Paul E. Stepansky, Ph.D.

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National Institute for the Psychotherapies Workshop, New York, NY, January 27, 2007

Clinical Writing: The Good, The Bad and The Ugly — Paul E. Stepansky, Ph.D.

Dr. Stepansky, the Managing Director of The Analytic Press since 1984, has had a career in psychoanalytic publishing that brought him into contact with the major analytic and psychiatric writers of the last three decades. As a personal editor of distinguished analysts such as Margaret Mahler, Heinz Kohut and Stephen Mitchell, he is intimately acquainted with the psychoanalytic canon and the nature of psychoanalytic writing and writers.

Drawing on this vast experience, Dr. Stepansky will illustrate how from Freud on, writing and publishing have occupied a special place in the being and becoming of analysts and psychotherapists. But he ponders the contradiction that the very people whose professional lives are given over to disciplined self-inquiry are rarely given to investigate why they need to write and what they can do to write better. In this workshop Dr. Stepansky will systematically explore these two questions.

Workshop participants will engage in considering the interrelated professional and personal reasons that writing and publishing matter so much to them. These reasons, Dr. Stepansky will show, provide a ground for understanding both how they write, and how well (or how poorly) they write. He will enlarge on participant reflections by considering the role of writing in the history of psychoanalysis. Writing and publishing in psychoanalysis and psychotherapy will be compared and contrasted with writing and publishing in academia and in medicine.

On the basis of these personal, historical, and disciplinary considerations, the workshop will proceed to examine the nature of clinical writing. Dr. Stepansky and the participants will explore this mode of professional communication in its conceptual, structural, and narrative aspects. As an aid to the process, Dr. Stepansky will make available to participants select writing samples from his personal files of the past quarter century.

About the Workshop Leader: Following training in European Intellectual History at Princeton (where he was a University Scholar in History and Psychoanalysis and recipient of the Walter Phelps Hall Prize in European History) and Yale (where he was the first Kanzer Foundation Fellow for Psychoanalytic Studies in the Humanities), Dr. Stepansky launched a career in psychoanalytic publishing. He has been Interdisciplinary Research Faculty, Institute for the History of Psychiatry, Weill Medical College of Cornell University since 1982. His own books include Freud, Surgery, and the Surgeons (1999); In Freud's Shadow: Adler in Context (1983); and A History of Aggression in Freud (1977).top

Psychoanalysis Division, American Psychological Association, Toronto, April 21, 2007

Panel: Theoretical Pluralism or Sectarian Isolation: The Current State of Psychoanalytic Theory

Uncommon Ground: Psychoanalytic Sects in Historical Perspective — Paul E. Stepansky, Ph.D.

Sectarianism has been intrinsic to psychoanalysis for more than a century. But it has intensified over the past quarter century, as psychoanalytic thinking has evolved along a series of parallel tracks, no one of which speaks for, or even commands the attention of, the profession at large. Evolutionary advance, it is argued, has become understandable only within intradisciplinary paradigms, the proponents of which increasingly speak different languages and make partly incommensurable claims about what psychoanalysis is and how and why it purportedly works. What Robert Wallerstein terms the "common ground" linking all psychoanalysts has not been able to mute particularized commitments and their economically consequential sequelae. To the extent that common ground exists, it remains tacit knowledge that has not translated into the kind of public, codifiable, and publishable knowledge that sustains a coherent idea of progress. Collapsing sales of psychoanalytic books over the past two decades is merely one symptom of the field's fractionation into a congeries of isolated sub-communities.

This presentation explores psychoanalytic sectarianism in terms of philosophy of science and history of medicine. Difficulties in promoting dialogue among psychoanalysts of different theoretical persuasions are examined in terms of:

1. The paradigmatic incommensurability of different psychoanalytic schools of thought (as per Kuhn, Feyerabend, and Lakatos). Examples of this incommensurability are found in the different baseline “facts” accepted by analysts of different schools.
2. The social-structural entrenchment of the various psychoanalytic schools, which entails particularized institutional commitments that are financially consequential.
3. The field's troubling embrace of “theoretical pluralism” as an epistemically viable solution to the existence of rival grand theories. In science, it is argued, “pluralism” is not a conceptual resting place that can be theoretically grounded. Tolerance of a plurality of grand theories — which is what “theoretical pluralism” actually denotes — is a temporary way station in the early history of sciences-in-the-making. Examples of 19th-century medical advances that overcame a plurality of theories illustrate how maturing sciences overcome theoretical pluralism and achieve disciplinary integrity. Analysts have much to learn from the development of “scientific medicine” as they go about promoting dialogue among proponents of different psychoanalytic schools of thought.top

Rapaport-Klein Study Group, Austen Riggs Center, Stockbridge, MA, June 10, 2007

The Rise and Fall of Psychoanalytic Publishing in America — Paul E. Stepansky, Ph.D.

Drawing on his personal experience as Managing Director of The Analytic Press (1984-2006) and on sales data of psychoanalytic books published over a 65-year period by trade publishers, university presses, and mental health firms, Stepansky charts the history of psychoanalytic book publishing decade by decade, highlighting major books, subject areas of emerging and declining professional interest, and sales trends across the American market. He begins by surveying psychoanalytic book publishing in the three decades that followed World War II, which he terms the “glory era” of psychoanalytic book publishing. Between 1945 and 1975, psychoanalysis not only dominated American psychiatry but was also de rigueur in mainstream American culture. Prominent analysts such as Erich Fromm, Erik Erikson, Karl Menninger, and Karen Horney became successful trade authors whose accessible books appealed to hundreds of thousands, and in the case of Fromm and Menninger, to millions, of social scientists, historians, college students, mental health professionals, and educated lay readers.

Stepansky then examines the sea change that began in the late 70s, when psychoanalysis lost its foothold in psychiatry and its central role in cultural life and higher education. The erosion of sales of psychoanalytic books was temporarily halted by the popularity of relational and interpersonal books from the mid-80s to the mid- 90s but thereafter resumed a fateful course that has brought psychoanalytic book publishing to the brink of extinction. Stepansky is especially attentive to the relationship of declining psychoanalytic books sales over the past quarter century to the increasing fractionation of American psychoanalysis into rival schools of thought. As a publisher of psychoanalytic books over a 28-year period, he witnessed first-hand the decline of “general interest” psychoanalytic books and the ascendancy of subspecialized books targeted to one or another psychoanalytic school of thought. The “fall” of psychoanalytic book publishing represents a synergism more than a quarter century in the making. Over the same period as the market for psychoanalytic books in toto significantly contracted, the American psychoanalytic profession lost disciplinary cohesiveness and splintered into rival Freudian, interpersonal, relational, self-psychological, infancy research-oriented, and neuroscientific subgroups. Whereas major psychoanalytic books published during the glory era could speak to the entire American psychoanalytic profession, books published from the 90s on, with rare exceptions, speak to proponents of one or another psychoanalytic school of thought.top

Richardson History of Psychiatry Research Seminar, Institute for the History of Psychiatry, Weill Medical College of Cornell University, New York, NY, October 3, 2007

Humanitas: Nineteenth-Century Physicians and the Classics

Contrary to conventional wisdom, which correlates declining interest in the classics to the growth of scientific medicine in the late 19th century, Stepansky holds that the inspiration provided by the ancients was a guiding thread in the lives of those great pioneers who dragged medicine into the realm of scientific “doctoring” in the late-19th and early-20th centuries. Throughout the 19th century, a thorough grounding in Latin and Greek was not only a sine qua non of rigorous medical study; it also signified the kind of literacy that permitted a holistic grasp of human suffering. Canvassing a wide range of biographical and autobiographical literature from Europe and America, Stepansky highlights the importance of classical knowledge, especially proficiency in Latin, among 19th-century exemplars such as Claude Bernard, Samuel Gross, Robert Koch, René Laennec, Joseph Lister, James Paget, and Mary Jacobi Putnam. The founding fathers of Johns Hopkins Medical School, the first modern medical school in the United States, were outstanding Latinists one and all. The classical grounding of William Welch, William Osler, Howard Kelly, and Harvey Cushing, Stepansky holds, was not only consistent with their scientific aspirations but tightly wed to their identities as medical educators. When, in 1890, Welch and Osler founded the Johns Hopkins Hospital Historical Club, it was with the explicit understanding that knowledge of the ancient sources, including the Hippocratic writings on medicine, hygiene, surgery, and gynecology, were essential building blocks in the formation of a medical identity.

Stepansky links the declining role of Latin in premedical education after the second decade of the 20th century to the revolution in medical diagnosis and treatment that commenced around 1890. In the intersection of hospital-based procedure and medical specialization, he finds the locus of the devaluation of classical knowledge. The economic and cultural restructuring of medical practice effected by specialization “dramatically altered the socialization experience of physicians-in-the-making and the emergent sensibility that informed their specialty practices.” In our own time, when medical care-giving has grown subservient to the agendas of medical subspecialists, insurers, and managed-care administrators, the classics still commend themselves as a conduit to a healing sensibility that transcends instrumentation, procedure, and technique. In the 19th century, classical learning underwrote the physician’s epistemic and moral obligation to understand people who happened to be ill. What, if anything, has taken its place?top

Psychoanalysis Division, American Psychological Association, New York, April 9, 2008

Workshop Leader: Why Do Analysts Write?

Paul E. Stepansky, Ph.D., Managing Director of The Analytic Press (1984-2006) and personal editor to leading analysts of several generations, Heinz Kohut, Margaret Mahler, John Gedo, Merton Gill, and Stephen Mitchell, among them, will guide the workshop participants in considering the interrelated professional and personal reasons that writing and publishing matter so much to psychoanalysts. These reasons, he will show, provide a ground for understanding both how analysts write, and how well (or how poorly) they write. Dr. Stepansky will enlarge on participant reflections by considering the role of writing in the history of psychoanalysis and by comparing and contrasting the role of writing in psychoanalysis and psychotherapy with its role in academia and in medicine.top