Some Issues in Community Mental Health—Psychoanalysis and Community Psychiatry: Confrontation or Collaboration?

AT FIRST SIGHT psychoanalysis and community psychiatry seem to be natural enemies. Psychoanalysis is the epitome of private practice psychiatry; community psychiatry is really a new term for public health psychiatry. As community psychiatry has grown to become a major force in American psychiatry, confrontation between these two opposites would appear to be as inevitable as that between free private enterprise and socialism, and any unforced collaboration would seem unlikely.

Nevertheless, there has been collaboration of a kind between community psychiatry and psychoanalysis. Regardless of the emphasis it places on social factors in mental illness and on social action, community psychiatry must also be concerned with individual patients, and psychoanalysis provides by far the most comprehensive framework for understanding individual psychology yet devised. Furthermore, although some psychoanalysts have perceived the community component of psychiatry only as a threat to the purity of psychoanalysis, others have contributed substantially to community psychiatry. They have contributed a basic understanding of unconscious mechanisms and a deeper awareness of the individual as he participates in his social systems. They have helped workers in the field of community psychiatry to understand resistance, and to tolerate hostility on the part of others. They have helped to adapt to community settings concepts of transference and countertransference. Lindemann and Caplan have developed theoretical concepts of prevention and of crisis theory, and Bernard and Caplan have pioneered in the