An Amateur in Expert Opinions

Jerry M. Wiener, M.D.  served as chairman of the psychiatry department at The George Washington University Medical Center.   He was also a past president of both the American Psychoanalytic Association and The American Psychiatric Association.

October 31, 1994
3801 Connecticut Avenue, NW
Apt. 136
Washington, DC  20008

William D. Jeffrey
Editor
The American Psychoanalyst
The American Psychoanalytic
  Association
309 East 49th Street
New York, NY  10017

Dear Mr. Jeffrey:

I read with interest Dr. Jerry M. Wiener’s comments, in the third quarter 1994 issue of The American Psychoanalyst, concerning the role of psychotherapy in psychiatry.

I was taken aback, however, by Dr. Wiener’s curious--and, one hopes, unintended--revisionism relating to the history and origins of psychiatry.  “First and foremost, of course,” Dr. Wiener writes, “is the revolution in the science of psychiatry, from a point where its roots lay almost exclusively in psychology to its current state, where they are predominantly biological.”  As anyone with even a passing familiarity with the history of psychiatry will know, the origins of the science are firmly embedded in medicine, not psychology.

In his article on psychiatry in the Encyclopedia Americana, the late Dr. William Niederland writes: "During [the 19th century] physicians generally believed that the most likely cause of mental illness was physical degeneracy of the central nervous system.  The end product of mental illness, insanity, was seen to arise from heavy-metal poisoning or neurological disease such as advanced syphilis.  Emil Kraeplin in Germany began a new era in psychiatry by describing psychotic illnesses such as manic-depressive disease and schizophrenia, which he called dementia praecox.  The psychological era began with Sigmund Freud in Vienna at the turn of the century.”

One wonders whether the heightened pace of medicalization, or remedicalization, of psychiatric science that has occurred in the last 30 years is an advancement or growth--a "a source of great strength,” as Dr. Wiener puts it--or an atavism: in psychoanalytical terms, a none-too-salutary regression or return of the repressed.

Concerning the related issue of medical bias in  the American psychoanalytic community, I will note, only part tongue-in-cheek, that the deconstructionists might have a field day with the implications of The American Psychoanalysts’ erroneous attribution of a medical degree to Dr. Erik H. Erikson in the publication’s May 20, 1994 death announcements.  Dr. Erikson was, in fact, a lay analyst -- his lack of a medical degree was a source of great strength.

Sincerely,

Gary Freedman