Dr. Snyder: I suppose we should start at the beginning of your professional life. How did you become interested in psychiatry and psychoanalysis?
Dr. Curtis: My father was a physician. He often took me with him on his calls to his patients and sometimes explained to me the nature of their illnesses including the role played by their personal and family problems. I observed and was fascinated by the often intense therapeutic interactions between him and his patients. Later, I was interested in both psychology and literature. In medical school, my first purposeful planning for my future work began. My senior thesis was on electro-shock therapy. My advisor for this project was a psychoanalyst who helped guide my interest into psychiatry and psychoanalysis. After internship and a residency in internal medicine, I went into the service where I spent most of my time doing psychiatry. After my discharge, I began a psychiatric residency and started my analytic training in 1950. I graduated in 1955 and became a member of the American in 1957.
Dr. S: When did you become a training analyst?
Dr. C: In 1962.
Dr. S: So again very quickly. You became a member of the American in 1957. Five years was the absolute minimum permissible time in which you could have become a training analyst.
Dr. C: Our institute's procedure then was that those who were thought to be potential training analysts were asked to travel to a different city and have consultations with a training analyst there. For a year, I consulted with Jack Arlow and attended classes at the New
York Institute. The relationship with Jack has been an important one for me. As a matter of fact I think he was instrumental in getting me to work with the American. He appointed me to the Chairmanship of the Committee on New Training Facilities and that, over time, led to my consideration for election as Chairman of the Board on Professional Standards.
Dr. S: What other positions have you held in the American?
Dr. C: In 1961, I became Executive Councilor, representing the Philadelphia Association. I was very interested in the Committee on New Training Facilities and succeeded Francis McLaughlin when he retired from the chairmanship. Eli Marcovitz, Francis McLaughlin and I developed principles and procedures that have been followed ever since. I'm referring to the sponsorship of new institutes by established ones. New training analysts appointed under the “geographic rule” would attend meetings at the home institute in order to learn how it was done. When my term there expired, I was appointed by Ed Weinshel who had just taken over as Chairman of the Board to head a new Committee on Prerequisites for Training. This was the first of a series of committees: the Committee on Feasibility, the Committee on Desirability, then the Spruiell Committee, and now the Davis Committee by way of the Gaskill Committee.
Dr. S: That's quite a genealogy.
Dr. C: Yes, it is. What we were doing was finding some kind of basis for people to think that the hitherto unthinkable was not only thinkable, but possible. We were educating people. It all happened gradually. When the vote was taken on the Gaskill Proposal (which was built on our work) the result was a more resounding majority than I had expected. I think it was around 67 percent. I was pleasantly surprised. While we have important allegiances to medicine and psychiatry, I personally consider myself a psychoanalyst first. Maybe some of my previous identities have been integrated into that. If someone asks me what I am, I say I am a psychoanalyst, not a psychiatrist. I then expand on my answer. I let them know I value my psychiatric and medical training too, but my first love is analysis and that takes precedence over any other professional identity I have. For that reason I feel strongly that, as long as the people we pick are carefully selected and their preliminary training provides some of the same things that are provided by medical and psychiatric training, we really owe it to analysis to pick the very best people and not limit ourselves to those with only one kind of pre-analytic training.
Dr. S: Tell me more about your term as Chairman of the Board.
Dr. C: I became Chairman in 1982 and served until ′85. That too was a very interesting time. There was the big argument about opening up membership. I consider it one of the important achievements of my term that we were able to reach what I consider a decent compromise.
Dr. S: When the new categories of membership were established, there was a big ingathering of people. This must have been gratifying for you.
Dr. C: I think the jury is still out on that, because many who might have been spurred to take the next step and go through certification and become Active Members, may now find it comfortable to stay in the category of Extended Associate Members. On the other hand, I know that a lot of people (partly because of the difficulty in getting good cases) have needed a place where they could be affiliated and be an important part of the American while they finished their work preparing for certification.
Dr. C: I think Dick Simons has done a wonderful job. I'm sure he feels relieved to be free of the Presidency. He deserves a rest. Knowing him, I doubt that he will take one. He has been very responsive to the Council. Dick, by his nature, is a diplomatic, very decent person who feels his responsibilities very deeply and takes into account the feelings of others. He has been a very good force in making the Council realize that it is an important part of the Association.
Dr. S: What are some of the hopes and agendas for your Presidency—not just surviving the lawsuit?
Dr. C: When I was President-elect I hoped that things would be settled by this time. I think Dick has done a fine job in dealing with the lawsuit. He was responsible for what I think was the crucial decision to bring in Joel Klein. Joel has been a breath of fresh air and his skill and dedication have been a source of strength to us.
Dr. S: I think he is really identified with analysis. But, what would you like to do?
Dr. C: Well first, carry on Dick's work, to follow his example. Different people have different styles. He has had more experience than I with large organizations such as departments of psychiatry. I have picked up some of the things he has learned in those capacities and I hope to be able to use them to good advantage.
Another important concern is the relationship between the American Psychoanlytic and the American Psychiatric. We have common interests, but we differ on a number of points. I do not feel (as some people do) that our field is exclusively tied to psychiatry. That attitude is based on the premise that analysis is a sub-speciality of psychiatry, I don't see it that way. I think that analysis is a basic science for psychiatry—an important source for many of the things with which psychiatry is concerned. I think analysis can function in a fashion similar to neurophysiology and neuropharmacology in providing very important basic work and concepts for psychiatry.
Quite apart from the lawsuit, I would like to see us expand our own efforts to attract candidates, including nonmedical people. Recently I discussed a paper at a meeting of the Philadelphia Society for Psychoanalytic Psychology. It's a group of psychologists, a number of whom I know very well. Two of them were CORST trainees in our institute. They are now graduates, members of our group and members of our faculty. They were instrumental in founding this psychological society whose major interest is to promote psychoanalysis among psychologists. I was pleased to be a discussant. There were perhaps 100 people present, psychologists, younger people. I hope that we will find some very good people from among them for our own institute. As yet, they have not wanted to start a training program of their own, although that has been done in a number of cities—New York, Boston, and Denver. As President, I will be interested in promoting a search for good candidates, medical and nonmedical. I will be part of the Coordinating Committee which will serve as a link between Council and Board on that issue. I think everyone is concerned that our programs have the highest educational standards, and also that they be in the best interests of the membership at large. We don't want to sacrifice our standards just to get bodies to fill programs. I think our concern will be the best reassurance we can give to those members who are worried that, with the training of non-medical people, the floodgates have been opened to mediocrity. In addition to our programs, there will be many programs started by groups which are not part of the American.
Dr. S: I think you are saying that the American has to take a more active role in its relations with the rest of the world. What are some of your other hopes for the Presidency?
Dr. C: I would like to make the Executive Council even more important. I want to see what can be done to enhance the role of the committees of the Council. For example, I think Steve Sonnenberg's Public Information Committee is doing a great job. The Committee on Professional Insurance chaired by Jerry Mechanick, which grew out of the misfortune we had with our insurance coverage in several states, is pursuing not just the liability questions but other kinds of things we need to know about. Things that may be important in educating us in how to avoid lawsuits. I think they can teach us quite a bit about how to be proactive in the sense of getting guidance from legal counsel to avoid problems that can get people into trouble, such as matters of record keeping, responsiveness to patients, etcetera.
Dr. S: How vulnerable have we been? It seem to me, though I don't follow the subject closely, that the number of lawsuits has been vanishingly small.
Dr. C: I think there have been more than you are aware of. There have been a number of settlements that we don't hear about. That is why our premiums have been raised. Anyway, before Dick leaves office, I intend to go over all the committees with him. I want to get his impression of which committees need to be reinforced with new blood, new chairmen, or new charges; which committees might be consolidated; or where new committees need to be formed. I would like to streamline things.
Dr. S: Is it routine, when a new President takes office, for everyone to tender his resignation?
Dr. C: No. The tendency has been rather to hope that the people will continue, at least until the new President knows what is going on. While there may be an opportunity to make some new appointments, I personally feel it might be a big mistake.….
Dr. S: … to shake-up too much, too rapidly. These are difficult times to be President, I would think. You are trying to run the organization and to help it grow, improve and expand while there is the black cloud of the lawsuit hanging over us. It's like the English during the blitz trying to keep the country running.
Dr. C: Without this being an exercise in grandiosity, wasn't it Churchill who said he didn't become Prime Minister to officiate over the dissolution of the British Empire? I certainly don't have any feeling that I would want to do anything that would radically change what has worked so well for the American.
This brings me to another problem. There may be, especially in view of the difficulty people have in getting good analytic cases, finishing their training, and getting certified, increased pressure to address the issue of whether Active Membership should depend on certification. I still feel the way I did in ′81 and ′82 when that issue came up. There is something vitally important to the concept that it is a part of the continuing education of an analyst for him to submit his work to a group of his peers. The analyst should feel that he has joined a very important group that meets very high standards. The vote should go with Active Membership. I feel personally that the high standards of analysis are best left in the hands of those who have dedicated themselves to analysis, who feel that it is the central focus of their lives. When things that are of crucial importance come to a vote, that vote had better be cast by the informed people who have been central to analysis and for whom it is a major interest, even though they might certainly have wider interests. I feel that path, where the vote is tied to certification, is much safer for analysis and safer for the maintenance of standards than to throw the vote open to those people whose other interests might be more important to them. I know a lot of people feel very strongly that graduation from an institute should automatically make you a full-fledged member, based on the assumption that accreditation by the Board guarantees the same kind of education in all the institutes. The institutes have a great deal of autonomy and I think that is a good thing. I would not want everything to be homogenized.
Dr. S: I know a number of people, who are at this time Extended Associate Members, who are preparing another case. It will be interesting to see.
Dr. C: I am sure that in another five years the Committee on Membership will do a study on that.
Dr. S: Most of your experience with the American has been on the Board, except for your time on the Executive Council. That's an unusual history for a President.
Dr. C: Well, I was a member and then Chairman of the Joint Committee on Ethics during the late ′70s. That was an interesting experience, because you get to see some of the things we can't be proud of. I think, though, we can be proud of the efforts we made to look at and treat some of our problems in really honest ways. I was impressed by the diligent efforts that this committee made to protect the good name of analysis and also to protect the people who were damaged or those who were, in an unfair way, accused of causing damage.
Dr. S: I thought that, in general, people either came up through committees of the Board and stayed with the Board and perhaps, if they were specially gifted and hard working, became Chairman of the Board or that they came up through the Council and its committees and then, perhaps, became President. Would you know how many people have both been Chairman of the Board and President of the American?
Dr. C: Jack Arlow and Francis McLaughlin. Jack was President first and, after a period of time, became Chairman of the Board. Francis went from Chairman of the Board to the Presidency.
Dr. S: So it's not common that someone does both.
Dr. C: I think now we may see, and I am very hopeful about it, a closer collaboration between Board and Council. That very thing you are speaking about, two tracks, may have accounted for some sense of two cultures or two administrative groups. That has been unfortunate. While there needs to be some tension for productive exploration of all the angles, too often, I think, there has been a kind of rivalry. It is similar to the unfortunate envy on a very personal level that occurs between those who are appointed training analysts and those who are not, and between institutes and societies. The Board and Council have been subject to some of those feelings.
Dr. S: I think those people who are not training analysts have seen the Council and the Presidency as speaking for them. The Board, which is officially closed to them, and whose deliberations are often conducted in secret has had for many of them the exclusionary and elitist quality that the Training Committees at their own institutes have had.
Dr. C: I understand what you mean. I don't know how much that can be corrected except by greater collaboration between Board and Council. As I said, I think there has been some movement in that direction. For one thing the lawsuit has necessitated the Council's becoming more involved and active. I think that has made the Council feel more important. Since both the Board and Council have been involved I think that process has brought the two together.
Dr. S: I guess that comes under the Silver Linings Department. It is always useful to have an external enemy.
Dr. C: It forces us to pull together. I think that such things as the special meeting of the Council that Dick Simons called in 1986 are very important. People came from all over the country. They deliberated long and hard. It was a tough period and the Executive Council played an important role. I know that the Executive Committee felt on the spot to demonstrate to the Council that we were doing the very best we could and that we had conducted the lawsuit in the best interests of the American. It was very gratifying to get the Council's unanimous approval.
Dr. S: I think that, for the first time in my memory, the Council feels that the Executive Committee is being responsible to it: that the Committee is reporting to the Council not simply in a pro forma way, and that the Executive Committee is very eager for the support
and agreement of the Council and the Affiliate Societies.
Dr. S: Do you think that the majority of psychologists interested in analytic training will apply to our institutes, or to newly organized ones?
Dr. C: I think a number of psychologists who are worried that they will be second class citizens will want to found their own organizations and train their own people. If that is what they want to do, fine. I think there will be others for whom the idea of second class citizen is not an issue. They do not see it that way, or even if they do, they still prefer to have their training with us. Because there will be two general kinds of institutes between which people can choose, the number who will apply to us will be limited. I don't think a large number will be clamoring to get in. We will retain our very high standards, so that the number we take will be limited, not by a quota, but by the standards.
Dr. S: I think there were 14 people approved by the Davis Committee in December. I was surprised at the large number of people accepted who were not psychologists, who had other degrees.
Dr. C: I know there were several social workers …
Dr. S: … a nurse, an art therapist and some others. I wonder if we will get large numbers of applicants from other disciplines.
Dr. C: Some of the new programs that are not going to be part of the American will have open admissions too, they won't be limited. So, at least nominally, some of those places will be open to other disciplines, including psychiatry.
Dr. S: That would be very interesting. I've recently spoken with a number of officers of the American Psychiatric, most of whom, as you know, are analysts. One thing that we are facing is the decreasing influence of psychoanalysis in departments of psychiatry. Do you have some thoughts about that?
Dr. C: A number of people tell me, and it seems true at least to my observation in Philadelphia, that the pendulum may be swinging back a bit. The new Chairman at Jefferson is Troy Thompson who was trained at the Denver Institute. Arthur Meyerson, whom you may know, was trained at the New York Psychoanalytic and has just become the new chairman at Hahneman. In his introductory address to the faculty, he made a point of saying that he was a graduate analyst and very proud of it. He said that he intended to represent that point of view among all the others. I think most good chairmen recognize the importance of having analysts on their faculty as a teaching resource for their residents. For example, our institute has had requests from residents at a number of places around Philadelphia to give courses for them. At some of these places there were analysts on the faculty. Because the residents had been exposed to analytic thinking and had analysts for psychotherapy supervision they requested more training, more exposure. We have also had the experience of people leaving non-analytic residencies to finish at my hospital, The Institute of Pennsylvania Hospital, where they get a lot of exposure to analytic ideas.
Dr. S: Do you see any role for the American Psychoanalytic in fostering the interest of psychiatrists in analysis?
Dr. C: Bob Michel's Committee on University and Medical Education has a program where selected analysts visit departments of psychiatry which don't have analysts. I think that is a valuable program. Arnie Cooper is now going to be heading that committee.
Dr. S: The Johnny Appleseeds of Analysis.
Dr. C: They have been quite well received. I think more can be done. The Association has been interested in and has certainly always talked about the need to represent analysis in psychiatric residency programs. How to implement that I'm not sure. I value the discussions we have had with people from the American Psychiatric. I am hopeful that Herb Pardes will be their new President-Elect. [Editor's note: this interview took place before Dr. Herbert Pardes was elected.] It will be good to have another analyst in that position. Herb is not only the Chairman of a major department of psychiatry, but he
has also managed to retain his interest in private practice. He has valuable connections with some of the citizens' organizations that I think are going to be increasingly important. Perhaps through him and maybe through our own Public Information Committee we can do more to interest NAMI (National Association for Mental Illness) in psychoanalysis and to counteract their misconceptions. Maybe some of our members who are especially and personally interested could carry the message. Perhaps some of our people in a more or less official capacity could meet with NAMI. Many of the people in NAMI blame Freud and analysis for stigmatizing parents as the cause of mental illness. Initiatives like that could go some distance to counteract the adverse publicity analysis has gotten.
Dr. S: Like French primary education?
Dr. C: Yes. I think there is value in heterogeneity. A different vision can lead to experiments in different kinds of teaching and different kinds of practice. These can be presented to the Board. The feedback from the Board at site visits can lead to a very interesting reciprocal relationship. Out of the differences among institutes, we can distill some very good standards that apply to every institute, every training program. This reciprocal relationship is reinforced by the certification process. The information of the Certification Committee feeds into the work of the other committees of the Board, the Committee on Institutes, the Committee on New Training Facilities, the Committee on Psychoanalytic Education. The work of these committees in turn gets fed back to the institutes. Gradually, training standards do rise, not as a result of something imposed on the institutes but rather as the result of the reciprocal relationship. It seems to me that the Committee on Certification does a very important job in reinforcing those standards. It is a stimulus to the younger people to continue their education and not to feel that they are a finished product.
Dr. S: I am in accord with you about the importance of certification by the American, but I think one difficulty is that, when people are not certified, rather than the institute taking it to heart and perhaps altering their training or raising their standards, the onus falls completely on the recent graduate. I am impressed with the fact that the Committee on Certification is now interviewing so many of the applicants for certification.
Dr. C: I think that is a very interesting evolutionary development. Interviewing has been a very difficult procedure to implement because it takes a great deal more manpower, but I think it is a direction in which we need to go. It does give a much greater feeling of a personal interest to the applicant. The interview removes some of the aura of mystery and elitism and reassures the local institute too. I think the workshops and meetings which potential applicants, young graduates, and even candidates can attend have also been helpful. Some of the procedures that might seem very harsh and arbitrary and mysterious can be talked about. The anxious applicant can master some of his anxiety through real information. I think we should do something about encouraging the institutes to give more help to their senior candidates and young graduates. It would be helpful if all institutes had a course where candidates have the opportunity to write up a case in the mode of the American
application. They would then present it, first to a supervisor for a critique and then to their peers in a case conference. They would come to this conference with the idea of sharpening up their work with the patient as well as with the write-up and seeing what it is like to submit a case to a group something like the Certification Committee. I see that as an important educational experience, rather than simply coaching the applicant about his writing.
Dr. S: You mean like the coaching courses on passing the SAT's?
Dr. C: Exactly. I know that, in the past, some institutes assigned a coach to someone who had trouble and who then helped him with the write-up. Now I can conceive of that maybe being educational around the edges. But to the extent that such coaching takes away the initiative from the applicant and deprives him of the work and effort of seeing why his case report is psychiatric and not analytic, I think it's not a good idea.
Dr. S: What else would you like to say? What haven't I asked you that I should have asked you? Are you looking forward to your presidency?
Dr. C: Yes, of course, with some trepidation, some reservations about the size and complexity of the task. I must say that I am glad that I have been a part of things for a number of years. I am not coming in as someone who has not been working in the inside of the American. It would be a terribly difficult task for someone with no experience. Of course that is the reason the Exploratory Sub-committee on Nominations does look in the Board Committees and the Council Committees for names to suggest to the Council for the next round of officers.
Dr. S: It seems to me that the lawsuit may have inhibited some people from running for office.
Dr. C: That is unfortunate. Some people who would otherwise be excellent choices for office have been disinclined to run because they just didn't want that extra work and anguish. I can understand that. I had a little hesitation myself, but I felt that I had had such a good experience in the American, enjoyed it so much and been so challenged by it, that in spite of there being a lot of work, traveling, and anxiety, that maybe I had an obligation, and also, that I could enjoy filling that obligation.
Dr. S: I think we are all pleased that you are going to fulfill that obligation. I hope you will enjoy it. Thank you very much.
Dr. C: Thank you.