Psychoanalysis and child and adolescent psychiatry.

This report describes psychoanalytic advances in theory and practice as well as changes in knowledge about determinants of behavior from infancy through adolescence. These changes influence how dynamic psychotherapy is conducted. Mother-infant research, affect development, object relations separation-individuation theory, and newer concepts of regulation of self-esteem are explored as they affect treatment strategies. The authors also review countertransference transference and psychoanalytic reconstruing of adolescence as a stage and their influence on how therapy is conducted. Finally, the authors propose using a dynamic formulation as a means of determining where or when the therapist intervenes.     

The Left and Far Left in American Psychoanalysis: Psychoanalysis as a Subversive Discipline

This article explores the political commitments of the European-born émigré psychoanalysts and a group of American-born psychoanalysts who had a far left (Communist or fellow traveler) past. It describes the national and local struggle for power and ascendency in these two groups. Also, the article explores the impact that Marxism had on the theory and practice of what I call “American Communist Psychoanalytic Thought Collective,” in particular on pragmatic optimistic and dialectical theory. The downside was rigidity, a sense of certainty, and lack of tolerance of dissent and organizational authoritarian structures. The article ends with a plea to restore the balance between control and risk in order to restore the vitality of psychoanalysis and assure its growth. After years of repression, exclusion, and schism, we need to subvert entrenched power and advance the thesis of roles and the antithesis of insurgency.     

The industrialization of American psychiatry

Physician surpluses and escalating medical care costs have fostered an alliance among government, corporate America, and health insurers that has inspired medicine's industrialization. These same forces will transform psychiatry into an industry where prospective payment, automation, salaried employment, and central control of clinical activities threaten to become the dominant form of medical practice. Emerging trends suggest that both patients and health professionals will gravitate to various forms of alternative provider organizations in an effort to shield themselves from the economic uncertainties of seeking and providing care. The chronically mentally ill and others requiring extensive treatment risk exclusion from this new system, where cost consciousness may supplant compassion.     

Twentieth-century developments in American psychiatry

This article traces the development of psychiatric services from their institutional base at the turn of the century to the enactment of the Community Mental Health Center Act of 1963. Many perceived this legislation, which brought about community based but federally funded psychiatric care, as a radical departure from existing trends; indeed, President John F. Kennedy introduced it as a bold new approach. In fact, it represented the culmination of a slow, gradual evolutionary development. This article identifies the concepts underlying community psychiatric services and their programmatic elements and specifies their time of origin. The author concludes that while the current federal initiative in community psychiatric care (e.g., CHHCs) may be in jeopardy, its evolutionary nature ensures its continuance in one manner or another.     

Peer review and PSRO in American psychiatry

The past 5 years have provided major pressures for and development in the varied areas of peer review of medical services. Organized psychiatry's activities on the national and local levels have been vigorous and responsive. The author traces the development of the mandated, professional and third party payer forms of peer review and the mechanisms and requirements within these programs. The specific programs and projects within the American Psychiatric Association and it's district affilates are also reviewed.This paper was presented at the Ninth Biennial Divisional Meeting, Area-II Council, American Psychiatric Association, New York, Nov. 7, 1976.