Under the banner of the “remedicalization” of psychiatry, medical schools have placed increasing emphasis on the biological, medical, and epidemiological aspects of psychiatry, as they, at the same time, have deemphasized the importance of psychodynamic theory and therapy. Reflecting this shift is the dramatic decline of the number of psychoanalytically trained psychiatrists who chair departments. In 1980, of the approximately 120 chairmen, 24 could be viewed as psychodynamically trained; in July 1985, the number had dwindled to 12. Commenting on these recent trends, Robert Michels said “we think this reflects important growth in psychiatry. But we want to make sure that in the process psychoanalysis isn't treated inappropriately or reduced to an inappropriately small or uninfluential position in psychiatry.”
Michels and Robert Wallerstein are Co-Chairmen of the Committee on University and Medical Eduation, which first met in December, 1981. Charged with infusing fresh psychoanalytic capital in university departments, the committee, in its first report to the Executive Council, recommended undertaking five separate activities in the hope of returning the pendulum to dynamic psychiatry.
One important task, initially to be undertaken by Stuart Asch, will be to review all the current standard textbooks in psychiatry. These texts will be specifically examined for their treatment of psychoanalytic knowledge. A review, written as a discursive book essay, may then be published. “The hope,” Wallerstein reflected, “is that directors of residency training and medical student education who have a psychodynamic orientation will read and be persuaded by these reviews to influence textbook selection.”
A closely related task of particular interest to Jay Katz and Paul Ornstein is a survey of those medical school curricula which are the most successful and innovative in teaching psychoanalytic ideas. Those new teaching techniques or innovations discovered will then be widely circulated, perhaps beginning with panel presentations at both the American Psychoanalytic and American Psychiatric Associations.
The committee plans to offer to psychiatry departments bibliographic assistance with reading lists graded to training level. The committee believes the publication of a new psychoanalytic text may be the needed injection to revitalize psychodynamic education and stands ready to contribute support and assistance.
Because the structure of National Board Examinations exerts a powerful influence on the content of psychiatric education in medical schools, the committee has secured approval to review both parts I and II of the examination. Under Dr. Alfred Margulies' supervision, a detailed study and item-analysis will be conducted on the questions in behavioral
science and clinical psychiatry to determine if there is an adequate examination of psychoanalytic knowledge. If there is not, it is hoped that psychoanalytically knowledgeable psychiatrists, acceptable to the examination writing body, can be enlisted to write these difficult-to-construct test questions. Michels emphasized, “I am quite convinced we could have an influence on making sure of the representation of psychoanalysis in textbooks and board examinations … if the world of psychoanalysis regards it as a high priority. If the world of psychoanalysis regards it as a low priority, it will serve as a most powerful argument for those who want to diminish the role of psychoanalysis in psychiatry.”
For the last of their initial recommendations, the committee asked for and was awarded by the Executive Council $5,000 to $10,000 annually to support a Visiting Psychoanalyst Lecturer program. These funds are intended for five medical schools annually in geographic areas underserved by psychoanalytic educators. The nation's medical schools will now be informed of this program and of its extraordinary educational opportunity for medical students and psychiatric residents.
The committee has also been exploring questions of career opportunity for academic psychiatrists within their psychoanalytic institutes. The committee's charge is that because academic psychiatrists are not full-time clinicians, they are at times viewed as second-class members within their institutes. The committee further believes that academic psychiatrists are at a disadvantage when being reviewed for training analyst appointment. In their May, 1985 report to the Executive Council, the committee called on the Association “to have flexible enough, context-dependent criteria so that academic psychoanalysts, if their work is of requisite high calibre and highly enough regarded, would at least not be barred from consideration for training analyst positions on the basis of an actual or only implicit reliance on a number count…”
Although the committee acknowledges the vital contributions of clinical faculty to psychiatry departments, they note that clinical faculty do not make the key department decisions, do not teach the major medical student courses, nor conduct intra-departmental psychoanalytic research. The committee concludes that if our institutes continue to look to departments of psychiatry for the “best and brightest” applicants, then our institutes need to lend their support to assuring that academic psychoanalysts have access to leadership positions in their institutes.
Michels also argues strongly for psychoanalytic teaching to medical students and residents. “If the psychoanalytic community believes that its members are fulfilling their appropriate professional responsibilities by teaching psychoanalysts without teaching medical students or residents, then inevitably psychoanalysis will move further and further away from the psychiatric and medical community.”