Psychoanalysis, Psychotherapy and Prozac
Harvey L. Rich
Washington Psychoanalytical Association
President Lettieri called the 2073rd meeting to order at 8:18 p.m. on April 4, 1997. The Recording Secretary read the minutes of the 2072nd meeting and they were approved.
The speaker for the 2073rd meeting was Harvey L. Rich, from the Psychoanalytical Association. The title of his talk was, “Psychoanalysis, Psychotherapy and Prozac.”
Mr. Rich opened his talk with a comparison and differentiation of psychoanalysis and psychotherapy. He discussed at length the development of psychotherapy and the historical role of Sigmund Freud. He then went on to discuss the relationship between these two talking therapies versus pharmacological treatments in mental health.
Any discussion of mental health requires a definition of mental illness. Historically, this issue has left much to be desired since mental illness has been described as any aberration from the social norm. For example, can two people of the same sex have a life long, meaningful caring relationship? With this rather shaky basis for defining mental illness, the discipline of “Mental Health” evolved into the discipline of “Behavioral Science.” The word “mental” had too many overtones and vagaries associated with it. In spite, of these difficulties in defining mental health, most Americans have a sense of health issues that are a problem and health issues that are not. However, this concept is turned over in other countries. Mr. Rich described his recent experience in Angola. When Mr. Rich inquired of Angolan government officials about health care problems associated with 400f the population being HIV positive, he was told it was not a problem. This was because the government chose not to treat it as a problem considering the impact of their civil war. In Angola there are 150,000 amputees, 10 million land mines still in the ground and 3.5 million people with no shelter what-so-ever. These situations are problems — not the HIV infection. And so it goes with the perception of mental health as a “problem.”
Mr. Rich next described the historical treatments to restore mental health which included “moral suasion.” What “moral suasion” included was brutal confinement complete with shackles. To bring the image home, Mr. Rich pointed out that the shackles were retained by our beloved St. Elizabeth's hospital until First Lady Eleanor Roosevelt insisted they be removed. With that reassuring note behind us, Mr. Rich then turned the tables and pointed out that we still shackle people but with drugs. As an example, Americans now buy more tranquilizers than aspirin.
In spite of the concerns of insurance companies and the average skeptic, people do not seek mental health treatment for trivial reasons. They seek help when they are suffering. To justify this conclusion, Mr. Rich pointed out that the number of federal employees seeking help is the same now as in 1974 and as in 1962, no matter who is paying for the treatment.
Mr. Rich then closed his presentation and kindly responded to questions from the audience. President Lettieri thanked Mr. Rich for the society and announced the next meeting. He then made the usual parking announcement and adjourned the 2073rd meeting to the Social Hour at 9:45 p.m.