Psychoanalysis is, fundamentally, about the internal psychological world of humans. It's not that we ignore or discount the rules of behaviorism, or the gifts and strictures of biology, or the inevitabilities of history. But we alone among the clinical professions stand up for the inchoate vagaries of a person's internal life-memories, transferences, wishes, fears, conflicts, half known or unknown.

It is this irreducible stance -for the internal life is always profoundly individualized, hard to measure and often revealed only in the subtlest of ways often in an intimate and itself immeasurable and unique relationship-that gives our psychoanalytic field difficulty when it comes to broad health policy trends like comparative effectiveness, evidence based medicine, threats to privacy in the name of data collection.

My old friend and colleague Mark Smaller, is I think among the most radical of psychoanalytic optimists I know. Like a handful of others around the world (Stuart Twemlow of Houston is a notable pioneer in this area), Mark sees the promise of using a psychoanalytic approach in settings few would conceivably associate with our field, often seen as remote and elitist.