At my first reading of Jonathan H. Slavin's “What Do Psychologists Want?” (TAP 26 1), I was somewhat taken aback by his remarks; on a more careful reading, I felt even more concern. I suggest he reword his title to read, “What Psychologists Want: The Eroding of American Medical Psychoanalysis” (the psychoanalysis taught and supported by the American Psychoanalytic Association).
The interplay of psychiatry and biology is conceptually quite complex, both for general psychiatrists and for psychiatrists trained as analysts. The profession's involvement with biology has waxed and waned through the years and at present is certainly very great. Psychoanalysis has at times had difficulty with psychiatry's identification with biology, but for The American to move further away from biology, as Dr. Slavin recommends, would create even deeper problems, both political and theoretical. It is important that Dr. Slavin keep in mind that psychopharmacology is but one aspect of biology; there are others that are important in the work we do as analysts. To suggest that psychoanalysis is not involved in the practice of medicine is to forfeit any attempt to reverse the “decreasing interest in psychoanalysis among psychiatric residents” and poses serious consequences for psychoanalysis as a theory and for its place in American medicine.
Dr. Slavin refers to the need to separate science from conventional practice. Again, I think he fails to recognize that science is the backbone of clinical medicine and practice. Each practitioner, though not necessarily a formal scientist, can certainly strive to apply the principles of scientific inquiry. Any attempt to segregate science has the effect of distorting and disrupting some very important elements of medical psychoanalysis.
Dr. Slavin also seems to call for a change in the way institutes are established. He points out that the exclusionary practices of the past have limited the opportunity for psychologists to establish institutes. It was my understanding that the efforts of the American Psychological Association were intended to open the doors for admission to the American Psychoanalytic Association. But in his disregard of the educational principles and processes that establish quality standards and practice philosophies, Dr. Slavin appears to want to establish a very different type of association. It seems strange that the desire was first to join The American and now to change it beyond recognition. Certainly, the politics of any organization can be scrutinized and over time changed. However, to disrupt its methods of training and education seems more destructive than constructive. Dr. Slavin's use of terms such as “genealogy,” “spurious,” and “episcopal” seem merely sarcastic attempts to degrade a very important process.
Dr. Slavin goes on to take on the value of obtaining a specific degree that in turn is used as a basis for entry into the educational process as well as the organization. He refers to the “magical” reliance on a degree as if it lacks any basis in rational thought. He points out how the Ph.D. in social work is strictly a research degree, of little clinical importance. Reference is made to other degrees that certainly lend themselves to psychoanalytic work, yet the very notion of credentialing, which presupposes a base of fundamental knowledge, is wiped off the table in a single brief statement. Rather than regarding exceptions to the rule as providing important contributions to psychoanalytic thought, he seems to believe that almost anyone can participate in the training and delivery of services. Yet, degrees do serve as a rite of passage. They have many implications, and to discount the importance of a degree process in certain fields prior to additional training makes no sense.
Perhaps Dr. Slavin's difficulty is with the medical profession and the medical degree. Yet it is no accident that the founder and many of the earliest scientists and practitioners of psychoanalysis were physicians. The medical model is not only a way to approach disease but rests on centuries of history, philosophy, and a very strong scientific tradition. It is a mistake to discount the importance of objectivity, diagnostic acuity, and technical precision. One aspect of the medical model does speak to expertise, as any professional-client relationship must. The doctor-patient relationship is no exception. A psychoanalytic relationship is always two people, but one has the expertise; that is why the patient enters into the relationship. There is a constant emphasis in psychoanalysis that the “patient is not being analyzed but an analytic process is about to
be undertaken.“ The medical model does not infringe on this tenet of therapy; only a practitioner does.
It seems to me that Dr. Slavin has provided the members of The American an opportunity to reassess its values, ethics, and direction. His wish to separate psychoanalysis from medicine and to dilute principles that have been the basis of psychoanalysis for many years will hopefully serve to strengthen psychoanalysis. If Dr. Slavin feels strongly about his ideas, and he would appear to, then perhaps he and those who agree with him should establish their own institutes and association, and practice their own form of psychoanalysis without “the medical model” interfering with their professional pursuits.
Barry Ostrow, M.D.