We hear much about the alienation of our members from the International Psychoanalytical Association (IPA), of which we are a regional association, but it is time to recognize that a major attitudinal shift is occurring among our members. In recent years, an increasing number of American colleagues have become more involved in the scientific, educational and research activities of the IPA. In part, this is due to the gradually accelerated democratization of the IPA. From only a handful of societies with committee representation, today a large number of American colleagues from more than half of our societies are now active in IPA committees.
This policy has been promoted by the current president of the IPA, Horacio Etchegoyen, as part of his program to increase the activities of the IPA in response to membership needs through establishing many new committees (e.g. Committee on Congresses, Committee on Development of Psychoanalysis in the Middle East, Committee on Elections, Task Force on Publications, etc.). The proliferation of committees, however worthy their aims, could prove financially burdensome for the limited IPA budget. However, in today's hi-tech communications world, most committees need meet only at biennial Congresses and can manage during the interim by using E-mail, fax, and telephones to carry on their business. Additionally, many IPA committees now have regional subcommittees which can meet at regional meetings for face to face contacts. Many colleagues also became more aware of the issues facing the IPA as they participated in increasing numbers in the IPA elections, thanks to the mail ballot innovation which was established during the presidency of Robert Wallerstein.
Nor can we ignore the additional stimulus brought about by the creation of the IPA House of Delegates during the presidency of Joseph Sandler. This new body, which represents psychoanalytic societies throughout the world, has created a channel for membership input through their societies to the IPA. The American's Executive Council, for the first time this year, elected two delegates to this body. There is every assurance that Otto Kernberg, the president-elect, will vigorously continue and enhance the growing inclusiveness and democratization of the IPA when he assumes the presidency at the Barcelona Congress this summer.
Yet these positive developments have not sufficiently engaged our members, nor has discussion of the IPA agenda become commonplace at meetings of our societies. The average member of our Association still remains remotely related to the IPA, although approximately a third of our dues are assigned to the IPA and the International Journal of Psycho-Analysis. Most of our members have little knowledge of how this money is applied. Some even resent this financial commitment and would like it to be ended. Only a minority of our members attend the biennial international scientific programs of the IPA. The worldwide psychoanalytic movement is much more involved in the affairs of the IPA and feels more closely affiliated. How can we understand the persisting alienation of our members? Some of this alienation might be attributed to the very growth of psychoanalysis within each of the three regions of the IPA. The average member worldwide is somewhat distant from the leadership, agenda, and constitution of the IPA. We are no longer a small band of colleagues known personally to each other and centered in Western Europe, as was the case prior to World War II. However, there is a particular intensity to our American alienation. Our detachment has been likened to a Chinese-wall mentality. Certainly the relative geographical remoteness of North America has contributed to this phenomenon. The usual American lack of foreign language facility may be another factor. Our European and Latin American colleagues read our publications to a greater extent than we read theirs. At best, many of us read the International Journal of Psycho-Analysis, a publication of the British Psychoanalytical Society. Perhaps this professional isolation is also a reflection of our version of Fortress America? At times an air of arrogant superiority is reflected in our indifference to and distrust of the IPA.
Our members do not look to IPA congresses as their source of primary scientific discourse. Most feel that the scientific and educational activities provided by the twice-yearly meetings of The American adequately fulfill their professional needs. IPA Congresses are often seen as being too costly and interfering with family vacations. In these days of reduced professional income, our members must pay thousands of dollars a year in dues to local and national psychoanalytic groups, while still paying local and national dues to medical, psychological, psychiatric, and social work local and national entities.
They complain about their American dues burden but feel that their affiliation yields tangible benefits. Their view is, at best, that the IPA is only marginally useful, while some feel that we are used as a “cash cow” to support activities that meet the needs primarily of our foreign colleagues.
To what extent is this continuing alienation disadvantageous to our membership? I believe there are some very clear reasons. As in any science and profession, we can profit from the new understandings arising from the clinical and scholarly activities of all IPA colleagues. Perhaps even more important, there is a worldwide decrease in psychoanalytic practice that has stimulated societies in every part of the Western world to seek new strategies to reverse this trend. My recent visits to Holland, England, and Argentina have convincingly brought these issues to my attention. It is striking how similar are the problems that we are facing, despite the significant differences in our political, cultural, and economic situations. Worldwide, psychoanalysis has lost its former standing as a major source of new insights into the treatment of the mentally ill. Biological psychiatry and a variety of briefer psychotherapeutic treatments have taken center stage. We have been marginalized in the academic world. Throughout the psychoanalytic world there is a tendency to deny the inherent danger of this development. The pendulum will not automatically swing back in our favor. These observations echo similar conclusions long held by Otto Kernberg and Robert Tyson and other leaders in the present and incoming administration.
The reasons for our difficulty are complex. It is clear that we promised more than we could deliver. We disappointed too many. In an effort to seemingly protect standards, we excluded from training and alienated many professionals in our field. The post-modem era does not accept kindly the often arrogant elitism and authoritarian stance of our educational institutions. We need now to bend our energies to win back the minds and hearts of the academics,
students, mental-health professionals, and general public. We have to deepen our internal group analysis of the successes and failures of our theoretical and technical approaches through augmented research and scholarly efforts. This does not mean that we cannot be properly proud of our ability to heal troubled minds. But we must take a more objective approach to the value and limits of our knowledge.
The frontiers defined, we can then push forward through both traditional ideographic and nomothetic research strategies to improve the services that we offer — psychoanalysis, psychotherapy, and a wide range of psychoanalytically informed types of help. Societies all over the world are learning to once again become warm, open, and exciting places to learn, teach, and develop programs that improve the communities in which we live. We have much to offer each other by sharing our observations and attempts to cope with this “crisis.” An Argentina society (APdeBA) recently had a panel discussion including a politician, writer, epistemologist, sociologist, and several analysts. The hall that seated hundreds was filled to overflowing with university students, psychotherapists, and analysts. Yet this is a society that has experienced a dramatic drop in patients, candidates, and has previously closed most of its scientific meetings to the community. It was an exciting, cultural event in their community that we could all learn from. In Lima, a similar event, but on a much larger scale, is now being planned and jointly sponsored by UNESCO and supported by major corporations. The conference will be entitled “At the Threshold of the Millennium” and will focus on culture, environment, gender, and violence. The Chilean society will be conducting seminars for its entire local mental-health community in Santiago to prepare them for the 1999 IPA Congress in Santiago, Chile.
At the same time, both in Amsterdam and Buenos Aires I have observed the dangers of not offering psychotherapy training under our auspices. Psychotherapists excluded from our milieu drift toward more welcoming groups and become our opponents rather than our partners. In these psychotherapy institutes, the differences between psychotherapy and psychoanalysis were not well-taught. Institutional isolation on our part paradoxically leads to a blurring of the distinctions between psychotherapy and psychoanalysis—to everyone's disadvantage, especially patients. Many of our American societies and institutes have not yet grasped this fact. Many societies worldwide seem to be developing a range of educational programs that we all could learn from. In short, we can all profit from each other's attempts to strengthen psychoanalysis.
The Executive Committee and Council have begun to consider proposals for the IPA that would further diminish our isolation in the IPA and strengthen psychoanalysis worldwide. One major organizing principle is that our members must receive an equitable share of IPA benefits for their dues. The following topics are a continuation of this discussion.
The IPA needs to establish working groups of colleagues that will develop strategies to strengthen and promote private practice through community education and outreach. We could pool our experience in working with governmental and private sector involvement in health care. In particular, we need to protect the confidentiality of the therapist-patient relationship and fight for the patient's right to quality mental-health services. In this respect we are one global village. The experiences of psychoanalysts and patients with the Canadian, German, and British health-care systems are relevant to us. Finally, we must include efforts to address the social problems of the communities in which we live.
Both The American and IPA are dedicating substantial amounts of their budgets to promoting research. These research efforts ought to be coordinated. Some of this can be seed money for small, innovative pilot projects. Larger cooperative, worldwide studies could pool the creative efforts of our researchers who are interested, for example, in outcome studies. The research conferences and training efforts of the IPA now held solely in London, although laudable, should now be organized on a regional basis. New York, Chicago, Los Angeles, or sites in South America such as Buenos Aires and San Paulo are equally suitable venues for these efforts. Perhaps regional accessibility needs to be considered along with financial considerations. Otto Kernberg's previous proposals lead us to expect that research will be a major priority in the next administration.
The Executive Council and the House of Delegates need to become more empowered and responsive to membership priorities. For example, the House of Delegates surveyed all societies, and is largely responsible for the new attention being given to the apparent decline of private practice throughout the world by conveying members' concerns to the IPA Executive Council. This illustrates why the House of Delegates needs to be in closer contact worldwide with the societies (and their presidents) in The American. The House of Delegates agenda will become an important part of Executive Council and society presidents' discussions and thus will establish a direct link to our membership.
It has also long been advocated that vice presidents now elected on a worldwide basis be elected regionally. There is widespread support for this proposal in The American. European and Latin Americans should not determine the North American vice presidents. Once elected, North American vice presidents should participate in North American activities, e.g., they should attend our Board and Council meetings, as well as those of the Canadian and IPS groups. Of course, we need not await such a development in order to invite the present North American vice presidents to attend these meetings.
Our candidates should also be welcomed into the IPA as affiliate members. Today, the International Psychoanalytic Studies Organization is structurally outside the IPA. Similarly, we ought to consider strategies to allow affiliation of psychotherapists, academics, and mental health students to participate and be involved in IPA activities. These walls, too, should come down. Future generations of candidates will be drawn from these cadres. From this perspective, it would be desirable if we could reduce high registration fees for these groups. High-cost opening receptions can also be eliminated.
The recent proposal to sponsor IPA regional scientific meetings, which would allow our membership greater proximity to such international scientific discourse, is very worthy of consideration. Perhaps we might refer this proposal to the Committee on Societies to ascertain the extent of local interest and support. The IPA could also promote interchange of visiting professors from Europe and South America to teach, supervise, and present scientific/clinical papers to our societies. Such tours could be totally financed by consortia of local societies.
Most major centers of population in this world lack psychoanalytic societies and institutes. North America is no exception. We are about to embark on a major effort to develop new sites in the United States. Many of our potential new sites are remote from well-established American institutes and societies. The experience of the IPA New Groups Committee, chaired by David Sachs, could be accessed in our need to enhance our developmental strategies. Perhaps some of our soon-to-be-developed plans could in turn prove to be useful in other areas of the world? In general, it is time to extend a welcome to mental-health colleagues throughout the world who wish to develop a stronger psychoanalytic presence in their countries to join in these efforts.
We recognize the greater need of Eastern Europe and other underdeveloped areas in the world to make a claim on these limited funds. In fact, we are well-prepared to help these new regions by virtue of the diversity of our American membership. American Psychoanalytic Association Pakistani, Indian, Arabic, and Turkish colleagues are already lending their energies to IPA efforts to develop psychoanalysis in these areas. Many American colleagues are also prepared to help when the time comes for the IPA to establish a presence in Africa. There are international institutions that could be approached to financially support these efforts (e.g., World Bank, UNESCO, etc.). Perhaps the time has also come to establish an IPA Foundation to raise funds for these efforts?
Arguably, the IPA has been too preoccupied with internal matters to devote sufficient interest to this area. In the past, some IPA leaders viewed our involvement in the Psychoanalytic Consortium with indifference or outright suspicion. Our efforts to promote psychoanalysis in North America could better proceed through a unified psychoanalytic movement. It appears that the majority of American colleagues see a need for external credentialing to lend psychoanalysis enhanced credibility. Many of us would see this best accomplished in concert with other psychoanalytic groups who support similar or identical standards of training. Beyond credentialing, perhaps we could dream together of an organizationally unified psychoanalytic movement in the future? We look forward to working closely with Otto Kernberg, the president-elect of the IPA, as his projected programs are so compatible with our own priorities. His presidency will prove to be an exciting time for the further development of the IPA.
Our own Chinese wall is coming down. For the first time, The American has opened its societies and members to direct contact with the IPA. Why this wasn't allowed before is a sad reflection of our defensive isolationism. Perhaps it is not too quixotic to hope that analysts worldwide can learn to trust each other and not hemorrhage our precious energies in internecine political rivalries. The American (as well as the IPA) has been no stranger to such a debilitating political process. This, too, could well be studied by a new IPA committee to study psychoanalytic institutional conflict.
A new Golden Age of psychoanalysis with new societies, increasing cadres of candidates, and rising numbers of analytic patients accompanied by a renewed respect for psychoanalysis in our communities, is possible. The IPA can play the major leadership role in this development. Our growing presence in the IPA in contrast to our past alienation is in our own interest. Let us go forward together and mutually profit from our worldwide affiliations. It can be exciting, rewarding, and also enable us to make our world a better place for mankind. The next International Psychoanalytical Congress will take place in Barcelona (July 27–August 1). The theme of the program is Psychoanalysis and Sexuality. The pre-Congress conference will be an opportunity for training analysts and candidates to discuss issues in supervision. I hope many of our colleagues will attend and participate.