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“The world breaks everyone, and afterward many are strong at the broken places.” So wrote Ernest Hemingway in A Farewell to Arms, a line quoted by President Bill Clinton, who was deeply affected by the Columbine tragedy.
With the generous new funding by President Barak Obama of preventive medicine through the Affordable Care Act, there seems to be a revival, of a limited sort surely, of the community psychiatry movement of the 1960s and 1970s; there is at least the hope that the phoenix will rise from the ashes and yield a more fruitful outcome this time. The truth is that, with rare exceptions, our community mental health centers are doing poorly and that those that do well are lucky enough to have a good grant writer. That said, what is of continuing interest to psychoanalysts is whether there is a useful role for the psychoanalyst in community psychiatry, as there was at its inception. Since that time, the nation has experienced the effects of international terrorism, as well as massive public tragedies such as the Columbine school shootings in 1999. In that incident, two boys, in a matter of twenty minutes, killed twelve students and a teacher. At the height of the turnout, 750 police officers were present, and yet it took several hours for them and a SWAT team to settle things down, by which time the two boys had turned their guns on themselves. At least one student had suffered extremely serious injuries, due in part