The Art of Medicine

The Practice of medicine is founded upon a number of “basic sciences.” These become less “scientific” as they shift from physics to zoology, and eventually the axioms and theorems of psychology are even less acceptable as “scientifically” valid. In fact, some critics would take psychoanalysis outside of psychology altogether and relegate it to “philosophy” which, Bertrand Russell1 says, lies somewhere between science and religion. That is, psychoanalysis is to these critics more a matter of faith than of logical deduction from acceptable premises. They accept neither the premises as realistic, nor the deductions as justified by reason.

These critics are, of course, correct—but then they are merely saying the same as those psychoanalysts, philosophers, and theologians who have always deplored the ambitions of thinkers who want to transpose these fields into sciences. The word “thinker” is used advisedly. For one who “feels” does not have to be presented with logical argument. He who “feels” is the artist. This is not too difficult to understand. It is much more difficult to appreciate the artist's struggle in trying to communicate and share this feeling; and why he has the compulsion to want to do this.

The scientific approach helps medicine insofar as it enables us to read a laboratory report or an electrocardiograph; it is the art of medicine which permits the information to be utilized in its true perspective as a guide toward diagnosis and subsequent management. The course of treatment is not the same for each patient carrying the same diagnosis. Details of treatment must vary-according to the individual.

Both in the diagnostic formulation and in the treatment plan, the “art” is born of the interpersonal relationship between the patient and his physician. This relationship is a meeting of the minds which has its only reasonable explanation in terms of psychoanalytic principles, that is, in terms of the ideas, feelings, hopes, and motives which in each participant ar