Mind Over Matter

For two decades, psychoanalysts have held fast to their slow, deep exploration of the psyche, reaping only scorn from the science-driven psychiatrists at Washington University. Good thing they didn't listen.

It didn't help, note Wash. U. insiders, that Robins' Boston psychoanalyst, a pupil of Freud himself, misread the early atypical symptoms of multiple sclerosis as anxiety. It's said Robins' fury triggered a now-legendary series of studies emphasizing precise, standardized classification of psychiatric symptoms. Two like-minded colleagues, Dr. George Winokur and Dr. Samuel Guze, joined his quest, with Guze eventually succeeding Robins as department chair.

Brilliant, dispassionate and methodical, Guze had done a residency in internal medicine before his interest in psychosomatic disorders drew him into psychiatry. Affect, the messy emotions that drench individual therapy, was never his forte. When a Harvard psychiatrist guest-lectured about dream research and psychoanalysis, he jumped to his feet and yelled the Wash. U. question: "Where's the proof?" He would remain convinced until his death in July 2000 that "mental phenomena are based upon brain function. There isn't anything else there" (Dallas Morning News, July 21, 1999).

By 1980, the Wash. U. team had literally rewritten the profession's Diagnostic Standards Manual, dividing psychiatric disorders along two clean axes. The result neatly cleaved the major, biologically based mental illnesses from "social" and "personality" disorders. Insurers began to draw lines accordingly, stipulating what sorts of treatments, along what diagnostic axis, they would reimburse.

Lynne Moritz found psychoanalysis deeply satisfying, but year after year she watched it grow more suspect.
Lynne Moritz found psychoanalysis deeply satisfying, but year after year she watched it grow more suspect.

The medical model had won.

While Robins was weighing the brain, Moritz was girding herself to receive its secrets. "Your biggest worry is, are they going to lie down on the couch?" she admits, eyes twinkling. "Then you realize you don't have to be concerned about that. If somebody won't lie down, you're of course interested in why. But you can do analysis with people pacing defiantly, or with children, who won't lie down at all. A couch is simply a useful way to help people relax and turn inward, and it gets your own reactions out of the picture."

Her own couch was long and clean- lined, upholstered in a gray-and-cream windowpane plaid -- nothing like the curved-back, armless velvet chaise of popular imagination, accompanied by an aloof, goatee-stroking analyst whose own ego was unassailable. Americans grew angry at that mythical figure -- there were too many real-life analysts whose arrogance and vivid imaginations had ruined people's lives, and the culture as a whole had invested too much hope in Freud's shocking new mythos. "There was a kind of overselling of it," admits Moritz. "The expectations were far greater than what could be delivered." By the '80s, the country had lost interest in subterranean lusts and terrors -- why venture into dark dripping caverns where monsters lived if you could pop a pill or memorize new habits? Cast to the side, psychoanalysis began to revise itself into something humbler and warmer, open to multiple interpretations.

Moritz's own approach was instinctively warm, her reading of the dogma broader and more flexible than the original Freudians'. Still, she refused to throw out classical methods altogether. "Oral" and "anal" and "oedipal" stages were just one very useful way to diagram the complex evolution of a child's consciousness. And she was perfectly comfortable with the notion of penis envy -- not as the grounds of female sexuality (Freud was a little skewed by his own conditioning, she notes), but as an overall insight into the human condition. "It's something little girls have; it's something little boys have with their friends," Moritz says easily. "And little boys also have breast envy and pregnancy envy. We are all envious people, and what we don't have, we want."

She kept the basic schema, and she kept the tricks, too: the careful distance and reserve, the deliberate silences begging to be filled. "Psychoanalysis is always about the relationship, about a deeper and deeper knowing of each other," she says. "But for me there is a definite importance to not being known from the start in all your details. It gives the patient a chance to imagine you and relate to you the way they need you to be." The process, unprovable as id itself, is called "transference": It assumes that patients arrive with all the emotionally charged assumptions, desires and expectations of their past and project them onto the expressionless face of the analyst. "I've been Amazon sexual temptress, seductive mother, critical father -- patients go through a number of these as their treatment unfolds," she explains calmly. "Then, as it's no longer important, it's gradually given up, and they see you more and more realistically, as a struggling human just like them."

Her first patient was a woman in a baggy woolen shirt and pants who trembled with anxiety whenever her boss gave her an instruction. She'd been sexually abused by her grandfather, and now her husband was having affairs and flirting with their daughter in a way she was helpless even to acknowledge, let alone stop. The therapy lasted three years (a time frame most Wash. U. docs would find unconscionable), but the changes started within the first six months, as the woman realized the reasons for her own helplessness. "For most people, what happens is, their outside lives clear up and the symptoms come into your office," explains Moritz, adding that by the end of treatment the woman had divorced her husband, married someone healthier, become a stronger mother for her daughter and eased into what she continues to describe, in grateful Christmas cards, as a happy, regular life.

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