Psycho-Analysis and Medical Practice1

In recent years, the training of general practitioners and non-psychiatric specialists in psychiatry and psychotherapeutic methods has become a public problem of some importance. The reason for this change has been the realization that a substantial number of people asking for surgical and medical assistance are in fact suffering from emotional problems. To offer them surgical or medical treatment has proved inefficient and unhelpful, a waste of time, money, and energy, and has often amounted to gross neglect, or even cruelty.

Freud was one of the very first to foresee this development: in his Budapest Congress paper in 1918 he predicted that the time would come when society must accept that the individual has the same right for help in his neurotic or emotional suffering as in his organic illnesses. At present, all over the Western world, and in particular in the United States, large sums of public money are spent either in the form of grants to non-psychiatrists, especially general practitioners, to induce them to change over to psychiatry, or for organizing courses to teach those who want to remain in their branch of the profession some kind of psychotherapy.

An important question faces us here: Shall we analysts accept any responsibility in this field? If so, what sort of responsibility? Or shall we keep out of it? As the answer to this question is rather complex and bristles with difficulty, it is worth remembering that we were faced on two previous occasions with similar problems, and on the two occasions the psycho-analytic movement gave two diametrically opposite answers.

The first occasion arose in the early twenties, when the question was: Should we psycho-analysts accept responsibility for developing techniques for child psychotherapy? The answer was an unqualified 'Yes', and the result of this decision was the development of child analysis, a real pride for us, and a great impetus for the development of both our theories and techniques