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By Peter Fonagy
:$(&+$('! The situation within which psychoanalysis has to exist today has radically changed from the conditions which prevailed 30 or 40 years ago. There are two major aspects to this change: (a) there have been major advances in the basic sciences underpinning clinical work in the mental health field; (b) there has been a rapid development of relatively “effective” approaches to the treatment of many of the mental disorders which had previously been the unique purview of psychoanalytic clinicians. Under the first category, one could single out the biological revolution, particularly our increased understanding of brain function and under the second the cognitive revolution in psychology. This summary is divided into three parts. The first will review the current epistemic problems of psychoanalysis including some worrying indications of a fragmentation within the discipline. The second will consider an alternative epistemological approach, which, if adopted, might ultimately radically change the status of psychoanalysis as a discipline. The third section will consider some of the philosophical problems and difficulties which efficacy studies of psychoanalysis entail. We shall conclude that efficacy studies are necessary – but they are the right answer to the wrong question and as such are unlikely to yield entirely satisfactory results. ?4&!/-((&#.!&%*2.&0*/!%($X5&02!$,!%23/4$1#1532*2! 8%$6$6}!K#2(!7%$6$6n! We have become quite accustomed to worrying about the future of psychoanalysis. Mostly, when concerned about the future of our discipline, we tend to focus on the lack of psychoanalytic patients, lack of appropriate candidates, persistent and increasingly well-received critiques of psychoanalytic theory and practice, the strengthening of alternative therapeutic approaches (particularly biological psychiatry and cognitive-behaviour therapy). Perhaps even more worrying is the spawning of more or less psychoanalytically oriented psychotherapeutic approaches, often masquerading as psychoanalysis, which insidiously invade our practice. What I would like to focus on is far worse than any of these, and may even be responsible for some of our other problems - the knowledge base of psychoanalysis. ?4&!,(1Y0&#.1.*$#!$,!.4&!%23/4$1#153.*/!R#$+5&'Y&!X12&! "#0!8$(2($)*!;*&0c!6(B&4! My colleagues and I have reviewed the Social Science Citation Index (Fonagy, 1996). We were curious to explore how often the average article in the International Journal of Psychoanalysis and The Journal of the American Psychoanalytic Association is referred to in other major journals (medical and non-medical). Overall, the numbers are on the decline, even when adjusted for the tendency for more recent papers to be somewhat less frequently cited across the entire Citation Index. This means that the scientific impact of psychoanalysis upon other disciplines may be on the wane. This trend is even clearer when we look at the expected number of citations of all the articles selected from the first issue of the International Journal over the past decade. What is this apparent loss of interest due to? Is it that non-analysts (those publishing in psychiatric or literary studies journals) are less interested in what we write? When we looked at these journals, the trend indicating a decreasing
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