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Medical problems do arise during psychoanalytic therapy. Patients bring them with them or the problems become apparent during a therapy—which may extend over a period of four or more years. For a number of reasons, a restatement of the analyst's role concerning medical problems seems essential at this time.
There has been a considerable increase in the numbers of persons receiving analytic help. Medical men are more frequently referring their patients to analysts, but most of the increase is due to individuals contacting analysts on their own initiative. Many do not have a family physician, have not been physically examined in a long time or may be antipathetic to medical men for various reasons. They may have had some unpleasant experience clue to actual or imagined medical mismanagement. They in fact may have been over-, under- or erroneously treated for a physical disorder, subsequently diagnosed and adequately treated by another internist. Or their analytic therapy may have been delayed by their physician's lack of knowledge of analysis or bias against it. Such instances are diminishing.
Other changes make this redefinition necessary. Prior to World War II, most psychiatrists who subsequently became analysts had a long background in the practice of medicine and hence more immediately concerned themselves with medical problems. Others had practiced psychiatry in institutions where it was their daily duty to care for their patients' medical needs. Medical consciousness—a spontaneous thinking in terms of the maintenance of physical health and the treatment of physical disease—became an embedded part of their functioning as therapists.
More recently, psychiatrists are beginning their post-graduate training in psychoanalysis much earlier in their medical careers. One reason is the significant position psychoanalysis has attained in the medical world and in the mind of the public. Also, service in the armed forces made for some physicians th