To the Editor:
I view with alarm the conclusion at the Annual Meeting reported in the last Newsletter (Summer, 1984) that the Association shall discontinue its efforts to explore ways we might open our institutes to qualified nonmedical applicants for full clinical training. I fear for the future of our profession and our Association.
We need new blood to continue to have active training programs. There are less physicians going into psychiatry and fewer of these will make the sacrifices necessary for psychoanalytic training. There is no question that good clinical psychologists should be and are being encouraged to become psychoanalysts.
Some colleagues are concerned that we will lose our medical identity and that such a change will damage our relations with other physicians. Those who came and continue to come to psychoanalysis from medicine will always have a special interface position in the biopsychosocial world. As long as we from medicine choose to practice and keep abreast in medical and psychiatric activity, we will continue to be recognized as practicing physicians and psychiatrists. We will not lose our individual medical identities, but as psychoanalysts we will share an identity with psychoanalysts from different mental health fields.
Training nonphysician psychoanalysts can have many positive aspects. We can continue to be leaders in both psychiatry and psychoanalysis, and we psychiatrists can be enriched by the broader field of general psychology. Psychoanalysis would have a much wider influence in the mental health field. Psychoanalysis is not a biological process or a physical treatment. Psychoanalytic societies of many other countries, including England, recognize this fact and successfully train clinical nonphysician psychoanalysts …
There can be a tremendous advantage to psychoanalysis in forming a unified whole instead of promoting factionalism and competition. There are numerous assaults on psychoanalysis today and many of our most vocal adversaries are mental health professionals who are reacting to the patronizing exclusivistic attitude of physician analysts. It makes sense to form a guild, to open the training and membership doors to qualified clinicians — psychologists and physicians. This would strengthen the analytic position and a more unified whole can deal better with the opponents of psychoanalysis.
As an analogy, think of the benefits achieved by the joining together of the original American Colonies or the unification of Germany from the small city-states. In both instances, with unification came a tremendous increase in available people and resources to effectively deal with outside events. Both countries became powerful forces in world politics, rather than wasting energies in endless struggles among partisan competing factions. A unified psychoanalytic discipline can be a much more powerful factor in the mental health of our country.
At present, we have the best training in psychoanalysis, and we should share it with qualified nonphysicians. This will improve the pool of available applicants, candidates, and eventual practitioners. We can with ease add a number of people. Doing so will appeal to our own sense of fairness and will result in enhancing our own and our profession's respect. If we do not accept clinical psychologists, we will remain a minority in psychiatry. We also may receive growing resentment from both psychoanalytic psychologists and from the public at large.
As an example of a possible trend, most of the current UCLA extension courses offered on psychoanalytic topics are taught by nonphysician therapists and many of these instructors are listed as analysts or psychoanalytic candidates. Are we to remain leaders in teaching psychoanalysis? There now exist other branches on the vine of American psychoanalysis. Will our branch adapt and grow or is it too old and rigid? Will it wither and be overgrown? In the future could our institutes also lose the support of some valued medical analysts who might choose to support these other branches?
Today we have the opportunity to continue to lead American psychoanalysis, but if we fail or delay too long others will grow stronger and we may lose this position. Many psychological psychoanalytic institutes already exist and will become better established. If the Psychoanalytic Division of the American Psychological Association proceeds as it has suggested to sponsor these or its own Psychoanalytic institutes, then before long we may no longer be able to claim the better training programs. Also, if we exclude nonphysician analysts we will not be able to lead them, and the future may hold a lesser role for our institutes. By continuing to exclude others we may end up being excluded ourselves.
When in a position of power and control, a social group or an individual commonly has trouble adapting to transition and to changing times. Stifled by orthodoxy and prompted by fear of loss, there is an emphasis on maintenance of conventional values and tradition instead of adapting, as we ask our analytic patients to do. We ask patients to adapt to their current reality, to maintain an honest psychoanalytic approach, and to confront unpleasant truths. Often they turn these traumas and pains creatively into triumphs or constructive factors in their lives. Should we not ask the same of ourselves concerning this issue?
Scott L. Carder, M.D., Ph.D.
San Marino, CA