Tuesday, August 30, 2016

Psychoanalysis Is Dead

I don’t quite see why, but some people doubted me when I said that psychoanalysis, or long term talk therapy was a thing of the past. I was certainly not alone in having this opinion. Dr. Jeffrey Lieberman, head of psychiatry at Columbia Presbyterian Hospital said exactly the same thing.

But, some still cling—bitterly—to their hopes and dreams and fantasies. If they have been well-enough analyzed they take their longings for reality.

Some still believe that classical analysis and its many avatars is still a viable practice. Evidently, they should read my book The Last Psychoanalyst, to disabuse themselves of the notion, but analysts and therapists are not, alas, big readers.

If they read the New York Times they might have noticed this article, by Ginia Bellafante, on the end of the August vacation. You see, back in the day, all analysts, as a homage to Freud, used to take August off. It was a cultural fact, widely noted. It isn't any longer. And the Times notes, the profession of psychoanalysis has largely lost its prestige, its glamour and its reputation.

It took New Yorkers some time to catch on to the scam, but catch on they did.

Ballafante writes:

… what has ultimately disappeared is the centrality and even glamour so long attached to the therapeutic profession in the life and culture of New York. In the 1980s, when Judith Rossner’s novel “August” came out, dealing with the relationship between a Manhattan analyst, her analysand and the particular agonies of the warm-weather hiatus, it was still possible to find regular coverage of the best, and most outlandish, methods for coping with the loss of the departing clinician. In 1985, The Times took note of a woman named Leslie Baines who called the other members of her therapy group and asked if they wanted to rent a bus to the Hamptons to besiege their vacationing therapist, who had left for two months without providing forwarding contact information. (“We pretty much have his location targeted,” Ms. Baines said.)

Of course, psychoanalysis has lost out in the marketplace. Since the results of analysis were most often mediocre at best, the arrival of treatments that could produce positive results caused a sea change. One that drowned classical Freudian psychoanalysis.

According to Bellafante:

The changing nature of treatment means that practitioners are seeing fewer patients for talk therapy. According to study published several years ago by researchers at Columbia University and the University of Pennsylvania who analyzed patient data from Medical Expenditure Panel Surveys, the percentage of patients receiving only psychotherapy dropped from 1998 to 2007, while the percentage of those receiving drug therapy exclusively rose sharply, to 57 percent from 44 percent. Beyond that, standard Freudian psychoanalysis has loosened to the point that few patients see analysts four or five days a week; the fashion now is for two or three. 

She concludes by tracking the presentation of psychoanalysis and psychotherapy in the culture. From the time of Annie Hall to the Sopranos to Billions:

We are far from the days of romanticized depictions of psychotherapy in popular culture — far from the era of “Manhattan” and “Annie Hall,” as well, when inclusion in the bourgeois intellectual class required participation in the 50-minute hour. When “The Sopranos” began in 1999, the premise was that a mobster sought personal betterment in the context of talk therapy. By the time “Homeland” made its debut more than a decade later, a C.I.A. operative was getting her help from lithium prescribed by her sister. And when, more recently, television delivered “Billions,” a series about hedge-fund malfeasance and excess, the role of the psychologist was relegated to that of an in-house performance coach helping asset managers achieve the right mental balance to make more money.

Yes, I know, my analyst friends—the few who remain—are in serious denial about all this. But, there comes a time in everyone’s life when they have to come to terms with reality. And the reality is: it’s dead, over, finished, done.

And not a moment too soon. The Times said so...what more do you want?


AesopFan said...

"And the reality is: it’s dead, over, finished, done."

Maybe the analysts can find more work after the Zombie Apocalypse.

Sam L. said...

Oooooh, I get to say it: Psychiatry? It's dead, Jim."

Ignatius Acton Chesterton OCD said...

Too bad, so sad...

Ignatius Acton Chesterton OCD said...

Decadence meets its comeuppance.

Ignatius Acton Chesterton OCD said...

And I'm glad we're still American enough to believe in what works. Talk therapy doesn't.