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The viewpoint I am espousing here is neither as pessimistic and critical as that expressed by Kubie (Pitfalls of Community Psychiatry, Archives, Vol. 18, p. 257), nor as optimistic and enthusiastic as Dr. Linn. I feel I am more of a realist, with awareness of both the dangers as well as the constructive possibilities in the mental health movement. As an analyst who is concerned with and involved in community psychiatric activity, I believe that psychoanalysis has much to offer and can be fruitfully used, and that analysts should devote themselves to such activities and can derive as much satisfaction from it as from the more traditional form of practice. But these beliefs are not unqualified ones, and I feel some questions must be raised at the same time about our basic premises and underlying suppositions, about techniques and means now being used, about our goals and ends. However, let it be clear, lest these remarks be misinterpreted, that this questioning is not a denial of the need to change so many adverse and unhealthy socio-cultural conditions which contribute to emotional pathology, nor of the need to improve and extend mental health care for many who cannot sufficiently procure it today. Nor is this a denigration of the sincerity, the intentions, the efforts and work being done by many concerned professionals. It is rather an attempt to advocate caution, reason and attention to certain realities which some of us may be overlooking.
There is no doubt that this effort to bring psychiatric care to the large, hitherto rather neglected lower socio-economic group of our population, embodied in the community mental health movement, has constituted a third psychiatric revolution. The first two, the advent of psychoanalysis and then psychotropic drugs, were also thought to be panaceas at first. With each of them, many felt we would soon be able to eradicate mental illness, and their use spread rapidly. But since then the original enthusiasm and excessive claims have