The Idea That Wouldn't Die

Gary Shteyngart has written three best-selling novels and been hailed by critics as one of today's most gifted young authors. But ask Shteyngart about his life a decade ago and he sums it up in two words: "major dysfunction."

 

Shteyngart was just 7 when his parents transplanted themselves from Leningrad (now St. Petersburg) to New York City. Theirs was the ever-better immigrant experience. Gary's was not. Quiet, frail, frequently bedridden with asthma, Shteyngart was sent to a Hebrew school where he was incessantly teased about his wardrobe (he had two shirts), his heavy accent, and his preference for Russian food. He had few friends, frequently worried about dying, and felt neither Russian nor American.

 

And so Shteyngart, still in his 20s, embarked on a course of psychoanalysis. Although he was often depressed, there were no specific symptoms he sought to address. "I felt that my entire personality needed to be entirely re-examined and, when necessary, changed," Shteyngart says. "Other forms of therapy do not explore and rewire the personality to the same extent."

What attracted Shteyngart to psychoanalysis is precisely what has for more than a century made it fodder for impassioned, and often ugly, debate.

It is time-intensive and prohibitively expensive. Its benefits are not easy to measure, particularly compared with those promised by more popular, contemporary methods of treatment like cognitive behavioral therapy (CBT). As a result, psychoanalysis has been dropped from the curriculum of many medical schools and is rarely covered by insurance plans. When it is taught and practiced, experts say, modern psychoanalysis, also called psychodynamic psychotherapy, often bears little resemblance to the treatment put forward by its founding father, Sigmund Freud.

But psychoanalysis is a profound exploration of human subjectivity—our inner world with all its memories and desires and impulses—and its relation to the external, objective world. And it is much more than a treatment. It's also a set of theories about the nature of human experience, its depth and complexity. "Analysis is the most elaborate and nuanced view of the mind that we have," Nobel-winning neuroscientist Eric Kandel recently told a meeting of the American Psychoana-lytic Association.

At its center is the belief that subjectivity matters, that regardless of how many millions of circuits science shows are carrying out the work of the brain without our awareness, we still experience a unified sense of self that gives our lives coherence and meaning. In this regard, experts argue, psychoanalysis, which celebrates its hundredth anniversary in America this year, is very much alive.

"Psychoanalysis reflects decades and decades of thinking about and pondering on the nature of the human mind," says Peter Fonagy, Freud chair in psychiatry at University College London and director of the London-based Anna Freud Center. "We've identified the core constructs within psychoanalysis as a theory"—the nature of consciousness, the role of early childhood in shaping understanding and behavior, the effect of unconscious processes on everyday life, to name a few—"and shown that they continue to advance our understanding of the human mind. In this sense, I think psychoanalysis is in the best shape it's ever been in."

Fonagy and other long-time psychoanalysts credit the staying power of psychoanalysis in part to a culture shift among their colleagues. For most of the 20th century, psychoanalysis became a guru science, driven by cults of personality around Freud and other dominant figures rather than by scientific investigation.

Many analysts were spinning out theories about the mind without gathering evidence to support them—say, the idea that all our thoughts and actions are driven by only two basic motives, sex and aggression—and doing little to disseminate them outside their own exclusive circles. One result was the creation of factions and intense infighting within them over details that had no currency in the wider world of psychiatry.

"There were prejudices built into psychoanalysis that really hurt it," says Mark Solms, head of neuropsychology at the University of Cape Town, South Africa, and a practicing psychoanalyst. "Many psychoanalysts felt they didn't want to reduce what they did to numbers, that their work was about the soul. So when other sciences were advancing with research, psychoanalysis didn't. They essentially shut their eyes and said 'we don't do that.' And that only reinforced the caricature" of a field that was old-fashioned, spoke largely to itself, and was obsessed with sex.