In general, I have been pleased with the American coming out of its ivory tower, and working with issues that can have a political impact in defense of our profession. However, I found myself reacting negatively to an “absolutist” position in the articles by Dr. Pyles and Dr. Shopper. I have always been impressed with the psychoanalytic stance of non-judgmentalism and neutrality in dealing with conflicts in the individual. Psychoanalysts seem to have trouble in using the same attitudes when dealing with societal conflicts.

First, in relation to the privacy needs brought up by Dr. Pyles: Privacy is not an absolute. If [it were], we would have no case discussions, oral or written. We have tried to defend the welfare of our patients, but I think the same methods could be tried with third-party payers. They feel responsible for spending funds responsibly, and I am afraid we have not always shown our responsibility. I reviewed cases of adolescent psychiatric hospitalization some years ago. It was amazing how often discharge “as cured” occurred when the insurance ran out.

Dr. Shopper's attitude concerning capital punishment is also absolutist. One cannot deal with the ethics of killing in this situation without also dealing with killing in police work, war, revolution, abortion, and euthanasia. Very few people hold a consistent position throughout all of these. Apparently many think it is more ethical to eliminate the unwanted than [to] kill the killers.

It is dangerous for professional organizations to take political positions, even if they think their science or clinical experiences seem to back it up. I don't recall when the American Orthopsychiatric Association began to use the results of psychological studies to justify political activism. Using psychoanalytic theory for the same purpose is similarly not valid and may polarize the membership.

Helen R. Beiser, M.D.