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A pioneering ethnography of psychoanalysis, Illusions of a Future explores the political economy of private therapeutic labor within industrialized medicine. Focusing on psychoanalysis in Chicago, a historically important location in the development and institutionalization of psychoanalysis in the United States, Kate Schechter examines the nexus of theory, practice, and institutional form in the original instituting of psychoanalysis, its normalization, and now its "crisis." She describes how contemporary analysts struggle to maintain conceptions of themselves as capable of deciding what psychoanalysis is and how to regulate it in order to prevail over market demands for the efficiency and standardization of mental health treatments.
In the process, Schechter shows how deeply imbricated the analyst-patient relationship is in this effort. Since the mid-twentieth century, the "real" relationship between analyst and patient is no longer the unremarked background of analysis but its very site. Psychoanalysts seek to validate the centrality of this relationship with theory and, through codified "standards," to claim it as a privileged technique. It has become the means by which psychoanalysts, in seeking to protect their disciplinary autonomy, have unwittingly bound themselves to a neoliberal discourse of regulation.
- Sales Rank: #1291496 in Books
- Published on: 2014-08-20
- Original language: English
- Number of items: 1
- Dimensions: 9.00" h x .70" w x 6.00" l, .0 pounds
- Binding: Paperback
- 288 pages
Review
"One can read Illusions of a Future as a key interlocutor for Foucault and Derrida, and as a counter to readings of Foucault (Rose and Rabinow are named) that do not allow for the internal divisions and messy historical shifts within psychoanalysis. It will appeal to readers in the humanities, to social workers and psychologists who think dynamically, to science studies scholars (collegiums of expertise, boundary work, trading zones, epistemic cultures), to debates about the repetition compulsions within the creation of biopolitical objects, and to psychoanalysts themselves."
(Michael M. J. Fischer, author of Anthropological Futures)
"Illusions of a Future is not only a careful, fightingly smart account of what happens to middle-American psychoanalysis and its 'crisis' under neoliberal conditions of risk and accountability. It is an argument for a rethinking of biopolitics. Kate Schechter uses a rigorous historical and ethnographic account of twentieth-century and contemporary psychoanalysis in Chicago to address and extend Foucauldian and Derridean readings of analysis and of Freud at the very point where these readings appear to falter or reverse course. She does so through empirical engagement with 'local catalogs of resistances,' a project that she terms 'rethinking biopolitics with renovated psychoanalytic resources' and one that makes intense and rewarding demands on its reader." (Lawrence Cohen, author of No Aging in India: Alzheimer's, the Bad Family, and Other Modern Things)
“Schechter’s brilliant study combines ethnography and intellectual history to explore how psychoanalysis is practiced today…. Schechter poignantly illustrates arguments about precarity pioneered by scholars such as Judith Butler and Lauren Berlant. This book is required reading for humanists, social scientists, social workers, and therapists…. Summing Up: Highly recommended.” (D. Stuber Choice)
“Schechter’s text is an interdisciplinary feat that combines ethnography with archival research to chronicle the crisis of American psychoanalysis as it adapts to an industrialized, neoliberal health system, governed by insurability, standardization, ‘flexible specialization,’, and ‘medically necessary’ services. … Illusions of the Future is a remarkable contribution to the history and anthropology of the ‘psy’ sciences, and Schechter opens up a world of possibility for further ethnographically analyzing this discipline.” (Julia Gruson-Wood Journal of the History of Behavioral Sciences 2015-09-01)
‘This book is a multifaceted gem. … Schechter helps us to understand traumatically induced change in the theory, organization, and practice of psychoanalysis in the U.S. Her book is implicitly a stinging critique of the harm managed care has done to analysts and patients alike.” (Howard F. Stein Journal of Anthropological Research 2015-07-01)
“For anybody interested in psychoanalysis, its institutions, history, theory, practices and personnel, this book makes a significant contribution that should have some (possibly even beneficial!) effects upon, and for, contemporary practitioners themselves. More generally, the book also contains incisive and interesting interpretations that bespeak the ongoing impact of biopolitical domination upon the mental health professions more generally — and should therefore also attract the attention of a wider audience.” (Justin Clemens Society & Space 2015-02-13)
About the Author
Kate Schechter is Assistant Professor in the Department of Psychiatry at Rush Medical College, Chair of Conceptual Foundations at the Institute for Clinical Social Work, and faculty at the Chicago Institute for Psychoanalysis. She is in the private practice of psychoanalysis and psychotherapy in Chicago.
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8 of 8 people found the following review helpful.
The Anthropologist on the Couch
By Etienne RP
Have you ever been tempted to eavesdrop on a psychoanalyst's conversation? Not in a therapy session of course: these conversations are private, and they usually take the form of the patient talking and the analyst listening. But psychoanalysts also talk about their trade in professional associations, congress meetings, or interviews. This public discourse is what interests Kate Schechter in Illusions of a Future. As an anthropologist-in-training, she took as her dissertation topic the psychoanalytic community in Chicago, going through their local archives and interviewing key members. Combining ethnography, history, and theory, she went beyond participant observation and archival work: she herself underwent psychoanalytic training, and is presented on the book cover as being "in the private practice of psychoanalysis and psychotherapy in Chicago." According to Dr. Schechter (and here the title "Dr." refers to her PhD, not to her qualification as a medical doctor), there are three remarks that are often made by psychoanalysts when commenting on the activity of their peers. "Where does she get all her analytic patients?" "It's not psychoanalysis." "It's all about the relationship." Three mechanisms are at play in these remarks: envy, denial, fetishization. Let us consider each of them in turn.
Psychoanalysts nowadays suffer from a bad case of patient envy. The majority of psychoanalysts in the United States—and the Chicago practitioners are no exception—have only one or two patients in actual psychoanalysis. Some of them achieve to get a higher number of subjects in analysis—defined as a demanding regimen of intensive, four-times-a-week introspective sessions on the couch pursued over a period of several years. A lesser intensity and frequency means that a treatment is expressly not psychoanalysis but rather psychotherapy. Measured by that rigid standard, most psychoanalysts nowadays only have one or two analytic patients in tow, if any. The other patients who visit them are here for therapy or counseling. They don't sit on the couch, they don't consult three or four times a week, and the expect answers to their problems from their analyst, not just passive listening. But psychoanalysts don't think of themselves as therapists or counselors. They are in the business of getting analytic patients—hence their envy for the analysts who ostensibly attract a higher number of analysands.
So most of what psychoanalysts do is "not psychoanalysis". How today's psychoanalysts manage to maintain their professional identity while they cannot practice what they preach is the topic of Kate Schechter's ethnography. Finding, making, and keeping analytic patients when there are none has become an existential challenge for Chicago psychoanalysts. Some blame the patients themselves: "people simply don't want to do the work anymore," says one. "Psychoanalysis is too rigorous for people today; patients want a quick fix, they want symptom relief as opposed to enduring structural change," says another. Others blame the system: in the era of psychopharmaceuticals, managed care, and cognitive-behavioral therapy, psychoanalysts have to demonstrate value as defined by neoliberal medicine. After World War II, generous medical insurance plans and government programs funded psychoanalysis because it was the only treatment for anxiety and depression that was available. By the 1980s however, with costs in medicine exploding and numerous new and cost-effective pharmacological treatments of anxiety and depression emerging, the psychoanalytic talking-cure has come under attack as ineffective, unaccountable, and wasteful.
Psychoanalysts overall take issue with the epistemic universe of managed care and evidence-based medicine. Historically, many psychoanalysts have viewed quantitative and behavioral research with disdain. They strongly reject the categories of the DSM-V, which explicitly excludes psychiatric notions based on Freudian theory. Nonetheless, psychoanalysts have to find ways to negotiate with the insurance companies and managed care organizations that will allow them to preserve their practices and their sense of autonomy. They report their cases using DSM diagnoses and CPT codes to keep records and submit to out-of-network benefits. Some analysts insist among one another that they are doing psychoanalysis but nonetheless code for psychotherapy because most insurance plans will cover psychotherapy (90801) but not psychoanalysis (90845). They use numbers to quantify the frequency and duration of analysis, basically responding to corporatized health care on the enemy's terms. Some even craft their defense using the audit practices and scientific methods of neoliberal medicine: "We need to start speaking the language of evidence-based psychology," advocates one. Others remain strangely in between, tinkering with categories and practices, like this analyst who reports having "four and a half" patients under analysis.
Psychoanalysts also have to grapple with issues of deskilling, feminization, and the lower status of mental health professions. One interviewee bemoans this loss of status: "There's been an enormous change in the whole character of the profession. People used to wear ties. I think someone who is a doctor, someone who's seeing patients, should." The fact is that being a medical doctor is no longer a prerequisite to become an analyst. From the late 1930s until a 1989 lawsuit, the psychoanalytic regulating body held firm to the view that psychoanalysis was a medical science and that only physicians should practice it. Now the profession is open to psychologists, social workers, group therapists, family councillors, and other kinds of care providers. The only requisite is that they follow a full analytic talking-cure provided by a training analyst—in fact, analysts-in-training may be the last patients willing to submit to the strict discipline of the traditional analytic cure. Once trained, these therapists offer various kinds of services, from child psychology to group therapy or marriage counseling. They develop these psychotherapeutic activities "in a psychoanalytic way", based on their training and understanding of the discipline, but for the purists and guardians of the profession, "it's not psychoanalysis".
So let's sum up. A growing number of analytically-trained professionals compete for a dwindling number of patients ready to subscribe to the whole analytic course: four weekly sessions, the use of the couch, the interpretive resolution of a transference neurosis, a proper termination. Most psychoanalysts practice some kind of psychotherapy that is, by their own recognition, "not psychoanalysis". They envy those who are able to secure proper patients, and deny that their profession as a whole might be to blame. Another mechanism is at play here: the logic of the fetish, the denial of a feared absence through a replacement with a substitute presence. Fetishization takes the form of the emphasis on the importance of the relationship between the analyst and her patient. This personal relationship was deemed nonessential by the founding fathers of psychoanalysis. What mattered was "transference", that artificial illness whose resolution by interpretation led to psychoanalytic cure. The analyst's ostensibly technical work was reading and interpreting the transference neurosis. In more recent years however, the relationship itself has come to be seen by many psychoanalysts as curative.
Kate Schechter shows that the opposition between these two logics—the orthodoxy of transference, and the heterodoxy of the relationship—goes back to the origins of the Chicago school of psychoanalysis. I will not try to summarize her history of the debates between the two ancestors, Lionel Blitzsten and Franz Alexander, as well as the constant infighting between their disciples and epigones. Based on archival work, her analysis straddles several disciplines: the sociology of the professions, the history of scientific knowledge, the anthropology of medical care, and psychoanalysis itself. This is not just local history: the Chicago school of psychoanalysis was the most important one west of New York City, and the quarrels between its founders echo wider debates in the discipline. But I found this historical part less interesting than the firsts chapters when the author eavesdrops on psychoanalysts bemoaning the lack of proper patients, the elusive nature of psychoanalysis, and the growing importance of the human relationship between analyst and patient.
1 of 1 people found the following review helpful.
This is a fascinating look at the politics within psychoanalysis ...
By J. Martin
This is a fascinating look at the politics within psychoanalysis that led to its fall from the "Gold Standard" of mental health treatment in the 1960s to its utter isolation from psychiatry and medicine today.
1 of 1 people found the following review helpful.
Five Stars
By Jim
This is an outstanding book. Very well researched and a clear exegesis of psychoanalysis in Chicago and America.
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