Dr. Jeffrey: Steve, what do you feel have been the most important accomplishments of the Committee on Public Information in the recent years?
Dr. Sonnenberg: The greatest accomplishment is that the Committee has worked successfully to inform the American that as an organization it must appreciate the importance of providing information to the general public, to communicate with the public, and to have a meaningful dialogue with various groups that make up the public. That the American has responded is very gratifying.
Let me give you a particularly important example of how this has worked. Even though the majority of us are psychiatrists, I think we now recognise that the psychiatric community represents a “public.” Unlike the situation years ago, today many psychiatrists have hardly any understanding of analysis. But recognizing this, we have opened a dialogue with the psychiatric community. I would hope that in the years ahead we will open dialogues with other groups in the health and mental health professions.
We also have recently attempted to open a dialogue with non-psychiatric physicians, and with the general public. So the second major accomplishment of the Committee on Public Information is that it and the American have begun those dialogues.
This process began, as far as I know, when David Dean Brockman of Chicago was the Chairman of the Committee on Public Information and Arnold Cooper was the President of the American. These two leaders made a commitment to bring onto the Committee individuals with experience communicating with the public in different ways. For example, Arlene Heyman, who was a writer before she was a medical student, was brought onto the Committee.
Talking about Arlene leads me to think about what was, historically, a very significant achievement for the Committee and the American. That is the production of the pamphlet About Psychoanalysis. Many members of the Committee helped, but Arlene and Gerry Fogel made enormous contributions. The production of that pamphlet is now taken for granted, but at the time there was a good deal of soul searching and deliberation as to whether that was an appropriate thing to do. The production process involved serious discussion about how we define ourselves and how we define our tasks. I believe it convinced many analysts that public information could be provided in an appropriate way — that we could agree on how to define ourselves and convey that to the public. And, of course, that pamphlet has proven to be excellent, explaining psychoanalysis to a range of audiences in a concise and coherent way.
Dr. J: At one time, I believe, the Committee on Public Information had some concerns about how the Executive Council would respond to the proposal to publish the pamphlet.
Dr. S: Well, I don't remember from where in the American the initial suggestion for the pamphlet arose, but I believe it had existed before 1980. My sense is there was discussion about it in the organization for many years but substantial ambivalence about doing it. I don't think this ambivalence was just at the level of the Executive Council or the Executive Committee, but also at the grassroots level. So, as I suggested earlier, publishing it was an important exercise for our organization.
Another major achievement involved an initiative by Paul Fink, a psychoanalyst who will be President of the American Psychiatric Association. Several years ago he came to the Committee on Public Information with the proposal that we enter into a contractual arrangement with the American Psychiatric Association for the APA Division of Public Affairs to produce press releases for the American. He felt the APA had a very professional staff in this area and was well equipped to do this. Again there was much soul searching within the American about whether to do this.
We are about to issue the first of these press releases. It took a long time to develop it, and I think the reason is that the staff at the APA Division of Public Affairs, because it had a great deal of experience in preparing psychiatric releases, was sophisticated enough to know that writing a psychoanalytic press release was a new challenge. Doing that release well took training of that staff, and the evolution of the American's relationship with the Public Affairs staff at the APA is extremely important. I expect the press releases will flow now.
Dr. J: I have heard the first release is about bulimia.
Dr. S: Yes. It makes the point that to understand a psychological disorder that is currently very much in focus, training in psychoanalysis is an invaluable perspective. Several psychoanalysts were interviewed for that release.
Dr. J: Who were they?
Dr. S: Lynn Reiser, Martin Ceaser and David Jimerson. Dr. Jimerson, for example, is an experienced biological researcher, in addition to being an analyst. The comments in the release make it very clear that the skills that analysts possess, in combination with other scientific training, are invaluable in understanding a psychological condition in a human organism — a biological entity.
We plan other releases dealing with stress disorders, the aging process, and early childhood development. The same point will be made. This erodes a certain caricature which depicts the analyst as sitting behind the couch hour after hour, with knowledge of limited usefulness. It is important that we convey not only the richness of our clinical skills and knowledge, but the broader applicability of our theory.
Dr. J: In working with the APA you were also involved with the Physician Awareness Campaign which used medical community interactive workshops to teach primary care physicians about depression.
Dr. S: Yes, that was what I was referring to earlier when I noted we had attempted to open a dialogue with non-psychiatric physicians. This part of the APA Physician Awareness Campaign is designed to teach primary care physicians about depression. I believe it is significant that this is occurring right now, at a time when there is much sentiment within some segments of American psychiatry that psychoanalytic treatment of depression is not appropriate. The Physician Awareness Campaign has the potential to reach thousands of primary care physicians. Not only have a large numbers of psychoanalysts become involved as teachers in the program, but we have had significant input into the background reading material for the workshop participants. I think it would have been unfortunate if this program did not have that psychoanalytic input.
I would consider the pamphlet, the press release program, the various dialogues we have begun, and the American's awareness of the importance of public education as the most important specific achievements of the Committee on Public Information.
Dr. J: What have been other achievements?
Dr. S: We feel it is important that what we do is understood by the growing
patient advocacy movement, and to that end we have reached out to the National Alliance for the Mentally Ill. I have already met with various leaders of that group, and I will be meeting next week in Montreal with Aurie Flynn, the Executive Director of NAMI.
I also met with Paul Dewald, the Chair of the Program Committee of the American, to discuss a proposal for a panel to be held at a meeting of the American, which would convey to the membership the current psychoanalytically-informed views concerning the development of the major mental disorders. This would be a panel in which analysts would discuss current biological research perspectives, current concepts about the role of developmental difficulties in producing the major mental disorders, and family research.
This panel will serve two purposes. It should be held on the basis of scientific merit to inform our membership; at the same time it will send a message to the outside world that we are able to modify our ideas in the light of new data.
Dr. J: Getting back to the APA. Some psychoanalysts feel that in the APA there are segments that have a great deal of hostility to us and disparage psychoanalysis. How do you feel that the APA relates to psychoanalysis?
Dr. S: That's a good question and it has a complex answer. To answer that question we need as a frame of reference an understanding of what has happened to psychiatry in the past three decades. Psychiatry today is not what it once was: it is a field of medicine that deals with mental disorders from a range of perspectives, including non-psychological perspectives. And it deals with a broad range of mentally troubled patients. For example, psychiatrists may deal with homeless people, many of whom, we know, are seriously disturbed, discharged mental patients; they deal with groups of chemically dependent individuals; they deal with patients with a range of behavior problems, like delinquency; they deal with psychotic patients; they deal with older age populations. Traditionally, these have not been groups considered appropriate for classical psychoanalytic treatment and we psychoanalysts have not made them a primary focus of our research or clinical interest.
The APA has the specific job of synthesizing and integrating the interests of its members — members who work with this range of patients. It happens that some of the people representing various interest groups are very hostile to psychoanalysis. There are a number of reasons for that, including the fact that what we analysts talk about and write about frightens people who have not dealt with their own unconscious conflicts. Another cause of hostility is that people who are doing biological research, or applied psychopharmacological research, may feel in their zeal that they have all the answers, and that psychoanalysis has none of the answers. I'm not defending these attitudes, but simply explaining that there are understandable reasons for them.
I don't think it is accurate to characterize the leadership of the APA as hostile to psychoanalysis. I think those leaders are struggling to deal with a very broad range of responsibilities, including the need to synthesize and integrate the range of opinions of psychiatric practitioners. I think what organized American psychiatry wants to have with us is an honest dialogue, a frank exchange, and a real partnership. A real partnership, in my view, does not mean a uniformly high level of agreement. We and the APA can have deep affection, respect, and admiration for each other, and at the same time recognize that the other may do something on his own, because that's what is in his own best interest. I believe that's the kind of relationship the APA wants to have with us. Further, I think the APA is trying to educate its membership, so that irrational attitudes about psychoanalysis are dispelled.
I think what has really been striking in the relationship with the APA is that once the American made it clear that it intended to develop a pro-active posture, the dialogue between the organizations became much healthier. That is because now both organizations can respectfully agree to disagree.
Dr. J: In what areas would we agree to disagree? Where has that come up?
Dr. S: Before I answer that, let me say that the top leaders of the APA in recent years have been analytically trained individuals. Mel Sabshin is an analyst; George Pollock is an analyst;
Paul Fink is an analyst; Herb Pardes, President-Elect, is an analyst. And it was Paul Fink who first came to us with the proposal to work with the APA Division of Public Affairs.
In answer to your question, a significant amount of APA activity deals with the issue of insurance coverage for mental illness. And we have a different view of what is appropriate. That's an area where we agree to disagree. And that's fine. We in the American should and can speak for ourselves.
Dr. J: In regard to speaking for ourselves, the American is creating a public information network. Could you tell us more about what is happening?
Dr. S: Let me give a brief introduction. The APA, through its Division of Public Affairs, for several years has had a network of psychiatrists in APA district branches throughout the country who are interested in reaching out to the public and the media, who are available to talk about psychiatry. People will call the APA and ask a certain question, and will be given the name of a psychiatric expert to contact, or the Division of Public Affairs will contact that expert and set up an interview. Many analysts have participated in that program, but there hasn't been an organized program on the part of psychoanalysis to have its own parallel network. This is changing.
The Executive Committee of the American, again recognizing the importance of public information, charged the Committee on Public Information with the development of a network, and a dozen analytic societies were represented at network organizational meetings in May and in December. These representatives are in the main, very experienced analysts, including analysts who are institute faculty members. They are analysts who have a commitment to provide the public with information and a commitment to encourage members of their analytic societies to do the same.
In the interim they will be asking us for help. They will be identifying ways in which the national organization can be of help in local public education efforts. And we plan to have a network meeting at every Fall and Annual Meeting of the American. This is the beginning of a process through which the national organization will provide local societies with assistance, so they can get the word out in their communities about what psychoanalysis is and what it has to offer.
We do not live in a society which is passive in regard to public information. The intelligent, literate public wants to know about issues that concern them — they demand to know. This is not neccessarily derived from the unconscious psychic conflict of individual members of the public. And very often, when the public is informed, they respond very favorably to information they get.
In that spirit, we have begun the process of establishing a national public information network. For example, in the future, if there are specific pieces of information that the American wants to disseminate to the public through its local societies, there will be a means of doing this. As a matter of fact, the press release we spoke of earlier will be distributed not just to nationally known writers and national media but through local societies to local journalists and media.
Dr. J: I've heard that in the past the attitude of the American toward public information could be described, at best, as neutral or indifferent. How do you account for the change?
Dr. S: Well, we analysts have a very special perspective on the life of the mind as we focus on unconscious process and unconscious conflict. But we also live in the outside world and recognize that this is a world in which people expect information. Because we study the mind, we realize that the nature of mass communication today is very different from what it was a quarter of a century ago.
There are other ways to understand the change in attitude within the American. In part there is the matter of necessity. We aren't the only, or most popular, show in town, anymore. During the ‘50s and ‘60s, after the war and the influx of European analysts, there were hopes in our society that analysis could provide solutions to the problems that beset civilization. I think analysis rode the crest of a wave of enormous hope and popularity. Because of that, patients were plentiful and no other mental health discipline could compete with us. Regardless of what those in other disciplines had to say, they could not capture the public as we could.
While I think some of the impetus for reaching out reflects the ways those conditions have changed, I really suspect that the most compelling reason for our change, and this may be overly idealistic on my part, is our understanding that we all live in this society and in this society it is appropriate to provide information — we recognize that people here have a right to know.
Dr. J: What do you see in the future for the Committee on Public Information?
Dr. S: The Committee will serve as the conduit between the national leadership — the Executive Committee and Executive Council — and the national public information network. Members of the Committee have experience in providing public information and will be developing programs and policies which will be presented to the Executive Committee and through it to the Executive Council. When appropriate, when approval from those bodies is received, those policies will be implemented through the network. That's how About Psychoanalysis and the press release program became realities. I also think the Committee will conduct assessments of specific programs. For example, if the APA develops another program like the Physician Awareness Campaign, it would be appropriate for the Committee to consider if we should participate, make a recommendation to the Executive Committee, and implement whatever is decided, where appropriate.
Dr. J: How will the network be involved in the new Task Force to determine efficacy of psychoanalysis?
Dr. S: As you know, there is going to be a Task Force with input from the Committee on Public Information, the Committee on Scientific Activities and the Committee on Government Relations and Insurance. The initial charge to the Task Force will be to develop strategies for testing the efficacy of psychoanalysis. This is very complex. There will be a review of the literature on efficacy, and then strategies for studying efficacy will be developed. As we gather information about the efficacy of psychoanalysis, we hope, naturally, that information will be generated which confirms what we believe on the basis of clinical experience: that analysis is an efficacious mode of treatment. As that information develops, it will be disseminated through the public information network; analysts functioning as public educators will explain the results to interested public groups, and, I believe, we will do this aggressively. Similarly, there will be a network dealing with government relations and insurance which will convey the results of our studies to those who make decisions and policies about insurance coverage for mental disorders.