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These days, the patient is no longer simply that “other” across from us. The signifier, patient, has absorbed a new complexity. The governing usage is now that patient refers to the focus of clinical attention and treatment. That focus is usefully ambiguous, referring at one and the same time to that person, there, and something more than or other than that person. Sometimes the therapist may seem more the patient than the patient. Perhaps the patient is a construction of ineffable characteristics of the therapist and patient transacting therapy. If so, the patient is co-created in the intersubjective space between the two. At the same time as society is defining just what constitutes the reimbursable health-care consumer and what constitutes the provider, what constitutes the patient is a crucial agenda item for the psychoanalyst. If patient is to be retained, its usage must change: patient evokes doctor. The distance between doctor and patient strikes current sensibilities as vertical, authoritarian, demarcated, and dehumanized.
We appreciate the intersubjective aspect of our work by asserting, for example, that self and object representations are projected back and forth. The analyst is no longer secure in presuming to know which of his or her feelings are autogenic and which are allogenic. Nevertheless, it now appears that perhaps this signal improvement in the ambiguity of what constitutes the patient may be a particular expression of more far-reaching cultural shifts in how conceptualization itself is getting accomplished. In considering the question that serves as the title of this excellent book, we are considering perforce the question: What constitutes a person?
The decentering of the object of clinical attention has its origins in Hegel, running through Feuerbach, Marx, Nietzsche, Heidegger, and most prominently these days, Foucault. In psychoanalysis the culturalist thesis—;that the object of clinical attention is the person freighted with cultural trends