The Need for Psychoanalysis to Have a Public Health Mission by William H. Gottdiener
In a recent online discussion, a number of psychoanalytically oriented clinicians bemoaned the lack of attention that psychoanalysis gets from grant funding institutions such as, the National Institutes of Mental Health (NIMH). The lack of attention was put forth as evidence of an anti-psychoanalytic bias at NIMH. I replied that, although, an anti-psychoanalytic bias might exist that it is necessary for psychoanalysts to realize that the purpose of NIMH is to fund research that will lead to reductions in public mental health problems and improved treatments for those problems. I further noted that although many psychoanalysts work with people who are diagnosed with severe psychopathology, psychoanalysts have largely avoided development of new treatments for those problems or new ways of reducing those problems that can be applied on a large scale without highly specialized clinical training. This is not true across the board, of course.
A significant and related problem is that few psychoanalysts do empirical research; many even dislike empirical research and at one time an interest in doing it was pathologized by some members of the psychoanalytic community. Furthermore, most psychoanalysts and psychoanalytically oriented clinicians work in private practice and not in the public health sector. In fact, I have been told by some colleagues that my interests in addictions, psychosis, and psychotherapy for these problems was a sign that I was not really interested in being a psychoanalyst.
Psychoanalytic journals are not read by most researchers or policy makers and most of our journals publish little empirical research on public mental health problems. Hence, there is a disconnect between psychoanalysis and the mission of organizations such as, NIMH. NIMH used to regularly fund psychoanalytic research and did so for decades, but that funding did not lead to large scale improvements in public mental health or large scale engagement by well-trained psychoanalytically oriented clinicians in the public health sphere. My hunch, is that a big reason for this outcome is that little to none of the findings from that NIMH funded psychoanalytic research reached the classrooms of psychoanalytic institutes and the pages of psychoanalytic journals.
To compound the problem, psychiatric, clinical psychology and social work training programs that used to be and are psychoanalytic did little and do little to encourage their students to pursue academic careers. Having more psychoanalytically oriented people in academia would increase the amount of psychoanalytic research done to address public mental health problems. At least in clinical psychology, what I know best, it is clear that most students regardless of theoretical orientation want to enter private practice, but there are, nonetheless, a large enough proportion of students with a cognitive-behavioral orientation who want to enter academia and very few psychoanalytically oriented students who want to do so.
I, therefore, do not see NIMH as being against psychoanalysis per se. Instead, I see psychoanalysis as being against NIMH because psychoanalysis lacks a public health mission. Without a public health mission that encourages the development of new treatments for severe public mental health problems and encourages students to pursue academic careers, the field of psychoanalysis will remain largely ignored by organizations like NIMH.
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