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The American Journal of Psychiatry, VOL. 157, No. 4
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Book Forum: PSYCHOANALYSIS   |   April 01, 2000 
Lay Analysis: Life Inside the Controversy
LEO H. BERMAN, M.D.
Am J Psychiatry 2000;157:652-653. 10.1176/appi.ajp.157.4.652
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By Robert S. Wallerstein. Hillsdale, N.J.Analytic Press, 1998, 511 pp., $69.95.
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This is a strange book. I had difficulty deciding for whom it was written. It purports to be an account of the struggle of nonmedical analysts to be accepted by official psychoanalytic organizations. Although the International Psychoanalytical Institute did accept members who were not physicians in other countries, it had a special arrangement with the American Psychoanalytic Association that only physicians from the United States could be accepted officially as psychoanalysts. This arrangement was challenged by a number of psychologists in 1985, who sued the organization, claiming that "the American [Psychoanalytic Association] unfairly monopolized the quality psychoanalytical training market across the nation and thereby barred psychologists from proper access to this training and practice, which deprived them of this lucrative and prestigious means of earning a livelihood" (p. 137).
The negotiations sparked by this litigation carried over for 6 years, and Dr. Wallerstein, as President of the International Psychoanalytical Institute, traces in detail the correspondence, interactions, and interventions that took place during this extended period, but for what purpose? Who, other than legal experts or students of organizational development, would be interested in such a meticulous and detailed description encompassing more than 450 pages? The struggle can be summarized in a quotation from the book:
The years of the lawsuit, from March 1985 to October 1988, were especially stressful and combative. Unhappily, even after the settlement of the lawsuit, the struggle between the defendant organizations and the erstwhile plaintiffs continued and at times seemed unabated in intensity. A quieting ultimately came as the IPA processed and accepted into component society status, those nonmedical psychoanalytic training organizations in the United States that desired the IPA affiliation and were willing and able to bring their training practices into accord with IPA requirements. (pp. 440–441)
This exhaustive examination of the issues, however, does not really come to terms with the basic question of why the conflict occurred. Was it a matter of economics alone or a more philosophical issue as to whether this method of treatment is a subspecialty of psychiatry? The training of the physician, with the experience of being present at childbirth and at the deathbed, provides him or her with unique view of mankind, which I believe is not given in any other training (and I say this having both an M.A. in psychology and an M.S.W.). The problem presents itself today in a variety of other ways. Can the analyst prescribe medication, or does he or she have to use another person to manage the prescribing, and how does this affect the analytical situation? Psychologists are trying to deal with this now by attempting to get legal approval to prescribe medication.
Toward the end of the long drawn-out suit, the issue became one of whether psychoanalytic treatment had to be conducted four times a week, or whether three times a week could be accepted. No one questioned how it came about that four times was good and three times was bad. Why not five times a week? Is it an apocryphal story that when asked, "Why four times a week?" Freud is said to have answered, "Four times five is 20, and five times four is 20, and so if we see a patient four times a week, we can see five patients." So perhaps it does all come down to economics.
There is no question that there are excellent analysts who are not medically trained. Nor is there any likelihood of turning the clock back at this point. The situation will remain as it is, and other forces are already at work to change the face of psychoanalysis. This book, then, will remain as an archival account of a particular and peculiar struggle in the life of a profession.
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