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Unfree AssociationsReview - Unfree Associations
Inside Psychoanalytic Institutes
by Douglas Kirsner
Jason Aronson, 2009
Review by Samuel Lézé, Ph.D.
Mar 9th 2010 (Volume 14, Issue 10)

Up to the 80s, most sociological studies of psychoanalysis addressed its social success, especially in the United States, France and England. We must now understand such a decline. Douglas Kirsner, a professor of philosophy and psychoanalytic studies at Deakin University (Melbourne, Australia), attempts to answer this question based on a study of American psychoanalysis. This is an updated edition, with a new epilogue, of an book originally published in Britain in 2001.

The strength and originality of this research rely on three remarkable features:

First, It is an empirical study based on interviews with more than one hundred psychoanalysts in the United States. This approach is in fact particularly rare because psychoanalysis field is a closed and quite inaccessible universe.

Second, inquiry focuses on the political history of four local training institutes (New York, Boston, Chicago and Los Angeles) of the IPA (American Psychoanalytical Association) which he reports of precisely and fairly the issues (charismatic authority, schisms, lack of democratic organization and dogmatism) on the right to train and to be a psychoanalyst. These case studies monographs are organized in the four mains chapters and break with generalities about the Freudian movement.

Third, the result is an internalist and critical approach that eludes two very common forms of theoretical reductionism in respect of psychoanalysis: to denounce or overestimated Sigmund Freud’s legacy. However, the criticism is not absent, and focuses on training system.

These undeniable qualities (empirical data, local political history and theoretical neutrality) unfortunately lead to some thorny difficulties in explaining the psychoanalytic decline and crisis in United States:

The responsibility for the decline of American psychoanalysis is based on the diagnosis that psychoanalysts do themselves (as stated in his forward by Otto F. Kernerg about the "dysfunctional consequences of the present educational system," p.vii): idealization of hierarchy, dogmatism and intellectual arrogance, transference unresolved, internal conflict between personality as means of control in training and scissions, inability to cope with modernity (e.g. effectiveness and scientific nature of psychotherapy), etc. Thus, the explanation stresses the negative dimension of psychoanalytical organization: indeed, psychoanalysis suffers from a lack of formal training, political transparency and objective criteria for assessment (i.e. rationalization).

On the contrary, we could think that custom transmission, charismatic authority and symbolic efficiency (i.e. anti-rationalization) could explain, more positively, the perpetuation of an intellectual movement which survival is not based on a professional organization or an academic discipline. Why should we ask the psychoanalysts to cope with modernity as if psychoanalysis were not a component of the definition of modernity during so many years without raising any questions?

This tension between rationalization of psychoanalysis versus anti-rationalization is an essential dynamics to understand the psychoanalytic movement. While the lacanian school has been spreading in United States and the medical monopoly on psychoanalysis has been vanishing since 1985, an anti-rationalization movement could stand as a possibility to revive American psychoanalysis.

By focusing on a social decline (or success) psychoanalysis is neglecting to question the basis of cultural authority, in a comparative survey analysis worldwide.  The answer cannot be found in the political history of local training institutes. Psychoanalysis considers to be isolate in society, marginalized and confronting many enemies. But it is a social distinction. We could not otherwise understand how psychoanalysts were successful (and yet succeeding abroad) to join permanently at the intersection of medical and intellectual world. Similarly, it is in a context of globalization of psychiatry and psychotherapy that psychoanalysis is questioned. So, the explanation of the authority of psychoanalysis relies on its social ecology and political strategy, not at a local but general scale.

This interesting book is easy to read and may appeal to a wider audience than the mental health’s Professional and psychoanalysts. Psychoanalysis stands as a cultural fact and Douglas Kisner provides a valuable account of a little-known world.


© 2010 Samuel Lézé


Samuel Lézé is social anthropologist, postdoctoral research fellow at the CNRS and member of IRIS, EHESS, Paris, France. His research interests focus on contemporary mental health issues in France within political and moral anthropology. He recently completed The authority of psychoanalysts (Puf, 2010). Website:



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