It is commonly said these days that psychoanalysis is undergoing difficult and critical times. Recently a book appeared derived from a series of articles in The New Yorker, written by Janet Malcolm and entitled Psychoanalysis: The Impossible Profession. The title of the book expresses its theme directly.
Doubtlessly, psychoanalysis is currently facing a number of challenges. The conflict which has existed in this country since the 1930's between psychoanalysts with medical degrees, and lay analysts, many of whom have Ph.D.'s in clinical psychology, and some even degrees in clinical social work, has recently become exacerbated.
A primary question, which is by no means a new one, that psychoanalysis is currently entangled in is therefore whether psychoanalysis is a medical science or a cultural movement with a therapeutic branch. Does psychoanalysis have to be based on medical science? Sigmund Freud himself did not think that it had to be, even though in his case it was. He favored allowing lay analysis and training psychoanalysts who did not have a medical degree. His daughter Anna Freud, who was also one of his prime disciples, was not an M.D. Nor was his last student, Erik Erikson.
The second and perhaps more important issue that is facing psychoanalysis is that of the rise of what is called psychopharmacology, that is, the use of drugs to alleviate mental illness that had hitherto been treated by psychoanalysis. This concerns particularly the illness of mood-swing, or mood-polarization, called manic-depression. At least one third, and possibly one half of the patients that psychoanalysts normally treat are people whose moods undergo swings from mania to depression, remaining for the most part in depression and occasionally breaking into euphoric hyperactivity or mania. It became known in the fifties that Valium or a similar substance can help many people in a depressed or anxious state. But for those in a severe arc of moodswing another treatment had to be found.
About twenty years ago, largely by the trial-and-error method of experimentation, it was discovered that a certain lithium compound had the effect of flattening out the mood-swing, or at least of reducing the swing's curve, thus alleviating the depression to a significant degree for seventy per cent of manic-depressive patients. This lithium compound also almost eliminates the manic euphoria. Severe depression hurts work performance, impairs family relationships, and sometimes leads to suicide. The manic mood-swing can lead