To the Editor:
The Fall, 1985, Newsletter contained a number of items which, taken together, prompt me to comment. The issue was both interesting and informative. The report of the Hamburg meeting of the International Psychoanalytical Congress and the interview with Shelley Orgel, the new chairman of the Board on Professional Standards, were outstanding, in my opinion. They spoke to our continued search for honesty and truth through persistent self-examination, our pride in that search, and the high standards which motivate our organization, to which our leadership is committed in action. As Dr. Orgel said, “The strength of the American Psychoanalytic Association derives from our standards.”
Dr. Orgel's interview needs to be read as a statement of the principles which guide the organization and provide the basis for our prestige and strength. Ironically and sadly, however, I believe that the way we have been pursuing these worthy and necessary principles may also be contributing significantly to serious problems within the American — problems which threaten our survival as an effective organization.
Inasmuch as I first read the Newsletter during the recent New York meeting, my thoughts were centered on the problems of our members and graduates. As president of my society, I have become aware of a pervasive feeling that the American and our local society offer little to many of our members. Maintaining standards appears to be too abstract a benefit for those who are neither candidates nor training analysts; those who do not attend national meetings are unaware of the excitement generated at these meetings and do not become involved with national committees, discussion groups, or workshops.
But why don't they attend these meetings? Does the American care enough to find out? Why do these analysts see organized psychoanalysis as unhelpful or even useless? Does our leadership think their attitudes should be understood and remedied, or will this state of affairs be allowed to continue? Might a legitimate concern with ideals and standards mask the relative neglect of the equally necessary tasks of reaching out both to our own larger membership and to important individuals and groups outside our organization? Might this neglect be hurting us by limiting our power to influence and to lead, thereby undermining the very ideals which our concern with standards is intended to protect?
Dr. Orgel, by the way, deserves major credit for implementing the report of Joan Fleming's 1976 Ad Hoc Committee, which mapped out a new relationship between the Committee on Institutes and the various institutes. As chairman of the COI Dr. Orgel was the spirit who guided the change he described. I can testify that a collegiality is now operating where there was suspicion and distrust in the past. In discussing further improvements in the relationship between the Board and graduates of Institutes, he thinks the Certification Committee should communicate with graduates who have not applied for certification. I applaud his idea. We need such approaches if our problems are going to be understood and remedied.
In fact, I have been pondering a similar question, on the society level, for months. How can we call the attention of the President of the American to the problem of those members who pride themselves on being psychoanalysts, who find excitement and stimulation in practices featuring psychoanalytic psychotherapy, but who believe that organized psychoanalysis does little to connect with them in their real, everyday world?
The Newsletter articles on the NIMH grants and the manual on psychoanalytic psychotherapy, the report of the Committee on University and Medical Education, and the letter from Dr. Klumpner all serve as indicators of the kinds of concerns expressed by the “silent” and underrepresented graduates when I have solicited their thoughts. These have to do with the status of psychoanalysis in the medical and university communities, especially as represented by our local society and the American. Legitimate, cost-effective ways to represent ourselves to the public via the various media and practical, working liaisons with other organizations and institutions are not being given their proper priority nor being effectively implemented by us. While we ponder our excellence, we risk becoming irrelevant.
The number of patients in formal psychoanalysis has dropped below two per analyst, which means that a lot of psychotherapy is being practiced, firmly founded on psychoanalytic knowledge and training. Although psychoanalytic psychotherapy, however defined, is becoming the foundation of clinical practice following training in our institutes, our national organization steadfastly refuses to legitimize this valued and effective child of psychoanalysis.
Dr. Klumpner's letter touches on some problems inherent in governing democratically where problems experienced by a sizeable minority conflict with the desires and esthetics of the majority. He points out how those members housed at the Waldorf apparently subsidize the scientific and administrative meetings every December. This touches on the very high cost of these meetings for
those living beyond the New York area, with costs increasing geographically, so to speak. Housing, transportation to and in New York, hotel food charges, and additional loss of practice income (it takes at least one extra day out of practice to come from the West coast) all add up to a growing economic problem. So far the American has refused to deal seriously with these matters, and the apparent indifference does not go unnoticed on the West coast. Arguments which rely on technicalities (e.g. that we are forced by State law to meet in New York) do not soothe psychoanalysts.
So we have problems. In Los Angeles, and my impression is that it is so in New York too, there is a ferment of psychoanalytic activity. The undergraduate campus at UCLA has classes in psychoanalytic theory, conducted by professors of English literature, psychology, anthropology, social work, and so on. Almost all were trained at the newly arising schools of psychology which teach and train in psychoanalysis. It is refreshing to hear about this new excitement about psychoanalysis, except that our Society plays no part in it, being unable to train most of the participants or accept them as members. They read the same texts we do, and understand our vocabulary, but they are isolated from us, and we from them. It discourages and bewilders.
The medical schools and residency programs are increasingly under financial and conceptual strain, which moves them to teach assembly line psychiatry and medicine, in which doctors will not come to know their patients. They need us, we need them, but as psychoanalysts we are no longer consulted or seriously listened to about curriculum matters. This does not have to be the case, but it would take energy and resources beyond ours to make a difference.
So the American maintains our standards, and does so well and much more agreeably than it used to. But organizations are supposed to be in place to also serve the needs of their members and to represent them in the outside world. We need to get on with those tasks. We should recognize at least some of the needs of our members, in addition to maintaining training standards. Any perceived involvement in issues which are important to those graduates and members could serve to mobilize their energies and provide more strength and power to the local and national organizations. In any case, should they not receive a welcoming attention from the psychoanalytic organization which supervised their training, and to whose membership they must have been aspiring when they began that training?
Melvin Mandel, M.D.
Los Angeles