For the Psyche

About 8,000,000 U.S. citizens are neurotic or worse by the estimate of the Social Security Board (based largely on Selective Service statistics). Last fortnight the U.S. Government began to take steps. A newly created six-man National Advisory Mental Health Council sat down in Washington to map a $10,000.000 attack on mental illness. The 4,000 overworked U.S. psychiatrists thought it high time.

By the time the Government got to work, an appointment with a psychiatrist was as hard to get as an apartment. Some of the work was caused by moneyed folk who wanted some hand-holding to help them through the perils of life in U.S. nightclubs. But most needed help.

The Analysts. In the hierarchy of psychiatric treatment, ranging from a single $5 (or free) clinic visit to a $25,000 lifetime course, the luxury trade is psychoanalysis.* Concentrated mainly in neurotic Manhattan, psychoanalysis is split into at least a dozen schools, from orthodox Freudians to socially conscious Horneyans (leader: Dr. Karen Horney), who dispute Freud's idea that sex is everything and put more emphasis on environment. Its big-league practitioners include Dr. Franz Alexander, who directs the Chicago Institute for Psychoanalysis; Dr. Gregory Zilboorg and Dr. Lawrence Kubie, fashionable Park Avenue analysts; Drs. William and Karl Menninger of Topeka's Menninger Clinic and Dr. Horney.

Analysts' fees to private patients range from $5 to $50 an hour. The average treatment (an hour a day, five days a week) takes 18 months, costs $1,500 (the Chicago Institute) to $5,000 (Park Avenue). Orthodox analysts spend most of their time listening, let the patient gradually unveil his subconscious through random talk and dreams. Eventually his repressed fears and feelings of guilt are supposed to come to the surface. Exposure of the hidden difficulty to the patient helps him find a remedy and relieves him of his anxiety and physical symptoms of illness. There are no solid statistics on "cures." Reasons: 1) the only judges are the analyst and his patient; 2) no two analysts agree on a definition of what is "normal" in the first place.

The Short & the Long. Surveying the histories of several thousand psychoanalyzed patients, Psychoanalyst Joseph Wilder of Manhattan recently reported that there were few "cures," but "good results" (i.e., substantial improvement) in some 30-40% of the patients. About 20% of neurotics snap out of their funk without psychiatric treatment. Dr. Wilder's most significant finding: "brief psychotherapy," i.e., 30 to 40 sessions, produces just as good results as the prolonged orthodox treatment.

In "brief psychotherapy," the doctor does not wait for the patient to arrive at a solution by trial & error. Instead he tries to speed the patient along by interpreting his dreams and verbal ramblings and diagnosing his troubles one at a time.

Despite its faddist aspects and doctrinaire squabbles, psychoanalysis is a serious, exacting process. Analysts take great pains to disassociate themselves from the horde of phony "psychologists" and other quacks. A psychoanalyst, like any other psychiatrist, must have a medical degree, spend at least five years in psychiatric study after his internship and have a complete psychoanalysis of himself to win professional recognition by his colleagues. Many states have no law regulating the practice of psychoanalysis, but associations of psychiatrists lay down standards, try to police their profession.

Psychiatry Begins at Home. Last week the National Advisory Mental Health Council made ready to attack its chief bottleneck: the shortage of psychiatrists. To carry out its program--research in mental disease and establishment of federal-aided mental clinics in all states--the nation needs at least 20,000 more mental doctors. No more than 500 a year can be trained in existing institutes and medical schools. The council will build a $7.500,000 mental health institute for training and research in Bethesda, Md., help medical schools' enlarge their psychiatry departments, send demonstration teams to state mental hospitals.

It will also try to teach a little psychiatry to the family doctors. Said Dr. Robert Felix, chief mental hygienist in the U.S. Public Health Service, who is the council's executive officer: "It is just as essential that the general physician be able to handle mild emotional upsets as to be able to handle fractures or deliver babies."

* Psychiatry is a general medical term embracing all types of treatment of mental disease; psychoanalysis, one of the methods, depends on deep probing of a patient's subconscious and past emotional experiences.

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