Greatness or Obsolescence—The Challenge of Niko Canner

Instead of publishing the column I prepared following the January meetings, I have decided to use this page to recall to you the extraordinary challenge set out for us by Niko Canner four years ago. Canner, a management consultant, interviewed a wide range of Association representatives in the midst of our governance wars. He spoke to the Executive Council on January 22, 2004. The following is not a transcript, but a detailed summary I prepared as secretary.

Niko Canner has been a friend to psychoanalysis from an early age—his father introduced him to Freud as a teenager: There is a way of finding an abundance of meaning. It is a great motivation to think he could be helpful to a community of people who are advancing this knowledge in the world. His intention is to reflect back—through his own prism—some of the inferences he's drawn from what he's heard from some leaders of our group.

He began with “apparent facts”:

• The base of patients is decreasing slowly—about one percent per year.

• Increased challenges to reimbursement in a culture where all health professionals are worried about the reimbursability of their work.

• The policy environment is not friendly—confidentiality, certification standards, etc. Psychoanalysis has too few friends in the policy world.

• Although this varies, too few analysts are regarded well by other mental health professionals, and the profession as a whole is not regarded well and frequently with distrust.

• The membership base of the Association is aging. New entrants enter at mid-life and not at the height of their creative work and careers.

• The profession is organized around a model of analysis that accounts for less and less of what an analyst actually does.

• The public's need and ability to pay for treatment has changed. There is too little evidence that psychoanalysis delivers outcomes that patients need and that insurers are willing to fund.

• There is little, and decreasing, interest in funding research on psychoanalysis and its impact as a form of treatment. Little public funding is devoted to it.

The world presents a challenging environment for psychoanalysis, and it will take an extraordinary effort to change this environment. Many forces are trending against the kind of treatment and way of thinking that we all want to see sustained and extended over the course of the next generation.

During this time of significant external challenge, a great deal of energy is focused inward on the dynamics of the Association itself. Particularly, there has been great emphasis on how the Association and its component parts will be governed. This emphasis seems out of all proportion to the stakes involved. Canner estimates that the entire discretionary budget available to the Association and its boards and committees amounts to less than one-tenth of one percent of the income earned by psychoanalysts in the U.S. The stakes for the things that the Association actually controls—that can be formally governed—are very small in terms of the sum of personal and professional concerns of its members. There is a strong perception of entrenched adversarial positions on issues related to the Association's dynamics and governance. The emphasis is on process and compromise between interests that are taken for granted to be in opposition.

These observations are striking to an outside observer. A great deal of contest, consuming a great deal of energy, is going on at multiple levels. There are potential legal challenges, elections, special committees, and task forces that are rarely able to fulfill their missions. A tremendous energy is being expended on the question of the formal design of the organization, while in fact, the organization controls very little of the future of the profession.

At the same time, the stakes are very high. The fact that the external environment is so challenging means that our acts could potentially be deeply important. What is critical is the extent to which the organization can harness the energies of our bright and talented members in order to pursue a few salient aspects of the collective challenge.

Canner described a BOPS fellow's comment on the preceding day about a Shakespeare festival and a program for local university students that showed how psychoanalysis could contribute to the understanding of the plays. It seemed to be a small instance of the way a few people could change the way psychoanalysis is viewed in the community—a way to deepen one's understanding of the world. This exemplifies how a few members can work on a local scale, but united behind a few common themes. Such activities impact how the public thinks, whether patients become interested, and perceptions of colleagues in the mental health professions. The sum total of such activities is deeply significant—much more so than the formal actions of the Association itself. Our formal actions are important primarily in a symbolic way to unite people behind a common end, even if the many means to achieve that end are very different.

Canner suggested that perhaps neither the right nor the left of the organization is strong enough. We seem to have a deep-seated worry about making any mistake. We are risk averse. What if we enable people to do the “wrong thing”? What if people with the “wrong views” are enabled to proceed? Perhaps there is a way to bracket those worries—to disagree about how things should be pursued—but to go into the world in different ways and experiment to find what works.

For psychoanalysis to overcome these trends, the concerted action required will be significant. The question is not whether we will be functional or dysfunctional, but rather a question of greatness or obsolescence. If we do not together do extraordinary things, simply good efforts will have little effect on righting trends that have been set in motion by forces much larger than ourselves. It is not a question of getting things “right” in terms of the mechanics of our organization, it is a question of learning to imagine new possibilities for the profession that have not yet been dreamed. The questions are fundamentally creative rather than fundamentally reactive.

Canner asked himself, how many of the 10,000 brightest minds in the generation now graduating from college are likely to have any significant contact with psychoanalysis in the course of their lives? As things are now, the number is small. He compared that to the number in Freud's Vienna. Is there a way to invent and articulate relevance so that coming generations will have psychoanalysis as a larger part of their repertoire for understanding the world and creating within the world? There is no reason that this should not be possible, but the scale of efforts and the variety and richness of experimentation required seem beyond where the sum total of organizational efforts and individual efforts seem likely to go today.

Since we are an organization of volunteers, we are difficult to govern, but it is a source of strength. It makes us able to tolerate a diversity of efforts. We need to identify the few goals that we collectively care most deeply about and create many different kinds of efforts in support of these goals. We can take risks about the formal structure of the organization and the nature of our formal, shared decisions, because the action is, and will always be, in the decentralized, volunteer work.

Canner wanted to speak about how to deal with governance because there had been so much controversy about it. He proposed a simple way of proceeding. Governance of the Association should not be about finding “the best” solution, but a “good enough” solution. Understanding that the action will always be elsewhere, the question is how to get to a governance structure that won't hold us back—get there quickly, with minimum friction, and distract us as little as possible from the real and important work that must be done in the world. He proposed a plan with a division of labor between three different roles.

The executive group (elected leadership) would initiate a process and set parameters for a governance structure; a representative group would do the detailed work to develop a single proposal; and the membership would make the decision whether it was good enough to accomplish immediate goals.

Canner closed with an excerpt from a poem by W. H. Auden, “In Memory of Sigmund Freud”:

Canner concluded:

You seem over-familiar with a certain way of debating with each other, with a future that doesn't look friendly, but that could be approached as a friend. It could be a setting in which you exercise your considerable talents, your imagination, and create out there in the world a new set of things that psychoanalysis can do, a new level of impact in how we understand ourselves, each other, and our possibilities for health…. If this conversation gives us any further momentum in that direction, it will have been a conversation worth having.