As principal investigator of the Survey of Psychoanalysis of The American, I wish to respond to Dr. Maher's letter, in which she describes her reluctance to participate.
Dr. Maher points out that many in society take psychoanalysis for granted, and that we have to become better at articulating how extraordinary psychoanalysis is in transforming lives. I couldn't agree more.
However, Dr. Maher argues that the survey implies that this field is “running scared.” Why? Because in documenting that analytic patients often attempt other forms of treatment before attempting analysis, the survey implies that analysis is the treatment of last resort.
While I can well imagine that certain individuals, hostile to analysis, might make that interpretation, the idea that analysis is a treatment of last resort is far more flattering to analysis than what is currently being said in certain quarters, which is that analysis is totally irrelevant, as shorter, less intensive forms of treatment are adequate for all the patients in analysis. But if analytic patients prove to have attempted those treatments, to little avail, then the assertions of these critics are shown to be anecdotal.
The public is aware that there are many cases in medicine where intensive treatment is the first treatment of choice, and where less intensive approaches (often penny-wise, pound-foolish) range from the palliative to the preposterous, such as treating a bellyache caused by appendicitis with Rolaids. We must begin to document, in a large group of actual analytic practices, what analytic patients look like. This large group picture, partial to be sure, may then be compared by each of us with our own clinical experience and what we have read in case reports. These different forms of gathering data are not mutually exclusive, but in fact reinforce one another.
Having a data base will be extremely helpful in documenting the attempts analytic patients have made with less intensive forms of treatment before entering analysis, as well as various aspects of illness, childhood trauma, and the like. None of the notions or observations we cherish as analysts—unconscious fantasy, transference, resistance, defenses, or development—are threatened by attempts to document other facts as seen in the psychoanalytic field of observation, whether types of psychopathology derivative of unconscious conflict, types of trauma occurring in some analytic patients, or levels of functioning.
Norman Doidge, M.D.
Toronto