How psychoanalysts diagnose

The “Art of Loving” by Erich Fromm [wiki] [bio] was a best seller in humanist circles from the 50s to the 70s.

Jumping from a post at wood s lot, I found a thorough narrative about Erich Fromm posted by one of Fromm’s students and associates.

For instance, Fromm is describing psychoanalytic diagnosis at a 1963 class at the Mexican Institute:

The analyst should determine first, the symptoms, goals and pathology of the patient. What is the type and the degree of pathology, e.g. regressive symbiosis, narcissism, and/or destructiveness? Fromm advised that most conflicts presented by the patient are screens. The analyst cannot help the patient decide whether or not to get divorced or leave a job. These hide the deeper conflicts, which Fromm sometimes called the secret plot. An example is Ibsen’s Peer Gynt: the modern alienated man who claims he wants to be free and express himself but really wants to satisfy all his greedy impulses and then complains that he has no self, that he is nothing and nobody.

The prognosis is better if the patient’s goal is to achieve health in terms of increased capability for freedom and loving relationships, rather than getting help to solve a specific problem which may be merely a symptom of the failure to maintain the cover story.

Second, the analyst should determine the strength of the resistance. He suggested a test of telling the patient something which appears repressed, indicated by a slip of the tongue, a contradiction, or a dream. If there is a positive reaction, the prognosis is better. If there is anger or the patient doesn’t hear, the prognosis is very bad. Fromm considered a sense of humor the best indication of a positive prognosis. Lack of it was an indication of “grave narcissism”. Humor is the emotional side of reason, the emotional sense of reality. Fromm himself had a keen sense of humor with a taste for the sardonic. He loved good jokes.

Third, the capacity for insight is another indication of good or bad prognosis. The analyst should make small tests, such as “You complain about your wife. Perhaps you are afraid of her.” It is a bad sign if the patient either denies an interpretation too quickly or submissively agrees to everything the analyst suggests.

Fourth, what is the degree of vital energy? Is the patient capable of waking up? A person can be quite crazy, yet have the vitality essential for transformation.

At this time, Fromm was no longer claiming that neurotics were healthier than normal people. However, he did maintain that some patients with a severe psychopathology had a better prognosis than those with milder pathology. The key diagnostic factor was the patient’s creative potential or ability to struggle against the pathology.

Fifth, has the patient shown responsibility and activity during his or her life? Fromm contrasted obsessive responsibility with the ability to respond to challenges. If the patient always escapes with a magical, irresponsible flight, analysis is not impossible, but extremely difficult.

Sixth, is there a sense of integrity? This refers to the difference between a neurotic and psychopathic personality. Does the patient accept a truth once experienced? Or is there a quality of bad faith, wiggling away from inconvenient truths, a bad sign for prognosis.

Michael Maccoby says about his ally,

“Although he introduced many American intellectuals of the 40s and 50s to the relevance of psychoanalysis to understanding 20th century social pathology, typical intellectuals of today think of Fromm, if at all, as a critic of the mass consumer society.

A smaller number recognize the contribution he made in Escape from Freedom to understanding the psychic appeal of fascism, an understanding relevant to current events in Russia and the Balkans.

But relatively few appreciate his most valuable and original legacy: understanding human character in relation to society.”

Maccoby concludes:

“As a student of Fromm, I believe the task remains of integrating the analytic and the prophetic voices, the understanding of what is and what can be with a compelling vision of what ought to be in order to create a better life and a more humane world.”