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A Critical History of
Psychotherapy, Volume 2

From the Mid-20th to the 21st Century

By Renato Foschi and

Marco Innamorati
First published in English 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2023 Renato Foschi and Marco Innamorati
The right of Renato Foschi and Marco Innamorati to be identified
as authors of this work has been asserted in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act
1988.
All rights reserved. No part of this book may be reprinted
or reproduced or utilised in any form or by any electronic,
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publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Published in Italian by Raffaello Cortina, Milano, 2020
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library
ISBN: 9781032169415 (hbk)
ISBN: 9781032172385 (pbk)
ISBN: 9781003252412 (ebk)
DOI: 10.4324/9781003252412
Typeset in Bembo
by Apex CoVantage, LLC
Contents

Editorial note for volume 2 vi

6 A middle earth:The 1950s 1

7 The outbreak of new treatment paradigms in the face of a

changing social climate 62

8 The 1970s and 1980s between social engagement and

individualism 113

9 From the past to the future 171

Index 228
Editorial note for volume 2

This is the second of two volumes that together make up a revised and edited
translation of Foschi, R. and Innamorati, M. (2020). Storia Critica della Psicotera-
pia, Raffaello Cortina Editore, Milano.
This work intends to be above all a history of “Western psychotherapy” that
critically discusses the way in which “traditionally” a movement composed of
technicians and scholars who emphasized the treatment of mental patholo-
gies developed, through means “à visée scientifque” that were not physical or
chemical but behavioral and based on communication. Because of the monop-
oly on physical or chemical therapies, Western medicine became the frst
domain from which psychotherapy of psychopathologies emancipated itself.
However, as we will see, discussing psychotherapy implies a broader discipli-
nary and even transdisciplinary horizon. Many of the scholars described were
in fact not doctors, and others freed themselves from their medical identity to
deal with psychotherapy.Therefore, we do not agree with a radical constructiv-
ism that considers psychotherapy a domain so full of aporias and ambiguities,
a mythical construction of self-celebration of Western psychotherapists, that
it is impossible to historicize. Although ours can be considered an attitude of
old-fashioned historians, we believe it is more useful to use classical distinc-
tions between a psychological and a neurological domain, but also between a
magical and a sociological domain in order to “critically” illuminate the path
that led to what is now considered psychotherapy. Psychoanalysis is treated
by us as a psychotherapy. Actually, most other psychotherapies either devel-
oped from psychoanalysis or used it as a point of reference, even if often a
negative one. However, if we saw psychotherapy with the eyes of an orthodox
psychoanalyst, but not of Freud himself, we could even exclude psychoanalysis
from the history of psychotherapy! In fact, orthodox psychoanalysts consider
psychoanalysis as a domain so different from psychotherapy that it should not
be subjected to the laws regulating the professional practice of psychotherapy.
In the same way, according to other categories we could reduce psychoanalysis
to a myth with little value for the history of psychotherapy, but also for the his-
tory of psychology itself. Psychotherapy then would still be a patchwork full of
different things from each other:Western, Eastern, esoteric, magical, initiatory
 Editorial note for volume 2 vii

notions, and so on. In all epistemological positions there is a grain of truth, but
this grain of truth considered in an absolute way does not help to critically
understand the history of Western psychotherapy because, willingly or unwill-
ingly, psychoanalysis has had a central role in the history of psychological tech-
niques for the treatment of psychopathologies. Psychoanalysis has also played
a central role in the history of Western ideas and culture.Therefore, this work
intends to present a brief excursus into the more distant past of psychopathol-
ogy therapies, but then especially the history of psychotherapy from the late
18th century to the 2000s.The Italian edition published by Raffaello Cortina
has been updated with some changes and additions. While the frst volume
ends with World War II, the second volume accompanies the reader from the
1950s to the third millennium.Well aware of being susceptible to criticism of
various kinds, we have accepted the challenge of a history of psychotherapy
that is neither merely an abstract critical exercise nor a mere celebration of
specifc professional techniques.
The authors discussed the contents of this volume in depth and appear
on the cover in alphabetical order. Specifcally, Renato Foschi dealt mainly
with external history, the history of science, the 19th-century period, behav-
ior therapies, early cognitivism, family and community therapy, hypnotherapy,
Gestalt theory and therapy, phenomenological therapies, relationships between
education and therapy, relationships between religion and psychotherapy, sex
therapies, attachment and psychotherapy, the relationship between psychiatry
and psychotherapy, and “crazy” therapies. Marco Innamorati dealt mainly with
internal history, ancient philosophy and medicine, the relationship between
science and philosophy, psychoanalysis, individual psychology, analytical psy-
chology, psychodynamic psychotherapies, cognitive psychotherapies, Dasein-
sanalyse, psychodrama, group psychotherapy, research, and psychotherapy. Both
have always tried to hybridize their point of view, each contributing to the
work of the other.This is, therefore, a book in which responsibilities are fully
shared.
Thanks are due to the colleagues and friends with whom the topics have
been discussed over the years: Giuseppe Allegri, Mario Ambrogi, Mauro
Antonelli, Saulo de Freitas Araujo,Antonello Armando, Bernd Bocian, Claudio
Buccolini, James H. Capshew, Vincenzo Caretti, Jacqueline Carroy, Elisabetta
Cicciola, Guido Cimino, Jean-Christophe Coffn, Daniele Cozzoli, Alejandro
Dagfal, Nino Dazzi, Alessandra De Coro, Giancarlo Dimaggio, Paolo Fabozzi,
Cristiana Facchinetti, Aude Fauvel, John Foot, Pier Francesco Galli, Nuccio
Gennaro, Christopher D. Green, Patrizia Guarnieri, Horst Gundlach, Ben
Harris, Suzanne Hollman, Costanza Jesurum, Ulrich Koch, Mauro La Forgia,
Chiara Latini, Marco Lauriola, Martin Liebscher,Vittorio Lingiardi, Giovanni
Pietro Lombardo, Sarah Marks, Pompeo Martelli, Jelena Martinovic, Luciano
Mecacci, David Meghnagi, Paolo Migone, Alfonso Montuori, Annette Mül-
berger, Annick Ohayon, Francesca Ortu, Cecilia Panti, Lorenzo Perilli, Wade
Pickren, Regine Plas,Tommaso Priviero, David K. Robinson, Rachel Rosner,
viii Editorial note for volume 2

Giovanni Maria Ruggiero, Mariano Ruperthuz Honorato, Massimo Saccà,

Diego Sarracino, Sonu Shamdasani, Chiara Simonelli, Maria Sinatra, Michael
M. Sokal, Akihito Suzuki, Renata Tambelli, Ruggero Taradel, Marco Tarantino,
Nadine Weidman, Robert H. Wozniak, and Phil Zimbardo. To all of them go
our apologies, if we were not able to use all their suggestions correctly.
6

A middle earth
The 1950s

Therapies during the Cold War

The 1950s can be considered a “middle ground” between the era of mass ide-
ologies and an age marked by great civil battles, at least in the West.The world
had come out of a war period in which human beings had shown their worst
side, planning and carrying out genocides, and producing and using without
scruple weapons so powerful as to threaten the existence of humanity itself.
A complete reconstruction was needed.
The period following World War II, however, was marked not only by the
reconstructive momentum but also by the Cold War.The opposition between
the Axis and the Allies was replaced by that between an “Atlantic” bloc, led by
the United States, and a “Soviet” bloc, led by the USSR.The subdivision had
been foreseen in the Yalta Conference (February 1945), which had established
the areas of infuence of the two so-called superpowers, even before the victory
over Germany and Japan. It was later sanctioned by the Atlantic Pact (1949)
and the Warsaw Pact (1955), which committed the nations belonging to the
two blocs to defensive military alliances.The Cold War never resulted in a real
military war, even when the USA and the USSR took sides with the two con-
tenders in local conficts – in particular in the Korean War (1950–1953) and the
Vietnam War (1955–1975). A wider war was made impossible by the so-called
MAD strategy. MAD was the ironic acronym for Mutual Assured Destruction:
the guaranteed effect of the use of atomic weapons by either blocs.The Cold
War was essentially fought through propaganda and a struggle between secret
services.The two blocs both tried to bring countries belonging to the oppos-
ing side into their orbit, offering an alternative model of state and develop-
ment, focusing from the West on greater freedom and from the East on greater
social equality (regardless of the reality).1 In the United States, the fght against
communist ideology was characterized in the 1950s by McCarthyism. Joseph
McCarthy (1908–1957), an ultra-conservative senator in the American Repub-
lican Party, went down in history for giving life to the fear that the communist
system supported by the Soviet Union could prevail over the liberal organiza-
tion of the West, and even threaten the United States. By the end of the 1940s,

DOI: 10.4324/9781003252412-6
2 A middle earth

McCarthy had set in motion a series of political-institutional initiatives aimed

at searching for subversive elements linked to the Soviet Union and commu-
nism within American society. McCarthy considered anyone who supported
ideas oriented to social criticism, expressed dissent, or who was the bearer of
progressive demands as a communist, even if they fully supported the Ameri-
can state structure.Thousands of people were persecuted, and just as many lost
their jobs. Anyone who supported new libertarian demands was considered a
dangerous opponent, an enemy of the state, a spy, or an ally of communism
(Schrecker, 1998). Many intellectuals, actors, artists, university professors, and
activists for the rights of women,African Americans, and homosexuals became
enmeshed in the McCarthyist inquisition.
The American ruling class of the 1950s was therefore characterized by a deep
conservatism. From the same historical and social context, however, came those
libertarian instances that until the 1980s were the only novelty of the political
scene, characterized by the bitter confrontation between two opposing world-
views.These instances were represented in the frst place by the so-called “beat
generation” in America (Jack Kerouac, J.D. Salinger, Lucien Carr, Allen Gins-
berg,William Burroughs, Gregory Corso, Neal Cassady, Lawrence Ferlinghetti,
and Norman Mailer) and later by politicians who fought for a different kind
of society and new rights: Martin Luther King (1929–1968), John F. Kennedy
(1917–1963), and Robert Kennedy (1925–1968) were the main opponents of
the authoritarian, sometimes called fascist, drift of McCarthyism.
Psychoanalysis and psychotherapy were also infuenced by the ideological
context of the Cold War. On the one hand, behavioral, psychophysiological,
and organicist theories and techniques were accepted in the Warsaw Pact coun-
tries, and in any case were in line with the political systems expressed in com-
munist countries (Marks & Savelli, 2015). On the other hand psychoanalysis
also underwent a process of desexualization and Christianization in the United
States and Europe in order to neutralize those libertarian elements that could
have destabilized Western society (see Herzog, 2015, 2017). In fact, the decen-
tralizing of the sexual libido in psychoanalysis had already begun with the ideas
of Adler and Jung, with object relations theories, and with the neo-Freudian
movement.The sociocultural context of the 1950s, however, helped to acceler-
ate this trend.
In the Soviet Union, forms of therapy based on Pavlovian conditioning2
replaced the initial Russian interest in the “psy” in psychoanalysis and psycho-
analytically inspired psychopedagogy during the Stalinist era. Many important
Russian psychologists, such as Aleksandr R. Lurija, had initial psychoanalytic
training. They abandoned it, however, because of the censorship imposed by
the Soviet regime against all so-called bourgeois psychologies, and even against
the autochthonous historical-cultural school of Vygotsky, characterized by a
clearly materialistic approach.3 The rediscovery of a cultural-historical psycho-
logical approach took place only with the end of Stalinism.The complex ideo-
logical context in which the psy sciences operated in the communist countries
 A middle earth 3

is described in a recent historiography of psychotherapy in the Warsaw Pact

countries.They used exclusively moral forms of treatment and suggestive, per-
suasive, work, behavioral, and group therapies, hybridized for the ideological
purposes of the communist culture proper to real socialism (Marks, 2018). It
must be remembered, however, that in the USSR, psychiatry, which subsumed
psychotherapy, also put itself at the service of the regime to diagnose political
opponents as mentally ill and subject them to a supposed cure. A diagnosis of
sluggish schizophrenia was applied to many such people in order to describe their
anti-Soviet convictions as presumed symptoms of a mental illness which, if
not yet evident, would undoubtedly later manifest itself with forid symptoms.
Internment in specifc institutions was explained as preventing danger to both
themselves and the state (Innamorati, 2021).
On the other hand, after World War II psychotherapy took root in American
institutions primarily as a tool that could be used to manage the trauma that the
war had caused in veterans.The psychoanalyst William Menninger (1899–1966)
was the chief of U.S. psychiatrists during the war and later distinguished himself
for his ability to manage psychological support for the troops. Together with
his brother Karl (1893–1990), he directed a clinic in Topeka (founded by their
father, Charles F. Menninger [1862–1953]), which was characterized by impec-
cable organization, the ability to accommodate large numbers of patients, and
a therapeutic effcacy that soon became legendary. In addition to psychiatrists,
American clinical psychologists had also been called upon to contribute frst to
the war and then to the postwar period, thereby gaining professional prestige
and increasingly differentiating themselves from psychiatrists (Capshew, 1999).
Between the 1940s and the 1950s there were changes in mental health ther-
apies that seemed revolutionary. Lobotomy was increasingly popular for the
control of mental symptoms. Walter Jackson Freeman II (1895–1972) was the
American psychiatrist most engaged in the widespread use of lobotomy in
the 1950s. Freeman is now well known in the history of psychiatry, he was a
thoroughly mainstream psychiatrist, and the grandson of one of the pioneers
of brain surgery, William Williams Keen Jr. (1837–1932). Freeman was con-
vinced that lobotomy was a panacea for mental illness in a period, between the
1940s and 1960s, conditioned by the impotence of asylum psychiatry for treat-
ing psychosis. Starting from classical surgery, he developed a minimally inva-
sive method that used an ice pick to reach the prefrontal cortex from the eye,
and thus lobotomize patients (transorbital lobotomy). Freeman became a sort
of maverick of lobotomy, and lobotomized thousands of adults and children
throughout the United States, often people who were demonstrating normal
developmental crises.The patient’s personality changed radically after the oper-
ation, from less severe cases in which the outcome was a fattening of affections
and an infantilization to patients who had to remain in institutions for the rest
of their lives because they were no longer self-suffcient (e.g., Rosemary Ken-
nedy, John F. Kennedy’s sister) (Dully & Fleming, 2008; El-Hai, 2007).As is well
known, electroconvulsive therapy (ECT) was the other important “therapy”
4 A middle earth

used extensively for psychosis throughout the twentieth century, and estab-
lished during the Cold War. It was created by Ugo Cerletti (1877–1963) and
Lucio Bini (1908–1964) in the 1930s, and despite having fewer side effects than
lobotomy, it was also limited in its use, as the neurological mechanisms were
not clear, and above all it was a therapeutic device that created a doctor-patient
relationship clearly based on power that could result in abuse. From the frst
half of the 1950s, chlorpromazine and reserpine represented psychiatry’s hope
of having drugs capable of controlling psychotic symptoms without the severe
side effects of lobotomy and the limitations of electroshock (Shorter, 1997).
The introduction of psychotropic drugs offered the possibility of controlling
the most severe symptoms of psychosis, and this period also saw the devel-
opment of the frst systematic attempts to treat psychosis with psychoanaly-
sis. Although Freud had created a psychological theory of psychosis, to which
other psychoanalysts contributed during the 20th century (e.g.,Abraham, Fed-
ern, Tausk, Klein, Bion, Fromm-Reichmann, Sullivan), he famously thought
it impossible to create a real therapeutic relationship with a psychotic patient
(Weiss, 2020). Psychoanalytic therapy for psychosis became an increasingly rel-
evant topic in the 1950s. Silvano Arieti (1914–1981) in the United States and
Gaetano Benedetti (1920–2013) in Europe were the most prominent schol-
ars in this feld. The psychoanalysis of psychosis attracted criticism from both
Freudian psychoanalysts and organicist psychiatrists, but also interest among the
innovators and pioneers of the psy sciences especially in the 1960s. The psy-
chotherapy of psychosis was also considered very useful in the search for new
intervention techniques that could be used in psychiatry. For example, theories
of psychoses by psychotherapists were useful in training all those young psy-
chiatrists who tried to dismantle asylums in the 1960s. Arieti became a very
well-known psychiatrist, and at the end of the 1900s, his books could be found
in the private libraries of any psychotherapist trained at the turn of the 1960s
and 1980s (see Arieti, 1955; Passione, 2020).
In Europe, the wide promotion of psychotherapy became an opportunity
for the modernization of medical facilities and institutions for mental health
care. The end of World War II and liberation from the Nazi-fascist nightmare
prompted some young psychiatrists and psychologists to redefne the mental
health sciences and their professional role. Some young people trained in psy-
choanalysis became promoters of institutional renewal. They saw psychology
as a new and fertile territory for modernizing old psychiatric cultures. The
innovators were often politicized doctors with psychological and psychoana-
lytic training.Two emblematic fgures in this sense were Daniel Lagache (1903–
1972) in France and Adriano Ossicini (1920–2019) in Italy. They were both
psychoanalysts and enthusiasts of Lewin’s social psychology. Both relaunched
the identity of the clinical psychologist as a new professional, equipped with a
method derived from psychoanalysis, but applied to the needs of reconstructing
postwar society. Lagache and Ossicini believed in a psychotherapy committed
to the service of society, and created new psychological services for children
 A middle earth 5

and adolescents, using a psychoanalytic approach. Both were also at the center
of complex institutional events involving psychoanalytic societies and academic
psychology. Lagache and Ossicini moved under the hostile eyes of the old psy-
chiatry, which saw the psychologist as subordinate to the physician, as a mere
assistant, an applier of mental tests, without the right to practice psychotherapy.
Actually, in countries such as France and Italy, non-doctors who practiced psy-
chotherapy risked being accused of abusing the medical profession. Lagache
and Ossicini believed that the clinical psychologist was instead supposed to
work autonomously from the psychiatrist, with a unifed body of knowledge
that had as its cornerstone the idea that psychology was an experimental and
applied discipline, rooted in the natural sciences, and also in the humanities
(Cimino & Foschi, 2017; Ohayon, 1999, 2008).4
Despite the emergence of these new themes in the United States, a psy-
choanalytic school, Ego psychology, which matched well with American prag-
matism, ruled with undisputed hegemony in the 1950s. As will be seen, Ego
psychoanalysts emphasized people’s adaptive strategies. The study of develop-
mental tasks and cognitive abilities in the management of drives became of cen-
tral importance. Object relations theory (later absorbed in the United States by
relational psychoanalysis) became widespread in England. The psychoanalytic
movement in general, however, came into line with the idea that it was neces-
sary to radically renew drive theory and arrive at a theoretical model that col-
laborated with general and developmental psychology.The new psychoanalysis,
while aimed at promoting satisfying affective relationships rather than exploita-
tive ones (Cushman, 2015), constituted a neutralization (if not, for some, a dis-
tortion) of the original Freudian model. Psychoanalysis retained the feature of
an instrument of social change in the hands of Freudomarxists, however. Some
exponents of the Frankfurt School were in fact among the major intellectu-
als of reference for the generation born in the economic boom resulting from
World War II (the baby boomers), which would spark the revolutionary 1968.
The “middle ground” of the 1950s, therefore, foreshadowed the subsequent
dynamics of the 1960s in which the international psychotherapeutic movement
was profoundly infuenced by the Western cultural context in a continuous
oscillation between progress and reactionary conservatism.

Object relations theories in the UK

The basic theoretical idea of the model of object relations (or relational/struc-
ture model) was that relationships with signifcant others were more important
than the simple satisfaction (or discharge) of drives, from the earliest stages
of a human being’s development (Greenberg & Mitchell, 1983). If, as a result
of this approach, Sullivan tended to abandon the Freudian concept of libido,
other authors tried, in different ways to revisit it.The idea of a “primary object
love” could be considered here (Balint, 1937/2018), its existence, according to
Michael Balint, did not invalidate the structure of Freudian theory. Balint was
6 A middle earth

convinced that someone’s relationship with their mother at the beginning of

their individual life was completely independent of the erogenous zones. The
wound caused by the end of the privileged relationship with the mother was,
in his opinion, the “basic fault” (Balint, 1968) from which people tried to free
themselves throughout life.
Above all, however, one must read the well-known and much-cited statement
by Ronald Fairbairn (1889–1964) as regards a radical rethinking of Freudian
metapsychology, according to which libido is a search for an object rather than
for pleasure (1952a). A different consideration of the role of the object with
respect to classical Freudian theory, however, came from “Hungarian roots”
(Rayner, 1991), meaning analysts such as the already mentioned Michael Balint,
his teacher Sándor Ferenczi and especially Melanie Klein. Several authors (the
so-called Independents of the British School) offered theoretical and clinical
contributions oriented to the model of object relations.
The history of a discipline can be written in different ways, especially if those
who write it assume a specifc theoretical perspective. Historical syntheses (par-
tial or overall) of psychoanalysis have generally been written by psychoanalysts.
Probably for this reason, Melanie Klein’s theory has been defned several times
as a theory of transition, so to speak, placing itself in a certain sense between the
classical Freudian model and the relational/structure model (e.g., Bacal & New-
man, 1990; Greenberg & Mitchell, 1983). Some have even considered Klein the
leader of object relations theory (Hughes, 1990).These positions are somewhat
tenable because, as we have seen, Klein retained Freud’s concepts of libido and
the death drive, while asserting that the life of the mind was constituted from
the beginning mainly by fantasies concerning objects. Ronald Fairbairn, a lead-
ing exponent of the relational/structure model, wrote:

The ground has already been prepared for such a development of thought
[i.e. in the direction of the model proposed by Fairbairn] by the work of
Melanie Klein; and indeed it is only in the light of her conception of inter-
nalized objects that a study of object-relationships can be expected to yield
any signifcant results for psychopathology.
(Fairbairn, 1943/1952c, p. 60)

Fairbairn, conversely, defned his own perspective as “an inevitable implica-

tion of the illuminating conception of internalized objects, which has been so
fruitfully developed by Melanie Klein” (Fairbairn, 1944/1952d, p. 82). How-
ever, to see Klein’s theory as a sort of provisional theory would be ungenerous
as well as inaccurate, because several authors can be considered direct pupils
and followers of Klein’s thought (Paula Heimann, Joan Riviere, Roger Money-
Kyrle, Donald Meltzer, and especially Wilfred Bion), maintaining the origi-
nal framework that emphasized the decisive role of fantasies and the internal
world with respect to environmental infuence. In the United States, however,
the object relations theory was born completely independently of Kleinian
 A middle earth 7

contributions, with Sullivan: if anything, a common root may be recognized

in the ideas of Ferenczi alone. In the United Kingdom, in any case, the object
relations theorists developed their conceptions in parallel with Klein, and often
in controversy with both Freudian and Kleinian thought.
The remainder of this chapter describes the theoretical paths of the two most
important analysts of the British School of Object Relations, namely Ronald
Fairbairn and Donald Winnicott. It is also worth mentioning a little-known
author, who should be acknowledged as a historical priority. Ian Suttie (1898–
1935) was responsible for the frst comprehensive examination of the link with
the object that went beyond the theory of drive and defense (Bacal & Newman,
1990).A contribution sent to the International Journal of Psycho-Analysis by Sut-
tie in 1923 was rejected by Ernest Jones, evidently because it was considered
too original in its intent to describe the human being as a social animal from
birth, and oriented to establishing relationships with signifcant others (Brome,
1982). Suttie developed his model in a book on the origins of love and hate
(Suttie, 1935), but this has waited more than 50 years to receive the attention it
deserves (Bacal, 1987), although only from a historiographic perspective.

Fairbairn: object dependence

Ronald Fairbairn is known for a book published in the 1950s (Fairbairn, 1952a)
that collected a series of contributions dating back to the frst half of the previ-
ous decade. In fact, his vocation as a psychotherapist dated back to 1915, when
he had the chance to visit a psychiatric hospital (Sutherland, 1989), and his sys-
tematic reading of Freud’s works began in the 1920s. Fairbairn approached psy-
choanalysis from a background built on both medical and philosophical studies.
His solid intellectual background included a thorough knowledge of irrational-
ist theories of the unconscious prior to Freud (Schopenhauer, Nietzsche, von
Hartmann), of empiricist and pragmatist philosophical psychology from Berke-
ley to James, and of classical German philosophy from Kant to Hegel (Fair-
bairn Birtles & Scharff, 1994). It could be said, therefore, that Fairbairn knew
at least as much about the epistemological assumptions of Freudism as Freud
did. In any case, his attitude toward psychoanalysis was characterized from the
beginning by a critical adherence. Five years after the publication of The Ego
and the Id (Freud, 1923/1961), Fairbairn held a seminar (in which he exposed
what he considered the irremediable faws of the drive/structure model) that
prefgured his defnitive positions: the idea of a mind divided into zones or
even entities with anthropomorphic features seemed inconsistent to him.The
conception of the id and libidos as reservoirs of energy seemed brainless, and he
saw irresolvable contradictions inherent in the relationship between ego, id, and
superego: there would be a confict between the ego and id, but also between
the ego and the superego, and also between the superego and the id (Fairbairn,
1928/1994a).The questions posed by the origin and role of the superego (par-
ticularly in its relationship with the ego ideal) and the nature of the libido were
8 A middle earth

further explored and dissected in two large contributions in the subsequent

years immediately following (Fairbairn, 1929/1994b, 1930/1994d).
The notes taken during his participation in the Oxford Psychoanalytic Con-
gress of 1929 give the impression of a Fairbairn who was very perplexed about
the characteristics of the psychoanalytic movement. Freud’s words, in such an
environment, seemed to constitute an unquestionable ipse dixit. The Interna-
tional Psychoanalytic Association was shrouded in secrecy and entry was by
initiation, analysis seemed to be considered a process of conversion intended
to lead a patient to salvation (Fairbairn, 1929/1994c). Fairbairn therefore kept
himself on the margins of the IPA and certainly showed little interest in inter-
vening in its political affairs: all his clinical activity took place in Edinburgh, in
relative isolation.
Fairbairn’s physical and political detachment, however, did not correspond
to a lack of theoretical ambitions. In the few but dense essays he published
from the 1940s onward, Fairbairn proposed a radical reform of psychoanalysis.
According to Fairbairn, “the point had now been reached at which, in the
interest of progress, the classic libido theory” was “to be transformed into a
theory of development based essentially on object-relationships.” Fairbairn did
not deny the reality of erogenous (“erotogenic”) zones but defned them as
“channels through which libido fows,” specifying that “a zone becomes eroto-
genic when libido fows through it”: in other words,“the ultimate goal of libido
is the object” (Fairbairn, 1941/1952b, p. 31).
A human being, at the beginning of their development, might go through an
oral phase because the mouth is the organ with which it is easier to enter into
a relationship with the object (in this case the mother), through the act of suck-
ing the maternal breast. In the same way, the genital phase would correspond to
the achieved potential to live a mature sexuality. However, Fairbairn wrote, “it
is not in virtue of the fact that the genital level has been reached that object-
relations are satisfactory. On the contrary, it is in virtue of the fact that satisfac-
tory object-relations have been established that true genital sexuality is attained
(p. 32). All psychosexual development would ultimately have to be reread as “a
process whereby infantile dependence upon the object gradually gives place to
mature dependence upon the object” (p. 34).
The importance of dependency was amply confrmed by Fairburn’s work as
a consultant psychiatrist at Carstairs Hospital, where he had occasion to visit
numerous soldiers suffering from “homesickness.” Just as his regular neurotic
patients seemed to be searching for their lost relationship with their parents,
the war-neurotic soldiers displayed a dependence on distant family (Hughes,
1990).
That libido was “primarily object-seeking (rather than pleasure-seeking as in
classical theory)” (Fairbairn, 1944/1952d, p. 82) meant in essence “that pleas-
ure is gained by the quality of the state of an ego-object relation – internal or
external – rather than in discharge of energy.” Similarly,“anxiety is reduced by
a change in object-relations rather than by any discharge of energy” (Rayner,
1991, p. 121).This change in the conception of libido implied the need to: (1)
 A middle earth 9

re-describe infantile development in terms of object relations, and more specif-

ically in terms of different forms of object dependence; (2) “it is to disturbances
in the object-relationships of the developing ego that we must look for the
ultimate origin of all psychopathological conditions” (Fairbairn, 1944/1952d,
p. 82).
The pattern of normal child development proposed by Fairbairn included:

I Stage of Infantile Dependence, characterized predominantly as an Atti-

tude of Taking

a Early Oral-Incorporating-Sucking or Rejecting (Pre-Ambivalent)

b Late Oral-Incorporating-Sucking or Biting (Ambivalent)

II Stage of Transition between Infantile Dependence and Mature

Dependence, or Stage of Quasi-Independence – Dichotomy and Exteri-
orization of the Incorporated Object.
III Stage of Mature Dependence, characterized predominantly by an
Attitude of Giving – Accepted and Rejected Objects Exteriorized.
(Fairbairn, 1941/1952b, p. 39)

Deviation from the norm was interpreted by Fairbairn essentially in terms

of an environmental defcit: the cause of several mental phenomena wrongly
considered normal by Klein or Freud. The internalization of the object was a
defensive maneuver originally adopted by the child against the original object
(the mother and her breast) when it became unsatisfactory (Fairbairn, 1963).
The reaction to the frustration and deprivation of the ego in its search for the
object was aggression (Fairbairn, 1941/1952b, 1944/1952d).The id, according
to Fairbairn, was a meaningless theoretical construction. Its initial properties
and functions being proper to the ego (1944/1952d). It was not the ego that
derived from the id: instead, it was the unconscious components of the person-
ality that were derived by repression from the ego, or rather from the central
ego, as Fairbairn (1944/1952d) preferred to call it.
If the primary motivational factor was object seeking, it would not be
unconscious conficts that would entangle a person in psychopathology but
rather fdelity to known object relations. By abandoning the known path, the
neurotic was convinced that they would be alone – a far worse alternative
than a bad, but still existing, relationship. This scheme, for example, clarifed
the origin of masochism much better than Freudian theory: it was easier to
understand masochistic pleasure as a function of the search for proximity to
someone sought-after but refusing than as a deviant landing place in the search
for libidinal discharge.
All this had profound consequences for the conception of analytical psycho-
therapy. Insight in itself was insuffcient to enable a cure: in order for the ana-
lyzand to renounce the old forms of bonding with the analyst, the transferential
bonds, they had to begin to believe in new, less limiting models of relationships