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APsaA Statement on the DSM-5

The DSM-5, published by our colleague organization the American Psychiatric Association, has been met with both praise and criticism. Like its predecessors, this fifth edition of the Diagnostic and Statistical Manual will be widely used in the mental health field to classify mental disorders according to diagnoses based on descriptive criteria.  There is a place in the field for classifying patients based on descriptions of symptoms, illness course, and other objective facts.  However, as psychoanalysts, we know that each patient is unique. No two people with depression, bereavement, anxiety or any other mental illness or disorder will have the same potentials, needs for treatment or responses to efforts to help.  

Whether or not one finds great value in the descriptive diagnostic nomenclature exemplified by the DSM-5, psychoanalytic diagnostic assessment is an essential complementary assessment pathway which aims to provide an understanding of each person in depth as a unique and complex individual and should be part of a thorough assessment of every patient.

Even for psychiatric disorders with a strong biological basis, psychological factors contribute to the onset, worsening, and expression of illness. Psychological factors also influence how every patient engages in treatment; the quality of the therapeutic alliance has been shown to be the strongest predictor of outcome for illness in all modalities. [1]

For information about a diagnostic framework that describes both the deeper and surface levels of symptom patterns, as well as of an individual's personality, emotional and social functioning, mental health professionals are referred to the Psychodynamic Diagnostic Manual, published conjointly by the American Psychoanalytic Association, International Psychoanalytic Association, Division of Psychoanalysis (39) of the American Psychological Association, the American Academy of Psychoanalysis and Dynamic Psychiatry, and the American Association for Psychoanalysis in Clinical Social Work.

[1] Krupnick JL, Slotsky SM, Simmens S, et al The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J. Consulti Clin Psychol 64:532-539, 1996

Newtown: Horror and Tragedy

Mark Smaller, Ph.D., APsaA President-Elect

 

I happened to be working from home today when I received the first CNN. As the morning wore on, worst fears were realized. Again, unthinkable horror of children, teachers and staff being cut down by a shooter. I knew our association would need a response, but thinking of my own young children at school today immobilized me. I went grocery shopping to cope. I focused on a grocery list.

It wasn’t until I picked up my kids at school that I began to think again. I explained to them what had happened, and my 12 year old middle school daughter said she had heard. My seven year old twins had not.

Explaining this to our children or grandchildren is complex but must be done. One wants to be clear about what happened as the TV will make things not only clear but scary. Being truthful while assuring safety is the challenge for any parent, while taking age and development into account. My seven year old son responded, “Dad, I'm not afraid because we have lockdown drills. We know what to do.” I assured them that their school takes precautions with locked doors and drills and they are safe. When he asked why someone could do this, I hesitated. “We don’t know. We will find out what happened.”

It is true that we will find out through the media and hear about it throughout the holidays. Our helplessness, the worst of all possible human feelings, demands it. Our anger, disbelief and sadness will help us organize some story, psychoanalytic or not, in our minds after facts of the shooter’s life emerges.

But even finding out, even developing profiles, and greater school, mall, or workplace security, will not prevent such tragedies. Sadly, they are unpredictable and will continue to occur. I have always believed they will become worse with the the inaccessibility for mental health services for most Americans, a poor economy, the remaining stigma and resistance for getting appropriate help, easy access to guns, and something that goes wrong in our culture.

As an adult and child psychoanalyst I still can’t sort it out. After practicing over 40 years I have seen adolescents, and adults who I imagined would be capable of such violence. Although I work with students in an alternative high school, many of whom are in gangs, they are not necessarily the ones I think about when this kind of tragedy occurs. Gang culture is violent, and frightening but somehow more predictable than what happened today in Newtown.

No, its the students who have been quietly bullied for years, or seriously neglected at home, or subtly marginalized by the time they are young adults. I think of the ones who were not disruptive at school, but rather gradually socially withdrew during high school. I think of severely traumatized returning veterans who are no longer themselves when they arrive home and cannot get appropriate help. Overwhelming helplessness, isolation, and possibly access to weapons can compel one towards explosive violence.

We as psychoanalysts, as parents, grandparents, friends, and fellow citizens in our communities must pull together and help each other cope. Speaking to each other of this tragedy is a critical start. And we can’t forget. A dear friend, now 25 years later, still suffers the impact of having been in an elementary school as a student when such a shooting took place. Survival has meant reliving this trauma each time these tragedies occur. We cannot forget.

Helping survivors, helping our children, our communities, our schools, and our politicians, will not happen with quick answers or glib solutions. Rather, we must first share common pain and making our compassion known in word and action. We cannot immediately make sense of this, but we can try together.

I was walking across a parking lot later today with my son. I found myself not being able to let go of his hand, even once in the building. We should all hold each other a little more tightly tonight and for awhile.

 

Press Releases

Date Title
June Psychoanalysts Continue Centennial Celebration at APsaA’s 100th Annual Meeting 
April Call for Submissions - $1,000 Essay Prize in Psychoanalysis and Culture
January Psychoanalysts Kick-Off 100th Anniversary at 2011 National Meeting

 

APsaA and Psychoanalysis in the News

September 16 – APsaA psychoanalyst and Chair of the China American Psychoanalytic Alliance (CAPA), Dr. Elise Snyder and her outreach efforts are profiled in China Daily

August 25 – APsaA psychoanalyst Maida Greenberg and her son David analyze the downside to being a twin in this column for Slate.

August 25 – APsaA psychoanalyst Mark Smaller has a letter to the editor published in The New York Times in response to a recent article on the encroaching level of corporate marketing toward children.

August 22 – APsaA psychoanalyst Arnold Goldberg, M.D. is profiled in the Chicago Tribune for his decades of service in the mental health field and his latest book "The Analysis of Failure: An Investigation of Failed Cases in Psychoanalysis and Psychotherapy".

August 20 – Stephen Sonnenberg authors an opinion column for the Austin Statesman that warns of the perils that could come from compressing undergraduate and medical education into a single program, as recently proposed by the University of Texas. Read the column here.

July 17 – Dr. Procci was given the opportunity to provide the final word on a recent essay by Peter Kramer in defense of anti-depressant medications, based on Procci's letter in the July 13th edition of The New York Times. Read the follow-up letters from the public and Dr. Procci's rebuttal in the Sunday Dialogue section of the newspaper's website. 

July 11 – APsaA member and organizational consultant Kerry Sulkowicz, M.D. writes about the future of America's space exploration in light of the final liftoff of the Atlantis on July 8th. Sulkowicz analyzes the process by which NASA's administrator has handled the end of this era and the impressive way that he has kept the spirit and morale of NASA employees high in this period of transition. Read his article in The Washington Post's Leadership Roundtable series.

July 3 – APsaA philosopher and author Nancy Sherman, Ph.D. has an entry published on The New York Times ‘Opinionator’ blog regarding the unbearable guilt that returning veterans struggle with as they re-acclimate into society. Read her piece here

July 1 – APsaA member Glen Gabbard, M.D. recently spoke at the American Psychiatric Association’s Annual Meeting on the benefit of neurobiological research in using psychotherapy to treat patients with Borderline Personality Disorder (BPD). Read coverage of his address here

June, 2011 – APsaA psychoanalyst Malkah Notman, MD co-authors an article in the current issue of Psychiatric Times on the pitfalls of mobile technology and the use of social media by mental health professionals with their patients. Read the article here. Free registration is required to access content.

June 28 – APsaA federal legislative counsel Jim Pyles appears on a Bloomberg News report to discuss the real threat of patient identity theft within the healthcare industry. Watch the report here.

June 21 – APsaA psychoanalyst Gail Saltz discusses the lasting benefits of friendships in women in this article for USA Today.

June 20 – APsaA psychotherapist Andrea Corn has an op-ed published in the South Florida Sun-Sentinel regarding the Mimi Heat in the wake of their loss in the NBA Finals.  Read the column here.

Health Privacy Summit

APsaA member Deborah Peel, Founder of Patient Privacy Rights, co-hosted the inaugural Health Privacy Summit on June 13, 2011. Read below for media coverage of the conference.

June 17 – How good are those rules?

June 15 – Don't bet on knowing your records' whereabouts

June 13 – Another Reason to Prevent Breaches, Attorney Warns of an 'Insurance Crisis'

June 13 – Report from first health care privacy conference


June 15 – APsaA psychoanalyst and management consultant Dr. Ken Settel discusses the nexus between politics and power in context with the recent scandals involving elected officials throughout the U.S. Read the article in the India edition of Forbes magazine here.

June 7 – APsaA psychotherapist Dr. Andrea Corn is quoted in the South Florida Sun-Sentinel discussing the world of distractions that teenagers face in an era of social media. Read the article here.

June 1 – Dr. Leo Rangell’s life is immortalized through obituaries in the L.A. Times, the Sacramento Bee, the Kansas City Star and the Bellingham Herald.

May/June 2011 – Psychology Today magazine provides a vivid and positive overview of the merits of psychoanalysis and psychodynamic psychotherapy in its current issue.  Read an abstract of the article here.

May 18 – APsaA psychoanalytic business consultants Kerry Sulkowicz and Alexander Stein provide expert commentary in this article titled "Keeping the Con Artist at Bay".

May 18 – APsaA psychoanalyst and Harvard Medical School professor Ken Settel, M.D. comments on the emotional damage that could be inflicted on the newly reported son of Arnold Schwarzenegger. Read the column in the Boston Herald here.

May 5 – APsaA philosopher and University of Chicago Professor Jonathan Lear looks deeper into the recent firing of U.S. State Department Spokesman P.J. Crowley for The New Republic. Read the article here.

May – Lawrence Blum, M.D. highlights the psychoanalytic treatment that Prince Albert receives in the recent Academy Award-winning film "The King's Speech". Click here to read the commentary.

April 10 – Psychoanalyst Michael Good responds to a recent interview in The Boston Globe with J. Allan Hobson, a renowned critic of Sigmund Freud. Read the letter here.

April 3 – Ken Settel analyses the loss of privacy that Pippa Middletown will soon face as the sibling of a soon-to-be famous bride of Prince William in an article for The Daily. Read the coverage here.

April 1 – Glen Gabbard, Chair of the Brown Foundation for Psychoanalysis Baylor College of Medicine discusses the successful use of psychoanalytic techniques in treating patients with Borderline Personality Disorder (BPD). Read the article here.

March 25 - Kenneth Settel, M.D. describes the symptoms that indicate “when being frugal becomes an obsession” in this article for creditcards.com.

March 24 – APsaA child and adolescent analyst Jason Gold, PhD offers advice to Parenting magazine on ways that children can make new friends without copying bad behavior that they see in the media.

March 23 – APsaA member and organizational consultant Kenneth Settel, M.D. helps readers better understand the patient/therapist relationship in this article for the Chicago Tribune.

March 18 – Leon Hoffman, APsaA member and co-director of the Pacella Parent Child Center responds to a recent column by The New York Times’ David Brooks with a letter to the editor in the online edition. Read the letter here.

March 14 – Judith Broder, MD, founder of The Soldiers Project, comments on the emotional toll that military deployment has on children of service members.  Read the article here.

March 9 – APsaA member and radio host Keith Kanner, hosts four APsaA colleagues on his program to point out the value of talk therapy in response to a recent New York Times article that points to shift away from this mode of treatment within the psychiatric field.  Listen to an archive version of the radio show.

March 9 – APsaA member Larry Sandberg responds to the recent article in The New York Times on the disappearance of talk therapy within psychiatric practices in this letter to the editor.  Dr. Sandberg’s letter is the sixth entry on the page.

March 1 – APsaA member and founder of The Soldiers Project Judith Broder, MD offers analysis on the mental health impact that military deployment has on children of soldiers for the Sacramento Bee. Read the article here.

February 17 – APsaA Member and winner of this year’s Edith Sabshin Teaching Award, Bruce Levin is profiled in this article for his efforts to promote the profession nationally, and in the Philadelphia region where he practices.

February 7 – Julie Jaffee Nagel comments on Christina Aguilera’s National Anthem flub at the Super Bowl and answers the question for CBSNews readers: Was it just stage fright or something more?

January 29 – Critically acclaimed author, mental health advocate and psychoanalyst Elyn Saks is profiled by The Los Angeles Times in a recent Q and A column.

January 26 – APsaA member and president and founder of the China American Psychoanalytic Alliance, Elise Snyder is interviewed on National Public Radio’s “Need to Know” program discussing the growth of psychoanalysis in China.  Read the transcript here

National Meeting Coverage

March 18 - Read here for a summary of Arnold Tobin and Eva Lichtenberg’s Discussion Group on “A Streetcar Named Desire”

March 18 - Click this link to read more about the Educator’s Symposium “Bullying is a Process, Not a Person” led by anti-bullying expert and APsaA member Stuart Twemlow. 

March 4 issue of Psychiatric News

1. Analysis Can Use Dose Of Neuroscience, Kandel Says
2. Amazon People's Dreams Hold Lessons for Psychotherapy
3. Accepting Loss Said to Be Key to Overcoming Narcissistic Injury
4. Nature, Nurture, or Both Influenced Freud Descendent?

January 25 – Jane McAdam Freud's family lineage and her appearance at the 2011 National Meeting are discussed in this article from The Daily Beast/Newsweek.com

January 18 – Huffington Post blogger Penelope Andrew reviews Jane McAdam Freud’s new sculpture exhibit in New York and mentions her recent appearance at APsaA’s 2011 National Meeting.

January 13 – The Wall Street Journal's "Metropolitan" blog covers the meeting and APsaA's 100th anniversary here.

January 13 – The Wall Street Journal covers Jane McAdam Freud's exhibition opening and participation in the APsaa National Meeting.


January 10 – Elise Snyder and her efforts to promote the use of psychoanalysis in China are covered in this article in The New Yorker.  Note: Paid registration is required to access the full text of the article.

January, 2011 – APsaA member Glen Gabbard is sourced extensively in this article from Psychiatric Times on the importance and effectiveness of psychodynamic psychotherapy as a mental health treatment.  Free registration is required to view the article.

Resources



Ask Your Doctor About Psychoanalysis

APsaA member Norman Kohn, M.D. develops an animated video using fictional characters and case studies to explain the long-lasting benefits for patients who undergo psychodynamic psychotherapy, also known as psychoanalysis.  Click the ‘play’ button below to learn more about the positive changes that psychoanalysis can bring, when medication and other short-term forms of therapy fall short.

 

Play Ball!

Analysts combined work and play at the recent 99th Annual Meeting in Washington, D.C. Washington Nationals President Stan Kasten, renowned sports psychotherapist John Ratey, APsaA President-Elect Robert Pyles and APsaA child analyst Paul Holinger joined a panel developed by member Bruce Levin to explore the psychoanalysis of baseball. This unique event was capped off by on-field access and prime seats to that evening’s game against the Pittsburgh Pirates at Nationals Park.