Freud's Furniture

Quite a few naked women fill the pages of Nathan Kravis's On the Couch: A Repressed History of the Analytic Couch From Plato to Freud (MIT Press). Even those depicted as fully clothed tend to be conspicuously dishabille or sunk in languor, if not half-asleep. A number are mythological figures; none are patients. The painter or photographer (or, in the case of the oldest images, mosaic maker or relief carver) gazes at them full-on -- unlike the psychoanalyst, who normally sits perpendicular to the couch, with an ear turned to the analysand.

This arrangement, established by Freud himself, turned into one of the definitive protocols of “orthodox” analysis (along with 50-minute sessions conducted four or five times a week) as well as the premise of countless New Yorker cartoons. That a piece of furniture has become practically synonymous with psychoanalysis seems odd given how little the founder said about the couch. And when he did, as in the paper “On Beginning the Treatment” (1913), it’s clear that the practice originally had “a personal motive, but one which others may share, namely: ‘I cannot put up with being stared at by other people for eight hours a day (or more).’”

OK, but still: Why a couch? For as Kravis points out, having the patient sit in a chair, suitably angled, would presumably do the trick just as well. Freud refers to having the patient assume a reclining position as a “ceremonial” aspect of the treatment. Someone unimpressed by psychoanalysis’s claim to the status of a science might well take this as an inadvertent admission that the technique is grounded in ritual, not research. In that case, the unconscious and the superego are mythological figures, too, just like Venus and Cupid.

The efficacy and centrality of the couch have come under scrutiny within the analytic community itself, and Kravis’s lavishly illustrated book contributes to that effort. The author, a clinical professor of psychiatry at Weill Cornell Medical College, is also a supervising analyst at the Columbia University Center for Psychoanalytic Training and Research. He notes that many analysts now regard the couch as “nonessential” and “no guarantor of an analytic process,” and even “a relic of a more authoritarian era, a power play on the part of the analyst that unnecessarily regresses or infantilizes the analysand.”

On the Couch neither endorses those criticisms nor categorically rejects them. Kravis treats both automatic conformity to tradition and a dogmatic rejection of it as instances of “a frozen, rigid, doctrinaire or overly detached stance on the part of the analyst rather than an effort to sense what’s going on [in treatment] and adapt accordingly.” The challenge is to comprehend how the couch entered the analytic tradition in the first place -- following some 2,500 years of development as part of material culture.

The need for a piece of furniture designed for comfort during the hours one spends neither toiling nor sleeping was not especially urgent for most of humanity through most of its history. “If today the bed is associated primarily with sleep and sex,” writes Kravis, mentioning two matters of great psychoanalytic interest, “in earlier centuries it was strongly associated with grandeur and privilege, just as the couch was associated with ease and luxury in Greco-Roman culture.” The couch was more status symbol than convenience: the wellborn and prosperous would dine and socialize on their couches -- inspiring envy and, when possible, imitation by those lower in the social hierarchy. Among the early images that Kravis presents is a funerary sculpture depicting a woman reclining in the company of her children and a slave who, of course, stand. A number of depictions of the Last Supper less well-known than Leonardo da Vinci’s portray Jesus and the disciples lying on their sides on couches around a table.

The fall of the Roman Empire brought “the decline of reclining dining,” to borrow the author’s once-in-a-lifetime phrase, but imagery from later periods continue to associate the couch with luxury and social position. It also provided room for the pleasures of reading and conversation.

“Newly emerging ideals of comfort were becoming inseparable from notions of social intimacy,” Kravis writes. “These are among the changes that provided the cultural conditions necessary for the eventual emergence of psychotherapy in general, and psychoanalysis in particular.”

Finally, war casualties and the spread of tuberculosis in the 19th century saw the rise of the mass production of recliners and daybeds, including furniture that could be adjusted to provide “as many graduations as possible between sitting and lying.” Freud trained and practiced as a doctor while this market was growing, and it seems significant that the German word he used for couch (or “sofa,” in the earliest English translation) literally means “resting” or “calm” bed, with connotations of the sanatorium or “rest cure” rather than the bourgeois drawing room.

“For it even to become thinkable to lie down in the presence of another person for the purposes of talking to him or her,” writes Kravis, “there had to be an evolution in attitudes toward the private and the social reflected in the history of recumbence -- its social meanings and contexts.” And ultimately, it is the combination of intimacy and distance associated with analysis that he wants to preserve, whether or not the couch facilitates it in a given case. The analytic couch has a rich cultural heritage, which it is possible to defend without succumbing to a fetish.

But one of the articles in his bibliography is a reminder that it is not the public who need persuading. “The Couch as Icon” by Ahron Friedberg and Louis Linn appeared in The Psychoanalytic Review five years ago. The authors did a literature review of “over 400 papers on the usage of the couch in analysis.” And while they found no real consensus on its value or effects, clinical reports suggested that with some patients, the lack of eye contact could be a problem or even dangerous. A depressed person with limited social contacts “may come to an analytic hour and find his loneliness reinforced,” for example. Someone dealing with trauma or early loss can find the experience not just alienating but seriously damaging.

At the same time, Friedberg and Linn reported that a considerable number of their colleagues continued to think of the “orthodox” arrangement as the gold standard of the profession. It’s what they went through and what their training analysts did before them. And patients who do not benefit from it have, in effect, failed the legacy, not vice versa. On the Couch is an interesting and attractive perspective on the roots of an analytic tradition, but parts of that tradition sound downright compulsive.