Preventive Community Psychiatry: Psychoanalytic Homecoming? A Panel Discussion

As the pressure for effective community mental health measures becomes greater, more and more of our colleagues are responding with interest and enthusiasm. Mingled with this response, however, may be a sense of confusion, doubt and some little anxiety. The existence of these feelings in some of us requires that we consider and reconsider our position in this psychiatric thrust towards the total community. Many of us feel that as a methodology, classical Freudian or neo-Freudian analysis is not suitable for comprehensive mental health care. Yet, analysts are among the most highly and, I might add, most expensively trained specialists in our profession. Many questions, then, arise. What is to be done with all this training in a new milieu? Are we analysts to be merely the gleaners, or are we to be primarily the reapers of the advantages we hold because of this rich background? Are we to make abundant, rather than incidental, contributions towards the growing crises of our day? Will it be possible to develop a discipline, which has been only for the few, into an affective one which will serve thousands? Can we create a true homecoming of psychoanalytic theory and practice so that rich and poor alike, the learned and the ignorant, can benefit?

My own interest in preventive psychiatry was given impetus when I was invited into a public school in New York City as a consultant. It soon became clear that, in addition to a chronic shortage of personnel, there were feelings of uncertainty and frustration regarding practices designed to help problemed children. Further, school personnel were so involved in trying to meet the needs of these particular youngsters that the possibilities for prevention were largely unexplored. It was on this latter point that I felt I could be of service, and I initiated programs with parent groups for the primary prevention of learning and behavior disorders in school children. The programs included parent group discussions, and the simultaneous t