The Iconic Couch

Here's what I don't understand. As a psychoanalytic organization we struggle to refute the old canard that "psychoanalysis is dead". We fight to ensure that psychoanalytic theory and therapy are still taught in the core mental health professions of psychiatry, psychology and social work. We labor on public information efforts to make sure that people are still aware of our profession and our theory, because we truly believe they are invaluable.

But for decades we have been aware that it is a hard struggle. Mental health professionals frequently exit their training without any exposure to an in-depth understanding of "what lies beneath" patients' manifest behaviors. We still encounter educated people who say "Psychoanalysis--what's that" or "isn't that gone". I won't (right now) even go into the issues with third party insurers, with medication, with evidence based medicine.

So back to what I don't understand. I often seem to run into uses of the psychoanalytic couch as evocative image in fashion and design magazine, television commercials and shows. The surrounding drama or copy often suggests that psychoanalysis is fresh on every cultured and educated person's mind. I mean really, fresh, right there is the forefront of their collection of cultural iconic associations.

Case in point: I'm reading the December/January Dwell magazine. Dwell, for those of you who don't know it, is a modern design magazine, very hip and successful. Each issue has a feature "In the Modern World" which covers the products, furniture, buildings, books etc that interest the editors that issue. So in the furniture section of this winter issue, page 58, is a beautiful piece of furniture called "lounge chair" by Kaj Franck for Artek (artek.fi). It's black leather and bent plywood, sleek and elegant. Here's the copy from the Dwell editors:

Lie back, relax, and tell us about your mother. Innovative bentwood, L-leg construction ensures this lounge chair's longevity, so generations to come can reflect on the simplicity of the design.

So back to the mystery. How can we psychoanalysts be both struggling to avoid obsolescence at the same moment that we are a vivid cultural icon, rich with collective associations? How can we exploit the lingering traces in the public's minds that say it really really is important, sometimes, and for some people, to lie back, relax, and tell us about your mother.

Waxman Chairmanship Bodes Well

Congressman Henry Waxman (D-CA) has unseated Congressman Dingell (D-MI) as chairman of the House Energy and Commerce Committee. This could be a positive development for privacy protections in health IT legislation (electronic medical records). Mr. Waxman was very helpful to APsaA in its efforts to promote the inclusion of a provision in the Energy and Commerce HIT bill that expressly preserved the psychotherapist-patients privilege. Mr. Waxman has also expressed concern over the number of electronic health record breaches and the lack of enforcement of provisions (weak as they are) in the HIPAA Privacy Rule. We at APsaA have worked hard with the Energy and Commerce Committee, and congratulate Congressman Waxman on his chairmanship.

Daschle to be HHS Secretary--will he uphold his own views on health information privacy?

The Obama transition team has named former Democratic Senator Tom Daschle as the Presdient-Elect's pick for Secretary of the Department of Health and Human Services.

APsaA's Legislative representative, Jim Pyles, reports the following:

Senator Daschle, as Senate majority leader in 2000, established the Congressional Privacy Caucus which is currently co-chaired by Congressman Ed Markey. In announcing the formation of the Caucus, Senator Daschle issued the following statement [in 2000]:

The issue of privacy touches virtually every American, often in extremely
personal ways. Whether it is bank records or medical files or Internet
activities, Americans have a right to expect that personal matters will be
kept private. Today, in too many ways, however, our right to privacy is at
risk. Our laws have not kept up with sweeping
technological changes. As a result, some of our most sensitive,
private matters end up on databases that are then sold to the highest
bidder. That is wrong, it's dangerous, and it has to stop.

Psychoanalysts, because we work with the most sensitive and personal information, are exquisitly sensitive to issues of health record privacy. We know that without absolute assurance of confidentiality, our patients won't be able to get the help they need. So confidentiality and privacy are never far from our minds. Secretary- to- be Daschle will have many issues and demands on his attention. We hope that his exquisite sensitivity to privacy issues, eloquently expressed in his 2000 statement, will remain strong under the onslought of pressures he is about to face. The American Psychoanalytic Association and our partner organizations will continue to be loud advocates for privacy in the coming health care revolution.

Military Families top priority of new first lady

On Veteran's Day APsaA announced its Soldiers and Veterans Initiative . I was very pleased to hear Michelle Obama say, in last week's interview on 60 Minutes, that meeting the needs of military and veterans families would be an area of focus for her as First Lady. It's gratifying how many Americans, both as individuals and as activist groups, are trying to make a contribution to the needs of soldiers and their families. They have served in a difficult, frightening and unpopular war. They deserve the best the country can provide. As psychoanalysts we wanted to make our contribution to the public conversation as specifically psychoanalytic as possible. What do we know something about, as psychoanalysts, that might not be the focus of other groups? We decided on two core themes:

• The effect of war trauma on families and children of soldiers, including the transgenerational transmission of trauma
• The need for long term mental health treatment and/or long term access to treatment for soldiers, veterans and their families who are suffering the sequelae of war trauma

We hope to join our efforts with other mental health and veterans groups, and the new first lady.