Mad Women and the Right to Privacy

Mad Men, a hip and quirky TV drama on AMC, won the NY magazine's vote for best TV show of 2008 in their review of "The Year in Culture" (New York Magazine, Dec 13, 2008).

The show's premise is unappetizing--a bunch of drinking- before- lunch Madison Avenue advertising executives in 1960, busily engaged in sexual harassment of their secretaries, with pre Betty Friedan wives writhing in neurotic misery back home. It's execution is impeccable and addictive.

NY Magazine describes it as

A corkscrew meditation on gender, all retro-visual pleasures and sideways rhythms, the second season focused on the collect-'em-all triad of Betty, Peggy, and Joan.

Among the show's mesmerizing gimmicks is to show how far we've come (not an unwelcome trick in times that feel so spoiled). It throws in 1959-1960 era behaviors that simply take your breath away. In one scene, the gorgeous Draper family goes on a family picnic, trying to repair assorted wounds. At the end of the picnic everyone stands up, shakes the trash off the table cloth and gets back in the car, leaving the litter on the beautiful grass hill. Oh yeah, 1960 was before Betty Ford's (or was it LadyBird Johnson's) beautify America campaign.

Betty Draper is the wife of the lead character, Don Draper, and in Season One, she is introduced as very unhappy, with hysterical numbness of her hands and generalized anxiety. Her doctors find it's all in her head, and she persuades her reluctant husband to send her to a psychiatrist. We then see her in a classic analyst's office. Lying on a couch free associating while a dour and silent analyst takes notes and says basically nothing. The caricature of the silent, remote and disconnected analyst is mildly disturbing, but then something far more shocking happens.

After Betty presumably has had a couple of diagnostic sessions with the analyst, Don slips away one night and secretly makes a phone call. The person on the other end of the phone is not a mistress, as we might guess, but the analyst, who is expecting Don's call. Apparently they have an arrangement that they can talk about Betty and her treatment without her knowledge. The violation of Betty's privacy is absolutely shocking on screen. Whether such a practice was accepted in 1960 I don't know. Today, it would be a grave error and ethical lapse for a psychoanalyst to conduct herself that way. As jarring as throwing a bucket of litter on the road, though more serious.

Yet today we are still fighting to preserve patient privacy. The American Psychoanalytic Association has been working for years to preserve the right of consent for the release of personal health care information. And more recently, we are fighting to include privacy protections in the forthcoming health information technology efforts that will be part of the Obama administration's health care reform package. The Associations website (www.apsa.org) contains a vast amount of material related to the fight for patient privacy.

The Unconscious--2nd Place Prize from CNN

I'm grateful to APsaA member Paul Brinich, a reliable source of interesting and sometimes quirky information, for calling our attention to a wonderful article on the European edition of CNN's website. CNN's Mairi Mackay wrote the piece, which lays out the staff's list of the ten best ideas, ever. The first is farming, not to be argued with. But the second is the psychoanalytic concept of the unconscious.

CNN describes the impact of the idea like this:

When Freud, the father of psychoanalysis suggested that our behavior is not always ruled by our conscious thoughts, nor is it always in our best interests, he formed the basis of the idea that individuals can be curious about themselves and make a study of their own minds....His ideas have permeated pop culture to such an extent that much of what we understand about the sexes, relationships, films and books can be seen as reflected through a Freudian mirror.

Coming after farming and the unconscious are

• relativity
• vaccination
• human rights
• evolution
• world wide web
• soap
• zero
• gravity

Interesting company.

The complete article can be viewed at http://tinyurl.com/613nag

I also poured through the New York times list of the 100 best ideas of 2008 from last Sunday's paper. The list includes such striking ideas as "eat kangaroos to fight global warming" and "moonvertising". Some of the 100 are interesting and quite serious. But alas, psychoanalytic ideas, being not brand new, didn't make it into the NY Times list. I'm happy we got into the top 10 of all time. I'd add "transference" and "development" as two other all time greats.

My neighbor, Governor Rod Blogojevich

For the last year, while gutting and remodeling my home and office a couple of miles East, I have lived in an apartment in a NW side neighborhood of Chicago sometimes called Albany Park, and sometimes called Ravenswood Manor, depending on which side of the class divide you're on. One block North of my apartment is the home of now notorious Illinois Governor Rod Blogojevich. Right now the streets are filled with parked satellite vans, and about 10-15 videocameras are trained on the alley to the side of his house, hoping to catch a climpse of the recently arrested Governor as he enters or exits.

Before the Gov was arrested 3 days ago, I was already mildly fascinated with his home. I'd walk my dog there last summer, and, regretfully, stop her from doing her business on his property for fear of the constantly present state troopers There were always three or four freshly washed vehicles parked and running (and the same number of armed guys). As I drove by on my way to the office I'd find myself wistfully envious of a position that meant you always had your car washed. This is particularly important in a Chicago winter, because your car always gets covered with salt which quickly smears itself on your winter black clothes. Not the governor's though.

Last night, I gave in to the desire to walk down the block and gawk. It was dark and cold. The NE corner of the intersection was as bright as day with some TV kleig lights.  Across from the Governor's alley were the gaggle of cameras. There was really nothing much to watch, but the anticipation of catching someone so blatantly corrupt and garandiose, so outrageous, was exciting. Watching the media watch for him, waiting to pounce was exciting.

I think there is great comfort for us all when a public figure is caught being so blatantly (allegedly) bad. There's comfort in seeing a bad guy in a bad spot. Our badness, and guilt, and rough spots seem so much easier to handle. Anxiety drops as we watch him squirm.

In today's Chicago Sun Times, on the 2nd page, there is a prominent story where a psychologist offers a diagnosis to explain the governor's behavior, and says that his hair is a giveaway to the diagnosis. As psychoanalysts, our ethical code prohibits offering diagnostic formulations about someone we havn't seen in consultation. Anyway, what I'm finding more interesting at the moment is the impact of his behavior on the rest of us. I noted in myself a surge of voyeurism, and a not too pretty feeling of glee.

It simply proves the point that psychanalysts have known, and worked with, for so long. That none of us lacks the darker aspects of human nature--greed, selfishness, lack of empathy, voyeuristic or sadistic pleasure. The hard work of self awareness enables most of us flawed humans to maintain a moral compass.

Pragmatism, George Engle and PPP

There's a journal I've subscribed to for a couple of years that I like very much. It's called Philosophy, Psychiatry and Psychology (PPP) and is a joint American-- British effort with an international editorial board of, not surprisingly, psychiatrists, psychologists and philosophers.

The latest issue is devoted to a consideration of George Engel's biopsychosocial model, which Engel unveiled in 1977 and which had a tremendous impact on medicine and psychiatry. Being a person with a very practical turn of mind, I always loved Engel's theory, so I was delighted to see the special issue in PPP. For me it immediately served as an organizing principle for clinical work that never lost its utility.

When I fret about contemporary health care policy, with its corporate flavors of pay for performance and misusing the valuable scientific approach of seeking evidence for the effectiveness of treatments to curtail treatment provision, I think of the corrective that the biopsychosocial model can immediately provide for health care policy.

Bradley Lewis, in the lead article in the journal, says that

the biopsychosocial model has become a beacon for the balanced and humanistic approach to clinical encounters. Indeed, it has become a beacon for the soul of medicine and psychiatry in the twenty first century.

The lead article in the Engel issue of PPP considers the question of whether the biopsychosocial model fits with the principles of philosophical pragmatism. Being too pragmatic to be philosophic, I can't address the question, but it interests me. Can psychoanalysis be pragmatic?

President-elect Obama has been announcing his cabinet appointments over the last week or two, and I noticed that the descriptor "pragmatic" was used in more than one introduction. Suddenly pragmatism is in the air. That's interesting.

I got in touch with the co-editor of PPP, John Z Sadler, who is professor of psychiatry, and, among other distinguished roles is Chief of the Division of Ethics and Health Policy at the University of Texas Southwestern Medical School. He mentioned that the journal has had substantive contributions from psychoanalytic scholars over the years, and welcomes submissions. He also told me that they are always looking for good peer reviewers and would welcome some new psychoanalytic reviewers. Psychoanalysts interested in reviewing for PPP should contact Dr. Sadler by email (linda.muncy@utsouthwestern.edu)

Keith Olberman makes a pretty good interpretation

I'm continuing on the theme of how come, if we're obsolete etc, sparks of psychoanalytic thinking crop up regularly in the most unexpected places?

Here's the background. 

Item one,  for those of you who don't know, Keith Olberman is a former football player, former sportscaster turned political opinion/news show host with a nightly hour on MSNBC.  He is an unabashed liberal.

Item two, George Bush is giving a series of "exit interviews" with prominent members of the press.  Today the pundits, like Keith O., were discussing Charlie Gibson's interview with Bush.

Item three, Gibson asks Bush about the economic problems we are facing, and Bush replies essentially that it's not his fault, that bad decisions were made on Wall Street at least 10 years before he arrived in office.

I'm not going to discuss the merits of his argument.  What amazed me was Olberman's approach to the content.  He had as his conversatonal foil esteemed Newsweek journalist Howard Fineman.  He tagged the segment "Denial".

Olberman says to Fineman, "the math suggests over a decade.  1990, 1991, even 1989.  Did George W Bush mean his father [was at fault]?  Are we getting into Freudian territory?"

Fineman responds, "We don't have to get into Freudian territory.  He was trying to blame Clinton [too]."  Then Fineman gets going, with increasing (though controlled) passion:  "[Bush is] fiercely opposed to introspection.  A lack of reflection.  It's a family tradition.  It served him well only once [and otherwise was a great liability]. "

So, in short order, we have, on Olberman's the former sportscaster's part,  a declaration of "denial" and a speedy jump to an oedipal interpretation when trying to explain it.  Fineman is not so sure about the oedipal interpretation, despite the evidence of the "math", but launches immediately into a description of the President's lack of introspection, and the perils of such a stance.

A satisfying day for psychoanalysis in my book.  Two intelligent and passionate people--on TV!-- comfortably using psychoanalytic concepts  to attempt to explain an important phenomenon that troubled them.  I think our theory is widely usable.  

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.