PSYCHOANALYSIS TODAY
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this age group of university graduates that a significant segment of
the analytic population was drawn in the past. It is possible that the
alienation of this group from psychoanalysis is only a temporary
phenomenon .
There is another trend that has been developing over a longer
period of time. The nature of the presenting psychopathology seems
to have changed. Controlled studies have demonstrated that the
percentage of neurotics coming for treatment has declined steadily
over the past thirty years. These were the patients for whom the
primary indication was always classical psychoanalysis. Today, the
practitioner is more likely to see patients with narcissistic character
disorders, perverse characters, and borderline personalities. Further–
more, the patients seem to be older and frequently have problems of
alcoholism and drug abuse. This is a far cry from the type of patient
for whom psychoanalysis represents the best form of therapy.
These changes in the nature of current psychopathology reflect
a transformation in our culture and in the moral values of the
community. What used
to
be unthinkable has now become express–
ibl e, what is expressible becomes do-able. The untrammeled expres–
sion of what used to be private fantasy life, be it of a perverse,
criminal or narcissistic character, has found its way into the popular
literature and the media. I am not suggesting censorship as a form of
mental hygiene, nor do I minimize the profound social and political
problems involved, problems that involve freedom of the individual
and freedom of expression. What I am trying to say is this: conflicts
over impulses, perverse, criminal or narcissistic, which in previous
years the individual tried to contain within himself through the
mechanism of symptom formation, now find less warded-off, less
distorted expression in the psychopathological entities the therapist
encounters. The attitude of society is an inexorable dimension of
pathogenesis and psychopathology.
There are two conclusions that I think can be drawn from the
foregoing. First, it is difficult to judge from the facts available to us
whether or not psychoanal ysis really has lost its appeal to physicians
interested in psychotherapy or
to
patients seeking psychotherapy.
My second conclusion is that the current trend does not necessarily
reflect on the appeal, the validity, or the relevance of psychoanalysis
for today's world.
It
may be that what we observe taking place
around the theory and practice of analysis is on ly a measure of the
changes that have taken place in our society, changes which have
affected and will continue to affect the development of psychoanaly-
