In his recent column, “The Enemy Within” (TAP Vol. 37, No. 3), Dr. Fischer encourages “local outreach” as the remedy for the declining credibility of psychoanalysis. I believe that this solution is vastly inadequate. Furthermore, our new attitude of inclusiveness, frantic search for empirical justification, vigorous efforts at marketing, and finger pointing within our ranks will have limited effects. Our problems are the direct consequence of a powerful anti-psychodynamic lobby that has hijacked psychiatry and effectively promulgates this bias within the therapeutic community. This has been implemented through official American Psychiatric Association policies and activities, par ticularly the publication of DSM-III in 1980, which served as a singularly devastating renunciation of psychoanalytic principles.
In my opinion, the APsaA's response has been mostly one of appeasement and self-reproach. Perhaps this is because so many of our members are also psychiatrists who question themselves whenever critics dismiss analytically-based therapies as not “evidence based.” Yet Dr. Portuges' article, “The Power of the Antidepressant ‘Placebo’” (TAP, same issue, pp. 7, 26), amply documents the thin margin of therapeutic effectiveness of SSRI antidepressants and exposes the historic manipulation of “evidence” favoring these medications.
Undeniably, the fate of psychoanalysis rests on our relationship with psychiatry. Furthermore, time is running out. Senior non-analyst psychiatrists who learned before DSM-III arrived about the critical role of unconscious conflict in psychopathology and who have served as role models for psychiatric residents and other trainees are being replaced by a new generation of psychiatrists with little conviction in psychodynamics.
APsaA must formally and vigorously challenge today's APA regarding the consequences of a “mindless” psychiatry. Long overdue is the establishment of a broad-based, amply funded, politically oriented APsaA campaign designed to revitalize the “psycho” of the biopsychosocial model within psychiatry and psychiatric training and reassert psychoanalysis as its proponent. The enlightenment of tomorrow's psychiatrists must be regarded as important as the training of new psychoanalysts.
They say that in death, you die twice; once with your actual death, and a second time when those who remember you die. Regrettably, I believe that within American medicine psychoanalysis is on life support… and those who will remember her are not far behind.
Norman M. Camp, M.D.
Clinical Professor of Psychiatry, Virginia Commonwealth University Medical Center Past President, Virginia Psychoanalytic Society