Remember those cartoon Zoloft commercials? A sad white blob mopes around, but, presumably having taken Zoloft midway through the commercial, is bouncing around happily in the end. Abilify, Cymbalta, Prozac. Before the era of Netflix, I remember being bombarded with pharmaceutical ads on cable television. In fact, the pharmaceutical industry spent $27 billion for drug promotions in 2012 alone. Since the 1980s, the growth of pharmaceuticals has had a significant impact on clinical practices and psychiatry units around the world. The turn to medicine is so common nowadays that it may come as a surprise to know that other forms of engaging with mental health are still available.
One of the known alternatives is psychoanalysis — often referred to as psychodynamic psychotherapy, or a more comprehensive psychotherapy. However, the basic assumptions made in the one-paragraph explanations in Psychology 101 textbooks and the quick jokes made about Austrian psychologist and credited founder of Psychoanalysis Sigmund Freud don’t detail the ways in which psychoanalysis can be valued and beneficial to our mental health. Why go to a psychoanalyst when the outcome is clear? According to the Oedipal complex, you simply love your mom and you hate your dad. Outside such useless caricatures, accusations of patriarchal imposition and heteronormativity lead many communities to stray away from the psychoanalytic discipline all together.
These caricatures and accusations hold some truth in the history of psychoanalysis, reflecting many of the cultural values of the 20th century society in which it emerged. However, since its inception, Freud’s successors have taken his groundwork in new, progressive directions. Frantz Fanon, a psychiatrist from Martinique when it was still a colony of France, sought to employ in works such as “Black Skin, White Masks” the concepts of psychoanalysis during the 1940s and ’50s in order to understand not only the effects of colonialism, but also the Black experience in the normatively white societies of Europe and America. Feminist psychoanalysts Luce Irigaray, Hélène Cixous and Julia Kristeva, during the ’70s and ’80s, challenged the psychoanalytic interpretation of women’s psychology, updating the discipline for the demands of a Second Wave feminist audience.
The rather mocking way in which some handle psychoanalysis obscures both these progressive developments, as well as the rich history the discipline has had in Ann Arbor. Walking down Washington Street, one may see a sign that reads “Michigan Psychoanalytic Institute” and assume it to be the relic of some fortunately forgotten past. Yet Ann Arbor offers a vibrant community of analysts and scholars who employ psychoanalysis in their work and everyday lives, and who see its potential for understanding human relations and seek to push back against some of the numerous misconceptions that have emerged during its century-long history.
In the 1970s, psychoanalytic practitioners worked side-by-side their nascent biomedical partners at the University’s Psychiatric department. Analysts, like University alum Jean-Paul Pegeron, a practicing psychoanalyst in the Ann Arbor area, were trained in both disciplines during their residency at the University.
“There was no question at the time, at least in that particular setting, that the two could not be compatible,” Pegeron said.
In a psychiatric ward where both biomedical and psychoanalytic disciplines are used, the clinician would determine when medication was necessary and when long-term psychoanalytic therapy may be better suited. Pegeron, a certified prescriber, often provides consultation to other psychoanalysts in making this decision.
“There’s obviously a gray zone,” Pegeron said. “In the less severe cases, you often find some underlying emotional issues, maybe some traumatic experiences and losses which would kind of tip you off to a more emotional issue.”
Pegeron said that though there is a whole range of depressive symptoms that can be diagnosed, the issue might be more biological, in which case it cannot be treated solely through psychoanalytic therapy.
“Their clock is set a bit lower than most people, so they might be in therapy for a while but nothing changes,” Pegeron added. “So that would be an example of why you need to think about medication; lift enough of the mood and symptoms that their life hasn’t changed yet, so then they can make use of therapy.”
In media, these therapy sessions have the stereotypical image of the patient lying on a reclined couch lamenting about their life while a silent analyst looks on indifferently. But whatever experiences Woody Allen may have had, the practitioners of Ann Arbor paint a different picture.
“The invitation we make to our patients is this: to speak as freely as they can about whatever comes into their minds,” University alum Michael Shulman, faculty member of the Michigan Psychoanalytic Institute, said. “Thoughts may occur that they’re not sure they can or would like to say, but we ask them to do their best to speak them anyway.”
“What psychoanalysts do when we think we have something useful to say to help our patients speak more freely about what is inside,” Shulman added. “But there is much more quiet and listening that develops than in ordinary conversation.”
Through this dialogue, both analyst and patient seek to understand the unconscious determining factors that may lead to recurring problems in relationships and everyday life. These factors can be so habitual or commonplace in the life of the patient that they become difficult to determine where they are and why they are at play. Examinations of childhood experiences and past relations, along with present issues, work toward uncovering the hidden ways in which patients’ past experiences affect their present. At the same time, the analyst seeks to prevent their own sentiments from influencing the patients’ understanding of their issues.
“It’s been said by an analyst recently, one who is especially articulate, that Freud’s greatest discovery was of a new form of human relatedness,” Shulman said. “It is a unique form of human relationship that allows an unfolding of the self through this process.”
As ideal as the process sounds, psychoanalysis has found difficulties retaining credibility in the public eye. In recent years, a lack of exposure to the process has been result of the pressure from insurance companies.
“Most insurances don’t cover psychoanalysis,” Pegeron said. “They will cover psychotherapy, usually with a limited number of sessions even though they claim it’s unlimited. And what they use is medical necessity. In other words, you have to show that the person is still having enough disturbances that they require continued therapy.”
The psychoanalytic process, however, never has a set trajectory. While four to five sessions a week is typical, patients are free to choose their own pace and gradually build momentum. Even the conclusion of sessions comes from the patient.
“People begin to talk about, and become able to think of their psychoanalysis ending, when they feel that enough of the difficulties they started with have been resolved and can be looked back on, and that they can reflect enough on their own about all that they have learned about themselves to carry on alone,” Shulman said.
Pharmaceuticals, however, provide a quick fix with fewer costs for insurance companies. Additionally, in the University setting, the capacity of pharmaceuticals to be tested on hundreds of subjects with immediate results makes conducting research simpler than in the case of long-term therapies. As a result, the convenience of medication has led to fewer practitioners such as Pegeron, who seek to bridge the two disciplines.
While psychology departments in the United States have seen a decline in practicing psychoanalysts, University students can still gain exposure to the ideas of Freud through a variety of courses taught in LSA and seminars and conferences held at the Michigan Psychoanalytic Institute. Tomoko Masuzawa, professor of comparative literature and history, and Andreas Gailus, associate chair and professor of Germanic languages, have offered such an opportunity to varying degrees of success.
“I tend to have a number of classes that include some Freud texts,” Gailus said. “The first thing people will tell you is, well clearly isn’t he wrong? They always assume that (psychoanalysis) has somehow been completely superseded and that it’s now entirely clear that everything Freud has to say is wrong.”
“I usually, as a beginning, say sexuality or sex in Freud isn’t what you think,” Masuzawa said of the way she overcomes many student’s initial mindset. “I can’t really elaborate more. Stay around three months and then you’ll find out.”
For Gailus, starting with a work by Freud on a topic outside sexuality is a rule of thumb. Mourning and Melancholia, Freud’s essay on depression, has proven to be a popular read among students. In it Freud argues that the “extraordinary diminution” of “self-disregard” in people suffering from melancholia emerges after an experience of severe disappointment in a person or ideal they were emotionally invested in. Rather than give up that person or ideal, however, the melancholic comes to believe the faults of the person or ideal are their own. Psychoanalysis, then, seeks to help the patient in determining what caused this disappointment, but also, facilitate the process whereby the patient no longer sees these faults as his or her own.
“(Students) find (the essay) fascinating and they realize that (Freud) has a way of bringing into relief the landscape of experience,” Gailus said.
Even in such a negative environment, students continue to find many concepts in psychoanalysis useful.
Rackham student Shannon Winston, who founded the University’s psychoanalysis reading group, uses Freud’s “The Interpretation of Dreams,” examines the ways in which the imagination creates associations between objects that aren’t necessarily connected by ideas, but rather by simpler qualities like shapes or color. For Winston, this approach becomes a new way of reading works such as “The Iguana” by Italian author Anna Maria Ortese.
“In Ortese’s ‘The Iguana,’ I chart the color turquoise in its different manifestations,” Winston said. “In the beginning of her novel, Ortese mentions the beautiful turquoise of the Mediterranean. Then the narrative invokes stones and the Iguana of the same color. What I’m tracing are visual and perceptual networks of color throughout the narrative, which reveal perceptual resonances with the Sea.”
As Freud famously wrote in “Three Theories of Sexuality,” the only abnormal person is a psychologically normal person. As one in 10 adult Americans suffer from depression today, according to the Center for Disease Control, Freud’s claim seems to be corroborated. With the prevalence of depression in many people’s lives, one must wonder what the consequences are for a culture that largely resorts to one way, namely medication, in dealing with mental health and the interior landscape of the mind.