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Psychoanalysis came to North America in two major waves, the first one following Freud's visit in 1909, and the second one following the Nazi takeover in Germany and Austria. Each wave stimulated the exploration of psychoanalysis' scientific and curative potentials while encouraging popularizations by the American public. However, this dual, though separate, reception engendered ambiguities and misunderstandings, and built up unwarranted expectations that led to inevitable disappointments.

American physicians had been seeking to cure neurasthenia, which, already in 1869, George M. Beard (1840-1883) had called "the American disease" arising from so-called "civilized morality"—hidden conflicts due to hypocrisy. According to Beard, upwardly mobile citizens professing continence, religious purity, and even married celibacy, were having illicit affairs with "loose" women, which often created "mental problems."

Around the turn of the century, American neurologists such as Morton Prince (1854-1929), James Jackson Putnam (1842-1918) and S. E. Jelliffe (1866-1945) had been investigating the "French school" of Charcot, Bernheim, and Janet, and were practicing suggestion and (occasionally) hypnosis in order to cure these neuroses. So were psychologists, among them Stanley Hall (1844-1924), William James (1842-1910), and Boris Sidis (1867-1933). When they read that Freud's patients by talking about previously repressed fantasies had lost their hysterical symptoms, and that this had happened by bringing forth unconscious memories, they wanted to learn about his method, and about the relation between his patients' symptoms and sexual repression.

Consequently, philosophers, psychologists, and the educated public were as interested in what Freud had to say as were American psychiatrists—who were caring for psychotic patients in institutions and did not know how to cure neuroses—and clergymen who were no longer able to help people by instilling a fear of God.

For these reasons, Freud's visit to Clark University attracted diverse listeners: the psychologists William James and Edward Bradford Titchener, the anthropologist Franz Boas, the revolutionary anarchist Emma Goldman, and many Protestant clergymen, psychiatrists, and neurologists—among them Abraham Arden Brill (1874-1948), Adolph Meyer (1866-1950), and James Jackson Putnam. Freud's lectures, which for the first time synthesized his discoveries, turned out to be tailor-made for this audience. He spoke extemporaneously. He stressed his hopes for the scientific exploration of the laws governing the unconscious; the liberating benefits psychoanalysis would bring to individuals and humanity; the role of sublimation, of trauma and catharsis; and the efficacy and benefits of psychoanalytic intervention. The American press gave him wide, even sensationalist, coverage, so that he was met with an enthusiasm usually accorded entertainers and charismatic heads of state. Then, general physicians and neurologists wanted to understand more about the influence of the unconscious on illness; feminists and other radicals foresaw the end of sexual and social repression; and mind healers perceived answers to troubling questions. To them all, psychoanalysis promised to resolve theoretical dilemmas, while offering a method to help ailing, malingering patients: it became a pivot for disparate intellectual endeavors and disciplines, aims, and interests.

Since the analysis of dreams caught the imagination of the larger American public, psychoanalysis started being cast as the new road to happiness. Broad applications ensued, not only by doctors and clergymen but by social workers, experts in child rearing, and in criminology. And zealous charlatans called themselves psychoanalysts.

Freud was dismayed by these facile applications that bypassed the laborious efforts required to reach the deepest unconscious of patients. As he stated in "On the Question of Lay Analysis" (1926a), "Americans came too easily by truths others had struggled to discover . . . and were too easily satisfied with superficial appearances."

However, Freud kept in touch with a number of Americans. On November 9, 1909, for instance, Putnam wrote: "Your visit to America was of deep significance to me, and I now work and read with constantly growing interest on your lines." Less than a month later, he informed Freud that "the real psychoanalysis begins where the primary 'confessional' ends." Freud urged his American correspondents to organize and to affiliate with the International Psychoanalytical Association (IPA)—which had been launched to facilitate communication among followers wanting to exchange scientific information.

By 1911, twelve persons, mostly physicians, set up the American Psychoanalytic Association (APA). In the same year, fifteen physicians, under the leadership of A. A. Brill, established the New York Psychoanalytic Society (NYPS). By 1914, they founded the Boston Psychoanalytic Society, appointing Putnam as president, and soon formed groups in the Washington-Baltimore area and in Chicago. But despite these organizational setups, the first wave of American Freudians was too geographically and/or intellectually dispersed to make many scientific contributions, and thus crested after a few years.

By then, psychoanalysis was expected to explain nearly every individual and social phenomenon in the culture at large: the American propensity to overgeneralize was casting psychoanalysis as a cure-all. As Nathan Hale summarized, "between 1915 and 1918 psychoanalysis received three-fifths as much attention as birth control, more attention than divorce, and nearly four times more than mental hygiene. . . . The unconscious had become a Darwinian Titan and dream analysis the road to its taming" (Hale, 1971, p. 397). Proselytizing practitioners bragged to journalists of miracle cures, and reporters wedded clichés to exaggerations and heightened enthusiasm.

During these years, Freud wrote to Putnam about the impending splits with Alfred Adler and Carl Jung. But he did not yet realize that the American ambiance would engender other sorts of splits. Since the American groups, mostly, were started by self-selected and self-trained doctors, they differentiated themselves—professionally—from the growing numbers of social workers, clergymen and charlatans who were also doing "psychoanalysis." This disjuncture between psychoanalysis' public acclaim and its (flagging) clinical success was unique to North America and, ultimately, created a storm within the movement. By 1924, due to a mixture of professional responsibility and self-interest, and to desperation, the APA voted to keep out all lay analysts. At the IPA meetings in Innsbruck, in 1927, twenty-eight papers were presented on the question of lay analysis. Wanting to distance themselves from "impostors," American Freudians remained adamant and insisted on breaking IPA rules against lay analysts by restricting access to physicians alone. They even referred to Freud as the "Pope in Vienna." Freud expressed his disagreement with the Americans in "On the Question on Lay Analysis" (1926a).

Nevertheless, American psychoanalysts realized that they were not keeping up with scientific advances and that they needed more training. Therefore they invited a number of Europeans as training analysts (including Freud, who refused for reasons of health). By 1930, they formed the Chicago Institute under the aegis of Franz Alexander (1891-1964), and in 1931, the New York Psychoanalytic Institute under the aegis of Sándor Radó (1890-1972). But the rift between European and American Freudians continued to widen over training lay analysts. In 1936, the APA declared that it would veto any resolution by the IPA addressing American issues, and by 1938 had set up its own criteria for "minimal training of physicians" at its affiliated institutes, spelled out proper conduct of members, and reaffirmed the ban against laymen. They also put the IPA on notice not to train Americans who had not already been "approved" by the APA.

In a way, Freud had described some of these dilemmas as arising from the fact that psychoanalysis was a social and intellectual movement, a clinical therapy, and a theory of mind. He maintained that these major thrusts were bound to come into conflict from time to time. But he could not foresee that the Nazis would come to power, that most of his disciples would move to America, and that World War II would nearly abolish psychoanalysis on the European continent.

America's second major wave of psychoanalysis arrived with theémigrés. From the start, Freud had referred to his disciples as pioneers into the workings of the unconscious. After the majority of these disciples arrived in the country of pioneers they, literally, were cast as pioneers for their cause.

At first, their reception was mixed. American psychoanalysts had sent affidavits, and Lawrence Kubie (1896-1973) had organized an extremely efficient Emergency Committee to help them get into the country. But members of the American Medical Association were afraid that the Europeans would compete for their jobs and patients. Legally, immigrants had to become American citizens before practicing medicine in all but five states; and they had to pass medical boards before becoming psychoanalysts. They also had to prove that they would be self-supporting within a year before they entered the country, and they were branded as Jews. They already had to adapt to their delegitimation as psychoanalysts and human beings, to overcome the shock of brutal ostracism. Now, they had to learn English in order to establish themselves in their (still) struggling profession. Manyémigré Freudians worked in hospitals. There, they could demonstrate the efficacy of the "talking cure" to colleagues. By 1942, every medical student learned about the unconscious factors that might influence their patients' behavior. Many of these students later became psychoanalysts.

Under the circumstances, the organizational feuds receded. Theémigrés became a resource for American colleagues. They offered training analyses and held the most prestigious positions in the new institutes that, mostly under their leadership, were springing up around the country. The former disagreements were not settled, but Freud's death in September 1939 and the war overshadowed IPA concerns. What would have happened to psychoanalysis had most of its proponents not come to America after the Nazis took power (a much smaller contingent went to South America and England) is a moot question.

In North America, the organizational repercussions of the split between medical and lay analysts at first determined who among theémigrés would be allowed into the APA and its affiliates, but later on this differentiation led to the formation of "deviant" associations. Still, some prominent psychologists who had been close to Freud, such as Ernst Kris (1906-1957), Siegfried Bernfeld (1892-1953), Erik Erikson (1902-1994), Otto Fenichel (1897-1946), and Theodore Reik (1888-1970), were accepted as "honorary members." But Reik, for instance, did not appreciate this distinction and, by 1948, started his own society—to train psychologists in psychoanalysis. His graduates, in turn, taught others. Similar situations arose in cities throughout the country, especially on the two coasts. Already in 1941, Karen Horney (1895-1952) had left the New York Psychoanalytic Institute (NYPI) after a heated controversy over theoretical priorities which would determine, also, what type of psychoanalysis candidates were going to learn and then to practice. Basically, she argued that her colleagues' ego-oriented psychoanalysis was culture-bound rather than universal, and that they ought to address a patient's present circumstances in order to understand his or her past rather than to begin by eliciting insights into this past.

By then, Karen Horney's books, (1937, 1939), as well as Erich Fromm's (1942) were introducing psychoanalytic concepts to a broad public—which was not all that interested in the theoretical disputes among psychoanalysts, but found their writings more accessible than the works of the "classical Freudians." In fact, Horney and Fromm were addressing social issues, and, though far from simplistic, were appealing to the American habit of believing in quick fixes, and to the native optimism about the malleability of human nature. But they were only the forerunners of what would become some of the "cultural" or "applied" psychoanalyses and psychotherapies which subsequently flooded the country. In other words, Freud's influence on the culture—whether appreciated or rejected—from then on became ubiquitous.

Still, the theories based on Freud's postulates in The Ego and the Id (1923b) would dominate the profession for a long time. The division into id, ego, and superego as structural components of psychic life converged with the American scientific bent, and with the language of medicine.

But other proliferations of psychoanalysis occurred via the social sciences. For instance, anthropologists such as Margaret Mead, Gregory Bateson, and Ruth Benedict, and psychoanalysts such as Sándor Radó and Abram Kardiner, in the Columbia University Institute for Psychoanalytic Training, were doing research on tribal societies; the Harvard sociologist Talcott Parsons postulated psychoanalysis as a mainstay of his social system, to incorporate the unconscious elements of human motivation into social institutions; and the political scientist Harold Laswell explored the behavior and ambitions of political figures in terms of their psychic make-up.

Like Freud, theémigrés were steeped in the classics. They were products of the Enlightenment, and they foresaw that the future of civilization would be dominated by discoveries science alone could further. But they also kept reading classical and contemporary literature in order to enrich their theories. And they explained human psychology—the typical patterns of mind being formed in response to early experiences that later guide behavior—via literature. They continued to attempt analyzing literary works in relation to the personalities of their authors, and to be particularly interested in having creative individuals on their couches. Therefore, they cooperated with literary scholars such as Lionel Trilling, and art critics such as Ernst Hans Gombrich and Clement Greenberg who, themselves, enriched the studies of literature, art, and criticism by responding to the challenges posed by psychoanalysis. They warmly welcomed psychoanalysts, and arranged meetings and symposia with them, thereby furthering the acceptance of psychoanalytic insights by the intelligentsia.

Because Freud's European disciples had come to psychoanalysis not only from medicine but from art (Erik Erikson and Ernst Kris), education (Anna Freud [1895-1982]), philosophy (Robert Waelder [1900-1967]), and literature (Henry Lowenfeld [1900-1985]), they were attuned to the preoccupations of American intellectuals. And the self-assurance they had gained from their work with Freud, as well as their range, helped propel them into the maelstrom of American intellectual life.

Heinz Hartmann, for instance, a central figure among the so-called "scientific ego psychologists," already in Vienna, had addressed questions of adaptation. Now, he investigated individuals' relations with and adaptation to reality as indicators of mental health which, he held, was emotional and biological. He maintained that "instinct" has a double meaning: the genetic relations between animal instinct and human drive, and between animal instinct and human ego-function. This brought him back to addressing cultural issues. Together with Ernst Kris and Rudolph Loewenstein (1946), he wrote the definitive paper summarizing the clinical theories Freudians had derived from their (recent) America-based research. These findings were syntheses on a highly abstract, theoretical plane. The general and cultural questions they were addressing, along with the clinical ones, would set the Freudians' extensive research agendas for the coming years. This acceptance in America, at least in part, is what made their work so appealing after the war, when they reconvened on the European continent, and why their theories were referred to as "American" psychoanalysis.

In 1947, David M. Levy, in New Fields of Psychoanalysis, delineated the astounding influence psychoanalysis had gained in every sphere. He noted that psychoanalytic terminology in child guidance, such as maternal overprotection, maternal rejection, etc., had become ubiquitous; that psychoanalysis could predict criminals' recidivism; and he outlined collaborations among psychoanalysts, social workers, educators, industrial and military psychiatrists. Clearly, Freud's disciples had become pillars of the American establishment. Inevitably, prestige and research moneys accrued to the profession.

Ego-psychology remained the leading theory well into the 1970s. By then, however, the members of groups outside the APA were increasingly discontent: they resented being peripheral. Their own successes with patients, and their work in hospitals, went nearly unrecognized outside the country. At home, they were analyzing psychologists and social workers who, sooner or later, formed associations and networks—which gave them a certain amount of clout. Belonging to the IPA would allow them, too, to mix and exchange information with European and Latin American colleagues, and to set up collaborative research projects. In 1985, this situation came to a head in a lawsuit by non-medical American Freudians—some of whose institutes have since then been accepted by the IPA and the APA.

Altogether, by the time Philip Reiff published The Triumph of the Therapeutic (1966), America had become the therapeutic society par excellence. But the patients who expected psychoanalysts to cure their neurotic symptoms, or their general malaise, were very different from Freud's repressed, hysterical ones. And the analyses by his many descendants were initiating more and more discussions about changing clinical pictures and problems, and possible solutions to them. Gradually, the clinical techniques based on the "structural theory" (the division of the personality into id, ego, and superego) were being questioned, and no longer seemed to be as efficacious as they had been before. And many people argued that psychoanalysis took too long and was too expensive.

By 1971, Heinz Kohut (1913-1981), a member of both the APA and the IPA, had been dissatisfied enough to have explored, and then moved, Freud's theories of narcissism to the center. He had noted that children tend to make up for the "unavoidable shortcomings" of maternal care, and the concomitant primary narcissism, either by evolving a grandiose and exhibitionist self-image, or by creating an idealized parental image. As the gleam in the mother's eye mirrors the child's exhibitionist display, he found, the child's self-esteem and grandiosity became inflated. This necessitated, he said, more empathic and demanding interactions with patients, rather than the classical analyst's technique of abstinence. His so-called self-psychology, which focuses on the interactions between mother and child, became more integrated into the classical Freudians' practices. Soon thereafter object-relations theory (based primarily on the relationship between mother and infant), which originally had been advanced by Melanie Klein (1882-1960), in London, was being furthered by Otto Kernberg.

Whether or not these approaches were due to changing symptomatology alone, or to the fact that the acceptance of psychoanalysis itself had made promises for cures it could not achieve, is a debatable issue. Certainly, contact with psychoanalysts from Europe and South America, and changing cultural trends, were playing their part as well. (In academic circles, beginning in departments of English and French, Lacanian psychoanalysis made large inroads.) But psychoanalysts, themselves (Kurzweil, 1989, 1995) were both products and shapers of their culture. In sum, in the United States psychoanalysis has evolved in line with cultural prerogatives and advances in psychoanalytic knowledge. What aspects of psychoanalysis are being stressed or denied keeps changing, and its first and second major waves undoubtedly will be followed by others. On the one hand, Freudian ideas are permeating American society, which, in turn, influences the practice of psychoanalysis itself. On the other hand, there has been a proliferation of therapies. But the popularization has encouraged simplifications and quick modes of treatment at the expense of analyzing the unconscious. Thereby, what Freud called the "gold of psychoanalysis," that is, the mining of the unconscious, has been lost. However, many of his contributions live on in the culture at large, and are applied by many social scientists, especially psychologists.

EDITH KURZWEIL Bibliography

   * Hale, Nathan G., Jr. (1971). Freud and the Americans: The beginnings of psychoanalysis in the United States, 1976-1917. New York: Oxford University Press.
   * Horney, Karen. (1939). New ways in psychoanalysis. New York: W. W. Norton.
   * Kurzweil, Edith. (1989). The Freudians: A comparative perspective. New Haven, CT: Yale University Press.
   * ——. (1995). Freudians and feminists. Boulder, CO: Westview.