Abstract
Nathan Kravis’s On the Couch: A Repressed History of the Analytic Couch from Plato to Freud was not what I was expecting—and in a fascinating way. In its pages you will not find a history, repressed or otherwise, of the rationale for use of the couch in psychoanalytic practice, nor will you find a summary of arguments made over time for or against its use. Instead, Kravis draws together several interpenetrating influences that, he posits, heavily predisposed Freud, likely at an unconscious level, to adopt the couch as a standard instrument of analytic practice. These influences include art, fashion, philosophy, furniture design, and medicine, along with prevailing cultural trends in Freud’s time and before. Kravis uses this multidisciplinary kaleidoscope to explain how the couch became a universal symbol for interiority in general and, in particular, an iconic shorthand for the practice of psychoanalysis. Generously sprinkled throughout the book’s pages are beautiful photographs and humorous cartoons featuring the couch in its many incarnations and with its various connotations.
One such connotation, of course, is the association between the couch and the pursuit of self-knowledge. The familiar reasons offered for its use—that it is a holdover of the hypnotic method, or that it stems from Freud’s discomfort at having patients stare at him all day—have always been unsatisfying. Some argue (e.g., Starr and Aron 2011) that the emphasis on the couch’s central place in hypnosis as the basis for its use in psychoanalysis obscures Freud’s association with the little explored practices of electrotherapy and genital stimulation practiced by his colleagues as treatments for hysteria. Others hold that Freud’s preference for the couch is rooted in (and today can perpetuate) an intolerance for disagreement (Schachter and Kächele 2010).
However, Kravis looks to times before the practice of psychoanalysis, and beyond it, and discovers links between the couch and the mind that predate Freud and hypnosis, or Freud’s immediate predecessors in the fields of psychology and medicine. While it is true that hypnosis and other psychiatric treatments common in the nineteenth century (e.g., hydrotherapy, cutaneous electrotherapy and faradization applied to the skin) were all practiced with the patient in a reclining posture, Kravis invites us to consider the interplay of additional historical currents.
Given the book’s intriguing title and the fact that our history is littered with incidents, as well as treatments, that we now view as controversial at best, I suppose I expected Kravis to look at some of the more shameful aspects of our history. He does briefly bring up the erotic and transgressive potential of the couch, but gives less attention to this than, for example, to the role of “rest cures,” common in the nineteenth century. He also emphasizes the cultural drift toward the pursuit of comfort in clothing and furniture as an important influence.
Kravis explains how evolving societal attitudes toward intimate conversation steered architecture and furniture design, which in turn influenced women’s clothing toward freer, less constrictive styles. We learn that these cultural trends predated and were privileged over technical advances such as electricity and indoor plumbing.
At the outset of the book, Kravis notes—as have others (see, e.g., Skolnick 2015; Schachter and Kächele 2010)—our field’s undertheorizing and relative lack of research on the role of the couch compared to the attention it has received in the arts and elsewhere.
Freud himself, in “On Beginning the Treatment,” offers an uncharacteristically thin rationale for its use: Before I wind up these remarks on beginning analytic treatment, I must say a word about a certain ceremonial which concerns the position in which the treatment is carried out. I hold to the plan of getting the patient to lie on a sofa while I sit behind him out of his sight. This arrangement has a historical basis; it is the remnant of the hypnotic method out of which psycho-analysis was evolved. But it deserves to be maintained for many reasons. The first is a personal motive, but one which others may share with me. I cannot put up with being stared at by other people for eight hours a day (or more). Since, while I am listening to my patient, I, too, give myself over to the current of my unconscious thoughts, I do not wish my expressions of face to give the patient material for interpretations or to influence him in what he tells me [1913, pp. 133–134].
At another point in the same essay, Freud points out that many patients will object to lying down with the analyst out of sight. His only comment about this is to say, “Permission is regularly refused” (p. 139). The Freud I am accustomed to would typically explain and elaborate on this refusal. In any event, the couch has become a concrete shibboleth, a fixture of the analytic consulting room, even as, according to informal surveys (e.g., Skolnick 2015), many of us, regardless of theoretical orientation use it less and less.
Two colleagues were chatting, and one shared a piece of information about a third. “How do you know?” “From the couch,” came the reply. The questioner knew that the tidbit had come from a patient, and to be cautious about asking anything further. This past July an article appeared in the New York Times titled “Instagram Therapists Offer Advice, No Couch Needed” (July 4, 2019), in effect reinforcing the couch’s iconic status by rejecting it. Just a few weeks later (August 29) another piece in the Times, “New Age Care Finds a Place in Therapy,” depicted crystals and the like placed on a classic analytic couch.
As with many oft-bashed Freudian ideas, popular culture seems unaware of how thoroughly suffused our current ethos is with Freudian thought. One more example: a recent exhibit about the singer/songwriter Leonard Cohen at the Jewish Museum in New York includes an installation by the artist Avi Folman called “The Depression Chamber.” It consists of a small room with an analytic couch. Viewers are meant to experience the work one at a time, lying down on the couch alone in this room while images and text, perhaps the artist’s associations to Cohen’s work, swim around on every surface. No explicit link is made to psychoanalysis, yet the artist quite literally puts us on the couch.
Addressing criticisms that have been leveled at the couch as infantilizing or as an enactment of the hierarchical status of analyst and patient, Kravis provides an interesting glance back in time to ways in which power and status have been symbolized by a sitting or recumbent position. The word chairman is a case in point. Even earlier, in ancient Greece and Rome, dining while reclining was a sign of privilege, again signaling power, status, and pleasure rather than submission or lower rank. Pre-Renaissance paintings of the Last Supper depict Jesus and the apostles lying on their sides. To this day the Passover Seder invites participants to eat while reclining. This position marks the separation of this special meal, with its greater freedom for thought and discussion, from the everyday.
Over time, the reclining pose has been a recurring theme in portraiture. It has been used to depict everything from comfort, to interiority, to potential transgression, and carries the power differential between the (typically) male gaze upon the (typically) female subject. Freud’s own couch was a gift from a former patient, Madam Benvenisti, at a time when many famous actresses were painted reclining on couches.
Kravis points out how the increase in war casualties against a backdrop of changing cultural ideas of comfort ushered in a need for portable “invalid” furniture. Comfort became “medicalized,” and lying down became part of the healing process. Around the same time, asylum-based, open-air rest cures gained popularity as the treatment of choice for increasingly common conditions like tuberculosis.
Freud’s attachment to the couch, according to Kravis, lay in its twin identities: it afforded the recumbent posture that had earned favor in medicine, and represented a tie to romanticism, with its emphasis on subjectivity and a rejection of rationalism. Both elements fit well with Freud’s psychoanalytic sensibility. On the Couch is full of this type of interesting historical information, as well as musings on language and the arts. All these factors, Kravis argues, provided the necessary cultural climate for the emergence of psychoanalysis and the treatment’s placement on the couch.
To conclude, I will share some associations inspired by my reading this book. Reviewing it led me to read other works about the couch, including criticisms of its use. Some writers caution that we miss important visual information when we do not face our patients (Skolnick 2015). Others seem to treat the couch as a necessary, one-size-fits-all ingredient for a “real” analysis, rather than a careful choice based on the needs and characteristics of the individual patient. A comment by Fred Pine comes to mind. “You need a contained mind to work in uncontained ways” (personal communication 2018). For some people with some analysts, the couch can provide this container. Under other circumstances the couch becomes just the opposite—an unseaworthy vessel in a vast, dark, and dangerous ocean. And of course the couch can transform into more than one kind of vessel for an analysand over the duration of an analysis.
As a doctoral student studying psychological testing, I learned that a standard battery began with the Bender-Gestalt and the House-Tree-Person measures because as structured activities they provide a kind of holding and organizing function for anxiety—a container provided before asking the examinee to wade into the relatively untamed territory of unconscious material elicited by the Rorschach. (Of course, this is subjective as well. I am sure that for some people, the thought of drawing anything produces rather than decreases anxiety). A friend consulted an analyst while in a crisis. The analyst, it seemed to me, rather automatically put her on the couch, with disastrous results. On the other hand, some of my patients, people who learned as young children that for their own emotional safety they had to be vigilant, ever mindful of the adults around them, and to adjust themselves accordingly, have found that the couch frees them from having to be so aware of me. As a result, they have been able to claim the time and space for themselves in ways that eventually include exploring what it means to them to be more aware of me.
An essay in Sebastian Zimmerman’s Fifty Shrinks (2014) by Elizabeth Danze, a professor of architecture, discusses the importance of the space where therapy is done. She quotes Gaston Bachelard’s The Poetics of Space (1958): “For not only do we come back to it, but we dream of coming back to it, the way a bird comes back to its nest or a lamb to the fold” (in Zimmerman 2014, p. 9).
All of this brings me back to something we have always known: as with any aspect of psychoanalysis, be it technique, theory, or the space in which we practice, its usefulness depends to a huge extent on the particular analytic dyad. The couch, like any other tool, can be misused. It is not for everyone. Yet, to quote Kravis, The use of the couch can open the door to an oddly powerful discourse on the self that can’t be had elsewhere. The function and meaning of recumbent speech are key to this discourse. Recumbent speech transcends free association in that it authorizes a mode of intrapsychic and interpersonal luxuriation. Recumbent speech allows for an experience of selfhood that simply has no parallel anywhere in the social world [p. 167].
This gives me hope for the future of psychoanalysis, conducted on a couch or not. And this is reason enough to treat yourself to Kravis’s delightful book.