Dr. Daniel Irving, a psychoanalyst in upper Northwest Washington, scared off his first patient. She was a school teacher in her mid-20s, and by the glacial time clock of psychoanalysis the doctor barely had begun treating her. She was only three months into her analysis when Irving jumped the gun.
"I interpreted to her that she had penis envy, and I said this much sooner than she was prepared to hear it. So she got indignant, you know: 'Who the hell are you to tell me I have penis envy? That's a male chauvinist concept. I'm not going to lie here and take that.' She quit."
Irving (as he will be called in this story) was painfully insecure when he blurted "penis envy" to the school teacher. Then in his early 30s, he felt he was wasting a patient's time if he didn't spew out the Freudian lingo he was learning in his analytic training. He wasn't sure whether the mysterious, labyrinthine process called psychoanalysis could "cure" anyone. Most disturbingly, he remembers: "I always had this question, you know: Do I know what I am doing?"
Since the school teacher walked out more than a decade ago, Irving says he has told scores of female patients that they have penis envy and none has walked out on him. He's told male patients who are horrified by homosexuality that they secretly want to have sex with him. They don't walk out, either. Irving says he has learned to gauge when a patient is ready for the insights of psychoanalysis -- insights the doctor realizes can be unsavory, insulting, meaningless and even laughable when taken out of context. In the case of the school teacher. Irving now says all he needed was more patience and better timing. "It would have taken a long time of her relaxing her defenses to really experience, to really feel just how much penis envy she has."
Irving, who is married and has teenage children, no longer has many doubts about psychoanalysis or himself. He is a respected and active member in one of Washington's two psychoanalytic societies. He receives patient referrals from some of the city's best-known psychoanalysts. He has seven patients in long-term analysis: a high-level business executive, two government lawyers, an editor with a large publishing firm, a newspaper reporter and two mid-level bureaucrats. They come four times a week to lie on a Queen Anne-style couch in an office tucked away in a mid-rise apartment building near Connecticut Avenue. They keep coming, on the average, for about four years.
Irving also has five patients in analytically oriented psychotherapy. They come between one and three times a week and sit in a chair. A 50-minute hour with Irving, whether lying down or sitting up, costs $ 60. The doctor's analytic patients, six of whom have mental health insurance, pay an average $ 11,520 a year each. Irving makes $ 100,000 a year.
The doctor's professional success has given him an abiding faith in analysis. He is convinced it works better than any other "talk" therapy in digging out and curing certain deep-seated psychological misery. His faith remains unshaken despite storms of criticism that have, in recent years, dislodged classical Freudian psychoanalysis as the dominant clinical influence in American psychiatry.
Irving believes that highly publicized attacks on the cost, utility and inhuman coldness of analysis have been ill-informed and unfair. Yet, he blames himself and his colleagues for failure to fight back in public forums, for remaining so aloof.
That's one of the reasons Daniel Irving agreed, with the promise that he be given a pseudonym, to talk about himself, his patients and his much-maligned profession in a series of extended interviews.
Irving, himself, has analyzed some of his other reasons for talking: "On the most infantile level, I'm probably just showing off... This is a very isolating profession. You talk to patients all day and that isn't talking. I sit all day. That's why I wanted to do this. I get to talk about myself." He also said: "Times are getting tough. During the '50s, analysis was a big deal. It was prestigious to say you'd been analyzed. Now, with the competing therapies -- all this holistic stuff, the social workers, the psychologists and also in Washington there are a hell of a lot of psychiatrists -- it is harder to get an analytic patient."
Irving is frightened by this story, afraid that he will be identified within the somewhat inbred community of 235 practicing psychoanalysts in Washington. The psychoanalysts, as part of their training, are analyzed by each other. "Everybody has been analyzed by somebody else. Nothing is too private, you know," Irving says. After two meetings, Irving called me last summer and tried to back out of any further interviews. He said that talking to me made him feel "just like a patient" and that he found it difficult to overcome his fear and defensiveness. I agreed not to disclose his precise age, the precise number of years he has worked in Washington and to omit certain inconsequential details, such as the color of his psychiatric couch. Otherwise, nothing in this story has been altered.
My first office appointment with Irving was on a warm mid-July morning. I arrived early and sat alone in a narrow windowless waiting room on the same uncomfortable sofa where all Irving's patients sit until the doctor opens the door to the inner chamber. The waiting room is dimly lighted and painted a soothing brown. It has an oriental rug, four framed and numbered abstract prints and an end table covered with recent copies of the New Yorker and Smithsonian magazines. Across the room, a radio tuned to a classical music station plays a sonata by Grieg.
Like many psychiatrists, Irving has an exceptionally low business overhead. He has no secretary. He pays less than $ 500 a month for his office, a parking space and an answering service. Other than the traditional psychiatric couch, Irving has no special medical equipment. His malpractice insurance, as a psychoanalyst, is just $ 1,000 a year, the lowest of any medical specialty. Obstetrician-gynecologists, who have the highest malpractice insurance, pay eight times more.
At precisely 10 a.m., the hour of our appointment, the door to the inner office opened and a patient, who appeared intent on avoiding any eye contact with me, walked out. A few seconds later, Irving emerged. He is a handsome man in his mid-40s with straight brown hair and a trim, athletic build. Unlike many psychiatrists, he does not dress as though he keeps his clothes on his closet floor.
Despite the heat, he wore a neatly tailored blue blazer, a white shirt with fine red and white stripes, a striped red tie cinched close to his neck, tan slacks and black loafers. Irving limply shook my hand and admitted me to the inner chamber.
"Most of my patients notice how this office is too neat, too perfectly arranged. It's me," Irving said at one point in our interviews. The office, remarkable only in its tidiness, has a small walnut desk, four upholstered chairs, an expensive-looking oriental rug and a large bookcase filled with psychiatric journals and books, most prominently James Strachey's translation of the 24-volume "Standard Edition of the Complete Psychological Works of Sigmund Freud."
Irving, who seemed extremely nervous to be talking to me, sat in a frumpy, soiled and badly worn overstuffed chair located just behind the head of the Queen Anne-style couch. He sits in that same chair eight or nine hours each working day. As he later told me, he has given that chair considerable thought. "I don't quite like that chair.I don't know why. Do you like it? It is not good looking. There is something wrong with it. It doesn't quite fit in with the rest of the room. I hate to spend the money [to replace it]."
It didn't take long to discover that Irving gives considerable thought to virtually everything. Freud developed the concept of psychic determinism, that human beings say and do everything for specific, although frequently unconscious, reasons.
Irving embraces psychic determinism.He is a man with a most unflinching, agonizing bent for digging up and brooding over his own motivations. Irving says, for example, that he is materialistic. He derives immense pleasure from owning a stylish wardrobe, fine works of art (he owns several pieces valued at more than $ 10,000) and a $ 300,000 house in suburban Maryland.
"I like nice things, material things. I don't know why. Well, I do know why. Because my mother was a beautiful thing. And all these things are like having her and wanting to touch her. It's her body. All these things that I like are her body. That's the psychoanalytic reason, which may sound crazy to you or to anybody else."
Irving, in another of his candid pronouncements, also told me how he feels about treating disadvantaged, uneducated people:
"I hate to say this, but I don't like to work with poor people. Culture has a lot of relevance here. They [poor people] are talking about stuff that doesn't interest me particularly. They are the kind of people who don't interest me. I can't help it. I'm not a nice guy, taking care and loving the poor. I don't like poor people. It's not that I wouldn't want to help out [he laughed, apparently embarrassed]. I don't do it. I wouldn't want to spend my day treating people like that because they are inarticulate. I suppose it I were a really good scientist I wouldn't mind. This is going to make me look bad."
Dredging up his character weaknesses and impolitic prejudices is clearly unpleasant work for Irving. He does it, he said, because as a psychoanalyst he has no choice. He feels that unless he understands himself completely, in all his frailty and pettiness and bile, he cannot help his patients.
As Irving describes it, his tidy, quiet office is transformed by the mysterious processes of psychoanalysis into a kind of emotional jungle where none of the normal rules of social discourse, good taste and common decency apply.
While Irving sits passively in his chair, analytic patients slip into what Freud called the "transference," in which they project onto the analyst their intense emotional attachments to key people out of their past. For his patients in the transference, Irving can become a beloved mother, a feared father, the object of wild sexual desire or the butt of ridicule and hatred. All of this, obviously, is not easy to put up with.
So Irving must, first of all, be careful in his selection of patients. A rule of thumb in analysis is that patients must be sick enough to need the treatment and healthy enough to endure it. Like all psychoanalysts, Irving chooses patients he believes are suffering from neurotic conflicts that have roots in childhood, who are verbal and who are not so crazy that they will slide irretrievably into a transference psychosis, sexually assaulting or pummeling Irving in the belief that he is an incarnate figure out of their past.
"If some guy comes in talking about how the FBI is out to get him, I don't recommend analysis. I'd recommend some other kind of therapy. I would be in big trouble if I accepted him in analysis because it wouldn't work, and I would have nothing but headaches," Irving said. "Analysis is a powerful tool for helping someone, or, if it is the wrong patient, for hurting them. My patients may whimper and cry on the couch, but they have the strength to get up, walk out and go back to their jobs."
Most of Irving's analytic patients, consequently, are professional people who have the appropriate temperament (and income or insurance) for treatment. Irving sees almost no "poor people" for analysis, either because they are too mentally ill, too unsophisticated or too poor.
Even with careful screening of patients, Irving's office, during the transference, still can be an emotional snakepit. Irving says he gets awfully stirred up while his patients lie on the couch and talk, according to the Freudian prescription, about "whatever comes to mind." The talk occasionally seduces Irving into wanting to have sex with some patients, beat the stuffing out of others or, more often, fall asleep. None of his desires, for a Freudian like Irving, is accidental.
"My job is to convert these raw emotions inside myself to a higher purpose of understanding. I have to figure why I'm feeling a certain way and from that infer what the patient is doing and why he's doing that," Irving said in one interview. To elaborate on the ideal of the analyst as a sort of finely tuned, well-integrated human apparatus that uses everything from an erection to a sneeze as an analytic clue, Irving jumped up from his chair, as he frequently did, and went to his bookcase for a salient quote.
He directed me to an article by Dr. Jacob A. Arlow in the Journal of the American Psychoanalytic Association entitled "The Genesis of Interpretation." Among the less opaque sentences that Irving, a compulsive underliner, had underlined was this: "If the analyst finds himself responding to the patient with feelings of sexual excitement, anger, depression, frustration, impotence, and confusion, he must always raise in his own mind the possibility that these feelings are what the patient consciously or unconsciously intended for him to experience."
Irving's excruciating honesty about himself, he claims, allows him to survive the analytic process without ignorantly mixing his own neurotic problems (compulsive neatness, compulsive formality, an inability to relax) with the emotions that he receives from his patients as part of the transference. When Irving was new at analysis, he told me he had a much harder time keeping his "unanalyzed feelings" separate from his patients' problems.
"This happened to be a successful case, but in the beginning this patient [an attractive 30-year-old woman who is a successful painter] always provoked me by ignoring whatever I said. I would make what I thought was a perfect interpretation, and she would acknowledge what I said but go on as if it made no difference to her.
"So what I did was I got angry. The way my anger came out was to make more and more brilliant, complicated interpretations. Or hit her over the head with a barrage of interpretations. I might say something five times in five ways, each way being more 'brilliant' than the last.
"She drove me crazy. I couldn't stand her. How would you feel? I was doing the best of my professional ability and she's telling me it stinks. There were times when I really did not look forward to seeing her.
"Since she wasn't paying attention to what I was saying, I would give her even more profound interpretations much sooner than they were called for in hopes that something would make an impression on her. I told her she wanted to bite her mother's breasts off [he said this because the woman resented her mother and felt competitive with her]. I said that sort of for shock value, to get her to pay attention to me. But she did what she always did. She said, 'Ah, interesting,' and then she went on talking.
"What I didn't realize was the thing for me to do was not to give her all these brilliant interpretations, but find out why she was ignoring me. On one level her intent was to learn about herself, that's why she came into analysis. But her transference was to prove that all my knowledge wasn't really much. I think she always had the impression from her relations with her parents that the woman was inferior. Her father didn't have time for her. What went on in the back of her mind is that men are better than she is. Her whole life was designed to get even, to tear men down.
"Here I was a man who was trying to help her. Her conscious wish was that she wanted my help and she'd be glad to hear all my brilliant interpretations. Unconsciously, she wanted to prove that I was worthless, that I was nothing and destroy me. She was successful for a long time [the analysis lasted five times a week for six years]. Instead of me trying to find out why she was doing this, I was too busy trying to defend myself from being made to feel like a jerk."
Irving didn't expect psychiatry to be such an exasperating, emotionally draining profession. He said he was interested in it because, more than any other medical specialty, he felt suited for the work. "I am basically passive, in that I don't mind sitting back and letting the action unfold. I don't have to be running in there and intervening and giving a shot of penicillin."
Irving grew up on the East Coast. His father is a lawyer, his mother is a housewife. A bookish teen-ager interested in art, music and literature, he majored in premedical studies in college and attended one of the nation's prestigious Ivy League medical schools. After four years in medical school, he interned for one year at a well-known hospital in the West and did his three-year residency back on the East Coast at a similarly prestigious hospital. In the '60s, Irving came to Washington to finish off his 18-year marathon of higher education. He attended one of the two psychoanalytic institutes here.
As part of his analytic training, Irving went to night classes for six years and took on four analytic patients under the supervision of a senior psychoanalyst. At the same time he underwent his own analysis. Irving estimates the cost of his Washington training at $ 60,000, most of which went to pay his "training analyst." The current estimated cost of analytic training here is more than $ 100,000.
Irving paid for his analytic education with the earnings from a fledgling practice he began when he moved to Washington. The practice included part-time work at one of the city's mental-health institutions, which primarily serve the inner-city poor.He "hated" the work and quit as soon as he had enough private patients to pay his bills.
When Irving began at the analytic institute, he said he felt like he was a B-plus intellect and hoped that his own analysis would make him an A.
"I found out when I got out of analysis that I'm not ever going to be an A. I settled for what I am [a B-plus]," Irving said during an interview on a warm morning in late July. Although the air conditioning in his office wasn't working well that day, he still wore a sports jacket and the top button of his Brooks Brothers shirt was buttoned. One of the things Irving learned about himself in his five-day-a-week, six-year analysis is that he is "very conventional. I guess I'm a little bit of a formal guy. This is my business here."
During an extended monologue, Irving explained what he gained from his own analysis. He became a believer in the tenets of Freudian psychology. He said he is convinced that human beings, like all animals, are motivated primarily by sex and aggression, and that these drives work, for the most part, on an unconscious level. Irving also believes that the only way to cure the emotional problems of his analytic patients is to direct their conscious attention, through a long and tortuous "regression," to their instinctual drives and their infantile sexuality -- the culmination of which is the Oedipal drama.
Freud believed that little boys at the age of 4 or 5 want to make love to their mother. Little girls, angry that they lack a penis and on the prowl for a substitute, want to make love to their father. These wishes, Freud said, are ultimately frustrated by parental authority and the reality of being a child. It's the fallout from that Oedipal frustration, in all its particularity, that Freud (and Irving) believed provides the key to understanding many adult emotional problems.
Not all psychoanalysts agree on the pivotal importance of the Oedipal complex or that it even exists. Many, if not most, analysts recently have concentrated on pre-Oedipal infant experiences as the key to unlocking personality disorders. But Irving has kep the faith, saying that his analysis and clinical experience have taught him to zero in on the Oedipal experience.
"I learned in my analysis that a lot of my [aggressive] behavior was because of feeling guilty about my childhood. It is the classical stuff, really. I realized I wanted my father to go away and never come back, just totally get rid of him. He was getting in my way for my mother's affections.
"As my analysis went on, rivalry and antagonism toward my analyst started getting stronger and stronger. At the same time, my feeling for my analyst was that he was great, he knew everything. That's how I learned what is so difficult for a patient to believe -- that his attitude toward the analyst is from childhood. My attitude toward my analyst was the same as it was toward my father. I was terribly envious of my analyst. I wanted to trip him up, to prove that he wasn't so smart.
"You see, the great admiration was a defense for my hostility at his being better than I am, for being more experienced. I often felt I wasn't doing as well with my own patients as he was doing with me. He could have his way with patients. He knew what he was doing. The translation is that my father could have his way with my mother and I couldn't.
"I could have a lot of my mother's affection, but, uh, not all of it. I had to go to bed when they told me to, and they retired to their room and had some kind of intimacy that I was shut out of. The hooker in all this -- this is where my guilt comes in -- there were times when I was a child where I felt I was better than my father. I stole my mother away, at least I thought she was paying more attention to me than to him. The reason I felt guilty is because I loved my father, too."
Irving says he learned his Oedipal guilt had made him alternately submissive and, in a defensive reaction, arrogant with his parents and others in authority.
"It is all very convoluted. This is the crazy part of the unconscious mind. There are different layers so that one defense brings up another. But the point is that it all has meaning. I was arrogant for a reason."
Until Irving went into analysis he says he was unrealistically self-demeaning and found it hard to take pride in his academic and professional success.He also felt strangely guilty around his parents.
"I couldn't really enjoy when my father gave me affection because I felt I'd outdone my father, rubbed his nose in it. Even though my mother gave me the natural affection that all proud mothers give their son, my unconscious mind thought my mother had her sexy eyes on me and that she was waiting to say, 'Listen, forget your father.'"
Besides showing him the practical value of Freudian psychological concepts in his own life, Irving's analysis also convinced him that the best way to treat analytic patients is to be neutral and detached. Irving does not shake hands with his parients. He engages in no chitchat, refusing to tell them anything about himself or his interests. He sits behind his couch-prone patients (as Freud advised) to avoid eye contact that might give away his reactions to what they say. He sometimes struggles to keep his voice calm and unaffected. When patients whine and cry and beg to be comforted, he refuses. If a patient comes into his office with a broken leg in a fresh cast (as one has), he will wait until the patient brings up the injury before discussing it.
Irving, as always, has his reasons for acting like a cold fish. An analyst and his patient cannot be buddies, he says, because it contaminates the transference: A patient, who's projecting his past life onto the analyst, gets the most accurate picture if the analyst remains a blank screen.
"When my patients say why don't you love me, why don't you hug me, I have to say what comes to mind about that. It brings out more material. If you gratify them, they just want more and they don't try to understand the meaning of their wishes," Irving told me.
He's skeptical of his patients' most innocuous requests, such as when they ask to change the hour of their appointment: "It does seem petty, yet there is a lot of [analytic] meat in that. When I found out from the patients themselves that there was a lot more to it, I stopped taking their reasons at face value. The patients may want to change the hour and if I don't change the hour it means I don't love them as much as they had hoped. That's not the reason they said originally. They said originally that they had another appointment.
"The problem with the stereotype of the analyst is that people believe these people [patients] don't mean anything to you. That's not true. I have all the range of human feelings. I just don't express them in the usual sense. So the patient comes in with a broken leg, I take note of it, I might think, 'Are you all right?' But I don't say anything."
I asked Irving if his coldness doesn't drive some patients up the wall.
"Yeh, sure. Because they want me to love them, they want me to be interested in them. They want me to be a mother and father to them. They want me to be a loving mother who will kiss their broken leg and make it better."
In our conversations, whenever Irving got onto a touchy subject such as his sexual desires for his mother or for female patients, he'd conclude his remarks by saying "this is the kind of stuff that people don't believe" or "this probably sounds crazy to you."
The public still won't accept the unexpurgated gospel according to Sigmund Freud, Irving feels, because, first, it is hard to believe and, second, it sounds disgusting.
"Freud is radical. The reason it is radical is because it contains things that we don't want to know that we think," Irving said. Irving's argument -- that those who reject Freudian psychology do so out of an anxious refusal to face up to their own unpalatable drives -- has an undeniable power. Anyone doubting that sex and aggression are the fundamental human motivations is guilty, at least in Irving's office, of "resisting" the doctor. Moral qualms - in fact, all morality-and any anti-Freudian ethics are causes of "resistance."
In his recent book, Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend, Princeton University historian Frank J. Sulloway writes that this "notorious 'repression-resistance' argument is psychoanalysis' most effective propaganda mechanism." It places "the whole burden of blame for deviance upon those who defect."
I sought out Sulloway's book after Irving and I had a confrontation in one of our last interviews. In asking him a question, I misread a transcript of a remark Irving made in a previous interview. My mistake cast Irving in an unfavorable light. He jumped on the error, saying I made it for a reason. He accused me of unconsciously believing that psychoanalysis was baloney and that he was a jerk.
The fascination of Irving as psychoanalyst and man, perhaps the power of all of psychoanalysis, is that his accusation disarmed me. I didn't know why I made the mistake, but for some reason I felt guilty.