Psychoanalysis: A Thing of the Past? (4 Letters)

SEPT. 16, 2007

To the Editor:

Re “Patching Up the Frayed Couch” (Sept. 9):

It is not only psychoanalysis, but all intensive psychotherapies that have become less popular in contemporary culture. This is due, in part, to the introduction of alternative therapies like drug therapy and cognitive behavior therapy. But there is also a devaluation of time and an overemphasis on speed and efficiency that discourage many people who are in need from engaging in a deeply introspective process.

A competent and empathic therapist or analyst gives his patient time and attention uninterrupted by the intrusions of beepers, cellphones, BlackBerries and the like. How common is it these days for two people to engage in a meaningful and deep conversation for 45 minutes without such intrusions?

Larry S. Sandberg, M.D.

‘Is Mr. Trump Nuts?’ Analyze This.

To the Editor:

Re “Is Mr. Trump Nuts?” (editorial, Jan. 11):

If President Trump were clutching his chest or falling down repeatedly and the medical community were silent, the public would wonder what cardiologists and neurologists thought of the president’s physical health and why they were not speaking up.

In your editorial you problematically argue that the perspective of the psychiatrist is simultaneously irrelevant because the “obvious” is being stated and dangerous because of public misunderstanding and stereotyping. But these are not the only possibilities.

It is one thing for psychiatrists to assume the role of the armchair psychoanalyst, presuming to know the deep unconscious conflicts of our president without examining him. It is this kind of (mis)conduct for which the Goldwater Rule was put in place. It is quite a different situation for a psychiatrist to illuminate an aspect of President Trump based on his observable behavior and to raise legitimate concerns about his mental health.

As a psychiatrist and psychoanalyst I do not presume to know why President Trump has trouble staying in reality. But I do know, and the public should as well, that decision making is seriously affected when “reality testing” is impaired, and the consequences can be catastrophic.

This discourse is essential regardless of the practical impediments involved in having President Trump examined. It is a moral imperative and an act of conscience. It is also a public service — educating the electorate and daring to lift the veil of shame around mental suffering and its impact. The risk of misunderstanding and stereotyping is only exacerbated when mental health professionals are encouraged to be silent.

LARRY S. SANDBERG, NEW YORK

The writer is a clinical associate professor at Weill Cornell Medical College.