I am not prone to procrastination. However, writing this editorial for the newsletter—my first as President of PINC—has been a continuous process of avoidance. With all that is going on in the world—COVID, Black Lives Matter, the environmental impact of global warming, this country’s corrupt and inadequate leadership, the looming election—trying to hone in on a single topic has been quite difficult. The times in which we are living are urgent ones, calling upon each of us to plumb previously untapped resources. These times, however, have also brought into sharp relief a gross inequity in the way resources in our society are distributed.
Little about this year has been predictable. However, the ability of individuals and families to cope with uncertainty has been highly dependent on their financial resources. Many of my more affluent patients escaped the most traumatic immediate impacts of COVID by holding up in rural second homes or by renting Airbnb’s in vineyard, beach, and mountain communities. Few have been furloughed or hard hit by job loss. Most adapted easily to working from home. As back-to-school season approached, those with children organized childcare or even private instruction to solve the challenges of home schooling.
By contrast, 13.6 million people remain unemployed in the U.S. (Bureau of Labor Statistics, Sept. 4, 2020). More than 5000 Bay Area businesses were forced to close, 2000 of which have been shuttered permanently (SF Chronicle, Aug. 8, 2020). Among my less affluent patients, some are struggling to make rent. Others are exhausting what little savings they have. Those lucky enough to work must simultaneously juggle employment and childcare responsibilities. Those without jobs and savings must cope with the threat of eventual eviction.
The CDC has noted that social inequities have put many people at greater risk of getting sick and dying from COVID (CDC, July 24, 2020). A recent study found that poorer counties—notably, those with substantially Black and Latino populations—had COVID infection rates of nearly 8 times that of wealthier counties and a morbidity rate that is more than 9 times greater (JAMA, July 28, 2020). Such studies highlight the additional burdens placed on these communities, including subsistence-level jobs, higher-density living situations, inadequate access to healthcare, and lack of savings to cover essential needs and emergencies.
Class and social inequities are important but long-avoided topics that should be taken up by psychoanalysis and our institute. Despite our significant investment in launching a Community Psycho analysis Training Track—a remarkable feat for any psychoanalytic institute—psychoanalysts seem to mostly cater to wealthier people, who can afford high-frequency, long-duration treatments. This is not to say that we do not see the occasional low-fee case. Some of us may treat mostly lower fee patients. However, the current model of psychoanalysis demands a tremendous amount financially—an amount that may be infeasible for most people. We perennially speak about the risk of psychoanalysis losing its significance. Affordability may be our most formidable challenge.
The problem of affordability extends to training our candidates. My own training, completed five years ago, cost in excess of $200,000. I imagine that number would be even greater today. Only a very small percentage of this—about 7%—was tuition. No surprise, the bulk of the cost had to do with my personal analysis and supervisions. The high cost of training is burdensome to our candidates and prohibitive for many clinicians in our community. Some candidates go into debt to complete their training. A number of clinicians say that they would like to do training but inevitably conclude that this is beyond their financial reach.
If we hope to increase the relevance (viability, availability, value) of psychoanalysis, we will need to work on issues of affordability—both for analysands and potential candidates. I do not have a simple answer to this issue. However, the current economics of psychoanalysis—both treatment and training—ultimately determines the demographics of our membership. If we want to build a more diverse institute, we must attend to these economics. This touches on the question of who can afford training, and therefore, the inherent whiteness of our membership. By whiteness, I am referring to the historical and ongoing institutional structure, elitism, and exclusivity inherent to psychoanalytic training and, perhaps, to psychoanalysis itself.
Melanie Suchet, in her eye-opening paper, Unraveling Whiteness (2007), defined whiteness as “that which is not seen and not named. It is present everywhere but absent from discussion. It is the silent norm … an ideology, a system of beliefs, policies and practices that enable white people to maintain social power and control” (p. 869).
Our Community Psychoanalysis Training Track is not the answer to affordability for either analysands or candidates. This program is important because it brings PINC into contact with other organizations in the community—agencies that serve diverse populations. It is not a salve for the challenge of affordability. Tackling this problem will take years. It will require us, as a community, to look at the truth of who we are and who we serve. It will require our openness, humility, and courage to see our community accurately and a willingness to change.
In collaboration with PINC’s Board and motivated, committed leadership—Gail Kaplan, Julie Leavitt, Kali Hess, and myself—PINC has begun the process of looking at itself with regard to whiteness. In August, our diversity consultants, Visions, Inc., began to meet with focus groups. This process will likely continue for several months. At the end of this process, our consultants will engage the community in a town hall meeting with the goal of raising our awareness regarding institutional whiteness and the work required at PINC to invite diversity. Many of you will be asked to participate in focus groups to help in this learning process. I believe this project will raise some uncomfortable questions and will lead us to look at ourselves and psychoanalysis in a clear and honest way. In the end, we are asking of our community no less than we ask of our analysands: to tolerate truths about ourselves in relationship to others and to our community as a whole.
