It will be ten years this May since the Standing Committee on Community Psychiatry was established. In 1968, when it came into being, wide-scale and profound changes were underway in American psychiatry under the general rubric of “Community Psychiatry.” The Association's interest in social and group phenomena had long been evidenced in various ways. But community and social psychiatry had gained unprecedented momentum in the 1960s. Its push to extend more comprehensive and relevant mental health services to all segments of the population was greatly intensified by new Federal legislation and funding. This governmental role contributed to making community-based mental health service patterning a socio-political issue enmeshed in the social ferment of the times: the civil rights and black protest movements, the “war on poverty,” student unrest, and Vietnam, with all its psychosocial repercussions.
Many psychoanalysts viewed the burgeoning of community psychiatry quite negatively. Yet, much of its pioneering had been by analysts. These two approaches to psychological well being, psychoanalysis and community psychiatry, had become polarized to the detriment of each. In setting up this Committee, the Association sought to counteract this adversary situation and to give affirmative organizational support to community-oriented analysts for working toward synergistic relationships between community psychiatry and psychoanalysis.
The Committee's work of the past ten years is best reviewed in terms of evolutionary process. This process, interactive with concurrent developments in psychoanalysis and community psychiatry throughout the decade, has moved, for example, from our initial emphasis on community program dynamics to our current focus on theory and training.
The Committee was charged primarily with studying the contributions and limitations of psychoanalysis with respect to community psychiatry, and with relating to Affiliate Societies, the membership, and various other committees of the American.
To fulfill this, we have used since 1969 a three-track method. Three interrelated sets of meetings have been held twice a year. The Committee itself has functioned as a study group for two days each November and April. Affiliate Society representatives have met with us at both annual Association meetings (known as “Reps Meetings”). Also, at both annual meetings, we have organized
discussion groups. Since Dr. Bandler started these, their Chairmen, all Committee members, to insure coordination, have been Drs. Linn, Coleman, Hitchcock, and Shopper. Records have been kept of this total of six meetings a year for nine years.
For the first years we heard and discussed candid, confidential case-method presentations of the complex dynamics of specific community mental health programs. These case histories provided a base of raw data. The study group and Reps then worked on a systematic way to organize such data. We produced an instrument for describing the dynamics of the development and course of a community mental health service program. It was a tool for determining program success or failure through the interactions, over time, of seven components.
In 1974, the Committee organized a panel for the annual meeting. Two papers were presented: “Interactions Between Community Psychiatry and Psychoanalysis in the Understanding of Ego Development,” by Davis and Coleman; and “Superego Variants: Lessons from Community Psychiatry,” by Linn, with Block and Zinberg as discussants. The Panel, reported by Wadeson (Ref. #1), reflected shifts in Committee process: from stressing analytic contributions to community psychiatry, we came to emphasize their two-way relationships; and from a major focus on service issues, to their theoretical implications.
This was also reflected in the discussion group topics. Thus, in 1974, Wallerstein's 1972 Presidential Address, “Psychoanalytic Perspectives on the Problem of Reality”, was discussed, and several subsequent discussion groups centered on social reality.
In 1974, the Committee was strengthened by Stanley Block's appointment as Co-Chairman. By then we had decided to produce a book of which Jules Coleman and I have assumed co-editorship. (The Maurice Falk Medical Fund awarded funds in 1976 for editorial help and office expenses.) Consisting mostly of writings not published before, the book will seek to demonstrate relationships and complementarities between psychoanalysis and community/social psychiatry. Its current working title, Psychoanalysis, Psychiatry, and Social Reality, reflects the present direction of our thinking, as well as awareness of the misconceptions, negative connotations, and limitations of the term “community psychiatry.” Although intended for a range of readers, a main purpose of the book is to provide a resource for broadening the present curricula in psychoanalytic institutes.
Toward this goal, the Committee and 22 Reps had already, in 1972, recommended to the Association's President, which he conveyed to the Affiliates, that on-going, elective workshops and seminars be developed. Nothing came of this then, but renewed effort was made through COPER. A working paper for Preparatory Commission VIII, “The Rationale and Strategies for Greater Inclusion of Social and Community Issues in Psychoanalytic Institute Curricula” (by Burnham and Dorn), was used by the Reps and Committee in evolving our current project toward developing a tentative course. With Moise Shopper as Chairman, twelve “modules” for a course on Psychoanalysis and the Community have already been presented and discussed at annual meetings since December, 1976, with the final four planned for this May. Two consecutive four-hour discussion groups on Wednesday and Thursday permit one-hour presentations by analysts with particular areas of expertise, plus a one-hour discussion per module. This format not only helps develop a course, but a faculty to teach it. Meanwhile, two Institute courses along these lines were developed in Topeka and Cincinnati.
Another current activity of the Committee is its survey of societies and institutes, to update, systematize, and add new kinds of information to our more informal collecting of data from them in 1969. At that time, we asked what they were doing or planning, organizationally or on the part of some members, with regard to community psychiatry. Our feedback to those respondents stimulated the ongoing Reps Committee. The data from our 1976 questionnaires are now being analyzed.
As we round out this decade of activities, we are thinking about next steps. In May we recommended and the Executive Committee approved changing the name of the committee to reflect its present scope more accurately. It is now the Committee on Psychoanalysis, Community and Society. Because of their overlapping boundaries, our Committee and the Committee on Social Problems are exploring if and how they might fruitfully relate. Also, the Chairmanship of this Committee should rotate soon.
This account would be incomplete without expressing the Committee's appreciation to the successive Presidents of the American for their consistent support, and to Mrs. Fischer and her staff for their unfailing and essential assistance.
Viola W. Bernard