Love and Fellowship in the Doctor-Patient Relationship in Psychiatry

This paper examines the doctor-patient relationship from a phenomenological viewpoint. It follows Lain Entralgo's four specific parameters, namely the cognitive, the operative, the affective, and the ethic. It adapts these to the very special situation of Intensity and depth that develops in the psychiatric encounter.

In his important work, “The Doctor-Patient Relationship,” Lain Entralgo (1964) has established that the doctor-patient relationship is, generically considered, an interpersonal helping bond. This interpersonal relationship is defined by the author as a quasi-dyad, different from other similar encounters such as the dyad, the objectifying relationship, and the duet. The dyad is the perfect form of interpersonal relationship, or “the we constituted by an I and a Thou blended by caring.” Opposite to the dyad is the purely objectifying relationship wherein the other becomes a simple object, “an external reality lacking in personal freedom and individual aim.” Midway between these two polarities of binary relationship, Lain Entralgo (1961) describes two intermediate ones: the duet and the quasi-dyad. The duet is a functional relationship geared to attaining a common goal that is external to the relationship. The quasi-dyad is a relationship established to reach an objective essentially relevant to one of the members.

Although the doctor-patient relationship may be—and unfortunately has been—purely objectifying, it is not by a need inherent in the relationship itself, since “within the realm of interpersonal relationships the doctor-patient relationship is a quasidyadic cooperation of help geared to the attainment of the psychosomatic condition we call health.” Although this relationship may frequently have other goals, its unique characteristic of seeking personal health gives it a particular character. Unlike other quasidyadic relationships such as those involved in counseling or education (I would add the relation between priest and penitent), there is no “