Some Aspects of the Psychoanalytic Psychology of Physicians

Article excerpt

An earlier publication (Halpert, 1994) dealt with patients' magical expectations of physicians. In this presentation, aspects of physicians' expectations of themselves as doctors will be explored. This exploration will include material from the history of medicine, a series of interviews with non-patients and the analyses of two physicians. One element in the psychology of physicians not previously appreciated that can be drawn out of this material is the role and importance of knowledge and knowing and their relation to illness, death, rescue fantasies and reality in the psychology of physians.

Keywords: applied analysis, history of psychoanalysis, motivation, research

During more than 46 years of practicing psychoanalysis and psychotherapy I have treated more physicians than persons engaged in any other type of work. While many were psychiatrists, many others were internists, surgeons, pediatricians and other medical specialists. It is the psychology of those physicians who treated physically ill patients and dealt with life-threatening organic illness that is the focus of this paper. Since people are easily recognizable from the details of the work that they do, it is difficult to report such material from patients despite its importance in meaningfully addressing their expectations of themselves in their work. Even in the two cases that I am able to present, certain pertinent surface material had to be omitted. In an attempt to offset some of the distortions that arise from these omissions, material from the history of medicine and from a series of non-therapeutic interviews will be presented. These physicians, 16 men and four women, who ranged in age from 30 to 60, were interviewed from 50 minutes to up to two and a half hours. The interviews took place in various locales - their offices in hospitals or outside of them, their homes and in my office. Except for two of them whom I knew the other 18 were strangers who agreed to a request for an interview made on my behalf by a hospital-based psychiatrist and an internist who were friends of mine. There were 12 oncologists, four pediatricians, two internists, an immunologist and an anesthesiologist in this group. No effort will be made to present any statistical data based on these interviews. They will only be used to provide some illustrative examples of the working lives of physicians and the interviewees associations to those surfaces.

The history of medicine

Physicians' expectations of themselves have always been related to the societies' as well as the physicians' understanding of the etiology of illness. In antiquity, whether it was Egypt, Persia, Greece, China or the pre-Columbian Americas, illness and the cure of illness were understood in terms of magico-religious beliefs. Fenichel (1945) wrote: "The influence of magic is greater in medicine than in pure natural science, due to the tradition of medicine, which stems from the activities of the medicine men and priests" (p. 3). Sigerist (1961), a historian of medicine, noted that the ancient Hindu texts known as the Vedas medicine was:

a combination of religious, magical and empirical views and practices. The gods were thought to make a mortal sick as a punishment, either directly or through demons; treatment consisted in placating the irate deity and in driving out the demons. Or a man could become ill as a result of witchcraft, and a magical cause of disease had to be eliminated by magical means.

(p. 155)

A feel for the grandiose, narcissistic, magical expectations that physicians in antiquity had of themselves and that their public shared can be gained from the words of Empedocles, a 5th century BCE Greek physician, scientist and poet, who wrote of himself:

But unto ye I walk

As god immortal now, no more as man,

On all sides honored fittingly and well,

Crowned both with fillets and flowering wreaths.

When with my throngs of men and women I come

To thriving cities, I am sought by prayers,

And thousands follow me that they may ask

The path to weal and vantage, craving some

For oracles, while others seek to hear

A healing word 'gainst many a foul disease

That all too long hath pierced with grievous pain. …