John A. MacLeod, M.D., Cincinnati, Candidate for the office of President of the American
Dr. Elise W. Snyder: Good morning. Would you tell me about your background, where you're from, where you trained, and whether that's a capital “L”?
Dr. John MacLeod: It is—and I'm from Cincinnati, where I came in 1950 for my residency training. I was born in Chicago, and raised in Amherst, Massachusetts. After Harvard Medical School, I had a two-year appointment at Hartford Hospital, and then Cincinnati. After residency, I stayed in the Department of Psychiatry on the full-time faculty for a number of years. I was in charge of the outpatient program, and very involved in residency training. During that time, I had my analytic training at the Chicago Institute.
Dr. S: So, you were one of the commuters?
Dr. M: Yes, I finished my analytic training in 1963. I continued on the full-time faculty in Cincinnati for a few more years. Then, as we began to get closer to having a training program in psychoanalysis in Cincinnati, I left the university and went into private practice. Since that time, I've been primarily in private practice and very closely involved with the development of our psychoanalytic training program which began about. 1973.
Dr. S: Were you one of the original training analysts?
Dr. M: Yes. Several years after we started to train candidates in Cincinnati, 11 partners designed a building for psychoanalytic practice for the institute. We wanted a faculty connected geographically as well as emotionally to the institute so that they would be really involved. Now there are 15 analysts practicing in the building which contains our institute. There are about 30 analysts in Cincinnati.
Dr. S: And how is the health of analysis in Cincinnati? I gather that one of your real interests is in education and training?
Dr. M: It is. It is. That's really where my time and energy have gone. In Cincinnati we have rather active analytic practices. We don't have a flood of patients for supervised analyses, but then we don't have a flood of candidates. We have had a class of four to six candidates starting every two or three years.
Dr. S: In many parts of the country, analysts are not so satisfied with their practices. Do you have some notions of what you're doing right in Cincinnati?
Dr. M: Well, every community is unique in terms of how analysis developed, how practices are organized, the relationship of institutes to the medical centers, etcetera. What we're doing in Cincinnati may not apply to other communities. We've worked hard to establish a relationship between our training program, institute activities and community, not just the university and the medical center, but the community at large. This has given us a good sense of what's going on, of how to relate to other doctors and other institutions in the community. We are not isolated.
Dr. S: The Chicago tradition.
Dr. M: Yes, the developmental line for Cincinnati does connect with Chicago.
Dr. S: While it may be difficult to discuss policy and goals very deeply, I think we've all adopted a kind of “business as usual” notion as being most helpful at this time. What sort of things would interest you as President of the American? What kind of internal priorities would you set for the organization?
Dr. M: I haven't had a lot of time to think about this. The possibility of being president is relatively new. It's not been in my mind as the place where my career was going. I do think there might be things that can be done to increase the flow of qualified doctors, as well as nonmedical professionals, to psychoanalytic training. For example, if analysts were more involved with medical schools, they might be able to interest people in what analysis has to offer as a treatment and as a career. There's quite a bit of discouragement around the country about analysis as a career.
Dr. S: Do you have children?
Dr. M: Four.
Dr. S: And if one of them was thinking of applying for a psychiatric residency, would you advise them to go into psychiatry at this time?
Dr. M: Yes, I feel that I would do that, and I would be enthusiastic in doing it. I have not been at all sorry that I did it. My intention when I graduated from medical school was to be an internist. Gradually, as I got more clinical experience, I realized how important the emotional factors were in illness, its development and its cure. I've been very pleased with my life as a psychoanalyst.
Dr. S: What sort of things have you been involved with in the American, which committees, what have your interests been?
Dr. M: I started out with the Committee on Institutes before we had our own training program. I had an invaluable exposure to training programs all over the country. I couldn't have had better preparation for thinking through how we wanted to organize our own training program. I didn't take a second tour on that committee because I then became director of our program. For a number of years I was on the Committee on Confidentiality. We dealt with concerns about candidate records, the issues of confidentiality, of insurance, malpractice, and confidentiality with regard to publications. Over the years, Ive intermittently been on the Executive Council; and, of course, almost continuously, I've been a Fellow of the Board on Professional Standards. I've had a lot of meeting time. I chaired the committee which prepared the study for the Board on how institutes were represented in the various committees of the Board—that was when Homer Curtis was Chairman of the Board. There was concern that some institutes were disproportionately represented. While that may have been true in the past, more recently, the skewed representation has become more balanced. I've just finished a three-year term on the Committee on Certification which has been extremely intense and very valuable. I think it's a tremendously important committee that is doing a very good job. Its workload is enormous.
Dr. S: Another question concerns the ferment about the relationship of Board to Council and Council to Board. I know it has a long history. With your experience both on the Board and the Council, I am interested in your views.
Dr. M: They do function differently. I don't think I have any real sense of how that's going to move along. A number of things, maybe the lawsuit, but certainly the initiation of the new nonmedical training is stimulating a reexamination of a lot of things: selection procedures, the information needed about prior training and clinical experience in order to select candidates, the curriculum, what the curriculum should contain given the varied prior experiences of non-medical people and medically trained candidates. In a leisurely way we will have to study whether we are a certifying, or an accrediting body, or both or neither. Both Board and Council will need to study those issues because there are changes occurring in the way things are done, and these may alter the way the Board and Council function together.
Dr. S: Obviously, the role of President of the American is determined partly by one's beliefs in what needs to be done, but also by one's character and how one goes about doing things or overseeing the doing of things. This is a very broad question: How do you see yourself functioning as President? We're in difficult times, I think, in a lot of areas.
Dr. M: I don't think it's going to be an easy few years, and that was certainly one thing my family and I had to look at. We are talking about the next five years, and I don't think they're going to be uneventful. Yet, I don't think the strain will be as great as it is now. We have some ideas about how to proceed now with the lawsuit, the non-medical training has been launched, the wheels are turning a little more smoothly. It is going to be a time of self study. A lot of communication among the institutes and among the members of Board and Council will be needed. My style is that of a communicator and I believe in communicating in person. When you have complicated enterprises, you need to find ways of having numbers of people work together in a collaborative way.
Dr. S: Do you see yourself spending a lot of time on the telephone or actually traveling around and speaking?
Dr. M: Well, I hope it won't mean a lot of travel, though I can see that travel might be a part of the activity.
Dr. S: It seems to me there's so much demanded of members of the Executive Committee in terms of travel that it often happens they wind up talking only to the six or eight other members of the Committee and not to anyone else.
Dr. M: That can be a hazard. One of the things I also want to do is maintain a clinical practice. How to do that and also do all these other things is going to be an interesting problem.
New Editors Elected to the Journal of APsaA
Six editors were added for three-year terms to the Journal of the American Psychoanalytic Association, three elected for service for the first time, and three who have served in the past. Also, two Associate Editors were chosen who will serve for one year. The new editors are: Ethel Person, Henri Parens, and Stuart Hauser. The returning editors are: Calvin Settlage, Lorraine Siggins, and Alvin Frank. The two Associate Editors are: Salmon Akhtar and James Frosch.
Dr. S: Particularly since they've been interviewing so many of the applicants.
Dr. M: I think the interviews of the deferred applicants and of the reapplicants are very important. There is some thought that interviews should be part of the original consideration of all applicants. I'm not sure, because in order to discuss intelligently and helpfully an
applicant's analytic training and the analytic work which they have written up, you really have to be immersed in their record. That's possible, but it takes a long time.
Dr. S: It seems to me that one can't simply add the presidency to an already committed life. What are you thinking of dropping?
Dr. M: I'm not sure. I expect that I can redistribute some of my administrative responsibilities in Cincinnati. I may have to reduce some of my hours doing clinical work. Perhaps some of my community work will have to be reduced.
Dr. S: It seems to me your life has been involved in education and administration and in organization. Growing things, like growing an institute from seed. What have been your intellectual concerns in analysis?
Dr. M: Teaching, supervision, and curriculum development have been my major interests. I've done no technical or scientific writing, other than book reviews. The research interests that sort of bud once in a while are very hard to do when you're involved in other things … for me it is. Some people are able to. I am involved in a group project working with delayed post-traumatic stress syndrome in Viet Nam veterans, however, our material will be published in a book later this year brought together by Jack Lindy.
Dr. S: What's your greatest concern about the American over the next five years? Not the things outside our control, but for the American as an organization.
Dr. M: Many people are discouraged. There is an unnecessary and unjustified air of pessimism. I am optimistic about analytic training and about psychoanalytic practice. I think there are good things ahead for the organization. The weariness and discouragement about what can be done is a major reason why we don't get people who are interested in psychoanalytic training. They've been told that psychoanalysis is a dying specialty.
Dr. S: What do you think the presidency or the organization can do to combat this attitude?
Dr. M: I'm not sure what will be possible, but whatever leadership is, I think that it can have an impact on an organization if the members feel that I have some vision of what is possible. I don't know that what we've been able to do in Cincinnati can be duplicated. I'm more of an administrator than many people are, and with the talent that's in this organization, and by working together, I just think that things can happen.
Dr. S: What have you thought about relations between the American Psychoanalytic and the American Psychiatric Association?
Dr. M: I'm a member of the American Psychiatrist, and I've been president of our local association, but I've not had anything to do with the national organization. I don't have a real sense of how the two organizations are getting along. I know the American Psychiatric Association has been anxious about the direction the analytic group is taking. I believe that they re not happy about the non-medical training program which we're moving into. I personally support that program. The medicalization of psychiatry is leading to a move away from dynamically oriented psychotherapy. I would want to argue against that move. The debate may not be so necessary now with George Pollack as President of the American Psychiatric. I think their leadership is a good team with an interest in the goals of the American Psychoanalytic. But there are still areas of tension: all the discussion and controversy about DSMIII, and the way residency training programs are being oriented away from dynamic psychotherapy, for example.
Dr. S: Right. I don't really have any more questions to ask. Is there anything else you think the people who are going to read this interview should know about you or your ideas?
Dr. M: I can't think of anything right now. I think you've gotten the feel of what I've been doing. Until now I saw my activities as continuing to be focused in Cincinnati, although I've had plenty to do with the American. Whether my way of doing things would be helpful to the American, I'm not sure. But when I said yes to being on the ballot, I was saying that I'm willing to see how it works.
Dr. S: Well, I hope it goes very well. Thank you very much. It's been kind of you to speak with me on such short notice, and I'm very grateful. Thank you.
Dr. M: I'm pleased to do it. I didn't expect to be interviewed so promptly.