Dr. Ennis (TAP 25/2) is probably correct in his view that the majority of members of The American wish to retain the medical character of the association, and, believing that the waiver will protect our medical identity, Dr. Ennis argues for the maintenance of the waiver procedure for nonmedical candidates.
Dr. Ennis's quandary—how to open our doors to nonmedical trainees and still remain a medical group—was the core issue of the debate a decade ago that culminated in the approval of the Gaskill proposal. I believe that it was clear then, as it is now, that the decision to train nonmedical clinicians would inevitably lead to our becoming a nonmedical organization, since any attempts at quotas or special admission hurdles would be both unfair and illegal. That debate was characterized, however, by the reluctance of much of the leadership and the majority of the membership to confront the fact that a choice had to be made: are we medical or not? The waiver procedure was a cumbersome attempt to avoid that decision and somehow gratify the contradictory aims of being a medical organization training nonmedical candidates. Since there was never any question that nonmedical persons can be superb psychoanalysts, the only serious question was whether there was any continuing value to an organization of medical psychoanalysts.
Now that we are training nonmedical persons, it is inconceivable that we would in any way give them second-class status or impose unnecessary blocks in their professional paths. We must, therefore, move to amend our bylaws so that these nonmedical graduates will have equal access to membership in The American. That step is necessary to avoid discriminatory categories for these graduates, and that step will eliminate our official position as a medical organization.
This outcome, a predictable part of the Gaskill proposal, may well turn out to be desirable as well as necessary. Most of the international psychoanalytic community has arrived at this conclusion. However, this review of a bit of our organizational history reminds us that some difficult and painful conflicts and choices cannot be settled satisfactorily by compromise, and the desire to appease both sides does not always work.
Arnold M. Cooper, M.D.
Professor of Psychiatry,
New York Hospital—Cornell Medical Center