Save paper and follow @newyorker on Twitter Evan Osnos JANUARY 10, 2011 ISSUE Meet Dr. Freud Does psychoanalysis have a future in an authoritarian state? BY EVAN OSNOS Video consultations are popular, but some question whether China should bother with a therapy that the West has largely discarded. ANDRÉ CARRILHO lise Snyder fell in love with the world of Sigmund Freud at a public library in the Bronx when she was fourteen. At sixteen, sEhe went into analysis, against her parents’ wishes, paying for it with money that she earned babysitting. An hour of excavating the unconscious to her was like a string quartet, in which, as she put it recently, “one could hear all four instruments and all four melodies and how they fit together.” Snyder, who was born in 1934, grew up as a latchkey kid, and she enjoyed the independence. During school lunch hours, she walked home to eat and listen to soap operas on the radio: “Our Gal Sunday,” “The Romance of Helen Trent.” Her father, Harry Wechsler, had been a promising lawyer until he lost a race for a judgeship in 1933 and was left unemployed and depressed. Her mother, Dora, a bookkeeper, was barely five feet tall, with a regal voice that reminded people of Eleanor Roosevelt’s. Dora had always expected more out of life and had “no talent for happiness,” her daughter thought. Shortly after Elise discovered Freud, she contracted bulbospinal polio, which interfered with her breathing and paralyzed her left leg. Doctors advised her parents to send her to Warm Springs, Georgia, to recover, but Snyder refused, in the belief that “if I didn’t keep moving very quickly I would cave in.” She recovered, and graduated from high school at sixteen. (She had turned down Bronx Science because it did not require Latin.) She went to Queens College, and then to medical school at Columbia, where she earned money editing a manuscript by the anthropologist Géza Róheim about a trip to Australia— sponsored by the psychoanalyst Princess Marie Bonaparte—to determine if Aborigines had an Oedipus complex. (Róheim concluded that they did.) Judith Schachter, who was a medical resident a few years ahead of Snyder, recalls, “She was extremely beautiful” and “very, very, very smart,” adding, “And I know the difference between smart and very, very, very smart.” In her fourth year, Elise married a young professor of medicine named Arthur Snyder. She graduated in 1958, and received two presents: a sewing machine and the collected works of Sigmund Freud. She entered psychiatry at a time when the field was heavily influenced She entered psychiatry at a time when the field was heavily influenced by psychoanalysis. It was surging in popularity amid postwar opposition to totalitarianism and dissatisfaction with the overuse of organic treatments such as shock therapy and frontal lobotomies. Between 1940 and 1960, according to the historian Eli Zaretsky, the American Psychoanalytic Association expanded more than fivefold. A story on the cover of Newsweek in October, 1955, titled “The Mind: Science’s Search for a Guide to Sanity,” estimated that one in every seventeen Americans needed psychiatric care. That year, the president of the American Psychoanalytic Association, Ives Hendrick, told members that success had given analysis “unsought and unexpected powers.” Snyder built a busy practice in Manhattan that eventually included two forms of treatment: initially, she conducted psychoanalytic psychotherapy, in which patients came one, two, or three days a week and sat upright; later, she began conducting full Freudian analysis, in which patients visited four or five days a week and lay on the couch. When she was thirty, shortly after the birth of her second child, Snyder had a disturbing nightmare and arranged to visit one of her former analysts, Victor Rosen, a well-known figure who had been elected president of the American Psychoanalytic Association. Snyder later recalled of the visit, “I realize he’s not listening to me, and suddenly he jumps up and says, ‘I’m in love with you. I’ve been in love with you for the past two years.’ ” Romance with a patient, current or former, was taboo in analysis. But Snyder was unhappy in her marriage and was flattered by Rosen’s interest. “What a narcissistic gratification this is: here’s the person you talk to about your toilet training, and he says he’s in love with you,” she said. They left their spouses and married in 1965. Because of Rosen’s position, it was a full-blown scandal. Heinz Kohut, one of the patriarchs of analysis, warned that it “could weaken the position of our science.” It was the most notorious affair since Elaine May, the comedienne, had married her analyst, David Rubinfine, in 1963. (For a while, the two couples, estranged from peers, socialized with each other.) Roger Goettsche, an analyst in Clinton, Connecticut, said of Snyder, “She was both an insider—she married her analyst, who was president of the American Psychoanalytic; how much more insider can you be?—but an outsider, too, in that there was this taboo that had been somehow broken.” Rosen left a prestigious post at the New York Psychoanalytic Institute, and the couple moved to Connecticut. Snyder discovered that her new husband was addicted to Demerol. He quit, then relapsed, and the addiction worsened. He had become suicidal. After seven years of marriage, she told him that she was leaving. He went missing the next day. Police found him in his car in the woods, dead from an overdose of Demerol and barbiturates. Snyder was suddenly a widow with two children living in an old house in Connecticut. “I would get so lonely that I would drive around to the gas station and get a dollar’s worth of gas just to chat,” she said. Professionally, her reputation had suffered. Goettsche said, “For some, there was always this sense that she crossed a line, so I don’t think she was always treated with the regard that I think she should have been.” A veteran New York analyst told me recently that Rosen became a symbol of the perils of getting involved with a patient: “People would say, ‘Remember Victor Rosen.’ ” Other psychoanalysts responded, Snyder said, “as though I were the scarlet woman who had seduced their beloved Victor.” She added, “That I have stayed so committed to analysis is truly amazing.” Psychoanalysis, however, was falling out of step with the times. Bruno Bettelheim declared that antiwar demonstrators were simply acting out an Oedipal conflict. Hollywood, which had lionized analysts in the fifties, began depicting them as corrupt or pathetic. In Woody Allen’s “Manhattan” (1979), Diane Keaton’s analyst phones her at night to sob. Gloria Steinem wrote that Freud had inspired “modern psychiatry’s refreshing ability to ignore poverty, deprivation, power systems of sex, race or class.” Patients had new options: Miltown, America’s first minor tranquillizer, had cleared the way for a spate of new drugs, and cognitive behavioral therapy, or C.B.T., promised an average duration of just sixteen sessions, instead of years of awkward silences. Insurance companies and managed-care organizations favored the newer, less expensive approaches, and when they pushed psychoanalysis to produce empirical measurements of its effectiveness the profession was slow to respond. By 1997, nine million Americans were in therapy, but fewer than a million were in the long-term frequent treatment that Freud ordained. In 2010, one-third of the members of the American Psychoanalytic Association were over seventy years old, and its president, Dr. Warren Procci, said in the group’s newsletter, “There is an unavoidable message here, much as we do not want to hear it. We are in a decline.” But Snyder, who is now an associate clinical professor of psychiatry at Yale, never lost faith. She returned to a prominent role in the psychoanalytic community, in part through her dogged efforts to promote it. To rally the membership, she once printed hundreds of T- shirts bearing Freud’s portrait for analysts to wear during a road race in San Francisco. She held various offices in the association and, in years of debate over issues such as the requirements for membership and the selection of training analysts, she was a vocal, and polarizing, advocate for relying on a board that is elected, rather than appointed. On occasion, she compared her opponents to the Committee of Public Safety under Robespierre—or, worse, to a New York co-op board. “She just has that quality: people get agitated by her,” Schachter, a friend who is the treasurer of the American Psychoanalytic Association, said. In 1999, Snyder ran for the presidency of the association and lost. In In 1999, Snyder ran for the presidency of the association and lost. In 2001, she attended a literature conference in Beijing. She had been to China once before, as a tourist, but this time she sent e-mails around before she left to find out if the Chinese were studying analysis. She was referred to a group of professors, students, and others in the western city of Chengdu, who were studying psychoanalysis as a theory, not as a clinical practice. Freud was translated into Chinese as early as the nineteen-twenties; one scholar, Gao Juefu, had wondered if psychoanalysis might combat Chinese superstitions, though he found some of the sexual theories “preposterous.” Over the years, modernist writers such as Shen Congwen, Lu Xun, and Qian Zhongshu drew on Freud to express ideas about individuality, but his following was limited. In the eighties, before the crackdown at Tiananmen Square, an interest in psychoanalysis became a symbol of openness for a generation of élite college students, a fad known as Freud Fever.