The American Journal of Psychoanalysis, Vol. 61, No.

2, 2001

THE HOFGEISMAR LECTURES: A

CONTEMPORARY OVERVIEW OF
HORNEYAN PSYCHOANALYSIS

Douglas H. Ingram

Part I of this paper describes Karen Horney’s theory of neurosis. In the 1930s, Horney repudi-
ated Freud’s view of female developmental psychology. She argued that cultural factors rather
than anatomy or innate biological drives were the primary determinants not only of female
development but of personality, as well. When genetic and environmental circumstances to-
gether lead to basic anxiety early in life, she believed a deep inner conflict emerges in the
individual leading to the need for elaborating layers of rigidified protective defenses. She
called this the neurotic process. This process can result in discrete symptoms of mental disor-
der as well as the more generalized problems of alienation from the person’s real self and
reliance on neurotic solutions. In Part II, the practical application of Horney’s theory to clinical
work is demonstrated in a case presentation of a notably timid and perfectionistic man. Part
III points up elaborations of Horney’s theories by later workers of her school, the American
Institute for Psychoanalysis, and provides a history of her school within the broader context
of American psychoanalysis. The author’s emphasis on postmodern and narrativist elements
of Horneyan psychoanalysis are illuminated, as well.

KEY WORDS: psychoanalysis; Karen Horney; feminine psychology; psychoanalytic education;

narrative; neurotic process.

I. THE IMMEDIACY OF KAREN HORNEY’S THEORY TO THE

PRACTICE OF PSYCHOANALYTIC PSYCHOTHERAPY

It is my intention in this first of three presentations to explain Karen Hor-

ney’s approach as she might have taught it herself through her books and
lectures. The second presentation shall be a case report that demonstrates
the application of theory to actual practice. The third will discuss the devel-
opment of Horney’s theories, controversies concerning them, how her ideas
are taught at the American Institute for Psychoanalysis (which was founded
in 1941), and something about my own neo-Horneyan perspectives. I will
also speak about her contributions to American psychoanalysis. If I succeed

Address correspondence to Douglas H. Ingram, M.D., 4 East 89th Street, Suite 1C, New York,
NY 10128; e-mail: DHIngramMD@aol.com.
113
0002-9548/01/0600-0113$19.50/1  2001 Association for the Advancement of Psychoanalysis
114 INGRAM

in even a small way in this ambitious enterprise, I believe we all can feel
quite pleased.
At the American Institute for Psychoanalysis, the Karen Horney we con-
sider is the Karen Horney who first emerges in the 1937 publication of The
Neurotic Personality of Our Time. For the prior 15 years, Horney wrote
from within the Freudian establishment, objecting to concepts of penis envy
and the ubiquity of the oedipal complex as lying at the heart of character
development. Also, Horney had insisted that Freud was mistaking as bio-
logical those matters that are essentially cultural. She hammered away at
Freud’s endorsement of a conservative cultural belief system that subordi-
nated women to men and that, in her view, provided that endorsement with
the authority of biology. Frustrated with the indifferent reception of her
ideas in the power centers of the Freudian heirarchy—yet finding support
in many other quarters—she stepped up her challenge and moved beyond
questions of feminine psychology, throwing doubt on the ubiquity of the
oedipal complex, the importance of repetition compulsion, the origin of
masochism, and so forth. Figuratively speaking, in New Ways in Psycho-
analysis, published in 1939, she nailed on the church door a list of all her
objections to Freudian theory. In lectures, articles, and books—culminating
with Neurosis and Human Growth in 1950—she developed an alternative
set of propositions from which to approach clinical work. Horney con-
tended that it was parsimonious to recognize that cultural factors could
account for personality difficulties and suggest how treatment of the neu-
rotic should proceed,and that such an approach was superior to derivatives
of unproven biological propositions. Otherwise, she retained Freud’s basic
concept of unconscious process and the essential features of existing psy-
choanalytic technique.
Essential in both Freud’s and Horney’s theories is that the unconscious is
characterized by hidden conflict. When unconscious elements are in only
mild conflict, all we may observe is mild forgetfulness, occasional moodi-
ness, slight instability in self-esteem, and so forth. But unconscious inner
conflict may be of such magnitude that a person is in nearly continual
psychological pain, commanded internally to behave compulsively and in-
discriminately, or wracked by having lost conviction of possessing a self
that is real and true. When there is a sense that one’s self has been lost, all
activities, things and relationship with others lose meaning. There is a pro-
found sense of being counterfeit. Horney referred to this as alienation. She
used this term to express how a person might feel and to indicate that,
regardless of how a person felt, the person had lost touch with essential
aspects of self.
Alienation is a tragic consequence of the neurotic process. For Horney,
the neurotic process meant a kind of human development that interfered
 THE HOFGEISMAR LECTURES 115

with the realization of a person’s own potential. Whereas favorable condi-

tions permit a person to grow according to his or her own capacities, incli-
nations, talents, and limitations, in an environment inimical to healthy de-
velopment, a person becomes alienated from the real self. Horney used this
term to refer to the nucleus within each of us from which growth proceeds.
The real self is the source of wholeness and spontaneity, of choosing, devel-
oping values, bearing responsibility, of intensity and nuance of feeling. Self-
realization is the process of allowing the real self to unfold and is synony-
mous with the healthy growth of one’s constructive forces. In order for
self-realization to occur, the environment as shaped by parents and other
significant figures needs to respond with an appreciation of the child—
willingly accepting the child’s temperament, abilities, inclinations, and lim-
itations. Additionally, these parental figures are the vectors for accultura-
tion—for bringing the child into a world full of complexity, conflicting and
ever-changing values, and multiple currents of communication. The patho-
genesis of neurotic mental disorder arises when the individual is unable to
sort out effectively encounters with the environment. The internalization of
certain cultural trends, exaggerated and rigidified, become the organizing
principle for patterns of individual neurotic development. This view of the
pathogenesis of mental disorder is distinctly different from that of Freud
and, even more notably, of Klein, for whom enormous internal conflict is
inherent in infancy and childhood with comparatively little reference to the
environment. It is because she saw neurosis as culturally induced and
therefore subject to modification that Horney is often regarded as opti-
mistic.
For the developing child, assurances of security, love, and respect often
come in subtle ways. Damage may result through inconsistent regard, in-
dulgence, overprotectiveness, and lack of appreciation for who the child
really is. Parents, grandparents, teachers, and older siblings may have gran-
diose expectations of the child, exploit him, stifle his creativity, disparage
him, mystify and confuse him, and in general terms subordinate the child
to their own unconscious needs and conflicts. To the extent that the child
feels security and genuine self-esteem, he grows freely and well. To the
extent that he falls prey to adverse influences, the child develops a deep
insecurity, what Horney called basic anxiety, the feeling of being helpless
and alone in a world experienced as potentially hostile.
Basic anxiety is intolerable if it is intense and sustained. The child must
act to allay it. He or she may decide to change his or her views of certain
things, try to feel differently, and try to reorient to others in order to reduce
the sense of threat. Horney framed these efforts at reorientation as interper-
sonal moves. The child may move toward others by showing a clinging
neediness, dependency, and self-effacement if loving submission appears
116 INGRAM

to be the safest strategy. Or, the child may move against others by showing
aggression, expansiveness, grandstanding behavior, competitiveness, con-
trol, contempt, and exploitation of others. Included within this general ori-
entation are tendencies to narcissistic grandiosity, perfectionism, and arro-
gant-vindictiveness. Finally, the child may move away or detach himself
from others, showing efforts to disengage from others and thereby avoid
conflict between the tendency to either submit or to dominate.
There are four important points to keep in mind. First, these moves begin
in infancy and may be traced to mother–child interactions. Mary Ainsworth
and attachment theorists have shown that when infants are placed in a
special laboratory procedure known as the strange situation paradigm, ob-
servations of infants who are alternately separated and reunited with their
mothers fall into categories readily identified as moves toward, away, or
against (Feiring, 1983). These early, simple moves are elaborated in a vari-
ety of ways as the child matures. With the acquisition of language, style,
values, moral capacity, and advanced intellectual ability, the enormous
elaboration of these moves will occur.
Second, these moves have intrapsychic correlates. A person may show
moves toward, away, or against not only in connection with another per-
son, but also in connection with the intrapsychic image of another person,
or of an activity or thing that represents another person. This is crucial to
keep in mind because the intrapsychic correlates of what begins as interper-
sonal moves accounts for a rich understanding of psychic process.
Third, we identify a person as healthy to the extent that he can move
flexibly and appropriately in all these directions. A person who can love
tenderly, yet in another situation exert control or, in still another, wisely
withdraw, is a person capable of constructively choosing his behaviors de-
spite conscious awareness of conflicting impulses and feelings. In the ideal,
one is spontaneously able to experience every kind of feeling, both in-
tensely and with nuance. Likewise, one’s capacity to fantasize freely is sub-
stantial. We identify people as healthy to the extent that they can move
considerable distances in each of these three directions. When the child
suffers from excessive insecurity these moves—toward, away, and
against—become increasingly fixed and rigid. Generally, one move is se-
lected and the others are repressed. The entire spectrum of attitudes, beliefs,
needs, qualities, and sensitivities that are consistent with the strategy se-
lected becomes organized and valued. The person who learns that security
is achieved and basic anxiety allayed by moving toward others comes to
value love, charity, kindness, self-sacrifice, and intimacy. One may show
kindness even when it is evident that the object of that kindness sees gener-
osity as a clear sign of weakness and stupidity. The person who feels secure
only when in overt control may come to value strength, power, money,
 THE HOFGEISMAR LECTURES 117

and prestige. That person sulks, perhaps, when failing to win yet another
award or when his or her spouse doesn’t jump when a command is given.
The person who feels safe when detached comes to value freedom and
serenity. That person may care about a certain issue, but does not want
to ‘get involved.’ When the neurotic process is underway, restrictions are
imposed. Ways of feeling, thinking, and acting that are experienced as at
odds with the primary solution are automatically and unconsciously re-
jected; the person is alienated from them.
Fourth, you must bear in mind that the alternate moves, the ways of
thinking and feeling and acting that are at odds with the primary move do
not disappear. They remain alive in the unconscious and constantly struggle
for expression against the primary move. The constant flux of the pressure
created by these alternate moves provides the dynamics that are so crucial
to understanding the person in clinical context and making sense of incon-
sistencies. Hence, for example, the person who rigidly moves against others
and endorses strength is likely to experience softer feelings as threatening.
The person rejects such feelings and is alienated from them. Yet they con-
tinue to operate unconsciously and result in behaviors, dreams, and errors
in daily living that seem very much at odds with the person’s preference. It
is these opposing strivings that generate much of the inner unconscious
conflict that Horney saw as the basis for neurosis. The self-effacing person,
for example, may unknowingly exert considerable control by inducing guilt
in others. Or, the person seeking to control his feelings may feel con-
founded by their sporadic eruption. The internal conflict generated by these
opposing strivings, which have become not only rigid and fixed but insatia-
ble, compulsive, and indiscriminate, was called by Horney basic conflict.
Elevating one of the basic moves into a dominant position and repressing
the others constitute what Horney called a neurotic solution to the underly-
ing problem of basic anxiety. Of course, these solutions are actually pseu-
dosolutions because the person is relying on a desperate quick fix.
Please remember that although some few people may actually look like
they fall into these descriptions, most do not. This is not a nosology of
types. It is a misreading of Horney, or Fromm, or any psychoanalytic author
who attempts classification for heuristic reasons, to interpret their descrip-
tions as providing a nosology of types. Again, these are dynamic trends,
not types. To not see this is to eviscerate the complexity and subtlety neces-
sary to any valuable theory of analytic process.
In neurosis, life becomes narrowed because energy is expended in fulfill-
ing these limited strivings and in repressing anything in conflict with these
strivings. Self-realization is supplanted by neurotic process. The person be-
comes more and more alienated and impoverished. Inherent constructive
forces grow weaker, and retarding, obstructive, or even destructive forces
118 INGRAM

in the person come to the fore. In order to retain a sense of integration

and wholeness, the neurotic person must avoid awareness of conflict. The
eruption of what seems like a sudden, new feeling—say, of competitiveness
in a primarily submissive person—is internally rejected or questioned
rather than acknowledged as valuable. Often, the person must act immedi-
ately to get rid of the feeling, which is then lost and unacknowledged. The
person more strongly affirming his or her neurotic solution is not enough,
and more radical maneuvers become necessary. What else does the person
in the thrall of the neurotic process do to protect the solution?
To bolster the neurotic solution to basic conflict, the person may uncon-
sciously elect to experience internal attitudes, feelings, and impulses as oc-
curring outside the self—or may respond with disproportionate intensity to
certain external events. Horney termed this process externalization, and it
has much in common with the better known concept of projection. For
example, the neurotically expansive person who has an incipient feeling of
tenderness toward another may immediately and automatically repress its
awareness, imagining instead that it is the other who feels the tenderness.
Because tenderness is threatening to his or her rigid need to dominate, the
person may experience the other’s supposed tender feelings as having some
ulterior motive. The person may take some action to ward off or control
the imagined danger, perhaps by humiliating or abandoning or even de-
stroying the other. In addition to externalization, there are general measures
to relieve tension and to further defend against disruption of the neurotic
solution and the sense of wholeness it provides, however fragile. These
include compartmentalization, automatic control, streamlining, supremacy
of the mind, blind spots, rationalization, arbitrary rightness, elusiveness,
cynicism, and narcotization. Through her writings, Horney added and sub-
tracted from this list. I think we can each add our own favorite defenses.
These defenses, plus externalization, plus alienation, plus the neurotic solu-
tion are like bands of steel holding together the person’s psyche, keeping it
from exploding outward. That should be enough, but it isn’t. Remarkably,
it turns out that still more is needed. Yet another structural support is neces-
sary to sustain the increasingly jury-rigged personality of the neurotic.
Horney wrote, “While feelings—because unruly—are suspects to be
controlled, the mind—imagination and reason—expands like a genie from
a bottle” (Horney, 1950, p. 182). In his or her imagination, the neurotic
can finally seem to put to rest inner conflict by imagining an idealized
version of the self. Horney called this an idealized image. Depending on
which orientation one has selected, that vision is elevated to a status of
utter grandiosity. The person is not merely kind, but the kindest person, not
merely a tough person who can negotiate any business deal, but the tough-
est son-of-a-bitch you can imagine, not merely a person who enjoys free-
 THE HOFGEISMAR LECTURES 119

dom, but one who is—like the song says—king of the road. The person
comes to believe in the idealized image, an unconscious structure of the
mind. With the idealized image, the neurotic solution becomes a compre-
hensive solution. Actual statements along the lines of, “I am the best there
is,” are poor reflections of the actual grandiosity and power that the ideal-
ized image possesses. The neurotic seeks a transformation into an idealized
self, a transformation that is—as one might realize—the very antithesis of
self-realization.
The quest to actualize the idealized self, like so much else, is uncon-
scious. At any moment, the individual or observer may catch sight only of
its shadow. One critical way by which we recognize the neurotic process
is in the irrational claims the neurotic makes on others and the world—and
on himself, by the way. The assumption of entitlement, that one has a right
to be loved, to receive a promotion, to be treated fairly, to be left alone, to
be understood without needing to communicate (or even with communica-
tion!), serves to point up the deep conviction that the person has achieved
a certain specialness. Healthy wishes, desires, hopes, and aspirations are
strikingly different from neurotic claims. In the latter, there is a clear quality
of entitlement. One may feel disappointed when a wish doesn’t come true.
But when a claim is frustrated, the neurotic reacts as if his or her very being
is threatened.
Closely related to these claims, these unfounded presumptions of how
the world should behave, are equally unfounded presumptions of how the
neurotic believes he or she should feel, think, behave, look, dream, and so
forth. These constitute inner dictates and what Horney described as a tyr-
anny of the shoulds. Sometimes the shoulds are experienced as entirely
from within, sometimes as coming from outside oneself. Guilt, self-recrimi-
nation, compulsive behavior, critical attitudes toward others, fear of critical
attitudes from others, inhibitedness, and loss of spontaneity in feeling and
action emerge as consequences of severe inner dictates. When inner dic-
tates arise from different trends they may be in conflict, and a virtual paraly-
sis may ensue. Not infrequently, the neurotic acts in a way that makes
matters worse. Compulsively and indiscriminately, the person turns the
other cheek, for example, gets slapped again, feels distress—but because
turning the other cheek is all that is possible within the rigidly fixed neurotic
solution—repeats the process. Of course each time this occurs, the ideal-
ized image of one as, say, a martyr enduring injustice for the sake of ulti-
mate goodness, is endorsed and promoted. The vicious circle that results is
often traceable in neurotic patterns of behavior.
To the extent that the neurotic imagines he or she has become an ideal-
ized self, there is a sense of pride. Horney uses pride in a special way. For
her, this sense of pride is not a pride in true achievement or appreciation
120 INGRAM

of real talent or abilities. Instead, it is a false pride rooted in the imagined

fulfillment of invented inner dictates, themselves a function of the neurot-
ic’s search for glory. Glory is the goal and is sought in vain. The quest is to
become one’s idealized self, finally, for once and for all. Catching a
glimpse of his actual self, perhaps when a claim is frustrated or when a
should is not achieved, the neurotic may fill with self-hate. The person
hates himself for falling so far short of the idealized self. The person paints
the picture of what is seen far worse than what is deserved. Not surpris-
ingly, the person acts in a manner consistent with one who hates. Hate is
directed against the self in the form of torment, destructive behavior, con-
tempt, guiltiness, and severe criticism. Help is refused, pleasure is denied,
and depressive symptomatology may emerge. In hating oneself for failing
to fulfill inner dictates, the person further endorses those same dictates and
the neurotic process. That is, the hate is necessary. An instructor I admired
enormously said to a patient who was berating himself, “Do you really
need to beat up on yourself this way?” He was inviting the patient to relax
the torment emanating from the self-hate. He was casting doubt on the
necessity of such behavior and suggesting implicitly that the patient stop
doing so. I have come to doubt the wisdom of that kind of statement, be-
cause self-hate indirectly affirms the idealized image, which is in immediate
need of shoring up. Probably a better comment is the simple statement,
“You are in a lot of pain.” Self-hate and neurotic pride, far from being at
odds, are therefore linked in what Horney called the pride system. The
effort to actualize the idealized image leads increasingly to alienation from
the real self. The critical conflict between the idealized self and the emer-
gence of the real self is termed central inner conflict.
The patient comes into psychoanalytic treatment because of psychic dis-
tress or some difficulty functioning. In Horney’s terminology, the patient
seeks help because his or her neurotic solution is not working. The symp-
tom is an unacceptably painful manifestation of a desperate measure that
the unconscious is forced to take. The analyst is supposed to fix the solution
and make it work again. Sometimes that is possible—and may even lead
to what passes for an excellent outcome. The person is happier and more
productive. But we also must keep in mind that the solution is only a pseu-
dosolution. The analyst needs to provide relief while at the same time disil-
lusion the patient concerning the search for glory, pride system, tyranny of
the shoulds, various defensive tactics, and the primary solution. This is
done not by a direct assault but by exploring the issues that naturally unfold
in the course of the patient’s discourse about daily events, history, dreams,
hopes, and imaginings. Therapeutic benefit occurs because the disillusion-
ment weakens obstructive forces and enables the activation of constructive
forces of the real self.
 THE HOFGEISMAR LECTURES 121

We have now reviewed classic Horney theory in a cursory fashion. We

will proceed with the presentation of an actual clinical case. Then, we will
provide an overview of how Horney’s contributions have fared in the nearly
50 years since her death in 1952.

REFERENCES

Feiring, C. (1983). Behavior styles in infancy and adulthood: The work of Karen
Horney and attachment theorists collaterally considered. J. Amer. Acad. Child
Psychiatry, 22(1), 1–7.
Horney, K. (1937). The neurotic personality of our time. New York: W. W. Nor-
ton & Co.
Horney, K. (1939). New ways in psychoanalysis. New York: W. W. Norton & Co.
Horney, K. (1945). Our inner conflicts. New York: W. W. Norton & Co.
Horney, K. (1950). Neurosis and human growth: The struggle toward self-realiza-
tion. New York: W. W. Norton & Co.

II. TOWARD THE PSYCHOANALYTIC THERAPY OF ‘CASPAR MILQUETOAST’1:

A CASE ILLUSTRATING THE APPLICATION OF KAREN HORNEY’S THEORY

Roger, as I will call him, had been a patient of mine for a number of
years in the 1970s. He entered treatment because of anxious depression
and disabling worry associated with fear of failure in business. What struck
me the most about him was his terror of others’ anger. An exceedingly timid
and obsequious man, and utterly compliant to his superiors, he seemed
apologetic about his very existence. He dressed with no sense of style or
fashion, but attended punctiliously to the shine on his shoes, the crease in
his slacks, and the knot in his predictably blue-and-red striped ties. He
was of average height, appearing athletically slender although lacking true
athletic interests. He spoke softly and deliberately in a voice as thin in
timbre as his thinning blond hair, gesticulating very little. He moved cau-
tiously, as if the very air around him would shatter. He had entered three-
times-weekly analytic treatment and served as a control case during my
own analytic training. That work terminated after 4 years with his marrying
Louise, a woman who genuinely cared for him, reassured him, and encour-
aged his capacities for softness and generosity. By the time of that termina-
tion, he had gained optimism concerning his employment and his future.
Although he continued to show significant areas of psychic vulnerability,
he had markedly improved in his everyday function. He was still fearful of
others’ anger at him and still tended toward timidity. Nevertheless, he was
showing progressive capacity to assert himself and, on occasion, act boldly.
The affective coloring of his ideation had grown much richer, and his ca-
122 INGRAM

pacity to move and act in the world had shown gains in many spheres. The
disabling anxiety and continuous worrying about his career that had
brought him into treatment were gone. A marked decrease in alienation
was manifest in his feeling more at the center of his own life and a sense
of ownership about his immediate world.
During both that earlier treatment and the current period about to be
described, reports or associations to sexual fantasy were absent. Sexual ma-
terial did not come forward despite the quality of trust exhibited in the
relationship, interpretive efforts to reduce resistance, and specific encour-
agement to enter this area.
In what follows, the dates of session notes have been modified and other
disguise or disinformation have been introduced to protect patient pri-
vacy. Original session notes are inserted with minor editing. The note of
12/28/92, his first session on return after many years, is as follows:

This 52-year-old lawyer, a former patient of mine for a number of years, returns
with complaints of excessive alcohol use, rage reactions, and concerns that his
wife, Louise, will leave him. He looks much as he did years ago, except he is
nearly bald and what hair there is, is gray. He also reports business reversals.
They have no children, and neither he nor his wife apparently wished for any.
Alcoholic disinhibition has been leading to progressively more intense and fre-
quent rage reactions over several months, accompanied by terrifying ideation—
but not the immediate impulse—that he could shoot someone. Most recently,
after drinking, he spoke angrily in his wife’s presence to a train conductor, de-
meaning the conductor and threatening violence. With his wife, he was put off
the train at the next stop to the considerable shame of both. It seems likely that
his self-effacing, compliant solution is threatened by a surfacing of unacceptable
expansive-aggressive impulses. I speculate inwardly that while alcohol numbs the
experience of erupting conflict, it also enables it. The actual intrapsychic dynamic
source of the violent-sounding rage reactions is not clear to me at this time. The
death of his mother 6 months ago probably figures in this.
Of clinical significance is that he does not possess or have access to a gun,
and he is highly motivated to begin receiving immediate treatment for rageful
feelings. He has no history of violence of any kind. He has no social acquain-
tances or clients with violent histories. There is no history of violence in the
family. Nevertheless, he has little anger regulation, and alcoholic disinhibition is
very difficult for him to tolerate having been raised in a family in which the
expression of anger was prohibited. (Of note is that his wife was raised in a home
where anger was experienced as highly disruptive.) He is less wooden in his
presentation than I recall, but his speech and gestures are still excessively con-
trolled. His thinking is discursively rational, rather like a legal document. There
is little in the way of affective nuance or intensity other than apprehension and
worry. He is a Caspar Milquetoast—or that is what occurs to me. I recommend
that we meet again very shortly. We discuss Antabuse [the generic drug disul-
 THE HOFGEISMAR LECTURES 123

firam that blocks ethanol metabolism and produces immediate and immobilizing
nausea, dizziness, and weakness upon the ingestion of alcohol-containing bever-
ages], and I give him the phone number for Alcoholics Anonymous. I also suggest
that perhaps Louise would like to come in with him.

Born the only child of a lawyer and his midwestern wife, Roger experi-
enced a household where overt anger was unacceptable. I inferred that he
had little opportunity to develop regulation and moderation of healthy
anger, resulting in his being susceptible to outbursts of rage or, on the other
hand, needing to utterly suppress rageful feelings. Outside the orderliness
of legal discourse, he is terrified that others might yell at him. However,
within the compartment of professional activity he seems to experience
anger as part of the theatre of the profession. Early in his life there was a
great sense of order imposed by his mother. She valued his achievements
and performance, largely pointing with pride to her son with the church
group that constituted her social universe. Exploited to her narcissistic ends,
he learned that being obedient, disciplined, and compliant to her wishes
and values would win him security. Real affection remained out of reach.
Being rich, according to his mother’s and the church’s doctrine, was proof
that one was successful as a person in all spheres. The oppressive, inflexible
tyranny of his mother was apparently overpowering. From early on, and
with no evident adolescent rebellion, he subscribed to these maternal dic-
tates, internalizing them. Yet, at the same time, a deep, consciously experi-
enced, but unexpressed rage festered within him. Although he experienced
it manifestly, he felt overpowered by his mother’s influence and had no
way to express his anger. Perfectionism, usually a manifestation of an ex-
pansive solution, organized within this man as a self-effacing solution:

‘I always had to be perfect so my mother would love me—so anyone would. . . .

>Are you a perfect patient here?< Yes. I cannot say anything too bad about myself
or you will think I am really crazy and find me repulsive. I want to be the most
perfect at everything I do.’ Being most perfect at everything he does encapsulates
his idealized image. (7/8/96)

His father, much older than Roger’s mother, died when Roger was about 8
years old. He seems to have been a warm person, but still somehow distant.
He made what Roger’s mother regarded as a modest livelihood, a source
of consternation to her.

Roger shows rage at his own helplessness and stupidity on the sailboat. But we
find out that his father was, according to his mother, ‘good with his hands. By
contrast, I am inadequate.’ He speaks about replacing the screen on the screen
124 INGRAM

door to his house. He has no garage or basement shop. He has no specifiable

memories of his father. (6/21/96)

Roger attended one of the most highly regarded colleges and law schools
in the United States. On completion of his degrees, both with honors, he
worked with two major New York law firms before going off on his own,
developing enough of a client base to do so but failing to make partner in
the law firms.
A week after his initial visit, he was enraged because it appeared that his
wife of 20 years might request an order of protection as Roger was continu-
ing to speak violent thoughts. His rage was manifest in the sessions through
very angry statements softly uttered through clenched teeth. Meanwhile,
though, he had begun attending AA and was no longer drinking. He and I
arranged to meet two times weekly. Within 2 weeks of his initial consulta-
tion, Roger’s wife withdrew the intention to secure the order of protection,
and the intense difficulties between them began to subside (1/11/93). We
learned that his anger takes the form of starchly withholding behaviors,
sarcasm, and tacit disregard toward lower social and occupational groups,
including low-level law associates, secretaries, paralegals, letter carriers,
train conductors, clerks, bank tellers, waiters, etc. (1/19/93). Studied care-
fulness and timidity characterized his behavior with peers and clients. Nor-
mally, his wish to express anger overtly was held in check, at least partially,
by the projective fear that those at whom he is angry will yell back at him,
a terrifying prospect. His anger is compartmentalized and displaced onto a
group from whom he feels he has little to worry about in terms of social
and professional standing. There is nothing Caspar Milquetoast-y about his
behavior to these groups. His snobbery makes it difficult for him to learn
simple clerical tasks, including word processing:

He is too big a bigshot to do his own word processing and learn the ropes. His
arrogance and contempt for the tasks of lowly secretaries makes him unwilling
to do ordinary clerical tasks himself, and, at the same time, through projection,
make him fearful that he will get yelled at by them if he turns to them for help.
At the same time, he has a claim that they should be willing to do whatever he
requests within their job definition. Because he imagines they are angry with him,
he speaks to them with unnecessary sharpness. They, in turn, raise the ante and
passively withhold working for him even more. This becomes a vicious circle.
(2/20/94)

With this session of 2/20/94, it became possible to return to the initial

complaint of the violent, angry feelings that brought him back into treat-
ment initially and gain a more persuasive sense of Roger’s intrapsychic
dynamics. It seemed likely that business reversals were assaulting his com-
prehensive solution, the key to which is perfect professional performance.
 THE HOFGEISMAR LECTURES 125

Financial success proves he has fulfilled the dictates of perfect performance.

To support this idealized image, he relied on externalization of self-hate.
Those with lowly jobs are the recipients of this externalization. They are
unsuccessful and lack the discipline and perfect capacities that he grandi-
osely supposes he possesses. To keep his solution working, he needed to
maintain a level of success that would ensure that he is not one of them.
The angry comment demeaning the conductor (which, incidentally, he
never articulated to me), ‘putting him down,’ was a desperate effort to af-
firm that he was not one of them. Shooting the conductor, or the violent
fantasy of doing so, would have constituted the destruction of the hated
self. The idealized image is then secure. His attendance at AA meetings
provided a substitute externalization. The meetings offered him the oppor-
tunity to contrast himself with the ‘losers’ around him. Although he was
one of them, he rarely spoke up and thereby secured his secret sense of
superiority.
A second pillar of his idealized image is perfect control. That, too, came
under attack by the outburst of anger. Such overt emotionality is prohibited
by his inner dictates. The sudden experience of such intense anger would
be—and was!—terrifying. No longer drinking, and experiencing his ses-
sions with me as rational, quiet discussions, eruptions of discontrol ceased,
further restoring his comprehensive solution.
It is worth recognizing the constructive forces in this man’s character, in
particular, his capacity to persevere and withstand his own psychic distress.
His diligence and steadfastness in relations with others despite his anger
and shame at complying with their wishes is notable. He is dedicated to
his wife’s happiness and wants nothing more than to please her. He can be
generous and softly gentle. His intelligence is considerable, but because he
relies on the cautious ordering and sequencing of his thinking, creative
inductive leaps are infrequent. He wants to do the ‘right thing,’ even if the
right thing is determined by the wishes of others who may be less capable
than he. Fortunately, too, he has a capacity for playfulness that emerges
tentatively at those times when his distress is minimal. Although much of
what appears constructive within him proceeds from his neurotic compliant
solution organized predominantly around perfectionism, we still want to
regard it, optimistically, as constructive because we can work with it.
By 2/2/93, about a month after the initial consultation, tensions had sub-
sided substantially and Louise came with him to a session. The session was
useful. Subsequently, we witnessed how much his life is filled with
‘shoulds,’ which he hates, and which organize in the session of 2/22/93
through the signifier, ‘chores’:

‘Chores’ are everywhere. In session, I dramatize myself as one of them. I am the

spokesperson for all the ‘chores’ that he hates. We are altogether. He refuses
126 INGRAM

responsibility for us, making the task of fulfilling chores oppressive. He denies
true ownership of them. . . . [2/26/93] He reported that a bird landed on his win-
dowsill this morning, chirping, signaling spring had arrived. What a delightful
scene, I think. But his immediate thought is: ‘Now, I’ll have to mow the lawn
and do all the spring chores. . . . I argue that turning everything into a compulsion
or routine or codification is symptomatic of his inability to trust himself to take
care of things unless they are codified. . . . [3/22/96] ‘We were thinking of paying
off the mortgage with Louise’s inheritance. But it seems so final.’ I ask about that
and he speaks about what if he needed capital, it would be hard to get. I stay
with the idea of ‘final.’ The irrevocability of paying off the mortgage, as it turns
out—surprisingly—is associated with death. Unnecessarily, I find myself interpre-
ting this in the context of his need to live in the ‘imperative mode.’ He does more
than suffer from a tyranny of the shoulds—he actually has taken to living in what
we might call an ‘imperative mode.’ The loss of an obligation, in this instance
the paying off the mortgage, is an assault on his identity and therefore becomes
a kind of a death.

Coming at this same matter differently:

[4/8/93] He connects himself with Louise’s father because both are ‘complainers.’
Roger’s fundamental wish is to be recognized, to be appreciated, to be liked. He
was never known or appreciated by his mother. He was her trophy son. She
never recognized him or showed him affection. That, the failure to be recognized
and treated affectionately is the Complaint, with a capital ‘C.’ Anyway, all the
specific complaints that he produces come off that. They are synecdoches for that
great Complaint. [A synecdoche is a kind of metonymy where the part stands for
a whole or a whole for a part, as a single uniformed soldier can represent an
entire army.] He knows himself through the synecdoches of his Complaint—
nothing seems to solve the Complaint. Indeed, they mustn’t, perhaps, or he would
fail to identify himself to himself. . . . [6/3/93] Recall his big Complaint, that there
is no place for him, that he has never been liked. His anger at the world goes
beyond the failure of the world to live up to his claims. His ordering of the world
necessarily creates a fantasized reciprocal world, one in which he has someplace
that is his, someplace where he is liked.

His mother’s recent death may have allowed him to express the primitive
rage that had been so strictly prohibited during her lifetime. But, and I think
more likely, her death may be the cause of rage from another source. Much
of his life was directed to satisfying her need to exploit his successes. Bril-
liant success would finally release him from her grasp, but it would also
have little meaning for him. He would be alienated from any success he
might enjoy because it would be in the service of his mother’s needs, not
his own felt desires and sense of his own accomplishment. We could un-
derstand, therefore, how he would be caught in a conflict of both wishing
 THE HOFGEISMAR LECTURES 127

to win his mother’s approval—being the very best son anyone could be—
and also deeply resenting her and wishing to deprive her of any possible
success he might attain. That is, much of his life is undermined by uncon-
scious spite. We see something of this in his relationship with me and how
it reflects his relationship with his mother:

When he tried to tell me some positive things in the session of 3/7/93, I suggest
that he is speaking to me as if I were a proxy for his mother. Although this may
be correct, dynamically, my saying so proved to be a technical error. I realize I
am annoyed with his efforts at being a perfect patient when, in fact, he is forever
missing the forest for the trees. He had been trying to right the balance, to desist
from always speaking about difficulties, from complaining. My interpretation that
he was seeking a positive report from me, now in the transferential role of his
mother, deflated him, much as he had been deflated by his mother through their
history together. If he said he had a bonus, she’d ask: Why wasn’t it more? If he
announced a promotion, she’d ask: When will you be president? If he got mar-
ried, she’d ask: When are you having children. He was trying to please me, as
he tried to please her, and like her, I turned out to be deflating. His response, on
being deflated—and here is the pathetic and tragic result—is to ask for something
to read so he could become more productive in these sessions. That is, as with
his mother, he strives to become still more perfectly compliant. That is all he
knows, the totality of his repertoire.

We learn that he has a frequent dream: He is lost in an airport and trying

to get to a flight (5/20/93, also 4/24/94 and 5/5/94). This appears to be
associated with ‘connecting’ with a father: ‘Always looking for a father,’ as
he says. He presents two dreams: In one he cannot find a connecting flight.
In the other he cannot recall the name of the senior partner at a law firm
where he had worked. As a result he has nothing to do. Finding a father, a
futile effort, is associated with finding something to do and with success.
These dreams of connecting with a father stand in contrast to dreams that
are associated with disconnecting from his mother:

He presents a set of dreams. These seem to be about disconnecting from his

mother (a hoarder and saver), much as the other dreams suggested his difficulty
in locating his father: (1) moving his offices and cleaning out, (2) moving from a
rooming house and cleaning up. His life feels under greater control to him when
moving out and cleaning up. This is all left rather ambiguous. (4/28/94)

There was a sense transmitted through the dreams that his life cannot begin
until he finds his father, perhaps thereby gaining what he needs to satisfy
his mother. If he can find the father within himself perhaps he can satisfy
his mother. This had a strong oedipal flavoring. But it is worth recalling,
128 INGRAM

for these purposes, that his father was not associated by his mother with
professional success. That is, even if he found his father, his hope of satisfy-
ing his mother is futile. He needs to find his father and then correct his
father’s failures through his own achievement. But then he risks erasing the
father whom he struggled to find.
His love of his cat Charlie was very important to him—it reflected the
kind of affection that I know he wished he had had from his mother. ‘I want
people to like me and pat me on the head and say what a good job I am
doing’ (7/19/96). The death of Charlie in late 1994 was very hard on him.
Their other cat, Percy, died on 10/29/95. A third cat, Josey, which was
brought in after Charlie’s death to give Percy companionship, developed
severe separation anxiety when Roger and Louise left for work each morn-
ing and was started by their veterinarian on clomipramine. It mattered that
I knew his cats, including their names and routines. Roger acknowledged
on 6/25/95 that he would like to be a furry little cat. Of interest is that ‘he
takes his Teddy to sleep with him’ (9/11/94). He read The World of Pooh
(7/20/95). After much effort, he located several pairs of Winnie-the-Pooh
pajamas. All this was to self-nurture. I found it painfully sad, yet comic. He
identified with the child world and the pet world, lovingly caring for him-
self through the care he gave them.
Earlier, still only several months into our work, I had recommended med-
ication to reduce his obsessional preoccupation and associated depressive
mood, but he refused (8/18/93). Finally, on 11/11/93, nearly one year after
we resumed our work, he agreed to take fluoxetine (Prozac), gradually in-
creasing the dose to 20 mg daily. The effect of the fluoxetine was highly
beneficial in reducing his irritability and worriedness. This clearly contrib-
uted to liberating his constructive forces so that he could work more effec-
tively with others.
Soon after our work began, he moved his practice to a smaller, less ex-
pensive office and seemed able to deny himself the more extravagant ap-
purtenances of success. He hired a secretary with whom he developed a
tolerable relationship. A full year after we began our work, he reported
accomplishing more and making more money (1/30/94). Whatever analysis
of his major solution and pride system we were accomplishing, it is also
true that the reaffirmation of his solution has been accomplished by his
new success aided by medication. Paradoxically, his success was under-
mining our analytic efforts. He was once again fulfilling his shoulds, more
or less. Much of our work during this time was devoted to my serving as a
kind of auditor to his reviewing his different legal matters in our sessions. I
would ask questions that served to clarify issues muddied at times by his
own characterological vulnerabilities and defensive moves. While this was
 THE HOFGEISMAR LECTURES 129

of considerable interest and help to him, after a while he began to resent it

and feel ashamed because of it:

He interprets my interest in his projects as my having given up on him. In a

seemingly unrelated association, an episode of anger on a flight is described—it
is a source of great shame to him, that I would think he is nuts. The object of the
anger, the flight attendant, is displaced from me. I say nothing about this, but
note inwardly that he is desperately fearful of expressing his anger at me. I need
to redirect my attentions. He wants us to do less of this ‘business consultation’
work. The decision to engage with him in this way had served a useful function
and now needed to cease. (4/17/94)

His attendance at AA was about three-times-weekly. That, with the Pro-

zac and our work in modified analytic therapy, seemed to be a formula for
his success: “Roger announces to himself that he has a lot to be grateful
for, and then adds in surprisingly strong tones, ‘I am grateful’” (3/27/94).
The year 1994 turned out to be his most successful year ever (10/6/94). He
began bringing in other attorneys to work with him, expanding his firm and
moving back to larger quarters. The year 1995 saw a continuation of this
prosperity. On 10/15/95, nearly 3 years after his return to analytic work, he
and his wife, with whom his relations were once again excellent, bought a
$200K sailboat. That he could purchase what he regarded as an expensive
boat signaled his success and fulfillment of critical internal shoulds. Re-
markably, he says, “My life is like I died and went to heaven” (5/3/96).
Despite this apparent success of our work, he and I recognized the fragility
of his well-being, relying as it did on finding a congruence between his
professional success and his inner dictates, dictates that were a legacy of
his neurotic compliance to his mother’s exploitative demands. A series of
disruptions in our schedule accompanied by his continuing to feel genu-
inely happy led to his asking about stopping our work. We discussed this
at length. It was my private view that our work reconstituted Roger’s com-
prehensive solution while rendering it less impoverishing. Our work con-
tributed to a reduction in his alienation and provided considerable en-
hancement of constructiveness. Our effort might be more regarded as
analytically informed supportive therapy rather than a successful, com-
pleted analysis. What matters is the sense of the patient’s deriving benefit
from the work. I was satisfied with the efforts here.
Roger and I did not work through to termination, but, as we did 20 years
earlier, we decided to stop at the end of 1996. We were explicit that I was
available if he wanted to return at any point for a single consultation, a
short period of therapy, or a longer re-engagement in analytic work. I
130 INGRAM

would want to see him at 3-month intervals for medication evaluation and
possible prescription renewal. By mid-1997, however, he discontinued Pro-
zac without eruption of difficulties. Greeting cards received from him at
Christmas season of 1997 and 1998 indicated that he enjoyed continued
prosperity in his law practice and in his marriage. In the greeting card of
1998, he said AA meetings are a weekly feature of his life and that Louise
and Josey are doing fine.

NOTE

1. Caspar Milquetoast, a character in a comic strip created by Harold Tucker Webster (1885–
1952) in 1924, was a timid and retiring man whose name was, of course, created from the
name of a timid food. The first instance of milquetoast as a common noun is found in the
mid-1930s (Microsoft Bookshelf, 2000).

III. ADVANCES IN HORNEY THEORY, THE AMERICAN INSTITUTE FOR

PSYCHOANALYSIS, AND A NEO-HORNEYAN NARRATIVIST INTERPRETATION

A central character is denounced by others in the early pages of Irvin

Yalom’s novel, Lying on the Couch (1996). The character acknowledges
and defends his sexual activity with a patient. Yet, he is portrayed as an
enormously gifted clinician and teacher—and a follower of Karen Horney.
Yalom, himself, is an admirer of Horney’s contributions. He was the 1999
annual Karen Horney Memorial lecturer and acknowledged the wisdom he
had gleaned from her work.
In recent years, Horney’s point of view has received renewed impetus as
a consequence of a surge of interest in the rights of women and of largely
disenfranchised cultural minorities. Because of her emphasis on the impact
of culture in forming character, her questioning of absolute truths emanat-
ing from seeming scientific verities, her interest in the meaningfulness of
symbols for the individual psyche, her spirit of rebelliousness and her valo-
rizing the cause of a subordinated group in the face of a power elite, Hor-
ney has received new attention. As a consequence of her culturalist orienta-
tion, in some circles she has been called a proto-postmodernist.
A question frequently raised about Horney’s work is: Why does Horney
use a vocabulary so different from Freud’s? Couldn’t she have said the same
thing in the language that had become traditional in psychoanalysis? As
Foucault emphasized, following Wittgenstein, all thought and communica-
tion must rely on the available discourses. Conversation—including dis-
senting points of view—will incline in the direction of those with estab-
lished power, those who originate and then sustain the lexicon in which
conversation is conducted. In order to articulate original concepts, accord-
 THE HOFGEISMAR LECTURES 131

ing to this neo-Marxist interpretation, one needs to invent new language

insofar as the available language inevitably biases the direction of thought
in predetermined lines. This view of language underscores the political im-
plication of all discourse, the discourse of psychoanalytic theorizing not
excepted.
Accordingly, if one has a strikingly new way of looking at things, it is
exceedingly difficult to use the old vocabulary and still be heard. This was
precisely the dilemma Horney faced. How could she be heard? How could
she influence the direction of psychoanalytic theorizing? The old words
inevitably conjured the old points of view. One cannot use transference
without calling forth implicitly repetition compulsion. Put differently, theo-
ries of knowledge cannot be separated from the language in which those
theories are articulated. For Horney to be heard, she would need a new
lexicon of terms. She would need to create from within the psychoanalytic
discourse a counterdiscourse. We can find current-day examples every-
where that can serve to describe how language games, as Wittgenstein
called them, powerfully influence cultural attitudes. What, for example,
happened to the term neurosis, at least in the United States? Why has it
been abandoned in favor of disorder? Who decided to make this change?
Why? What is the consequence of this change for psychoanalytic clini-
cians?
That an effort would be made to place psychoanalytic approaches on a
cultural base rather than a biological base came as no surprise to those
living in the 1930s. The disciplines of psychology, anthropology, and soci-
ology, which had germinated in the late nineteenth century, were flower-
ing. It was becoming increasingly acceptable to recognize that people
could think, feel, and behave very differently because they lived in very
different cultures. Unlike today, when neuroscience, genetic engineering,
and computer technology are holding sway, in the 1930s it was the social
sciences that seized imaginations. It seemed to many that the Freudian posi-
tion with its heavy, unproved biological emphasis need to be forced-fit to
address differences in culture. For Freud, culture had its origin in biological
factors. For Horney, matters were reversed: Biological factors arose from
and were used for the purpose of affirming dominant cultural attitudes.
Was Horney the only analyst to move in this culturalist direction? No.
More classically, Abram Kardiner’s work addressed this question. In France,
Jacques Lacan was writing on early development at the same time that
Horney was writing The Neurotic Personality of Our Time (1937). His work
would also rely on how culture, more specifically culture as expressed in
language, was a focus for psychoanalytic inquiry. Not many years later,
both Horney and Lacan would leave major psychoanalytic societies, the
American Psychoanalytical Association and the International Psychoanalyt-
132 INGRAM

ical Association, respectively, creating divisions for those who immediately

followed them and later, for all of us, right to the present.
The counterdiscourse that Horney established was immensely popular. It
was based on a kind of common sense and used words in ordinary parlance
that an educated laity could understand. Her English prose was lucid, her
thinking clear and concise, and her case examples compelling. Her reader-
ship discovered themselves in her pages. Horney’s writings caused her to
fall out of favor with the leadership of the New York Psychoanalytic Insti-
tute. She was demoted and immediately resigned from that Institute and the
American Psychoanalytic Association. She formed the American Institute
for Psychoanalysis, which broke the monopolistic hold in America of ortho-
dox psychoanalysis. Soon, Sandor Rado, who led the psychoanalytic insti-
tute at Columbia University, likewise would grow disaffected with the
American Psychoanalytic Association and, with the graduates of his insti-
tute, moved to its political fringes.
Meanwhile, Horney’s institute encountered its own political difficulties.
The American Institute for Psychoanalysis struggled with the question of
whether nonphysicians had equal standing with physicians. This arose
largely in connection with the possible faculty appointment of Erich
Fromm, clearly an outstanding scholar and teacher, but not a physician.
Not incidentally, Horney had earlier engaged in a lengthy intimate liaison
with Fromm. On this matter of Fromm’s appointment, Horney was devoutly
conservative: She insisted that psychoanalysis be kept medical. The Wil-
liam Alanson White Institute was the product, in part, of this controversy.
It would not be until the 1970s that the American Institute under the leader-
ship of Theodore Isaac Rubin began accepting psychologists, social work-
ers, and psychiatric nurses. Another group within the American Institute
wished to affiliate with a medical school, New York Medical College. This
group, too, departed. As a consequence of the burgeoning of interest in
psychoanalysis that occurred in America in the late 1940s and 1950s, many
psychoanalytic institutes subsequently were formed by graduates of these
institutes or by members of the American Psychoanalytic Association. Many
of these new institutes shared a common distaste for the control exerted by
the central governance of the American Psychoanalytic and for its insis-
tence on theoretical orthodoxy. A surprising number of these institutes took
their theoretical lead from Horney’s culturalist orientation—or at least
wanted the freedom to make room for it. That orientation became so influ-
ential that citation to Horney’s pioneering work diminished; it had entered
the zeitgeist of much of psychoanalysis. The founding of the American
Academy of Psychoanalysis in 1956 provided a national alliance and forum
within the United States for the medical graduates of these institutes, now
referred to as ‘neo-Freudian.’
 THE HOFGEISMAR LECTURES 133

At the American Institute for Psychoanalysis, a sister society, the Karen

Horney Clinic, was founded in 1955. It has continued to offer low-cost
psychoanalytic and other treatment, and has enabled candidates at the In-
stitute to acquire clinical experience. The American Journal of Psychoanal-
ysis and the Association for the Advancement of Psychoanalysis, founded
by Horney almost immediately after her departure from the New York Psy-
choanalytic Institute, provided for the dissemination of work produced by
herself and her followers.
During the 1970s, the work of Alexandra Symonds, springing from the
earlier writings of Horney yet amalgamated into her later theory, served as a
rallying cry within the women’s movement—particularly within psychiatry.
Symonds founded the American Women’s Psychiatric Association. In multi-
ple papers, seminars, and presentations, Martin Symonds showed the appli-
cation of Horney theory to the understanding and treatment of victims of
crimes. The popular books of many authors, most notably those of Theo-
dore Isaac Rubin (e.g., 1983), have done much to promote acceptance of
the psychoanalytic paradigm, and more specifically the contributions of
Horney. Scholarship within the American Institute for Psychoanalysis has
continued with academic publications drawing important links between
Horney and Bowlby (Paul, 1984, 1985; Ingram, 1984), Mahler (Lerner,
1983), object relations theorists (Lerner, 1985; Ingram and Lerner, 1992;
Rosenthal, 1983), the borderline syndrome (Mitchell, 1985), self-psychol-
ogy (van den Daele, 1981; Paul, 1989; Danielian, 1988), personality devel-
opment and the idealized image (Tershakovec, 1979), Buddhism (Westkott,
1998; Morvay, 1999; Christensen and Rudnick, 1999), self-esteem (Katz,
1998), gender feminism (Dimen, 1995; Price, 1995), and marital therapy
(Horwitz, 1994). Over many years, Bernard Paris, the eminent literary critic,
has applied Horney theory to literary work (e.g., Paris, 1991, 1999b). His
recent biography of Horney (1994), like those of Susan Quinn (1987) and
Jack Rubins (1978), and his recently published collections of her papers,
entitled The Therapeutic Process (1999) have done much to draw together
and unify the corpus of scholarship about Horney and her life. Candidates-
in-training at the American Institute and students of the program in dynamic
psychotherapy, as well as psychology and social work interns at the Karen
Horney Clinic, all take courses in Horney theory. Candidates study the de-
velopment of Horney’s thought over a year of weekly classes. Her early
papers on feminine psychology are reviewed. The clinical application of
her theory is taken up in other courses and in case conferences. Freudian
theory, object relations, relational theory, and self-psychology are all taught
at the institute to ensure that by the completion of their studies, candidates
can feel secure that they have some comprehension of current psychoana-
lytic discourses.
134 INGRAM

Nevertheless, those of us who are steeped in the work of Horney and

have the highest regard for its value recognize that the wisdom and com-
passionate understanding it provides do not speak as mightily to the
younger generation of professional men and women as it did to our own.
The metaphors and usages, the case illustrations, the essential cultural
premises that made Horney’s writing salient during her own time and for a
while afterward, we acknowledge, are somewhat dated. In Horney’s day,
for example, ‘tyranny’ was a reigning cultural metaphor. It earned its vitality
from the concern about dictatorship and authoritarianism that dominated
in the first half of the twentieth century. ‘Tyranny’ was a signifier that com-
prehended the operations of government and, reapplied, served to compre-
hend the operations of the mind. Horney’s ‘tyranny of the shoulds,’ rather
like the Freudian notion of a ‘harsh superego,’ captured a general imagina-
tion. During the Cold War, the neat opposition of two superpowers and the
threat of nuclear annihilation supplanted concern about tyranny. Instead,
Winnicott spoke of ‘annihilating anxiety’ and Kohut of the ‘nuclear self.’
Much of psychoanalytic theory moved away from concerns about power-
ful, dominating structures of the mind and toward what a more Freudian
vision would call pre-oedipal considerations. Still more recently, the over-
whelming presence of electronic technology enabling an explosion of me-
dia input on all sides, of affordable transportation, and of easy telephonic
and e-mail relationships—and coupled with the absence of easily identifi-
able large enemies that can serve as fixed cultural displacements for fear
and aggression—have modified still further what seems salient within psy-
choanalytic theory. Add to this the newer generations of psychotropic med-
ications and advances in neurobiology and we find that psychoanalysis has
needed to move into a theoretical realm notably different from what Hor-
ney faced. The metaphoric substrates of the culture have shifted.
Still, I think you can appreciate my essentially Horneyan sensibility in
my inclination to look at the wider culture for cues about psychoanalytic
theory. In my own work I ask, what are people coming into treatment for?
Do they ask for psychoanalysis? I find it surprising how often referrals to
my practice say something like, “My wife said I have problems and I should
speak to someone.” After 30 years and what I estimate to be about 50,000
hours of providing direct patient care through psychoanalytic psychother-
apy, I have some ideas of my own about how to be helpful. For example,
I find that the phrase, ‘speaking to someone,’ matters more than the phrase,
‘I have problems.’ This is just the reverse of how I thought years ago. How-
ever useful medication is—and it can be immensely useful as we observed
in the case of Roger—people need to talk, to tell their story, to organize
their sense of personal experience in language and have that registered and
legitimated.
 THE HOFGEISMAR LECTURES 135

More and more, I regard my patient as a kind of storyteller, a maker of

narrative, what Hadyn White referred to as Homo Narrans. As Roland
Barthes (1977, p. 77) said: “Under [an] infinite diversity of forms, narrative
is present in every age, in every place, in every society; it begins with the
very history of mankind and there nowhere is nor has been a people with-
out narrative. . . . [N]arrative is international, transhistorical, transcultural:
it is simply there like life itself.” This view that I am enunciating, psychoan-
alytic therapy is a storytelling, is a metaphor that seems to me a salient
reconstruction of theory. This is the narrative metaphor (Ingram, 1998). The
times seem to call for it. People, regardless of their presenting symptoms,
need to talk about themselves. Telling one’s story—talking to someone who
is a trained interlocutor—is valuable. However beneficial Prozac was for
Roger, there was never any question that our talking was the larger context
of treatment.
Now, I am not saying that the narrative metaphor—about which I will
say more—is the be-all and end-all. It captures my clinical imagination and
seems to be helpful. It affirms the culturalist argument. In my judgment,
Horney dropped the culturalist ball along the way. Despite Barthes’s oracu-
lar utterance that sounds the alarm for the eternality and centrality of narra-
tive, I think that at some point the narrativist view will lose interest. Not
that it will be wrong, just that no one will care very much about it. Or
perhaps it will be absorbed thoroughly into social thought—rather like Hor-
ney’s culturalist position has been. Thinking back, it seems that even Hor-
ney lost interest in her own culturalist revolution within psychoanalysis. In
The Neurotic Personality of Our Time (Horney, 1937), culturalism and the
flux of human identity was a rallying cry. But by the time we reach Neurosis
and Human Growth (Horney, 1950), the cultural perspective has dwindled.
Although the theory is filled out and more useful, all we have is a shadow
of what made Horney’s original contribution so significant. She seems to
have shifted from cultural relativism to essentialism. Her approach to the
pathogenesis of neurosis became situated in a model that was outside of
cultural flux.
Take the concept of the real self, for example. The real self, please recall,
is that center in each person from which growth and constructiveness pro-
ceeds. The real self has a certain appeal, but to me it sets up a kind of
oppression by spinning our concept of health in the direction of a fully
organized, integrated, preexisting construct. It is an object one accepts on
faith. Calling it ‘real’ cleverly distracts our critical thinking from the fact
that there is nothing empirical to support it. Nowadays, it seems like we
are so many things, our interests so diverse, our social groups so heteroge-
neous, our discourses so various and multiple that we can seem like a
potpourri of many selves. For a fairly full discussion of this matter of the
136 INGRAM

real self, I refer the reader to a recent issue of the American Journal of
Psychoanalysis (Horner, 1999; Ingram, 1999; Paris, 1999a). Perhaps more
is gained clinically by regarding the person telling me his or her story as
the ‘storytelling self,’ seeking to gain some mastery over the battalion of
impulses, feelings, wishes, and identities vying for expression. I want this
storytelling self to succeed by narrating more conscious and unconscious
elements of psychic experience (see Schafer, 1992; Spence, 1982). Natu-
rally, the story lacks a plot and is not told artfully. In fact, if it is told with
a sense of seeking a dramatic or humorous or entertaining impact on the
analyst, we know the spontaneous flow of discourse is being shaped to
fulfill a private, perhaps unrecognized wish in the patient. We would want
to ask about it with a comment like, “I sometimes get the feeling that you
are trying to make me curious, to create a kind of suspense. Do you have
a sense of that?”
This leads me to another matter inherent in the application of the narra-
tive metaphor to psychoanalytic therapy. The essential secret that runs
through all of psychoanalysis is that the patient, in the telling of his or her
story, inevitably seeks to recruit the interlocutor, the analyst, into the story.
That is, usually our patient will construct us as the ‘listening Other’ in such
a way as to make the telling of the story worthwhile. At other times, the
interlocutor is constructed precisely to avoid telling certain aspects of the
story. Here are some of the kinds of questions we want to consider: Follow-
ing Lacan, we might want to ask ourselves, To whom is the patient speak-
ing? Who does the patient imagine the analyst to be? Who is the Other in
the dialogue the patient is having? What is the content of the discourse of
the Other? Following Bakhtin, we might ask: How is utterance and dis-
course fashioned by this Other whom the patient has constructed? In the
clinical illustration, Roger constructs me to represent his mother, a simple
transference in Freud’s language. He even conscripts me into the position
through what we could call projective identification. On one occasion, as
I reported, I became resentful and actually attacked him from within the
transferential imputation, becoming his rejecting mother and mobilizing his
own peculiar brand of perfection.
Bernard Paris finds the work of Karen Horney congenial to literary criti-
cism because it does not depend on knowledge of a character’s early devel-
opment as Freudian or object relations theories do. Similarly, Horney’s the-
ory enables the patient’s story to become comprehensible through
recognition of how events of the immediate past flowing into the present
shape psychic and relational processes. Horney’s theory is about the per-
son, here and now. It engages the person synchronically, whereas other
psychoanalytic theories with their greater insistence on historical etiology
are diachronic. In my view, each theory of psychoanalysis, including Hor-
 THE HOFGEISMAR LECTURES 137

ney’s, provides a metastory to help us listen and make some sense of what
our patient is telling us. The metastory, the story about the story, gives us a
lexicon that imposes a sense of what is likely to be meaningful in the pa-
tient’s discourse. It gives us a direction to follow, often vague, in further
elucidating what remains to be told. My interests are in praxis, in the practi-
cal doing of analytic therapy—in the hope of doing it better. The narrative
metaphor, psychoanalytic therapy is a storytelling, leads us to consider how
certain semantic usages gain special meaning. Roger’s use of ‘chore’ and
my use of ‘complaint’ with him reshaped those words in our work. For me
(apparently more than for him), the phrase ‘living in the imperative mode’
was especially meaningful. This sort of thing happens in ways large and
small with each of our patients. What emerges is a private microdialect,
one of several signature features containing elements unique to this and
only this dialogic encounter (Ingram, 1994). When Roger speaks the word
‘chore,’ the angle of interpretive impact is necessarily different from that
found in any of the multitude of lexical universes I inhabit. How words
mean and, more specifically, how various tropes—metaphors and metony-
mies, most importantly—figure in psychoanalytic technique become cen-
tral in a narrativist approach (Ingram, 1996a, 1996b).
I like to think that in my own work I reaffirm Horney’s culturalist position.
I have moved into what some colleagues have called a neo-Horneyan,
postmodernist position. I am of the view that sometimes symptoms of men-
tal disorder—including alienation and impoverishment of personality as de-
scribed by Horney—have arisen because unity and integration of character
are valorized by the culture to an excessive degree. That is, by imposing a
notion of a cohesive, unified, integrated self, the culture inflicts an oppres-
sion by requiring an internal sense of wholeness that may no longer be
possible in our present-day world. To the extent that this is so, Horney’s
theory and some other psychoanalytic theories may aggravate iatrogeni-
cally neurotic symptom formation. From my point of view, inconsistency
may be a kind of breeding ground for new life-forms within the psyche,
serving as an expression of multiplicity in self-identification. As Lyotard
(1979) has contended, the world—and by extension, ourselves—is proba-
bly not as integrated and comprehensible through coherent, value-free, po-
litically neutral knowledges as we used to think. The narrative metaphor,
psychoanalytic therapy is a storytelling, tends to subordinate the place of
conflict and cohesive integration as a value to be sought. Instead, it elevates
the benefit of talking itself.
There is something else that the narrative metaphor does—or more pre-
cisely, seems to invite of the analyst. (I acknowledge that what follows is
not likely to be a popular idea.) The narrative approach calls for the prepa-
ration by the analyst of case reports or some kind of ongoing supervisory,
138 INGRAM

perhaps peer supervisory, presence. The case illustration of Roger is an

example of this. It is modified from the actual record in order to hit home
certain points about Horney theory and to protect the patient’s privacy, but
is otherwise an example of ongoing analytic case reporting. At periodic
intervals, say every 3 months, it seems useful to review the patient’s record
and—for the purposes of self-instruction—to update the ‘story.’ Spelling it
out, writing it down, wondering whom one is writing to, and so forth—all
this goes into the task and promotes the clinical engagement. The advent
of word processing facilitates this task, which, once the clinician gets ac-
customed to it, is remarkable in the positive benefits it provides. This is a
very different position from Bion’s call for the analyst to leave memory and
desire outside the consulting room. On the contrary, the narrative perspec-
tive brings emphasis to the value of studying one’s notes and knowing what
is going on in all its specificity. It is easy, I find, for experienced clinicians
to forget that each patient entails a certain amount of homework—and not
simply financial bookkeeping.
For the patient to tell his or her story, it is of value to ask very specifically
about certain kinds of matters that are often considered outside the realm
of analytic discourse. Asking a teacher how she goes about helping students
to spell, or a mechanic about what a carburetor does, or a mother how she
puts her child to sleep—these kinds of questions bring aspects of the pa-
tient’s functioning into the story. Following this point of view, for example,
a supervisee asked his patient about how she went about canning tomatoes
(Ingram, 1997). What emerged beyond the step-by-step recounting of the
canning process was the sudden recognition of how much the patient’s
grandmother figured in her constructive childhood development, providing
a shaping presence. Similarly, during one year of my work with Roger, we
explored in detail the issues he faced in his practice of law. The opportunity
to lay it out, to teach me about his cases, provided him with a forum to
organize his own thinking. In teaching me, he also taught himself. My ques-
tions might sometimes enhance his thinking, sometimes not. Then he sig-
naled that it was time for us to stop, that this made him feel I had given up
on him. The value of inquiring about ordinary everyday matters was time
limited. Still, it seems to me that our task involves a considerable amount
of specifying and particularizing of the patient’s life—speaking about it,
registering it discursively, caring about it and, through caring about it, car-
ing about the patient. However the story is obtained, through free associa-
tion or the questioning about specifics, it is developing the story that we
seek.
Having said all this, I wish to close by noting that the narrative metaphor,
psychoanalytic therapy is a storytelling is flawed as generative metaphors
always must be. As I have written elsewhere, the narrative metaphor “high-
 THE HOFGEISMAR LECTURES 139

lights the storying rather than the sensual experiencing of life, the poetics
of description rather than the listing of symptoms, the multiplicity of voices
that live within a person rather than a single invariant self, and the emphasis
on language rather than action or feeling” (Ingram, 1998, p. 184). Further-
more, however useful that narrativist perspective is despite these limita-
tions, we must keep in mind that the lives and persons of each of our
patients inevitably overflows narrative organization. In neurosis, the desper-
ate urge to simplify their lives in the face of ongoing distress leads our
patients to develop inflexibly simple solutions, simply expressed in the ana-
lytic setting and interpreted through whatever theoretical metastory each
clinician happens to prefer.
The ambiguity of language, of venturing description, the turbulence in-
herent in every utterance as described by Bakhtin (1984) and the herme-
neuticists (e.g., Todorov, 1978 )—all this ensures that the patient’s story
can never be the whole story. Our task is to draw out the actual complexity
of their lives, enriching their stories with the help of our preferred metasto-
ries—such as Karen Horney’s—deconstructing signifiers, suggesting new
signifiers, destabilizing meanings and defenses, inserting overlooked mat-
ter, raising questions, specifying and particularizing, identifying the dis-
course of the Other whom the patient is addressing, and establishing a kind
of environment that is both interesting for the task it enables and comforting
for the care it provides.

Acknowledgments. The author wishes to thank Dr. Barbara Heller of the Evangel-
ische Akademie Hofgeismar for sponsoring this series of presentations and Dr. Lud-
wig Hochgeschwendter for so effectively translating these presentations to the
German-speaking audience. These lectures were delivered at a seminar at the Aka-
demie on October 23 and 24, 1999.

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