Discussion

Dr. Rubins has presented a thoughtful and timely paper on a topic which concerns itself with two important questions. The first concerns the nature and the future of psychoanalysis. The second is: how can the most effective and highest-quality care be given in a community mental health program?

There is a crisis in the field of psychoanalysis today. While most people acknowledge the great debt to psychoanalysis of psychiatry and of most approaches to mental health, it is evident that psychoanalysis as a therapeutic technique has fallen victim to a mess of confusion. To a large segment of the public and to many medical practitioners there is no differentiation between psychoanalysis, psychiatry, and psychotherapy. Most people have a vague concept of the traditional psychoanalyst, sitting behind his couch treating his patients three to five times a week. There exists widespread ignorance as to what a psychoanalyst really is and the many forms modern psychoanalytic practice may take.

The report of the Joint Commission on Mental Illness and Health, entitled Action For Mental Health, declares that psychoanalysis is impractical for the large-scale demands of a community mental health program. Such a mistaken conception is due to a restricted vision of psychoanalysis in which only the old, classical form is seen. This is far from the truth, and Dr. Rubins has shown in his paper that the psychoanalyst uses his special training and skills in many ways beyond traditional, classical psychoanalysis. We shall return to this later.

The first psychiatric revolution of this century, the emergence of psychoanalysis, provided a great leap forward in understanding the link between mental or emotional illness and so-called normal people. Freud, Horney, and other psychoanalytic thinkers revealed to us the existence and universality of unconscious forces, neurotic conflicts, and the development of the character structure from the time of earliest infancy. The personality structure of all pe