1995) "Creativity is no longer the exclusive preserve of the divinely inspired or the few great poets. From a psychoanalytic point of view, everyone is poetic; everyone dreams in metaphor and generates symbolic meanings in the process of living. Even in their prose, people have unwittingly been speaking poetry all along." (1995, p ) As a unique psychological discourse, psychoanalysis ventures into this poetic communication of everyday life via the associative method within a contextual metaphor from the arts such as, for example, the psychic theatre of the mind. (Kavanaugh, 1995).  As a venture into vitally metaphoric communication, the psychoanalytic discourse is understood to be a semiotic discourse; and, is to be understood as one would understand a poetic text. Thus, from this perspective, the psychoanalytic discourse is considered to be, much like with poetry, one of the most complex and intricate forms of human discourse wherein which all thinking is considered to be radically and vitally metaphoric. In this psychoanalytic discourse, there are no "facts" except as are construed within the mind of each person. Indeed, the subject is both the maker and the interpreter of meaning. The discourse of psychoanalysis is concerned with the understanding of these idiosyncratic meanings, ideas, desires, passions, beliefs, motivational causalities and psychic laws of the subject - ------ the ideographic meanings of which derive from the associative context of the analytic moment. As a work of art, the psychoanalysis of the postmodern is concerned with attempting to understand the "psyche", e.g., the soul, the spirit, the mind of the person. As a poetic work- of art, psychoanalysis speaks to the enduring and fixed traditions of the subject’s pheneomenal past as are co-existent and codeterminant with the subject’s present wishes, desires, and longings, and with their future purposes and goals. In so doing, psychoanalysis speaks with the voices of the dead in the present moment of the past. Psychoanalysis as derived from philosophy and the arts is considered to be a poetic work of art in that it registers, monumentalizes, and attempts to speak to the subject’s passage of time.........

Such versions of psychoanalysis as are derived from philosophy and the arts carry with them radically different visions for psychoanalytic education in terms of institutional structure, educational philosophy, and educational model. As we enter the postmodern era, it would seem that a rethinking of what is meant by ‘psychoanalytic education’, itself, constitutes a major and ongoing postmodern project...............

To return, however, to the question most immediately before us this afternoon: Is psychoanalysis in crisis?

Of course it is! ......

Unless, of course, it isn’t!..........

It all depends on the premise of your analysis......

And it all depends on the premise of your psychoanalysis.......


Dr. Kavanaugh received his doctorate in philosophy (psychology) from the University of Windsor in Ontario, Canada.  Since the completion of his doctoral studies, he has been active in the academic, organizational, and practice areas of the psychoanalytic-psychological community.  In the academic area, he has served as Director of Clinical Training and member of the core teaching and supervisory faculty in the doctoral program in psychoanalytic psychology at the University of Detroit; as a member of the teaching and supervisory faculty in the Program for Advanced Studies in Psychoanalysis in Wyandotte, Michigan, an interdisciplinary program for the study of the analytic discourse; and, as a member of the teaching and supervisory faculty in the pre-and post doctoral educational programs at the Detroit Psychiatric Institute, the Wyandotte General Hospital, and the V.A. Medical Center in Detroit.  In the organizational area, he is the founding and current president of the Academy for the Study of the Psychoanalytic Arts; past president of the International Federation for Psychoanalytic Education; the Michigan Psychological Association, and the Michigan Society of Clinical Psychologists.  In the practice area, many of his professional interests during the past 35 years are directly related to experiences in the discourses of various residential treatment facilities.

Dr. Kavanaugh is a recipient of  The Distinguished Psychologist Award  from the Michigan Psychological Association and the Master Lecturer Award from the doctoral students at the University of Detroit.

Currently Dr. Kavanaugh is in the private practice of psychoanalysis in Farmington Hills, Michigan:

Office:  31805 Middlebelt, Suite #305
               Farmington Hills, Michigan, USA  48334
               Phone: (248) 626-6460
               Fax:      (248) 626-4808