In the first decade of the 21st century, there were approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association (APsaA), which is a component organization of the International Psychoanalytical Association (IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland,  and many others, as well as about six institutes directly in the .
The Congo River is the key to Africa for Europeans. It allows them access to the center of the continent without having to physically cross it; in other words, it allows the white man to remain always separate or outside. Africa is thus reduced to a series of two-dimensional scenes that flash by Marlow’s steamer as he travels upriver. The river also seems to want to expel Europeans from Africa altogether: its current makes travel upriver slow and difficult, but the flow of water makes travel downriver, back toward “civilization,” rapid and seemingly inevitable. Marlow’s struggles with the river as he travels upstream toward Kurtz reflect his struggles to understand the situation in which he has found himself. The ease with which he journeys back downstream, on the other hand, mirrors his acquiescence to Kurtz and his “choice of nightmares.”