Even before The Lawsuit and the Gaskill Proposal, there were tremors in the relationship between organized psychoanalysis and academic psychiatry. With the precipitous drop in total applications for psychoanalytic training since 1980—a decrease accounted for mainly by a fall in medical applications—the tremors have grown to foundation-shaking proportions. The post-World War II era, in which analysts dominated department chairs and psychoanalysis was the major basic science taught to psychiatric residents, can now be viewed as a bygone age in more ways than one.
Many within the American are worried about the decline in psychiatrist applicants. Among those concerned is Dr. Arnold M. Cooper, chairman of the Committee on University and Medical Education, which is proposing a workshop to examine the facts of the issue and to come up with a plan of action. In a recent interview, Dr. Cooper portrayed the situation as urgent He said that the current climate in American psychiatry “has drastically weakened support for psychoanalysis in university-based medical schools and departments of psychia1 try.” The losses, he added, will be significant if nothing is done to stop the trend.
“… the emerging picture of psychoanalysis may be distorted when portrayed without an adequate sense of the clinical roots of psychoanalytic thought.”
“The experience of medical school and the immersion in internship and residency are formative experiences for medical psychoanalysts and help to shape their character and give a particular flavor to their later analytic work. Medical and nonmedical analysts each have unique contributions to make to psychoanalysis. While in the past we probably slighted the role of the nonmedical analyst, there are many forces at work today endangering the future role of the medical analyst,” he said.
Perhaps because of the privileged position psychoanalysis enjoyed in psychiatry departments in the past, organized psychoanalysis could then afford to see itself as totally independent of psychiatry. Apparently there even was at one time a feeling that organized psychoanalysis could, or had a need to, “protect” itself from too close an association with academia Looking back from our current vantage point, one is hard pressed to comprehend such a need to avoid “closeness” or the need for “protection.” Indeed, few would now call the relationship between analysis and most psychiatry departments “close.” Only four institutes affiliated with the American have formal associative ties with departments, and few chairmen of psychiatry are analysts at this time.
To the extent that psychoanalysis is now perceived by medical students or psychiatric residents as a nonmedical specialty or possibly even as arrogantly elitist, the separation has been destructive to the education of young physicians in psychoanalytic psychiatry. To the extent that chairmen and potential supervisors and mentors of residents no longer are analysts, the separation may have unwittingly deprived psychiatrists-in-training of crucially placed role models.
The erosion of interest in psychoanalysis, at least as measured by the number of physician applicants for psychoanalytic training, has been especially visible in the past six years. In 1983 there were 245 applications to affiliated institutes, 77% made by physicians. In the 1987-88 year, there were only 182 applicants (down by about 25%); physicians made up only 60% of the applicants (down by 39%). In 1988-89 only 68 physicians began analytic training in the United States.
The altered climate in departments of psychiatry very likely also adversely affects affiliated academic psychologists with psychoanalytic research interests. Their career efforts also suffer when professional support for analysis diminishes, as it does when help in obtaining grant support becomes less available and when appropriate mentors are fewer.
For psychiatrists and psychologists early in their academic careers, the issue of time is of considerable import. In those departments uncongenial to analysis, taking time away for one's analysis or for institute classes may be difficult or impossible. “Organized psychoanalysis,” Dr. Cooper says, “has not always been aware of the extent and significance of the tacit support provided by departments of psychiatry to analytic candidates and faculty. These include the basic clinical training of the medical analyst and often part-time positions that provide financial support during critical early career phases.“
Dr. Cooper also pointed to a paradoxical situation at the undergraduate level. “At a time of increasing academic interest in psychoanalytic theory, history, and application, an increasing portion of psychoanalytic scholarship is being conducted by nonanalysts, not infrequently by individuals with little contract with the analytic profession. While we welcome scholarship from any source, the emerging picture of psychoanalysis may be distorted when portrayed without an adequate sense of the clinical roots of psychoanalytic thought and history. The minimal presence of psychoanalysts on the undergraduate academic scene takes on added importance when we realize that there is likely to be a shift in recruitment of candidates from the medical residency to the undergraduate university, from which students may enter training programs that are already specifically
geared toward analysis. If there are no medical psychoanalysts as role models for these undergraduates, it is unlikely that many of those persons Interested in psychoanalysis will chose to go to medical school“
How can the American help? How can the “tone” and contribution of a significant medical ambience and the vivifying influence of medical school and university alliances be maintained? The Committee on University and Medical Education has called for a broadly constituted workshop to consider the merits of several possible avenues of action:
Development of a variety of career tracks within organized psychoanalysis for academic, nonpracticing, analytically trained physicians and psychologists.
Reward for academic or research activities.
Recruitment of academic analysts to administrative and policy-making bodies of the American, particularly to the Board of Professional Standards and its subcommittees.
Opportunities for attaining training analyst status for academic analysts. Expand the range of possibilities in psychoanalytic career development beyond that of training analysts alone.
Options in the kinds of psychoanalytic training that would foster or fit productively with an academic career.
Increasing the options for training scheduling.
Membership categories in the American to include academicians with some analytic training.
Drawing on the interests and contributions of academic psychoanalysts that go beyond psychoanalysis itself.
Professional recognition for analysts involved in university teaching.
We do not know what the consequences of taking no action would be—except perhaps to exacerbate the existing situation. If, however, we address this growing rift, the prospects seem at least fair for an improvement in the status and prominence of psychoanalysis in medical schools and in universities. Prompt and vigorous collaboration of the Board and the Executive Committee, along with the Council and members of the academic psychoanalytic community may help to realize the goals of the Committee on University and Medical Education.
Michael G. Moran