the SPRING/SUMMER 2009 AMERICAN Volume 43, No. 2 PSYCHOANALYST Quarterly Magazine of The American Psychoanalytic Association

The Long Haul: INSIDE TAP... Healing the Wounds of War AMICA ...... 8–9 Jonathan Shay Freud in America Jonathan Shay is internationally renowned for rather sweet story—I hope you’re moved in 1909 ...... 10 his groundbreaking work on the psychological that sense—of how these two Homeric books sequellae of war. His two books, Achilles in Viet- on war and returning from war came to be. I’ve Bear Market Blues. . . . . 12 nam and Odysseus in America, have created also discovered that there’s a “man bites dog” new and deep insights into the nature of these newsworthiness to my improbable career. APsaA Impacts injuries. Shay has compared his work with Vietnam I went to work for the VA in 1987 expect- veterans to the descriptions of battle trauma in ing to do something utterly, utterly different. I Stimulus Package. . . . 14 the works of Homer, providing new perspectives was expecting to re-open the experimental Special Section on on issues related to the traumatic effects of neuropathology laboratory that I had had at combat that are as old as mankind itself. In Mass General Hospital, and the veterans kid- Outreach to High recognition of his work, Shay was honored with a napped me. They saw something in me that School Students . . 20–23 MacArthur Fellowship. Shay was the keynote I for sure didn’t see in myself, and they redi- speaker at the Presidential Symposium of APsaA’s rected my life by at least 90 degrees. And I The Candidate Winter 2009 Meeting; an excerpt from his mov- thank them for it. Another way that the vet- Online Journal . . . . . 27 ing presentation entitled “The Long Haul: Heal- erans redirected me is that I have learned ing the Wounds of War” follows. It is also available over 20 years that while they are a very con- Remembering on the American Psychoanalytic Association tentious bunch who will argue about anything, Samuel Ritvo . . . . 34–35 Online Audio Library at http://www.apsa.org/ the one thing that they are absolutely unified onlinelibrary. This excerpt opens with his intro- on is they don’t want duction by Robert Pyles. other young kids wrecked the way I consider it a singular honor to have the they were wrecked. opportunity to introduce Dr. Shay. I can think And so it is the of no more fitting speaker to begin our Asso- veterans who have ciation’s Soldiers and Veterans Initiative intro- set my feet on the duced by our president, Prudy Gourguechon. missionary path. I I believe you will find Dr. Shay’s work fasci- describe that when nating, and his personal story as moving as I speak with active those he writes about. Dr. Shay. duty folks as a mis- sionary from the vet- 8 erans I serve. They don’t want other It really is a great pleasure to be here. Dr. young kids wrecked Pyles’s enormously generous introduction has the way they were wrecked, so listen up. given me a license to tell you some of the Continued on page 30

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 1 CONTENTS: Spring/Summer 2009 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: Prudence Gourguechon Prudy Gourguechon 3 Reporting In President-Elect: Warren R. Procci Certification Examination Committee: Status Report Secretary: Robert M. Galatzer-Levy 5 Treasurer: Judith S. Schachter Written in collaboration with the Certification Examination Committee Executive Director: Dean K. Stein 6 BOPS and Council Report: Highlights from January 2009 Meeting Jane Walvoord THE AMERICAN PSYCHOANALYST 7 Projections: Psychoanalysts and Film: Then and Now Bruce H. Sklarew Magazine of the 8 AMICA American Psychoanalytic Association Editor 10 After Freud Left: Symposium on His 1909 U.S. Visit John Burnham Janis Chester 12 The Pain of a Bear Market John W. Schott Editorial Board Brenda Bauer, Vera J. Camden, 14 APsaA Secures Privacy Protections in Stimulus Bill Jim Pyles Leslie Cummins, Phillip S. Freeman, Maxine Fenton Gann, Noreen Honeycutt, Bob Pyles 15 Politics and Public Policy: Our Finest Hour Sheri Butler Hunt, Laura Jensen, Poetry: From the Unconscious Sheri Butler Hunt Nadine Levinson, A. Michele Morgan, 16 Julie Jaffee Nagel, Marie Rudden, Letters to the Editor Hinda Simon, Vaia Tsolas, 17 Dean K. Stein, ex officio D. B. Ruderman 18 Aliens and Alienists Senior Correspondent 19 Inner Space Esther Rashkin Jane Walvoord Photographer SPECIAL SECTION Mervin Stewart Outreach to High School Students Manuscript and Production Editors Michael and Helene Wolff, 20 American Psychological Association Publishes High School Technology Management Communications “Lesson Plan” on Psychoanalysis and Psychodynamic Psychology James Hansell The American Psychoanalyst is published quar- terly. Subscriptions are provided automatically to 21 Education Division Launches Teen Web Site Project members of The American Psychoanalytic Asso- Stephen Sonnenberg ciation. For non-members, domestic and Cana- dian subscription rates are $36 for individuals STDs—Reaching Out to Teens Dottie Jeffries and Mary E. Tressel and $80 for institutions. Outside the U.S. and 22 Canada, rates are $56 for individuals and $100 for American Psychoanalytic Foundation Committee: institutions. To subscribe to The American Psy- 24 choanalyst, visit http://www.apsa.org/TAPSUB, or Grants Awarded July 2008–December 2008 write TAP Subscriptions, The American Psycho- analytic Association, 309 East 49th Street, New 25 COPE: Meeting the Challenge of Rehabilitation for Boundary York, New York 10017; call 212-752-0450 x18 or Violators Marvin Margolis e-mail [email protected].

Copyright © 2009 The American Psychoanalytic SPECIAL SECTION Association. All rights reserved. No part of this Candidates publication may be reproduced, stored in a retrieval system, or transmitted in any form or by Affiliate Council President’s Message: June 2009 Carmela Perez any means without the written permission of The 26 American Psychoanalytic Association, 309 East 27 The Candidate Online Journal Thrives Brenda Bauer 49th Street, New York, New York 10017. 29 The Importance of Becoming Involved: Finding a Home ISSN 1052-7958 and a Future in Psychoanalysis Hilli Dagony-Clark The American Psychoanalytic Association does 34 In Memoriam: Samuel Ritvo not hold itself responsible for statements made in Rachel Z. Ritvo, David Z. Ritvo, and Jonathan I. Ritvo The American Psychoanalyst by contributors or advertisers. Unless otherwise stated, material in The American Psychoanalyst does not reflect the endorsement, official attitude, or position of Correspondence and letters to the editor should be sent to TAP editor, The American Psychoanalytic Association or The Janis Chester, at [email protected]. American Psychoanalyst.

2 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 FROM THE PRESIDENT

issues. A statement opposing corporal pun- Reporting In ishment of children is in the works. The Prudy Gourguechon Soldiers and Veterans Initiative (SVI) has accomplished quite a bit, with a strong section When my chil- governance, and conflicts over governance, on our Web page, several position statements, dren were in when the only point of governance is to a dedicated Internet discussion group, sev- grade school, allow us to accomplish our mission of serv- eral press placements, and the moving article they were taught ing members and advancing the profession of by Russell Carr, a candidate stationed in Iraq, to write essays psychoanalysis. In all we do organizationally, in the last TAP, calling us all to service. A spe- by a method that we should be continuously asking ourselves cially designed logo called attention to SVI spooked me. if the effort spent best serves the members, activities and various speakers and sessions They had to the profession, and the public. at the January 2009 Meeting, including the write an intro- Reviewing my original campaign platform Presidential Symposium with Jonathan Shay.

Prudy Gourguechon ductory para- and early TAP articles, I can list these origi- We are now identifying our focus for a next graph listing nal goals: stage of activity. three points they were going to make, then • Focus on societal issues, especially veter- write three paragraphs, one on each point, ans and their families Education Department and a concluding paragraph saying what they • Form a comprehensive Education This project has far exceeded my wildest had said. This technique was stunning in its Department hopes. The outreach Education Division is lack of creativity, but somehow comforting in • Attend to outreach and membership morphing into an Education Department, a its rigid structure. I secretly envied the structure needs common structure in successful nonprofits. and certainty. How calming to know exactly where you were in an argument or a process. And perhaps this pedagogic method did not I believe our organization still spends far too much time really teach writing, but it certainly reinforced dealing with governance, and conflicts over governance, accountability. For this presidential column, I decided to when the only point of governance is to allow us to adopt some of that elementary structure and accomplish our mission of serving members and demand for accountability. It is now a year into my service as your president—halfway advancing the profession of psychoanalysis. In all we do through my term. What did I say I was going organizationally, we should be continuously asking to do? What did I do? How did I do at doing what I said I was going to do? ourselves if the effort spent best serves the members, This exercise is as much for myself as it is the profession, and the public. for you. One of the frustrations of the APsaA presidency, acknowledged by many of my predecessors, is that you feel you are elected • Support ongoing and new activities in With generous support from the Ticho Foun- to accomplish certain goals. Goals associ- advocacy, public information, and com- dation, the highly energetic leadership of Steve ated with improving practice or the state of munications, as well as psychoanalytic Sonnenberg and with staff support from Deb- psychoanalysis in the United States. Goals, science, psychoanalytic education, and bie Wardell, this division now comprises nine you hope, that would make analysts proud psychoanalytic psychotherapy committees, which cover outreach to educa- to be APsaA members. And then you quickly • Promote a personal analyst system tional systems from pre-K through post-grad- face a host of distractions in organizational • Bring to fruition an expanded membership uate level. Each committee has articulated a preoccupations with governance and other pathway mission and goals, and intercommittee collab- intercurrent crises that lead to a diversion oration is built into the division’s functioning. from one’s goals. I believe our organization THE STATUS OF THESE EFFORTS You will see the results start to emerge dra- still spends far too much time dealing with Societal Issues matically over the year ahead. We have created a template for position statements to guide committees unfamiliar Outreach and Membership Needs Prudence L. Gourguechon, M.D., is with this mode of action. Position statements We are currently analyzing the results of the president of the American Psychoanalytic are a key step in ensuring a psychoanalytic Member Needs Survey that was distributed Association. voice on a wide range of important social Continued on page 4

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 3 FROM THE PRESIDENT

Reporting In are extremely active and working in a strong within BOPS of the two-track system that Continued from page 3 collaborative way. Lynne Moritz and I suggested last year does Public information and communications has allow for the possibility that a group of insti- online in March. The purpose of the survey been strong for a long time, but it also requires tutes wishing to make slight or even radical was to find out the level of satisfaction with much ongoing maintenance and attention. changes in the training model could assemble existing member benefits and what ideas The Executive Committee just approved an and with great collaborative effort produce an members have for new benefits. The Practice upgrade in the content management system of alternative set of standards that would be dif- Toolbox on APsaA’s Web site is one member our Web site which will have numerous ben- ferent but no less excellent. I think this is the benefit that I think has tremendously useful efits including the ability to host blogs, a func- best available opportunity for change. information as well as great growth potential. tion that improves our standing in Internet The issue of expanding membership to Outreach was the siren that originally called searches. At the encouragement of the staff, include those who have trained outside the me into work in psychoanalytic organizations. I have started a president’s blog as an exper- institutes of the Association or IPA is now in I still remember hearing, about 15 years ago, iment. We need to modernize the Find an the hands of the membership in the form of a about San Francisco’s outreach program to Analyst feature on the Web site so that it proposed membership bylaw amendment that local judges and New Haven’s community po- includes pictures, maps, and personal Web will make it possible, if it is approved, for indi- licing project. I am concerned about the sup- site links. The Web site should be updated viduals with equivalent training to apply for port for creative outreach in the organization. more regularly. membership. I strongly support the bylaw amendment and encourage you to do so as well. I believe passage of this amendment will only benefit our profession and our Associa- Advocacy efforts continue to be strong, tion, and will not hurt it in any way. with our special expertise in privacy playing I will spell out the following goals for the remaining half of my presidency, in addi- a pivotal role in the formulation of the tion to not dropping the threads that have privacy provisions of the electronic medical already been woven into something strong and interesting: record portion of the Obama stimulus package. • Examine our organizational stance towards supporting outreach efforts and propose needed structures to improve this support • Finish the communications plan and the The American Psychoanalytic Foundation We are completing a communications plan updating of the infrastructure of our Web supports outreach efforts, and APsaA’s direc- that sorts out various possibilities and sets site, with consolidation of the audio library, tor of public affairs, Dottie Jeffries, conducts priorities among the burgeoning new media blog (add a science blog), and an enhanced an excellent workshop at the meetings. But opportunities. A wise consultant has advised us Find an Analyst feature the Committee on Foundations, a major site to concentrate on our own Web site, and • Identify a meaningful next focus for the for the dissemination of information on out- avoid the temptation to get involved in a great Soldiers and Veterans Initiative and set reach projects, has disbanded. Also gone is number of social media sites. A terrific new up a structure to monitor the Obama Forward!, the newsletter that featured out- feature of the APsaA Web site is our new health-care plan as it evolves reach efforts. Outreach is something that audio library—a very long time in anticipation This deliberate gaze backward leaves me happens locally, but inspiration and commu- and finally arrived. pleased with what’s been accomplished. At nication about outreach projects has to be Advocacy efforts continue to be strong, the same time, I am left with a cautious feeling. done nationally as well. It’s a tricky thing to with our special expertise in privacy playing Our organization is at once incredibly vibrant embed in our national organization and I a pivotal role in the formulation of the pri- and able to accomplish a tremendous amount. plan to give it more of my attention in the vacy provisions of the electronic medical We need to watch our tendency to get year ahead. record portion of the Obama stimulus pack- preoccupied with governance issues at the age. We can expect many more develop- expense of programmatic focus. We must SUPPORTING ONGOING ments on the health-care front in the next keep our attention always on what we the AND NEW EFFORTS year, and should be alert to their effects on members need and want to have for suc- The Psychoanalytic/Psychodynamic Research our members. cessful professional lives, and what we need to Society has received seed money and is pur- Regarding the personal analyst system: No, do to advance our profession of psychoanaly- suing incorporation. The Roose/Columbia pilot I have not made that happen, nor can I alone. sis and realize its potential in contributing its study has been funded. Our science committees However, the discussion recently undertaken unique insights to the larger world.

4 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 CEC STATUS REPORT

have been very high (p<.001). In addition, in Certification Examination Committee: 2009 the CEC began conducting exit inter- views and written surveys. The exit interviews Status Report resulted in suggestions about CEC procedures Written in collaboration with the specifically and ideas about psychoanalytic Certification Examination Committee education in general; nearly all the interviewees commented spontaneously about how much The Certification Examination Committee their subgroups used by the CEC to aid in eval- they had learned in the process of writing up (CEC) is fully aware of and very concerned uations. Initially, these emerged over the years their cases. The exit survey was anonymous about the problems involved in having an organ- during the CEC’s research on validity; subse- and comprised both specific questions as well ization with both membership and accreditation quently, many institutes have found them use- as an open-ended section. Questions such as aspects, the controversies about the relation- ful as they grapple with articulating various “Were the interviewers courteous, respectful, ship between certification and appointment of aspects of the psychoanalytic process in their and collegial?” and “Were you satisfied with the training analysts, and the serious difficulties educational programs. interviewers’ understanding of your cases?” in conceptualizing and carrying out a fair and Several additions and innovations have were ranked on a negative-to-positive scale, informative certification exam in psychoanalysis. occurred over the past several years. Two in and the applicants ranked these very posi- Much discussion and/or research is being con- particular should be noted here. First, the tively; the applicants also had several excellent ducted on all three levels. Alternative Certification Process (ACP) has suggestions in the open-ended section. As these larger and very complex issues been established; in this pathway, the applicant With respect to future directions of the are being sorted out, the current CEC is com- chooses two evaluators from a national roster CEC, three issues stand out. First, research will mitted to improving certification and provid- of analysts and presents cases to them over continue in several areas, particularly on the ing the best process possible. As Abraham about a six-month period. Second, a mentor interviews and inter-rater reliability. Second, the Lincoln stated in his 1862 Annual Message to program has been started; this involves pro- ACP will be assessed following its initiation in Congress,“We can succeed only by concert. It viding applicants with a mentor to help with the spring of 2009; the number of applicants is not ‘can any of us imagine better?’ but,‘can we the application process (pre-application men- will be expanded if it proves effective. Third, all do better?’… Object whatsoever is possible, tor) or to aid them should their application be the CEC will work with the Committee on still the question recurs, ‘can we do better?’” continued (continuation mentor). Institutes (COI) to consider integrating certi- fication with pre-graduate education. This The CEC has an evaluative function and, on several levels, would mean reconceptualizing certification and having a two-part or possibly three-part educative aspects as well. The CEC continues to strive evaluation, with applicants able to take parts to improve in all areas. Above all, the CEC wants to of the exam during their candidacy if they help applicants succeed. choose, much like the National Boards in medicine or the dissertation process in psy- chology. This process would also allow for (emphasis in original). The CEC has an evalu- Research is essential to the CEC, and the more discussion and collaboration between ative function and, on several levels, educative CEC has been actively involved in research on local institutes and national committees on aspects as well. The CEC continues to strive to many levels. As noted above, studies of valid- issues of curriculum and clinical standards. As improve in all areas. Above all, the CEC wants ity occurred over the past several years, with always, your thoughts and ideas are encour- to help applicants succeed. one result being the psychoanalytic compe- aged and welcomed. The most comprehensive description of tencies. This work, under the direction of the the purpose and procedures of the CEC can late Stuart Hauser, was conducted in collabo- be found in the CEC’s “Standards, Procedures ration with the CEC and a group of non-CEC Editor’s Note: The Board on Professional and Guidelines.” This can be accessed online at scholars and clinicians. More recently, with the Standards invited the Certification Exam- the APsaA Web site or obtained in hard copy assistance of Isaac Galatzer-Levy, studies of ination Committee to submit a column from the National Office. Of particular inter- inter-reliability have been performed, on both for this issue.The regular BOPS column will est may be the description of the 11 so-called the 11 major groups and also the several sub- return in the next issue. guidelines or psychoanalytic competencies and groups. The inter-rater reliability correlations

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 5 BOPS AND COUNCIL REPORT

could study the TA system with an intent to BOPS and Council Report publish its findings. Such a subcommittee would guarantee both the institute and the commit- Highlights from January 2009 Meeting tee a fair process and a chance to learn from Jane Walvoord each other. The members of PIPE anticipate that the subcommittee will operate in good AFFILIATE COUNCIL REPORT enriched since faith and the institutes will know they have Laura Jensen, the outgoing president of the PPRS will hold its some leeway, fostering trust between the insti- Affiliate Council, reported that the Affiliate meetings simulta- tute and the organization. Council is developing a blog site that will neously, allowing Another focus of the PIPE committee is on increase the dialogue among candidates. It the researchers TA qualifications. Training analysts are expected, will allow for posting photos of meetings as to meet and at all times, to be as qualified as they were well as polling and informing candidates about form an identity when they were appointed. Therefore PIPE important issues facing the Association. The site with APsaA and recommends a culture of development at all will be available to all candidates, including its members. levels which will provide avenues for devel- those who are not yet members, thus encour- Jane Walvoord opment prior to and after being appointed TA. aging Affiliate membership. This was Jensen’s PROJECT FOR This development might include attendance at last report as Affiliate Council president. Jensen INNOVATION IN PSYCHOANALYTIC required study groups on the institute level or was thanked with a standing ovation. EDUCATION (PIPE) REPORT workshops, either local or national. Encour- PIPE has been focusing on the immersion agement of consultation among peers would INNOVATIONS OF CERTIFICATION standard for training analyst (TA) appoint- also contribute to a spirit of collegiality, toler- EXAMINATION COMMITTEE ment. This standard needs to be updated ance, and overall career enrichment. Paul Holinger, chair of the Certification because many analysts today have fewer Examination Committee (CEC), reported patients in analysis and some institutes have POSITION STATEMENTS FROM THE that new applicants for certification are now an urgent need for training analysts. The cur- SOCIETAL ISSUES DIVISION assigned a writing mentor for the purpose of rent standard is four patients seen four or The Executive Council unanimously ap- making the certification process a better five times a week over five years or 3600 proved the following position statement pre- learning experience. If applicants are better hours, with a minimum of two cases for a sented by Ethan Grumbach, chair of the prepared and know more about what to period of time longer than five years. However, Committee on Lesbian, Gay, Bisexual, and expect when they enter the interview, the this seems unreasonable given today’s practice Transgender Issues: encounter stands a better chance of becom- climate. Therefore, if an analyst is well thought ing a rewarding and educative experience. of in his/her institute and is five years out, the The American Psychoanalytic An exit survey and interview are underway in members of PIPE recommend a lower require- Association opposes the military order to gain valuable feedback for the CEC ment of 2700 hours over the five-year period policy mandated by Title 10 of the to evaluate the usefulness of their methods post graduation, with the expectation that United States Code (Section 654) and procedures. these hours will contain significant experience which prohibits an individual’s serv- begun after graduation. With a minimum of ice in the military on the basis of PSYCHODYNAMIC/PSYCHOANALYTIC two cases seen four times a week, the require- sexual orientation. Section 654 bans RESEARCH SOCIETY (PPRS) ment could be attained in just over seven openly gay, lesbian, and bisexual indi- In recognition of the vision of Stuart Hauser years. In the evaluation of TA applicants, insti- viduals from serving in the military. and with thanks to others, Linda Mayes pre- tutes are encouraged not to focus on the APsaA strongly advocates that the sented a formal proposal to the Executive hours alone but on the overall quality of the United States Government overturn Council for a separate but affiliated research work. If a talented analyst achieves the required the current policy. society. PPRS will be a not-for-profit mem- hours in just four years, a waiver of the five- bership corporation with APsaA as the sole year requirement would be considered. PIPE The Council also unanimously approved a member. PPRS will provide a home for inves- also envisions a waiver system, with a sub- position statement presented by Mark Smaller, tigators who are not eligible to become mem- committee of the Committee on Institutes chair of the Committee on Social Issues, enti- bers of APsaA or IPA. APsaA meetings will be administering waivers. The subcommittee tled “Inner Wars Come Home: The Traumatic would also handle other matters of develop- Impact on Families and Children When Our Jane Walvoord, L.C.S.W., is a TAP senior ment and continuing education of training Veterans Return.” The statement includes the correspondent and a faculty member of the analysts such as oversight of the evaluation of following actions: Oregon Psychoanalytic Center. training analysts. In addition, the committee Continued on page 35

6 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 faithful disturbance of this relation—finds here Psychoanalysts and Film: an imaginative representation.”

Then and Now CONTEMPORARY CONTRIBUTIONS Bruce H. Sklarew Irving Schneider focused on categorization of how psychiatrists are presented in film in a The first doc- einer Seele (Secrets of the Soul). In the film, a 1977 paper on “Images of the Mind: Psychia- umented view- Viennese chemist struggles with an impulse try in the Commercial Film” in the American ing of a film by to slit his wife’s throat and has a knife phobia. Journal of Psychiatry. Freud occurred This man leaves his keys on a table in his club. The psychoanalyst Harvey Greenberg wrote in 1907 on a Another man picks up his keys and follows the first book approaching film through psy- rooftop at the him home. As he fumbles in his pocket to find choanalytic ideas, Movies on Their Mind in 1975, Piazza Colonna his keys, the other man hands him his keys and in 1994, Screen Memories. Later books in Rome. In a saying, You have some mixed feelings about include Images in Our Souls: Cavell, Psychoanaly- letter home he going home. When asked,“How do you know?” sis and Cinema, edited by Smith and Kerrigan in

Bruce H. Sklarew wrote that the the other man says, I am a psychoanalyst, the 1987; Bertolucci’s The Last Emperor: Multiple audience was first appearance of a psychoanalyst in film. Takes (1998) edited by Sklarew, Kaufman, beguiled by “pictures of landscapes, Negroes He proceeds to cure his new patient, largely Spitz, and Borden; and Psychiatry in the Cinema of the Congo, and glacier ascents” mingled through dream interpretation. Freud, strongly (1999) by Glen and Krin Gabbard. Psycho- with ads. During their 1909 visit to the United objecting to the collaboration of Abraham analysis and Film, edited by Glen Gabbard, is a States, Freud, Jung, Jones, and Ferenczi viewed and Sachs, said, “Pictorial representation of compilation of papers from the International silent one reelers in New York. psychoanalytic abstractions is not at all possi- Journal of Psychoanalysis (IJP). T. Jefferson Kline’s Ferenczi was very excited; Freud was only ble.” He believed that nothing good or useful Bertolucci’s Dream Loom is an excellent use of quietly amused. In “Freud and Film: Encounters could come out of the project and he pre- psychoanalysis by a film and literature scholar. in the Weltgeist,” in a 1999 issue of JAPA, I spec- ferred that his name not come into it at all. Psychoanalytic Inquiry published an issue on ulated that Freud, without attribution, incor- porated knowledge of the 1895 Lumière film apparatus into his model of the mind in chap- “Freud Rebuffs Goldwyn; Viennese Psychoanalyst Is Not ter 7 of The Interpretation of Dreams, written in Interested in Motion Picture Offer.” the mid- and late-1890s. Freud refused a $100,000 offer from Samuel —The New York Times, 1925 Goldwyn in 1925 to consult on the making of a film about famous love stories in history, beginning with Anthony and Cleopatra. Keenly The cinema project was, to Freud, an unques- Cinematic Visions of Psychoanalysis in 2007, and sensitive to the exploitation of psychoanalysis tionable betrayal of his theories. This “film Esther Rashkin published Unspeakable Secrets for sensationalist ends, he rejected the offer, as affair” resulted in a crisis between Freud and and the Psychoanalysis of Culture in 2008. reported in The New York Times: “Freud Rebuffs Abraham that continued unresolved until Andrea Sabbadini edited two volumes, The Goldwyn; Viennese Psychoanalyst Is Not Inter- Abraham’s death. Couch and the Silver Screen: Psychoanalytic Reflec- ested in Motion Picture Offer.” Nevertheless, Sachs became the film’s chief tions on European Cinema (2003) and Projected consultant, explaining that film was an excellent Shadows: Psychoanalytic Reflections on the Rep- FILM’S FIRST PSYCHOANALYST medium for presenting dreams and wrote a resentations of Loss in European Cinema (2007), Also in 1925, producer Hans Neumann monograph to accompany the film. The film both evolving from the biannual European Psy- approached Karl Abraham and Hans Sachs was shown on Freud’s 70th birthday at the choanalytic Film Festivals sponsored by the to collaborate on G. W. Pabst’s educational and Berlin Psychoanalytic Conference, which he Institute of Psychoanalysis in London. A com- dramatic film about psychoanalysis, Geheimnisse was too ill to attend. plete bibliography is available at their Web site In contrast to Freud’s view, Otto Rank said in [see box on page 11]. The fifth conference, Bruce H. Sklarew, M.D., is an associate 1914 that cinematography reminds us of the “Screen Memories from Eastern Europe,” will editor of Projections: The Journal for Movies dream-work. “The uniqueness of cinematog- be held from October 29 to November 1, and Mind, organizes the film programs at raphy in visually portraying psychological events 2009, featuring psychoanalysts and eminent meetings of the American Psychoanalytic calls our attention with exaggerated clarity to film scholars. Andrea Sabbadini is the chair Association, and has co-edited two books the fact that the interesting and meaningful and Bernardo Bertolucci is the honorary chair. on Bernardo Bertolucci. problems of man’s relation to himself—and Continued on page 11

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 7 PSYCHOANALYSIS IN NEW YORK

fashion magazine AMICA Italian recently published a photo-essay on psychoanalysis in New York,citing Freud’s influence: “After Freud,affect became language.”Seven psychoanalysts were pictured,including four members of the American Psychoanalytic Association,along with one canine companion.Some statistics about modern practice were highlighted including the average analytic work week (48 hours),the number of Americans involved in psychotherapy at some point in their lives (50%), the average length of treatment (12 sessions),the total number of mental health professionals in the U.S.(467,000),the annual income of a psychoanalyst ($168,000–248,000),the cost per session ($60–125). The American Psychoanalyst would like to thank AMICA for granting permission to reprint the article, and to acknowledge the work of Michele Ciavarella (writer) and Jonathan Torgovnik (photographer) along with Stefano Bolognini,M.D.(translator). Bolognini is a member of the Italian Psychoanalytic Society and Bologna Psychoanalytic Institute.

8 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 PSYCHOANALYSIS IN NEW YORK

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 9 FREUD’S 1909 U.S. VISIT

palace awaits you, only just in time.” Above all, After Freud Left: Freud found that his digestion was thrown off. He even believed at one point that he may Symposium on His 1909 U.S. Visit have had a small attack of recurring appen- John Burnham dicitis. In any event, the diet he was fed in America caused him constant unhappiness, Sigmund Freud made his one and only visit It is only fair to the memory of which stayed with him the rest to the United States in 1909, 100 years ago. ask: Why make so of his life. He arrived on August 29, and he departed on much of Freud’s Sept. 21 from a pier in Hoboken, New Jersey, expedition to the AMBIVALENT REACTION just across the river from Manhattan. He finally United States? Another set of historical accounts traces arrived back in Vienna on October 2. A cen- The answer may Freud’s continuing criticism of Americans and tury after the trip was completed, on October not be obvious to their culture. The usual story is that, condi- 3-4, 2009, a symposium at the New York people who see tioned by his unhappy culinary experiences, Academy of Medicine will offer “After Freud psychoanalysis Freud was at best ambivalent about the United

Left: Centennial Reflections on His 1909 Visit John Burnham from the inside: States or, more often, hostile or contemptuous. to the United States.” Freud’s visit has Many of his comments were truly “dyspeptic.” Psychoanalysis flourished among Americans become one of the iconic events in American Ernest Jones quoted Freud’s later remark, more than anywhere else in the world. The history. Every basic college textbook in U.S. which has in turn been much quoted: “Amer- symposium participants will explore Freud’s history, regardless of the author’s approach, still ica is a mistake; a gigantic mistake, it is true, North American legacy. He once remarked includes a mention of the visit as a symbol of but none the less a mistake.” But for a while, mischievously that he left the Americans “a cultural change. The visit provides the means at least, Freud also had other thoughts. Four virus.” What happened with the virus is an his- by which American historians remind a very weeks after his return, he wrote to his British torical question, and the speakers will combine general audience of the importance of Freud’s colleague,“The memory of the trip becomes the history of psychoanalysis and American ideas and the power of those ideas. more and more wonderful.” intellectual history, offering perspectives to Most of the detailed past accounts of the In any event, speakers at the October sym- illuminate thoughtfully the larger interactions of visit focus on Freud’s personal experiences in posium will take a new look at what happened Freud’s teachings with practice, institutions, the New World. He was impressed by the “After Freud Left.” Indeed, because of the and culture. skyscrapers. He had great difficulty with the symbolism of the visit, it is safe to say that the The speakers represent fresh, twenty-first- public toilet facilities: “They escort you along symposium itself will be a significant event in century scholarship in the history of psycho- miles of corridors and ultimately you are American psychoanalysis and culture in general. analysis and its cultural context. Several of the taken to the very basement where a marble Continued on page 13 presenters are conspicuous in the current “New Freud Studies” movement. Scheduled speakers are Ernst Falzeder and Hale Usak from Austria, Sonu Shamdasani and Richard Skues from the UK, and from the United States, Elizabeth Lunbeck, George Makari, Louis Menand, and Dorothy Ross. I am working with the New York Academy of Medicine as the outside organizer. Major funding comes from the Foundation for Idiodynamics, Personality Theory and the Creative Individual, based in St. Louis, with substantial assistance from the Austrian Cultural Forum of New York. Centennial Events To publicize the symposium, on Sept. 21, the 100th anniversary of when Freud left the New World John Burnham, Ph.D., is research professor and boarded the North German Lloyd Line luxury steamer, Kaiser Wilhelm der Grosse, there will be a media event in Hoboken on the site of the departure pier. It will be preceded by a of history and (by courtesy) professor of preparatory lecture at the Hoboken Historical Society on September 20. Another media event psychiatry at Ohio State University. He is is planned at the Freud Museum in Vienna for October 2, the day when 100 years ago Freud once the author of many books and articles on the again reached his home at 19 Berggasse. history of psychoanalysis and related subjects.

10 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 PSYCHOANALYSTS AND FILM

Then and Now The Forum began with a major conference Award Winner Continued from page 7 co-sponsored with the Film Society of Lin- coln Center and the New School for Social Recently Projections won the award INTERDISCIPLINARY APPROACH Research in New York in 1985 with Bernardo for the best new journal in the social The self-published journal, Projections,by Bertolucci. These collaborations led to visits to sciences and the humanities from the the Forum for the Psychoanalytic Study of Bertolucci film sets in Morocco, Katmandu, Professional and Scholarly Publishing Film began in the late ’80s and continued Seattle, Tuscany, and Paris. He later partici- Division of the Association of American through 2002. In 2007 it was reformulated pated in two other Forum sponsored confer- Publishers. A distinguished panel of 15 by Ira Konigsberg, a film scholar and frequent ences and speaks of psychoanalysis as another judges acclaimed Projections for increas- presenter at the film programs at APsaA meet- lens on his camera. He said that he makes his ing our understanding of film and how ings, as editor-in-chief and myself as associate films on a “dream loom.” Further information film itself facilitates investigations into editor. Projections: The Journal for Movies and on the Forum and Projections is described in the nature and function of the mind. Mind (www.Berghahnbooks.com/journals/proj) TAP 42/3. Krin Gabbard elaborated on the exemplifies an interdisciplinary approach that approaches used by film scholars to study includes psychoanalysis, film scholarship, neu- film in TAP 29/4 and Glen Gabbard described Initiated in the mid-‘80s when Paul Dewald roscience, and cognitive views in exploring the methods used by psychoanalysts to under- was the program chair at all APsaA meetings, film. The editorial board consists of many emi- stand film in the IJP, 1997. extensive film presentations and discussions nent scholars and psychoanalysts. Submission under my chairmanship have continued at all of articles is welcome at [email protected]. FIRST PSYCHOANALYTIC FILM APsaA meetings. Two or three sessions show- In 1985 the Forum for the Psychoanalytic PROGRAM ing complete films are usually accompanied Study of Film, recently renamed the Forum for The first major program on psychoanalysis by discussion groups using clips on the same Movies and Mind (www.cyberpsch.org/film and film was initiated in the early ’80s by Steven theme. Film scholars often are co-discussants forum/index/htm), began to present film view- Steury of the Baltimore Washington Institute with psychoanalysts. The topics have included ings and psychoanalytic discussions in many for Psychoanalysis and held in Washington. the works of Bergman, Bertolucci, Kieslowski, Vigo, and Woody Allen; viewing film and the dream experience; Holocaust films; and loss Film discussion is an excellent vehicle for the public and trauma. The New York Times, Dec. 23, to engage with psychoanalytic ideas in a lively 1991, covered the American Psychoanalytic Association’s film program that included my and palatable way. oedipal interpretation of Casablanca. Collaborations with art museums, film soci- eties, and universities provide large lay audi- venues including Congresses of the Interna- The program, which presented 16 films, was ences and the venue. Film discussion is an tional Psychoanalytic Association, the National co-sponsored with the American Film Insti- excellent vehicle for the public to engage Gallery of Art, the Corcoran Gallery of Art, tute. Leon Levin of the Baltimore Washington with psychoanalytic ideas in a lively and palat- the Smithsonian, the New School for Social Institute for Psychoanalysis organized a nearly able way. Psychoanalysts have studied litera- Research, the American Film Institute, the Film 15-year collaboration with the Baltimore ture because it offers portrayals of people in Society of Lincoln Center, universities, and film Institute of Art showing and discussing four conflict and insight into human motivation and festivals. Sometimes coordinating with film films a year. In London, Andrea Sabbadini behavior. We have also explored content scholars or film historians, it has sponsored or organizes frequent film programs with the and the creative process in mythology and co-sponsored more than 100 presentations. British Psychoanalytic Institute. Other Insti- the arts. The Forum provides a clearinghouse for peo- tutes presenting film discussions are Wash- Now psychoanalysis has been applied to ple programming or writing about film and has ington, D.C., St. Louis, Chicago, Denver, Los the twentieth century’s most prominent new chapters in many cities. Angeles, Seattle, and Boston. art form—film. Glen Gabbard has said that films “serve many of the same functions for FIFTH EUROPEAN PSYCHOANALYTIC FILM FESTIVAL contemporary audiences as tragedy used to serve for fifth-century Greeks. Not only do October 29 – November 1, 2009 they provide catharsis, they also unite audi- ences with their culture with their mytholog- London ical dimensions in the same way that Aeschylus www.psychoanalysis.org.uk/epff5/contact.htm or Sophocles provided vision for the citizens of Athens.”

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 11 PAIN OF A BEAR MARKET

The Pain of a Bear Market John W. Schott

Almost every never heard the sage Wall Street saying,“Never investor has confuse genius with a bull market.” Wise heard the cau- investors in the late ’90s made some easy tionary state- money and then battened down the hatches ment,“Beware of even if it meant being on the sidelines during greed in a bull the latter part of the bubble. market and fear in a bear market.” BEAR MARKET DEPRESSIVE SYNDROME This interdiction The same grandiose aspect of the personality

John W. Schott is a valuable one. is at play in bear markets, but in reverse. Hav- Today we want ing taken a huge amount of undue credit for to take you to a higher level of understanding itself in the bull market, the self now blames about this statement especially as it applies to itself for the failures in a bear market. The emotions felt in down (bear) markets. combined pain of loss of self-esteem and loss Let us begin with the happier days of up or of money damages an investor’s narcissism in bull markets. Most investors during a bull a severe way, sometimes even to the point of Therefore, remember every investment carries market (the exception being traders) do not an actual depression or at least a mental state risk and it is not always possible to tell in so much experience greed as they do marked highly similar to a depression, which I call the advance what the risk will be. happiness or excitement. Rising markets stim- bear market depressive syndrome or BMDS for ulate ideas of retirement and the fulfillment short. In BMDS individuals experience some RISK: THE BETA FACTOR of dreams. The higher the market goes, the combination of dysphoric mood, sleep distur- Before investing think about risk and con- more extreme the hopes become. Remember bance, decreased concentration, irritability, guilt, sider it in two dimensions. First, calculate the back in 1998 and 1999 how many people were discouragement, and somatic symptoms such risk in the usual ways. Be cognizant that most going to, or in some cases actually did, leave as gastrointestinal disturbance or headaches. investments carry both market risk and com- pany specific risk. By market risk, I mean inter- est rate risks, wars, political risks, acts of God, “Never confuse genius with a bull market.” broad market declines, and others too numer- ous to mention. Company specific risks mean management skills, management honesty, excellent jobs and professions to “play” the The rational person would say to himself, “I product problems, lawsuits, and whatever market full time. How many friends and acquain- know markets are cyclical. I know a market competition can throw at the company. When tances were planning to retire at age 55. bubble must be followed by a severe correction assessing these risks, it is helpful to discuss The significant fact about this kind of eupho- to get values back to normal.” In fact, rational them with a neutral third party, a friend or, ria is that it means that the person has become and experienced investors know that while a perhaps better, a financial advisor. You will gain grandiose. Grandiosity is a stage gone through bear market may be painful, it affords the valuable insight from the process, something in early childhood which can easily be rekin- opportunity to buy good stocks at bargain akin to financial psychotherapy. Be warned dled. The easy money of the late ’90s came prices. For the mutual fund buyer, he or she that Wall Street and academia have a different from being a participant in a market mania or knows that dips provide a useful way to dollar- definition of risk than you do. To them,risk is market bubble. However, the exuberant cost-average and ultimately give superior results. volatility. It is measured by beta, the measure- investors believed that it was their skill which The very important lesson for all investors ment of how closely an investment mimics led them to a sense of grandiosity. They had is to appreciate that every investment carries the market as a whole. A beta of one means risk, some greater than others. U.S. and Cana- that stock rises and falls exactly with the mar- John W. Schott, M.D., is a member of the dian government bonds (as well as those of ket, generally meaning the S&P 500. A beta of Boston Psychoanalytic Society. He is director other developed nations) are sometimes per- less that 1.0 indicates low volatility and a beta and portfolio manager at Steinberg Global ceived of as risk free. However as buyers of U.S. of greater than 1.0 indicates high volatility, Asset Management. He also publishes a T-bonds have learned in recent years, currency but remember volatility and risk are not at all monthly newsletter on investment psychology, and interest rate risks are associated with the same thing. The Schott Letter. government bonds and can be fairly severe. Continued on page 13

12 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 THRILL SEEKING VS. RISK AVERSION individual believes he can tolerate twice as error. Remember no one can accurately The second aspect of risk, equally if not big a loss as he actually can. In other words, predict the future. If 60 percent of your more important, is the psychology of risk if you believe you can tolerate a 20 percent investments turn out to be successful, and what it means to you individually. People decline in the market value of your invest- you will do well. If your batting average is differ widely from each other in this impor- ments without feeling much pain, you will higher, you will do really well. tant dimension. Certain reality factors will actually begin to panic at 10 percent decline. Second, concentrate on your invest- bear on this. They include your age, your What can you do with all this knowledge to ments as businesses. Follow the compa- earnings, your inheritances and expected become a better investor? nies’ business results more than you follow inheritances, your health, and whether or not • Consider being a dollar-cost averaging the shares’ prices. If the business is doing you are married and have children. In addi- investor. Select good mutual funds or well, ultimately the stock price will follow. tion, your attitudes about risk will be shaped stocks that you regard as excellent long- Third, my colleague Dick Geist has ob- consciously and unconsciously by your genes, term investments and systematically invest served that many of the greatest investors by your parents’ attitudes toward risk, by the same dollar amount at fixed time have had a friend or partner on whom your feelings about money, by your confi- intervals, e.g., quarterly. ideas could be tried out. Warren Buffett dence, and by your past experiences with • Diversify your investments. If you have all and Charley Munger are the most famous losses. If you are a person who has experi- growth funds, add some value funds or example of this. At first glance, they seem enced many painful losses in your life, you vice versa. If you buy individual stocks, like an odd couple, but their differences may be very loss averse. Yet this is a highly diversify by always investing in many sec- apparently complement each other. Cer- personal quality, because some people with a tors which are uncorrelated, meaning that tainly no one could challenge the results. history of many painful losses are driven to they tend to perform independently of So if you have a friend whose input you repeat them in an attempt to gain mastery, a each other. Therefore your results may be value, try running investment ideas by form of repetition compulsion. smoother causing you less anxiety. Beware him or her. Absent such a person in your At first glance this may seem daunting. It is of “di-worsifying.” Do not make a bad life, try to utilize your broker or advisor truly complicated, but be assured most people investment for the sake of diversification. this way. can invest successfully. Be aware as you begin Incidentally, 17 stocks, if chosen from dif- • Repeat to yourself every day that this is to think about risk and how to manage it that ferent sectors, will give 90 percent of the the kind of market Warren Buffett and the research has shown we tend to overestimate diversity of the market as a whole. Thirty other truly great investors relish. Keep a our capacity to tolerate loss. Danny Kahneman, stocks will give you 98.6 percent of mar- wish list of the companies that you con- a psychologist at Princeton University who ket diversity. sider the greatest investments and at what shared the Nobel Prize in economics for his • Emulate the great investors. price you would like to buy them. If the work in behavioral finance, and his mentor First, these investors know they will make share price is reached, buy the stock with- Amos Tversky demonstrated that the average errors. In fact, it may not even be their out trying to get it more cheaply. • Time is your friend. In growing economies like the U.S. and Canada’s, the long-term CALL FOR SUBJECTS: trend of the market is almost always up. If you have shares in a good business, Study on even if the price drops, your odds of doing Termination well in time are very good. The termination phase of psychoanalysis has limited representation in psychoanalytic literature. I am interested in studying the process from the perspective of the patient, and would like to interview people who have After Freud Left terminated a psychoanalysis to explore several questions about their Continued from page 10 experience and any others that may emerge. These interviews could be conducted on the telephone at the convenience of the volunteer. All material The best news is that it will be free and will be strictly confidential and presented anonymously. The participant will open to the public, and members and associates have the opportunity to read and approve the use of his or her material of the American Psychoanalytic Association will prior to any publication of the findings. be especially welcome. Details are available on the New York Academy of Medicine Web site Please contact: Judy L. Kantrowitz, Ph.D. (www.nyam.org, click on events, then confer- 617-738-1689 ences). While registration is free, one can also [email protected] sign up for a luncheon on the premises on Sat- urday (for which there will be a fee).

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 13 PRIVACY PROTECTIONS

• Restrictions on sale: New prohibitions are APsaA Secures Privacy Protections placed on the sale of health information without the individual’s authorization. in Stimulus Bill • Restrictions on marketing: New restric- Jim Pyles tions are added on the use of health information for marketing without the The American The HITECH Act contains the following individual’s authorization. Psychoanalytic provisions that should help preserve the • Fundraising: A new right gives individuals Association patient’s right to health information privacy the opportunity to opt out of fundraising (APsaA) worked as a national electronic health information sys- communications that use identifiable intensely and tem is implemented: health information. directly over the • Privileges: Nothing in the legislation shall • Consumer representation: The number past year with constitute a waiver of “any privilege other- of consumer representatives on a key many members wise applicable to an individual,” thereby policy committee is increased from one of Congress to expressly recognizing and preserving by to three.

Jim Pyles secure privacy statute the psychotherapist-patient privilege • Public participation: HHS must provide protections in recognized in the Supreme Court’s 1996 notice to the public and an opportunity the Health Information Technology for Eco- decision in Jaffee v. Redmond [see page 16]. for public comment on regulations imple- nomic and Clinical Health Act (HITECH Act), Private pay: Under a new right, individuals menting the act. which was part of the American Recovery who are willing to pay privately cannot • Enforcement: New civil and criminal and Reinvestment Act of 2009 signed into have their health information disclosed to penalties are established for business asso- law by President Obama on February 17. health plans without their consent for pay- ciates (those who handle health informa- That legislation will be implemented by regu- ment and health care operations. tion on behalf of practitioners) and for lations adopted over the next year. The goal • Minimum necessary: Covered entities employees of covered entities (hospital of the legislation is “utilization of an electronic (including psychotherapists) and business personnel, for example). The act also health record for each person in the United associates disclosing identifiable health increases the civil monetary penalties for States by 2014.” information shall have the right to decide privacy breaches and provides for state It is likely that many of the privacy protec- what is the minimum necessary amount of attorneys general to bring enforcement tions included in the HITECH Act would not information for any use. actions to protect residents of the state have been included had it not been for APsaA’s • Breach notice: Individuals have a right to from violations of the HITECH Act. efforts. The success of this effort was due to notice when their identifiable health infor- the commitment of APsaA leadership working mation has been, or reasonably is believed OUR KEY STRATEGY with Washington counsel, APsaA members, to have been, accessed or acquired as The strategic key to obtaining these new pri- and key members of Congress who with- the result of a security breach. vacy protections was APsaA’s adoption of a stood intense lobbying pressure from the • Segmentation: The Department of Health clear set of privacy principles in July of 2007, insurance and information technology indus- and Human Services (HHS) is required which became the core privacy concepts con- tries to defend the ethical practice of medicine to consider issuing standards for tech- tained in joint letters to Congress from nearly and psychotherapy. Members of Congress nologies that protect the privacy and pro- 30 members of the Mental Health Liaison who deserve particularly high praise for their mote the security of health information Group as well as numerous additional letters efforts are Congressman Ed Markey (D-MA), by allowing segmentation of particularly filed jointly by APsaA and the National Asso- Congressman Henry Waxman (D-CA), and sensitive health information (such as men- ciation for Social Workers. Those privacy prin- Senator Olympia Snowe (R-ME). Others who tal health information) in order to mini- ciples then were incorporated into the TRUST were also helpful were Congresswomen Lois mize concerns by patients. Act (H.R. 5442) introduced in February 2008 Capps (D-CA) and Jan Schakowsky (D-IL) • Encryption: HHS is required to consider by Congressman Markey and 13 other key and Senators Chris Dodd (D-CT), Ben Cardin issuing standards that allow individually Democratic members of the House including (D-MD), and Barbara Mikulski (D-MD). identifiable health information that is being Rahm Emanuel (D-IL) and Henry Waxman. transmitted or transported to be rendered Senator Snowe led the effort in the Senate unreadable by unauthorized individuals. to block repeated efforts by Senator Kennedy Jim Pyles, J.D., is co-founder and principal • Accounting: Individuals have new rights to pass the Wired for Health Care Quality Act of the national health law and policy firm to obtain an accounting for disclosures of (S.1693). The Wired Act, sponsored by Sen- of Powers, Pyles, Sutter & Verville, P.C., identifiable health information for treat- ators Ted Kennedy (D-MA), Hillary Clinton in Washington, D.C. ment, payment, and health care operations. Continued on page 16

14 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 POLITICS and decision. While this was vitally important, legal decisions are vulnerable to being overturned PUBLIC POLICY by legislation. The “privilege” is now officially encoded into law for the first time.

Our Finest Hour PROTECTING PRIVATE PRACTICE Bob Pyles To sum up our achievements: Private prac- tice is protected, personal health information On June 18, 1940, Sir Winston Churchill, The stimulus cannot be sold or marketed, the Jaffee privilege prime minister of England, prepared his coun- package included is protected, and practitioners can determine try for massive air attacks by Germany, which $19 billion for what is the “minimum necessary” information became known as the “Battle of Britain.” He the initiation of that has to be turned over to insurance com- said to his countrymen,“Let us therefore brace an electronic panies for payment of claims. [See “APsaA ourselves and so bear ourselves that if the health records Bob Pyles Secures Privacy Protections in Stimulus Bill,” British Empire and its Commonwealth last for system. An all- page 14 for further details.] a thousand years, men will still say, ‘This was encompassing Electronic Medical Records Our Association has played a major role their finest hour.’” After Britain successfully (EMR) system is being viewed by the Admin- throughout this struggle which began during repelled the repeated attacks by the Wehr- istration as an essential portion of their health the last Congress, when Senators Hillary Clin- macht, Churchill said about their young fighter care reform effort, and one they are certain ton and Ted Kennedy introduced S.1418, the pilots,“Never in the field of human conflict was will save money and improve care. Unfortu- “Wired” bill. We were able to help stop this bill, so much owed by so many to so few.” nately this appears to be an unwarranted with the help of several senators, most notably I was reminded of those inspiring historical assumption, based on a single seriously flawed Senator Patrick Leahy (D) of Vermont. On events, certainly among the major turning study by the Rand Corporation. Many studies the House side, Congressman Edward Markey points in World War II, by the major role of suggest quite the opposite, i.e., health care (D-MA), working closely with us, introduced pri- this Association in protecting health care pri- quality is not improved, medical errors may in vacy principles into the Pro(Tech)T Act HR 6357. vacy for all Americans, which was included in fact be increased. Estimates for “wiring” the Like the Senate bill, the House bill also did the American Recovery and Reinvestment country run to $500 billion. not pass, but both the Senate and House bills Act, signed into law by President Obama on February 17. This was the culmination of the most successful advocacy effort by the Amer- Nonetheless, EMRs are viewed as a kind of “magic bullet” ican Psychoanalytic Association to date and which will give the impression that Congress is taking resulted in major health care privacy protec- tions for 304 million Americans. significant steps to improve health care policy.

LEADING ROLE While other groups were involved in Nonetheless, EMRs are viewed as a kind of were poised for the advent of the EMR effort achieving these results, our Association played “magic bullet” which will give the impression in the stimulus package. a leading role, along with Deborah Peel’s that Congress is taking significant steps to Ultimately, the Pro(Tech)T Act became the “Patient Privacy Rights” and National Associ- improve health care policy. prototype for the privacy protections included ation of Social Workers (NASW), in obtaining In the beginning, the EMR legislation had in the stimulus bill. We owe special thanks to strong privacy protections where none existed almost no privacy protections, and most Representative Markey, whom our Associa- before. This is all the more remarkable, con- dangerous to us, private practice was not tion honored last year with a Special Presi- sidering the massive lobby opposing such exempted from the requirement for inter- dential Award, and Senator Olympia Snowe protections by such powerful groups as the operable electronic medical records. We were (R-ME). Working closely with them, we were insurance and managed care industries, the able to get this completely reversed, so that able to play a leading role in both the House American Hospital Association, and the infor- identifiable health information can be pro- and Senate versions of the bill. mation technology industry (with the excep- tected if the individual “has paid out of pocket Over the past two years, a great many of tion of Microsoft, which supported our stand). in full” for the services. our members have called their congressmen Another critically important achievement and senators with enormous effect. The Asso- was the recognition of the psychotherapist- ciation owes particular thanks to David Miller Bob Pyles, M.D., is chair of the Committee patient privilege. Previously, we were protected and Joanne Gold of the Washington Center for on Government Relations and Insurance. only by the Supreme Court Jaffee v. Redmond Continued on page 35

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 15 Privacy Protections From the Continued from page 14

(D-NY), Mike Enzi (R-WY), and Orrin Hatch Unconscious (R-UT), had none of the privacy protections poetry Sheri Butler Hunt that were included in either the TRUST Act or the HITECH Act. The failure of the Wired Act The American Psychoanalyst has had the pleasure of featuring one of John Samuel to pass in the Senate allowed new bills to Tieman’s poems before, entitled “Prodigal.” We are very pleased to feature this one, progress through the House that contained with its stark, affecting imagery and interesting endnote. more of the privacy protections that were included in the TRUST Act championed by Congressman Markey. As the HITECH Act moved toward a final vote, a strong effort was made by Senator Enzi to strip out the privacy protections. We also had to work intensely ST. PATRICK’S BASILICA, MONTREAL with Senator Snowe’s staff to obtain last minute changes to the breach notice provi- the leaflet says Emile Nelligan once prayed here sions to prevent them from being weakened horrified and solar and pale by an exception. dementia like an ice violin a vein where no one finds gold FUTURE FOCUS As with any major piece of controversial legislation, we did not get all that we sought. what did you see when you saw Jesus APsaA privacy principles that were not a rag doll a neon eclipse Baudelaire included in the HITECH Act were express fantastic nostrils sudden birds recognition that individuals have a right to psalms sung by orphans health information privacy, consent for all dis- closures of identifiable health information, and nearly fifty years in a hospital and a definition of privacy that includes the indi- vidual’s right to control uses and disclosures of I envy you, Emile Nelligan, envy you composing health information. With more than 42 million the same poem every morning and every morning electronic health records improperly disclosed since January 2005, those protections are likely in a later day. The near term goal for APsaA is to make sure the hard won gains reflected in the HITECH Act are not lost as the regulations When my wife, Phoebe Cirio, and I vacationed in Montreal a few years ago, I was are formulated. amazed at how little I knew about Canadian poetry. We went to Sunday mass at St. Patrick’s Cathedral, where I read in a brochure that Emile Nelligan was baptized there. Without explanation, it read “Nelligan” like I should just know him. He is Jaffee v. Redmond considered the Arthur Rimbaud of Canada. Schools and libraries are named after him. Like Rimbaud, he stopped writing in his late teens, in Nelligan’s case at the onset of On June 13, 1996, the U.S. schizophrenia. Emile Nelligan spent the rest of his life, the next 42 years, in a hospital. Supreme Court ruled in favor of And became a legend. the psychotherapist-patient privilege. —John Samuel Tieman This important decision was the ultimate societal expression of the need to provide reliable protection from disclosure of communications Sheri Butler Hunt, M.D., is a graduate analyst in the adult and child divisions at the between psychotherapists and Seattle Psychoanalytic Society and Institute. A published poet and member of TAP’s editorial their patients. board, she welcomes readers’ comments and suggestions at [email protected].

16 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 TH TO E E S D R I E T O T

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CANADIAN HEALTH-CARE SYSTEM and strong convictions) rather than a fox other countries,letters and the physical quality of You would not learn from reading Dr. (pragmatic, more prone to self doubt, and clinics and hospitals remains far superior Berger’s article, “Canadian Health-Care inclined to see complexity and nuance). to all except a very small number of highly System Not the Answer for U.S., Single Joseph Schachter expensive and exclusive private institutions. Payer No Panacea,” (TAP,43/1) that the U.S., Similarly, it is absurd to choose just one compared to Australia, Canada, Germany, Joseph Schachter, M.D., received a Ph.D. from item of measurement—such as infant mor- New Zealand, and the United Kingdom, has Harvard University, an M.D. from NYU Belle- tality levels—and imply that such a statistic the most expensive health-care system, vue, and psychoanalytic training at Columbia can demonstrate the superiority of one both in terms of cost per person and per- University Psychoanalytic Center. He was a system over another, when there might be cent of gross domestic product, and the training analyst at Pittsburgh Psychoanalytic, numerous other factors affecting any such poorest quality of health care (Davis et al., and is an honorary member of the William statistic, and when other measurements 2007). For example, U.S. infant mortality Alanson White Society. might produce different results. rate is higher than that in Canada, the I would urge Dr. Schachter and other United Kingdom,Australia, Germany, Spain, readers who might still think that the France and Japan. RESPONSE Canadian system might be the solution Although he is comparing the Canadian Dr. Schachter’s gratuitously offensive to the admitted deficiencies in current U.S. system to the U.S. system, you would learn response to my article—making insult- health care, to read the superb testimony nothing about the millions of Americans ing comparisons of me to various ani- titled “Canadian Care. So Many Lessons, who have neither health care nor access to mals—reflects the simplistic nature of So Little Time” just recently presented to psychiatric care. Nor would you learn that his comments. the Pennsylvania House of Representatives virtually all health-care experts acknowl- Many years ago economist Irwin Stelzer by Brian Lee Crowley, president of the edge that a single payer system is the least rejected the notion of comparing the qual- Atlantic Institute of Market Studies. This expensive health-care system (though they ities of health-care systems in different brilliant survey explains in greater detail don’t all agree it would be the best sys- countries according to the percentage of the pitfalls of allowing medical care to tem) and therefore one that could provide GDP spent. In most areas of life, if you become more socialized and politicized health care to all members of the society. spend less you run the risk that you will than it is already. Certainly he doesn’t acknowledge that the receive poorer quality of whatever it is Joseph Berger health-care system for the elderly in the that you are buying. It applies to your U.S. (Medicare) is a government run, single clothes, your food, your housing, and to Joseph Berger, M.D., grew up in London and payer system which has remained extraor- almost any service you can think of. studied and worked as a doctor in the social- dinarily popular, although very hard on its If Americans have been prepared to pay ized British system. He trained as a psychia- medical providers. What Dr. Berger high- more for their health care, then maybe trist in the United States and has practiced lights is that Canadian psychoanalysts are that is because what they expect to receive for the past 35 years in Canada. underpaid, and that Canadian patients in most cases is prompt care, of very high have long delays before obtaining medical quality, in comfortable surroundings. In care (the U.S. and Canada rank lowest in countries that spend less, each of those the prompt accessibility of appointments benefits may be much reduced. Most read- TAP welcomes letters to the editor. with physicians). ers will have heard about very long wait- Letters must be less than 350 words It seems clear that in his dichotomous ing times for consultation and treatment long. Letters will be printed as space nosology Sir Isaiah Berlin would have char- in Canada. allows and at the discretion of the acterized Dr. Berger as a hedgehog (a The quality of diagnosis and treatment editorial board. focused worldview, an ideological leaning, in the U.S. remains far above that of most

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 17 STAR TREK: THE NEXT GENERATION

Aliens and Alienists D. B. Ruderman

At the APsaA first place. Early in her talk, she recounted the Winter 2009 contested history of psychoanalytic theories National Meeting of development in order to argue that it may be in January, as part precisely a desire for human contact, rather of the APsaA than, say, a drive for pleasure, that grounds and Workshop on defines our humanity. Rashkin brilliantly suggested that Data is a Film and Psycho- The paper liminal figure, on the boundary between analysis, Esther focused exten- authentic human experience and inauthentic Rashkin deliv- sively on a scene automatism. Complicating this already rich

D. B. Ruderman ered a fascinating in which Dr. reading, Rashkin pointed to Dr. Crusher’s inabil- paper entitled Crusher, the ship’s ity to respond to Data’s need for nurturance “On the Desire to be Human: Androids, chief medical and suggested that, at least emotionally, Cyborgs, and the Analytic Process in Star Trek: officer, teaches Crusher too might be a cyborg—part authen- The Next Generation.” Evincing the same sensi- Data to dance. tic and part inauthentic at the same time. tivity and erudition that she displays in her new Rashkin’s reading Rashkin’s unique melding of science fiction book Unspeakable Secrets and the Psychoanaly- shows the ways and psychoanalysis not only stirred the audi- sis of Culture, Rashkin brought together close in which dancing is an essentially human activ- ence to ask question after informed question, reading techniques borrowed from literary and ity, one whose social and cultural nuances are to which she deftly and thoughtfully responded; cultural studies with analytic psychosocial inter- not as automatically or instrumentally acquired it also resulted in a powerful reading that has pretations. The paper was an explication of as are its steps. Dancing, in other words, is at least two Data’s Day, a single episode of the legendary not easy for an android to master. In order for ethical impli- 1990s TV series still in reruns. In order that the Data to enter into the dance of human cultural cations. First, audience might follow the intricate close readings and social life, he needs what D. W. Winnicott she implies elaborated in the paper, the episode was shown famously termed a “good-enough mother.” that our at the beginning of the session in its entirety. Data chooses poorly insofar as Dr. Crusher is desire for Data’s Day,as unable to provide him with the nurturance and human con- its title suggests, guidance that he needs. Because Data appears nection and follows the char- humanoid—that is, physically, linguistically, and our ability to acter Data—a cognitively developed—he serves as an inter- experience technologically esting test case, a kind of postmodern corollary connection advanced android to the 18th-century figure of the wild child. that is “good who serves as an Rashkin argued that Data’s hybridism makes enough” may officer aboard the him closer in definition to a cyborg than an matter more in some ways than whether or Starship Enter- android: He is half human and half machine. not that desire can ever be completely satis- prise—throughout Using Winnicott’s concept of the false self, fied. Secondly, she powerfully demonstrates one eventful day. As Rashkin suggested but did that psychoanalytic traces in culture not make explicit, Data’s intense desire to be do not emerge exclusively in the realm human, or rather to feel human, mirrors our of high art. The world of pop culture own desires to establish and maintain meaningful is also rich terrain for psychoanalytic human connections. And while Data’s quest is thinking and deserves to be explored to become more human, part of Rashkin’s as seriously as Data takes his quest to quest seems to be to use Data’s dilemma to become more human. We can only help define what it means to be human in the hope that Rashkin will continue this line of inquiry and that this fascinating D. B. Ruderman, Ph.D., is a 2008-09 Fellow material will be available soon in arti- of the American Psychoanalytic Association. cle or book form. As Captain Picard He will be joining the faculty of Ohio State himself would say, “Make it so, Data. University, Newark, in the fall. Make it so.”

18 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 STAR TREK: THE NEXT GENERATION Inner Space

Esther Rashkin

How did I however, about the psychological dimensions decide to work of the android Data’s quest to feel human, or on Star Trek: The about Counselor Troi’s role as a clinician. Data Next Generation was of interest primarily as an incarnation of after years spent the promise—and also the dangers—of tech- writing about the nology, and of the complexity of living and complex inter- working alongside a sentient android. Troi was sections between generally dismissed as a sexist caricature of psychoanalysis women as overly empathic, nurturing care-

Esther Rashkin and literature, takers. Moreover, she couldn’t be taken seri- film, and the ously as a professional since she almost never sociohistorical problems of anti-Semitism, practiced therapy. racism, and colonialism? These responses were surprising since it It began one evening while channel surf- seemed to me that Data’s desire to experience ing. I landed on an episode about an inter- human emotion had a psychoanalytic richness species love affair that raised intriguing and complexity that begged to be explored. questions about desire, identity, sexuality, and At the same who—or what—one loves when one falls in time, Coun- space, but to elaborate the ways in which the love. Adding to my curiosity was the fact that selor Troi characters and stories of Star Trek: The Next a main character in the series, Counselor appeared to Generation dramatized the complex world of Deanna Troi, was be practicing intrapsychic, inner space. a bi-species em- a great deal Certainly, not all works of pop culture can path (half human, of therapy. sustain intensive psychoanalytic inquiry or half Betazoid), She just was reveal an awareness of mental functioning and who served as not doing it analytic process that clinicians or academics the chief psy- in a classical would find of interest. But just as Data’s chologist for the fashion with desire to learn to dance can be understood as crew and families patients lying the story of a failed therapeutic encounter aboard the Star- on a couch in that impinges on the android’s quest to ship Enterprise. her office. Instead, she provided therapy wher- become more human, so I expect to find, as I After a few more episodes, I was convinced ever and whenever it was needed: on the write about other episodes involving alien that the series had something to say about bridge, in the lounge, in the ship’s hallways, even encounters, technological advances, and suc- intrapsychic and not just interstellar explo- on other plan- cessful and aborted relationships, ration, and about the unconscious dynamics of ets. Far from a tacit dramas about unconscious individuals, families, and groups. I was hooked. non-practicing, process, psychic development, As I read through the numerous academic unprofessional and the way analytic therapy studies of Star Trek, I was struck by how enthu- maternal figure, works to alleviate suffering. siastically scholars discussed questions of race, Troi struck me Stay tuned. class, gender, capitalism, and colonialism in The as an astute, Next Generation. They said little, if anything, analytically ori- ented clinician. Esther Rashkin, Ph.D., L.C.S.W., She was well author of Unspeakable Secrets and the versed in the Psychoanalysis of Culture, and Family workings of the unconscious, defenses, and Secrets and the Psychoanalysis of transference, and she displayed a sophisticated Narrative, is University of Utah professor capacity to hold, contain, and (not surprisingly of French and cultural studies, former APsaA for an empath), empathically attune to others. Fellow, and in private practice, Salt Lake City. My mission was clear: not to explore outer

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 19 SPECIAL SECTION: OUTREACH TO HIGH SCHOOL STUDENTS

American Psychological Association Publishes High School “Lesson Plan” on Psychoanalysis and Psychodynamic Psychology James Hansell

We all know One of the “signature products” of TOPSS negative misrepresentations. When I con- how important is a series of “unit lesson plans” written by col- firmed that psychoanalysis was not adequately high school can lege psychology faculty that enable high school covered in the existing lesson plans, Jeffries be in creating last- teachers to teach specific areas of psychology; made contact with the staff of TOPSS to ascer- ing identifications they are provided free of charge to interested tain their interest in the development of a and ideals. As a teachers via hard copies and the Internet. To new week-long lesson plan on psychoanalysis. result, APsaA has date,TOPSS has developed 17 different week- With her usual effectiveness, Jeffries quickly been interested long lesson plans on topics such as learning, persuaded the TOPSS staff of the usefulness in bringing psy- memory, developmental psychology, and cross- of a psychoanalysis unit, and they agreed

James Hansell choanalytic ideas cultural psychology. Psychoanalysis, as you enthusiastically to support its development. into high school might guess, is virtually nonexistent in these (TOPSS support includes underwriting the curricula as part of our effort to attract the best 17 lesson plans. eventual publication of the lesson plan along “10,000 minds” of the next generation. For Enter Dottie Jeffries, APsaA’s public affairs with development and editorial assistance example, APsaA’s own Andrew Gerber first director. Jeffries became aware of the TOPSS from the TOPSS staff and the high school met APsaA member Stuart Hauser at a national program and asked me to take a look at the teachers’ network.) high school science fair. That encounter sparked current lesson plans. She saw this as an oppor- With TOPSS sponsorship in place, Jeffries a change in Gerber’s primary interest from the tunity to bring a positive, accurate picture of and I began to conceive the project. Most of physical sciences to psychoanalysis. psychoanalysis to this critical population of the existing units involve five or six separate For more than 15 years, the American Psy- teachers and young students before they are lesson plans which can be covered in one chological Association (APA) has maintained an turned off to psychoanalysis by the typical week. College faculty write content outlines, active educational and outreach program aimed and then high school teachers with an interest at high school psychology teachers and their in the subject add additional content such as in- students. This program,Teachers of Psychology INTRODUCTION class exercises, multimedia supplements, and in Secondary Schools (TOPSS) has almost homework assignments. With the help of the 2,000 teacher members (called Teacher Affili- Psychodynamic theory, despite TOPSS staff and the teachers’ network, we ates of APA), and offers them workshops, les- criticism that it is unproven, came up with a plan for a six-lesson unit on son plans, teaching standards, networking continues to be a popular “Psychoanalysis and Psychodynamic Psychol- opportunities, as well as scholarships, grants, and ogy” covering the following topics: and influential approach to awards. It is estimated that half a million high Lesson 1: Overview of Freud school students take a psychology course each explanation and treatment and psychoanalysis year. While the number of college students and is, in fact, supported by studying psychology is far higher, high school is a substantial research basis. Lesson 2: Psychoanalytic perspectives often the first time that young people are for- Psychoanalytic theory also has on mental disorders and treatment mally exposed to the field, making it a critical a particular place of importance Lesson 3: Psychoanalytic perspectives time for the formation of first impressions. in the field of psychology as the on development and personality

James Hansell, Ph.D., is training and first and most comprehensive Lesson 4: Psychoanalytic perspectives supervising analyst at the Michigan theory of personality and on dreams Psychoanalytic Institute and on the faculties psychopathology. Lesson 5: Psychoanalytic perspectives of the Departments of Psychology and on motivation and emotion Excerpt from Psychiatry at the University of Michigan. Lesson 6: Neo-Freudians and He is co-author (with Lisa Damour) Psychoanalysis and contemporary psychoanalysis of Abnormal Psychology, currently Psychodynamic Psychology in its second edition. Continued on page 24

20 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 SPECIAL SECTION: OUTREACH TO HIGH SCHOOL STUDENTS

Pereira-Weber, Education Division Launches who is not only an analyst, but a Teen Web Site Project Parker parent, and Stephen Sonnenberg two psychoana- lytically oriented In this Internet age, APsaA is aware of the SEX AND DREAMS psychotherapist importance of outreach to its members and In order to make the Web site a possibility it parents, Evelina the outside world via computers and other was clear at the start that a primary site where Pereira-Weber devices which access the World Wide Web. analysts and students could interact in an on- and Shira Saville. Stephen Sonnenberg Under a grant from the International Psy- going way had to be identified. Dan Frank was Parker teachers choanalytical Association’s Developing Psycho- approached, and he proposed a Francis W. included Theresa Collins, Mike Mahany, and analytic Practice and Training Program APsaA’s Parker-APsaA partnership. His vision for Web Kate Tabor of the English Department, Marty new Education Division has initiated the Teen site planning was that Parker students would dis- Moran and Julie Schumacher of the History Web Site Project, which is creating a Web site cuss sex and dreams with analysts and identify Department, Ray Llanes, who teaches Web for teens on sex, dreams, and how it helps to areas where analytic thinking could be helpful page design, Gary Childrey, a teacher of psy- think about life through a self-reflective, psy- to them. Frank also emphasized that students chology and the school counselor, and Duane choanalytic lens. The effort is an exciting col- and analysts would have to engage in a con- Freeman, another school counselor. Paul Erb, laboration among APsaA analysts, non-analyst versation through which analytic sensibility could of the Information Services Institute, partici- members of the Education Division Liaison to be defined in a way which made sense to high pated by telephone at the invitation of Frank. Schools Committee, and high school In addition, two Parker students students, their teachers, and in some attended the think tank, Nicole Hunter cases the clinician parents of students. and Joey Schullo. The development of this partner- As a result of the think tank the ship is an example of how the Educa- central goal of the Web site was tion Division is reaching out and established: to create an informative, partnering with institutions at every interactive site dealing with sex and level of the American education system. dreams, which would answer the Two important participants in the questions teens have, while promoting Teen Web Site Project are APsaA Edu- awareness of psychoanalytic sensibil- cator Associates who come from the ities and values. Education Division’s Liaison to Schools Committee. They are Tillie Garfinkel, WIKI POSTINGS the committee chair and a public school Project participants from left: Joey Schullo, senior; Marty Moran, The project manager’s position has principal with a longstanding interest teacher; Julie Schumacher, teacher; and Nicole Hunter, freshman. been assumed by Kate Tabor. Tabor in, and extensive knowledge of, the was instrumental in introducing the ways psychoanalytic understanding can be use- school students and form the foundation for think tank participants to a wiki, an Internet ful in the school environment; and Dan Frank, a conversations which would eventually appear space where students, teachers, and analysts member of the committee, a student of human on the Web site. He also recognized that have interacted through postings. An inter- development with a Ph.D. from the University Parker teachers would have to be involved, esting series of wiki contributions are the of Chicago (where his mentor was the distin- because interaction between students and dream poems of students in Mahaney’s English guished analyst, Bert Cohler), and the principal their teachers would also be an important class. These are poems based on dreams the of the Francis W. Parker School in Chicago. dimension of the developing Internet site. students have remembered upon awakening. Finally, seeing Parker as a learning community The poems will soon be discussed by the Stephen Sonnenberg, M.D., is Education which included the families of its students, analysts working on the project, and their Division coordinator; clinical professor Frank believed that mental health professional responses will be vetted by Garfinkel, who of psychiatry, Baylor College of Medicine, parents should participate in the project. will work with these analysts to craft their Houston, Texas; adjunct professor of In September, 2008, a think tank meeting was comments to the needs of teens using the psychiatry, Uniformed Services University held at Parker, in which Frank led a group com- Web site. of the Health Sciences, Bethesda, Maryland; posed of analysts Cynthia Carlson, Bert Cohler, Next steps, under Tabor’s management, will and training and supervising analyst, Robert Galatzer-Levy, Prudy Gourguechon, Jim involve working with Parker teachers, and Houston-Galveston Psychoanalytic Institute. Hansell, and me. In another category was Colin Continued on page 24

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 21 SPECIAL SECTION: OUTREACH TO HIGH SCHOOL STUDENTS

apsa.org/TRAININGANDEDUCATION/ STDs—Reaching Out to Teens EDUCATIONINITIATIVE/PRECOLLEGE/tabid Dottie Jeffries and Mary E. Tressel /198/Default.aspx). This Web page features: • A fully annotated lesson plan for addition Despite their fixation on all things digital, APsaA sought to build on the success of to high school social science curriculum, today’s teenagers still cling to a static art form the 10,000 Minds Project and drill deeper to “Freud’s Impact on the 21st Century” that has been popular since Baby Boomers develop an interest in psychoanalysis with • An article entitled,“Catching Them Early: were their age: the pop art poster. From the even younger students. An organizer of New Teaching Psychoanalysis to High School “Hope” posters of President Obama’s suc- York City’s primary science fair has com- Teachers” cessful campaign by graphic artist Shepard mented that interest in the behavioral sci- • Links to APsaA Web pages such as: Q&A Fairey to the standard rock band and movie ences is very keen among high schools so the about Dreams; Q&A about Guilt,Apathy, star variety, posters are a proven cultural organization’s objective is to expose today’s & Violence; Psychoanalytic Perspectives communications vehicle in public space. The teenagers to the benefits of psychoanalysis and about Dreams; and The American Psycho- American Psychoanalytic Association took to cultivate interest in learning more about the analyst Special Section on Dreams advantage of this phenomenon by developing field of study before they enter college. APsaA • Additionally, the cover letter offered local a new poster focused on “Psychological STDs” zeroed in on the two primary areas of interests members of APsaA as a resource for class- (Stress, Trauma, and Depression) to serve as that compel teenagers to enroll in psychology room speakers to interested teachers the heart of a new outreach effort to teens. courses during high school as reported by San Antonio, Texas, high school teacher of THE RESULTS THE RESEARCH psychology Kay Minter: sex and dreams. Psychoanalysts who attended APsaA’s Win- APsaA has paid close attention to the paths ter 2009 Meeting were fascinated with the professionals traverse on their way to becom- THE POSTER educational poster. ing psychoanalysts. The “10,000 Minds Project” APsaA worked with a graphic designer to “To me, the poster represents a new level of determined that the future of psychoanalytic create a poster that addressed the adolescent achievement for APsaA’s public information thought depends on engaging undergraduate fascination with sexual activity, while outlining outreach efforts,” commented APsaA presi- college students in psychoanalytic ideas. Further three of the most commonly experienced dent Prudy Gourguechon. “The STD theme is research and a New York Times article entitled, teenage psychological ailments. The “Psycho- incredibly arresting, and the twist, changing “Freud Is Widely Taught at Universities, Except logical STDs” are defined as “Stress, Trauma, the meaning of STD from the common one of in the Psychology Department,” revealed that and Depression.” A pensive teen girl provides sexually transmitted diseases to the newly psychoanalytic theories were often presented an illustration of the deeper issues at play in coined mental health message, grabs the by college professors in abstract or harshly the poster’s text. viewer and keeps her focused and thinking critical ways. In one effort to combat this tide For each of the STDs, a definition is pro- for a prolonged period of time. I think the twist of misinformation, APsaA established the vided along with suggested psychoanalytic and the new message are powerful tools to “Teach Psychoanalysis” Web site (www.teach treatment approaches. For instance, the dif- combat the micro attention span of most psychoanalysis.com) to provide course mate- ference between normal mourning behav- teens (and American adults). Our psychoana- rial, recommended resources, specific teaching ior and chronic depression is outlined. The lytic message must always be conveyed suc- aids, and career opportunities for interested text offers an affirming message: “Psycho- cinctly, but it is also complex and finding a instructors. Additional outreach efforts were analysis holds that by understanding on a visual and linguistic hook to slow down the utilized to enhance psychoanalytic dialogue deeper level what’s going on now and its con- observer and turn her into a reflective thinker and research through the nation’s higher nection to your past, you can experience relief is terrific. education system. from the current bout of depression and enjoy “When I first saw this poster at our January life again.” 2009 meeting, I immediately had visions of it The new poster introduces basic psycho- in every high school nurse’s office, home room, Dottie Jeffries is the director of public affairs analytic theories in an engaging, eye-catching and teen clinic. My dream would be to find a of the American Psychoanalytic Association. way. Approximately 1,600 posters were pro- partner with greater resources than ours to Mary E. Tressel is an award-winning duced and distributed nationwide via the mail- help distribute it widely. A space at the bottom independent public relations consultant ing list of the Teachers of Psychology in could be left to insert local resources,” Gour- with 20 years of experience. In addition Secondary Schools (TOPSS) division of the guechon said. to her work with the San Francisco Center American Psychological Association. A cover Copies of the poster for high school teach- for Psychoanalysis, she has been providing letter sent with each poster guides the teach- ers are available in APsaA’s Online Store. For public relations support to APsaA for the ers to a dedicated Web page in the Education more information about the poster, contact last four years. Division of APsaA’s Web site (http://www. Dottie Jeffries at [email protected].

22 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 SPECIAL SECTION: OUTREACH TO HIGH SCHOOL STUDENTS

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 23 “Lesson Plan” AMERICAN PSYCHOANALYTIC FOUNDATION COMMITTEE Continued from page 20 I then recruited some respected colleagues Grants Awarded July 2008–December 2008 to help write the outlines. Joshua Ehrlich, from the Michigan Psychoanalytic Institute, drafted BOSTON PSYCHOANALYTIC SOCIETY Lesson 2. Howard Lerner, also from Michi- $2,500 for the migration of its unique collection of deteriorating audiocassette tapes to gan, drafted Lessons 3 and 5. Wendy Katz, a digital format, thereby preserving valuable recordings and making them available to a wider from the Columbia Psychoanalytic Institute, community of psychoanalysts, historians, and other researchers. Once they are digitized, wrote Lesson 4, and I drafted the others. these recordings of interviews and lectures will be available online. After many months of e-mails and confer- ence calls to edit, coordinate, and consult CHICAGO INSTITUTE FOR PSYCHOANALYSIS (including very helpful input from honorary $5,000 for a new outreach initiative—The Analytic Service to Adolescents Project APsaA member Nancy McWilliams, then (ASAP) at Morton Alternative High School located in Cicero, Ill. This in-school program president of Division 39), the six outlines has a four-fold aim: were finalized in 2006. In 2007, the high school • To provide six high-risk students at Morton Alternative High School with the oppor- teachers added the supplemental content, tunity to meet with two clinical social workers in individual sessions once a week; and another round of editing began. Currently, • To provide group counseling to another set of six high-risk students once a week; I am pleased to report that APA has just pub- • To provide the parents and siblings of all 40 students enrolled at the school with the lished, and has begun to publicize, the whole, opportunity to meet with a family coordinator, an experienced social worker who final package. (APA members can check it out at: will make personal visits to their homes on a regular basis; and http://www.apa.org/ed/topss/unitlesson.html). • To provide weekly group consultation to Morton’s six teachers and six staff members As a result, we hope that some of next year’s so that they may better manage the emotional demands of their own positions, work- 500,000 high school students of psychology ing in a school setting that is rife with daily tension and difficulties. will be turned on to psychoanalysis, and may make their way in our direction at some point In this way, the ASAP project strives to be a community intervention whose activities in the future as mental health professionals, will help not only the high-risk students themselves, but also their families and teachers. Such patients, or supporters. an endeavor can have a tremendous impact on the school population as a whole, producing benefits that are powerful and far-reaching.

Teen Web Site Project JENNY WAELDER HALL CENTER FOR CHILDREN $2,900 to train military child psychiatry and social work fellows at Walter Reed Army Continued from page 21 Medical Center (WRAMC) in psychoanalytically-informed consultation to preschool day students, as well as analysts, to implement care center staff. WRAMC offers a two year post-graduate fellowship training program the transfer of material from the wiki to the to child psychiatrists and social workers (four to six each year) in the army and navy. This Web site. This will include writing scripts and project will provide the fellows with training specific to the particular challenges faced by outlines for tapings of conversations between children of military families, such as the impact on the children (and families) of parents who students and analysts, which correspond to are, will be, or have been deployed and parents who return from combat with significant the main questions students want answered. mental and/or physical impairments. These tapings will take place next September. The Teen Web Site Project is innovative APSAA MEMBER JULIE JAFFEE NAGEL, PH.D. because it blends the perspectives of APsaA $2,000 to support “On the Aural Road with Psychoanalysis and Music”—a series of analysts, high school teachers and parents, and programs available to APsaA’s affiliate societies that will focus on the concepts that link high school students, in the construction of an “tone and talk,” i.e., music and psychoanalysis. Each program will include a presentation, Internet site to be used by teens. This model a lecture/recital that illustrates the intersection of music and mind, and an opportunity of analysts working together with these groups for faculty and candidates to discuss how psychoanalysis and music inform each other. to create an educational vehicle which offers Each presentation will highlight music as an instrument of change in the clinical encounter. accurate, psychoanalytically informed and sen- sitive information is an exciting example of NEW CENTER FOR PSYCHOANALYSIS what is possible as APsaA actualizes its com- $4,000 to develop a training module for mental health professionals and others working mitment to finding its place in the arena of with patients with eating disorders. public discourse.

24 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 and even undermines the progression of col- leagues towards certification and training ana- COPE lyst opportunities. The psychoanalytic culture of these communities that contributes to the eth- ical morass must be changed. Our study group Meeting the Challenge of is collecting narratives of community healing to learn what they did to achieve their success. Rehabilitation for Boundary Violators Trauma can lead to growth. A psychoanalytic Marvin Margolis community that experiences ethics crises can emerge from such a calamity with greater The past 25 years have led to a sea change issues so that others could profit from their understanding of its problems and adopt cre- in the way our institutes and societies handle experience and hard-won insights. ative efforts to reaffirm its psychoanalytic iden- ethical issues. Ethics and assistance commit- tity. The same applies to the individuals involved tees have been mandated by APsaA. Our AMBIVALENCE directly in these problems. ethics code has been revised; we have pub- As analysts we might be curious about the Some feel that outside analysts by virtue of lished an Ethics Case Book, and made significant disparity between our vigorous attention to their greater objectivity ought to be in charge of advances in candidate and faculty ethics edu- sanctions and our relative neglect of reha- the transgressors’ rehabilitation efforts. They cation. As a result there seems to be a decrease bilitation. Clearly, we have been profoundly claim that local colleagues are too familiar with in the most egregious boundary violations. We disturbed by the unethical conduct of our col- the erring analyst and are less likely to be objec- cannot be as proud of our efforts to establish leagues. It is even understandable that we would tive. Protagonists of local efforts note that their rehabilitation programs for ethics violators. want to deny our commonality with such knowledge of and ongoing contacts with these Our ethics code is essentially silent about behavior by extruding them from our midst. colleagues is more comprehensive. Most would rehabilitation. There are no procedures rec- Therefore, we may tend to view such col- stipulate that a return to treatment and super- ommended by our Ethics Committee. In most leagues as being unworthy of remedial action. vision would be central to any rehabilitation plan. of our sites there have been at best only pre- However, as analysts we are also committed Many would also include restitution of analytic liminary discussions regarding rehabilitation. to a belief in the potential for change that can fees. All seem to agree that remorse and a Nevertheless, rehabilitation efforts are under arise from a treatment that aims at explicating personal apology would be desirable but diffi- way in a small number of our sites. The chal- and resolving unconscious conflicts. This is the cult to assess in regard to its sincerity. lenge for our Association in the next decade is tension we work with that undergirds our Colleagues who will monitor the transgres- the establishment of guidelines for rehabilitation. ambivalence towards rehabilitation. sors’ rehabilitation need to report their findings To further this process, the Committee on It has become painfully clear that the sequel- to an oversight committee distinct from the Psychoanalytic Education (COPE) established a lae of severe boundary violations are so wide- group that originally decided on the sanctions. new study group on “Boundary Violations and spread that rehabilitation programs must The period of rehabilitation is very difficult Rehabilitation,” which began meeting biannu- encompass our entire analytic community and for the sanctioned colleagues as well as the ally in 2007. The members of the committee, oftentimes our larger community of support. involved patients. Both therapist and patient which I chair, have been active in both local Of course the highest priority should be given often suffer ostracism. They are frequently and national ethics committees. The members to patient-victims as well as to the analysts who treated as toxic, damaged goods. All parties include: Sydney Arkowitz, Rita Clark, Suzanne have transgressed. Our rehabilitation focus in deserve our support and encouragement dur- Gassner, Prudy Gourguechon, Rion Hart, John the past has often been too narrowly directed ing this difficult period. Hall, Frederic Levine, and Vaia Tsolas. We began at the impaired colleague. Clearly the rehabil- by reviewing the existing literature and inter- itative effort for most situations will take place RESTORATION viewing former patients and their analysts as over a period of years. Clearly it is very difficult to determine an end well as colleagues involved in rehabilitation point to this process. The damage lives on for where that is in place. We are indebted to BROAD SPECTRUM years. Yet, the oversight committee must ulti- them for their courage to revisit these painful Where a broad spectrum of efforts has mately suggest a phased-in reentry for the full been mobilized, some communities have restoration of member privileges and respon- Marvin Margolis, M.D., Ph.D., is a responded positively. Where a comprehen- sibilities. As in clinical practice, we look for a training and supervising analyst at the sive strategy was not undertaken, the residual good enough result, not a perfect rehabilitation. Michigan Psychoanalytic Institute, past damages have been deep and of long duration. Some of our ethics committees are overly president and chairman of the Board on A demoralized, divisive, depressed psychoana- severe in their sanctions. This can be as unfor- Professional Standards of the American lytic community interferes with the growth of tunate as the earlier period in which ethical Psychoanalytic Association. practice, candidate recruitment and education, Continued on page 33

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 25 SPECIAL SECTION: CANDIDATES

Affiliate Council President’s Message Carmela Perez June 2009 Carmela Perez

I look forward to serving you as your president these next two years, and meeting and working with many of you during my term. I hope you enjoy this first issue of our revamped newsletter, The Candidate Connection. I want to thank Susan Flinders, editor, and Navah Kaplan, assistant editor, for all their hard work in bringing this project to fruition. I also want to thank all of you who contributed to this issue and to encourage everyone to consider writing for our newsletter in the future. The Candidate Connection will be published twice a year, in June and January. Before I share with you some thoughts on what issues I plan to focus on during my presidency, I would like to tell you a bit about the Affiliate Council officers who will be serving with me in the Executive Committee. The president-elect is Hilli Dagony-Clark, who is a fourth-year candidate doing combined adult and child training at the New York Psychoanalytic Institute. Richard Grossberg is the treasurer, and a fourth-year candidate from the Cleveland Psychoanalytic Center. He is a pediatrician who came to training through COPAP,the Committee on Preparedness and Progress. Anne Malone, secretary, is a senior adult candidate and a third-year child candidate from the Psychoanalytic Center of Philadelphia. We have been hard at work since our January meeting in New York, updating our rosters and reaching out to many of you to get involved in APsaA. For example, we learned that out of the 103 new candidates that started training in fall 2008, 34 had not joined APsaA. The Affiliate Council Executive Committee followed up with these candidates, many of whom had forgotten to join APsaA with the early pressures and busyness of beginning analytic training. It seemed that candidates were often uncertain where to get applications, and how to follow up with the application process. So, together with the National Office, we were able to put the APsaA Affiliate membership application online. All new candidates can download the application at www.apsa.org/joinapsaa. Please share this information with other candidates and your institutes.

THE BUSINESS OF RUNNING A PRACTICE As you know, the demands of analytic training, which can challenge the balance between personal and professional lives, and the recent economic pressures make this a particularly trying time for all of us who are beginning or developing our psychoanalytic practices. Throughout my training, both in psychology and psychoanalysis, I have been interested in how little attention is devoted to teaching the business aspects of running our practices. One gets the sense that discussions of promotional endeavors, marketing, and outreach are considered at the very least distasteful, if not unnecessary. This may have been the case decades ago, when psychoanalysis was in its heyday, and there was no shortage of patients interested in and eager to engage in psychoanalytic treatment. However, as you well know, we live in a fast-paced world that relies more and more on technology as a way of communicating, where many, if not most, patients expect speedy results, and where we now compete in a vast marketplace of mental health treatments. The recent economic downturn is an additional important example of how we need to contend with external realities. Although these may sound like considerable challenges, they are certainly not insurmountable, and I believe that they offer us great opportunities to re-enliven and propel the field of psychoanalysis forward, as well as develop successful practices. During my term as president, I would like to try to help us focus on these precise issues—how to develop successful practices as psychoanalysts in our current world and our current economy, and how to promote ourselves and psychoanalysis both in our local communities and nationally. Continued on page 28

26 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 SPECIAL SECTION: CANDIDATES

The Candidate Online Journal Thrives Brenda Bauer

The Candidate, a free online journal, now in numbers of unique visi- its fourth year, has stimulated lively, thought- tors visit its Web site. In ful scientific exchanges generated by its first 2008 alone, over 4,000 three volumes, and recently announced its call unique visitors logged on for papers for Volume IV, on Power (see box to the Web site, rivaling below). Conceived by 15 New York University the circulation of many Psychoanalytic Institute (NYUPI) candidates major journals. Could it to provide a context for candidates to think, be that high demand e n i F read, critique, and write about issues germane for The Candidate indi- n a s u S

to their candidacy and psychoanalytic educa- cates not only significant : o t o tion, the journal is guided by faculty members candidate interest but h P Rachel Blakeman and Hilary Rubenstein Hatch also greater than antici- From left, Carlos Almeida, Margery Kalb, CJ Churchill, Hilli Dagony-Clark, Greg Lowder, Hilary Hatch, and Kim Gelé (both inaugural editors of Volumes 1 and 2 pated general interest in enjoy The Candidate party and fundraiser at the Plaza Hotel while candidates), Donald Moss, Steven Reis- psychoanalysis? (Warren-Tricomi Salon) during the Winter 2009 Meeting in New York. ner, Joseph Reppen, Arden Rothstein, Jennifer The Candidate has Stuart, and Lynne Zeavin. The Advisory Board spawned other ventures, such as the Inter-insti- The journal, initially funded by the Foun- consists of analysts experienced in publishing tute Candidate Alliance, a group of candidates dation for the Support of Psychoanalytic from many institutes around the country. from several New York City psychoanalytic Education and Research (FOSPER), has grown The journal has always reached out to all institutes, APsaA institutes, and independent to become a self-funding venture, in that it psychoanalytic institutes, regardless of affili- institutes, which organizes free programs aimed organizes an annual fundraiser to maintain its ation or theoretical orientation. One goal of at candidates from the many psychoanalytic Web site (www.thecandidatejournal.org), to this endeavor is to deepen and enrich the institutes. Last September, for example, this host panels and roundtables, to document its training experience by encouraging such group organized a panel titled,“Orthodoxy activities and archive them via videotape and diversity. Although The Candidate directs its Is Unconsciousness: Examining Gatekeeping audiotape, and to announce and promote call for papers to candidates, it also wel- Practices at Our Institutes. A Dialogue across each volume. comes submissions from faculty, graduates, Institutes Initiated by Candidates.” The panel Fundraisers are held on Friday evening and non-candidates that address issues rele- included seven analysts, representing seven during the January meeting in New York. Past vant to candidates, such as psychoanalytic different New York institutes. Candidates fundraisers have been held at the Tina Kim Fine education and the institutional milieu. Addi- served as moderators. Continued on page 28 tionally, the journal occasionally invites specific authors to write on a particular subject, and frequently to prepare a presentation that The Candidate The official deadline for submissions is June 1, 2009, however, pertains to a specific volume. at a Glance The Candidate will consider submissions for Volume IV through- out the summer. The Candidate is always interested in receiv- POPULAR, INDEPENDENT, ( ing papers on other psychoanalytic topics. Submissions may be sent to candidatejournalsubmission@ THOUGHT PROVOKING Volume I: Beginnings gmail.com. Inquiries may be directed to Jason Wheeler, Ph.D. It is remarkable that at a time when many (2007) journals, and even magazines and newspa- We are pleased to announce that beginning with the publi- Volume II: Becoming pers, are folding, The Candidate has seen record cation of Volume 4, The Candidate Journal Prize will be awarded (2008) for the best paper published in each volume. Brenda Bauer, Psy.D., is a first-year candidate Volume III: Money To make a charitable donation in support of this free online at New York University Psychoanalytic (2009) journal, please make checks payable to “FOSPER” and indicate “The Candidate” on the memo line. Checks may be sent to Institute, chair of APsaA’s Committee on Volume IV: Power Students and Residents, and on the editorial (2010—in Terry Blanken, Ph.D., 5 West 86th Street, Suite 9C, New York, boards of TAP and The Candidate. She is development) NY 10024. in private practice in New York.

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 27 SPECIAL SECTION: CANDIDATES

Affiliate Council experience, being involved nationally at or even develop and propose ideas for APsaA and at my home institute (NYU), new committees. Finally, you can become Continued from page 26 as well as participating in a variety of a candidate member in many of APsaA’s KEEPING IN TOUCH community endeavors, has enabled me committees, where you can learn and There is a lot for us to do, but there to develop a network of colleagues and join in the efforts the Association is are simple steps we can begin to take. friends, which in turn has helped me putting forth to restore and develop the One is for us to communicate better build a more stable practice. place of psychoanalysis in today’s world. with each other and to use the resources The Affiliate Council meets during the we have to do so. This newsletter is one GETTING INVOLVED APsaA meetings on Thursday morning, way we can keep each other updated I want to end by briefly reviewing and this meeting is always open to all not only about committee work and some of the ways in which you can candidates. This summer, the Affiliate training issues at our institutes, but also get more involved nationally and to Council will meet during the IPSO/IPA about how we can further develop emphasize that the commitment to Congress (www.ipa.org.uk) on our practices and ourselves as analysts. participate in any of these does not Wednesday, July 29 at 9:00 a.m. My plan Another resource we have at our require endless hours of work. You is to devote a good portion of this disposal is our Affiliate listserv. Why will get out of it, as with many things, as meeting to a beginning discussion of the is it so underutilized? Finally, as some much as you put into it. First of all, you business of developing our psychoanalytic of you may have read in the minutes can become an Affiliate Council delegate practices—what we do, how we do it, of our January meeting, Laura Jensen, or alternate. Would it surprise you to and how we can do it better. I hope our previous Affiliate Council president, know that there are several institutes to see many of you there. In the interim, is working on a candidate blog, not currently represented? The delegates if you have any questions, please www.affiliatemember.wordpress.com, are the most important part of the feel free to contact me by e-mail, that will be up and running soon. Affiliate Council, because they are the [email protected], Another sure way to move forward link between APsaA and its individual or phone, 212-674-6444. in developing our practices and the field institutes. You can become a member of psychoanalysis is to get involved, locally of any of the existing Affiliate Council both at your institutes and within the committees (Affiliate Participation, The Affiliate Council will be communities where you practice, as Candidate Organizations, LGBT Issues, meeting in Chicago, during the well as nationally. The value and benefits IPSO Liaison, Racial and Ethnic Diversity, IPA Congress. Join us on of doing so cannot be stressed enough. Scientific Paper Prize, TAP newsmagazine, Wednesday, July 29 at 9:00 a.m. I can tell you that from my own and Scientific Programs and Training)

Editor’s Note: TAP has invited the Affiliate Council president to reprint the President’s Letter from the Affiliate Council newsletter, The Candidate Connection, on an ongoing basis.

The Candidate RICH MULTIMEDIA WEB SITE The “Culture Desk” offers book and film Continued from page 27 The Candidate also maintains an exciting video reviews and cultural commentary. Panels and audio archive on the “Screening Room” and roundtable discussions (events that are Art Gallery, Park Avenue Bank, and this year, section of its Web site. Here, Hilary Rubenstein free and open to the public) are also docu- at the Plaza Hotel (Warren-Tricomi Salon), all Hatch, a candidate then, interviews Roy Shafer mented and catalogued—most recently, of which were generously made available by about his psychoanalytic candidacy from 1954- the “Money, Gender, and Psychoanalysis supporters of the journal. Ticket sales and 1959, Shelley Orgel interviews Dale Boesky, Roundtable”—making for a rich multifaceted donations from supporters have funded recent Donald Moss interviews Nancy Chodorow, and Web site. volumes. The Candidate is investigating the candidate David Cole interviews The New Yorker In short, The Candidate is not simply an possibility of introducing a silent auction at art critic and bestselling author Adam Gopnik, online journal, but a unique repository of the 2010 fundraiser to enhance its ability to to name a few original video highlights. There original writings and recordings, as well as a expand its reach by offering an even richer are also videos of Jacob Arlow, Ernest Jones, growing media collection of seminal psycho- slate of events (roundtables, panels, the media reminiscences of Freud, and an online photo- analytic thinkers. Envisioned by candidates for resources to document these events, and graphic tour of Freud’s consulting room in candidates, it appeals to even the most expe- related publicity). Vienna to round out these offerings. rienced students of psychoanalysis.

28 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 SPECIAL SECTION: CANDIDATES

The Importance of Becoming Involved: Finding a Home and a Future in Psychoanalysis Hilli Dagony-Clark

After completing a psychodynamically- importance of the inner workings of the mind, are far from oriented doctoral psychology program, I found active participa- effortless. It is our responsibility as represen- myself deeply invested in learning more about tion in our field. tatives of our field to advance our position and the complexity of the human mind through the While the busy uphold psychoanalytic thought. Involvement most comprehensive and thorough method world keeps us in research; treatment of low-fee analytic I knew: psychoanalysis. While obtaining clinical all spinning, patients; pro-bono supervision and teaching; hours and studying for my licensing exam involvement with and participation in local, national, and inter- loomed large in my mind, more expansive was psychoanalytic national psychoanalytic committees are all the gap that was once filled with the magic of thought and prin- ways to ensure our lasting presence in the discovery. I very much wished to apply con- ciples provides a Hilli Dagony-Clark mental health world. cepts I found captivating during my graduate welcome anchor. studies—intrapsychic conflict, compromise PERSONAL GROWTH formation, transference—and see them come PROMOTION OF SOCIETAL AND DEVELOPMENT alive in a meaningful treatment process. Stuck MENTAL HEALTH Involvement in a professional body devoted between my newfound identity as a psycholo- The fact that Americans are in the midst of to the enhancement of psychoanalytic ideals gist and the clinician I wished to become, ana- a deep national crisis is well known. Families is essential to the psychoanalytic clinician. Since lytic training seemed an ideal option. Little did bereft of members serving in the military, indi- the work of psychoanalysis is at times chal- I know that this training would not only pro- viduals losing their jobs and homes, and the lenging, lonely, rewarding, exhausting, and deeply vide me with a precious scholarly future but threat of terrorism, are just a few of the wor- powerful, access to psychoanalytic education, would also afford me access to an intercon- ries plaguing the national psyche. Psychoanalytic peer supervision, and engagement with like- nected kinship spanning institutes, states, and treatment, with its comprehensive vision of minded colleagues is crucial for the personal countries. It is through involvement with this the unconscious and the endless possibility of and professional empowerment of the psy- psychoanalytic community that I received refer- creative thought in a quest for personal mean- choanalyst. The danger of committing ethical rals, began a private practice, and took on an ing, can provide infinite relief and adaptive violations, losing cases prematurely, or burning office; found exposure to teaching and super- solutions to those in the midst of sudden crisis out could be mitigated through participation in vising opportunities; and met a multitude of or chronic disturbance. Psychoanalysis is unique psychoanalytic activities aimed at uniting and likeminded, warm, and intelligent individuals in that it allows for discovery of the mind teaching analysts who are deeply invested in devoted to the field of psychoanalysis. My through a privileged and intimate relationship their work. involvement in the psychoanalytic community for the purpose of transforming long-standing, Participation in the psychoanalytic commu- has been remarkable in that it has allowed me maladaptive, and deeply entrenched responses nity provides opportunities to contribute to to discover the richness and depth that char- to the world. Promoting psychoanalytic treat- those in distress, ensures our survival as a acterizes stellar educational ideals fueled by ment through communication with the media field, and fosters academic growth and a sense the clear devotion and commitment of indi- and community outreach is needed to raise of community. Although conflict within psy- viduals at the very heart of the field. public awareness of psychonalysis and thus choanalytic organizations might decrease indi- There are endless reasons to become provide suffering individuals with enduring relief viduals’ willingness to commit to extracurricular involved in a psychoanalytic community that and intrapsychic freedom. psychoanalytic activities, the global rewards many consider home. Outlined are a few for involvement far outweigh the current dif- compelling motives aimed at addressing the PRESERVATION OF OUR FUTURE ficulties. I have found my professional home In a world where short-term psychothera- through my psychoanalytic studies, psychoan- Hilli Dagony-Clark, Psy.D., is president-elect pies based on symptom reduction and/or pure alytically related activities, and the people I of the Affiliate Council, a candidate in adult medication management are promoted by have come to know. I can think of no better psychoanalytic training at the NY Psycho- insurance companies and sought by many in way to ensure the progression of psychoana- analytic Institute, and a candidate in child desperate need of quick solutions, it is easy for lytic thought and treatment than to continually psychoanalytic training at the combined Child psychoanalysis to be overlooked. The intensive involve myself in the local, national, and inter- Program of NY Psychoanalytic, NYU Medical, time and financial obligations, as well as the national psychoanalytic community that has and Columbia Psychoanalytic Institutes. methodical and often painful uncovering of already given many of us so much.

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 29 HEALING THE WOUNDS OF WAR

The Long Haul were angry, abu- something decent about Homer, they will Continued from page 1 sive, demanding, literally read it for centuries. It has been narcissistic— extraordinary what that book has done in THE ESSENTIAL TRIAD: COHESION, gosh, they were the world and done for me, and veterans are LEADERSHIP,AND TRAINING wonderful peo- kind enough to tell me what it has done for Now I’ll give you a one-breath summary of ple!—I realized them. The second book, Odysseus in America preventive psychiatry in military organizations, that I was hearing was, of course, no accident, but I’m just your and it really is one breath although I may fragments of the ordinary human critter and I went back to expand some sentences and make it two story of Achilles the same well where I got an adequate drink breaths. But when you hear these three simple over and over before. I tried to pull the same stunt with The things I want you to know that it is a vast Jonathan Shay again, sometimes Odyssey and you have to judge whether I issue in practice and very heavy lifting for the the whole narra- pulled it off. It took a different approach military services. So here’s the pitch. tive sequence in the form Homer gave us in because these literary works are very differ- There are three things that protect the The Iliad. And in the same period I became ent. The Iliad is a tragedy; The Odyssey is a mind and spirit of the people we send into a painfully and embarrassedly aware that even in romance. The Iliad is a very straight ahead fight, and those three things are first, cohesion, the VA where you would assume that everyone linear narrative; The Odyssey is a widely com- which is positive qualities of community in understood how to take a decent combat plex narrative structure with stories within sto- the face-to-face unit; second, expert ethical history that there were very, very few ade- ries within stories. and properly supported leadership; and then quate combat histories in the clinical record. Maybe I pulled it off and maybe I didn’t but it third, prolonged cumulative and highly realistic So I wrote a little paper that appeared in the gave me an opportunity to do two things which training for what they actually have to do and Journal of Traumatic Stress. Basically what it said I wanted to do. One was to be explicit, it was face. Do those things and do what it takes to was if you want to take a decent combat his- implicit in Achilles in Vietnam, but to be explicit improve cohesion, leadership, and training and tory, remember the story of Achilles and in part three of Odysseus in America about avoid doing those things that wreck them. you’ll touch all the bases. I was proud of that. the preventive agenda that you just heard. But the story that I started to tell you was What a nifty teaching idea! Well, at the time my And the other was to make a point that this is how I stumbled into saying some new things daughter was a freshman at Harvard College not a partisan or ideological issue, and I made about Homer’s epics. During my first year at and taking Professor Gregory Nagy’s course it by soliciting the jointly written foreword by a the VA Day Treatment Center in Boston in a that the freshmen lovingly called Heroes for conservative Republican and a liberal Demo- program for Vietnam combat veterans who Zeroes. Gregory Nagy, I suppose it is fair to crat, both of whom have credibility as veterans, say, is the leading Homer scholar in the “people who paid their dues” and “had seen world, but maybe just to stick it to him I the elephant.” I can tell you it was work getting say one of the two or three leading them to agree on a common text. Homer scholars in the world. He came to my apartment and said,“Would you PARALLEL PROCESS AND expand this into a book for one of the SOCIAL TRUST series that I edit because this has never Having heard my rap on prevention, don’t been said before.” “What?” All I said is be surprised if you hear snatches of it coming that The Iliad really is about war and back when I talk about the situation of trying what matters in the heart of the sol- to get things right in the clinic. Remember, my dier in war. “Never been said before,” mantra is the positive qualities of community said Nagy. Well, I can tell you that if Shay in the face-to-face unit which is, in military says that something is or is not in the jargon, cohesion. In the clinic what we have to corpus of Homeric criticism that and a attend to is positive qualities of community nickel will get you a bowl of gum in the among the veterans in the program and also, supermarket, but if Nagy says something equally important, positive qualities of com- is or is not in the corpus then you can go munity in the clinical team. This is not intuitive. to the bank with it. There are traditions very much built into the So, I cut out the general psychiatry structure of American medicine and Ameri- part of my practice, kept the combat can psychiatry, and certainly psychoanalysis, veterans program, rented a studio, and that elevate the one-on-one dyadic relation- wrote Achilles in Vietnam. This was my ship between a skilled, empathic, and engaged one shot at immortality. If you write Continued on page 31

30 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 HEALING THE WOUNDS OF WAR clinician and a single person in pain or trou- That’s my working definition of social trust in ble. I’m here to tell you that is the belief of the treatment setting. the people who founded that program at Now trust is this explosive issue, espe- the VA 10 years before I arrived, and I came cially with those patients, those veterans, who to embrace that belief, that recovery happens drive us utterly crazy, the ones who are enor- only in community. What I learned from both mous consumers of our energy, our worry, the experience and these folks who had it all our hospital beds, our staff meeting time, figured out before I arrived, I just had the wis- prison cells, whatever resource you name; dom not to destroy it. As a new psychiatrist the key issue is that their capacity for social I would have had the power to destroy what trust has been destroyed. Now what’s left they had created but I would not have had when social trust is destroyed is not a vac- the power to create it myself. I wouldn’t uum, it’s not nothing. What’s left is an active have known. The thing that they arrived at is and potentially quite dangerous and firmly Now it is not as easy to pull off in the real that the minimum case of community is three. settled expectancy of harm, exploitation, or world as for me to stand up here and say it. I need to point out to you some of the depress- ing downside. Number one is that cohesion, to A stable trustworthy and safe environment of other use the military term, is simply a phenomenon veterans, in my view, is the royal road to recovery for of nature. It is neither intrinsically good nor intrinsically bad. It’s a little like electricity. If it veterans with psychological injuries. bakes your bread, it’s great. If it electrocutes your daughter, it’s horrible. Cohesion is much the same. Just as military small units can some- Now you may suspect me of playing some humiliation from every person and institution times degenerate into criminal gangs, in the sort of logical game with you here, but it isn’t. that they encounter. I confirmed the position long history of the VA and vet centers occa- It is very practical clinical stuff working with that the people I learned from originally sional groups of veterans have formed criminal this population. The key issue, the key barrier, asserted, that recovery from this situation gangs in the context of the treatment setting. to getting care of veterans with these severe happens quite well in a stable and safe com- So there are deformities and degenerations psychological injuries is the issue of trust, the munity of peers, peer veterans. of cohesion that these communities can un- issue of their settled incapacity for social trust. dergo. It’s critically important for the clinicians They are not going to trust you on the basis of THE ROYAL ROAD not to be so starry-eyed that they either get your credentials or your institutional position. TO RECOVERY co-opted by a world view that says that this So, let’s come back to this logical structure. Continued on page 32 Why is three the minimum case? Because community exists when each of this triad has the well-founded expectancy that when he or she is apart from the other two that the other two, first of all, remember his exis- tence, and second of all, continue to care about this absent person’s well-being and are not planning harm, exploitation, or humil- iation. I say all this not because I think that individual therapeutic work is worthless. Far from it, just about every veteran in this pro- gram spent long periods in very helpful and valuable individual therapy, but it was always in the context of the group therapies and of the milieu. The holding environment for them was their peers, the trustworthy community of peers. A stable trustworthy and safe envi- ronment of other veterans, in my view, is the royal road to recovery for veterans with psy- chological injuries.

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 31 HEALING THE WOUNDS OF WAR

The Long Haul BLOWING UP THE DSM Continued from page 31 Now, I am going to move onto something that is available on the Web and as someone misbehavior is good, right, just, and, in a way, cool who is given to ranting, I am offering you the and that clinicians intervene to stop destructive invitation to read the rant that I did at the things that can arise in cohesive groups of National Academy of Sciences Institute of trauma survivors. So it is not all sweetness Medicine (IOM) panel on the “Scientific Merit and light and that’s just an example. You have to and Clinical Utility of the Diagnostic Con- be vigilant and sure that your team structure struct PTSD.” If I trash the diagnosis PTSD, it and trust within the team in the mental health is because I regard it as badly out of focus, a workplace is doing its self-healing and self-crit- rather accurate description of a very narrow ical work in keeping itself open to the larger and specific sort of fear syndrome if you wish, ethical horizon. It’s very easy to lose the ethical but it misses what actually wrecks the lives of bubble under the enormous pressure that psy- veterans and their families and misdirects us in chologically injured veterans place on us. all kinds of bad ways. I worked hard on this your injury. Eric Shinseki, Obama’s cabinet nominee for Veterans Affairs, used to be army chief of staff and he still has a prosthetic foot, If I trash the diagnosis PTSD, it is because I regard it having lost it to a mine when he was a com- as badly out of focus, a rather accurate description of a pany grade officer in Vietnam. He continued to the rank of four stars and to chief of staff very narrow and specific sort of fear syndrome if you wish, and he was a fine officer and had a distin- but it misses what actually wrecks the lives of veterans and guished career. On the other hand, if you fall ill, get a disease, malady, or disorder, in military their families and misdirects us in all kinds of bad ways. service it is not dishonorable but let’s face it, it’s unlucky. And who the hell wants to share a fighting hole with an unlucky soldier or marine. There’s a lot more to say about all of these rant and it’s my best shot at blowing up the It’s stigmatizing on the face of it. things. I do hope that you will find a way to DSM and I hope you will download it from the I have been agitating for years to replace have a look at the chapter in the Saigh and Web. What I want to mention here is only the word with one drawn from the semantic Bremner textbook which is cited in your hand- some of the objections to the diagnosis. range of injury and wound. Psychological injury out [Posttraumatic Stress Disorder: A Compre- Starting right off with the word “disorder” is the simple locution that I prefer but it’s hensive Text, 1998]. I wrote that with my and you will hear in this my mission to the certainly not the only possible one. It has the colleague, Jim Monroe, and it covers a lot more armed forces. Now people do differ on advantage of removing a totally gratuitous than I can cover today. I regret that because of whether words really are important or stigma and, no less important, it shifts the intellectual property issues that chapter is not whether they are just a superficial crust on the perspective of a lot of players on the matter available on the Web, which is a drag. reality that everyone can touch, so what’s the of complications of the primary injury. I really difference. Well, in want to get everybody thinking like a trauma military forces dis- surgeon rather than an internist. If you’re a order is stigma- trauma surgeon, you’re thinking about com- tizing in itself. Why plications right from the first moment. In fact, is that? If you’re you’re thinking about identifying and pre- injured in the serv- venting them even before you do anything ice of your coun- else. If an infantryman has an arm blown off in try, that’s entirely a flash, and just a reminder this is part of my honorable and perverse run in the rant at the IOM, we don’t there’s a long tra- speak of this person as suffering from “MAD,” dition of being able missing arm disorder. It’s ludicrous, and I sub- to continue with mit that only habituation and professional your military career acculturation prevent us from finding post- with distinction traumatic stress disorder just as ludicrous. It’s after you have an injury. So back to this unfortunate soldier. recovered from Continued on page 33

32 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 When the trauma surgeon encounters this injury rarely wrecks a veteran’s life and this infantryman, he or she, the surgeon, is thinking is part of my gripe with PTSD. PTSD is not a first of all about controlling hemorrhage which bad summary of the persistence of valid kills people fast and controlling infection which adaptations. Just like the primary injury, that kills them more slowly. These are the two traumatic amputation, just like that is rarely main complications of ballistic and blast injuries. with today’s military medicine fatal to the Obviously the medic out in the field has been infantryman, but the complications can be; just thinking about these complications, the soldier’s like that complications of primary psycho- buddies, and if he is able the soldier himself. logical injury can be disastrous and fatal, and The validity of this way of thinking does not I regard suicide as a complication of combat rely on the injury being as extreme as a total trauma. Even lesser complications than sui- traumatic amputation of the limb. cide can totally wreck the capacity for a flour- ishing human life, not only of the veteran, but ADAPTATION AND PHYSIONEUROSIS the whole family, sometimes their workplace, Now in the mental health arena I have sometimes their local community. And I, and advocated that we think of the primary psy- many historians, believe that the pathogen chological injury as the persistence into civilian burden, to use a public health term, of un- life or into life in garrison as the persistence of Just as an aside, I know that some will bri- healed combat trauma and the complica- absolutely valid adaptations that kept you alive dle at applying the word “injury” to the bonds tions of combat trauma contributed mightily in a situation where other human beings were of absolute obligation that arise between to the destruction of the Weimar Republic in trying to kill you. And doing a damn good job combat buddies but ask military and veteran Germany in the 1920s… of it because the person to your right, the families about this. Ask direct leaders in gar- person to your left were dying or being rison about this and ask them if these virtu- maimed by the enemy’s action. These are seri- ous adaptations in combat do not sometimes ous adaptations and they’re as much in the become disabilities when put into play in Editor’s Note: Shay’s talk did not end physiology as in the mind and Abram Kar- civilian or garrison life. This is awkward and here; this excerpt may inspire readers diner referred to combat neurosis as a phys- uncomfortable. We don’t like to think of to read his self-described “rant” at ioneurosis to emphasize this. But it’s also in virtues as disabilities, but I submit that it’s an www.iom.edu/?id=32937, and to read his the social connection which we witness as accurate and actionable understanding. But it’s work. After Shay’s talk there was some the incredible bonding of people who fight side not real comfortable. time for questions and comments from by side. The primary injury is the persistence I’m speaking as someone who has done a the audience, which were as moving and of these adaptations into civilian life or life in lot of work with the military forces but as a riveting as the talk itself. A good number garrison. The adaptation occurs in the brain, clinician I’ve only worked with veterans who of psychoanalysts reflected on their own the mind, the social, and the cultural because were injured years ago. And on that basis I wartime and military experiences. we’re just one critter. have come to the conclusion that the primary

Boundary Violators We are at the very beginning of a long While much progress has occurred in recent Continued from page 25 period of evaluation of these recent rehabili- years, we all recognize that there will always tative efforts. We are all indebted to the be a few who become involved in unethical problems were neglected. Knowledge of the groundbreaking efforts of Glen Gabbard and behavior. Our group feels that most colleagues potential for professional ruination can there- Andrea Celenza who have written about our can slip into unethical practices at times of fore lead some colleagues to bypass our insti- organization’s efforts to create pathways of uncommon stress and vulnerability. They, along tutions to create their own rehabilitation rehabilitation. Many models of rehabilitation with their patients and communities, merit our program. We need to study the problem of need to be studied. Long term follow-up of best effort at rehabilitation. overkill as an impediment to improving the results is necessary. Our study group would In closing, we can acknowledge that the ethical climate. Our goal is to create a welcome information of any rehabilitation ethical climate in our institutes and societies has respected, fair system that all will seek out for programs ongoing or completed, formal or improved. APsaA has a deserved worldwide help. Finally, it must be recognized that some informal; complete confidentiality will be fol- reputation for developing strategies to deal colleagues may not be capable of rehabilitation. lowed. We would hope to present a report with these problems. The development of a This determination is a difficult one and may based on aggregate data so that no institute, comprehensive approach to rehabilitation is require a long period of time. society, or individual can be recognized. our next challenge.

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 33 In Memoriam Samuel Ritvo Rachel Z. Ritvo, David Z. Ritvo, and Jonathan I. Ritvo

Samuel Ritvo, former president of the and unconscious conflict American Psychoanalytic Association, passed struck a chord in Sam, away on December 3, 2008, at the age of 91. who had faced a slew of He was an active contributor to the field of challenges as a child with psychoanalysis, in particular child psycho- a congenital clubfoot. His analysis, whose illustrious career spanned medical school thesis, Samuel Ritvo 60 years. written under the guid- Sam first learned of psychoanalysis from ance of pediatrician and psychoanalyst Helen many individuals—as well as non-medical articles about Freud he happened upon Richter Gilmore, applied Erikson’s epige- mental health professionals as a group— while delivering newspapers to pay for his netic theory to a child with an eating disor- whose psychoanalytic careers were being education at Harvard during the Depression. der. Unlike pediatrics, the Yale Department sidetracked, stalled, or thwarted by what he In medical school at Yale in the late 1930s, of Psychiatry in the early 1940s was hostile saw to be, all too often, hasty and biased he participated in a discussion group in the to psychoanalysis. On his psychiatry rotation, dismissal by powerful analysts. Department of Pediatrics led by Edith Jack- Sam would hide his Freud volumes by turn- In 1950, Milton Senn invited Sam to join son, an analysand of Sigmund Freud and ing the covers inside out. Thus Sam began his the Yale faculty and participate in the trans- co-worker of Anna Freud. The Freuds’ ideas residency training in pediatrics at the Uni- formation of the Gesell Institute into the about psychological development, fantasies, versity of Minnesota in Minneapolis rather Yale Child Study Center (CSC). Sam had than in psychiatry. research and teaching responsibilities. He The authors are the children Homesickness and the desire to under- set up the child psychiatry training pro- of Samuel Ritvo, M.D. take a personal analysis motivated Sam to gram, one of the first in the nation. His leave Minnesota, after his internship year, first trainee, Al Solnit, became president of Rachel Z. Ritvo, M.D., is clinical for New York, where he did a further year APsaA two years after Sam. He remained assistant professor of psychiatry at George in pediatrics at Babies Hospital, an affiliate training director until 1963 and a member of Washington University; a child, adolescent, and adult psychiatrist and psychoanalyst of Columbia University Medical School. the faculty until last year. practicing in Kensington, Md.; and a He continued at Columbia with a three- Sam’s research assignment was to assist member of the Baltimore Washington year residency in psychiatry at New Yo r k Ernst Kris with The Yale Longitudinal Study Center for Psychoanalysis. State Psychiatric Institute. His residency of Child Development. A prospective, directors supported his leaving the hospi- observational study of families enrolled David Z. Ritvo, M.D., is a child, adolescent, and adult psychiatrist and tal each day for his analysis with Marianne during the mother’s first pregnancy, The psychoanalyst in Walnut Creek, Calif.; Kris. The New York Psychoanalytic Insti- Longitudinal Study employed a multidisci- a member of the San Francisco Center tute was not so supportive, rejecting his plinary team of psychoanalytically oriented for Psychoanalysis; and a delegate to application for training because he was pediatricians, psychologists, early childhood the American Academy of Child and “too anxious.” Determined to pursue an educators, and psychiatrists to document Adolescent Psychiatry. analytic career, he made an appointment the development of the children and the Jonathan I. Ritvo, M.D., is clinical with the chair of the Education Committee, family. When indicated, psychoanalysis was professor of psychiatry, University of Sally Bonnett. He told her he had been provided. A second research project, The Colorado School of Medicine; medical further analyzed and was no longer so Family Study, arose out of the Longitudinal director, Center for Dependency, Addiction anxious. To his amazement she scrawled Study. Under the guidance of Marianne and Rehabilitation Program, University of a note in response: “Admit Dr. Ritvo to Kris, the Family Study took advantage of a Colorado Hospital; and practices psychiatry classes!” For the rest of his life he was an rare opportunity that arose when all four and addiction psychiatry in Denver. ally, always quietly and discreetly, of the Continued on page 35

34 THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 members of one family were in psycho- 1963, later serving as president of the BOPS and Council analysis simultaneously. The process of association. Active in the American Psy- Continued from page 6 these analyses in conjunction with obser- choanalytic Association, he served on many vations from nursery school and pedi- committees and as president in 1968. 1. Greater public and private access to and atric visits of the two children provided a Sam was a sophisticated analytic thinker support for mental health services to treasure trove of data for articles pub- whose writings were based on keen clini- veterans, their families, and children. lished primarily in the Psychoanalytic Study cal observations and the organizing influ- 2. Guaranteed privacy, a foundation of effec- of the Child. Yale Press will publish a volume ence of ego psychology. His early writings tive treatment and patient rights, with on the Longitudinal Study in the coming were on child analytic process and the release of information only with the patient’s permission or legal compulsion. year. Three weeks before his death, Sam development of the ego and superego. 3. Preventive support services for children completed a chapter for that volume Because he analyzed so many Yale stu- and families when a family member is which includes a follow-up interview, con- dents, late-adolescent development and deployed. ducted in 2005, with “Evelyn,” whom he the transition to adulthood became a focus 4. Education of mental health students and had analyzed as a child 50 years earlier. of his writing. When Yale became coed in professionals about the long-term effect The Child Study Center and the West- the 1970s, eating disorders and mother- of parental trauma on children. ern New England Psychoanalytic Society daughter conflicts drew his attention. Con- 5. Support for public awareness and edu- and Institute (WNEIP) were Sam’s two flicts of aggression interested him late in his cation through the media about the professional homes throughout his long career as he came to value the contribu- impact of depression, PTSD, and brain career. At CSC he had a unique position as tions of Paul Gray. injuries not only on the veteran but also a clinical faculty member with an office on Sam was a long-time, loyal participant in on his or her family and children. site where he could see private patients as the Princeton Center for Advanced Psy- 6. Advocacy for any legislation that will sup- well as teach and supervise. In 1965 he was choanalytic Studies groups organized by port diagnosis, immediate, and longer the first clinical faculty member ever to be Sam Guttman. Enjoying the twice-yearly term care for veterans, their children, made a full professor. He taught generations opportunity for deepening psychoanalytic and families. of child psychiatrists, who visited New dialogue, Sam cherished the opportunity to Haven’s many ethnic grocery stores during engage with Paul Gray, who elaborated a their peripatetic supervisions with Sam. technique for listening closely to the inter- Our Finest Hour Curiously enough, walks to collect food play of drive and defense in the moment- Continued from page 15 also stood out in Evelyn’s recollection of her to-moment utterances of the analysand. analysis some 50 years after the fact. Testing out this technique with his own Psychoanalysis, who worked doggedly to help achieve this victory. Sam was a founding member of the patients and teaching it to colleagues at Having established this successful beach- Western New England. He served as a WNEIP kept Sam excited about psycho- head, we have much more to do. We are training and supervising analyst from 1957 analysis to the day he died. now moving into the implementation phase, to mandatory retirement age, director of Sam will be remembered not just for and any or all of these hard won achieve- the clinic from 1962 to 1970, and chair of the contributions he made to the field ments could be undermined by guidelines the Education Committee from 1974 to but also for his remarkable personal qual- and regulations yet to be written. Certainly 1983. With Sy Lustman, Sally Provence, ities. People were drawn to Sam—to his the health information technology (HIT) and and Al Solnit, he founded the child analytic warmth, his lack of pretense, and his humor. insurance industries are already gearing up program at WNEIP in 1962. Sam always He conveyed his sense that each human to try to roll back as many of those gains as brought bagels and lox to Saturday morn- life is to be embraced and celebrated in they can. The secretary of Health and Human ing meetings. all its diversity of strengths and frailties. Services (HHS) has been empowered to enact Although Sam did not enjoy adminis- But he didn’t stop there: He also sincerely a number of regulations in the coming months trative tasks, he valued active participa- believed in the power of the ego—that regarding implementation of HIT policy. tion in professional organizations. He was people could face and master the chal- With the strong alliances we have devel- a founding member of the American Acad- lenges their psyches presented to them. He oped, with our members who are increasingly emy of Child and Adolescent Psychiatry leaves behind untold patients, students and active advocates for our patients and our pro- and was one of the five signatories to the colleagues, family and friends who are grate- fession, and with our respected leadership articles of incorporation that created the ful to him for the support he gave to their on Capitol Hill, our Association is in a very Association for Child Psychoanalysis in personal strivings. strong position to help defend and expand these privacy achievements.

THE AMERICAN PSYCHOANALYST • Volume 43, No. 2 • Spring/Summer 2009 35 NONPROFIT ORG. US POSTAGE PAID ALBANY, NY PERMIT #370

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IPA Congress in Chicago

To coincide with the centenary of Freud’s visit on the occasion of his Clark University lectures, the IPA will be holding its biennial Congress in Chicago. With the theme “Psychoanalytic Practice: Convergences and Divergences,” the Program Committee wants you to share your clinical experience with some of today's most important psychoanalysts: Anna Ornstein, Antonino Ferro, Arnold Goldberg, Cecilio Paniagua, César Guerrero, Claudio Eizirik, Ilse Gubrich-Simitis, Janine Puget, Jean-Claude Rolland, Juan Pablo Jiménez, Leonardo Peskin, Leopold Nosek, Marilia Aisenstein, Robert Paul, Ron Britton, and Warren Poland. Recent research shows the efficacy of psychoanalytical therapy for some of the most frequent psychological problems. As reported in JAMA, “the therapy can be effective against some chronic mental problems, including anxiety and borderline personality disorder.” This gives us the hope we need to keep working on a field that has been cited as relieving “symptoms of those problems significantly more than did some shorter-term therapies.” With a variety of themes that includes: eating disorders in adolescence, couple and family psychoanalysis, new parental configurations, transracial adoption, migration, clinical practice in social crisis, building up subjectivity, neurosciences, encopresis, “telephone analysis,” the focus will be on clinical practice and how various theoretical models, as well as our different cultures, psychoanalytic traditions, societies and realities, give rise to different practices. Famous for its architecture, its beautiful urban landscape, its museums and concert halls, its parks and beaches, Chicago is also an important center in the history of the psychoanalytic movement. Franz Alexander, Thomas French, Therese Benedek, Maxwell Gitelson, and Heinz Kohut are significant figures in Chicago’s psychoanalytic tradition and have impressed an indelible stamp on contemporary psychoanalysis.

We look forward to welcoming you to the 46th IPA Congress!