Off the couch, back on its feet

The American Psychoanalytic Association recently set up a task force with an ambitious goal - to "reach and captivate the 10,000 best minds of the next generation with the power of psychoanalytic ideas". Clearly worried that its influence was in decline, it employed Jonathan Redmond and Michael Shulman to research "access to psychoanalytic ideas in American undergraduate institutions". Their report was recently published in the association's journal.

After looking at the course catalogues of 150 highly ranked colleges and universities, the authors note that "psychology departments typically offer little coursework on psychoanalysis ... most often it is mentioned dismissively in textbooks describing psychoanalytic ideas as scientifically invalid, or in misleading, incomplete or simplistic ways". Readers could well conclude that it was just "a desiccated and dead tributary of the psychological mainstream".

Yet this is only half the story because "six times more courses featuring psychoanalytic ideas are available outside psychology departments than in them". Many are in the humanities and social sciences, where "basic psychoanalytic concepts have been undergoing significant transformation". As a result, the report points out, "clinically orientated analysts might find themselves on unfamiliar ground", particularly when courses are "steeped in Lacanian concepts or postmodern theorising".

In truth, Redmond and Shulman seem rather baffled by psychoanalytically inflected courses on "Law's madness", "Psychoanalysis and colonialism" or "Digital bodies, virtual identities", not to mention the use of phrases such as "global psychoanalytic subjectivities". They admit that a course on "Psychoanalysis, gender, and sexuality" "confronts head on one of the most basic issues in psychoanalytic theory: sexual difference". But they take exception to its claim that "psychoanalysis is, in the end, a form of reading". ("Is that the only thing it is 'in the end'? What about its also being a form of therapy?") And they characterise its focus on "fictions from As You Like It to Some Like It Hot ... (and) Antigone, 'chick flicks' and 'buddy' movies" as "novel and playful juxtapositions of cultural texts and authors". "Novel and playful" sounds like a euphemism for shallow and superficial. Is this what academics are doing with their beloved psychoanalysis, they seem to be asking. And what has it got to do with the tough work of an analyst trying to help a suicidal teenager?

Britain has been crucial to the history of psychoanalysis, because Freud and some of his circle found refuge from Nazi persecution here. Yet psychoanalysis has never had the same impact in the UK as in the US and much of continental Europe. So how far does the British experience parallel what we find in the APA report?

Michael Rustin is a professor of sociology at the University of East London who has long drawn on psychoanalysis in his work. He says: "The situation here was never like that in the US, when there was a period in which psychoanalysis had a very large influence on psychiatry and became quite fashionable in some circles. Thus there was a strong position from which to decline steeply. In Britain, psychoanalysis was more of a minority interest in the first place, and there has not been such a dramatic rise and fall."

Here, as in America, he continues: "The discipline of psychology is probably the least hospitable of any discipline to psychoanalytic ideas - it has a long commitment to positivist methods in its ambitions to be a science - but that has always been so in Britain." And there is also the problem that "psychoanalytic psychotherapies are under great pressure to justify themselves in the NHS against the allegedly more 'evidence-based' cognitive behavioural therapy".

That is the bad news. But Rustin's overall view is much more positive. "In the past 20 years or so," he says, "there has been a significant development of psychoanalytically informed studies in the British university system." A lot of this has taken place in humanities departments, but the accreditation of professional clinical training in psychotherapy by universities has also played a part.

Peter Fonagy, Freud memorial professor of psychoanalysis at University College London (and chief executive of the Anna Freud Centre), agrees that "there is some hostility to psychoanalysis in academic psychology", although this was by no means a one-way street. "Most of the hostility", he says, "came from 'my own side' (psychoanalysts), who felt misrepresented by an empirically oriented psychology. Psychological research was (is) considered irrelevant, and work attempting to systematise psychoanalytic ideas is considered inherently alien to the discipline."

A number of factors, however, have led to a dramatic shift. "Psychoanalysts have recognised that research in collaboration with (rather than in not-so-splendid isolation from) other disciplines", elaborates Fonagy, "is the key to the survival of the profession as well as the intellectual basis of clinical work. In particular, outcome studies and the use of empirical evidence to determine which of the rival clinical approaches will be supported by public moneys have changed the shape of the land."

Roger Kennedy, president of the British Psychoanalytical Society, believes many of the divisions - like the one between psychoanalysis and psychiatry - can and should be overcome. "Clinical evidence", he argues, "supports the notion that a combined approach, drugs and therapy, is much more effective for many severe psychiatric conditions than either alone. Drugs are essential. Analysts in the past tended to say crazy things like 'Drugs are no good'. Psychiatrists denied that therapy is any help." A rapprochement can only help patients.

It may be patchy, then, but there are signs of increased openness and dialogue between psychoanalysis, psychiatry and neuroscience. But what of the other gulf mentioned by the APA report, that between clinicians and academics based in arts and humanities departments? Kennedy, although no stranger to humanities research, is clearly surprised that even introductory textbooks on Chaucer now make use of psychoanalytic vocabulary. He has been involved in the European Psychoanalytic Film Festival and has also, with Neil Vickers, lecturer in the English department at King's College London, set up an "academic think-tank" designed to bring practising analysts together with interested academics once or twice a term. "Among academics who are getting fed up with more esoteric approaches," he notes, "there's a hunger to hear from clinicians." Many of his colleagues shared his commitment to such outreach, although a relative dearth of numbers - there are only about 150 fully practising psychoanalysts in Britain - imposed limits on what was possible.

There are, of course, questions about using psychoanalytical concepts within an academic setting. The discipline relies largely on material from the consulting room that students have to take on trust. It can make intense emotional as well as intellectual demands, while also challenging much of what is normally considered common sense. "In the very first months of the baby's existence," wrote one of Freud's most extreme disciples, Melanie Klein, "it has sadistic impulses directed, not only against its mother's breast, but also against the insides of her body: scooping it out, devouring its contents, destroying it by every means sadism can suggest." It is one thing to use Kleinian notions as tools of cultural analysis, but do many people really see (far less want to see) their own children in such savage terms? Notions that make sense within a clinical context can become purely intellectual counters outside it.

Kennedy seems well aware of these issues. "Psychoanalysis is primarily a treatment and a clinical experience. Because it is a rich and powerful way of understanding the mind, there is a great temptation to overapply it. I'm sure in the early days people got excited trying to apply it to everything they could." As the subject matured, it had learnt to avoid "the danger of the Chinese takeaway approach - coming up with interpretation No 99".

Yet, despite such risks, psychoanalysis is flourishing in arts and humanities departments, and some seem happy to accept what the APA report calls the "growing divide in the languages spoken by clinicians and academics". Vicky Lebeau, reader in English at the University of Sussex, has written largely on film, most recently in her book Childhood and the Cinema. "For me," she says, "one of the most productive ways of thinking about psychoanalysis in the academy is to start from (French analyst) Jean Laplanche's idea of 'extra-mural psychoanalysis': in particular, his emphasis on the need for non-clinical psychoanalysis to develop methods of its own ...

"It needs to discover questions and invent methods: psychoanalysis should make the reading of a film more complex, more interesting, not more 'simple' ... Looking for experiences or concepts shared between psychoanalysis and cinema seems to me the most productive way of thinking about the teaching of psychoanalysis and film. (Catastrophe would be one such theme - both discourses seem obsessed with it!)"

Mary Jacobus, Grace 2 professor of English and director of the Centre for Research in the Arts, Social Sciences and Humanities at the University of Cambridge, has had "a long involvement with psychoanalysis in British and US academia" and has "written several books on psychoanalysis from a literary perspective". She points to "plenty of well-respected work, especially on Shakespeare" going all the way back to Freud himself and also cites continental analysts who have "suggested that psychoanalysis needs to take up residence in the universities in order to flourish".

Yet Jacobus is well aware of the gulf between practitioners and theorists. "The problem is that literary and other theorists have taken up both Freud and Lacan, but often without taking on the body of clinical theory and the practice it is based on. It remains quite hard for academics and analysts to talk across their specialisms, and those of us who have worked at facilitating the dialogue get discouraged at times."

Freud wrote about pretty much everything under the sun. For better or for worse, psychoanalytic concepts have now escaped from the clinic and are widely used in the humanities in ways that can baffle or shock traditional clinicians. Yet other academics devote much time and energy to determining exactly where psychoanalysis can - and can't - help illuminate the puzzles of their disciplines.

Daniel Pick, professor of modern history at Birkbeck, University of London, as well as a qualified psychoanalyst, defines himself as "an historian with a close interest in psychoanalysis rather than a psychohistorian".

"Like most movements," he suggests, "psychoanalysis has generated its own zealotry" - as when old-style "psychohistory" treated it as "a key to all mythologies" that could replace other kinds of historical knowledge. Far from being a toolkit that can be applied mechanically, it tends to "make one more hesitant about motives". Although historians inevitably make assumptions about psychology, they often fall back on vague and simplistic notions such as "vested interests" and "an appetite for power". A knowledge of psychoanalytic theory, backed by different kinds of expertise, might help them portray historical actors with greater depth and subtlety.

Pick tested some of these ideas in his book Rome or Death. This explores an episode towards the end of General Garibaldi's life, when the great hero of Italian unification came out of retirement to pursue a plan to divert the River Tiber. His actions were clearly motivated by political considerations - "such burning contemporary concerns as public health, agricultural and economic development in the new state" - but were there also more personal factors at stake? "Cultural history", writes Pick, "often risks bypassing ... 'interior' biographical questions altogether, while psychoanalytic approaches to history have often been accused, rightly, of sounding too sure about the unconscious motivations of the dead." His book attempts to steer a middle path between these opposing dangers.

Michael Lacewing, senior lecturer in philosophy at Heythrop College, University of London, teaches both the philosophy and theory of psychoanalysis. He has explored the internal coherence of psychoanalytic claims, without ignoring the issue of therapeutic effectiveness (although he notes that many people have read the critiques of psychoanalysis without bothering to look at the responses). But his main concern seems to be "using psychoanalysis in philosophical argument".

"Moral philosophy", he has written, "must address the question of the gap between 'our ordinary human capacities' and 'what we might best achieve', and this is both something on which psychoanalysis has a great deal to say, and something it seeks to ameliorate." The philosophy of mind needs to draw on "a psychologically rigorous theory of mind, using neuroscience as well as psychoanalysis". "If you're interested in human nature," he explains, "psychoanalysis's contribution is unavoidable. It's crucial to understanding emotion, desire and self-deception."