The Social Turn: Psychoanalysis at an inflection point (Maggie Doherty, April 2025, Harpers)
[I] was in New York mainly to investigate rumors I’d heard about major changes afoot in the American psychoanalytic community. Psychoanalysis, I’d heard, was modernizing. APsA was opening up to the broader world. There was a push to bring in new members, as well as a rising tide of psychoanalytic work that sought to make analysis more accessible to and effective for people of different stripes. I wanted to understand what these changes meant for clinicians and patients and whether they were being resisted. What would it take for psychoanalysis to change?
APsA may have an iron hold on the profession, but it has a small fist, I thought, as I counted the people milling about on the hotel’s second floor. It was Thursday, the convention’s third day but only the first with a full slate of panels and discussions, and there were perhaps fifty people present before the afternoon sessions. The crowd seemed old, strikingly so; I saw a lot of gray hair and sensible shoes and the kind of funky jewelry worn by women of a certain age. According to their name tags, many attendees hailed from a few coastal cities: Boston, San Francisco, New York. Almost every person I saw was white. There was a small book exhibit next to a poster display that reminded me of a high school science fair. Representatives from the mental-health treatment center Austen Riggs, advertising in-patient treatment in the Berkshires (more than $70,000 for six weeks), had set up shop just a few steps away.
The sleepy atmosphere, the sparse crowd: it was hard to believe that psychoanalysis had once been central to American culture. From the aftermath of World War II through the mid-Sixties, analysis was seen as a reliable treatment for mental illness. Psychoanalysts sat on the boards of medical schools and chaired departments of psychiatry. Psychoanalytic researchers received government funding. A rosy portrait of the psychoanalyst appeared in the press; journalists themselves entered treatment. The historian Nathan G. Hale Jr. calls this time the golden age of psychoanalysis.
But the golden age didn’t last. In the Sixties, psychoanalysis came under attack from feminists, as well as from advocates of community mental-health services who derided the practice as a luxury for the well-off. Meanwhile, a new generation of physicians and psychiatrists were turning away from psychoanalysis—particularly with the development of what would later be called cognitive behavioral therapy (CBT), which was evidence-based and promised concrete results within a set time frame. By the late Seventies and early Eighties, insurance companies largely excluded psychoanalytic treatment on the grounds that it wasn’t evidence-based, and the majority of analysands had to pay out-of-pocket. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders purged its pages of psychoanalytic theory, explicitly bringing American psychiatry into a post-psychoanalytic era that was more focused on “biological” explanations and cures, like drugs. Soon pharmaceutical companies began promising patients that their depression or anxiety could be treated with selective serotonin reuptake inhibitors, and by the end of the century, mainstream American psychoanalysis could be said to be on the decline—and in crisis.
