the FALL 2003 AMERICAN Volume 37, No. 3 PSYCHOANALYST Quarterly Newsletter of The American Psychoanalytic Association

Who Killed Julius Caesar? INSIDE TAP... Psychoforensic Analysis of Decisionmaking Under Stress

Harold J. Bursztajn Omnibus Science Initiative Update . . . . . 6 Psychoanalysis has had a long tradition of informing psy- Fund for Psychoanalytic chohistorical inquiry. Research ...... 8 Forensic neuropsychi- atry has experienced Virtual Psychoanalytic a rebirth and resur- gence of interest in Society ...... 11 the courtroom. Two somewhat pio- Architecture and neering applications Psychoanalysis . . . . . 12 of psychoanalysis— psychoanalytically informed decision Anna Freud Centre . . . . 14 analysis and psycho- analytically informed with permissionPhoto: Atlantic Productions/used APsaA Campaign neuropsychiatry—can Psychoanalytically informed forensic analysis: raising startling questions about the assassination of Julius Caesar on the Discovery Channel. Statements ...... 18 deepen understand- ing of such phenom- ena as leadership, political decisionmaking, uncertainty, humans choose based on rational and courtroom processes. Given the chasm self-interest—with the psychoanalytic per- between private and public settings, this may spective that “rational” and “irrational” in a seem paradoxical. given context may not be obvious, common- APsaA Elections Psychoanalytically informed decision analy- sensical, or universal. I use the term “psycho- Candidates for office in the fall sis modifies the assumption of traditional analytically informed neuropsychiatry” to refer 2003 American Psychoanalytic decision analysis—that under conditions of to similar applications of psychoanalysis to Association elections: reconsider “closed” questions reopened by President-elect: K. Lynne Moritz, Harold J. Bursztajn, M.D., has served since advances in modern neurobiology. Judith S. Schachter. 1982 as co-director of the Harvard Medical I was born in Poland just after World War II. Councilor-at-large: Elizabeth School Program in Psychiatry and the Law As a child strolling with my father in Lodz I saw Brett, Joanne E. Callan, Prudence L. at the Massachusetts Mental Health Center strangers rush up to thank him once again Gourguechon, Richard Lightbody, in Boston and is in private practice in for saving their lives as a leader of the Shoah and Robert L. Pyles. Cambridge, Mass. He may be reached resistance. Thus early on I was inspired by Candidates’ statements begin via [email protected]. the wonder of leadership and decisionmak- on page 18. For more information about his work, ing in times of uncertainty, conflict, and crisis. see http://www.forensic-psych.com/. Continued on page 9

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 1 CONTENTS: Fall 2003 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: Newell Fisher 3 The Enemy Within Newell Fischer President-Elect: Jon Meyer Secretary: K. Lynne Moritz Treasurer: Warren Procci 4 Mostly Museums: Winter Fun in New York City Arlene Kramer Richards Administrative Director: Ellen Fertig

6 Omnibus Science Initiative: Progress Report Allan Compton THE AMERICAN PSYCHOANALYST Newsletter of the American Psychoanalytic Association Psychoanalytic Science for the Clinical Psychoanalyst: 7 Editor The Power of the Antidepressant “Placebo” Stephen Portuges Prudence Gourguechon Member, Council of Editors of Psychoanalytic Journals The Fund for Psychoanalytic Research Linda C. Mayes 8 Associate Editor Stephen Portuges 10 The Institutional Ego: A Psychoanalytic Consideration National Editor of Ethics Review David H. Brendel K. Lynne Moritz Editorial Board Harriet Basseches, Abbot Bronstein, 11 The Virtual Psychoanalytic Society Humberto Nagera and Frances Marton Randi Finger, Sheri Hunt, Lee Jaffe, Janice Lieberman, Jack Miller, Caryle Perlman, Marie Rudden, 12 Architecture and the Self: Lucy Daniels Foundation Conference Hinda Simon, Michael Slevin, Julie Tepper, Explores Inner and Outer Space Heather Craige Robert S. White, Harriet Wolfe, Sharon Zalusky, Ellen Fertig, ex officio William D. Jeffrey, Consultant 14 New Directions, Directorate for Anna Freud Centre Robert L. Tyson Paul Mosher, Consultant Francine Krasowska, Manuscript & Production Editor 18 APsaA Elections Mervin Stewart, Photo Editor The American Psychoanalyst is published quar- TechNotes: Protecting Your Computer Paul W. Mosher terly. Subscriptions are provided automatically 25 to members of The American Psychoanalytic Association. For non-members, domestic and Canadian subscription rates for 2003 are $32.50 25 Membership: Mid-Career Analysts Discuss How to Join for individuals, $75.00 for institutions. Outside Committees, Write and Present Innovative Papers Zoe Grusky the U.S. and Canada, rates are $52.50 for indi- viduals, $95.00 for institutions. To subscribe, write Journals, The Analytic Press, 810 E. 10th Street, P.O. Box 1897, Lawrence, KS 66044- 28 Politics and Public Policy: An Ordinary Man Bob Pyles 8897; call 800-627-0629 (U.S. and Canada) or 785-843-1325 (elsewhere, fax 785-843-1274); or e-mail [email protected]. ShrinkWatch: “Have a Fireball” Prudy Gourguechon 28 Copyright © 2003 The American Psychoanalytic Association. All rights reserved. No part of this Poetry: Poetry and the Unconscious Sheri Hunt publication may be reproduced, stored in a 29 retrieval system, or transmitted in any form or by any means without the written permission of The American Psychoanalytic Association, 309 East 31 Council Report: Politics, Governance Dominate June 19 49th Street, New York, New York 10017. Executive Council Meeting ISSN 1052-7958

APsaA Awards at 92nd Annual Meeting Jack A. Miller The American Psychoanalytic Association does 34 not hold itself responsible for statements made in The American Psychoanalyst by contributors or A Time of Change—BOPS After Boston Ronald M. Benson advertisers. Unless otherwise stated, material in 36 The American Psychoanalyst does not reflect the endorsement, official attitude, or position of The American Psychoanalytic Association or The 37 BOPS Report: Board Considers Reorganization, Standards; American Psychoanalyst. Nuetzel Next BOPS Chair

2 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 FROM THE PRESIDENT

and isolate ourselves from other mental health The Enemy Within professionals. We draw unfair, demoralizing, Newell Fischer and judgmental divisions between “real analy- sis” and “analytically oriented” work. Com- In previous columns I have supported the As I travel and menting on the defensive and self-aggrandizing strategies and plans that enhance local out- meet with our nature of these behaviors and attitudes seems reach to communities, potential candidates, societies, I feel superfluous for this readership. and patients. These grassroots programs are encouraged, and We are drained and depleted by internal diverse and evolve from the specific needs of I sense a new organizational struggles.This is clearly evident the community. Participating in teaching and vigor and creativ- on the national scene but is equally visible at seminars, holding discussions at art festivals, ity. Our member- the local society and institute level. It is very being involved in community services, hosting ship is increasingly difficult to invest in outreach if one is angry parent-child seminars, designing scientific meet- aware of how with and disillusioned by the local or national ings to be more inviting to other professionals, important it is to group. A few examples from my travels may Newell Fischer and providing room under our psychoanalytic emerge from illustrate this. umbrella to accommodate those interested in splendid isolation and to make a clear state- A town meeting with Society/Institute X understanding the mind—these are just a few ment about what we can offer, our unique seemed to go quite well.The discussion was examples of these efforts. analytic perspective and understanding, and lively and “flowed.” There were some innova- John Blamphin, an expert communication how psychoanalysis can help people attain a tive ideas. I noticed, however, that most of the consultant and former public affairs director of greater degree of personal freedom and a participants were “preaching to the choir”— the American Psychiatric Association, advised us, richer life. Mystification may temporarily attract relating the value of psychoanalysis and analytic attention, but it does little to enrich our pro- thinking—and I found myself working to focus Your outreach must be both national fession, and aloofness serves to further iso- on the question, “What are we going to do through “The American” and local late us as clinicians. locally to increase practice, to attract more through societies and institutes. You I see growth and I experience progress in our candidates, and to improve the tarnished image are known nationally as a profession efforts to “mix it up” with our communities and of psychoanalysis and psychoanalysts?” There and an association. But as “all politics to let it be known that analysts are thoughtful, were only a handful of younger members is local,” individual psychoanalysts don’t knowledgeable, and humane professionals who present, and they seemed unusually quiet. Sev- exist nationally; you live and work in make important contributions. eral days after the meeting, I received a letter from one of the more junior members:“Our energy and outlook [are undermined] by an “In the end, it will be grassroots psychoanalysts as individuals unreflected-upon patrimony. … The ‘Seniors’ who make the case for psychoanalytic theory. Individual did not only not ‘take care’ of psychoanalysis as our shared property, they did not teach those analysts … have to get out of the office and mix it up with of us coming after them how to ‘speak it’ to the other professional colleagues, the media, with politicians, and community, and they failed to nurture the school teachers, lawyers, clergy, and the family next door.” continuing flow of new recruits—candidates.” The writer went on to describe how the local society’s membership criteria are so narrow cities and towns and communities. ARROGANCE, ISOLATION, INFIGHTING that there is no place in the group for thera- In the end, it will be grassroots psy- I would like to turn, however, to a few old pists who had completed most but not all of choanalysts as individuals who make habits that undermine these efforts. the training, or the local psychoanalytic psy- the case for psychoanalytic theory. Confidence in ourselves and conviction in chotherapy program graduates. This means that individual analysts … what we can offer as psychoanalysts are essen- A senior training analyst wrote, have to get out of the office and tial. Arrogance and grandiosity, however, con- mix it up with other professional tinue to be harmful. Such traits find expression Unfortunately our Society has be- colleagues, the media, with politi- in various forms. Not infrequently, we pontifi- come, in a … smaller way, a reflec- cians, and school teachers, lawyers, cate and are unable and unwilling to listen or tion or a clone of the American, clergy, and the family next door. learn. In efforts to highlight our analytic work, regarding bureaucracy, attention to we somehow feel the need to depreciate legal details, administrative com- other forms of therapy.We may proclaim un- plexities, etc. It is as if structure has Newell Fischer is president of APsaA. real and wish-fulfilling goals. We condescend Continued on page 27

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 3 WINTER MEETING 2004

New York Transit Museum Store.You can dine Mostly Museums: upon a wide and fresh selection of fish and seafood in the classic Oyster Bar or choose Winter Fun in New York City from among many more restaurants. Arlene Kramer Richards Taking the Staten Island Ferry out across the harbor gives one a magnificent view of the Winter in New York is cold and sometimes A stroll down Fifth Avenue from the museum Statue of Liberty, Ellis Island, the Hudson River, snowy. One can take advantage of the snow by will give you a chance to choose from the and the Palisades—and it is free. The cold walking through Central Park when it is white institutions known collectively as New York’s weather of January and the crisp sea air require and quiet. One of my favorite places in the Museum Mile. One of the newer gems here is warm clothes, but the view is unforgettable. park is the Conservatory Garden at Fifth the Neue Galerie on Fifth Avenue and Eighty- My own favorite outdoor winter excursion is Avenue and 106th Street, a small and peace- Sixth Street. It houses a world-class collection a walk across the Brooklyn Bridge ending up a ful place in winter even when the fountains are of German and Austrian fine and decorative art few blocks up Flatbush Avenue at Junior’s for not running. It has strategically placed benches from 1890–1940. It also has a snazzy tea room, the best cheesecake in the whole city. for contemplation or photography. Cafe Sabarsky, for refreshment after a long walk. QUEENS’ JEWELS Then there are the museums newly located in Queens.The Museum of Modern Art, tem- porarily relocated in Queens while its midtown Manhattan facility is being renovated, has a spectacular film collection. You can make an appointment to see your old favorites or classics you cannot see anywhere else. The Museum of African Art has modern and rela- tively old African pieces that are always well curated (great documentation and descrip- tions) and displayed in stunning ways.The eth- nic neighborhoods near these museums offer food from all parts of the world: Greek, Indian, Chinese, Japanese, and many others.

DOWNTOWN AND OUT OF TOWN A new complex of museums and libraries in a stunningly beautiful building is the Center for Jewish History at 15 West Sixteenth Street. It

Photo: © NYC & Company, Inc. Photo: © NYC & Company, offers genealogy, exhibits of Americana by the Central Park in January is still a beautiful spot for a walk. American Jewish Historical Society, Sephardic history, German Jewish History from the Leo The garden is conveniently close to The Metropolitan Museum of Art has many Baeck Institute, and art exhibits from the another winter treasure, the Museum of the treasures. One of my favorites is the room of Yeshiva University Museum collection of mod- City of New York. Here the third-floor exhibit musical instruments. Only a few more blocks ern art. It also houses a music library, a film of toys yields a surprise: a magnificent doll and you arrive at the Frick Collection, a small collection, and the extensive print library of house made by Florine Stettheimer, a friend and intimate museum. Like the Isabella Stew- the YIVO Institute for Jewish Research. The of many artists of the early and middle twen- art Gardiner Museum in Boston, the Frick is a Palm Tree Café is a very nice refueling spot; tieth century and an artist of sufficient rep- personal collection of Old Masters housed in the Chelsea area has many other restaurants utation to have had her paintings shown at a mansion once owned by the collector. and cafes as well as art galleries that you might the Whitney Museum and other major muse- A short walk or cab ride from the Wal- never have visited before. ums around the world.The doll house is so dorf Astoria is Grand Central Station, with a A new favorite museum of mine is the DIA fragile that it never travels.The only way to see vast indoor mall that has been upgraded and Museum in Beacon, New York. Beacon is a it is to travel to it yourself. It is well worth the made more interesting with the addition of beautiful small city on the Hudson, sixty miles trip for both its historical interest and its aes- shops, services, and restaurants. Here you can from Manhattan. It has a sister museum in thetic quality. buy the best souvenirs of New York at the Continued on page 5

4 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 WINTER MEETING 2004

Chelsea at 548 West Twenty-Second Street, but the one in Beacon is a sight to behold.An old printing factory with glass ceilings origi- nally meant to aid the printers in typesetting, its huge rooms are filled with natural light by which to view monumental sculptures and paintings too large to be seen properly in other museums and galleries. Getting there by train is simple from Grand Central Sta- tion. It takes just over an hour, and the ride up the Hudson River in winter is beautiful. The museum is a short walk from the Beacon train station.A two- or three-hour visit can be fueled by lunch in the museum’s tiny but sophisticated café. All of these places have Web sites, and many can be visited virtually so that you can sample for yourself what you might most Photo: © S. Berger/NYC & Company, Inc. Photo: © S. Berger/NYC & Company, enjoy in New York. New York’s Lincoln Center: Destination for opera, jazz, ballet, and more.

Student Grants for Attending January Meeting Contacting the

A generous grant from several groups will make possible free registration for all National Office residents, post-docs, and students for the Winter 2004 Meetings. Please inform your students and any contacts in residency, post-doctoral, and other student programs. The American See the APsaA Web site for program and registration information. Psychoanalytic Grant donors for this program: Association

Association for Psychoanalytic Medicine & Columbia 309 East 49th Street University Center for Psychoanalytic Training and Research New York, NY 10017

New York Psychoanalytic Society and Institute Phone: 212-752-0450 Fax: 212-593-0571 New York University Psychoanalytic Institute E-mail: [email protected] & Psychoanalytic Association of New York,Inc. World Wide Web Site: http://apsa.org/ The American Psychoanalytic Foundation National Office Phone Update

The National Office’s voicemail Editor Search for Concise Encyclopedia system was knocked out during the August New York City power The American Psychoanalytic Association feels it is time to undertake the compilation blackouts, and we have been told the of a Concise Encyclopedia of Psychoanalytic Terminology.The idea originated in a suggestion old system is unrepairable.The staff of Burness Moore, one of the original editors of the Glossary of Psychoanalytic Terms and Concepts. Individuals interested in applying for the position of editor should, by apologizes for any inconvenience, and December 1, send a letter of interest and curriculum vitae to search committee chair they will continue to field your calls Sander Abend, c/o the National Office at 309 East 49th Street, New York, NY 10017. the old-fashioned way until a new Applications from teams of individuals are also welcome. system can be installed.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 5 SCIENCE

science advisor seen as a valuable contributor, Omnibus Science Initiative: Progress Report but also the Board wanted a science advisor of Allan Compton its own to sit with the Board and the Coordi- nating Committee. BOPS combined the posi- In the beginning there were discoveries: the tion of science advisor with that of the chair dynamic unconscious mind, mental conflict, of the Committee on Research Education the susceptibility of dreams and parapraxes to (CRED), appointing Stuart Hauser and Bob interpretation, the roles of pleasure and unplea- Emde as co-advisors and co-chairs. Between sure, forces in the mind emerging as wishful them, they are working with Board committees impulses to satisfaction, forces opposing those on Certification, Child and Adolescent Analy- impulses and the distressing feelings they gen- sis, and Institutes to enhance considerations of erated, and much more. Psychoanalysis was a reliability and validity and integrate research theory, a treatment, and a research tool. courses and research itself into institute cur- Discovery in the consulting room went on ricula.The science advisor positions and CRED for a long time; it still does. Eventually, though, give science a voice consistently present at psychoanalysis began to suffer from a superfluity the highest levels of decisionmaking.This voice of discoveries for which there was a lack of is beginning to be heard at the most basic evidence convincing to anyone who had no level of our field: education in institutes.

experience in the consulting room. Schools of Photo: Mervin Stewart The amalgamation of the OSI research psychoanalytic thought proliferated and Stuart Hauser, co-chair of the BOPS Committee associates, a new affiliated group, with the on Research Education and one of the Board’s acquired adherents while the rest of the world two science advisors, addresses BOPS longstanding research forum CAMP (Collab- moved on to “evidence based” treatment on at the annual meeting in Boston. orative Analytic Multisite Projects), is pro- the platform of a reliable diagnostic system. gressing well, guided by Wilma Bucci as chair. Justification—the invention of methods to sort OSI task force intended to find ways to (1) Under the leadership of Linda Mayes, the systematically between competing hypothe- enhance the position of systematic scientific Fund for Psychoanalytic Research has taken ses—has been an arena which psychoanalysts, efforts in APsaA without attempting yet again new directions. It has continued the Herculean for the most part, have been reluctant to enter. to alter the organizational structure and (2) task of reviewing grant applications and award- Systematic research struggled to obtain a provide a consistent and pervasive voice for ing the funds made available by Council and footing in our Association and in our educa- science in our affairs, a meaningful role in our by members’ direct contributions; it also is tional system. Support for systematic studies educational processes, and a stronger posi- becoming more transparent, more inviting, from public sources became scarcer because tion in our scientific programs and journals.The more user-friendly, recognizing the opportunity we did not already have an extensive portfo- task force felt it was essential to do this with- to support young scholars and provide a con- lio of systematic studies when related disci- out by-laws changes and without major finan- sultative body for more experienced investi- plines did.There were at least three attempts cial impact on the rest of the Association. gators.A good example of everything the OSI to give science, in this sense, a place in the gov- The OSI contained nine recommendations intended can be seen at the Fund’s Web site, ernance and financial structure of our organ- for action. Not all of the action items worked http://www.apsa-co.org/ctf/ffpr/. ization. One of them resulted in the formation out, but the five that endured have not only The editor of TAP recognized the value of of the Fund for Psychoanalytic Research, which grown but produced offspring. OSI tried to keeping our scientific efforts in the members’ remains a linchpin in our scientific efforts. But give systematic science a platform—or at least view and asked Steve Portuges to initiate a psychoanalysis continued to suffer, as a pro- stepping stones—to work from within our column on psychoanalytic science which fession and as a science, from a relative paucity Association, hoping that the value and practi- appears in most issues of TAP.The Public of systematic research, despite heroic efforts by cability of formal science would be more widely Information Committee appointed a science leaders like Luborsky,Wallerstein, Dahl, Shevrin, perceived and its influence would spread. liaison to smooth the flow of science related Bucci and others. information to public media. PROGRESS TO DATE The Committee on Scientific Activities, A NEW INITIATIVE Now, three years after initiating OSI, a chaired by Beth Seelig, has altered its emphasis The Omnibus Science Initiative (OSI), approved progress report is in order. from carrying out scientific projects to provid- by the Council and BOPS in May 2000, con- The appointment of a science advisor as a ing a forum for scientific issues within the Asso- sisted of a package of recommendations.The sitting (though non-voting) member of Coun- ciation, then spinning off subcommittees to cil and of the Executive Committee was initially carry out appropriate projects:Archives (chaired Allan Compton, M.D., is president of the Los met with skepticism.After a few months with by George Klumpner), Research Symposia Angeles Center for Psychoanalytic Research. Bob Galatzer-Levy in place, not only was the Continued on page 27

6 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 SCIENCE

the pharmacological effects of the medica- PSYCHOANALYTIC SCIENCE tion.” While the magnitude of depressive for the CLINICAL PSYCHOANALYST symptom improvement attributable to the active drug agent was large enough to achieve statistical significance, the average measured The Power of the Antidepressant improvement for patients receiving an SSRI was just a couple of points greater on the “Placebo” Hamilton Depression Rating Scale than for Stephen Portuges those taking the placebo.This fact led Kirsch et al. to question the clinical utility of adding Ever imagine that the Freedom of Informa- randomized, placebo-controlled trials of the six an SSRI in the treatment of depression and tion Act would be used to gain access to ran- antidepressants. Each clinical trial had been to assert that “by far, the greatest part of domized controlled clinical trials information conducted to support the various drug man- the change is also observed among patients about the efficacy of antidepressant medica- ufacturers’ efficacy claims and to gain FDA treated with inert placebo.The active agent tion? Well, I didn’t—and neither, I suspect, did approval for the pharmaceutical treatment enhances this effect, but to a degree, that the pharmaceutical manufacturers of the six of depression. Recall that evaluating a drug’s may be clinically meaningless.” most widely prescribed antidepressants consequences in a controlled clinical trial The implications of the re-analysis of the approved by the Food and Drug Administra- involves (1) prescribing an experimental pharmaceutical industries’ controlled clinical tion (FDA) between 1987 and 1999. Never- pharmaceutical to a group of depressed vol- trial data for the pharmacological treatment of theless, in the article “The Emperor’s New unteer participants, (2) prescribing a stan- depressive illness will be debated for some Drugs:An Analysis of Antidepressant Medica- dard pharmaceutical or a chemically inert time to come.The editors of Prevention and tion Data Submitted to the U.S. Food and substance (the placebo) to a second partici- Treatment invited nine prominent psycho- Drug Administration,” an enterprising group of pant group, and then (3) comparing their pharmacologists to comment on the methods scientists headed by Irving Kirsch with col- effects on a validated depression measure. In and findings of the Kirsch research team. leagues Thomas Moore, Alan Scoboria, and the typical FDA-approved “double-blind” con- While there were various interpretations as to Sarah Nicholls reported in the July 2002 issue trolled clinical trial, neither the prescribing why the magnitude of the placebo effect was of Prevention and Treatment that they peti- physician nor the participant knows which so large and the antidepressant drug effect so tioned the FDA and were granted access to substance is being administered. small, there was no debate about the major the medical and statistical evaluations of “every placebo[-]controlled clinical trial for depression … submitted for approval.” Kirsch et al. note The implications of the re-analysis of the that the only antidepressant medications that pharmaceutical industries’ controlled clinical trial made the “most frequently prescribed list” were six selective serotonin reuptake inhibitors data for the pharmacological treatment of depressive (SSRIs), including citalopram (Celexa), fluoxe- illness will be debated for some time to come. tine (Prozac), nefazodone (Serzone), paroxe- tine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). Since the same standardized clinician-admin- finding itself. In their reply to the commenta- We are left to wonder why the authors istered depression measure, the Hamilton tors, Kirsch et al. emphasize the difficulty the were obliged to fetch the antidepressant effec- Depression Rating Scale, had been used in all drug companies encountered in attempting to tiveness data in this unusual way. What their studies to estimate severity of depressive ill- demonstrate an antidepressant drug’s effect: straightforward re-analysis of the pharmaceu- ness, improvement rates could be computed tically sponsored and FDA-approved efficacy and compared across clinical trials in the Kirsch 57% of the trials funded by the phar- data revealed about the pharmacological treat- re-analysis. maceutical industry failed to show a ment of depressive illness makes their research The research team’s evaluation of the [statistically] significant difference efforts more than worth the trouble to which pharmaceutical industries’ controlled clinical between drug and placebo. Most of they must have gone. trials data indicated that improvement among these negative data were not pub- The Kirsch team reported that the FDA the placebo-treated depressed patients was lished … and were accessible only reviews were based on findings from forty-seven 82 percent of that found among patients by gaining access to U.S. Food and who actually received one of the six SSRIs. Drug Administration … documents. Stephen Portuges, Ph.D., writes a regular They interpreted this finding to mean that [italics added] column for TAP on psychoanalytic science. only “18% of the drug response [was] due to Continued on page 26

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 7 SCIENCE

GOALS The Fund for Psychoanalytic Research The goals of the fund are four: Linda C. Mayes • To support basic and applied research involving psychoanalytic perspectives and There is in- All members of the fund’s board are mem- observations. creasing interest bers of the American Psychoanalytic Associa- • To support young scholars interested in in innovative re- tion and are involved in psychoanalytic research psychoanalytic research. search methods as primary investigators or as consultants and • To provide psychoanalytic scholars an and programs informed scholars. Scholars who are not opportunity to consult with experienced within the psy- APsaA members and who may or may not be investigators around an idea, method- choanalytic com- psychoanalysts also serve as consultants to ological issue, or existing dataset. munity. There is the fund on its mission and the review of • To provide opportunities for beginning also increasing grant applications. psychoanalytic investigators to meet indi- evidence of con- Many well-established psychoanalytic inves- vidually and as a group with experienced Linda C. Mayes fluence between tigators were early grantees of the fund. Judy investigators. a number of branches of natural and social sci- Kantrowitz received a grant in 1976 for her The fund conceives of psychoanalytic ences and psychoanalytic ideas when the lat- studies of analytic suitability and fit. Investigators research along the broadest lines, including ter are placed in an empirical context. Our who have benefited from fund grants have scholarly and empirical investigative contribu- psychoanalytic culture benefits from such inter- ranged from the most senior and experienced tions that can advance (1) knowledge of psy- disciplinary input; research ideas have an invig- to the most junior scholars interested in psy- choanalytic theory and practice and (2) links orating effect on clinicians; ideas originating in choanalysis and trying to bring rigorous meth- between psychoanalysis and neighboring dis- the clinical realm have the potential to inform ods to questions of enormous relevance for ciplines such as developmental psychology scientific research. psychoanalysis. or neuroscience. The scope of this research The increasing relevance of research to A recent awardee, Kristine Freeark, is study- includes (but is not limited to): the status of practicing clinicians has created ing relationships within families with inter- • Systematic research into psychoanalytic a groundswell of demand for opportunities national adoptees, a line of work that focuses treatment processes and outcomes, both to conduct and to learn of high-quality on parental expectations and interactions including the development of reliable and research on the part of individual clinicians, and draws attention to the internal land- valid measures of appropriate variables particularly young people at the early stages scape of family dynamics. Ken Levy, another related to process and outcome. of their psychoanalytic and professional recent grantee, studies clinical processes • Developmental studies including experi- careers. related to therapeutic outcomes in psycho- mental and naturalistic investigations of The fund began in 1976 as an organization dynamic psychotherapy for borderline per- infant and child development or adult within the American Psychoanalytic Association. sonality disorders. Funded studies cover both development. The fund supports and nurtures psychoanalytic investigations of therapeutic process and tech- • Psychophysiological and other experi- investigative scholars and facilitates investigative nique, such as Annette DeMichele’s project on mental studies and other relevant social inquiry based on psychoanalytic theory and a method for assessing patient work in the science studies. principles of mental functioning. transference, and the application of psycho- • Intellectual history, philosophical studies, The fund is supported by donations from analytic theory and methods to develop- and scholarly applications of psychoanalysis APsaA members and through a regular allo- mental questions, such as Robert Waldinger’s in fields such as history and literature. cation in the yearly budget of the Associa- work on continuity and change in relationship tion. It awards two to three grants yearly, themes in adolescence. TYPES OF GRANTS AWARDED including smaller consultation grants. Since the fund’s inception, it has awarded In the beginning the fund awarded a single 111 grants.The names of the principal inves- type of grant to support small research pro- tigators and the titles of their projects may posals. Recently, the fund has defined four Linda C. Mayes, M.D., is Arnold Gesell be found on the fund’s Web site at http:// different types of grants with the intention of Professor of Child Psychiatry, pediatrics, and www.apsa-co.org/ctf/ffpr/. Within a year the providing support mechanisms suited to psy- Psychology at the Yale Child Study Center and site will offer a bibliography of research reports choanalytic scholars in varying stages of the chair of the Fund for Psychoanalytic Research. and scholarly papers that have emerged from research career development: She is on the faculty of the Western New the projects supported by the fund. Here 1. Grants of one or two years’ duration at England Institute for Psychoanalysis and has APsaA members will be able to see the range a maximum of $20,000 yearly for a spe- recently been appointed one of three directors and depth of work that their contributions cific project building upon psychoanalytic of the Anna Freud Centre in London. to the fund have supported. Continued on page 26

8 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 FORENSICS

Julius Caesar to understand the choices people make under Continued from page 1 conditions of uncertainty, conflict, ambiguity, or adversity. As an undergraduate at Princeton, I was intro- Although much of my work has been as a duced to the work of Freud by historian Carl confidential off-screen advisor, the following Schorske and to the emerging discipline of example of some on-screen work illustrates neurobiology by several pioneers in that field. how a psychoanalytically trained forensic After graduating in 1972, I entered Harvard psychiatrist can further public education by Medical School.There I was introduced to the working with the media. work of Amos Tversky and Danny Kahneman on the heuristics of judgment and decision- NEW PERSPECTIVE ON OLD DECISIONS making under conditions of uncertainty. (Kah- After I had served as an on-screen foren- neman, a psychologist, last year received the sic psychiatric analyst for Anthony Geffen’s Nobel Prize in economics.) London-based Atlantic Productions on a Photo: Atlantic Productions/used with permissionPhoto: Atlantic Productions/used Psychoanalysis and the cognitive psychology program for the Discovery Channel, “The Julius Caesar, portrayed by an actor in the of social judgment and decisionmaking prima Assassination of King Tut,” Ruth Sessions of Discovery Channel documentary — what was on his mind? facie are complementary approaches. Each the same production company approached recognizes that human beings regularly make me with an intriguing request: Could I par- Could Caesar’s epilepsy, well documented in choices that might not be rational from a ticipate in their investigation to help a TV ancient texts, have affected his behavior and decision-analytic standpoint. People who make audience understand how and why Julius led to his death? unwise or unproductive decisions are not nec- Caesar was killed? Our findings would be We contemplated an instance of Caesar’s essarily stupid, uninformed, or neurotic. Rather, telecast in the documentary (also for Dis- strange behavior when he failed to rise to they are applying strategies shaped by the covery) “Who Killed Julius Caesar?” The team greet the senate—a deep insult to that body— evolution of the mind, culture, personal history, included internationally distinguished foren- a few weeks before his death. One early his- and circumstance. sic investigator Luciano Garofano of Italy’s torical analysis gave the excuse of diarrhea; another, epilepsy. Considering other details in available descriptions of Did Julius Caesar, a genius and perhaps history’s greatest his behavior, the question as to military tactician, a general who never lost a battle, whether Caesar’s choices were in- really walk blindly into a trap? fluenced by temporal lobe epilepsy seemed well worth exploring. Symptoms of temporal lobe epi- It seemed natural to integrate both psy- carabinieri and several highly talented classi- lepsy, which become more common as the sei- choanalysis and the study of decisionmaking cal historians. zures progress and become more generalized, heuristics into my clinical and consulting prac- What made this project particularly satis- include increased dissociation and incontinence tice, as well as into my teaching and research. fying was that everyone was open to my of bladder and bowel. Might Caesar, driven by I also wanted to make these methods acces- developing and exploring with them ques- narcissistic concern with his own image and dig- sible to a wider public. To that end, I have tions that had been overlooked by many his- nity, who had risen to become the most pow- worked with talented documentary producers torians. For example, did Julius Caesar, a genius erful man in his world (and who could easily be and directors on historical investigations, serv- and perhaps history’s greatest military tactician, said to have suffered from grandiosity), have ing in a variety of roles ranging from confi- a general who never lost a battle, really walk found it deeply humiliating, frightening, and dential advisor to on-screen, psychodynamically blindly into a trap? He had access to high frustrating to lose control of both his sense of informed decision analyst. levels of intelligence. He had a warning note continuity in space and time and his body in As a working psychoanalyst, I exercise clutched in his hand at the time of his death. public? It is reasonable to infer that for Caesar, curiosity in the most private of settings about Why did he dismiss his bodyguard shortly it was far more painful to be seen as pitiable an analysand’s received truths and accepted before his murder? How could such a well- and incontinent than haughty and rude. It is not “absolute” wisdom, to help free the analysand informed man come to be killed in front of a stretch to imagine that the life choice he to ask previously unthinkable or unspeakable hundreds of witnesses at a senate gathering? faced was especially stark: old age and increas- questions. As a forensic psychiatrist, I work in Garofano also welcomed the opportunity to ing fits, temporal lobe–influenced loss of auto- interdisciplinary settings exploring the validity of explore questions regarding Caesar’s physical biographical memory that he so valued, and potential translations between the clinical world and mental condition.Why was his behavior so even public diarrhea, versus a dramatic exit. of meaning and the legal world of objectivity, strange in the weeks leading up to his death? Continued on page 17

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 9 ETHICS

medications and other interventions that may The Institutional Ego: advance our capacity to diagnose and treat mental disorders. Grant support, patents, and A Psychoanalytic Consideration academic advancement may depend on the successful conduct of research with human of Ethics Review subjects.While the vast majority of medical and David H. Brendel psychiatric researchers can balance their desire to conduct research with the needs and inter- Applying contemporary psychoanalytic diagnosed and ests of persons who participate in it, academic principles to enhance the ethical functioning treated. In reac- zeal may at times cloud their thinking about its of contemporary institutions is a complicated tion to this tragic possible drawbacks or dangers. More objective but worthwhile challenge. It is a challenge abuse, a federal individuals, who appreciate both the promise that I have assumed over the past year since advisory panel and the pitfalls of clinical research, are needed I began psychoanalytic training at the Boston was appointed to evaluate its ethical status. Psychoanalytic Institute and became co-chair- and wrote the Here is where IRBs assume a critical role in man of the institutional review board (IRB) at Belmont Report, addressing ethically sensitive questions about McLean Hospital in Belmont, Mass. which stated clinical research. Is use of a placebo control jus- The IRB performs ethical review of all the that research on tifiable in a study of a new antipsychotic med- David H. Brendel research studies that involve human subjects human subjects ication? Should young children be allowed to at McLean, which houses the largest and most must adhere to ethical principles of informed serve as healthy control subjects in studies highly funded psychiatric research program consent, favorable risk/benefit ratios, and fair that use powerful new magnetic resonance of any private hospital in the world. My back- selection of subjects. imaging of the brain? Can subjects be exposed ground in psychiatric ethics, which I acquired Since 1974, the U.S. government has man- intravenously to drugs of abuse or very high through my Ph.D. work in philosophy and a dated that all such research be reviewed and doses of prescribed medications in order to faculty fellowship at the Harvard University approved by IRBs, which are responsible for assess their behavioral and physiological Center for Ethics and the Professions, sparked protecting human subjects’ rights, assessing responses? Is it necessary to inform potential my interest in this work but only partially the risk/benefit ratio of the research, and subjects in an antidepressant drug trial that prepared me for the challenge it represents. ensuring a process of valid informed consent. alternative treatments (e.g., psychotherapy) An IRB is charged with ensuring that IRBs must include people from varying social are available and have a very different risk/ research on human subjects in American health and professional backgrounds who have no benefit profile? care facilities complies with ethical and regu- latory standards.The development of federal regulations to ensure ethical research methods Like the healthy and well-adapted ego of an individual, arose in part from anger and outrage caused a well-run IRB acknowledges and integrates wishes, by the infamous Tuskegee experiments, in moral scruples, and reality factors. which 400 African-American men in the rural South were followed over several decades (beginning in the 1930s) to observe the pro- conflict of interest with the research under As IRB members deliberate such questions, gression of their syphilis.The researchers inten- review. Institutions receiving federal funding they must keep in mind that the risks of tionally did not inform the subjects of their must follow rules and procedures described undertaking research on human subjects must disease, provided no treatment (even after in the “Common Rule” under title 45 of the be clear to potential subjects (or to their penicillin became available in the 1940s), and Code of Federal Regulations. proxy decisionmakers) and must be out- prevented their being drafted into the armed weighed by potential benefits to subjects or to forces, where they likely would have been DRAWING ON other people with similar conditions.The IRB PSYCHOANALYTIC PRINCIPLES fails in its mission if it becomes a punishing David H. Brendel, M.D., Ph.D., is an It is in the practical, day-to-day functioning superego for the institution by simply reject- instructor in psychiatry at Harvard Medical of the IRB that psychoanalytic principles can ing research proposals that carry any risk School and practices at McLean Hospital, come into play.The IRB can be thought of as whatsoever. Research on human subjects where he co-chairs the institutional review serving some important ego functions for always carries some degree of risk, and an board (IRB) and has a private psychotherapy research institutions such as McLean. Clinical overly rigid or uncompromising stance on practice. He is a second-year candidate at the investigators are motivated by the wish to the part of the IRB could threaten to shut Boston Psychoanalytic Institute. acquire new knowledge about psychotropic Continued on page 30

10 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 OUTREACH

The Virtual Psychoanalytic Society Humberto Nagera and Frances Marton

The Carter-Jenkins Center is a non-profit The International Virtual Psychoanalytic Soci- organization devoted to education on a local, ety lists its high quality programs on the cen- national, and international scale. Its informa- ter’s Web page—usually one or two new tional and educational efforts are directed to programs on psychoanalysis, applied psycho- the members of the local Tampa, Fla., com- analysis, and/or related topics every month. munity and, via “distance learning” technology, Many of these programs are lectures by vari- the mental health community worldwide. ous distinguished speakers. Frequently, the The center opened on December 8, 2001, PowerPoint presentations that the lectures Via computer, Humberto Nagera speaks to a participant in a Carter-Jenkins hosting the Scientific Program of the Tampa were based on and assigned papers can be distance learning program. (South West Florida) Psychoanalytic Soci- downloaded from the Web site. Programs are ety. For the occasion, the center’s director, added constantly and are available to anyone “Obsessional Neurosis” in Amsterdam with Humberto Nagera, read his paper “Reflec- with a computer and fast Internet connec- the contributions of Anna Freud,Arthur Valen- tions on Psychoanalysis and Neuroscience: tion anywhere in the world. stein, Max Schur, Paul Myerson, and Philip Normality and Pathology in Development, In the 2002–03 academic year, the Web Weissman. We also plan to make available a Brain Stimulation, Programming, and Matu- site has had more than 14,000 visitors. Many of number of video interviews with distinguished ration.” Since then we have offered more them viewed lectures, downloaded presenta- psychoanalysts of the past discussing their than eighty community and professional edu- tions, or read papers. careers and the development of psychoanaly- cation programs. We invite our analytic colleagues and all sis in their geographic areas. Our mental health educational efforts take psychoanalytic societies to submit contributions A new section is being added on “Life Long in psychiatry, psychoanalysis, neurobiology, of high quality to the International Virtual Learning for Mental Health Workers,” where and genetics. We are a freestanding psy- Psychoanalytic Society for consideration for psychiatrists, psychologists, social workers, choanalytic organization devoted to the inter- placement on our Web site. If individual psy- counselors, and others can update their knowl- national dissemination of psychoanalytic choanalysts or societies are willing to con- edge.We are preparing a series of HIV lectures knowledge in pure form and in its applications tribute programs for consideration and do by Frank Fernandez, chairman of the University to art, literature, neurobiology, law, politics, and not have video facilities, the center will lend you of South Florida Department of Psychiatry, other fields. one of our “traveling videocameras” so that and a presentation by Selim Benbadis on you can record the program. “Psychogenic Epilepsy.” A VIRTUAL PSYCHOANALYTIC SOCIETY We are able to hold a videoconference The Carter-Jenkins Center has a partial affil- The Carter-Jenkins Center has created the with connections from as many as eight coun- iation with the University of South Florida, and International Virtual Psychoanalytic Society. tries simultaneously and are planning to members of our faculty teach and supervise at We had become increasingly concerned at develop international study groups on Psycho- the USF Department of Psychiatry. Given the the very limited number of training facilities analysis and Art, Psychoanalysis and the Law, requirement by the Accreditation Council for and psychoanalytic societies in the United Psychoanalysis and Politics, Psychoanalysis Graduate Medical Education that psychiatry States and even more so in the rest of the and Neurosciences, and the like.We hope to training programs demonstrate that psychiatry world. In the United States only a few very assemble experts in these various areas from residents have achieved competency in various large cities have training facilities and psy- many different countries. Such study or dis- forms of psychotherapy, our downloadable choanalytic societies. Seventeen states have cussion groups may eventually lead to valuable programs are a significant resource—particu- fewer than four analysts. papers and books. larly in dynamic psychiatry and dynamic psy- chotherapy—for departments of psychiatry, Humberto Nagera, M.D., is a professor of HISTORICAL ARCHIVES social work, and psychology at any university. psychiatry at the University of South Florida AND NEW PROGRAMS The center was established through the and director of the Carter-Jenkins Center. We are developing a historical section of generosity of various members of a local fam- Frances Marton, LCSW, M.Sc., is a the International Virtual Psychoanalytic Society ily who wanted to contribute to the welfare of child/adolescent and adult psychoanalyst where short vignettes of the 1929 Psycho- people all over the world while memorializing in Tampa, Fla. She is the associate director analytic Congress in Oxford will be shown. a deceased family member. of the Carter-Jenkins Center and director These include a short film of Sigmund Freud At http://www.thecjc.org you can access of psychotherapy training at the University interacting with his grandchildren. We plan extensive and detailed information about all of South Florida’s Department of Psychiatry. to include as well the 1966 symposium on our programs and activities.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 11 OUTREACH

FREUD AND VITRUVIUS Architecture and the Self: Eugene J. Mahon, a New York City psycho- analyst and writer, delivered “The Freud- Lucy Daniels Foundation Conference Vitruvius Dialogue,” an imagined conversation between the great Roman architect and the Explores Inner and Outer Space father of psychoanalysis as the latter lay dying: Heather Craige Freud: Our dreams are haunted houses Architects design the spaces in which we Lucy Daniels, psychologist, writer, and phi- we sleep in, and when we wake the live and work, celebrate and remember, wor- lanthropist introduced the conference: ghosts go on our rounds, subtle, in- ship and compete. Psychoanalysts focus on visible, not like sun-cast shadows but our unique inner lives—the freedom to For those of you who’ve been so taking our full measure nonetheless. dream, think, create, and feel. What about lucky … to never have had to fight for Vitruvius: It’s blind fear that dimin- the interaction of these two realms, internal emotional freedom, let me define it ishes our measure. … Anxiety should and external space? more specifically. Emotional freedom be a signal, not a warning, as you put it, Sigmund.

Freud: You know me better than I know myself, Vitruvius. Yes, yes, yes, fear unanalyzed can make a single- room occupancy (a vile phrase if ever there was one) out of all the spacious chambers of the human heart!

Vitruvius: Fear, the most neurotic architect of all, you mean.

Michael Rotondi and Merrill Elam, interna- tionally recognized architects, illustrated their talks with slides of building projects evolving from first ideas through completion. Rotondi described how analysis and meditation enriched his development as a person and architect. He gave a moving presentation of the collaborative Photo: Timothy Hursley The Lucy Daniels Foundation, a beacon for the understanding and promotion process involved in the design of a new campus of psychoanalysis and creativity. for Gleska University, a Native American college built on the Rosebud Reservation in South The 2003 annual conference of the Lucy is the capacity to be aware of all Dakota. Rotondi and his colleagues used the Daniels Foundation, held April 5–6 in Raleigh, your feelings—joy, despair, shame, traditional stories of the Lakota Sioux elders to N.C., challenged its featured speakers—archi- excitement, guilt, fear, hatred, sad- inform design decisions.They created ways for tects and analysts—to expose the intricate ness, pride—and stand all your feel- the students to relive old rituals while moving in design of their work and to explore how ings without being forced to behave and among the campus buildings; for example, the self is expressed through the structures any certain way by them. That is, they aligned the buildings with the orbits of we create and how the self is shaped by the free to both feel and to choose your the sun and moon. structures we inhabit. response to those feelings, including Daniels gave F. Robert Rodman, a psycho- the alternative to not act. analyst and writer, credit for suggesting the Heather Craige, M.S.W., is a psychoanalyst conference’s theme.A Lucy Daniels Foundation in private practice, treating adults and children Daniels referred to psychoanalysts as “expert advisor and author of a recently published in Raleigh, N.C. She coordinates the evaluation clutter busters of our inner space” and asked biography of Winnicott, Rodman addressed and follow-up studies of creative writers who all of the participants to consider the ways in the conference about his search for the human participate in the Lucy Daniels Foundation’s which we can create internal and external essentials of architecture. Treatment and Research Program. spaces that foster emotional freedom. Continued on page 15

12 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 INTERNATIONAL PSYCHOANALYSIS

Brazil’s Eizirik IPA President-Elect, Levinson Elected Treasurer

Cláudio Laks Eizirik of Brazil won the IPA Nadine Levinson won the vote for IPA • Latin America, from the smaller soci- election for president-elect, the International treasurer, narrowly defeating Allan Compton. eties:Aloysio A. D’Abreu (Brazilian Psy- Psychoanalytical Association announced in Both Levinson and Compton are APsaA choanalytic Society of Rio de Janiero), May. Eizirik defeated Ana Maria Andrade de members. Carmén Medici de Steiner (Uruguay) Azevedo, also of Brazil, and Moisés Lemlij of • Latin America, larger societies: Celia Katz Peru. In this election cycle, the presidency of ELECTIONS TO BOARD de Eskenazi (Argentina), Leopold Nosek the IPA was designated for Latin America. OF REPRESENTATIVES (Brazilian Psychoanalytic Society of São Daniel Widlöcher, who ran unopposed, Paulo), Fernando Weissmann (Argentina) Globally Elected Representatives was re-elected for a second term as IPA • North America, smaller societies: Nor- Two candidates ran unopposed to be- president.Widlöcher asked Donald Campbell man Doidge (Canada), James Gooch come globally elected representatives for of London to serve with him as secretary (Psychoanalytic Center of California) Europe: Henk Jan Dalewijk of the Nether- general, replacing Alain Gibeault of Paris • North America, larger societies: Sander lands and Sverre Varvin of Norway. who declined to serve a second term as Abend, Richard Fox, and Robert Pyles, Raquel Zak de Goldstein of Argentina secretary general. all from APsaA and Marcelo Viñar of Uruguay were elected as the representatives for Latin American, winning office in a large field of seven candidates. Charles M. T. Hanley of Canada and Robert Tyson (U.S.A.) won the election for globally selected representatives from North America. Regionally Elected Reprentatives • Europe, from the smaller societies: H. Shmuel Erlich (Israel) and Agneta Sandell (Sweden) • Europe, from the larger societies: Marilia Aisenstein (Paris), Werner Bohleber (Germany), Donald Campbell Photo: Mervin Stewart Cláudio Laks Eizirik (Britain) Donald Campbell

Anna Freud Centre Announces New Directorial Triumvirate

In May, the board of trustees of the Anna Freud Centre in Hampstead, London, announced the appointment of Linda Mayes, Peter Fonagy, and Mary Target as the center’s new directorial team. Mayes will continue to be based at the Yale Child Study Center in New Haven, Conn., making regular visits to the Anna Freud Centre. As chair of the directorial team, she will work with the board to set policy.As chief executive, Fonagy will be accountable to the board for all the center’s activities.As professional director,Target will be accountable to the chief executive with responsibility for clinical services and the management of professional staff. Mayes, a child and adult psychoanalyst, is Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology at the Yale Child Study Center. Fonagy has been the Anna Freud Centre’s research director for ten years. Some of his other appointments include Freud Memorial Professor of Psychoanalysis and Director of the Psychoanalysis Unit at University College, London.Target will continue as the center’s deputy research director and is a senior lecturer in the Psychoanalysis Unit at University College, London. The team members took up their appointments on September 1, 2003.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 13 INTERNATIONAL PSYCHOANALYSIS

The board was extremely sensitive and New Directions, Directorate careful in the way it approached the complex issues involved. It gathered considerable for Anna Freud Centre expert advice in coming to its decision about how to advertise for the position of director, A Point of View and it gave extremely careful consideration to Robert L. Tyson those whom it interviewed at length, coming finally to a unanimous decision. Ultimately, a Anna Freud and Dorothy Burlingham estab- the team of Hansi Kennedy and Clifford Yorke, triumvirate was appointed to the director- lished the residential Hampstead Nurseries longtime participants in the life and work of ship: Linda Mayes (chair), Peter Fonagy (chief during World War II to house children evacu- the Hampstead Clinic. Subsequent directors executive), and Mary Target (professional ated from central London to escape the were George Moran,Anne-Marie Sandler, and director). bombing raids.After the war,Anna Freud and Julia Fabricius. All her colleagues transformed the nurseries into had to deal with a clinic for the psychoanalytic treatment of challenges to the children and adolescents, a preschool for way the center underprivileged children, and a center for train- was functioning ing child and adolescent psychoanalysts with a and the purposes full-time, four-year curriculum. that it served. Many graduates of this program became These were child analytic clinicians and researchers, while much the same others pursued adult analytic training in Lon- challenges don and in various institutes in the United responsible for States.The Hampstead Child Therapy Course the demise of a and Clinic became a center for research in number of cher- child development from which a number of ished psychoan- books and a flood of psychoanalytic papers alytically oriented were published. Support for the Hampstead institutions in the Centre Photo: Anna Freud London’s venerable Anna Freud Centre will be headed by a directorial team. Clinic came from charitable gifts, most of which United States, Linda Mayes (right) heads the team which includes Peter Fonagy as were solicited by Anna Freud herself, and from the most recent Chief Executive and Mary Target as Professional Director. funding of psychoanalytic research when this of which is the was an active interest of the National Institutes Menninger Clinic. These challenges included The board faced the distressing and of Mental Health and other charitable foun- increasing expenses, decreasing income, dimin- inevitable fact that it could no longer support dations including some in Great Britain. ishing grant support, and a contracting pool of the training program in its current form, though Even before Anna Freud’s death in 1982, accessible patients. I learned of these difficult it sought long and hard for a solution. The government and foundation support began circumstances in the 1990s during my time as troika directorate proposed that the center to wane.As psychoanalytic researchers in the a member of the board of trustees of the continue with those accepted for and in the United States and elsewhere well know, these Anna Freud Centre. process of training, but that another venue resources essentially are no more. After Fabricius announced her retirement, or strong partnerships should be sought for the board focused on several prospects for certain costly aspects of the training in future NEED FOR A NEW DIRECTION the future, one of which was to advertise for years. In this proposal, the complex training In 1983, the directorship of the clinic, a new director. I was invited to be an external program would have the same objectives, renamed the Anna Freud Centre, was held by participant in interviewing the short list this quality, and staff, but aspects of it would be past May. The board members had worked housed in a different place where it could be Robert L. Tyson, M.D., F.A.P.A., long and hard on this issue; two years previ- better supported than the center is currently F.R.C.Psych., is a training and supervising ously, they had concluded that a radically new capable of doing. analyst (adult and child) for the San Diego direction for the center was necessary for a I have heard about some discontent with Psychoanalytic Society and Institute. He is variety of reasons. What direction, exactly, these decisions and actions of the board, also a clinical professor of psychiatry at the would come from a new director whose apparently based on a wish to preserve Anna University of California, San Diego, and application, it was hoped, would sketch out a Freud’s legacy and a fear that the board and a globally elected representative from North realistic proposal for the future of the Anna new directorate aim to destroy that legacy. America to the IPA Board of Representatives. Freud Centre. Continued on page 15

14 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 INTERNATIONAL PSYCHOANALYSIS

The notion that things should stay the same Lucy Daniels Foundation The ongoing non-destruction of the was certainly not Sigmund Freud’s perspective, Continued from page 12 built environment reassures us. nor was it what I gathered from Anna Freud and the various study groups at the Hamp- NON-DESTRUCTION AND THE Artist Anne-Marie Levine, whose “Box Poems” stead Clinic in which I participated during my BUILT ENVIRONMENT were on exhibit throughout the conference, was seven years in London. Architecture, he proposed, is a setting that interviewed by Daniels about the process that provides security for the disorderly world led to the creation of these miniature rooms. A LEGACY OF PROGRESS inside and between people: Art historian and foundation advisor Donald All during Anna Freud’s lifetime in London, Kuspit made comments connecting and inte- there was constant ferment, change, and ongo- It has been theorized that in strong grating the diverse presentations, which led into ing research in various directions. She approved human relationships there is always a panel discussion and dialogue with the audience. of and participated in some of this work; she an urge to destroy the other and The conference was punctuated by several remained unconvinced about other ideas but that the fact that the other person meals and a reception on Saturday evening, nonetheless supported their exploration.To my continues to be there, visible and providing informal opportunities for analysts mind, the Hampstead Clinic was a breath of functional, accords him or her special and architects to meet and exchange ideas. fresh air compared with the analytic atmos- status, the capacity to be of use. … In “The Freud-Vitruvius Dialogue,” Freud phere in many other places at the time. The urge to destroy comes, some of implores Vitruvius: “Maybe you can build a I think those interested in the welfare of the us think, from recognition of the fact home for psychoanalysis, where no emotion Anna Freud Centre and in the future of psy- that what is out there in the world is will be ashamed to live and even ambiguity can choanalysis—and this includes psychoanalytic beyond one’s sovereign control. … rest from, and rest in, its confusions.” Within its practice; psychoanalytic theory; and psycho- One thing that could probably be celebrated post-modern building and through analysis of children, adolescents, and adults agreed upon is that the built envi- its unique programs of psychoanalytic treat- and associated training and research—can be ronment, by its very survivability, ment, research and education, the Lucy Daniels satisfied that the center’s future rests in the provides a reliable setting for the Foundation has created such a home for the hands of the highly experienced clinicians and disorderly inner lives that we all psychoanalytic exploration of creativity and researchers appointed as the new directorate. lead. The built environment is dis- the pursuit of emotional freedom. They deserve all the support and understand- tinguished by its structural pres- [More information on the Lucy Daniels Foun- ing that we can give them. ence, its quality of survivability. … dation appears on page 33.]

SARS Forces IPA to Postpone Congress, Rescheduled for New Orleans in March 2004

A rise in the incidence of Severe Acute Respiratory Syndrome (SARS) in Toronto in late spring prompted IPA president Daniel Widlöcher to announce the postponement of the July 2003 IPA congress because of health concerns for meeting attendees. ”Throughout the SARS episode the actions of the Executive Committee have been dictated by our overriding concern for the health and well-being of our members,“ Widlöcher wrote IPA members in early June. ”The latest increase in hazard level, however, has convinced us that to go ahead with the Congress in Toronto would be irresponsible—attendance would be low even if no new SARS events occur, and we cannot put at risk the health of our members, many of whom are of sufficiently advanced age that SARS poses an extreme threat. It is with great disappointment therefore that I am advising you of the postponement of the Toronto Congress,” Widlöcher continued. The IPA announced in mid-July that the congress would be held in New Orleans, March 10–14, 2004.The decision was based on a number of factors including the accessibility of the meeting to international visitors, weather at the chosen time, Photo: Mervin Stewart Nora Hinojosa attended APsaA’s annual and proximity to other events.The IPA worked with Division 39 of the American meeting and spoke to the meeting of members Psychological Association to minimize overlap with the APA meeting. in Boston. She represented the Mexican Psychoanalytic Association and the Monterrey Psychoanalytic Society.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 15 16 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 Julius Caesar Bursztajn’s [working hypothesis] is Continued from page 9 startling. [What if] the godfather who directs and controls the events of I next raised the question whether Caesar’s March 15, 44 BC, is not hot-headed dramatic exit was not simply a narcissist’s sui- Cassius or scheming Brutus[?] They cide, but also a consciously chosen strategic act are, as they always have been, far designed to ensure his succession. Cornell Uni- out of their depth, minnows in a versity professor Barry Strauss, of our classical political ocean patrolled by sharks. historians team, explained that Caesar effectively No: the man pulling the strings, the Meetings gave the conspirators a deadline when he orchestrator of his own death, [could announced he was about to leave for war in be] none other than Julius Caesar Calendar

Persia. Garofano noted that Caesar changed his himself.The outcome is exactly as he Upcoming will to name his successor, his nephew Octavius, had planned it. In every particular, he six months before his death. Just before his gets what he wants. The naive and death, Caesar left every citizen enough money foolish conspirators, on the other to live on for three months, guaranteeing a hand, go away empty-handed, beaten groundswell of mourning and adulation and the by superior tradecraft and the RECONCILIATION, REFORM historical immortality of a famous death that he poverty of their own imagination. AND RECOVERY: CREATING A FUTURE FOR PSYCHOLOGICAL so craved in writing about his life. In defending the republic they en- TREATMENTS IN PSYCHOSIS sured its demise. In fighting dicta- 14th International Symposium for the ET TU, JULIUS? torship they have guaranteed its Psychological Treatment of Schizophrenia While we worked to educate the public, victory. By killing Caesar they have and Other Psychoses we also were able to pose a previously over- made him immortal. Melbourne,Australia, looked question in Julius Caesar scholarship. In In this exploration I used psychoanalytically September 22–25, 2003 For information: the words of the London Sunday Times Maga- informed decision analysis and forensic neuro- Telephone +61 3 9521 8881 zine cover article on the investigation, “Et Tu, psychiatry as ways to open other paths of Julius?” (March 9, 2003): E-mail [email protected] inquiry, rather than to come to a definitive Web site conclusion. Such analyses are not to be confused http://www.conferencestrategy.com.au with a formulated forensic psychiatric opinion, as IPA Secretary Gibeault is offered in the courtroom, or a psychoanalytic Addresses Council interpretation, as is constructed with a patient PSYCHOANALYSIS AND THE Addressing the APsaA Executive in the consulting room. But by drawing from HUMAN BODY: BEYOND Council in Boston this past spring, IPA each, one is able to question received wisdom, THE MIND-BODY DUALISM secretary Alain Gibeault said that in creating a context of discovery in which new 6th Delphi International the next two years, the IPA will shift hypotheses can be explored while continuing to Psychoanalytic Symposium its attention from strengthening the acknowledge the ubiquity of both intrapsychic Delphi, Greece, organization to addressing the current and interpersonal conflict. October 27–31, 2004 international crisis in psychoanalysis. For information: There is a decrease worldwide in the E-mail [email protected] number of patients seeking four-or- Web site http://delphi.med.upatras.gr five-times-per-week analysis and a Correction decrease in the number of candidates seeking training in IPA societies. In the Spring 2003 TAP (37/1), in Despite the cancellation of the the article “Studying Psychoanalysis WORKING AT THE FRONTIERS Toronto congress, administrative in Turkey,” Leonard Gilman and Neil Annual Congress, International Psychoanalytical Association meetings were held in late July. Spira were inadvertently omitted The new IPA Board of Representatives New Orleans, March 10–14, 2004 from the list of American teachers and Executive Committee convened Web site http://www.ipa.org.uk mentioned in the article. Both Gilman for the first time in July 2003. Donald Campbell of London will and Spira met with the group while succeed Gibeault as IPA secretary. visiting Turkey.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 17 APsaA ELECTIONS: PRESIDENT

Statements from candidates in the 2003 APsaA elections begin on this page. K. Lynne Moritzelections and Judith S. Schachter are the candidates for president-elect.The winner will begin a two-year term in June 2004 and assume the presidency for a two-year term in June 2006. Elizabeth Brett, Joanne E. Callan, Prudence L. Gourguechon, Richard Lightbody, and Robert L. Pyles are the five candidates for councilor- at-large.Two will be elected for four-year terms beginning June 2004. Joanne E. Callan was nominated by petition. Ballots will be mailed from the National Office on December 1, 2003, and must be postmarked by January 2, 2004, to be valid. —Michael Slevin,TAP Board

We cannot afford to lose political awareness K. Lynne Moritz and presence; we must be lively at many tables Three years ago, We are thus brought to a unique creative when decisions are made, and we must speak when I first sought office, moment.We have a chance to look again—to for those who cannot. Alliances are essential; the Association was at decide what we want our Association to be our voices must join with those who share our a very different place. and to so frame it within the law. If better, we commitments and values. The work of the Task have a chance even to find a new state for My vision for our Association centers on Force on Education and incorporation with laws more commodious to functional support for psychoanalytic practice Membership was being our desires.We are embarked on reorganiza- in all its forms—this in a broad membership shaped into by-laws revi- tion. Surely we will welcome this moment of organization of proud members. Ours is the K. Lynne Moritz sions, culminating years renewal. It is time for everyone’s ideas to be pre-eminent psychoanalytic association, of work to settle Board-Council struggles heard, for all aspects of our functioning as well arguably, in the world.We lead the way.The collaboratively.The Omnibus Science Initiative as our mission and goals to be evaluated—a backbone of our strength has always been was in place; a marketing survey was under time for refreshing our special enterprise.And our educational and credentialing missions, way. Optimism seemed natural. Even the world this is under way. and these, I believe, are still crucial to our seemed more favorably poised toward fair Meanwhile, many things go well. Our affiliate identity. They must be preserved and pro- treatment for our patients. members now vote; we vigorously engage tected from political coercion, even if this The world has since grown darker. After the marketing results; we disseminate “best means externalizing them. Research must be 9/11, Enron, church scandals, continuing eco- practices”; we have confirmed a new executive an integral part of our training and outlook. nomic and health care crises, wars on terror- director; we stand on the brink of expanding We must take our place among the learned ism, perhaps all of us have grown into new our membership base. professions. cynicism and suspiciousness and seek someone What I have learned in these years of serv- My contributions here have been to share to blame.Within our organization, ancient ani- ice is the strength of our members, and their the burdens and joys of leadership at this mosities have been rekindled; Board-Council needs as well. Passionate debates are healthy— beleaguered time. Specifically, as secretary, I conflicts flame anew.This is not the collabo- signs of vigor and grease for change. But they have tried to actualize transparency in gover- rative joining envisioned by the E&M framers must not paralyze performance of critical func- nance—to bring members into the context and ratified by the membership. Rather, the tions. (How much of scarce dues dollars does and content of deliberations so that they can Council, as board of directors, reasserts its the average member wish to spend on these know, judge and respond. Presidents Fox and preeminent role. Since state law trumps our matters? What issues can afford to slip from Fischer were also so committed. My charge as by-laws, Council and Board cannot function as our focus while we fight?) Members need an secretary was also to respond to the specific co-equal collaborators. Thus, our certificate organization that functions, and they cannot needs of members. of incorporation (which sets psychoanalytic wait. Our world tolerates emotional suffering I have lived my working life as a psychoana- education and standards as part of our central and marginalizes the treaters; our world prefers lyst-activist. I have worked for patient care and purpose) and our by-laws (which now inscribe profit to treatment and sacrifices privacy for practice betterment in every organization I the collaborative functioning of Board and dividends. We must be prepared to do col- have served. I believe in alliances and consensus, Council) must be reconsidered. lectively what members cannot do individually. Continued on page 19

18 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 APsaA ELECTIONS: PRESIDENT

fostering dissatisfactions and apathy.They result Judith S. Schachter in underutilization of the talents of members I am running for The decision established an absolute priv- who have not opted for the certification/train- another term as presi- ilege for psychotherapy communication ing analyst track. Modifying our standards dent to present you in all the federal courts. through negotiation and even by-law changes, with a clear choice on • With the British Psychoanalytic Society as we did with our anti-discrimination state- the critical issues facing we created the PEP CD-ROM, which con- ments, enhances science, membership morale, us.This election is about tinues to return income to both organi- education, and our public face. the future of APsaA and zations while being a boon to scholarship. its role in the future of • We passed two anti-discrimination state- Judith S. Schachter psychoanalysis.We must ments, which freed APsaA from years grow to include and involve our students, our of prejudice against homosexuality, open- Community Clinic members who have not sought certification ing institute admission policies, changing Award Applications as well as those who have, and our graduates curricula, and modifying training analyst who have not become members. standards. Sought I ask for your vote, based on the achieve- • We conceived and organized APsaA’s first The Committee on Community ments of my first term and my vision for the public budget oversight process, which Clinics invites applications for the 2004 future. No accomplishments are possible continues to review and organize our Psychoanalytic Community Service without hardworking, creative cohorts. I am financial priorities. Clinic of the Year award.Applications proud that my good leadership recognized • We computerized the national office, cre- are due by November 1, 2003. Details and facilitated enthusiasm, cooperation, and ated e-mail lists for members, and origi- on eligibility and how to apply can be outreach to other organizations yielding sig- nated the Web site to serve members and obtained from committee chair Ruth nificant outcomes. project a worldwide public face. Yanagi: [email protected]. • I was elected in 1992 on a platform that Currently I embrace the constructive The award is designed to supported “de-linkage” of certification changes necessary to reaffirm our present recognize the achievement of clinics from members’ rights to vote and hold day relevance and enable us to remain influ- that provide a broad range of services national office. ential in psychoanalysis in the United States.To on a sliding scale basis, are affiliated • We took the lead in bringing about the accomplish that goal, we must avoid policies with a society or institute, offer a Psychoanalytic Consortium’s amici brief and attitudes that turn people away from us. means for psychoanalytic ideas to in Jaffee v. Redmond,written under the Residues of our two-tier past enable a fraction enter into a community, maintain direction of Carter A. Phillips, one of the of the membership to make decisions that a site for training in psychoanalytic most prominent Supreme Court attorneys. affect all of us.Those inequities hurt morale, psychotherapy, and provide cases for psychoanalytic candidates and a venue for clinical research. K. Lynne Moritz professor of psychiatry and have regularly Continued from page 18 taught both residents and candidates. Within the Association, I have served on the and I believe in service. Locally, I have served committees on Psychoanalytic Practice, Local Enrico Jones Dies as director of my institute and president of Health Care Initiatives,Affiliations with Other our county medical society and was in line for Groups, and Societies. I have worked with the at Fifty-Five president of our state medical association; I foundation, as TAP mid-america editor and was president and legislative representative national editor, in the Executive Council for Pioneer psychoanalytic researcher of my psychiatric district branch and delegate more than a decade, on BOPS for four years, Enrico Jones died in March 2003 from the American Psychiatric Association and in the IPA House of Delegates. after a long illness, leaving friends to AMA’s House of Delegates—a voice for To me, it is the needs of our patients that and colleagues deeply mournful. psychoanalysis both in the house of medicine unite us—our strongest bond, our touch- Jones’ remarkable, original research and in psychiatry. (During my term of lead- stone of meaning. I believe I bring a fair and contributions to the study of ership, our state passed “the most sweeping steady hand to divisive issues. I am a woman psychoanalytic process will be managed care regulation law in the coun- of much energy, and I would proudly serve this featured in a tribute article in the try,” according to the AMA.) I am committed Association once again. I ask for your vote for winter 2004 issue of TAP. to excellence in education. I am a clinical president-elect.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 19 APsaA ELECTIONS: COUNCILOR-AT-LARGE

functioning without fundamentally modifying Elizabeth A. Brett the organization. I am running for are an expectable source of dissension among Major shifts in our identity or governance councilor-at-large us,not a sign that there is something wrong will not reverse the decline in analytic prac- because of the impor- with the organization. An awareness of this tice. Outreach efforts aimed at strengthening tance of the member- reality might help us reduce some of the dis- psychoanalysis are required. Recently I have ship and governance tress caused by the dissension. been involved with the following projects. proposals facing the With respect to the proposals regarding All involved collaborations between analysts organization. With APsaA’s governance, it is generally acknowl- and non-analysts. I coordinated ten state and respect to the mem- edged that APsaA faces unusual challenges national professional organizations in their Elizabeth A. Brett bership proposals, because of its simultaneous but often con- defeat of a bill in the Connecticut legislature APsaA is an organization based on particular flicting tasks as a professional association and sponsored by the National Association for the traditions and definitions of psychoanalysis. standard-setting body.The fellowship and stim- Advancement of Psychoanalysis that sought There is no absolute definition of psycho- ulation of like-minded colleagues in a profes- to legitimize unacceptably low standards for analysis: only definitions endorsed by spe- sional association gets jumbled up with the psychoanalytic training. I obtained a grant cific groups of analysts. In effect, we are who dynamics of power and authority involved in from the American Psychoanalytic Foundation we define ourselves to be. This means that training analyst selection and standard-setting for and organized the production of a televi- substantial changes in our membership would activities. I support the Task Force on Educa- sion program on threats to the privacy of lead to equally substantial changes in our tion and Membership’s effort to address this medical information. The program was dis- definitions of psychoanalysis. I oppose signif- complexity by distinguishing, clarifying, and tributed to television stations nationally and icant changes in our identity brought about in strengthening both the professional association shown at the APsaA meetings in 2000.At the this way. and standard maintenance functions of Coun- Western New England Institute for Psycho- The self-defining function of APsaA has cil and BOPS. However we decide to alter our analysis, I guided the creation of Psychoanalytic another important consequence. The con- structure, the reciprocal and interrelated Theory for Scholars, a two-year program for sensus definitions of psychoanalysis and psy- nature of these tasks has to be appreciated. academics interest in applying psychoanalytic choanalyst are necessarily controversial; they We cannot eliminate either aspect of our concepts to their work.

ranging from preschools to higher education Joanne E. Callan programs. As well, I participate as a member I am running for schools. I have held a tenured appointment in on several education and art-related not-for- councilor-at-large a department of psychiatry, served as chief profit boards. because I believe that psychologist and acting director of an ado- This wide-ranging background would lead my experience in local lescent inpatient unit, and directed both psy- me, if elected, to work for the following goals: and national adminis- chology internship and group therapy training • We must take every opportunity to dis- tration and gover- programs. In California, I was dean, later seminate psychoanalytic thinking and make nance, ranging from provost, at the California School of Profes- known what the application of our insights academia to my soci- sional Psychology–San Diego, which served to has to offer our communities. Joanne E. Callan ety and institute, to the consolidate my administrative and academic • APsaA members, including affiliates, must Executive Council of APsaA, and to the Amer- experience. Currently, I serve there as pro- be assured of the right to vote for their ican Psychological Association, provides me fessor and also as associate clinical professor executive councilors, even in societies with a unique and valuable perspective than in the University of California–San Diego that prohibit their voting in other local can benefit our organization at this time of Department of Psychiatry. elections. critical choices. My analytic experience has been equally • We must make every effort to broaden My responsibilities as the first executive comprehensive, since I am president and chair our membership base and include IPA director of the American Psychological Asso- of the board of directors of the San Diego members who are currently ineligible. ciation’s Education Directorate (1991–95) Society and Institute and a training analyst at • We must develop mechanisms and included key issues such as accreditation at that institute. My interest and enthusiasm for processes that would assure the financial both national and international levels, national outreach has led me to serve as a supervisor in viability of the Association, including long- funding for mental health training, mental health many settings and to consult from a psycho- term planning. advocacy, and the application of psychology in analytic perspective at educational institutions, Continued on page 22

20 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 APsaA ELECTIONS: COUNCILOR-AT-LARGE

these endeavors. I find organizational work Prudy Gourguechon creative and challenging; I do it for pleasure The Council,APsaA’s and psychotherapists, accredit institutes, and more than from duty. I’m eager to stay involved governing body, has certify analysts.We must keep our own national with solving the problems we face. responsibility for over- and local organizations alive, viable, and running I am a natural problem solver—I’d rather seeing and encourag- in an efficient and fair way.Then there are the do something positive regarding a problem ing the accomplishment intangibles, no less important for their elusive- than wait for a perfect solution. While I can of our organization’s ness: bolstering our members’ morale as they ply take a firm and principled stand, I hate wast- complex mission. a very stressful trade and meeting their affiliative ing time on unnecessary internal conflicts At APsaA we have needs, often shortchanged in a profession that when the lions are at the gate. I would work Prudy Gourguechon set ourselves a stagger- lends itself to isolation. to achieve energetic, sensible, collaborative ing number of vital tasks:We want to support It is extremely difficult to fund, both finan- forward movement. psychoanalytic practice, encourage our mem- cially and with human capital, all these efforts. I think councilors and the Council as a bers’ career development, and meet their con- It is equally difficult to negotiate balanced whole can contribute to rebuilding the shaky crete needs for services such as insurance and priorities with so many competing needs and morale of the organization and its membership continuing education.We know we must foster interests. Each of us is more committed to if we function as a set of leaders who under- research in psychoanalysis and educate the some cluster of these goals, and we each pri- stand the myriad tasks APsaA faces. Balance, public and press about our field. We support oritize the long list of tasks differently. It remains wisdom, cooperation, leadership, enthusiasm, a efforts to apply psychoanalytic thinking to innu- the task of the organization as a whole to big-picture perspective—all these are needed merable fields, from the arts to sports to archi- address this entire broad agenda. In my view, it as general traits of the Council as a body, and tecture. We work with colleagues in allied is imperative to avoid factionalism. I think I can contribute them as an individual. disciplines to promote joint interests clinically, As editor of TAP and as a division coordi- I appreciate the honor of being asked to run legally, and socially.We train future psychoanalysts nator for the past three years, I have tracked all for national office.

Cleveland Psychoanalytic Society and Richard Lightbody its institute (now strategically merged The position of tiny Executive Committee might include into a center), and I sit on our endow- councilor-at-large is an expanding the role of councilor-at-large . As ment fund board. I have been increas- interesting one, and an much as I value efficient and nimble gover- ingly active on committees of Council evolving one. Councilors- nance, I believe that it is imperative to retain and BOPS, as member and as commit- at-large provide over- the fundamental authority of societies and tee chair. I have been involved in the sight of elections and centers: It is individual members, working foundation movement and traveled to recommend honorary locally, who make psychoanalysis visible, perhaps five annual workshops of the members.They also have knowable, and successful. We must find a Committee on Foundations. Richard Lightbody an opportunity over a proper balance. (2) I have educated myself in principles of four-year term to shape the broad debates of I have confidence that our democratic organizational leadership through post- our Executive Council. Particularly in the pres- process can identify and solve the myriad of graduate courses in the Center for ent charged atmosphere, I can imagine that problems facing us.The sense of mission, the Non-Profit Management at Case West- councilors-at-large will be asked to accept humor, and the eloquence of our colleagues ern Reserve University in Cleveland. broader responsibility because they are among provide room for optimism. I do not believe (3) I have been a councilor from Cleve- the few officers of the Association elected by that membership and educational goals are land for the last four years, aiming the entire membership. incompatible. I do not hold, as do some, that to articulate a judicious compromise Council itself is a large body composed of we are “broken.” There is a great deal worth between local autonomy and central local representatives, plus officers, past pres- keeping in our organization—and some care- cooperation. idents, ex officio BOPS officers, and coun- ful change to welcome. This would be a right time for me to cilors-at-large. As we re-organize to comply I believe I am qualified to serve as councilor- become a councilor-at-large. I am not young, with current non-profit law, there is some at-large no matter what the job becomes. nor old. I think I have a lot to say, and a will- discussion of a smaller and more active board (1) I have made it a goal to experience as ingness to say it. I am also capable of silence. of trustees—a natural compromise between many aspects of analytic organizations as I am intent on supporting my profession. Being a steadily enlarging Executive Council and a possible. I have held most offices in the elected would be ideal.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 21 APsaA ELECTIONS: COUNCILOR-AT-LARGE

amendments to the privacy rule, our Associa- Robert Pyles tion led the fight to restore them, launching a Over the last decade my professional focus broadened to include lawsuit against the Department of Health and we have witnessed the political arena. With a few APsaA col- Human Services. events we would never leagues I founded the Coalition for Patients We must continue to focus the energy of have thought possi- Rights, a political action group which later our organization on these important issues ble—the corporatiza- merged with the American Psychoanalytic so our members can deliver high-quality psy- tion, dehumanization, Association.We were successful in our efforts choanalytic care.We must not allow our focus and decline of health to protect private practice. to be overly diverted to the workings of the care in America.We have During my term as president, our Associ- American Psychoanalytic Association. During Robert Pyles seen a direct and delib- ation became a highly visible and effective the last Executive Council meeting, eight min- erate assault on the therapist-patient rela- influence on Capitol Hill. The American has utes were devoted to dealing with external tionship; human suffering has been reduced to emerged as one of the most (if not the most) challenges and eight hours were spent on a formulary. Discriminatory managed care and effective professional organizations in repre- internal issues.This trend must be reversed for government policies have combined to deal a senting the interests of our patients. In 1999 the sake of our members and our patients. near-mortal blow to our ability to treat the over 250 analysts took part in a town meeting I currently serve on governing bodies of mentally ill. in the capitol.APsaA went on to work closely the International Psychoanalytical Association, Until 1993, I devoted my professional time with the Clinton Administration in developing the American Psychiatric Association, the Mass- to a career centered on teaching, adminis- the HIPAA regulations, preserving the right achusetts Psychiatric Society, and the American tration, and the clinical practice of psychiatry of patient consent, and achieving special pro- Association of Practicing Psychiatrists and con- and psychoanalysis. When the Clinton Plan tection for psychotherapy notes.When these tinue to chair the Government Relations Com- threatened to make private practice illegal, protections were reversed by the recent mittee for the American. In the latter capacity, we have participated in landmark legal actions including the Eist case, the Shrager case, and the RICO class action suit. How to Participate in APsaA’s My work is primarily private practice; in Scientific Program addition to treating patients, I consult to major league baseball, and provide expert testimony, generally on issues related to privacy. I am a Scientific papers for oral presentation must be no longer than twenty-two pages, supervising and training analyst at the Psycho- double-spaced; longer papers (forty pages maximum) are considered for pre-circulation analytic Institute of New England. and small group discussion. Include an abstract and submit eight copies. JAPA has first It would be an honor to continue to serve our claim on any paper accepted for presentation or pre-circulation. Association as Councilor-at-Large. Panel proposals must be submitted in writing (two pages maximum, two copies). Each proposal should contain a description of the format, the objective of the panel, and names of possible participants (chair, panelists, discussant if any).The Program Committee usually chooses panels one year in advance. Joanne E. Callan Discussion group proposals must be submitted in writing (two pages maximum, Continued from page 20 two copies).The Program Committee chair selects new discussion groups based upon • We must clarify the current governance their subject matter vis-à-vis material covered by existing groups. structure and assure congruity between Symposia explore the interface between psychoanalysis, society and related by-laws and Council functioning. Rather disciplines, attempting to demonstrate how psychoanalytic thinking can be applied to than waiting for a grand overhaul, we non-psychoanalytic settings. Symposia must be in talking points format, ten to fifteen should make incremental changes that minutes per presentation (no papers read), with a minimum of fifteen minutes for are feasible now and would not impede audience participation with emphasis on audience interaction. Submit a brief (two pages our making subsequent changes. maximum) proposal outlining rationale, program format, and suggested speakers. I am eager to represent our membership The deadline for submission of panel proposals is October 1 for the Winter Meeting on the Council in order to work toward and March 1 for the Annual Meeting.The deadline for all other submissions is May 1 assuring the relevance of psychoanalysis. I for the Winter Meeting and December 1 for the Annual Meeting. believe the path towards a healthier APsaA Address correspondence to Glen Gabbard, Chair, Program Committee, c/o The will be through supporting practice, the appli- American Psychoanalytic Association, 309 East 49th Street, New York, New York, 10017. cation of psychoanalytic thinking in our com- munities, and research.

22 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 Robert A. King and Alan Apter, eds., Suicide in Children and Adolescents.Cambridge University Press, Cambridge, U.K. (2003). New Arnold Modell, Imagination and the Meaningful Brain. MIT Press, Cambridge, Books by Mass. (2003). Members Ethel Spector Person, Feeling Strong: The Achievement of Authentic Power. APsaA members wrote William Morrow and Company, an imprint or edited these books of Harper Collins Publishers, New York, in 2002 and 2003. N.Y.(2002). Joseph Reppen and Martin A. Schulman, booklist eds., Failures in Psychoanalytic Treatment. Salman Akhtar, New Clinical Realms: International Universities Press, Madison, Pushing the Envelope of Theory and Conn. (2002). Technique. Jason Aronson, Northvale, Justin Richardson and Mark A. Schuster, N.J. (2003). Everything You Never Wanted Your Kids to Salman Akhtar, Nadi ke Paas, a collection Know About Sex (But Were Afraid They’d Ask). of poems in Urdu. Star Publications, Ltd., Crown Publishers, New York, N.Y.(2003). New Delhi, India (2003). F. Robert Rodman, Winnicott: Life and Salman Akhtar and Vamik D.Volkan, eds., Work. Perseus Publishing, Cambridge, The Mental Zoo:Animals in the Human Mass. (2003). Mind and its Pathology. International Beth J. Seelig, Robert A. Paul, and Carol Universities Press, Madison, Conn. (2003). B. Levy, Constructing and Deconstructing Salman Akhtar and Vamik D.Volkan, eds., Woman’s Power. Karnac, London (2002). The Cultural Zoo:Animals in The Human Howard H. Shevrin, Subliminal Explorations Mind and its Sublimations. International of Perception, Dreams, and Fantasies:The Universities Press, Madison, Conn. (2003). Pioneering Contributions of Charles Fisher. Jerome Blackman, 101 Defenses: How Psychological Issues, Monograph 64, the Mind Shields Itself. Brunner-Routledge, International Universities Press, Madison, New York, N.Y.(2003). Conn. (2003). Robert F. Bornstein and Mary A. Languirand, Howard H. Shevrin, The Dream Healthy Dependency: Leaning On Others Interpreters:A Psychoanalytic Novel in Without Losing Yourself. Newmarket Press, Verse.International Universities Press, New York, N.Y.(2003). Madison, Conn. (2003). Robert Dalek, An Unfinished Life. John F. Laurie Wilson, Alberto Giacometti: Myth, Kennedy 1917–1963. Little, Brown and Magic and the Man.Yale University Press, Co., Boston (2003). New Haven, Conn. (2003). David James Fisher, Psychoanalytische Jerome Winer, ed., James Anderson, assoc. Kulturkritik und die Seele des Menschen ed., Bertram Cohler and R. Dennis Shelby, (Psychoanalytic Cultural Criticism and guest eds. The Annual of Psychoanalysis, the Soul: Essays on Bettelheim), to be Vol. XXX, Rethinking Psychoanalysis and published by Psychosozial-Verlag, Giesen, the Homosexualities .The Analytic Press, Germany (October 2003). Hillsdale, N.J. (2002). Alexander Grinstein, Wilkie Collins: Man Jerome Winer, ed., James Anderson, assoc. of Mystery and Imagination. International ed. The Annual of Psychoanalysis, Vol. XXXI, Universities Press, Inc., Madison, Conn. Psychoanalysis and History.The Analytic (2003). Press, Hillsdale, N.J. (2003). Lee Jaffe, Technique and Practice,Volume 3: The Training Seminars of Ralph Greenson, M.D. International Universities Press, Inc., Madison, Conn. (2003).

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 23 New Members (as of June 2003)

NEW MEMBERS Martha Brewer Koo, M.D. AFFILIATE MEMBERS Mary L.Adams, M.S.W.,ACSW Sandra L. Kryder, Ph.D. Soh Agatsuma, M.D. Christine Anzieu-Premmereur, M.D. Cornelia Lischewski, Psy.D. Janice Bingle, M.D. B. James Bennett, IV, M.D. Hollis McMillan, Ph.D. Daniel Blaess, Ph.D. Robin Bryant, Ph.D. Pamela Meersand, Ph.D. Hillery Bosworth, M.D. Gloria Sax Burk, M.D. Juliette Meyer, Ph.D. Anthony D. Bram, Ph.D. Laurie Hope Case, Ph.D. Linda S. Mullen, M.D. Linda G. Buchsbaum, M.S.W. Lynn Cetrulo, LICSW Julie Jaffee Nagel, Ph.D. Patrick Chamberlain, M.S.W. Victoria Ann Conn, M.D. Jeremy Eugene Orgel, M.D. Nam-Hyeon Cho, M.D. Siobhan H. Coomaraswamy, M.D. Barbara Rosen, Ph.D. Laura Crain, M.D. Laura Dansky, Ph.D. Mary Diaso Rudy, LCSW Cary D. Friedman, M.D. David J. Diamond, Ph.D. Mark A. Snyder, M.D. Joanna Goodman, Ph.D. Ann Dolinsky, M.D. Linda S. Stern, Ph.D. Patrick J. Haggard, M.D. Jane L. Dulay, M.D. Elizabeth Tillinghast, M.D., J.D. Anne Hoffman, Ph.D. Mario Fischetti, Ph.D. Sally Vrana, M.D. Shaily Jain, M.D. George Frank, Ph.D. Sandra C.Walker, M.D. June Kramer, M.D. Andrew C. Furman, M.D. Risa Weinrit, Psy.D. Sandra W.Park, M.D. Rajiv Gulati, M.D. Laura H.Weissberg, M.D. Betty Sonnenwirth, M.D. Jeanne C. Harasemovitch, LCSW Alethea E.Young,Ph.D. Susan Turner, M.D.

24 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 Unfortunately, conventional virus detection TECHnotes programs, important as they are, do not detect these programs. So in addition to an updated virus checker running all the time, you should Protecting Your Computer: also periodically scan your system for adware and spyware. Fortunately there are at least two Spying on Spyware very capable and highly recommended free Paul W. Mosher programs (for PC only) that can do this for you. I suggest that you use both of these pro- If your computer is connected to the Inter- programs, or they can get installed on your grams regularly; each of them can detect some net, chances are that some Web sites you have computer when you innocently click on certain unwanted programs that the other might miss. visited have attempted to install programs on Web links. Ad-aware, by a company named Lavasoft, can your computer that you don’t want.There are Without your knowledge, these programs be downloaded from http://www.lavasoft- now hundreds, perhaps thousands, of these can track your Web activity and send the usa.com/.Version 6 was the current version at programs, often referred to as “adware” and data to an advertising company, take over the time of this writing. “spyware.” These programs can also come your browser and change its home page, add Spybot Search and Destroy by PepiMK Soft- along for the ride when you download other “options” to your browser’s toolbar, change ware is found at http://security.kolla.de/. the way your computer operates, slow your Each of these programs uses reference files “TechNotes” runs in each issue of TAP, computer down, put advertising on your that need to be updated as new problematic with the aim of educating us about aspects screen, and pull many other undesirable tricks. programs appear on the Internet. Keep your of technology and communications relevant (See http://www.cexx.org/adware.htm for spyware detectors up to date just as you do to our work. more gory details.) your virus checker.

Many people are closet writers, wondering if they have anything valuable to say or if what they do have to say will be readily membershipaccepted.The Program for Mid-Career Ana- lysts is a place to try out your ideas and your writing while it’s still in a somewhat un- Mid-Career Analysts Discuss finished state. Sometimes taking the risk to present a work in progress can lead to a How to Join Committees, Write more experimental writing style or a more creative and integrative use of psychoanalytic and Present Innovative Papers ideas. Since contemporary psychoanalytic Zoe Grusky writing is becoming more creative, now is a good time to experiment. For those who Have you ever wondered how to join an Program for Mid-Career Analysts and find out are interested we can also talk about the APsaA committee? Are you curious about if there is a committee that you might be inter- procedures involved in submitting papers to what happens on our committees, how they ested in joining or a work in progress that the Program Committee. work, and what they do? Do you have a half- you’d like to present.This is a place to try out The Program for Mid-Career Analysts will be dozen ideas for a paper that you want to write creative and innovative ideas. meeting regularly at the spring and winter or a few semi-written papers that you can’t find You might be surprised to learn that you can meetings.We want to talk about the nuts and the time to finish? Come to a meeting of the offer to serve on a committee that intrigues bolts of getting involved in APsaA. If you are a you by talking to your society president, the recent graduate, roughly five so years post- Zoe Grusky chairs APsaA's Membership APsaA president-elect, or the chair of that graduate, or a member at large with an inter- Committee.This column, describing the benefits committee. By talking to people you will find est in finding out more about the inner of membership in APsaA, will appear from time out more about what your interests are, and workings of APsaA, we would welcome your to time. For a full list of benefits, see http:// you will probably discover that you have many attendance at this meeting. See your meeting www.apsa.org and click on “Member Benefits.” ideas and it’s a lot of fun to voice them. program for dates and times.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 25 SCIENCE

The Fund Every member of the fund’s board reads all applications. Three members of the board American Continued from page 8 and/or outside consultants are asked to pro- Psychoanalytic principles or directly investigating the vide detailed written reviews, which are pro- Foundation process and/or outcome of psychoan- vided to the applicant in a summary letter alytically informed treatments.While the written by the chair of the board.The identi- The American Psychoanalytic maximum award amount is not large ties of the reviewers are not made known to Foundation supports projects that compared to federal sources or other the applicant. develop and expand the impact foundations, the awards are often suffi- Many applicants have found the detailed cient to permit an investigator to start reviews useful for future submissions to the of psychoanalysis in the community a project. fund and to other agencies. Members of the through educational programs, 2. Small grants of less than $5,000 for one board are also available to applicants for clinical services, and research. year to permit a beginning scholar to consultation regarding the preparation of an To apply for a grant from the gather some pilot data in preparation application. If a board member serves as a American Psychoanalytic Foundation, for the submission of a full grant to the consultant, he or she does not participate in the please visit our Web site: http:// fund or to another agency. review of the application after submission. www.cyberpsych.org/apf.You can 3. Small grants of $3,000 to permit a also find the application form on this beginning scholar to spend time visiting APPLYING TO THE FUND site. Proposals must be submitted by and consulting with a more experienced Applications are accepted to the fund twice October 15 for consideration at the senior investigator who has agreed to yearly.All applications are reviewed during the January board meeting and by March help the junior investigator begin inves- winter and spring APsaA meetings.Applicants tigative work.Typically these awards are may obtain forms and instructions through 15 for consideration at the June made to permit the beginning scholar two sources: Call the national office of the board meeting. the funds to travel and/or to reimburse American Psychoanalytic Association or down- Donations may be given to the the senior investigator for travel and load forms and instructions from the fund’s American Psychoanalytic Foundation consultation.These grants may also be Web site. by mailing the American Psychoanalytic used to support travel to a research Foundation, c/o Nadine A. Levinson, training seminar in the United States Treasurer, 9 Breakers Isle, Dana Point, or abroad. CA 92629. 4. Awards of up to $15,000 annually for “Placebo” Donations may given to honor an up to two years to support the begin- Continued from page 7 individual’s or organization’s special ning career of a psychoanalytic investi- occasion or in memory of a death. gator. These mini-career awards are “Placebo” is the first person singular future intended, for example, to “buy time” indicative of the Latin verb placere. It is trans- An appropriate card will be sent for a junior faculty member or clinician lated as “I shall please” or “I shall be accept- notifying the person, organization, just starting a practice so that he or able.” Etymologically speaking, placebo effects or family of your contribution. she may consult with other investigators, are produced by the patient’s wish to please or Inquiries about the American join an investigative team, or attend to be acceptable to the doctor and by the doc- Psychoanalytic Foundation’s insurance year-long seminars on research method- tor’s evoked desire to relieve the patient’s program for the benefit of APsaA ology or specific methods relevant to pain. Kirsch’s analysis showed that in the brief members can be directed to Richard their research. pharmacological treatment of depressive illness, K. Matzker of Abrams, Gavin, & Vogel the placebo effect was remarkably strong. In Inc. at 800-968-1401. REVIEW PROCESS considering the meanings of these findings, it is The American Psychoanalytic All submitted proposals are carefully re- instructive to recall that Freud’s procedural viewed with respect to aims, methods, clarity, transition from hypnosis to free association was Foundation offers free Web sites and significance. Typically, the fund receives guided by his understanding of the role of to members of the psychoanalytic sixteen to twenty applications per year. Appli- placebo effects in symptom development, community. For more information, cations are funded based on merit.Thus the maintenance, and remission. He gave the see http://www.cyberpsych.org/ fund does not award a minimal number of placebo phenomenon a more functional name apf/apfhost.htm. applications every year but makes every effort by calling it transference. He never doubted for to find merit in individual submissions. a moment the power of its effects.

26 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 The Enemy Within Does this sampling of my experiences on Science Initiative Continued from page 3 the road represent the majority of our mem- Continued from page 6 bers? I personally doubt it. Does it reflect a replaced the original function from sizable number of people and perhaps a sig- (Robert Waldinger), Privacy and Ethical Issues which the structure was created nificant number of our societies/institutes? I in Psychoanalytic Research (Robert Galatzer- … If we continue in this path we believe it does. My focus in our town meetings Levy), Science Paper Prizes (Robert Michels), are going soon to end up analyzing has been on outreach, and in these meetings Scientific Survey Research (Lee Brauer), and each other. we have not fully addressed these internal the poster section. struggles. I am concerned that unless we put The poster section, co-chaired by Linda An advanced candidate from another society/ our full energies into these outreach endeav- Goodman and Linda Mayes, is perhaps the institute wrote, ors—into marketing and candidate recruit- most dramatic change resulting from the OSI ment—and start doing business differently, to date. It is safe to say that among scientific I read the [Open Line e-mail forum] we are going to shrivel up and our place in organizations of any size, only APsaA did not occasionally … and continue to be the therapeutic and intellectual world will offer an opportunity at national meetings to amazed at the ranting and raving of become trivial. There is a strong sense of display posters of research work until 2001. a few. I have been tempted to post movement and renewed vigor in APsaA.The Submissions for the poster section of our my own message, “You people are Association has recognized that its job at meetings have been numerous and of high nuts!!” … I would agree that unless the national level is to support societies and quality, coming from both experienced and we significantly change psychoana- institutes in their grassroots outreach with beginning researchers. In New York in January lytic education it will die. It has taken resource materials, training, and counsel. 2003, spot counts revealed attendance as great stamina on my part to par- APsaA’s public affairs efforts have blossomed follows: at 2:30, forty people viewed the ticipate in an educational system and grown nationally.The strategic marketing poster section; at 3:00, ninety-three; at 3:30, that focuses on keeping me in a workshops have been well attended. At the 125; at 4:30, more than sixty. From these data regressed, paranoid position when local level, where the action really is, we are and frequent personal expression by members, the reality is that I am … [an] increasingly “mixing it up.” we conclude that reception of the poster sec- extremely well regarded and pro- There is ferment and growth, but our time tion has been enthusiastic and widespread. fessionally competent psychiatrist in frame is short. We need growth in the pro- The committee responsible for the Omnibus the community. As I am ready to fession.Time is of the essence; we need the Science Initiative has every hope that APsaA’s graduate, I am seriously considering dedication and energy of every member at the scientific activities will eventually make a signifi- having nothing more to do with the local level, and of APsaA at the national level, cant contribution to the Association’s activities and Institute … Thank you for visiting us if we are to prevail. to psychoanalysis in the United States. and for speaking what the rest of us are thinking. U.S. News and World Report At one society/institute I visited, after about ten minutes of cordiality, it became apparent Honors Freud, Marx, Einstein that the agenda in my head about outreach would have to be abandoned. It clearly did not A special collector’s edition of U.S. News and World Report, “Three Minds That speak to what the thirty members in atten- Shaped the Twentieth Century: Secrets of Genius” was released in late spring and dance wanted to talk about. I put away my ten- featured Sigmund Freud, Karl Marx, and Albert Einstein. minute video about the Strategic Marketing A twenty-seven page section on Freud opened the magazine. Kerry Sulkowicz, Study; it would have been inappropriate and chair of APsaA’s Committee on Public Information, called it “remarkably well-written, insensitive. For the next ninety minutes I was balanced, and ultimately quite favorable.” Many APsaA members were quoted in the confronted with a heated and angry barrage piece.APsaA’s public affairs director Dottie Jeffries worked closely with the U.S. News of comments and questions about the rigidity writers, providing background information and arranging interviews. and elitism of the Association, its insensitivity to Sulkowicz said,“I found the section on Freud to be one of the most comprehensive the real needs of the local group and its mem- introductions to Freud and psychoanalysis I’ve ever read, and highly recommend it as bers. This steady and impassioned flow was a teaching tool.” occasionally interrupted by “We know, Newell, Copies of this special edition are available through the National Office. Send a check you are only the messenger, but …” Before I for $6.00 per copy to APsaA Store, 309 East 49th Street, New York, NY 10017. Checks left, the group insisted I take some sandwiches should be drawn on US funds and made payable to APsaA. back to my hotel for an evening snack.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 27 POLITICS

POLITICS and 2. If consent is required, whether it should be obtained by the company or by the PUBLIC POLICY treating psychiatrist. 3. Whether redacted (de-identified) records require patient consent. Magellan de- An Ordinary Man fended its position based on its contract Bob Pyles with the psychiatrist, which included an agreement to supply records for the Dan Shrager doesn’t look like a hero. He Three points were at issue: purpose of re-credentialing. Magellan also bears no resemblance to Arnold Schwarzeneg- 1. Whether Magellan had the right to maintained that the consent signed by ger. A Pittsburgh psychiatrist practicing psy- access patient records without patient the patient upon enrollment in the plan chodynamic psychotherapy and an academic consent for the purpose of physician is valid blanket consent. associate member of APsaA, he takes pride in “re-credentialing.” Continued on page 29 his work and is liked and respected by patients and colleagues. Shrager could be appropriately compared to David of Biblical fame.Acting with singular courage, he brought the Goliath Magellan to its knees. In 2000 A.D., Shrager was called by the insurer Magellan (a psychiatric “carve- SHRINKwatch out” for Blue Cross) and asked for five com- plete patient records. Magellan sought the records in order to review Shrager, whom “Have a Fireball” the insurer classified as a “high volume Prudy Gourguechon provider.” He responded that he could not comply due to concerns about his patients’ Judd Hirsch played a good enough psychia- Close to opening up, she grabs her face and confidentiality, none of his patients having trist in the film Ordinary People. Richard Drey- says,“Why is this so hard?” given permission for this. Anticipating a dia- fus was painfully funny in What About Bob. But Here’s the great moment. Dr. Drayton smiles logue with company officials regarding Mag- lately, my favorite movie shrink is the little gently and leans forward a little, picks up a ellan’s policy on privacy safeguards, he instead known Dr. Drayton, in What Lies Beneath. bowl next to his chair, and says,“Here, have a was met with removal from its panel of Robert Zemeckis’ 1999 movie What Lies fireball.” OK, questionable technique, needs to providers. Magellan sent his patients letters Beneath was a poorly received thriller with a be analyzed later, and all that, but what a terrific informing them that Shrager’s services would supernatural streak. Claire and Norman instant of connection. no longer be covered. Spencer (Michelle Pfeiffer and Harrison Ford) I hadn’t thought of fireballs for forty years Alarmed, Shrager engaged an attorney are struggling with their marriage, lost dreams, or so. In case you don’t know what they are, and obtained an injunction preventing his and a big remodeling job on their gorgeous old or have forgotten,Atomic Fireballs (their offi- removal from the panel, pending adminis- house. Norman sends Claire to a psychiatrist cial name, from Ferrara Pan, the candy com- trative review.The review confirmed his ter- because she is beset with anxiety, hearing pany that manufactures them) are extremely mination from the panel. Shrager went to whispers, acting increasingly paranoid, and hard candies that are so loaded with cinnamon court in October 2002, fighting to protect his seeing ghostly visions. they make your mouth hurt and so hard that patients’ privacy.The Pennsylvania Psychiatric Joe Morton has a brief part playing Dr. you have to choose between sucking forever Society supported him, covering two-thirds Drayton, Claire’s laid-back psychiatrist . But in or risk cracking a tooth by biting into one.Yet of his legal costs. their few minutes on screen together, cinema they are intensely pleasurable.What an exqui- doctor and cinema patient do a lot for shrink site metaphor for analysis. PR.They’re face to face and meeting for the The patient relaxes a little, and the thera- Robert Pyles, M.D., is chair of the Committee first time. In a spare performance, Morton pist says, “It’s hard because I’m a complete on Government Relations and Insurance, and conveys a calm acceptance, a useful curiosity, stranger and you’re talking about things that a former president of APsaA. He would be very and most of all an ability to attend humanely to are incredibly personal.” Dr. Drayton was pleased to discuss any of these cases further, his new patient’s discomfort. human, and more interested in the patient preferably by phone at 781-235-6211 or by Claire starts out her session saying she didn’t than himself. I’m thinking of getting some email at [email protected]. This is his regular want to come. Dr. Drayton patiently and non- fireballs for my office. column for TAP on politics and public policy. intrusively questions her about her anxiety. —Prudy Gourguechon

28 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 As the psychiatric expert for Shrager, I focused my testimony on the ills of carve- Poetry and the outs and managed care. Jim Pyles also provided expert testimony, using his detailed knowl- Unconscious edge of HIPAA. Fortunately, the amendments Sheri Hunt poetry to the HIPAA rules were not in effect at the time of the trial.The Magellan attorneys were I have recently made a point of attending more poetry readings. I hear a range of quality well aware that the HIPAA amendments gave of poetry at these events.What stands out when people get up in front of an audience carte blanche for the mining of information and read their poetry is that some poets are in closer touch with unconscious process and by insurance companies, without patient per- can let that process more immediately shape the content of their poetry.The metaphors mission, for business operations. are therefore fresher and have a quality of startling the hearer and making one say,“I think In March 2003, Judge Joseph James issued his I knew that, but I don’t think I knew it that way, until just now.” decision. Shrager’s refusal to turn over the In reading Sandra Walker’s poem below, I was first struck by its lyrical quality, and then records ”was justified and his termination was by the immediacy and freshness of the images that she allows to shine through. not warranted. … It is apparent that public policy and the standard of care require that a wall be erected around the confidentiality Landscapes of the patient’s psychiatric history.” However, he did rule that the company was justified in The small, somber canvas wasn’t present in our meetings then, asking for redacted records and that the psy- chiatrist should obtain that permission. (This or I never wondered of it. point has been appealed by Shrager.) Now it lives. This remarkable victory and significant legal You break silence to retrace its lineage: precedent did not impress the managed care Freud’s Wolf Man crossing boundaries in Berlin industry.Armed with the new HIPAA amend- to paint the Danube from forbidden hills. ments, managed care companies understand that patients have no privacy rights, and the Your story flows. companies have become more brutal in their demands for records. Shrager met recently I see the picture changing hands, crossing continents. with Blue Cross, the parent company that has Not beautiful, it is soft, unobtrusively displayed, taken over for the bankrupt Magellan. Blue your historic treasure. Cross indicated that the legal decision was inconsequential to it and applied only to a He, you tell me, risked arrest, crossed, again, political divides problem between Magellan and Shrager. Blue to teach a girl to paint. Cross made clear that it intended to continue to demand patient records without consent I wonder and would require Shrager to comply with if the Danube flows through years, breaks this policy were he to continue to serve on its into rivulets in urban, concrete deltas. panel. Shrager’s reply? “Not while I’m alive.” And so the battle continues. But this time it’s I can see it. different. Dan Shrager has made a lot of friends, Teach me how to paint. allies, and believers.This time he is not alone. —Sandra Walker [Editor’s note: For those still unfamiliar with some of the economic and legal terms involved, in this story, a “carve-out” occurs when an HMO subcontracts or “carves out” mental health serv- Sandra C. Walker, M.D., is editor of APsaA’s best practices bulletin, Forward!, a member ices to a subsidiary company. Carve-outs have of the Seattle Psychoanalytic Society and Institute faculty, and an assistant professor of been declared inherently discriminatory by both the Psychiatry and Behavioral Sciences at the University of Washington. Sheri A. Hunt, M.D., American Medical Association and the American who edits this column, is a candidate at the Seattle Psychoanalytic Society and Institute in Pyschiatric Association.“Redacted” is a technical both the adult and child training programs. A published poet and member of TAP’s editorial legal term meaning that identifying data has board, she welcomes reader comments and suggestions at [email protected]. been removed from the records.]

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 29 ETHICS

Institutional Ego from undue coercion to participate in research Continued from page 10 and undue harm that may result from such participation. Like the healthy and well-adapted down research programs that ultimately might ego of an individual, a well-run IRB acknowl- benefit large numbers of people suffering edges and integrates wishes, moral scruples, with mental disorders. Such a restriction on and reality factors. In the case of the IRB, research activity would be entirely inconsistent factors that must be kept in balance are the with the mission of institutions like McLean. human impulse toward scientific discovery; The IRB should work closely with clinical inves- the reality that financial and academic success tigators to ensure development of well- of individuals and institutions rides on con- designed studies that can answer pressing ducting clinical research; and the ethical values clinical questions while guaranteeing the pro- of respect for persons, their autonomy, and tections of informed consent and other rele- their basic rights. vant ethical imperatives. Interaction between Training in ethics and psychoanalysis has researchers and IRB members ought to be col- given me conceptual tools to approach these laborative and non-adversarial. issues, but unforeseen challenges keep me In the end, psychiatric researchers and IRB on my toes each time I examine a new members share the same fundamental value: research proposal and consider how to inte- to advance scientific knowledge and improve grate these various scientific, practical, and treatment options while protecting people ethical concerns.

Talking Points Cards Available

“Talking Points about Psychoanalysis” cards are available. The four-by-six-inch cards are printed on laminated stock, easy to carry without wear and tear, and ideal for your waiting room area. They can be ordered from the National Office.Ten cards are $5.00, twenty-five cards $10.00. Send your check to APsaA Store,American Psychoanalytic Association, 309 East 49th Street, New York, NY 10017.

New Committee on the Arts

Societal Issues Division coordinator Kerry Sulkowicz announced the formation of a new Committee on TAP board member Janice Lieberman picked up this ticket when she toured the Freud Psychoanalysis and the Arts. Laurie Museum at Berggasse 19, Vienna, this summer. Wilson will chair the committee. Janice observed that the designers translated Freud’s theory of psychic structure into contemporary graphic language.

30 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 COUNCIL

opposition to such a “piecemeal look at our Politics, Governance Dominate governance problems.” Allan Rosenblatt, speaking in favor of the June 19 Executive Council Meeting amendments, stated that an orderly hierarchy of power does not preclude collaboration. Councilors approved the California Psy- who has been advising APsaA choanalytic Society as a new affiliate society, on reorganization issues. despite concerns voiced by some members of The next Committee on LAPSI (the Los Angeles Psychoanalytic Society Council motion was described, and Institute). The California Psychoanalytic when presented by Gundle, Society becomes the third society in the Los as a “technicality.” It provided Angeles area. Sharon Zalusky, representing the that Council designate the CPS, was seated at the table as a guest of Executive Committee to act on Council.The new society will be able to seat its Council’s behalf for the next six own voting councilors at the January meeting. months, until the next national Treasurer Warren Procci reported that meeting. During the discussion we showed a $21,000 surplus for 2002, con- of this motion, Ron Benson siderably less than the anticipated $99,000 expressed the concern that surplus. Higher than expected legal fees con- small changes undermine our tributed to the difference, as did the shift of the system and can change the winter meeting to January, which moved some character of our organization. 2002 funds into 2003 accounting. Procci com- The motion passed, but protest Photo: Debra Steinke mended committee chairs for their continuing increased that these issues hadn’t Dean Stein (right) will become Executive Director of APsaA efforts to keep expenditures down. been pre-circulated. Jon Meyer in November. Ellen Fertig is retiring next year. observed that “we just got voted in by Coun- Judy Schachter explained the history of the cil for a six-month term, but by-laws proposals: In April of 2002, the By- we got voted in by members laws Committee was asked to develop a for two years.” procedural code that would only be modified A motion to encourage by joint action of the Board on Professional local societies to allow affili- Standards and the Executive Council, essen- ates to vote for Executive tially codifying a bicameral structure. At the Councilors at the local level time, Mosher argued the illegality of the was tabled until the next premise of a bicameral structure, and a group meeting because local soci- of members petitioned for the changes cur- eties had not had a chance to rently under consideration.The Council voted discuss it. against approval of the amendments (see box on page 33 for further details). BY-LAWS AMENDMENTS The Councilors considered ELECTIONS

Photo: Debra Steinke a motion to approve the two K. Lynne Moritz and Judith S. Schachter Marvin Margolis, coordinator of the Outreach Division, congratulates Stevie Smith, who completed her term as proposed governance by-laws received the Council’s endorsement as candi- chair of the joint Committee on Graduate Education. on oversight and de-linkage. dates for president-elect, for a two-year term Paul Mosher said the amend- beginning June 2004. MOTIONS ON GOVERNANCE ments provide the membership with a chance The Council elected four nominees from a Michael Gundle, chair of the Committee to express its views as to the proper rela- slate of nine to run for the office of councilor- on Council, introduced several motions on tionship between the board of directors at-large: Elizabeth Brett, Prudence Gourgue- governance issues. Some councilors objected (Executive Council) and the Board on Pro- chon, Richard Lightbody, and Robert Pyles. to these motions being offered without prior fessional Standards. Benson, however, argued Joanne Callan was nominated by petition sub- circulation. that the motions challenge our ability to sequent to the meeting. Two winners will The Council approved a motion to meet work together constructively. Nancy Kulish begin four-year terms in June 2004. in January with attorney Victoria Bjorklund, called the amendments divisive and voiced Continued on page 32

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 31 COUNCIL

Council Science: Beth Seelig presented the new Web site for the Fund for Psychoanalytic Executive Director Continued from page 31 Research, which can be accessed at http:// Approved George Allison and Peter Loewenberg www.apsa-co.org/ctf/ffpr/.The Science Divi- were elected to the Exploratory Subcom- sion is developing a number of new prizes to Dean Stein emerged from a field mittee of the Nominating Committee. encourage research in psychoanalysis. The of some fifty candidates to be chosen Arthur J. Farley and Lida Jeck were elected next poster session will be held at the Janu- by the Search Committee as APsaA’s for three-year terms on the Committee on ary meeting. new executive director. His selection Council. Communications: Prudy Gourguechon was approved by the Executive Eight individuals were elected to JAPA’s noted the ongoing efforts of the Strategic Council in Boston in June. Stein will editorial board: Sidney Blatt, Lewis Kirshner, Marketing and Public Information commit- assume his position on November 1, Lucy Lafarge, Janice Lieberman, Calvern Nar- tees. She announced that the first online edi- 2003, and will overlap with current cisi, Sidney Phillips, Alan Skolnikoff, and Leon tion of TAP appeared with the spring issue and administrative director Ellen Fertig Wurmser. henceforth TAP will be published on the (who is retiring in 2004), while he The Executive Committee asked the Coun- APsaA Web site at the same time as it is sent learns his way around the organization. cil to make the current treasurer of the Asso- to the printer. Most recently, Stein was deputy ciation a co-trustee of the Sigourney Trust. executive director of the Dyson MEMBERSHIP PROPOSAL Foundation in New York’s Hudson NEWS FROM DIVISIONS President Newell Fischer introduced his Valley. Prior to the Dyson Foundation, Governance: Richard Fox announced that new initiative designed to find paths to mem- he worked for fifteen years as Dean Stein is the enthusiastic choice of the bership for analysts who are not graduates of executive director of Chamber Music search committee for an Executive Director. APsaA institutes by noting that our member- America, where he oversaw a level The Council approved Stein’s hire. He will ship has dropped by 200 since January 2001 of growth including a twelve-fold replace administrative director Ellen Fertig, and that we are “graying” at an alarming rate. increase in earned income and a who is retiring in 2004. The average age of a member is sixty-four, or seven-fold increase in individual Outreach: Stephanie Smith completed six sixty-two if affiliates are included. memberships. Stein holds an MBA years as chair of the Joint Committee on Fischer said there are a variety of serious, from New York University. He has Graduate Education. She was the founding thoughtful analysts who cannot join APsaA experience in Web site development, chair of the committee, which has worked to because they do not meet our current mem- fundraising, conference management improve the presence of psychoanalysis in bership criteria. He has asked Harriet Wolfe and development, grant management, psychology and social work graduate pro- to head a task force to consider other possi- and program management. grams. Smith was honored for her contribution ble criteria. TAP will publish an interview with at the Friday Meeting of Members. Stein in the winter issue. Phylis Cath completed her second term as AFFILIATE COUNCIL chair of the Liaison to Schools Committee Affiliate Council president Nancy Blieden and received honors for her work heading announced that the council is concerned Amazon Fundraiser up this new outreach effort.The committee that 30 percent of current candidates have established the Educator Associates category not accepted affiliate membership. An Affil- Reminder of affiliation. iates Participation Committee has been The Council approved seventeen fellows organized to investigate. It will be interview- Members who order any products proposed by the Fellowship Committee. ing non-members to see what needs we (not only books) from amazon.com Division coordinator Marvin Margolis are not meeting. using the link on the APsaA Web site reminded councilors that the various out- Candidates are extremely interested in the will contribute a percentage of their reach committees can help societies develop re-organization process, particularly because purchase to APsaA. (Purchasing outreach programs to psychotherapists, stu- they feel they benefited so substantially from products from Amazon the usual way dents, educators, and other groups. The the education and membership agreement. doesn’t help the Association.You must Committee on New Psychoanalytic Centers Carmela Peres is the chair of a new Affiliate access amazon.com starting from has established groups in Birmingham, Mem- Committee on Racial and Ethnic Diversity.This apsa.org. ) All non-dues income helps phis, and Missoula, and there will soon be a committee will look at the lack of diversity keep down dues and helps support group in Sacramento.The goal is twenty cen- among the candidate body and work to increase our many programs. ters, but the committee is hampered by lack racial and ethnic diversity among the affiliate of funds. body and on the Affiliate Council.

32 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 for the PERPLEXED READER

As TAP’s circulation grows, an increasing number of our readers are not members of the APsaA but rather individuals who have significant interests in a psychoanalysis.TAP’sguide editorial board decided that it would be helpful to include a glossary of acronyms and abbreviations of the many groups frequently mentioned in TAP’s pages.We hope the following is useful.

Affiliate Council. A part of the APsaA that represents candidates from the institutes and new training facilities. Its officers are president, president-elect, secretary and treasurer. APsaA.The American Psychoanalytic Association. A national psychoanalytic organization of more than 3,300 analyst members, founded in 1911. Its component organizations are forty-two psychoanalytic societies, three study groups, and twenty-nine psychoanalytic training institutes. BOPS, the Board, the Board on Professional Standards.The part of the APsaA that establishes and monitors its educational functions, including accrediting institutes and certifying members. It consists of two fellows of the Board representing each of the twenty-nine institutes, and the chair and secretary of BOPS.The president, the president-elect, the secretary, and the treasurer of APsaA are non-voting ex-officio members of BOPS. The Board meets twice yearly at the national meetings. CGRI, the Committee on Government Relations and Insurance. A committee of the Council which deals with political issues on both national and local levels and analytic malpractice insurance. Committees. Council committees are created by and report to the Executive Council. Board committees are created by and report to the Board. In addition, there are joint committees of Board and Council.These committees are created by and report to both Board and Council to deal with overlapping responsibilities of the two bodies.Ad Hoc committees serve at the pleasure of the president, chair of the Board, or both. Divisions.The approximately 55 Council and Joint Council-Board Committees have been organized into six divisions: governance, psychoanalytic science, societal issues, communications, professional outreach and psychoanalytic practice. Each Division is headed by a Division Coordinator who assists chairs of committees with budgeting, program planning, manpower needs, and communication. Division Chairs report to the President and meet with the Executive Committee as part of the Steering Committee. Executive Committee.The leadership of the APsaA that oversees the many activities of the organization as specified by the by-laws.The committee comprises the president, the president-elect, the secretary, the treasurer, the chair of the Board, and the secretary of the Board.The Science Advisor to the Council serves as a nonvoting member. The Council, the Executive Council.The governing body of the APsaA. It consists of a councilor and an alternate councilor representing each of the societies and study groups, eight nationally elected councilors-at-large, the current officers, the last three past-presidents, and the past secretary. It meets twice yearly at the national meetings.The chair of BOPS and the Secretary of BOPS are non-voting ex-officio members. Members’ List, Openline, Brainstorming Line.Three internet listerves that members use to share views and information. Midwinter Meeting, January Meeting;Annual Meeting, Spring Meeting, June Meeting. The APsaA holds national meetings twice a year. In addition to the extensive scientific program, the Council, the Board, and the Affiliate Council meet.The Midwinter Meeting, also sometimes called the January meeting, is usually held in New York City.The Annual Meeting, also called the spring meeting or the June meeting, is held in various locations, usually in conjunction with the meeting of the American Psychiatric Association.An official meeting of members occurs at each of the two meetings. National Office. The APsaA national headquarters in New York City whose staff conducts the administrative work of the organization. www.apsa.org. url for the webpage of the American Psychoanalytic Association.

About the Lucy Daniels Foundation The Lucy Daniels Foundation is a private, nonprofit organization that fosters personal development, emotional freedom, and a deeper understanding of creativity through education, outreach, and a psychoanalytic treatment and research program. Writer and clinical psychologist Lucy Daniels established the foundation in 1989 to provide a means for creative people to learn how to cope with inner conflicts and to overcome psychological obstacles to self-expression. A national conference that features internationally renowned presenters is held each spring.Additional program offerings include “Dynamic Discourse,” an intimate discussion series with creative individuals from a broad variety of disciplines; an annual lecture series on art and psychoanalysis, featuring nationally prominent scholars, co-sponsored by the North Carolina Museum of Art; seminars and short courses for people engaged in a variety of creative media; and symposia in partnership with museums and other cultural and academic institutions, such as the National Humanities Center in Research Triangle Park. The foundation also conducts a unique treatment and research program, coordinated by research director Donald Baucom and psychoanalytic consultant Alan Stern. It is the first and only longitudinal study of the lives and complete psychoanalytic treatment of creative individuals. Currently providing treatment grants to a group of writers who are undergoing psychoanalysis, the foundation plans in the future to offer similar grants to individuals from other creative disciplines.A group of visual artists will be selected for the next segment of the research beginning in 2003. For details about the foundation and its programs, please visit http://www.ldf.org or call 919-677-9888, ext. 120.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 33 AWARDS

APsaA Awards at 92nd Annual Meeting Jack A. Miller

One of the highlights of the annual meeting Mary Scharold in Boston this past June was the presentation accepted the of Association awards. Excellence in teaching, award for the psychoanalytic scholarship, community service, institute. These writing, and outstanding service to the organ- clinics, chosen ization were recognized. for honors by Ethel Spector Person was awarded the the Committee Photo: Mervin Stewart National Woman Psychoanalytic Scholar on Community Brenda Solomon (left), standing with Ethel Person, Award. Brenda Solomon presented the award, Clinics, are ex- 2003 winner of the Woman Travelling Scholar Award. noting that Person’s long and distinguished emplary mod- career in practice, writing, and scholarship els of the interaction of psychoanalysis in a • Stephanie Dee Smith, who finished her has expanded and extended psychoanalytic larger community. term as the first chair of the Joint Com- understanding. The 2002 JAPA Awards for excellence in mittee on Graduate Education, was pre- The Third Annual Psychoanalytic Commu- psychoanalytic scholarship and distinguished sented with a certificate for her six-year nity Service Clinic of the Year Award was contributions to the journal went to Warren tenure on that committee. given to the Herbert Schiele Treatment Ser- S. Poland and Bonnie Litowitz. Poland’s award, • Phyllis Jean Cath, who completed her vice of the Saint Louis Psychoanalytic Institute. for his paper “The Interpretive Attitude,” term as co-chair of the Liaison Committee Nathan Simon accepted the award on behalf was presented by Rosemary Balsam. She and to Schools, was presented a certificate of the clinic. Paul Schwaber will succeed Poland as editors of recognition for six years of outstanding Honorable mention in Distinguished Psycho- of JAPA’s book section. Litowitz’s award, for work with that committee. analytic Clinical Service to the Community was “Sexuality and Textuality,” was presented by The Awards ceremony, though a small awarded to the Child Development Center of Steven T.Levy, editor-elect of JAPA. part of the meeting overall, demonstrated the Houston-Galveston Psychoanalytic Institute. Other awards for outstanding service: the vitality of the scholarship, service, and • Steven T. Levy, who is stepping down as interaction with the outside community Jack A. Miller, M.D., is a member of TAP’s chair of CORST, was presented with a that is helping to keep psychoanalysis in editorial board. certificate for service. the public eye. Photo: Mervin Stewart Photo: Mervin Stewart Warren Poland, a winner of the 2002 JAPA Prize, Bonnie Litowitz, here with JAPA editor-elect Steve Levy, with Rosemary Balsam, who presented the award. won the JAPA prize for her paper “Sexuality and Textuality.”

34 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 I n M emoriam

Harold S. Albert, M.D. Alfred Edgar Coodley, Janet Kennedy, M.D. Joseph Rudolph, M.D. May 8, 2003 M.D., Ph.D. May 25, 2003 July 2, 2003 April 16, 2003 Bernard Barash, M.D. Leo S. Loomie, M.D. Lionel A. Schwartz, M.D. September 22, 2002 Robert Gillman, M.D. March 16, 2003 December 24, 2002 July 1, 2003 David Beres, M.D. I. Floyd Mallott, M.D. Joseph L. Sheridan, M.D. February 15, 2003 Doris M. Hunter, M.D. April 17, 2003 June 30, 2003 July 8, 2003 Kenneth T. Calder, M.D. Leon L. North, M.D. James Titchener, M.D. April 23, 2003 Enrico Jones, M.D. April 1, 2003 February 28, 2003 March 29, 2003 Jerome Cohen, Ph.D. Milton Rosenbaum, M.D. Edward D. Titus, M.D. March 16, 2003 Jerome B. Katz, M.D. May 18, 2003 June 23, 2003 May 14, 2003

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 35 BOARD ON PROFESSIONAL STANDARDS

modifications in the wording of the BOPS A Time of Change—BOPS After Boston position statement. They opposed the pro- Ronald M. Benson posed amendments of the by-laws, feeling they were ill-timed and piecemeal at a time The meeting and the Board on Professional Standards and when comprehensive change was best.The Fel- of the Board on its accrediting bodies.The committee felt this lows felt also that the proposed amendments Professional Stan- was best to avoid any real or perceived con- contradicted the collaborative relationship dards in Boston flicts of interest and that it was best for the between Board and Council mandated by the last May was profession of psychoanalysis as a whole.The agreement developed by the Task Force on progressive and committee advocated a fast-track approach Education and Membership. productive. Issues toward achieving its recommendations. The final statement opposing passage of of governance A thoughtful and full discussion of the report these by-laws amendments was overwhelm- and of educa- followed its presentation. All the Fellows of ingly approved by the Fellows. On Thursday at tional methods the Board who voted accepted the report; the Executive Council, an equally rich discussion Ronald M. Benson and standards two abstained. took place. By a wide margin, the councilors were equally prominent in the agenda. I have already appointed a new ad hoc task voted not to accept the proposed by-laws The much-anticipated final report of the force, chaired by Beth Seelig, to develop a amendments. Ad Hoc Committee to Study Certification roadmap for achieving implementation within As I interpret the actions of Board and lived up to its billing. Co-chairs Cal Narcisi two years.This roadmap will define steps to Council, they both supported a collaborative and Don Rosenblitt and their committee pro- be taken within BOPS.The new task force will and consensual approach to reorganization duced a document whose implications went also need to consider how its report can be of our Association’s governance and opposed far beyond the matter of certification per se integrated with other efforts toward reor- piecemeal and divisive approaches. The two and addressed profound philosophic issues ganization now being considered within our representative bodies favored a consultative basic to our structure. (The full report is avail- Association. Our objective is to have the best, relationship to each other as was the mandate able on our Web site.) fairest, and most meaningful certification of the education and membership process. The committee strongly supports the con- process that can be achieved, one that will have cept of certification.The report asserted that wide recognition and prestige. TRAINING, MEMBERSHIP The Board considered the first report by the Task Force on Training Analyst Standards. Certification is necessary to assure the public that we Myrna Weiss, chair, said the task force was are committed to professionalism and self-assessment. rewriting the standards to emphasize the avail- ability of waivers.The most difficult situation to resolve is when a potential candidate is in the sole purpose of certification should be to REORGANIZATION, BY-LAWS analysis with an analyst who is not a training assure competence as a clinical analyst. The The new BOPS Task Force on Reorganiza- analyst. The task force considered means to committee concluded that certification is nec- tion made its first report. Co-chaired by Leon permit a continuation of this analysis for essary to assure the public that we are com- Hoffman and Eric Nuetzel, the task force training purposes, but it is a complex task to mitted to professionalism and self-assessment. began by considering the role of the educa- develop a methodology consistent with our The committee’s specific recommendations tional perspective within APsaA. It is consid- quality and educational responsibilities and were far-reaching.The report recommended ering such questions as the place of BOPS’s consistent with sound psychoanalytic principles. dividing the duties of the current Committee functions after a reorganization. Should they The Fellows were very responsive to the on Certification between two committees. be internal or externalized, in full or part? The issues raised by this initiative and made many One would administer the process, and the task force’s report said that the “educational excellent and wide-ranging proposals. Some other would study it.The report also made var- functions and values of APsaA are precious were concerned that methods for assessing ious suggestions to improve the validity and assets that should be safeguarded in any an analyst for a potential waiver be carefully reliability of the examination and to broaden its restructuring plan.” crafted to protect the privacy and integrity of methodology. Its most visionary recommen- The Fellows took up the two by-laws pro- the ongoing analysis. Others spoke of the finan- dation was that the certification body be inde- posals that were submitted by petition of cial burdens of training analyses on candidates pendent of both the membership organization members. BOPS has the right to send its com- and training analysts alike. The task force will ments along with the proposed amendments continue its efforts toward progressive and Ronald M. Benson, M.D., is chair of the when they are sent to the membership. In an responsible change. Board on Professional Standards. extensive discussion, the Fellows made several Continued on page 39

36 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 BOARD ON PROFESSIONAL STANDARDS

June 2004, when Ron Benson completes his Board Considers Reorganization, term. Nuetzel chose Beth Seelig to serve as secretary of BOPS during his term. Nuetzel Standards; Nuetzel Next BOPS Chair ran unopposed. Responding to a tide of change within the identifying problems, which include institutes The Committee on Certification requested organization, the Board on Professional Stan- competing with other training sites with less a legal consultation regarding HIPAA privacy dards heard reports from no fewer than rigorous standards, and expects to deliver its regulations; two of the current applicants four new task forces convened recently by final report in June 2004. were “covered entities” under HIPAA. The BOPS chair Ron Benson to address vital and committee announced that twelve first-time controversial issues. (See Ron and two continuing applicants Benson’s essay on page 36 for applied for certification. Seven a report on the work of these were approved: six first-timers task forces.) and one continuing applicant Recommendations of the (see the box on page 39 for certification task force included the list).This first-time approval preserving certification, exter- rate of 50 percent is lower nalization, improving validity than recent first-time approval and reliability and splitting the rates, which have run around certification committee in two, 70 percent. However, the num- one committee to administer bers are very small. the tests and the other to study Steve Levy was thanked the process. Several commen- for his work chairing CORST, tators, including Jon Meyer and a position he is leaving to as-

Betsy Brett, disagreed with the Photo: Mervin Stewart Photo: Mervin Stewart sume the editorship of JAPA. necessity or advisability of ex- As chair, Levy worked on the Eric Nuetzel, elected chair of the Board, will assume office in ternalization. Brett suggested June 2004, when current chair Ron Benson’s term concludes. procedures and standards of that we are moving a problem Nuetzel chose Beth Seelig to serve with him as secretary. the committee and estab- rather than fixing it. Bob Pyles lished CORST liaisons be- asked if there really is “political tween component institutes pressure” on the certification and committee members. process, and the answer was yes. CORST members will help the Pyles supported full externalization. Calvern TRAINING ANALYST STANDARDS local institutes with recruitment, preparation, Narcisi, co-chair of the task force with Don The Ad Hoc Task Force on Training Analyst and assisting CORST candidates with career Rosenblitt, noted that the task force believed Standards was asked to examine the stan- development. Because universities, like psy- unanimously that the certifying body needs to dards on selection of training analysts to see choanalysis, are committed to the life of the be external and independent. Rosenblitt stated what provision might be made for waivers in mind, a strong CORST program is seen as that the main problem is that the general the case of a potential candidate in analysis vital for our organization. Mel Lansky is the membership does not believe the certification with a non-training analyst.The task force has new chair. process has meaning and integrity. yet to arrive at a proposed solution to the The Committee on Psychoanalytic Educa- Many Fellows commended the task force on problem. One option is to consider an “asso- tion (COPE) announced a fall teacher training producing a superb report, praising the crite- ciate TA” category for certified analysts with- retreat.The committee is trying to retrieve the ria delineated and the clear thinking of the out immersion who are on the “TA track.” A archives of past COPE study groups for the use committee. full report is expected in January 2004. of the organization. COPE continues to study Peter Loewenberg spoke up in support of methods of pedagogy, having recently asked CANDIDATE RECRUITMENT institutes having local option. Newell Fischer Stuart Twemlow to teach a model class on The charge to the Ad Hoc Task Force on appealed to the task force to be diligent but community psychoanalysis. Recruitment, chaired by Philip Herschenfeld, speedy in its deliberations. The Committee on Institutes announced proceeded from the fact that the average that twenty-five individuals were appointed age of our trainees is increasing. The task OTHER BOPS NEWS as training and supervising analysts (see page force was asked to look at how to promote Eric Nuetzel of St. Louis, currently BOPS 39).The Committee on New Training Facilities recruitment of candidates at an earlier stage of secretary, was elected to serve as the next also announced the appointment of two train- their careers.The task force is in the phase of chair of the Board. Nuetzel will take office in ing and supervising analysts.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 37 APsaA GOVERNANCE

Proposed Governance By-laws

Two by-laws proposed by member petition will come before the membership for a vote this fall.The by-laws were widely discussed at the Boston meetings, at the Board and Council meetings and in other forums. The proposing group described itself as “50 voting members of APsaA including two former Presidents, two Councilors-at-Large and other Councilors.” It is affiliated with the Wednesday Group, a long-running ad hoc group that meets to address APsaA policy and governance issues.

DEFINING OVERSIGHT The Wednesday Group and the other proposers issued a statement explaining the by-laws. First, they remind us that the Executive Council is the board of directors of the corporation and the only body under law that can enact the policies of APsaA. The proposed “oversight” by-law has four provisions:

1. The Board on Professional Standards will report all its actions to the Executive Council at both national meetings. 2. Unless otherwise prohibited by the by-laws or state law, the actions of BOPS will be effective without Executive Council approval. 3. Any action of BOPS is subject to rescission or change by the Council. 4. The Council may submit to the members for approval any action it takes under the provisions above.

The proposers argue that the oversight by-law extends a special status to the Board, allowing it to take action without Council approval, even as it reaffirms the existing supervening authority of the Executive Council. Opponents argue that the by-law (1) is not necessary, as the Exectutive Council already has legal responsiblity for all organizational functions, and (2) violates the spirit of cooperation and balanced responsibilities between Board and Council carefully worked out in the report of the Task Force on Education and Membership (TFEM).

DE-LINKAGE The second by-law, called informally the “de-linkage” by-law, modifies the provision in the APsaA by-laws that currently requires that all members of BOPS committees and every applicant for training or supervising analyst status must be certified. According to its proponents, the proposed modification simply deletes the certification requirement in the by-laws. Supporters of the amendment point out that their proposal does not actually remove the certification requirement, since this can remain part of the Board’s rules; the amendment removes the issue from the by-laws only. It would remain the option of the BOPS chair to decide whether or not to appoint non-certified members to Board committees. Further, it would be the option of the Board to require training analysts to be certified.

COUNCIL AND BOARD VOTE AGAINST BY-LAW APPROVAL The Board on Professional Standards approved a statement recommending members vote against the by-laws.This advisory opinion of the Board will accompany the amendments when they are sent to members for a vote.The Board’s opinion stated that these by-laws are ill-advised at this time while a comprehensive revision of our governance is under way. The BOPS statement goes on to say that the de-linkage by-law is really two separate proposals.While appointment of non-certified analysts to Board committees may have merit, the de-linkage of certification from TA status directly infringes on BOPS responsibilities. Finally, the Board argued that approval of these by-laws at this time would needlessly complicate the process, currently under way, of revising our governance structures, prematurely foreclosing various options for reorganization. After considering the proposed by-laws at its Thursday meeting, the Council defeated a motion to approve the by-laws.A record of this negative vote will accompany the proposed amendments when they are sent to members for a vote.The Council does not have the prerogative, according to existing by-laws, of sending a more extensive opinion out with proposed by-laws.

38 THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 BOARD ON PROFESSIONAL STANDARDS

Certified in Training and Supervising Analyst Appointments, Psychoanalysis June 18, 2003 by the Board on Adult Psychoanalysis Training and Supervising Analysts Professional Aisha Abbasi, M.D. (Michigan) Standards, Barbara Almond, M.D. (San Francisco) Wednesday, Cecile R. Bassen, M.D. (Seattle) Lisa Buchberg, D.M.H. (San Francisco) June 18, 2003 Deborah L. Cabaniss, M.D. (Columbia Univ.) Lindsay Clarkson, M.D. (Washington) Certified in Adult Psychoanalysis Seth Eichler, M.D. (NYU) Mary Brady, Ph.D. Julie Gardner, Ph.D. Salee Jenkins, Ph.D. (Chicago) Sybil Houlding, M.S.W. Phil S. Lebovitz, M.D. (Chicago) Victoria Morrow, M.D. Milagros Picon, M.D. (NYU) Gay Parnell, Ph.D. Donald Ross, M.D. (Washington) Steven Shulruff, M.D. Marie Rudden, M.D. (Berkshire New Training Facility) Harvey J. Schwartz, M.D. (Philadelphia) Certified in Child/Adolescent Mark Scott, Ph.D. (San Francisco) Psychoanalysis Joan Wheelis, M.D. (Boston) Jay Alan Davis, M.D. Geographic Rule Adult Psychoanalysis Training and Supervising Analyst Roy Aruffo, M.D. (New Orleans)

BOPS After Boston Geographic Rule Adult Psychoanalysis Supervising Analysts Lawrence B. Inderbitzin, M.D. (Pittsburgh) Continued from page 36 Daniel Jacobs, M.D. (Florida) I announced to the Board that as suggested Edward R. Shapiro, M.D. (Boston) by Newell Fisher, the BOPS Membership Com- Henry F. Smith, M.D. (Florida and Minnesota New Training Facility) mittee will greatly modify its application proce- dures for IPA graduates who want to become Geographic Rule Adult Psychoanalysis Training Analyst members of APsaA.The current process is too Austin Silber, M.D. (Michigan) cumbersome. The new streamlined process will involve filling out a very simple application Child/Adolescent Psychoanalysis Training and Supervising Analysts form.I have also asked the BOPS Member- Helene Keable, M.D. (New York) ship Committee to consider methods to allow some non-IPA graduates to join APsaA. Geographic Rule Child/Adolescent Psychoanalysis Supervising Analysts The Fellows, by acclamation, elected Nuet- Judith Chused, M.D. (Seattle) zel and Seelig as the next chair and secretary Benjamin Garber, M.D. (New York) of the Board.Their terms will begin after our Irwin C. Rosen, Ph.D. (St. Louis) meetings in San Francisco next June. Phyllis Tyson, Ph.D. (San Francisco and Seattle) Once again, the actions and discussions of the Board and of the Council seemed to Robert Tyson, M.D. (Seattle) demonstrate that there is substantial consen- sus about the kind of Association we wish to be. It seems that our long-standing amalga- The task that confronts us now is to bring influences that might compromise their objec- mation of educational and membership con- those values within the umbrella of the laws tivity.We have managed the insulating aspects cerns is widely supported, and the consultative that govern non-profit corporations and to for many years and, with diligence and good relationship between Council and Board con- assure that such educational matters as accred- will, we can accomplish the goal of complying tinues to work effectively. itation and certification are insulated from with the not-for-profit laws also.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 3 39 NONPROFIT ORG. US POSTAGE P AID ALBANY, NY PERMIT #370

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