A PSYCHIATRIC PIONEER

August 28 my psychoanalyst died at the age of 100. It was a privilege to have been analyzed by him. He used to say, "I never cured anybody." I wondered how he could continue to practice if he never cured anybody, but he then added, "I help people cure themselves."

Then it made sense, because that is the essence of psychoanalysis. His name is Harry August, and he is not very well known on the east side. Everybody on the west side either knows or has heard of Harry August. He was the first physician in this area who took a serious interest in Freud's writings, because in his practice he encountered patients with many strange symptoms and disabilities for which there was no organic (physical) pathology. Some of these patients were considered hypochondriacs, and behind closed doors other physicians sometimes referred to them as 'crocks'. They were most often treated with patronizing, condescending support, reassurance and placebos.

It was all 'in their head,' anyway. Harry August did not accept the medical status quo or modus operandi and searched the medical library, where he came upon one of Freud's landmark books, "On Anxiety". Freud articulately proposed a conceptual scheme that said that unresolved, unconscious conflicts from childhood could cause mental symptoms and physical disability. Harry August was drawn to psychoanalysis like a magnetic needle to the North Pole. He studied it and then commuted to Chicago weekends for a personal analysis, which was and still is a prerequisite for doing psychoanalytic therapy.

Nowadays, psychiatrists are rarely analyzed. They mostly do short term psychotherapy. It is considered more cost-effective. In some cases that is true, but in other cases, long term, intensive psychoanalytic therapy is needed to correct longstanding problems in character and interpersonal relationships.

Most people do not realize the power of the unconscious to influence behavior. Most irrational, self-defeating or self-destructive behavior can be attributed to unconscious memories and learning misguided messages from an irrational parent, a dysfunctional family or community.

Psychiatrists now talk about drugs and side-effects and pharmacological actions, instead of unconscious, unresolved conflicts. Some of these drugs affect one kind of neurochemical imbalance and others modify different systems. The good effect has to be more influential than the side effects. When there is not a good therapist-patient relationship, there is a tendency to non-compliance, which means the person stops taking the drug without consulting his doctor. If the patient has confidence in his doctor, the medicines usually work.

If the patient distrusts or doesn't like the doctor, even the best medicine won't work. This is because of the phenomenon of transference. The patient transfers feelings, attitudes and behavior toward a parent-figure to the person of the analyst, without being aware of it. Analyzing this transference leads to developmental changes and more rational thinking and behavior.

Harry August was aware of this long before anyone else in the Detroit area and the state of Michigan. He did everything possible to promote psychoanalysis, psychiatry and mental health during his very long life. He was a role-model of personal integrity and community service. Ten years after Harry August was appointed chairman of the state Mental Health Commission in 1949 by the then governor, G. Mennen Williams, he quit to protest what he saw as an inadequate mental health budget.

But before that, he was influential in founding the Lafayette Clinic as the state's central research and training facility, and it became world renowned. As we well know, the mental health budget has been reduced further and further, and the Lafayette Clinic no longer exists. I was a resident staff psychiatrist there for many years, and psychotherapy and psychopharmacology was taught there in equal balance. Now, unfortunately, psychotherapy has an uphill battle against the forces of drugs and managed care.

Most people who get longterm, intensive psychotherapy, must pay out of pocket, as it is rarely covered by insurance. Dr. August worked against negative trends in society and founded local clinics where indigent people could get quality psychiatric care. He had amazing foresight. Back in 1937, he declared on a WWJ radio show that the cause of rising juvenile crime rates was poor parenting. He wanted a comprehensive state mental health system for the chronically, severely disturbed patients, who could not be adequately cared for by family or community. Since his words were not heeded, mental patients are now on the streets or in jails, which is a scandal, in our affluent society.

Dr. August has left a legacy of high-level psychoanalysis in the Detroit metropolitan area. Most analysts are on the west side. A few of us continue to practice the Freudian method here in Grosse Pointe. Psychoanalysis is not for everyone, but it is the treatment of choice for certain conditions. An in-depth consultation will usually provide the answer to the question of whether psychoanalysis would be useful or necessary.

The death of Dr. August is in some respect, the end of an era, when Freud was hugely respected and his lineage revered. Meanwhile, psychoanalysts have tested their theories and made modifications in theory and technique for the last 100 years, and so is more effective now than ever. Certain conditions need drugs to maintain neurochemical balance, and other conditions require psychoanalysis without drugs, and some need both, a double-pronged approach. Dr. August taught that insight, deep emotional insight, is necessary for either psychotherapy or pharmacotherapy to work. He has left a legacy which is invaluable and will be long remembered._________________________________________________________

Dr. Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and Life Fellow of the American Psychiatric Association. He is a member of the American Academy of Psychoanalysis and corresponding editor of their quarterly journal, Academy Forum and on the editorial board of the Detroit Medical News. He welcomes comments and questions at his e-mail address: vbloom@comcast.net.