Discussion of “Psychoanalysis Enters Its Second Century” by Robert Michels

Some weeks ago, a colleague responded to a lecture in which I explored “changing paradigms and psychiatric practice” (Astrachan, 1992) by asking why, in the face of such significant change, I continued to encourage students to choose psychiatry and why I continued to practice psychotherapy?

The answer, of course, is in the work and in those we serve. While change is inevitable and may be discomforting, the work that we do is useful, it is challenging, it is deeply interesting, and that work which yet will come, dealing with mind and brain together, holds the promise of even greater challenge. In his remarkably optimistic presentation, Dr. Michels examines two general issues, the clinical method of psychoanalysis and collaboration in the field, and in the face of great change he too sees promise. Michels' optimism is predicated on the receptivity of psychoanalysis to change. I am less sanguine about the willingness to change.

I am not a psychoanalyst, and I am thus not competent to discuss issues of psychoanalytic theory, the topic of much of this meeting today. I shall leave comments on Michels'remarks on theory to my codiscussant. After predicting how theory will change, Michels then looks at the social and cultural context of psychoanalysis—or to cut to the chase, who pays and for what services.

Michels challenges analysts themselves about the direction of practice; whether psychoanalysis can continue to pursue what he identifies as both medical and elitist definitions. It may be useful to restructure the argument. Years ago, reflecting on my interest in the nature and structure of psychiatric practice, I began work with Daniel Levinson and David Adler. The approach we developed draws upon sociologic theory and social psychology in order to try to understand psychiatric practice (Astrachan, Levinson, and Adler, 1976; Adler, Levinson, and Astrachan, 1978). Professions and their work do