The Changing Role of Psychoanalysis: Beyond Action for Mental Health

We Are Now Witnessing the third great revolution in psychiatry of this century. The first was, of course, the emergence of psychoanalysis as both a means of understanding mental functioning and as a treatment of the neuroses. Since then, the psychoanalytic movement has undergone many vicissitudes. Many of its principles and practices have had to be modified in keeping with later insights and changing social conditions. Newer psychoanalytic theories have become significant today. The apogee of this latter movement occurred immediately following World War II, when large numbers of young psychiatrists emerged, and psychoanalysis dominated not only the field of psychiatry but the other social disciplines, the humanities and the arts as well. During the past few years a reaction seems to have set in, and psychiatric interest in psychoanalysis has been waning. This is not general, however, and some reports indicate that interest is still high in some areas,¹ at least as evidenced by membership in analytic societies. Here, perhaps only 3 or 4 psychiatric residents out of 10 enter psychoanalytic training. Nevertheless, while the curve of enthusiasm for it has levelled off, it has retained a permanent place in our therapeutic armamentarium. Indications for the use of psychoanalysis in its original classical form have remained limited; but, in the newer modified forms, application of its principles have expanded into many newer therapeutic areas.

The second great revolution has been the introduction and use of psychotropic drugs in about the past 10 years. The degree of enthusiasm for this form of treatment was extremely high at first. Eight years ago, at an A.P.A. meeting, the opinion was expressed with enormous feeling that at last we had found a panacea in these drugs, and in a short time, with perhaps some refinements, we would see the eradication of mental illness. The use of these drugs has indeed changed the profile of psychiatric practice. Long-term hospitalization has