Medical Problems in Psychoanalysis: I. The Internist's Viewpoint

In recent years the number of patients who have entered analysis has increased tremendously. The medical profession as well as the laity has become more aware of psychosomatic mechanisms in disease and their treatment by psychoanalysis. Yet it appears that a majority of patients start psychoanalysis on their own initiative, while the minority have been referred by their doctors. These patients may have organic illnesses which precede the analysis or which occur during it.

The purpose of this presentation is to discuss some of the special aspects of practising medicine with patients who are undergoing psychoanalysis and to point out how the internist can help both patient and analyst.

The aim of the internist, regardless of the type of patient, should be to collect enough facts from the history and examination to make as complete and as accurate a diagnosis as possible and to prescribe the proper medical therapy. Because of certain special problems and attitudes, however, the internist has to be most discriminating in his approach to the patient in analysis. It is necessary for him to be generally sympathetic toward the idea of psychoanalysis and genuinely interested in people and their problems. That does not mean that the internist should act like an analyst. As a matter of fact, he would do well to avoid using any of the techniques or interpretations of psychoanalysis. There are dangers to him, to the patient and the analyst if he does not exercise caution. The danger to himself arises in becoming too interested in the emotional mechanisms of the patient's neurosis and not enough in ferreting out true organic illnesses from the maze of functional symptoms. The patient may suffer from the internist's allowing him to feel that another doctor is doing what the analyst should rightfully do. Too, if the internist allows it, the patient may play him against the analyst in very subtle ways. There are also patients who resent the internist's questioning them about their emo