Dr. Elise Snyder: I want to thank you for giving me some of your time. You're in New York for a meeting of the Executive Committee?
Dr. Justin Krent: And the Coordinating Committee.
Dr. S: What is the difference?
Dr. K: The Executive Committee consists of the President, the President-Elect, the Treasurer, the Secretary, the Chairman of the Board on Professional Standards, and the Secretary to the Board. They perform the usual tasks of the American. They go over the work of the Committees of the Council. The Executive Committee attends the meeting of the Coordinating Committee which is chaired by the Chairman of the Board. The Coordinating Committee makes rounds, so to speak, on all various committees and subcommittees of the Board.
Dr. S: I see. The Coordinating Committee is the Board's equivalent of the Council's Executive Committee. And you are the Chairman of the Board on Professional Standards. Each time around I forget. How does one get to be Chairman of the Board?
Dr. K: There is a Nominating Committee of five or six people appointed by the current Chairman. They propose a number of people. At least two are selected and they are put up for election by the Fellows of the Board.
Dr. S: I see. The officers of the Board are not elected by the membership of the American, but are nominated and elected by members of the Board itself. The members of the Board choose their own leader so to speak. Your term began in May?
Dr. K: Yes. It is a three-year term.
Dr. S: Is there a past-President/Chairman position?
Dr. K: Not exactly. The past-Chairman acts as a fellow-at-large and sits in with the Board. This is a relatively new development.
Dr. S: You mean previously the person who was Chairman …
Dr. K: … went off.
Dr. S: That sounds like a waste of expertise.
Dr. K: I think that is why it was changed.
Dr. S: Before I ask about your work in the American, please tell me about yourself. Where are you from?
Dr. K: Now, from Cleveland, but originally from Cincinnati. I went to college and graduated from medical school in 1947, and interned there.
Dr. S: Was Cincinnati a stage coach department then?
Dr. K: Not while I was in medical school. Sometime in the late ‘40s or early ‘50s both Cincinnati and Cleveland became stagecoach departments. John Romano, George Engel, and Milt Rosenbaum were in Cincinnati. I did my residency in Cleveland at Western Reserve, primarily in the University Hospitals.
Dr. S: Was Cleveland an analytically-oriented department at that time?
Dr. K: Very much so.
Dr. S: How did you become interested in psychiatry and then in psychoanalysis?
Dr. K: There are all kinds of reasons why someone gets involved in psychiatry. I can speculate on some of the reasons I did, but that is really not the issue here, I was introduced to psychiatry in medical school. I both liked it and had some negative reactions to how it was taught.
Dr. S: So, you had not planned to become a psychiatrist when you went to medical school. What turned you, so to speak?
Dr. K: I think the Department of Psychiatry in Cincinnati did. I enjoyed my psychiatric experience there. I then went to Cleveland which was, at that time, ahead of Cincinnati psychoanalytically. In the late forties, the Dean of the Medical School appointed Douglas Bond to form a psychoanalytic department. He had already started his analytic training before he went into the service. While stationed in England, he got to know Anna Freud. Through her he met Anny and Maurits Katan and urged them to come to Cleveland as training analysts. The department drew many young people interested in analysis. It was a very exciting and stimulating climate.
Dr. S: So you were part of that great era when the only game in town was analysis, and where the only place to be was in an analytically-oriented department of psychiatry. It was very exciting then.
Dr. K: It was also an era when there were excellent clinicians in psychiatry who were demanding of their residents. I think we had good training in psychiatry as well as in psychoanalysis. After I completed my residency in 1951, I went into the Air Force. I was at the School of Aviation Medicine in San Antonio, Texas, at Randolph Air Force Base. It was like being in a department of psychiatry. I taught, saw patients, did evaluations, consultations, that type of thing.
Dr. S: Did you know at that point that you wanted to be an analyst?
Dr. K: Yes. The psychiatric work was interesting, and the time in the Air Force provided a different type of experience from what I had previously known.
Dr. S: Like what?
Dr. K: Although we thought we worked fairly hard, we had sufficient time off to explore Texas. There were special missions occasionally that added a certain excitement.
Dr. S: What sort of special missions?
Dr. S: What is your background in the American? The position you hold is a very high one, obviously not a beginner's job. How did you get there?
Dr. K: I have been fortunate in having had the opportunity to be on many committees of the American. I started out in 1966, as a Fellow of the Board and was appointed to the COI then, and also another time, for a total of 12 years. I was on the former Membership Committee and then chaired the Certification Committee for seven years. I served on the CNMCT (Committee on Non-Medical Clinical Training) and on COPE.
Dr. S: You have been on committees of both the Council and the Board?
Dr. K: Primarily, I've been on Board committees. I was also on the Gaskill Committee which was a joint committee of Council and Board.
Dr. S: It seems to me that there are people who work primarily on Board committees and then others who work primarily with the Council. I know that there are some people who were both Chairman of the Board and President of the American, but that is very unusual. Why do you think that is?
Dr. K: I think individuals may have special interests or talents for the different tasks of the committees. If someone becomes involved with committees of the Board, for example, there is a tendency to continue with them. For instance, there are those who have a unique knowledge of insurance matters. This knowledge serves the American well and may lead to further assignment on other Council committees.
Dr. S: What do you think are some of the specific talents or interests that prepare one to work on the Board? Are they different from the talents or interests that might be useful on the Council?
Dr. K: Well, I wouldn't want to differentiate them from the talents or interests that would be useful on the Council. Board committees, for example, are involved with institute interests, psychoanalytic education, how institute administration affects educational programs. Council committees are involved more with the needs of members or with the professional interests of societies—program, arrangements, the Journal, government relations, insurance, public information, psychoanalytic practice—to name a few. I found my experience with Board committees helpful in work at my own institute and in the growth of my understanding of analysis. Exchanges with other committee members is stimulating. I'm sure this is true of Council committees as well.
Dr. S: Can you give me some examples?
Dr. K: Well, you might think that the members of the COI just go around checking off a checklist. That is not the case. They think, for example, about how candidates at an institute progress. While making such assessments they compare the institute under study with their own. They evaluate their own performances as training analysts or educators. They are challenged in their thinking by the other committee members. So that, as a committee member, one has to do many things that are really psychoanalytic.
This was true also of the Committee on Certification. There, one has the unique opportunity of observing the whole analytic development of an individual from the time of entry into an institute until graduation. The role of the institute in the analytic development and maturation of the candidate can be traced. The Certification Committee member can follow the development of the graduate's work and see how the institute did or did not help the growth of the individual. Serving on the Certification Committee provides one with a vast amount of clinical experience. Hundreds of cases are read and studied in great detail. Working on such a committee is really a challenging learning situation, which provides an opportunity for personal analytic growth. Members invest an enormous amount of time in the work of certification, much of it weeks and months before the actual Committee meeting.
Dr. S: It sounds like the Certification Committee was your favorite.
Dr. K: Well, I was involved in the process for nine years. I liked the work on the COI, too. It was my first committee assignment. There, one works as a member of a team and learns about the various facets of analytic administration. During the site visit, the COI focuses on the many ways an institute functions. It studies the way the institute impinges on the overall training of the candidates. The Certification Committee focuses on the analytic development of the individual, noting the way the institute facilitates this development. It may require people of somewhat different interests to be involved in different committees. I will have to take that into consideration as I make appointments to the various committees.
Dr. S: I have heard it said that the committees of the Board do the real work of the organization. They set our standards, they safeguard the educational process, they guard the treasures of analysis. At the same time, the committees of the Council have been described as functioning as a kind of “Ladies' Auxiliary” to the real work of the American.
Dr. K: I think you may get into trouble with that question.
Dr. S: I think you may be right. Actually, I think both of us may get into trouble with it.
Dr. K: I don't think I will, because I think what you've heard is just not true. Both groups of committees are necessary to the functioning of the American. The committees of the Council function in just as much of an analytic way as the committees of the Board. Just think of the Program Committee, the various scientific committees, the , etc. They are at the heart of our analytic endeavor. If committees working on such things as liability insurance, third-party payment, medical and university education or government relations did not function in a manner informed by analytic concerns and on an analytic basis, their endeavors would not be of use to us, or to the American or to analysis.
Dr. K: Yes, I do, but I hope that we will be able to see a greater number of patients than you mention. A lot depends on our convictions about analysis and on how we present our views to the public. Partly, it may depend on the kind of insurance available. In the future, analysis may be limited to those who have the financial means. I don't know what percentage of analytic patients at this time is significantly dependent on insurance for the analysis. If the insurance companies cut back, they will also cut back on analytically-oriented psychotherapy, as well as other forms of psychotherapy. In that case, analysts should do better than non-analysts. Analytic training enables one to do psychotherapy more effectively. Particularly with psychiatric patients, analytic training is a benefit.
Dr. S: I asked you first about the economic side. Now I want to ask about the other side. What do you think the future prospects are for people wanting to be analyzed? Never mind whether they can afford it or whether insurance companies will pay for it. What do you think the prospects are for analysis in our current social milieu?
Dr. K: Obviously, I don't know for sure. However, I think that people will want to be analyzed. I think we are seeing patients right now who have been through drug therapy and other treatment modalities. They are looking for a better understanding of their mental difficulties. I think this will continue to be true. A number of Council committees—Public Information, Government Relations, Insurance, the Task Force on Efficacy Studies—are working to correct misconceptions about analysis and to enhance the public view of psychoanalysis as the treatment of choice for certain individuals and conditions. It won't be as it was in the ‘50s and ‘60s when people thought analysis could do everything, but those years had their own problems. I think there is, and will be, a need as well as a desire for analytic treatment. Other treatments for people who are potentially analyzable are not that effective. Not everything can be treated with drugs. When people learn that they have to be on drugs for a long period of time, that there are dangers and side effects with drugs, that they don't get an understanding of themselves, and that they are dependent on something outside themselves—such individuals do seek analytic help.
Dr. S: I have another difficult question. It has to do with the relationship of psychoanalysis to psychiatry. It seems particularly important now, with the implementation of the Gaskill Proposal and the settlement of the lawsuit. What about our relationship to psychiatry in general and with regard to third-party payment, and what about our relationship to medicine?
Dr. K: I guess there's nothing wrong with a honeymoon if it's a prelude to a beneficial relationship. There have been tensions between the Board and the Council in the past. However, I don't think we will lack external stresses. We've already mentioned changes in medicine and the role of third-party payment. There may be new pressures brought about by the recent bylaw changes of the International.
Dr. S: I've heard rumors that some institutes may leave the American and apply directly to the International. You've heard those rumors, too. Has any institute already taken advantage of the new setup to apply directly to the International? That seems to me to be something that might come up during your tenure.
Dr. K: It might. I would hope not. It would weaken the institute and it would weaken the American. I think it would weaken us all.
Dr. S: Does the fact that the institutes now have a way of affiliating directly with the International weaken the power of the Board? Suppose Institute X has ten candidates applying for certification. Institute X has not done well in the past with certification. You've heard rumors that they feel badly treated. Their attitude is, “Why should we put ourselves and our people up for another humiliation? We'll go directly to the International and avoid all this.”
Dr. K: Yes, that could happen. I would hope that it wouldn't. First of all, I do not believe institutes would wish to leave the American and give up the services and protection the American provides. If an institute wanted to leave the American, I don't believe it would be an easy matter to establish independent membership in the International. Let's take the scenario that you have given. One thing that would act to prevent that from happening is that certification is going to be increasingly valuable in this wide-open world where various types of analytic training are clamoring to be considered equal. Certification is one of the manifestations of the American's respect for standards and for the welfare of analytic patients.
Dr. S: My patients know I'm a psychoanalyst, but I'm not sure that they know I'm a certified psychoanalyst.
Dr. K: I think, in the future, more people will be concerned about that. Certification may make a difference in third-party payment. Some states are considering various kinds of relicensing procedures. In some of those instances, certification may be very important. At any rate, it will help the consumer to identify those analysts who have been trained at institutes where attention is paid to psychoanalytic education and psychoanalytic values. Certification is an important aspect of the Board's quest for quality control. I want to make it clear that all of the members of the Certification Committee are very aware that some people who don't get certified on their first attempt feel humiliated. They are very concerned about that. If some applicants feel badly treated, we will have to explore their complaints. If there are wrongs, we will have to address them. The Chairman of the Certification Committee will meet with disaffected individuals and attempt to discover if there is a basis for their complaints.
Dr. K: I went to one nuclear detonation.
Dr. S: Were you there as a psychiatrist?
Dr. K: No. It was part of our medical assignment. We helped in some formal research.
Dr. S: And what did you do?
Dr. K: Not much. I just read a dial or pressed a button. No big deal. The experience of being involved in the study, however, was profound. We couldn't escape thinking of the significance of such an explosion. I remember the stillness and solemnity of the test. I was impressed with what seemed to be a very democratic atmosphere. High-ranking general grade officers ate next to noncommissioned ones. The overt presence of military rank was absent. The people there were quietly and seriously involved in a joint endeavor. There were aesthetic values as well. The desert at sunrise is beautiful, as was the explosion itself—in contrast to its destructive potential.
Dr. S: We lead rather quiet lives in our offices. Atomic detonations are really another world. And then, after your two years in the Air Force …
Dr. K: … 21 months to be exact.
Dr. S: Did they give you three months off for good behavior?
Dr. K: Actually, I suppose their 21-month stint was the equivalent of our 50-minute hour. I then went back to the Department of Psychiatry in Cleveland and began analytic training.
Dr. S: Was anyone other than the Katans doing analyses there in—I guess that was 1953?
Dr. K: Douglas Bond, Brian Byrd, and John Flumerfelt were also training analysts at that time. I finished my analytic training in 1960.
Dr. S: Did you have much connection with the Department of Psychiatry?
Dr. K: A lot. Primarily, I was responsible for the adult out-patient clinic. There was a unique arrangement in Cleveland at that time which, initially, was beneficial to the development of analysis. The Department of Psychiatry was a division of medicine and the Psychoanalytic Institute was part of that division. It was an undefined, fluid type of situation. I am sure there were Education Committee meetings, but the involved people also had major psychiatric responsibilities.
Dr. S: So the Institute and the Department of Psychiatry were essentially coterminous?
Dr. K: Yes. I think today there are only five psychoanalytic institutes affiliated with departments of psychiatry: Denver, New York University, UNC-Duke, Emory and Columbia.
Dr. S: But your setup sounds different. In the five places you mention, the Institute is only a small part of the Department of Psychiatry. In Cleveland you are talking about a coterminous psychiatry department and psychoanalytic institute.
Dr. K: It was certainly not clearly defined. Some of the senior training analysts led seminars as part of their psychiatric work. They were good seminars. The departmental chairman was a training analyst and a member of the Education Committee. It worked well in the beginning. That kind of organization wouldn't be possible at the present time. The interest in psychiatric departments is different now. There were built-in conflicts between our Institute and the Department of Psychiatry which grew as the years went on. Those institutes I just mentioned have a greater autonomy than we enjoyed.
Dr. S: Were all the residents candidates?
Dr. K: No. Our institute was just like any other institute as far as that went. All residents were not interested in psychoanalysis and everyone who was interested, wasn't accepted for training.
Dr. S: You said that it worked very well for a while. Do you think some of your interest in working on the Board and on the Committee on Institutes (COI) derives from having been in Cleveland when things erupted? Where were you in your analytic career at that time?
Dr. K: I had finished my training when the separation occurred in 1967. At that time I was Secretary of the Education Committee. I had been appointed a training analyst in 1966.
Dr. S: You started your analytic training in 1953 and graduated in 1960. There has to be five years between graduation and becoming a training analyst; so you were a very new training analyst.
Dr. K: Yes, although I was already on the COI. I think your question is an interesting one. My work in the Department gave me an understanding of how organizations work and of how difficulties arise among people in organizations. I felt at home in that arena. My involvement in the events in Cleveland undoubtedly helped my work on the COI.
Dr. S: Can you be more specific about the reasons for the separation?
Dr. K: I really don't want to go back into the whole history. Probably there were a number of reasons why the Cleveland Institute separated from the Department of Psychiatry. The primary reason seemed to be personality differences which the majority of the Education Committee felt could not be
resolved within the confines of the Department. They were concerned that if the Education Committee did not take a stand, its role would be undermined by departmental interests. Ultimately the Institute left the Department. I think the separation was inevitable if the identity of the Institute was to be preserved. Had it happened in a more agreeable way, it would have been much better than the strife that ensued. Considering everything, I suppose it wasn't so bad, either. Since you are interested in knowing about formative events in my life, those experiences were important ones. I was much involved; I took part in the events; I lived it, and I felt it.
Dr. S: It looks like I am the only one who is going to be in trouble because of that question. So, let's move on. As I understand it, the Board sets standards both for certification and for institutes. At the same time, the institutes have a great deal of autonomy. Another thing
the Board does is to go in when there is real trouble. That was what happened in Cleveland and in Los Angeles. I suppose it has happened in other places where the eruption hasn't been so noisy. How do you think the Board can best go about putting out brush fires before they become forest fires?
Dr. K: I don't think there is any one way. If, for example, an institute is aware that there are difficulties, then the solution is relatively easy. I think that is what happens most often. Events occur; people ask quietly for help; outsiders don't hear about it; and assistance is given in a very quiet way. Difficult personnel problems can be alleviated and the educational process can be strengthened with the result that the training of candidates is improved. Some institutes wish to do this by themselves. They zealously maintain their autonomy. That is fine, as long as they do address the problems. There is no formula for any of this. I think that if the COI is called in, the best thing it can do is to help the institute to take as much responsibility as possible for effecting the changes. No one wants their enterprise in the hands of a receivership, so to speak. It is a kind of failure if it gets that far. The Liaison Committee of the COI permits continued interchange between the COI and the institute. This is the first line of defense against the spread of brush fires.
Dr. S: Suppose you are not called in, but you hear, either through the grapevine or when you do a site visit, that things are not as they should be. Can you step in without being invited? I know you make recommendations after site visits, but those are only recommendations. No one has to follow them. What power does the Board have when it is not invited in or when its recommendations are not followed?
Dr. K: I don't think the Board has to wield any special powers per se, although, of course, it does have them. There is primarily the power of peer pressure and support, and the desire on the part of the institutes to improve psychoanalytic education. After all it isn't just the “American”, some distant organization. The American is a collection of all of us. Individuals of the COI from various geographic areas can talk with institute representatives about mutual concerns. Those institute members who have concerns which they feel have not been adequately addressed by their institute officers can write directly to the Board on Professional Standards or the COI.
Dr. S: You say someone can ask for help when they feel something is going on. Usually when “something is going on” there are two groups. One group thinks, “Nothing is going on. This is the way things are.” The other group feels, “No, something is going on and we don't like it.”
Dr. K: There is a problem right there. In such a situation, the COI would say, “There seems to be a major discrepancy in views. What is the nature of this discrepancy? Have you tried to resolve this yourself? How can we help?”
Dr. S: Was the Board at all active when PINE split off from Boston?
Dr. K: I don't know exactly. I think the desire to separate arose. They discussed it themselves and with the COI and the Board. The Board went along with what seemed to be the best solution at that time for that situation.
Dr. S: That is, they came to the Board after there were irreconcilable differences and the divorce proceedings were already underway. This might be a case of the Board not intruding on the autonomy of an institute. How do you spend your time when you are not presiding over divorces, certifying graduates, or putting out brush fires?
Dr. K: Primarily, I have a psychoanalytic practice. I have various teaching and administrative responsibilities at my institute. I also do some supervision at the Department of Psychiatry of CWRU School of Medicine and conduct “grand rounds” at the VA Hospital.
Dr. S: By the time you were halfway through medical school you were clear about what you were going to do. What is it that you like about doing analysis? Why is it a pleasure for you?
Dr. K: You ask easy questions. I enjoy the emotional involvement and being able to think and to feel along with the patient. It is not just solving a mystery, although I like that aspect of analysis, too. I enjoy seeing how the mind works, following the analytic process and the concomitant changes within the individual. There is also a pleasure in thinking analytically, shifting from relatively more secondary process thinking to more primary process thinking. There is a satisfaction in helping patients to become aware of and understand what they feel and think. There is an explanatory beauty in being able to understand the organizing fantasies and the developmental paths that led the patients to their destinies, a satisfaction in that analysis works.
Dr. S: Sounds good. What do you think about someone becoming an analyst now? What sort of advice would you give to a young person?
Dr. K: I think it depends on the individual and what they are interested in. Certainly for those who find aspects of the unconscious interesting, analysis is a good way to go. I think analysis has a future and I wish more well-qualified people would go into it.
Dr. S: When you say analysis has a future I am pleased to hear it, but what sort of future do you think it has?
Dr. K: Analysis will continue to be important … as a body of knowledge, a means of investigation, and as a therapy. The field may not be as financially rewarding in the future …
Dr. S: We have never made the most money in medicine anyway, so that is not the issue here.
Dr. K: Analysis has a great deal to offer from a theoretical point of view and is going to continue to add insight into the psychological workings of the mind. There are difficulties in the present climate, but I think, because of its strengths, analysis will endure.
Dr. S: I guess I am asking you to be more specific. I am not asking you whether you think analysis is a good thing. Of course you do. I think it is a good thing, too. I think it is a good theory, I think it is a good technique for treating people, and I think it is very interesting and exciting to do. But I don't know if it has a future. You think it does. What kind of future?
Dr. K: It depends on what you mean by future. You know that being an analyst used to be the way to become the chairman of a department of psychiatry.
Dr. S: Right, but it doesn't seem to have that future now.
Dr. K: It may come back to that state again. There are some new department chairmen who are analysts, but that may not be the best reason to go into psychoanalysis. I think there is something else that many people are unaware of: that is, by entering analytic training one helps oneself. That is a benefit and a bonus that most of us don't talk about. But analysis helps us, it helps our families, it brings a whole new dimension to life which is very beneficial. It is not just the training analysis. I believe that the whole analytic educational experience serves to integrate and reinforce the gains of the personal analysis.
Dr. S: I certainly agree with you, but I am going to push you further …
Dr. K: I haven't felt pushed so far …
Dr. S: Good. I will start by asking the question in economic terms. Let us assume that no one is going to make a cardiovascular surgeon sort of living as an analyst. There are many colleagues today who are analyzing only one or two patients. The rest of the time, they are doing a kind of psychotherapy that is informed by analytic ideas. My question is, do you think this will be possible in the future?
Dr. K: I would like to see us maintain contacts with medicine and psychiatry, with neurophysiology and other biological sciences, as well as with the humanities. I think that we can learn and gain from many fields. Our system of training in the past, using psychiatrists, graduates of medical schools, has given us good people. I think that we are currently in a position to get good people from medicine as well as other fields. The training in psychology is now somewhat more like psychiatric training than previously.
Dr. S: What would you like to do as Chairman of the Board?
Dr. K: My experience with the Board is that the incoming Chairman usually doesn't have a program for the next three years, like reducing the deficit or improving the balance of trade …
Dr. S: … or easy things like that. But what are your thoughts about what you would like to accomplish during your term as Chairman?
Dr. K: The Board has had unwavering goals for many years. They've been the same all along and the Board has been very successful at achieving these goals. The Fellows of the Board have been working to evolve standards and to maintain them. The goal has always been to further psychoanalytic education. The end of the lawsuit and the implementation of the Gaskill Proposal will result in major changes, but there are always crises which arise and threats of one sort or another. That's part of our existence as an organization. During my three-year tenure, I hope I will be able to further that primary goal. Even now, I can look back over a relatively short period of time and see how psychoanalytic understanding has been sharpened and analytic training improved.
The maintenance of standards and the improvement of psychoanalytic education is a very difficult task. The continuing soul searching and self-scrutiny of the institutes is crucial. Institutes under duress must resist cutting corners in ways that interfere with the training of their candidates and, ultimately, with their candidates' analyses of their own patients. Individual analysts have the same responsibilities. Improvement in our work is a lifelong goal of analysts, institutes, and the Board. I hope the Board's role in facilitating this growth will continue. I hope that, when my term is completed, the committees will function as well as they did when Shelley Orgel completed his Chairmanship. Secretly, I hope that they will function even better. All of them have been improving. When I look back over the past ten years, I'm impressed at the improvement in the work of the committees even in that short time.
Dr. S: I think one of Shelley Orgel's major concerns was that the lawsuit not interfere with the functioning of the American or of the institutes. From where I sit, it looks as though he's been pretty successful.
Dr. K: He's been very successful, and that's an extraordinary accomplishment. As a matter of fact, the crisis has even fostered some activity in the American in directons it should have taken in the past.
Dr. S: Can you give me an example?
Dr. K: Much of it has been Council activity, but after all, we are members of the same family. I think, for example, that the efficacy studies which the Council is fostering are very important. I think that the way people have been working together despite the lawsuit augurs very well for the future.
Dr. S: I agree with you. When Shelley became Chairman, he was concerned about the effects of the lawsuit. What are your concerns for your tenure?
Dr. K: There are a lot of concerns right now. Even if there had not been a lawsuit, things are changing in medicine and they're changing in psychiatry. We have to adapt to these changes in a way that will be beneficial for our educational concerns and for our field. There are bound to be stresses.
Dr. S: Do you have some notion of what ghost is going to jump out of the closet at you? Do you have some notion of where a brush fire may break out?
Dr. K: It will not jump out only at me. It will jump out at all of us. There's no place to take refuge. It's not just the Chairman's or the Board's responsibility. It is the responsibility of all of us. As we meet the pressures and strains, many kinds of proposals and ideas will have to be discussed and evaluated.
Dr. S: What sort of pressures? What sort of ideas?
Dr. K: I don't know. I won't predict. Perhaps I want to avoid self-fulfilling prophecies. I think you heard me say that the Executive Committee and the Council and the Board did a superb job through all the pressures. They maintained the Association's standards, and they did it in an effective way. They were under heavy pressure, and they could have fumbled or done something they and the rest of us would have regretted. But they didn't. They all worked together under the duress of endless phone calls, endless questions, and especially under the need to make tough decisions.
Dr. S: One of the things I noticed
was that, while the Council and the Board are not necessarily adversarial in their relationship, they were exceptionally cooperative and friendly during the lawsuit. There was an external enemy, so to speak, and we all pulled together. Do you think this kind of honeymoon will continue now that the external enemy is gone?
Dr. S: I understand that.
Dr. K: But at the same time, if there were no standards, if there were no real levels that one was trying to maintain—and did maintain and expect people to come up to—it would be a chaotic situation.
Dr. S: I'm not arguing from that point of view. I'm not saying, “Oh please sir, soften up.” I'm asking if you think the Board would be able to withstand the pressure of an institute or a group of institutes that wanted to secede?
Dr. K: I would hope that that situation never arises. We would all work to prevent it. I also think that the International would not openly make it easy for an institute to secede from the American. The International would have certain requirements. There would be procedures the institute would have to go through to be acceptable to them. The International has its own standards. It would not want to set a precedent that would weaken the American. We are an important part of the International. Our strength is helpful to them. It makes them stronger
Dr. S: Do institutes which currently are directly affiliated with the International have certification procedures which are separate from graduation?
Dr. K: There is no certification that I know of except in America. But I think that, if the situation you described arose, the Board and the institute would work together to forestall such an event. After all, affiliation with the American is a very precious achievement and not something that an institute or a member is likely to give up easily.
Dr. S: I think that's the important thing. What else would you like to talk about?
Dr. K: I'm glad you asked me what you did. I think that there's no doubt that there are difficulties ahead. Perhaps they seem more important to us now than they will ten years from now. I think we have many things going for us. We have a shared respect for analysis. We have built up an enviable reputation. We have talented people. We have established administrative structures and excellent procedures. Our long-time emphasis on maintaining our analytic integrity in the face of external pressures has served us well in the past and will continue to do so in the future. Our task won't be easy, but I'm optimistic.
Dr. S: That sounds good. Thank you very much.
Dr. K: Thank you.