I find that I remain reluctant to fill out The American's co-morbidity survey, which was sent to me a few months ago. This very unusual behavior—responsibility has never been one of my difficulties, nor has commitment to psychoanalysis—led me to explore the reason for my reluctance. I realize that I am troubled by certain implications of the survey.
Recently, several of us were discussing the impact of health care management. This fairly optimistic group concluded that analysis could not die out; once people realized that many conditions could not be treated with medication and a few sessions a year—once they saw that their problems remained—society would find its way back to analysis, perhaps after a few lawsuits. This is one of the questions the survey is designed to explore: How “sick” are the patients we treat, and how many of them come to us after unsuccessful attempts at other treatments?
The problem with this approach is that it communicates that the field is running scared, and that we are willing to see ourselves as a treatment of last resort. Society is treating us the way people would treat a well-meaning but neurotic patient. We defensively try to say, “Look how special we are; look what we can do,” and they respond, 'Yes, you're okay, but you aren't great; you have lots of problems, and you're certainly not worth a major investment.“ Because our field is in intense inner turmoil, part of us believes this, believes we can't really accomplish all we would like to think we can, particularly with nonclassical cases. If this is so, no matter how ”scientific“ our survey is, it will accomplish little.
Psychoanalysis is not only uniquely different from other forms of treatment; it offers something absolutely extraordinary. It is my firm belief that those of us who have experienced that difference need to find better ways of articulating and demonstrating it to others. If society realizes that we are capable of transforming lives—if we believe that—and if we can refocus our theoretical and clinical explorations to examine the circumstances in which we are able to do it, we will recapture the excitement of a way of thinking that, despite its flaws, was capable of transforming a society. We shouldn't need to expend so much energy advertising the extraordinary product we have in our possession.
Alice Lombardo Maher, M.D.
New York