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THE PSYCHIATRIST AND PSYCHOANALYST as consultants, and integral parts of medical treatment are becoming necessities in the holistic management of organic illness. The story of the analyst suffering a heart attack during a meeting of analysts and someone rushing to the microphone shouting, "Is there a real doctor in the house?" is an unfortunate one. Although M.D. psychoanalysts are removed from treating heart attacks, this possibility ought to remain as part of their knowledge. Analysts, in their daily behavior, are as prone as anyone to dichotomize the mind and body as many other medical specialists.
Discussing changes in medicine, Gottschalk (1975) wrote:
But will not these medical advances pose new problems for psychiatry and the mental health field? Yes. After the introduction of an indispensable body part, some people will react adversely to the idea of incorporation of and dependence on a foreign object. If a woman introduces some genetic characteristics into her offspring that are different from those contributed by the man who impregnated her, she may threaten the loyalty bond of her sexual partner. The reduction of the threat of death through lowered incidence of incurable disease will pose a problem for people who have latent death wishes and the suicide rate may temporarily increase." He even predicts, "Attempts will be made by some nations to combine Mental Health Sciences and the State in their Constitution … in order to decide a triage of life, death, health and illness.
The treatment of patients in renal failure illustrates these issues. Each patient connected to a hemodialysis machine is in an existential dilemma. All that has been familiar or anticipated, in order to experience life, changes to the unfamiliar. The machine becomes the instrument of survival in a never-ending, potentially catastrophic