Excerpts from Must Read Books & Articles on Mental Health Topics
Articles- Part I

Anatomy of Melancholy
Andrew Solomon, The New Yorker- 1/12/1998

I did not experience depression until I had pretty much solved my problems. I had come to terms with my mother's death three years earlier, was publishing my first novel, was getting along with my family, had emerged intact from a powerful two-year relationship, had bought a beautiful new house, was writing well. It was when life was finally in order that depression came slinking in and spoiled everything. I'd felt acutely that there was no excuse for it under the circumstances, despite perennial existential crises, the forgotten sorrows of a distant childhood, slight wrongs done to people now dead, the truth that I am not Tolstoy, the absence in this world of perfect love, and those impulses of greed and uncharitableness which lie too close to the heart--that sort of thing. But now, as I ran through this inventory, I believed that my depression was not only a rational state but also an incurable one. I kept redating the beginning of the depression: since the breakup with my girlfriend, the past October, since my mother's death; since the beginning of her two-year illness; since puberty; since birth. Soon I couldn't remember what pleasurable moods had been like.
    I was not surprised later when I came across research showing that the particular kind of depression I had undergone has a higher morbidity rate than heart disease or any cancer. According to a recent study by researchers at Harvard and the World Health Organization, only respiratory infections, diarrhea, and newborn infections cost more years of useful life than major depression. It is projected that by the year 2020 depression could claim more years than war and AIDS put together. And its incidence is rising fast. Between six and ten per cent of all Americans now living are battling some form of this illness; one study indicates that nearly fifty per cent have experienced at least one psychiatric disorder in their lifetime. Treatments are proliferating, but only twenty-eight per cent of all people who have major depression seek help from a specialist; fifteen percent of hospitalized patients succeed in killing themselves. Attempting to understand this strange malady, I plunged into intensive research shortly after my recovery. I started by attempting a coherent narrative of my own experience.
    In June, 1994, 1 began to be constantly bored. My first novel had recently been published in England, and yet its favorable reception did little for me. I read the reviews indifferently and felt tired all the time. In July, back home in downtown New . York, I found myself burdened by calls, social events, conversation. The subway proved intolerable. In August, I started to feel numb. T didn't care about work, family, or friends. My writing slowed, then stopped. My usually headstrong libido evaporated. All this made me feel that I was losing my self. Scared, I tried to schedule pleasures. 1 went to parties and failed to have fun, saw friends and failed to connect; I bought things I had previously wanted but gained no satisfaction from them. I was overwhelmed by messages on my answering machine and ceased to return them. When I drove at night, I constantly thought I was going to swerve into another car. Suddenly feeling I'd forgotten how to use the steering wheel, I would pull over in a sweat.
    In September, I had agonizing kidney stones. After a brief hospitalization, I spent a vagabond week migrating from friend to friend. I would stay in the house all day, avoiding the street, and was careful never to go far from the phone. When they came home, I would cry. Sleeping pills got me through the night, but morning began to seem increasingly difficult. From then on, the slippage was steady. I worked even less well, cancelled more plans. I began eating irregularly, seldom feeling hungry. A psychoanalyst I was seeing told me, as I sank lower, that avoiding medication was very courageous. At about this time, night terrors began. My book was coming out in the States, and a friend threw a party October 1lth. I was feeling too lackluster to invite many people, was too tired stand up much during the party, and sweated horribly all night. The event in my mind lives in ghostly outlines and washed-out colors. When I got home, terror seized me. I lay in bed, not sleeping hugging my pillow for comfort. Two weeks later--the day before my thirty-first birthday--I left the house once, to buy groceries; petrified for no reason, I suddenly lost bowel control and soiled myself. I ran home, shaking, and went to bed, but I did not sleep, and could not get up the following day. I wanted to call people to cancel birthday plans, but I lay very still and thought about speaking, trying to figure out how. I moved my tongue, but there were no sounds. I had forgotten how to talk. Then I began cry without tears. I was on my back. I wanted to turn over, but couldn't remember how to do that, either. I guessed that I'd had a stroke. At about three that afternoon, I managed to get up and go to the bathroom. I returned to bed shivering. Fortunately, my father, who lived uptown, called about then. "Cancel tonight," I said, struggling with the words. "What's wrong?" he kept asking, but I didn't know.
    If you trip or slip, there is a moment, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself--a passing, fraction-of-a-second horror. I felt that way hour after hour. Freud once described pleasure as the release of tension; I felt as though I had a physical need, of impossible urgency and discomfort, from which there was no release as though I were constantly vomiting but had no mouth. My vision began to close. It was like trying to watch TV through terrible static, where you can't distinguish faces, where nothing has edges. The air, too, seemed thick and resistant, as though it were full of mushed-up bread.
    My father came to my apartment with my brother, his fiancée, and a friend, fortunately, they had keys. I had had nothing to eat in almost two days, and they tried to give me smoked salmon. I ate a bite, then threw up all over myself. The next day, my father took me to my analyst's office. "I need medication," I said, diving deep for the words. "I'm sorry," she said, and she called a psychopharmacologist. Dr. Alfred Wiener agreed to see me in an hour. He seems to have come out of some "Spellbound"-era shrink movie: he is in his late sixties, smokes cigars, has a European accent, and wears carpet slippers. He has elegant manners and a kindly smile. He asked me a string of specific questions. "Very classic indeed," he said calmly as I trotted out my atrocities. "Don't worry, we'll soon have you well." He wrote a prescription for Xanax, then handed me some Zoloft. "You'll come back tomorrow," he said. "The Zoloft will take some time. The Xanax will alleviate anxiety almost immediately. Don't worry, you have a very normal group of symptoms."
    Once upon a time, depression was generally seen as a purely psychological disturbance; these days, people are likely to think of it as a tidy biological syndrome. In fact, it's hard to make sense of the distinction. Most depressive disorders are now thought to involve a mixture of reactive (so-called neurotic) factors and ("endogenous") factors; depression is seldom a simple genetic disease or simple response to external troubles. Resolving the biological and the psychological understanding of depression is as difficult as reconciling predestination and free will. If you remember the beginning of this paragraph well enough to make sense of the end of it, that is a chemical process; love, faith, and despair all have chemical manifestations, and chemistry can make you feel things. Treatments have to accommodate this binary structure--the interplay between vulnerability and external events.
    Vulnerability need not be genetic. Ellen Frank, of the University of Pittsburgh, says, "Experiences in childhood can scar the brain and leave one vulnerable to depression." As with asthma, predisposition and environment conspire. Syndrome and symptom cause each other: loneliness is depressing, but depression also causes loneliness. "When patients recover from depression by means of psychotherapy," Frank says, we see the same changes in, for example, sleep EEG as when they receive medication. A socially generated depression does not necessarily need psychosocial treatment, nor a biologically generated one a biological treatment."
    The day after my birthday, I moved to my father's. I was hardly able to get up for the next week. The days were like this: I would wake up panicked. Xanax would relieve the panic if I took enough, but then I would collapse into thick, confusing, dream-hallucinating sleep. I wanted only to take enough to sleep forever. Whenever I woke up, I took more pills. Killing myself, like taking a shower, was too elaborate an agenda to entertain. All I wanted was for it to stop, but I could not say what "it" was. Words, with which I have always been intimate, seemed suddenly like complex metaphors, the use of which entailed much more energy than I had.
    Little has been written about the fact that depression is ridiculous. I can remember lying frozen in bed, crying because I was too frightened to take a shower and at the same time knowing that showers are not scary. I ran through the individual steps in my mind: You sit up, turn and put your feet on the floor, stand, walk to the bathroom, open the bathroom door, go to the edge of the tub ... I divided it into fourteen steps as onerous as the Stations of the Cross. I knew that for years I had taken a shower every day. Hoping that someone else could open the bathroom door, I would, ,with all the force in my body, sit up; turn and put my feet on the floor; and then feel so incapacitated and frightened that I would roll over and lie face down. I would cry again, weeping because the fact that I could not do it seemed so idiotic to me. At other times, I have enjoyed skydiving: it is easier to climb along a strut toward the tip of a plane's wing against an eighty-mile-an-hour wind at five thousand feet than it was to get out of bed those days.
    Evenings, I was able to rise. Most depression has a diurnal rhythm, improving over the course of the day and descending overnight. I could sit up for dinner with my father. I could speak by then. I tried to explain; my father implacably assured me that it would pass, and told me to eat. When I was defeated by the difficulty of getting a piece of lamb chop onto my fork, he would do it for me. He would say he remembered feeding me when I was a child, and would make me promise, jesting, to cut up his lamb chops when he was old and toothless. "I used to work twelve hours, go to four parties in an evening," I would say. He would assure me that I would be able to do it all again soon. He could just as well have told me that I would soon be able to build a helicopter of cookie dough and fly to Neptune, so clear was it to me that my real life was definitively over. After dinner, I would return some calls. It is embarrassing to admit depression; to all but my closest friends I said that I'd developed an "obscure tropical virus." When you are depressed, the past and the future are absorbed entirely by the present, as in the world of a three-year-old. You can neither remember feeling better nor imagine that you will feel better. Being upset, even profoundly upset, is a temporal experience, whereas depression is atemporal. Depression means that you have no point of view.
    Since that first visit to Dr. Wiener, I S have been playing the medicine game. I have been on, in various combinations and doses, Zoloft, Xanax, Paxil, Navane, Valium, BuSpar, and Wellbutrin. This is a relatively short list. I do well with SSRIs ("selective serotonin-reuptake inhibitors," the growing family of drugs that includes Prozac, Zoloft, Paxil, and Luvox) and have good experiences with benzodiazepines (such as Xanax and Valium). I have never been on a tricyclic (which chiefly affects the neurotransmitters serotonin and norepinephrine) or on an MAO inhibitor (which influences serotonin, norepinephrine and dopamine). I have never taken a mood stabilizer/anticonvulsant (such as lithium or Depakote), or had shock treatments or psychosurgery. "Depression these days is curable," people told me. "You take antidepressants the way you take aspirin for a headache. Depression these days is treatable, you take antidepressants the way you take chemotherapy for cancer. They sometimes do miraculous things, but the treatment can be painful and difficult, and inconsistent in its results. Trying out different medications makes you feel like a dartboard. "If many remedies are prescribed for an illness," Chekhov wrote, you may be certain that the illness has no cure.
    Side effects arrive with the first pill and sometimes fade away with time. The real effects, at best, fade in with time. We cannot predict which medications will work for whom. Zoloft made me feel as though Id had fifty-five cups of coffee. Paxil gave me diarrhea, but fortunately Xanax, though it made me exhausted, was also constipating. Paxil seemed better than Zoloft, and I soon adjusted to its making me feel as though Id had eleven cups of coffee--which was definitely better than feeling as though I couldn't brush my own teeth. Only after a year did I discover Effexor, which made me appreciate that Paxil had been only partly effective for me. The side effects for which antidepressants are known (tension, irascibility, sexlessness, headaches, indigestion) are easily confused with the complaints for which they are taken (anxiety, irritability, and sexlessness, accompanied sometimes by headaches and indigestion), and so it was easy for me to conclude, two weeks after I began on Effexor, that I was probably having an adverse reaction to the drug. Dr. Weiner suggested that I might be having no reaction at all to the drug. He said, "Let's try doubling your dose. If you don't feel terrible, we'll keep going up. If you do, we'll come straight down." I'm now on triple the original dose.
    The most constant side effect of the SSRIs is sexual dysfunction, and it is a serious side effect. It is damaging to your existing relationships and hell if you want to get into a new one. It doesn't matter much when you're first recovering, when you have other things on your mind, but to get over unbearable pain at the cost of erotic pleasure is not a happy arrangement. Robert Boorstin, a senior adviser to the Secretary of the Treasury is manic-depressive and is an outspoken advocate, for the mentally ill, and he told me that during four years on Prozac he did not have an orgasm in intercourse which I considered a fairly major drawback."
    Popular articles seem to suggest that the neurotransmitter serotonin is the key to happiness--that giving serotonin boosters to depressives is like giving iron to anemics, or insulin to diabetics. This is wrong. It appears that depressed people do not have low serotonin levels, which explains what would otherwise be a puzzling phenomenon. For three weeks, you're on Prozac, a drug that has an instant effect on your serotonin levels, and you feel as lousy as you did before. Then things improve. Why this delay? When the serotonin levels go up, the brain appears to reduce the number of receptors, or decreases the sensitivity of existing receptors, which suggests that the brain is seeking a balance between output and receptivity. Over-all serotonin function is probably not very different from what it was before--and yet there are important subtle changes. Indeed, the most plausible explanation for the SSRIs is that they work indirectly. The human brain is stupefyingly plastic: cells respecialize and change; they "learn" new patterns of responding. When you raise serotonin levels, and cause some receptors to close up shop, other things happen elsewhere in the brain, and those other things are presumed to correct the imbalance that makes you feel bad.
    Less is known about an herb called St. John's wort (hypericum), which has become popular lately among fans of alternative medicine. "These treatments can sound batty," Tom Wehr, at the National Institute of Mental Health, acknowledges. "But, frankly, if you said to someone, 'Id like to put wires on your head and run electricity through your brain to induce a seizure because I think that might help your depression,' and if that were not a well-established treatment, you might have a hard time getting it going."
    But the precise mechanism of effect remains elusive even for the intensively studied mainstream pharmaceuticals. "It is in these subtle adaptations to nerve cells, these compensations meant to handle increased serotonin, that the actual healing process lies," Steve Hyman, the director of the N.I.M.H., says of the SSRIs, "'just as a pearl results from the adaptation of an oyster to the irritation caused by a grain of sand." Bill Potter, who until recently headed a research group in clinical psychopharmacology at the N.I.M.H., says, "Drugs that work by very different mechanisms produce antidepressant effects. It is possible for drugs with acutely different spectrums of biochemical activity to produce very similar long-term effects. It's like a weather system. Something changes wind speeds or humidity, and you get a completely different kind of weather a hundred miles away, but even the best meteorologists can't calculate all the variables." There is an ongoing quest for drugs that affect the brain with greater specificity. "The existing medications are just too indirect for us to fully understand how they are working," Potter says.
    "It was amazing," Sarah Gold, a young editor, said of her first months on Wellbutrin, a drug that affects the neurotransmitters, dopamine and norepinephrine but not serotonin. "I could pick up the phone and make calls--my life was no longer governed by fear. It was like my first experience of sunlight." But she was one of those people for whom medication is effective for only a limited time. She got a lift again from Effexor, but that, too, wore off too, after a year or so. "One of my roommates told me I had a black aura and she couldn't stand to be in the house when I was up in my room," she recalled. Gold went through other combinations of medications, only to end up taking Wellbutrin again, along with Zoloft and small doses of Risperdal. Sometimes, especially when she is dancing--and she is a wonderful dancer--she reaches the unsustainable height of normal feelings. Having lived them, she says, "I have them to aspire to."
    One woman who works in the mental health field and takes a panoply of SSRIs and mood stabilizers told me, "I have two children who also suffer from this disease, and I don't want them to think it's a reason for not having a good life. I get up every single day and make breakfast for my kids. Some days I can keep going, and some days I have to go back to bed afterward. I come into this office at some point every day. Sometimes I miss a few hours, but I've never missed a whole day from depression." We were in a cubicle at the hospital where she works. Her eyes were wide as she held forth. Her hands, folded in her lap, trembled from all the medicines she was on at the time. She soon had tears rolling down her face but went right on speaking. "One day last week, I woke up and it was really bad. I managed to get out of bed, to walk to the kitchen, counting every step, to open the refrigerator. And then all the breakfast things were near the back of the refrigerator, and I just couldn't reach that far. When my kids came in, I was just standing there, staring into the refrigerator."
    Two separate but inseparable matters come into play here: depression and personality. Some people are disabled by levels of depression that others can handle, and some contrive to function despite serious symptoms. Antidepressants help those who help themselves. To take medications as part of the battle is to battle fiercely, and to refuse them is as ludicrous as entering a modern war on horseback. "It may be a sign of character, not of weakness, to know when you have to ask for help," says Martha Manning, whose book, "Undercurrents," chronicles her depression.
    Two years before my first severe episode, a friend with an apparently terrible life, a regular old Richard Cory, committed suicide. It was no cry for help: he slit his wrists crosswise, and then went up to the roof of his building and jumped off. Suicide is a seductress, and those who have sailed near it stay alive only when they stop up their ears and flee from its Siren song. Even with chemical assistance, it's a fight against the wind and the tide to stay off the rocks. I don't believe that this friend's life had become more intolerable than Manning's, or mine. His life was not, however, strong enough in him to defy annihilation, and our lives, so far, are.
    It is possible to keep yourself alive without modern technologies, but the price can be high. At a cocktail party in London, I saw an acquaintance and mentioned to her that I was writing this article. "I had terrible depression," she said. I asked her what she had done about it. "I didn't like the idea of medication," she said. "My problem was stress related. So I decided to eliminate all the stresses in my life." She counted off on her fingers. "I quit my job," she said. "I broke up with my boyfriend and never really looked for another one. I gave up my roommate and moved to a smaller place. I stopped going to parties that run late. I dropped most of my friends. I gave up, pretty much, on makeup and clothes." I was looking at her in bewilderment. "It sounds bad, but I'm much less afraid than before," she went on, and she looked proud. "I'm in perfect health, really, and I did it without pills." Someone who was standing in our group grabbed her by the arm. "That's completely crazy. That's the craziest thing I've ever heard. You must be crazy to be doing that to your life," he said. Is it crazy to avoid the behaviors that make you crazy?
    Inconveniently, I had a reading tour to do after that birthday, and antidepressants usually take about a month to kick in. Still, I was determined to get through it, because I believed that ,meds or no meds, if I started giving up on things, I would give up on everything and die. Before the first reading, in new York, I spent four hours taking a bath, and then a friend helped me take a cold shower, and then I went and read. I felt as though I had baby powder in my mouth, and I couldn't hear very well, and I kept thinking I might faint, but I did it. Then I went to bed for three days. Though I could keep the tension under control if I took enough Xanax, I still found mundane activities nearly impossible. I woke up every day in a panic, early, and needed a few hours to conquer my fear before getting out in public for an hour or two in the evening.

The above text covers the first four pages of this thirteen page article. For the remainder, visit the archives of the New Yorker Magazine at www.newyorker.com/archive.

A History of Psychoanalysis in Michigan
Murray Meisels, Ph.D.

Precis. This article reviews the history of psychoanalytic organizations in Michigan and discusses their relations to the national organizations with which they affiliate. This is followed by a more detailed discussion of the history of The Michigan Psychoanalytic Council.

Early Years.  The first psychoanalytic organization in Michigan was the Detroit Psychoanalytic Society and Institute. In the 1930's, the fledgling DPSI was apparently situated in both Detroit and Cleveland, and only named itself DPSI once it had enough members to meet the requirements of being a separate organization under the rules of the American Psychoanalytic Association (APsaA), then its parent body. APsaA, at the time, was the only national psychoanalytic society in the United States and was primarily a psychiatric association. Richard Sterba, a psychiatrist and Editha Sterba, a psychologist and musicologist, had arrived in Detroit from Vienna before the war and were senior members of DPSI. In the early 1950's there developed considerable strife, jealousy, and conflict in DPSI which revolved around the Sterba's, including accusations that the Sterbas were conducting training analyses of nonphysicians, a serious violation of APsaA's rules. Various members of DPSI brought allegations to APsaA's Education Committee that Richard Sterba was conducting such analyses, and that he was also providing supervision to social workers, one of whom was Selma Fraiberg. In all, some 26 accusations against Dr. Sterba were presented to a board of APsaA, while Dr. Sterba was denied written knowledge of the accusations on the grounds that they were confidential!
    Dr. Sterba provided me with this information, which is in any event widely known, in a telephone interview in the 1980's; and he explained that these events took place in 1953, and he emphasized that it was the McCarthy era. I have been told that at the time APsaA wanted to consolidate its central power among institutes, and used DPSI as an example. The result of the hearing was DPSI was disaccredited as an institute; this, even though APsaA had no bylaw provision for disaccredidation.
    At the time, in 1953, Richard Sterba was furious and threatened to sue APsaA. However, Anna Freud prevailed on him not to do so since it might damage psychoanalysis. Dr. Sterba acquiesced, but this may also have damaged psychoanalysis, since it was not until the 1980s that psychologists successfully sued APsaA and forced open their doors to non-psychiatrists. Some thirty five years after these events, in the telephone interview, Richard Sterba was still enraged at the way he had been summarily dismissed by APsaA.

DPSI. After disaccredidation, DPSI continued to be a society of APsaA even though it no longer had an APsaA institute, a technicality. In practice, DPSI affiliated with the American Academy of Psychoanalysis (AAPsa), a psychiatric-psychoanalytic group, which had split from APsaA in 1955 because it disagreed with APsaA's authoritarian view of psychoanalysis. DPSI continued its training activities, including the education of a few psychologists, under the auspices of AAPsa until the 1980s. At that time, its numbers were reduced because the psychiatric residency programs from which it drew most of its candidates were ended by monetary and institutional contraction in the Michigan state hospital system. There is still a small study group of DPSI analysts who meet monthly during the academic year, and most members belong to MPC.

MPI/MPS. Two additional groups eventually emerged in Michigan as a result of the DPSI disaccredidation. The major group was the Michigan Psychoanalytic Society and Institute (MPI/MPS), the new affiliate of APsaA. It was founded in 1958 and eventually became the dominant society in the area. It adhered to the psychiatric bias in APsaA and officially trained only a few non-psychiatrists. Over the years, many area psychologists and social workers were analyzed, supervised (psychotherapy only), and taught (extension courses) by members of MPI/MPS. In the 1970s, a group of these mental health professionals formed the Friends of the Michigan Psychoanalytic Society, a sort of alumni club of former analysands, students, and followers. In the 1980s, the 'Friends' changed its name to the Association for the Advancement of Psychoanalysis, and now offers a speaking program that is coordinated with the MPI/MPS speaker schedule.

MAP. Richard and Editha Sterba, who had helped found DPSI and who had sustained its growth into the 1950s, were barred from participating in the training activities of MPI/MPS. In APsaA, certain members are designated as Training Analysts, and only Training Analysts may psychoanalyze candidates. The Sterbas were denied training analyst status, and thus were effectively barred from participation in the life of the MPI/MPS. In fact, Richard Sterba was then the premier psychoanalyst in Michigan, having been Vienna-trained, having analyzed numerous members of MPI/MPS and other leaders in the psychoanalytic community, and having written the classic paper on the splitting ego in psychoanalysis. Surely, the anger Dr. Sterba expressed in my telephone interview of him in the 1980s also reflected the repeated insult of his diminished role in the MPI/MPS community.
    After the 1953 disaccredidation, the Sterbas formed yet a third organization, the Michigan Association for Psychoanalysis (MAP). MAP did not have a formal training program, probably because the Sterbas adhered to the policies of the International Psychoanalytic Association (IPA). The IPA was the body founded by Freud to organize and direct the progress of psychoanalysis and, by the 1930s, the IPA assumed authority for psychoanalytic training as well. Its hegemonic position was that all psychoanalytic training should be under the auspices of IPA and be administered through a national association, such as APsaA. Since APsaA had the IPA monopoly on psychoanalytic training in the United States, formal institute status for MAP was not in the cards. Despite this, MAP proceeded to informally train a number of psychoanalysts, some of whom are MPC members. MAP gradually contracted over the years.

The pattern of growth in psychoanalysis. The history of psychoanalysis in Michigan is similar to other areas of the United States. In general, psychiatrists had the only national organizations in the United States until the 1970s, and in most geographic areas also had the only psychoanalytic institute until the 1980s. These psychiatric-psychoanalytic organizations firmly believed that psychoanalysis was the practice of medicine. Despite this formal belief system, they also provided training experiences for non-psychiatrists in many areas of the country. Significant numbers of psychologists, social workers, and non APsaA affiliated psychiatrists were informally trained in psychoanalysis. MPI/MPS did this, although it called these experiences study groups, extension courses, or psychotherapy supervision. MAP did this, while simultaneously denying it was engaging in formal training. Eventually, in line with the dictum in quantum physics that an increase in quantity leads to change in quality, the sheer number of psychoanalytically-informed professionals changed the structure of the field. This is now happening again in psychoanalysis, as the dramatic increase in the number of women psychoanalysts is changing theory and practice.

Midwestern Psychoanalytic Institute. By the 1970s, there was a coterie of independent, non-APsaA institutes in the country, mostly in New York, but also in a few other major cities. In 1970, they organized the National Association for the Accreditation of Psychoanalysis, with the acronym NAAP, which now, however, stands for the National Association for the Advancement of Psychoanalysis. This was predominantly an association of Jungian, Adlerian, and Modern Psychoanalytic (Hyman Spotnitz) institutes, although some Freudian institutes also participated. A branch of NAAP opened in the Detroit area in the 1970s called the Midwestern Psychoanalytic Institute. It lasted several years, trained a few people, but closed its doors in the late 1970s or early 1980s when its director lost his psychology license and other senior analysts resigned. There are no MPC members from that group.

MSPP. In 1979, psychologists in the American Psychological Association (APA) organized the Division of Psychoanalysis (Division 39), and APsaA now had its most significant rival on the national scene. Within a year, Michigan psychologists organized the Michigan Society for Psychoanalytic Psychology (MSPP), and other areas of the country organized as well,. There are now 30 local chapters of the Division in 27 geographic areas, with over 3,000 local chapter members. Almost all chapters are interdisciplinary.
    It is important to describe the change in the personal and professional lives of non-APsaA psychoanalytically-oriented colleagues, from the period prior to MSPP's formation compared to after it began. Except for some few individuals in DPSI, MAP, and the Midwestern Psychoanalytic Institute, most colleagues were not involved in a psychoanalytic organization. They could not train or be trained, read papers, participate in committees, hold meetings, or do any of the other myriad tasks of a professional association. MPI/MPS was the main psychoanalytic group in the area, and it excluded from training almost all psychologists and social workers, and many psychiatrists. Those colleagues could only be "Friends of MPS," could only stand on the outside and look in. Once MSPP formed, however, this array of colleagues developed a strong organization that nurtured the professional and educational aspirations of its members. Within four years, MSPP had 135 members, and by 1989 it had over 200 members. MSPP was interdisciplinary, held regular professional meetings in Ann Arbor, East Lansing, and Southfield (and sometimes elsewhere), offered coursework in Ann Arbor, East Lansing and Southfield (and sometimes elsewhere), sponsored winter and summer institutes, and encouraged its membership to pursue psychoanalytic scholarship and practice. Now psychoanalysts and psychoanalytic psychotherapists could read like-minded colleagues, make organizational decisions about psychoanalysis, and, after so many years have a psychoanalytic home. It was a dramatic change from the pre-MSPP years.
    By the middle 1980s, many MSPP members strongly favored the development of a psychoanalytic institute for formal training in our field. Indeed, as the Division 39 local chapters matured, and after these chapters learned that they may not accredit under APA rules, many of them established independent institutes for training and accreditation. Most of the institutes maintained close relationships with their "parent" local chapters. By contrast, in Michigan, the movement to form an institute engendered great strife and acrimony, because the main leadership of MSPP was fiercely antagonistic to institute training. I have never clearly understood their position, but one of their arguments carries weight, namely, that institutes may become dominated by politics, which influence such decisions as who may be a training analyst (e.g., not the Sterbas) or who may train in psychoanalysis (e.g., not psychologists or women). The view of the majority MSPP leadership was that our efforts to accredit would again produce an authoritarian, even totalitarian, structure. The rest of us were cognizant of this issue but were more sanguine or optimistic, and did not view it as a serious threat or obstacle to developing our institute. To date, MPC has indeed been open to discussion and feedback, and the fears of the majority MSPP leadership have proven unfounded.
    In any event, between 1986 and 1988, there was pressure for and against accreditation, and MSPP responded by seemingly collegial efforts at conflict resolution, i.e., discussions, committees, surveys, and special meetings. In the end, however, the antagonism was so deep that the differences proved irreconcilable, and a large group moved forward to form MPC. By 1990, MSPP had lost a large number of its members, lost its base in East Lansing, and lost a number of its students and teachers. The MSPP program of coursework contracted severely, and it abandoned its winter institute, its East Lansing program, and much of its outreach across the state. Again, in the early 1990s, MSPP was riven by further dissension around the reorganization of the University of Detroit Mercy doctoral program in clinical psychology, and several more of its leading members resigned. Despite this horrific factionalism, which some may view as a manifestation of the organizational rigidity that MSPP leadership so greatly feared, MSPP has continued to be a major player in Michigan. It continues to be a large organization with over 150 members, holds monthly meetings and a summer institute, publishes a newsletter, and, very recently developed the Michigan Academy for the Psychoanalytic Arts, a kind of non-institute for education in psychoanalysis.
    Starting in late 1988, MSPP and MPC went their separate directions. Curiously, the leaders of the two groups always maintained friendly and warm relations, and there were regular feelers for reconciliation, but these always foundered because of severe mistrust at the institutional level. It is a curious process, that contrast between the personal and institutional. Still, in November 1995, the two groups held their first joint meeting, which represents their first real step toward reconciliation.

MPC. During those years of intense conflict, roughly 1986-88, between the pro- and anti-accrediting forces, it happened, as it often happens, that even though battle lines had been clearly drawn and the issue justly joined, that other, seemingly unconnected, developments were also shaping events. Those other events were fundamentally demographic, since 60% of the MSPP membership was then comprised of women. A shift of power usually accompanies a shift in numbers, and the instrument for this power shift came from MSPP's Women's Study Group. While feminist issues, per se, were never an MSPP agenda item, once the accreditation issue was broached and once the battle lines were drawn, the feminists studied the issue from their perspective and concluded that the entire issue was male-dominated and detrimental to women. They argued that most institutes were for men and that women were systematically excluded; further, the programs themselves seemed to have no provisions for childbearing, child rearing, or single parenthood, (i.e., the institutes were for men who could delay or avoid parenting responsibilities.) For the feminist group, it was inherently desirable to accredit so that women could also be accredited, but the feminists considered that accreditation should redress the serious problem of the systematic exclusion of women. This meant that women should be senior analysts, that training programs should accommodate women's needs, and that the programs should educate both men and women in the goals of sexual equality and the vagaries of inequality.
    In 1988, the pro-accrediting group joined forces with the feminist group, and the two groups moved forward and created MPC. MPC thus represented the empowerment of the pro-accrediting and feminist movements in MSPP, and members of both groups constituted the MPC leadership. By 1989, MPC had enacted bylaws, created an institute program that accommodated the pro-accrediting and feminist perspectives, and elected officers. It now holds regular meetings in Ann Arbor, East Lansing, and Grand Rapids (and sometimes elsewhere), offers courses in Ann Arbor, East Lansing and Grand Rapids (and sometimes elsewhere), offers one program of study in psychoanalysis with twelve current candidates and a second program of study in psychoanalytic psychotherapy with five candidates. It has over 100 members, 27 of whom are accredited as psychoanalysts. Among its proudest achievements, three of MPC's students have graduated and been accredited as psychoanalysts. Its most recent achievement: this Newsletter, the very first issue of which you are now reading.  MPC is an affiliate of the International Federation for Psychoanalytic Education (IFPE). After the local chapters spawned a number of institutes, they all combined forces in 1989 to form IFPE as a parent body to address educational issues in our field, including institute education.

Summary. As this sketchy history indicated, there has been considerable change in the perhaps 60-year history of Michigan's psychoanalytic organizations, and some groups have decayed even in the face of an overall, if uneven, pattern of growth and differentiation. It is impressive that new organizations have eventually formed when existing structures did not accommodate emerging constituencies. As one of the three existing psychoanalytic organizations and one of the two functioning institutes, MPC has become an important part of the psychoanalytic landscape in Michigan.