Op-Ed Contribution by Henry J. Friedman by way of Jane S. Hall, our Op-Ed Editor:
Freud invented or discovered psychoanalysis in his role as a physician. Patients came to him suffering from symptoms, usually of a neurological type, and he uniquely found a way to penetrate beneath the surface of the symptoms to the unconscious elements that were generating these conflicts. Is it any wonder that his treatment, psychoanalysis, was viewed as a medical treatment and psychoanalysis in the United States was introduced as a medical speciality, a part of psychiatry, actually what might be called super psychiatry. Psychoanalytic training in the 60’s was understood to be restricted to those trained as psychiatrists. When waivers were granted to PhDs they were usually pledged not to practice as clinicians but to use their clinical training for research purposes.
One can only wonder about how the radical change that we can observe has occurred. Obviously, as has been documented by numerous commentators, this has been a gradual and building conversion from complete medical control to a clinical discipline that is largely training non-MD candidates. Freud himself was a great champion of what was called lay analysis. He wrote eloquently about the reasons that those trained in disciplines other than medicine might be better suited to practice and think psychoanalytically but his vision which carried in Europe failed to loosen the attitude of the APsaA which remained firmly psychiatric in its requirements for training.
A concise summary of the narrative from medical domination to where we are now would touch on those crucial points where the APsaA decided against becoming a subspecialty of the psychiatric speciality board. This decision, followed by the lawsuit of three psychologists that was settled to allow training of non-MD candidates and the movement of psychiatry in a biological direction, favoring psychopharmacology and a view of manic depressive and schizophrenic illnesses as anything but emotional based all have combined to change the face of psychoanalysis.
Whatever any individual psychoanalyst’s view of the change, approving or regretting, the change is here and we need not only to live with it but to find the advantages within it. Patients these days come for therapy and hopefully psychoanalysis because of problems in living, issues of unhappiness, often depression of a type connected to lack of fulfillment or anxiety about their day to day existence. More than ever psychiatric training while a good training for a psychoanalyst can hardly be seen as a necessity; immersion in the literature of psychoanalysis, extensive knowledge of literature, a capacity for empathic understanding are hardly restricted to those with medical training. Our current blending of backgrounds, psychologists, social workers, nurses, academics all may bring exactly what is needed to treat the emotional problems that currently bring patients to see us.
The history of the APsaA explains so much of our turmoil about who can be a psychoanalyst. We started as an exclusive set of psychiatrists who felt, correctly, more able and intensively trained than the average psychiatrist. It is hard to give up such a position and recognize that we are now more than ever a clinical discipline that looks to its own history as a source of coherence. Each of us has a valued background in clinical training that must be modified as we incorporate the essentials of a psychoanalytic approach, its multiple theories and its ever changing technical face. This is what has happened, this is what has evolved and makes us perhaps better than ever able to help those who seek our help.
Henry J. Friedman———————————————————————