Psychoanalysis and Christianity

Prologue:

A tedious bit of autobiography: since 1990, when I was in gr. 12 first reading Freud and Jung and trying to decide, first, what I was to study at university the following year (psychology? theology? history?) and, second, whether to pursue clinical and then analytic training in Montréal, or priestly ordination into the Anglican Church of Canada, I have lived my life at the intersection of theology and psychoanalysis. When I went on sabbatical in 2018, my project was to finally write the book I had been carrying around in my head for nearly thirty years at that point, then tentatively titled "Theology After Freud." (Events intervened and I turned my sabbatical project to writing Everything Hidden Shall Be Revealed: Ridding the Church of Abuses of Sex and Power, where Freud features very prominently and unapologetically throughout). 

I may yet write that book, though increasingly with a much different focus. Some of its materials have in the last decade worked their way into lectures on the relationship between theology (especially Orthodox and Catholic theology) and psychoanalysis that I have gladly given before academic and ecclesial audiences in England and Wales, Canada, and in several places across these United States. A version of that lecture is available here as a podcast.

The other development in 2018 that swayed me against writing my book on psychoanalysis was the appearance of the most powerful theological engagement of Freud I have ever read. The Spanish psychotherapist and Jesuit Carlos Dominguez-Morano (who has published many books in his native tongue, few, alas, having been translated into English) published Belief After Freud: Religious Faith Through the Crucible of Psychoanalysis. That book is, and remains, a stunning work of far-reaching criticism of the most prominent manifestations of the massive psychopathology at the heart of Catholic Christianity. I could only salute the author's penetrating insights and great courage in writing a much more forceful book than I would have attempted. If you read nothing else on this list, read, mark, and inwardly digest this book. The Catholic Church would be a far less objectively disordered and sadomasochistic institution if Dominguez-Morano's proposals were taken at all seriously, which they won't be. (I wrote a bit about him for the Jesuit periodical America, and in more detail at an old blog.) 

If you read Morano and then want to read more in this area, I have, over the last three decades, read as many books about religion and psychoanalysis as I can lay my hands on--with many more to read! What follows are a few notes on disastrous books to avoid, a few that are "good enough," and a rare few that our outstanding. 

Books Fit for Burning:

Previously I noted on here one book that, had it been edited and published properly, would have been a handy collection to have. But it was so shoddily produced it's not fit for reading and the publisher should be ashamed to have foisted such slop on us. 

The other book is one I can only think of as psychotic: by that I mean Bion's theory of psychosis as the severance of all meaning-making links and possibilities for rationality and reality-testing. I cannot in all honesty discern any sort of rational purpose to the book as it staggers around vomiting out incoherent statements unconnected to any sort of discernible purpose--or to each other. The Freud who features here, and the "arguments" made, bear no relationship to reality. There is of course no end of attacks on Freud, and almost all of them are at least generally coherent (see, e.g., Frederick Crews), but this book could not even manage to rise to the level of childish diatribe. 

Mediocre Treatments:

Beyond such egregious examples, there are plenty of books in which others might quite rightly find value but I found to be very thin gruel indeed. Most of them were written in too general a way, and often very poorly edited. Under this heading I include Christianity & Psychoanalysis: A New Conversation, eds. Earl D. Bland and Brad D. Strawn; and Marie Hoffman's sprawling Toward Mutual Recognition: Relational Psychoanalysis and the Christian Narrative. Her premise and methods were good but the execution very poor. Other books along these lines could be mentioned but need not detain us further. 

Good General Treatments:

If you are new to the area, then a 30,000-foot overview provided by one of the great scholar-clinicians and social critics of the last century, Erich Fromm, is a good place to start: Psychoanalysis and Religion was originally delivered as part of the Terry Lectures at Yale. Like all Fromm's books, it is written at a very general and accessible level. (I discuss Fromm in a bit more detail here but keep meaning to get back to him at some point.) 

A more advanced but still general treatment may be found in William Meissner, the Jesuit psychiatrist and psychoanalyst I wrote about in my America piece, who authored several decent books, including Psychoanalysis and Religious Experience.

Two other collections merit mention: Soul on the Couch: Spirituality, Religion, and Morality in Contemporary Psychoanalysis, eds. Charles Spezzano and Gerald Gargiulo is decent. Even better is Psychoanalysis and Religion in the 21st Century: Competitors or Collaborators? ed. David M. Black.

Ana-Maria Rizzuto's Works:

The Argentine-born but American-educated Catholic psychiatrist and psychoanalyst remains too little known, in my view, but deserves to be for her first book in 1979, The Birth of the Living God, which was based on fascinating and highly original research with psychiatric inpatients and their internalized God objects. 

Then her 1998 book Why Did Freud Reject God?, published by Yale, is the most careful and respectful such treatment yet published of a topic that almost always sees authors descend to the level of puerile polemics and "pseudo-mentalizing" (to borrow a phrase from Fonagy). 

Only recently has Rizzuto come in for some attention in this decent collection: Ana-María Rizzuto and the Psychoanalysis of Religion: The Road to the Living God, eds. Martha J. Reineke and David M. Goodman.

Winnicott and Religion:

Back when I taught undergraduates theology, I came across the works of the scholar and Jungian clinician Ann Ulanov, author of such books as Finding Space: Winnicott, God, and Psychic Reality as well as Primary Speech: A Psychology of Prayer (which my students loved). 

Stephen Parker has written an unexpectedly excellent monograph (I say "unexpectedly" because works like this are often ploddingly dull, having all the vices of a doctoral dissertation and none of its virtues), Winnicott and Religion, which is very much worth your time if you love Winnicott half as much as I do. Winnicott, as always, has a lovely and useful phrase to describe his own relationship to the Methodism and Anglicanism in which he was reared: traditions to "grow up out of." That phrase admits of wider application today if much research (e.g., Stephen Bullivant's important new book Nonverts: The Making of Ex-Christian America is to be believed on declining practices. 

Highly Specialized Scholarly Monographs:

Under this heading I put two dense but worthwhile works: Peter Tyler's The Pursuit of the Soul: Psychoanalysis, Soul-making and the Christian Tradition; and then Marcus Pound's Theology, Psychoanalysis and Trauma. Pound's book has the virtue of making some of Lacan accessible--a figure whom I otherwise find needlessly and vexatiously obscure so much of the time (though I did find something useful in him as I argued here). 

One of the best books I have read is Pia Sophia Chaudhari's Dynamis of Healing: Patristic Theology and the Psyche. I discussed its virtues and interviewed her about it here. 

Let me end with a new book I forgot to mention in a recent post on On Bare Attention: it is a book by Paul Marcus entitled Psychoanalysis as a Spiritual Discipline: In Dialogue with Martin Buber and Gabriel Marcel. The book is a bit choppy in execution, but it draws out useful material from its two named interlocutors. I read some of Marcel and Bueber in writing my M.A. in moral philosophy at the end of the 1990s (when I read rather a lot more of Alasdair MacIntyre and Emmanuel Levinas, whose "ethics of the face" and critique of abstraction I still teach to my students). 

Marcus seems to suggest in this book that for people who both find themselves "ecclesially homeless" (to use a phrase of Stanley Hauerwas) or "deconstructing" their faith, or otherwise alienated from religious institutions, and are clinicians or interested in psychoanalysis, then the analytic tradition offers both insights and "disciplines" similar to ascetical practices found in Judaism, Christianity, and Buddhism. This allows him to say that "psychoanalysis can reasonably be conceptualized as a spiritual/moral venture." As such, it has practices of "communion" (to borrow a term from Marcel) or what Marcus calls "the five essential elements of psychotherapeutic support--presence, holding, caring, challenging, and confirming."

 

Schizophrenia: Is the Past Prologue? Is the Future Condemned to a Repetition Compulsion of Failed Treatments?

Preface:

Every fall I teach my history and historiography of psychology course and for the last few years have struggled to help students come to understand that the history of any and every discipline is fluid and that certain categories and concepts--in psychology as in other disciplines--were not handed down on Sinai or at Delphi in a once-for-all manner eternally fixed and beyond us mortals to question. Ideas have a history, but such intellectual history properly so called is nowhere taught to undergraduates so far as I can tell. As a result, it is a real struggle for them to conceive of several things, including psychiatric nosology, as having a history. 

Additional complications abound: More than a third of our student body are nursing students, and so the perceived fixity of medical-diagnostic categories is a great comfort to many of them. But introduce to them the idea that psychiatric diagnostic categories do not enjoy just a biological basis, and are therefore much more fluid, and students are suddenly all at sea. 

I am hopeful that two new books might help us in this task of understanding the shifting history of diagnosis, and of nosology, starting with what has been called the poster-child for psychiatry, viz., schizophrenia.  

The first is Orna Ophir's new work, Schizophrenia: An Unfinished History. Just published last month by Polity, it is cogently written in a manner accessible to those with little background while also being grounded, in an unobtrusive way, in serious scholarship which is deftly handled. Because of these virtues, and because I cannot of course have my students read a history of every major disorder, and because schizophrenia is often described as the most serious and difficult concept and diagnosis in all of psychiatry and psychology, I have assigned this book to my students. I am eager to see what they make of it! 

Introduction:

In promoting her new book, the author recently published a short essay about it on Slate. As invariably happens, the title chosen by her editor and the spin given to the article immediately made Ophir's work sound more inflammatory and "radical" than I very much think it to be. And as also invariably happens in this social media age, people were immediately projecting into that article's title their own ideas and then criticizing Ophir for her apparent disagreement with them. It's all very tiresome. 

To come directly to the question thus raised on-line: does the author have an "agenda"? Almost certainly, but of which author is this not true? Is Ophir (a psychotherapist and psychoanalyst in private practice who also teaches at Cornell and NYU) crusading for the abolition of schizophrenia as a diagnosis, indeed even flatly denying that it is a disorder causing enormous distress for some patients? Not at all. (If she were, I would not assign such a book to my students because I would have to agree with a sentiment denied to me by my own private practice with psychotic and schizophrenic patients, whose suffering has stared me in the face.) 

These two questions cause enormous controversy: should the diagnosis of schizophrenia, which has changed greatly through five editions of the DSM, each of which she reviews carefully, as we shall see, be altered or even abolished? And should we make such an abolition because schizophrenia does not actually exist as a disease in the way we might say diabetes or cancer exist as diseases or disorders? 

Ophir handles both questions with skill and sympathy, after long reviews of the history and previous answers (going back to Greek antiquity, the Hebrew scriptures, the Latin Middle Ages, late Medieval and early-modern Europe and Byzantium, and right up through DSM-V). Her own highly provisional answers, are, to my mind, eminently defensible and worthy of ongoing discussion and debate. The singular virtue of this book is the author's lack of ham-fisted dogmatism in any of the matters she handles. Like a good psychoanalytic therapist, her practice of those sometimes misunderstood notions of "neutrality" and "abstinence" is well honed and expertly used throughout the book so that the reader never feels hammered by the author's views or compelled to agree with her. In that sense, her book is poor fodder for social media outrage and click bait, but excellent scholarship. 

As such, it will also give no comfort to those who wish to get up on their hind legs and shout at the rest of us--either in favour of retaining current names and nosology, or as a way of pushing for the abolition of the same. Ophir says--rightly--that all of us involved in these discussions should participate with humility and a lack of defensiveness (p.238), and we should be asking ourselves what the "prudent--indeed, ethically responsible" ways of proceeding are so that we do not leave people in the lurch. Even as we can see problems with current diagnostic criteria and categories, and even as we might want to change those, we must "acknowledge that so many of its elements, of its debris, and scattered building blocks...remain of importance for us" (p.239). Thus--as she concludes the book, perhaps a touch too neatly--she says that those involved in this discussion must ourselves be "of two minds" (!) in seeing what is good and conserving it, while discarding what is not good in search of better alternatives (p.244). 

Status Quaestionis:

But let us return to the beginning. The author begins by noting that for at least two decades now around the world more and more people have been wondering whether what we have (since 1911 only) called schizophrenia is in fact a distinct disease entity or not. There is not, she notes, any kind of objective test for it. There is no universal and unchanging agreement on what symptoms might--might--constitute sufficient evidence to make a diagnosis. Indeed, as she shows in detail, there is not even agreement on how to conceive of it in a basic nosological sense: should schizophrenia be seen as something radically other, a state or disease or disorder that in essence breaks with ordinary human experience and places one outside the realm of quotidian "reality"? Or is it a continuum on which people move around from time to time in life, never quite managing totally to leave shared human experience as they do? 

For some, she says, what are described as symptoms of that disease are, rather, "extreme versions of normal human experience" (xi). She here notes that some parts of the world--notably Japan, to which she will return late in the book--have attempted to take account of that and change the name from schizophrenia to something else, a move that a few other countries (also briefly noted below) have also undertaken. That global behemoth, the American Psychiatric Association, has, however, not followed suit even though it has been inundated with hundreds of possible changes to the name and diagnosis since the 1990s. 

History: From Ancient Israel through Byzantium and the Enlightenment:

Ophir begins the history section of her book (ch.1) with understandings of madness in Greek antiquity and in the Old Testament or Hebrew scriptures. Here she notes that for the latter text, the line between being cast as a "madman" and a "prophet" is vanishingly thin. The former is "other," likely under demonic influence, and often needs to be run out of town and destroyed. The latter, whose behavior is, curiously, often extremely similar to the former, will come to be seen--also after much suffering in many cases--as being divinely inspired and appointed rather than demonically disordered. 

She has a very brief section on this thin line between madness and sanctity in the Byzantine and later East-Slavic figure of the "holy fool," to which I have elsewhere many years ago paid not a little attention. Scholars of that phenomenon agree that it is never easy, and often impossible, to tell if holy fools are indeed "mad" in a pathological sense, or "mad" in the sense of being "possessed" by the divine and having a righteous mission whose oddness is reflected in the audience's profound estrangement from divine and holy purposes. Holy fools, then, are usually thought merely to look mad: underneath they are (ostensibly!) the ones who are truly rational in that they are at one with the Logos himself--though this is never demonstrated with complete certainty, leaving the figure a perpetually ambivalent and ambiguous one, which likely explains their enduring attraction. 

When she comes to the second millennium and the advent of what will come to be called the Scientific Revolution and the Enlightenment, Ophir notes that modern psychiatric nosology's problems begin here in attempting to pattern notions of mental disease after botanical classifications. At this point she introduces a metaphor that repeats regularly throughout the book: psychiatry's attempt to "carve nature at its joints." This, it will become plain, is--and perhaps only could be--a failed project. As she later puts it, "strictly speaking...there is no such thing as a single, stable object that corresponds to the word 'schizophrenia.' Rather, there is a complex description that has evolved through time (and does so to this very day)" (p.115). 

Psychoanalysis and Schizophrenia:

In her description of various ways over the last century to understand schizophrenia, the author tips her hand just a bit in the review of several psychoanalytic theoreticians, who include Freud and Jung. But Ophir seems to suggest that Melanie Klein's notion of splitting might have been, and yet remain, one of the most important theoretical concepts to help us conceive of what might happen in a schizophrenic mind. Others of note here include Harry Stack Sullivan and Silvano Arieti, who gets a very brief mention, along with equally brief mentions of Harold Searles and Frieda Fromm-Reichmann. But Klein predominates and of her Ophir says that she "does not see schizophrenia as a different natural kind or disease entity" (p.106). 

From here Ophir undertakes a careful, chronological review of each edition of the DSM.: Given the various axial configurations, DSM-IV could give us, she enumerates, 114 ways to be "schizophrenic"! For her DSM-V is only a slight improvement on this in some ways, but has other problems (p.148). 

Ophir's chapter on stigma--primarily, but not exclusively with schizophrenic patients--is very powerful and deserves much wider discussion than I will attempt here. There is one sobering thing she has unearthed that merits additional mention: she documents various ways in which empathy for severely mentally ill people can be increased in the general population, but a mere increase in empathy does not seem to correspond to a change in the problem of social distancing and isolation. In other words, I might learn to feel for and with "these people" but I still do not seek them out or necessarily want them around--a kind of very bloodless empathy. 

Ophir's careful handling of the Hearing Voices movement is fascinating and deserves deeper discussion. Equally fascinating were her reviews of the countries that have attempted name changes, including Japan (changed in 2002 to "integration disorder") and China. The new names are not without problems, to my mind, but Ophir does not really consider those. To be fair, I find it almost impossible to imagine that any change in nomenclature would not bring new or different problems. 

There is, however, perhaps one way around some of these difficulties, and here she quotes two British psychiatrists, Mohammed Abou-Saleh and Helen Millar, who suggested we simply rename schizophrenia "Kraepelin's disease" (p.226) on the same model of Alzheimer's disease (etc). On this point, see the recent and suggestive paper by two other British clinicians arguing we not quite jettison Kraepelin's categories just yet. 

Criticisms: 

It is never acceptable to fault an author for not writing the book you think they should have written, or for not writing a book they never said they were going to right in the first place. But it is entirely within the bounds of legitimate criticism, in the constructive and scholarly sense, to suggest that when an author says they will do something, and stresses the importance of that thing in the book, but then fails completely to deliver on it, that they be called to account for such a lacuna. And this is the case with Ophir, who more than once (e.g., p.242) says we must attend to forms of treatment for schizophrenia, but then signally fails to enter into any substantial discussion of treatments and their efficacy. Perhaps she lost steam, or her editor told her the book would be rendered far too long, if she also looked in greater detail at the history of treatments? I would not fault her for failing to do this if she had not raised hopes early in the book that she would attend in some detail to treatments, but does not. Overall, this is a rather minor weakness, easily remedied elsewhere. 

For such a remedy, we will have to turn to our second book, which does do this in some helpful ways, thus making this second book a very useful and important complement to Ophir's otherwise excellent text, which I am very grateful to have read and have profited greatly in doing so. It will bear re-reading and careful thinking about several important things. 

That second book is Matthew M. Kurtz, Schizophrenia and Its Treatment: Where is the Progress? To read this book with Ophir's is to find them very complementary. There is a bit of overlap in one or two areas, but Kurtz also goes much more into two areas that Ophir only skims: the results of decades of neurological research on schizophrenia, and how fascinating but largely clinically useless it has been; and then certain recent treatments--beyond psychopharmacology--that are showing promise in the psychotherapy of schizophrenic and psychotic conditions.

Kurtz is also, in both tone and conclusions, much less hopeful than Ophir is, and this is already telegraphed in his subtitle: Where is the progress, indeed, in treating schizophrenia? A cursory review of the data are not encouraging. We shall return to this later.

Kurtz says in his preface he will ask, and seek answers to, four questions, and he does this with admirable cogency and clarity throughout the book: what is the history of the category of 'schizophrenia' and how was it derived? What does neurology tell us about the brains of such patients? What does cognitive and affective science tell us about such a condition and its patients? And finally what psychotherapies are there that actually work? 

Already by the end of the brief preface, Kurtz says that "there remains no clear neural or psychological signature that is specific to the disorder of schizophrenia" (p.x). He hastens to add a little later--and will repeat this--that he is in no wise undermining or outright denying the idea that for some people this is a useful diagnosis. Kurtz is no anti-psychiatry radical--far from it: he attacks such zealots more than once (e.g., p.6). 

The first chapter is devoted to the first question noted above, and opens with some sobering statistics about how many homeless in the US are schizophrenic; about how the WHO lists "schizophrenia as one of the top 10 leading causes of disability among adults worldwide"; and perhaps most appalling of all, "rates of improvement have been less than 50% and largely unchanged since the 1890s"! 

From here Kurtz introduces an interesting discussion that Ophir did not: is schizophrenia actually one disease entity? He suggests that "there may not be a treatable core disease pathology in schizophrenia at all" (p.6). He will return to this later in suggesting possible reconfigurations in how certain symptoms might be considered and treated transdiagnostically. The chapter ends by asking how improvement in patients' lives might be meaningfully conceptualized and measured, and then how much (measured) hope we might have about possible progress and development of treatments. He cautions that any work on new or improved treatments cannot and must not be designed by academics and clinicians in isolation: here he nods to the Recovery Movement, and seems to agree with their slogan "no research on us, without us" (p.14). 

Chapter two is the most historical and usefully reviews several large-scale long-term studies in the US, including the Iowa 500 study, the Chestnut Lodge studies, studies in Vermont, and in Western Europe. He pays particular attention to the Chicago Prospective Longitudinal Study, saying that at the "15-year follow-up nearly half of the schizophrenia sample...had experienced at least a year of recovery" (p.23). The upshot of this literature review is his recognition that "it is clear from the data collected to date that initial conceptualizations of schizophrenia as a disorder that has a largely downward course is clearly not supported. Recovery is very much possible" (p.27). 

Ch.3 is devoted to the actual diagnosis of schizophrenia, noting that "the criteria for diagnosis...have changed radically over the past 100 years" before reviewing the five editions of the DSM and their indebtedness to Bleuler and Kraepelin. All this is situated within a broader context and wider consideration of psychiatric nosology. Kurtz says--somewhat staggeringly--of the early attempts to understand schizophrenia (roughly corresponding to DSM-I and DSM-II) that "accurate diagnosis was not seen as an essential first step for treatment" (p.44). 

The chapter that unfolds from here is not quite as detailed in some periods as Ophir, especially on Hebrew scriptures and Greco-Roman antique notions of madness, but it is still quite serviceable. It also includes gratuitous and amusing mentions (without, alas, elaboration!) of such things as "wedding night psychosis" and "masturbatory insanity" (p.37). When he gets to the 20th century and America, Kurtz is indebted to Richard Noll's 2011 book American Madness: the Rise and Fall of Dementia Praecox. Kurtz claims--based on Noll--that Kraepelin's classification scheme "took the United States by storm" and has exerted a lasting, and perhaps unduly strong, hold ever since. Others who have had influence here include John Feighner and Kurt Schneider, he of the (infamous?) first-rank symptomology.

The result of this lengthy and fair-minded survey is to claim that "there remains no reliable medical test for diagnosing schizophrenia or any other psychotic disorder" (p.52). But from this it does not follow that schizophrenia necessarily disappears as an actual disease: at most he says we can claim to have "modest evidence that an underlying disease entity might exist" (p.53). With equal care he ends this third chapter by arguing that "critiques of the category must balance calls for new nomenclature with the potential cost of losing a label that, with all of its limitations, rapidly identifies a group of individuals a large proportion of whom have profound disability and need for care" (p.58).

The fourth chapter reviews early (pre-revolutionary onward) asylums and treatments in the United States, including many things that rightly horrify us today. But he returns here to Bleuler and Kraepelin to make note that the latter "devoted only 5 out of 328 pages of text to treatment" and the former was little better: Bleuler's nearly 500-page text offered a scant 18 pages devoted to treatment of dementia praecox. 

Kurtz then looks at postwar developments, beginning, of course, with the invention in France of what became the first generation of neuroleptics. Psychoanalytic approaches get a wholly inadequate and totally unsatisfactory look-in here, along with R.D. Laing and Harry Stack Sullivan. 

Chapter 5 is devoted to biological mechanisms and the fascinating research that has been done here in the last several decades. Ch.6 is focused on the cognitive and affective dimensions of schizophrenia. This reviews data on neurocognitive functioning and testing before turning to recent attempts to theorize and treat schizophrenia as a disorder of self-cognition. This leads Kurtz to end the chapter with a brief look-in at a new approach developed largely here in Indiana with which I have some familiarity. 

This part of the book already needs updating in light of the ongoing research into metacognition, which is indebted to and very similar in some (not all) ways to Fonagy's famous mentalization treatments. Lysaker and others have been publishing at an impressive clip as they amass randomized control trials around the world to test their metacognitive approach, which is nicely outlined in the handbook linked at left. I have read it once, and want to read it again when I have time. 

Ch.7 looks at somatic treatments, reviewing the famous dopamine hypothesis and others. Along the way he notes what is already notorious: how huge numbers of patients in clinical trials discontinue their neuroleptics on their own because of absolutely intolerable side-effects. 

Ch.8 looks at psychological and psychosocial treatments of schizophrenia, and is perhaps the most hopeful chapter of the book. What Kurtz calls "evidence-based psychosocial treatments" include family interventions, social skills training, and CBT. He claims here, without any evidence, that "in recent years, the psychoanalytic approach has been supplanted by CBT." 

I do not buy that and the history does not bear Kurtz out on this. There are dynamic psychotherapies being successfully used right now, including those I discussed in some detail here, here, and here; and those developed by Andrew Lotterman; and then mention must also be made of the integrated approach of Psychotherapy for Psychosis: Integrating Cognitive-Behavioral and Psychodynamic Treatment by Michael Garrett. Still others could be mentioned, most notably and encouragingly those outlined in Downing's invaluable book. 

The chapter ends by noting--too briefly to be helpful--that international models, including that of Hans Brenner in Switzerland, might point the way to show us what future therapeutic models need to include. Kurtz then moves into a very brief epilogue where he laments the "profound lack of services available to so many people," especially in the US (p. 183) where "the science-to-practice gap has vastly widened" and where there is an appalling "absence of even minimal housing and institutional supports for people with schizophrenia" and equally appalling "very low rates of reimbursement provided for treatment of the...severely mentally ill" (p.184). 

Taken together, both of these are carefully written books by Ophir and Kurtz who have judiciously weighed competing theories and evidence, and done so with real concern for suffering human beings. They are not anti-psychiatry zealots, nor blind apologists for biological psychiatry either. Both books overlap but only modestly, and thus both books must be seen as more complementary than anything. Both books are at their most useful in reminding us of the appalling long-standing gaps in treatment and the fact that far from making progress, treatment seems to be stalled or even regressing (where, that is, it even exists at all). There is much work to be done if the past is not to be prologue to a future of continued, repeated failure. 

In Praise of Nancy McWilliams: On Psychodynamic Therapy

I forget when I first stumbled upon Nancy McWilliams, but it was some time ago. I had started with W.R.D. Fairbairn's pioneering work on the schizoid personality, and then read Melanie Klein and Harry Guntrip on the same phenomenon.

It was, however, only when I came to McWilliams that I found an essay on the topic that is the clearest and most compelling treatment of them all. Not unrelated to this post, McWilliams in that essay quotes Harold Davis to the effect that “'psychoanalysis is a profession by schizoids for schizoids'.”

On the strength of that essay, and also very much respecting Jonathan Shedler, who regularly extolls McWilliams work on Twitter, I put her Psychoanalytic Psychotherapy: A Practitioner's Guide on my reading list, and have now had a chance to go through it very carefully. It is excellent, especially for those with little background in psychoanalysis. 

I appreciate her openness in the preface where she recognizes that there is a legitimate diversity of treatments, but that psychodynamic approaches are often neglected when it comes to studies of their efficacy. From here she notes that her approach in writing this book will be to emphasize what may be applied "to all clients," and not just those who have signed up for psychodynamic therapy. I take her to mean that psychodynamic theory is applicable and useful in understanding patients even if a given therapist operates predominantly from a tradition of CBT or DBT (etc.). 

In this she puts me in mind of the great philosopher Alasdair MacIntyre whose early work in the philosophy of science and the development of theoretical traditions--and the clashes between them--rightly reminds us that one mark of a stronger tradition is its capacity to more fully and helpfully account in a better way for the gaps in, or problems raised by, its rivals. 

The other welcome note in the preface is that McWilliams is not going to be a zealous crusader insisting that everyone must slavishly imitate her methods, or those of psychoanalysis more generally. Instead she speaks of the "need for therapists to honour their own individuality in the arrangements they make" (xiii). The preface ends by McWilliams recognizing her own debts to various figures, including Theodor Reik (he of the "third ear") and especially Frieda Fromm-Reichmann, whom I wrote about appreciatively and at length here. 

Later on she returns to this theme, insisting in several places that one should "integrate one's individuality into the role of therapist" (p.52) and that therapists are most successful when they "relax and let their unique personalities become their therapeutic instrument" (53). As she notes later, "when it goes well, psychoanalytic therapy feels to both parties like a conversation from the heart, not the head" (66).

The patient seeing you being genuine and open, and speaking from the heart, can find all this therapeutic. But we must, of course, do more than that--if a bit of warm listening and sincere opening up were all that a patient needed, then they would simply turn to a good friend or family member, not a psychotherapist. The uniqueness of the role is that we must also challenge patients to grow. 

Throughout the book one has the sense of serenity in McWilliams: she is not someone who defensively feels she must be a fierce advocate for or against any particular approach, or to challenge patients in an obnoxious fashion. In this, as I have remarked elsewhere, she stands firmly in Freud's line who, pace the myths talked about him, emerges in his correspondence and in Paul Roazen's original and invaluable scholarship, as very "liberal" in encouraging all sorts of methods of healing, not just psychoanalysis. 

In her discussion on the "American Medicalization of Psychoanalysis," McWilliams, in fact, emerges as a critic of the tradition she is defending and its "cult-like atmosphere," its often ideological and hidebound ways that have, perhaps more than anything else, contributed to the vastly diminished standing psychoanalysis has in this country. 

By contrast, she notes that contemporary psychoanalysis in this country, to the extent it remains viable and healthy, tends, rightly, to eschew tendencies towards "purity" of both theory and method, being comfortably eclectic in some ways ("I remain skeptical of orthodoxies, especially technical ones" [p.23]). 

In her first chapter she draws close to something I am working on in my next book: the increased openness towards spirituality in psychoanalysis today, and psychology generally. Here she references the work of Bion in particular, whom I discussed a bit here. 

What, if anything, distinguishes a psychoanalytic approach from any other? McWilliams begins by noting that there must be a "curiosity and awe" for the unconscious, and an awareness that most of our behavior, thoughts, and feelings are not in fact consciously determined. This requires of the therapist a willingness regularly to have what one thought one knew about the patient disconfirmed and disturbed. If, she suggests, one is attempting to practice some version of Freud's "evenly hovering attention," then this might not be so difficult for in that state one has not fixated on any one thing, least of all some notion of causation which might blind us to other factors in play. 

In her second chapter, McWilliams quotes Christopher Bollas from his first (and to my mind still his best) book, The Shadow of the Object: Psychoanalysis of the Unthought Known: "in order to find the patient, we must look for him within ourselves." 

She rounds out this chapter with a brief discussion on the role of faith--in the process, in ourselves, and in our patients--though there is no mention here of the extensive writings on the topic by Nina Coltart, who, to my mind, has covered this topic perhaps more forcefully than anyone else I know of. 

Chapter 3, "The Therapist's Preparation," begins by noting that we are going to make mistakes, and need to be okay with that. What happens after the mistake is often more crucial than the mistake itself. Will this lead to an enactment, or rupture, and if so, how is that handled? 

In her fourth chapter, McWilliams discusses the well-known findings about the centrality of the therapeutic or working alliance to the success (or failure) of all therapies. The patient cannot be expected early on to know to check in about this, so the therapist needs to make a regular point of asking  "How are you feeling about working with me?" or "Are you finding yourself comfortable talking with me?" (p.82). 

I have, so far, only once been scared by a patient, but I managed to wrestle control over my fear by, as it were, "channeling" the spirit of D.W. Winnicott (whom I last wrote about here), about whom it was often said that he refused to be afraid of his patients. I thought fear would be something you'd just have to get used to, if it came to that, but McWilliams addresses fear and threats of various sorts in several places in the book, and she helpfully reminds us that "the therapist's sense of safety is as important as the patient's" (80). 

Later on in a related vein she will note that protecting therapist and patient alike is also part of the reason for the frame, and one should never deviate from it lightly. If, she says, you ever feel uneasy about any request that seems to veer towards a boundary violation, trust your gut and err on the side of being conservative. Boundaries and frames, moreover, are crucial in managing the huge power differential that exists in therapy, of which we must ever be mindful. 

If a sense of safety on the part of the patient exists, and boundaries are in good working order, then the patient may begin to experience his capacity to express hostility and contempt toward the therapist without fear of retaliation. Handling this requires a deft touch so that you do not masochistically collude in diminishing yourself on the one hand, nor in reacting defensively and perhaps vindictively on the other. 

The topic of hate returns late in the book, when she notes that a therapist might well need to encourage a patient not merely to express that feeling, but even feel encouraged to enjoy it. 

Handling other requests also requires a deft touch. A bit earlier, in her section "The Art of Saying No" (p.126), she has some very useful advice which I had no sooner read then within a day or two had occasion to put it into practice, finding success on both occasions (to my considerable relief!). She refers to those sometimes awkward conversations one must have with patients, often over fees, or no-show policies, or other limits. Rather than give them a lecture on how such limits or policies are really in the patient's best interest, she finds it much easier to elicit co-operation if she presents those as helping to fulfill her needs. 

I did this with a patient who had sustained a serious injury and then not showed up to two appointments in a row. I could legitimately tell this person that I was worried they might have been hospitalized with worsening injuries and I was worried about them. This prompted a phone call the following week when another (different but serious) reason kept my patient from making the appointment. I think both of us felt relief that this was handled now openly and simply via this expedient manner. 

Chapter six ends with some welcome reflections on the nature of psychoanalytic love. Here, as earlier, she has returned to Freud's famous observation in a letter to Jung that psychoanalytic cures are, in the end, ones of love. This, she insists rightly, is not an infantilizing form of love but one of serious respect that takes account of all qualities, positive and negative, in the patient. It is not cheap sentimentality, and certainly never exploitative. 

Chapter 10 offers some brief comments on sexuality, noting "how sexually diverse people are," and learning this can often be a very freeing part of good psychoanalytic therapy: "the appreciation of sexual diversity and the capacity to own one's unique sexuality without apology are frequent 'nonspecific' outcomes" (pp.254-55). 

The final chapters of the book offer an array of more practical tips to therapeutic practice, with welcome comments on malpractice hearings and ethical violations, and how to handle them. The very last chapter is focused entirely on self-care, one form of which she advocates that I also greatly love doing: writing. Here she quotes Michael Eigen that "psychoanalysis is a writing cure, not only a talking cure. Writing helps organize experience of sessions, but it also helps discover and create this experience." 

In the end, McWilliams has a lovely answer as to why many of us might be, at least in part, motivated to do this work: "our patients heal us as we heal them" (p.281). 

Daniel Burston on Psychoanalysis, Politics, and the Post-Modern University

Several years ago I came across Daniel Burston at Duquesne University in Pittsburgh. His biography of Karl Stern (A Forgotten Freudian) was fascinating, and since then I've profited greatly from several of Burston's books, including his study of R.D. Laing, and his work on Erich Fromm, about whom I have myself recently written a chapter for an international project based at Cambridge University in England.

Burston has a new book out, Psychoanalysis, Politics, and the Postmodern University (Palgrave Macmillan, 2020), and having read it with great interest, it was my delight to be able to interview him about it by e-mail.

AD: Tell us about your background

DB: I  was born in Naharia, Israel in 1954, and raised and educated in Toronto, Canada. As a child, I attended Bialik Hebrew Day School, and as a teenager, went to Forest Hill High School. I dropped out of High School after 10th grade, and enrolled in a “free school” modeled loosely on A. S. Neill’s experimental school Summerhill, where I focused on English, history and philosophy. After one year, I left that anarchic environment and my parental home, making a meager living on the fringes of Toronto’s waning counterculture, offering Yoga and guitar lessons to raw beginners, working odd jobs in vegetarian restaurants, bakeries, gardening and landscaping companies, picking up new skills and new friends, including some gifted and creative people who introduced me to spiritual, political and psychotherapeutic ideas, practices, and groups of various kinds. My immersion in the counterculture lasted three years, during which time I studied psychology, philosophy, and political theory; sometimes on my own, but often in dialogue with friends who, like me, were intellectually curious but not keen on acquiring a university education.

However, at 21, I finally decided not to remain an auto-didact. I needed a more formal education. So after completing an undergraduate degree in political science at York University, I completed two Ph.D.s there; one in Social and Political Thought (1985) and another in Psychology (1989). My second doctoral thesis became the basis for my first book, The Legacy of Erich Fromm (Harvard University Press, 1991). Shortly after the book appeared, I landed a job in the psychology department at Duquesne University in Pittsburgh, and have taught there ever since.

AD: What led to the writing of Psychoanalysis, Politics, and the Post-Modern University?

If I am honest, irritation and dismay--among other things, I guess. When I started my undergraduate career, the university was often described to me by my teachers as “a community of scholars” (Paul Goodman); a community in which the social sciences and humanities held a pivotal, if not a privileged place. Getting a proper education was valued as an end in itself, and not primarily as a means to other ends, i.e. launching a career, making money, etc. Yes, the old “Ivory Tower” was insular and elitist, and therefore in need of urgent reform, as Paul Goodman noted. 

But the neo-liberal version of the university, which is dominated by the STEM disciplines and corporate agendas of various kinds, is worse. The professoriate has been transformed, by and large, from a cadre of respected professionals into an army of service workers whose job is to stuff and stock students’ minds with a pre-packaged bundle of information and skills, enabling them to succeed--or at any rate, survive--on the job market. As a result, we have been debased to the status of service workers who increasingly fear the wrath or disapproval of their touchy customers, rather than the other way around, which was how things stood when I started university. 

Meanwhile, as the professoriate has been proletarianized, the Liberal Arts have declined steadily in power and prestige, and faculty have been profoundly disempowered by the rise of the administrative (managerial) caste. The ideal of shared governance, once highly prized, is often no more than a pretense.

So, at the end of the day, I have devoted my entire career to scholarship and to post-secondary education, and in the process, born witness to the emergence of many worrisome trends in contemporary university life. After reflecting on them, and how best to address them, for two decades or more, it finally dawned on me that a close look at certain trends in the history of psychoanalysis and critical theory might help illumine the state of contemporary university and intellectual life in useful and unexpected ways. Erich Fromm’s theory of authority – which has seldom received the attention it deserves – was particularly useful in this regard.

AD: I was glad to see your acknowledgement at the opening of your book of the work of the late Paul Roazen, whom I stumbled upon in 2018 and read with great profit. Tell us a bit about your own relationship to him, and why his work is important.

DB: When I was approaching 20 years of age, I stumbled across Paul Roazen's book Brother Animal. During the previous two years, I had struggled with a series of books by and about Freud, C.G.Jung, the Glover brothers, Erich Fromm and Erik Erikson, and the impressions I had gleaned of Freud’s personality from these disparate sources did not create a clear or consistent impression. Freud was doubtless one of the major thinkers of the 20th century. But Freud the man was a mystery to me, rendered all the more elusive by the dense controversies that swirled around him. 

So when I read Roazen’s gloss on the correspondence between Lou Salome and Sigmund Freud with respect to Tausk’s abortive analysis and subsequent suicide, I was completely “blown away”, as they say. Thirteen years later, while researching my 1991 book The Legacy of Erich Fromm, I discovered that Erich Fromm also greeted Roazen’s revelations with considerable shock, but in due course, praised Paul’s clarity and courage--unlike Kurt Eissler, whose odd, abrasive, and unpersuasive rebuttal, Victor Tausk’s Suicide set out to discredit Roazen entirely. Indeed, I soon discovered, Fromm recommended Brother Animal to all his students in Mexico and the United States, most of whom read the book with considerable appreciation.

Having read Brother Animal, I acquired a copy of Freud and his Followers, which was thoroughly engrossing.  And since Paul Roazen taught at York University in my own home town, I resolved to study with him. I spent my first year as an undergrad getting core requirements out of the way, but much of my second and third year centered around my course work with him. I was dazzled and occasionally confused by his richly stimulating (but poorly organized) lectures on Freud and his followers, which were leavened with lengthy reflections on Norman O. Brown and Phillip Rieff; philosophers Jeremy Bentham, John Stuart Mill, and Isaiah Berlin; eccentrics and free spirits like Dostoyevsky, Nietzsche, Thoreau, and T.E.Lawrence; poets like Rilke and Frost; and European and American political commentators like de Tocqueville, William Bullitt, Harold Lasswell, Walter Lippmann, and Herbert Marcuse, among others. It was quite an education! When I started on my MA, I was fortunate enough to continue on as Paul’s teaching assistant for two years, during which time I got to know him and his work even better.

Paul’s work has been largely forgotten in the aftermath of the Freud wars, but his pioneering work exposed many of the problems and oversights of mainstream psychoanalytic historiography right into the 1990s. Like Erich Fromm, he believed that the history of psychoanalysis provided by orthodox Freudians was riddled with distortions and omissions of truly Stalinist proportions. But while he freely acknowledged Freud’s authoritarianism and personal blindspots, he never wavered in his admiration for Freud’s courage and originality as a thinker.

AD: Having gone back to him in my own work just this year, I was even gladder to see Erich Fromm getting renewed attention 40 years after his death in your first and fifth chapters. Tell us a bit about your own work on him both here and in your earlier biography of him.

DB: As it happens, I stumbled on Fromm’s work a few years before I read Roazen’s works. Indeed, I was drawn to Roazen in part because he confirmed many things that Fromm had said earlier about the biases inherent in orthodox Freudian historiography. 

I think the first book I read of Fromm’s was The Sane Society, which was published in 1955, in the early years of the Eisenhower era, but which I only read in 1969 or so. What struck me then-- and strikes me still--was Fromm’s contention that an entire society can be mad, and that “adjustment” to a deeply disordered society--one largely unaware of or indifferent to its own perversity--constitutes a “pathology of normalcy.” Of course, in this context, the term  “normalcy” denotes something more akin to a chronic, low-grade deficiency disease than it does to genuine health. Normalcy, or normality in this sense reduces internal suffering and ongoing tension or friction with one’s environment to a tolerable minimum, but only at the expense of one’s development as an honest, intact and responsive human being. 

As an alternative to this kind of socially patterned defect, Fromm advocated what Martin Luther King Jr. later called “creative maladjustment.” Another thing that attracted me to Fromm’s work was the fact that he cared deeply about spiritual values, and despite his radicalism, demonstrated a deep familiarity with and respect for various (Eastern and Western) religious and contemplative traditions.

As I studied Fromm’s work more closely, it started to dawn on me that he had been unjustly dismissed by many fashionable intellectuals in the late 60s, 70s and 80s as a lightweight, a popularizer or as little more than a self-help guru. Moreover, the secondary literature on Fromm – in psychology textbooks and histories of psychoanalysis – is riddled with errors, oversimplifications, and omissions. That being so, I felt it was time to rehabilitate him, and to situate his work in the history of psychoanalysis and the Frankfurt School.

AD: In your fifth chapter Fromm appears again along with Reich, Adorno and others on authoritarian personalities, one of whose hallmarks is that they “may become attached or become passionately attracted to others. But they cannot genuinely love other human beings” (p.97). The study of authoritarianism began, as you note, in Europe in the interwar period, but has acquired more recent relevance in the US, Israel, and elsewhere in the last few years. Tell us about the forms of authoritarianism you analyze today—both of the left-wing and right-wing types.

DB: The literature on “the authoritarian personality” is now so vast that I find it difficult to summarize my own thoughts and conclusions succinctly. Suffice it to say that, as a rule, the main difference between Right- and Left-Wing authoritarians resides in the ideologies they embrace or espouse, not in their modus operandi once they are installed in power. In their efforts to win the hearts and minds of the populace, Right-wing authoritarians typically extol law and order, and promise a return to the status quo ante, or the “good old days,” which are heavily idealized, and  exist only in the collective imaginary. Their propaganda taps into people’s fear of change and nostalgia for the past, and they preach the pursuit of racial or religious “purity.” 

By contrast, Left-wing authoritarians promise their followers liberation and equality, the removal of the status quo and its replacement with a new egalitarian social order, only to renege on those promises later on. Their propaganda doesn’t dwell on the past, or indulge in nostalgia. Instead, they typically tap into people’s anger about current conditions and their hopes for a brighter future. And in theory, at least, they tend to eschew religious or racial purity in favor of ideological purity or “political correctness”, although many Left-wing authoritarians in the West have an affinity – or at the very least, a high degree of tolerance for – Islamic fundamentalism, even though they mistrust and revile Christian fundamentalists.

What authoritarians of the left and right both share in common, despite their different ideologies and rhetorical styles, is an attraction towards authoritarian strongmen who place themselves above (or outside) the law and show contempt for weakness, a strong attraction to violence as a means to solve (real or imaginary) social problems, and an eagerness to resort to secrecy, lies and deception to achieve their political ends, which have to do, above all, with seizing and holding onto power. They also have a pronounced tendency to dichotomous, “black and white” thinking, an intolerance of ambiguity and complexity, and to projection, i.e. to seeing authoritarian tendencies on the other side of the political spectrum, but minimizing or disavowing the same tendencies on their own side. All of these traits are in keeping with what Wilhelm Reich and Erich Fromm first described as the “sadomasochistic” or “authoritarian” character.

AD: Your chapter on Jordan Peterson (whose book I reviewed here) opens by discussing some aspects of the decline of the liberal arts in the university today, noting where Peterson is not entirely incorrect in blaming “post-modernism”, but that such a critique overlooks “cultural and market forces” and “the rather obvious fact that at the end of the day, most people care very little about the pursuit of truth” (136). You sift the contents of Peterson’s claims, and their reactions, and the debates they engendered, with great care before concluding that “Peterson [is] an enabler for Trump’s authoritarian agenda” (p.154). Tell us a bit more what you mean by that.

JB: Look, Jordan Peterson is a complicated man. I vividly remember an online interview he did with a crusty, conservative columnist in Canada named Rex Murphy several years ago. In this interview, Peterson was remarkably honest and vulnerable, the exact opposite of the aloof, steely, hyper-masculine presence he usually adopts in public fora. I remember thinking then that despite our political differences and all the bad press he’s received to date, this guy really means well, that he wants to make the world a better place. In that moment, I wanted to extend him the benefit of the doubt, even though I disagree profoundly with his one-sided analysis of our social ills and with the solutions that he proposes to the current crisis in the Liberal Arts. It struck me then that his basic intentions are good, nonetheless.

Unfortunately, however, Peterson seldom extends the benefit of the doubt to his liberal and left wing critics, whom he swiftly converts from potential partners in dialogue into implacable and unreasoning adversaries because of his penchant for polarizing people. You either love Peterson, or you hate him, as a rule. There is no middle ground. Those like myself, who are prepared to give him the benefit of the doubt, but dare to criticize his manner or ideas, are swiftly dismissed by his ardent supporters and his ferocious detractors.

That said, as a somewhat reluctant Canadian ex-pat, and as a (Jewish) resident of Pittsburgh for many years now, I was profoundly disappointed by Peterson’s public remarks about Trump after the Tree of Life massacre on Oct 27, 2017. Don’t get me wrong. Peterson is not an anti-Semite. 

However, his efforts to normalize the Trump Presidency, and to depict Trump as someone who is merely disagreeable and bombastic, rather than an authoritarian menace to democracy, seemed extremely blinkered, if not disingenuous, especially in light of all that has transpired since. Now that principled conservatives are slowly finding their backbones, and many are coming out publicly in favor of Joe Biden for president in November, 2020, one wonders why Peterson did not raise the alarm earlier, or say something strongly supportive of their efforts now. In dire situations, like the crisis facing America today, silence is complicity. What purpose does it serve, except to maintain a cozy relationship with Trump supporters?

AD: Your last chapter on anti-psychiatry was fascinating for several reasons, including the role played in it by R.D. Laing, on whom you published two earlier books. I always thought it was very much a fringe movement, but you open by noting that the “number of websites devoted to anti-psychiatry is utterly mind-boggling” (p.158). However, as you go on to show, the term is a bit of an omnium gatherum for diverse if not contradictory agendas. Tell us about how you understand anti-psychiatry and what may be valuable in parts of it today, including the critique of Big Pharma, and the still-relevant insights of Laing into alienation and estrangement.

DB: Like Erich Fromm, R.D. Laing was firmly convinced that psychological adjustment to an insane society was a symptom of alienation or self-estrangement; a form of pseudo-sanity, not the genuine article. Unlike Fromm, who leaned heavily on Marx, Freud, and classical sociology, Laing was schooled in existential psychiatry, and drew inspiration from a wide range of existential and phenomenological thinkers, including Kierkegaard, Nietzsche, Dilthey, Husserl, Heidegger, Sartre, and religious existentialists like Buber, Berdyaev, Marcel, Tillich, etc. 

Writing in the 1960s, Laing felt that the medical-model or classical psychiatric approach to schizophrenia is inadequate or misleading in many cases, and that the evidence on behalf of the medical model was weak and flawed at best. He believed that everyone, without exception, had the potential to go mad, regardless of their neurological integrity (or lack thereof), and invited his readers to consider madness as an existential crisis brought on by interpersonal defenses, dilemmas and stratagems that landed mental patients in a “check mate” position; one that the patient does not understand, cannot tolerate and yet is powerless to change.

However, despite his reputation to the contrary, Laing was not really an “anti-psychiatrist”, if by that we mean someone who called for the abolition of psychiatry as such. However, he did agree with the anti-psychiatric thesis that most psychiatric interventions into the lives of profoundly distressed and disoriented people entail a massive reification of the person, and an invalidation of their personal experience, and that psychiatric power is often wielded for the benefit of the powerful, not the powerless. And with rare exceptions, he was opposed to involuntary hospitalization and coercive medical treatments, i.e. involuntary drugging, electroshock, lobotomy, etc.

The anti-psychiatry movement took root in the mid-to-late 1960s, when involuntary commitment and old fashioned state-run mental hospitals were still prevalent. Places like these warehoused large numbers of people deemed to be deviant and/or dangerous to themselves and others, and deprived them of their basic civil rights. In those days, psychiatric power was exercised chiefly over in-patient populations like these, which were much larger than they are today. Moreover, the average length of stay in such places was much longer than it is now. All this changed with de-institutionalization, and the de-commissioning of state-run mental hospitals, which left many thousands of formerly hospitalized mental patients to fend for themselves on the streets. The resulting spike in homelessness, substance abuse and petty crime in the USA cost tax-payers at least as much as maintaining the old mental hospital system did. And Laing deplored this state of affairs, because it left former patients profoundly vulnerable, too.

However, the de-commissioning of state-run mental hospitals meant that the locus of psychiatric power shifted gradually from the steadily decreasing in-patient population to the burgeoning out-patient population. Why? Because, now people with diagnoses of severe mental disorders – schizophrenia, manic depression, refractory unipolar depression, etc. – were treated on an out-patient basis. If they were committed involuntarily, their stay in hospital would be curtailed to 2 weeks to 2 months, at most. This is when Big Pharma stepped in. As the number of people – including adolescents and children--diagnosed with severe mental disorders started to climb, so did the number of prescriptions they received. Even people who suffered symptoms of mild to moderate severity were now routinely medicated, and their access to long term, insight oriented psychotherapy curtailed by insurance companies. This was – and to this day, remains – a financial bonanza for Big Pharma, despite the fact that the drugs it produces seldom, if ever, cure the underlying disorder, and sometimes do not even control the patient’s symptoms effectively. Alternatively, their drugs may control the symptoms effectively for a time, but the so called “side effects” and neuro-toxicity that results from extended use are very injurious to people’s health in the medium to long term.

So, to summarize, the anti-psychiatry movement of yore emerged in response to conditions and institutions that no longer exist. Since their collapse, through its collusion with Big Pharma, psychiatry has extended its power immeasurably into the “out-patient” population since the de-institutionalization movement of the 1980s. And while the anti-psychiatrists of the 1960s faulted psychiatry for adhering rigidly to the medical model, and refusing to explore or acknowledge alternative ways of understanding madness, contemporary critics of psychiatry tend to focus on the utterly-mind boggling debasement of the medical model, when it is routinely subverted to serve corporate interests in defiance of the Hippocratic oath: “First, do no harm”. Fortunately, integrative and holistic medicine have recently generated many useful alternative strategies to mitigate and sometimes cure serious psychiatric conditions which do not require psychiatric medication. Indeed, in many instances, the first step in these treatment protocols is to wean patients off of the psychiatric meds they’ve become accustomed (or addicted to), sometimes for decades.

I am not an anti-psychiatrist. But I do think that the psychiatric profession is urgently in need of reform, and that both the earlier and current critiques of psychiatry have considerable merit. While the former is obviously less applicable to contemporary conditions, it still has much to teach us.

AD: As we come to the end of your book, it seems to me every chapter is an attempt to examine the question with which you began: “What happens when people lose all trust in authority” (p.3)? In place of different modes of rational authority, you write, we often instead get identity politics, conspiracy theories, and “irrational doubt.” And nobody, if I understand your argument aright, is free from the temptation of irrational authority or even outright authoritarianism—including not just politicians but also Freud himself and his defenders, or later Lacan, Peterson, or others in the academy, psychiatry, and elsewhere. Is that a fair assessment of what you were trying to do in the book?

DB: Well, not quite. Granted, mistrust of authority – of all kinds, and in all domains of expertise--is extremely prevalent nowadays. And perhaps no one is completely immune from the blandishments of power and irrational authority. But some people genuinely prefer to function and conduct their daily lives in an open and democratic fashion, and become profoundly distressed when the foundations of democracy are eroding before their eyes. But even democracies cannot function without relying (to some extent) on authority in the secular, scientific and spiritual domains. To imagine that we could do this is merely utopian nonsense. That is why it is important to emphasize that the way in which authority is wielded in these different domains of competence has a profound impact on how much the general population is able to trust those we deem to be experts, or to whom we entrust decision making powers.

The mode of authority most conducive to maintaining democratic norms and institutions is rational authority, because it promotes competence and mutual respect, values transparency and honesty, and does not stifle the critical faculties or the conscience of those who are subject to it in the course of their growth and training. Moreover, it strives to promote equality in the fullness of time by bringing those subject to it up the level of the person in authority, rather than the populist approach of leveling things by embracing the lowest common denominator. That being so, we should strive, as much as possible, to identify and root out irrational (and anonymous) authority and to encourage and augment rational authority whenever and wherever we can. This will never restore trust in authority completely, because a healthy dose of skepticism is consistent with an intact critical faculty, and because people in power can mask the exercise of irrational authority behind the rhetoric of freedom and emancipation quite easily.

AD: Having finished Psychoanalysis, Politics, and the Post-Modern University, what are you at work on now?

I am currently researching a book on the personal and cultural sources of anti-Semitism in the life and work of C.G. Jung and his inner circle, and their relevance to trends in contemporary Jungian (and post-Jungian) thought.