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The role of the psychoanalyst in the 1990s continues to change more rapidly than most of us would like. The forces precipitating and sustaining these changes are multiple; the evolution of psychoanalysis is multidetermined. Some of these forces are economy driven, for example, the rise of managed care. Others are market oriented as evidenced by the competition from other mental health professionals. One force that I have increasingly focused on professionally is crisis driven: the impact of the “Age of AIDS.” The healthcare crisis precipitated by the AIDS epidemic increasingly affords mental health professionals, and I believe dynamically oriented psychiatrists in particular, a prominent clinical role. Trained both medically and psychodynamically, the medical analyst (and the dynamically trained psychiatrist) has the comprehensive technical understanding and experiential skills to offer a wide range of therapeutic interventions for patients and professional caregivers. Leading a support group for health care staff working largely with AIDS patients in one such area.
Fifteen years into the AIDS crisis, the impact on those caring for persons with AIDS has become increasingly apparent. Nuland (1995), in his best-seller How We Die, writes:
In the calculus of death, no one before 1981 could have factored in HIV, the human immunodeficiency virus. The first hints of its gathering fury struck just at the instant when biomedical science was beginning to offer cautious congratulations to itself on having achieved a state of advancement where the final conquest of infectious disease seemed at last within sight. AIDS not only confounded the microbe hunters; it shook the confidence held by all of us that technology and science can keep humanity safe from the whims of nature. In a very few explosive years, virtually every