Psychoanalysis in Mental Health

In 1919, Sigmund Freud said: “At some time or other the conscience of the community will awake and admonish that the poor man has just as much right to help for his mind as he now has to the surgeon's means of saving his life; that the neuroses menace the health of the people no less than tuberculosis, and can be left as little as the latter to the feeble handling of individuals.

“It may be a long time before the state regards this as an urgent duty… sometime or other, however, it must come.

“The task will then arise for us to adapt our techniques to the new conditions … Possibly, we may be able to achieve something if we combine aid to the mind with material support.

“It is very probable, too, that the application of our therapy to large numbers will compel us to alloy the pure gold of analysis plentiful with the copper of direct suggestion …,”¹

For many years after the advent of Sigmund Freud, psychoanalysis was considered a one-to-one form of therapy. Only in the last decade, after group psychotherapy became better accepted, has there been an increasingly eloquent plea for psychoanalysis which could be made available for groups of patients in an effective manner. However, whenever and wherever a fully trained psychoanalyst would express the wish to return to the staff service of a state hospital, this would be considered either a waste of laborious and long psychoanalytic training, or unsuccessful or only partially successful personal analysis of the physician who wanted to go back to “State.” It was generally felt that the analyst who would choose a state hospital career was either personally insecure, unwilling, if not unable to face the Park Avenue competition, that he wanted to escape from a life situation with which he could not cope, or that in a symbolic way he wanted to escape from himself. I will not dwell on the merits of recognizing one's own neurotic residuals after analysis, nor on the possible neurotic residuals that could be inherent in opening an offi