In late May 1942, a powerful striking force of the Japanese Imperial Navy steamed towards the tiny American base at Midway Island, 1,134 miles northwest of Pearl Harbor. Admiral Nagumo had assembled nearly every capital ship in the Japanese navy to deliver a knockout blow to the American fleet, already reeling from the devastating losses at Pearl Harbor. Occupation of Midway Island and the use of its airfield to launch attacks upon Hawaii would make it impossible for the Americans to use the Islands as a military base. The ultimate result would be a complete loss of the Hawaiian Islands, and with them, the entire Pacific. The Pacific Ocean would become a “Japanese lake.”
The Americans, though overwhelmingly outnumbered, did have some things going for them. By sheer luck, the four fleet class carriers, Lexington, Yorktown, Hornet, and Enterprise, had been at sea on maneuvers when Pearl Harbor was attacked and thus escaped destruction. In the Battle of the Coral Sea a month earlier (a narrow strategic victory that prevented the invasion of Australia), Lexington was sunk and Yorktown badly damaged. In an effort that could only be described as Homeric, the fires on Yorktown were extinguished, repairs were made at sea, and it made the long voyage to join its two sister ships off the coast of Midway.
The other major factor was that unknown to the Imperial Navy, the Americans had broken the Japanese secret code (of historical interest, the American and British code-breaking efforts during World War II led directly to the development of the computer). The invasion plans and the approximate location of the ships were known to the American high command, under Admirals Nimitz and Spruance. The presence of the American fleet was unsuspected by the Japanese until they had launched their first air strike on Midway Island on the morning of June 4, 1942, and were beginning to recover their planes.
Realizing that the fleet had been spotted by a Japanese scout plane, Admiral Spruance made the difficult decision to launch the American attack two hours earlier than planned, in spite of the certainty of higher losses because of fuel shortages, and the equally difficult decision to launch every plane he had, retaining none for protection of the carriers.
The American air arm consisted of three types of aircraft: (1) fighters, fast, maneuverable, and designed to provide cover for ships and attacking planes; (2) dive bombers, which came in fast from high altitude, delivering a 500- or 1,000-pound armor-piercing bomb; and (3) torpedo planes, which had to fly slowly, close to the water, and in a straight line to accurately deliver a single torpedo.
The plan was for all three types of planes to rendezvous at a particular point, and deliver a simultaneous coordinated attack. However, because of the scramble to launch the attack early, the torpedo planes arrived first, and circled, waiting. The other groups did not arrive.
Lt. Cmdr. John C. Waldron, squadron leader, knew he had little chance to survive. The night before in his last message to his squadron, appended to his attack plan, he had written,
I feel we are all ready. …I actually believe that under these conditions we are the best in the world. My greatest hope is that we encounter a favorable tactical situation, but if we don't, and the worst comes to the worst, I want each of us to do his utmost to destroy our enemies. If there is only one plane left to make a final run-in, I want that man to go in and get a hit. May God be with us all.
Running low on fuel, without air cover, and knowing the odds were virtually hopeless, Waldron gave the order for his squadron to attack. Each did, without hesitation, as did the other torpedo groups. All fifteen planes of Waldron's squadron were shot down. Of the forty-one planes in the total attack, only six returned. No hits were scored on the Japanese ships. Even Nagumo was moved. He is said to have remarked, “they sacrifice themselves like Samurai.”
When Admiral Nagumo learned from his scout plane that American ships were in the area, his planes had been loaded with bombs for a second attack on Midway Island. He gave the order that the planes be refueled and rearmed with armor-piercing bombs, in order to attack the American fleet The attack of Waldron's squadron had caught the Japanese in a highly vulnerable situation, with aviation fuel and explosives on deck. Although his attack did no damage, it delayed the rearming. As Samuel Eliot Morrison, the official Navy historian, put it, “it was the stark courage and relentless drive of these young pilots of the obsolete torpedo planes that made possible the victory that followed.”
Minutes after the last of Waldron's planes had splashed into the sea, the dive bombers arrived. To deal with Waldron's attack, the Japanese fighters and Japanese guns had been pulled down toward the surface of the sea. The dive bombers attacked, virtually unopposed. With the explosives and fuel on deck, every hit produced an inferno. Within minutes, the four Japanese fleet carriers were ablaze, and would eventually sink. Although a last Japanese attack fatally damaged Yorktown, the back of Japanese naval power had been broken. They would never again mount a major fleet action. The Pacific had been saved.
There are important lessons here for us in the American and for the critical battles we are engaged in to protect psychoanalysis and our ability to deliver quality, confidential psychodynamic therapy. A major one is that it is possible for a small group of determined, focused people to make a real, and sometimes a monumental, difference, regardless of the odds. The problem, of course, is that one is never sure at the time whether an action or sacrifice will, in fact, make a difference. In Waldron's case, he had no way of knowing that the Japanese planes were being rearmed, or that his dive bombers would arrive soon after, which makes his heroism and that of his crews all the more remarkable. He did what he thought was right, regardless of the odds or the consequences to himself, and in this instance, it made all the difference in the world.
The American and the Coalition for Patient Rights (CPR) have both pursued a similar course, though in a less dramatic situation. In October 1993, when the Clinton “Health Security Act” threatened to make private practice illegal, both organizations, at first separately, and then in concert, worked doggedly to protect the right of patients to make their own choices. At that time on Capitol Hill, managed care was all the rage. We were lonely voices opposing what seemed like a juggernaut. At that time, it seemed difficult to imagine that we would be able to make a dent in
the overwhelming corporate and economic forces opposing us. We were joined by more and more concerned groups as the legislative process went along. Our strategy was to string out the process until the public could be truly informed. By the time the juggernaut ran out of gas, we had achieved the inclusion of protective language for private practice in every bill then extant.
And now, it appears to be managed care, and not us, that is on the ropes. I have received calls from a number of reporters who have asked what I might make of the recent study that showed as many as 98,000 people a year may be dying as a result of “medical mistakes.” It is sobering to reflect that this is more than ten times the number of people killed on both sides at the battle of Midway. My reply is, “Can you spell 'managed care?” Should it really be any surprise that people are dying as a result of a system in which corporate profit depends on minimizing care, and it is not possible to sue the companies and individuals who are responsible? It would be unconscionable for us not to speak out, both as individuals and as an Association, about such a medical and moral outrage.
We have seen a similar process with Medicare. Starting from a position of no contacts or influence with the Health Care Financing Administration, we have been able to achieve clarification of the patients right to protect the confidentiality of his treatment by requesting that his physician or therapist not file a Medicare claim. We have established good working relationships with high-ranking HCFA officials, who have promised their help should any of our members have difficulty under the 90845 coding for psychoanalysis.
With the defeat of the Clinton plan and others like it, the battleground for the control of the health care dollar has shifted to the control of health care information. Here too, the odds seemed hopeless at the beginning. Many said, and continue to say, “Why are you bothering with this? It's hopeless, it's over. There is no privacy.” Here is another lesson from Midway. When something is fundamentally wrong, destructive to people, and particularly to fundamental human freedom, the odds are irrelevant. There can be no surrender, no compromise, no quarter, and above all, no quit.
I have never been more proud to be a member of this Association than when I see what we have accomplished on the issue of privacy. The American and CPR are in the very forefront of this fight. It would be no exaggeration to say that we are driving this issue as a major proponent of true privacy. Working closely with key Congress persons on both sides of the aisle we have helped defeat or stall damaging bills and helped craft positive legislation. Working with the office of Vice President Gore resulted in his personal intervention in helping to forestall and change the notorious “OASIS” data-gathering regulations put forth by Medicare. This victory, and the close working relationship we established with John Fanning at our May meetings when he participated in our discussions of the implications of the Supreme Court decision in Jaffee vs. Redmond, resulted in special protection for psychotherapy notes in the recent regulations put forward by Health and Human Services. Psychotherapy is the only service to receive this special consideration.
The last, most easily overlooked, but possibly most important lesson from Midway is that it is always the people on the front lines, in the trenches, who by their quiet courage, devotion, and sacrifice make the difference. Though we know Waldron by name, it was the individual members of the crews of his squadron, and those of the dive bombers, working selflessly as a team, that achieved the result. Though the original plan failed, there were no prima donnas, no recriminations, no internal discord. Everyone continued to do his very best to achieve the common goal. What better example could there be for us, as we work to establish our grassroots political action groups in every society and institute? What better model could there be to illustrate the effect of concerted action by groups and individuals with a common goal?
Among the many recent examples of positive change brought about by psychoanalysts working together, a particularly notable one is the Jaffee-Redmond decision. Our Association participated with other members of the Psychoanalytic Consortium to file an amicus brief. At the time, it seemed unlikely that the Supreme Court, even if it decided in our favor, would produce more than a narrow finding. In fact, the result was a sweeping victory for psychodynamic therapy. This decision, and the reasoning of the court upon which it rests, has now become a major weapon in our political arsenal. We are now able to argue that the rationale of Jaffee-Redmond must be included in any privacy legislation or government privacy regulation. To know that this argument is being effective, one needs only to look at the Department of Health and Human Services regulations and the recent report of the Surgeon General, both of which prominently feature Jaffee-Redmond.
New Councilors-at-Large
Psychoanalytic groups in general, and our Association in particular, have a secret weapon that we have always had difficulty in using effectively, and that is our common bond: our mutual devotion to psychoanalysis and psychodynamic therapy. Other professional mental health organizations, such as the American Psychiatric Association and the American Psychological Association, are sometimes handicapped by their size and varied constituency. Similar to the U.S. Navy at Midway, all psychoanalysts and psychoanalytic organizations share a single goal — the preservation and protection of psychoanalytic therapy.
In practical terms, this means that it is imperative for all psychoanalysts and psychoanalytic organizations to work closely together to achieve our common goal. Our traditional schisms and suspicions must be put aside for the good of all. Our Association has the organizational structure to effectively carry out this effort. It is crucial for us to make every effort to welcome, include, and work with our respected colleagues.
This issue of TAP is devoted to our allies with whom we have been meeting in various venues for some time. It gives me great pleasure to welcome the William Alanson White Institute, the Psychoanalytic Consortium (the American Academy of Psychoanalysis, Division of Psychoanalysis (39) of the American Psychological Association, the National Membership Committee on Psychoanalysis and Clinical Social Work, and the American Psychiatric Association), and the Independent Psychoanalytic Societies to these pages.
A final note from Midway. What few things do people cherish so deeply that they are willing to put their life on the line to preserve them? What will move us, as psychoanalysts, deeply enough that we will be willing to lay aside our traditional differences? Is the need to protect psychoanalysis important enough for us to rise above turf concerns to achieve the greater goal? We have an historic opportunity before us: to create a strong alliance of psychoanalytic groups of high quality. For the sake of our profession and our patients, we must achieve this goal, and soon. To paraphrase Benjamin Franklin, we must hang together, or we most assuredly will hang separately.