When I was approached to write an article for TAP about my experiences as an analyst living in the small, federal territory of Puerto Rico, I immediately knew that I faced a major challenge. How would I avoid appearing contradictory in telling about my profound, personal satisfaction with my career while at the same time describing the sad state of affairs of organized psychoanalysis on this island? And furthermore, how could I do this without adding one more disheartening story to the already long inventory of unresolved issues which have created what psychoanalysts in all parts of the world have come to call “our crisis”? By “crisis” I mean our generalized concern about the survival of psychoanalysis everywhere.
As I thought about my experiences, I had to overcome my resistance to lamenting the untoward outcomes which have come about as a result of processes in which I had played a role as one of the protagonists. This lament, despite my recognition that even had I and my colleagues applied different strategies as we attempted to instill life into organized psychoanalysis in Puerto Rico, in all probability, we would still have come to the same, depressing situation in which we now find ourselves.
How would I avoid appearing contradictory in telling about my profound, personal satisfaction with my career while at the same time describing the sad state of affairs of organized psychoanalysis on this island?
First, a bit of personal history. I was born and raised here. After medical school, I left to pursue both my psychiatric and psychoanalytic training in Houston and Philadelphia where I spent 20 years. I then returned to Puerto Rico in 1987. To facilitate the transition from the mainland U.S.A., I accepted a position as medical director of a new private psychiatric hospital under development at the time. After 4 years in that role and once the hospital was firmly established, I left to open a fulltime private practice.
The practice attracted a large volume of patients and I decided to recruit other mental health professionals to serve them. Subsequent opportunities for innovative mental health programs and services emerged. Because our group, now formally organized and known as INSPIRA, was interested in offering psychoanalytically informed solutions, we became involved in developing them. As our group's activities grew, being the leader and with much regret, I had to gradually reduce the time devoted to clinical practice. This allowed me not only to manage our firm more adequately but also devote more time to other professional matters such as training, consulting, and becoming more actively engaged in our Puerto Rico Psychoanalytic Society, of which I eventually became president.
Because of the need for high quality mental health services on the Island, through INSPIRA I have had many opportunities to work at the highest levels with a large number of private organizations, key government agencies and officials, and educational institutions. And, yes, I have even made occasional forays into the forbidden and dangerous worlds of business and politics, from which, luckily, I emerged unscathed, or so I think. I have been involved in teaching in a wide variety of forums, some for mental health disciplines but many from other professional areas, such as law, religious, medical, and literary practitioners. I also became intensely involved in public mental health education activities through regular appearances on TV and in print media.
After 20 years of intense professional work on this island, I feel very satisfied with the many opportunities I have had to share and apply my psychoanalytic knowledge for the betterment of society. In the morally confused world we live in, I can proudly say that our group has been able to demonstrate that success and ethical values are not only compatible but indispensable partners. Without psychoanalysis, most of what we have been able to achieve would not have been possible. The positive results which we have been able to bring about serving clients and patients have strengthened my conviction that our theory still remains the most powerful body of knowledge ever created to understand ourselves, both individually and collectively. Even with its relative lack of advancement, it remains the ultimate platform from which to launch an all out attack on human misery. Ours is a mighty force indeed!
Despite my sense of personal satisfaction, I cannot help but regret the state of Puerto Rico's psychoanalytic society. When I returned in 1987, the society was composed of eight members, all trained in American Psychoanalytic Association sponsored centers. We met regularly, enjoyed excellent interpersonal relationships, discussed scientific and cultural matters, and sponsored educational activities for mental health professionals. We also attempted to open a training center. However, we were not successful in establishing one, due in part to the residua of the abandoned orthodoxy to limit training to physicians.
Over the last 5 years, we have lost five of the original eight analysts in our society. At the present time, there are three fully trained analysts (two recent arrivals and me) on the Island, and another two who are partially trained. There is a Lacanian group whose details are
Alberto M. Varela, M.D., is a psychiatrist and psychoanalyst living in San Juan. He is currently medical director of INSPIRA, a mental health organization he founded, which provides a wide range of services to individuals and organizations.
not available. After the more recent deaths, we stopped meeting on a regular, formal basis. Despite the generous and strong support from colleagues like Lila Kalinich from New York, both our society and our efforts are still in disarray.
I worry about mankind's future without psychoanalysis, a bleak future left to be dominated by the brute, commercially driven, managed care/medication-only industrial complex and surface scratching, cosmetic “cognitive” therapies. As I described above, with the demise of our psychoanalytic society, this is beginning to become a reality on our island.
I can only hope that our sad lesson in organizational development in Puerto Rico can spur colleagues elsewhere to work together and strengthen their psychoanalytic groups to ensure their survival. If they do not, Puerto Rico will not be the only geographic area where dark, implacable Thanatos will triumph over complacent, sweetly intoxicated, and tragically distracted Eros.