To The New York Times Book Review (published May 5, 1995). Judith Schachter thanks Paul W. Mosher for having prepared this letter for her signature. As the president of the American Psychoanalytic Association, I would like to clarify two points in Robert Stewart's otherwise informative review of Nathan G. Hale Jr.'s book The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–1985 (Jan. 29). Mr. Stewart repeats the assertion that between 1960 and 1985 “doubts were raised about the scientific validity of psychoanalysis… with its endlessly spiraling fees.”
Actually, doubts about the scientific status of psychoanalysis are as old as psychoanalysis itself. This issue has been raised by both enemies of psychoanalysis and sincere scientists. However, recent reviews and studies have shown that psychoanalysis, as a treatment procedure, is about as effective as most other medical procedures that are ordinarily accepted as scientifically based.
It is very difficult to study the psychoanalytic treatment process because of the need for confidentiality in the treatment relationship, but this is a research problem, not a scientific disqualification. Other, more superficial treatments were extensively studied “scientifically” during the 1960–1985 period, largely because those studies are much easier to do. But the demonstrated effectiveness of less intensive treatments, in situations where depth therapy is not required, does not contradict the enormous volume of observation and research that validates many of the basic assumptions of psychoanalysis.
As to the “endlessly spiraling fees,” it is probably more correct to say that in real dollars, psychoanalytic fees today are somewhat lower than they were in the sixties. Psychoanalysts are far from the most highly paid medical specialists, in spite of the very arduous training required. Most are in their late thirties by the time their training is completed. We all lose track of the declining value of the dollar and its effect on our perception of what things cost. In 1970, the Consumer Price Index was 38.8. In 1993, it was 144.5. The health care segment of the price index seems to have far outrun the increase in psychoanalytic fees, going from 34.0 in 1970 to 201.4 in 1993.
Judith S. Schachter, M.D.
Pittsburgh