Illness and the Working Analyst

VERY LITTLE HAS BEEN WRITTEN on the subject of illness and death in the analyst, partly, I believe, because it is such a painful topic to confront that it invites denial, and partly because of the fact that many of us may not find it so easy to bare our souls. As Abend (1982) has noted, countertransference contributes to the difficulty in writing about this problem. It may at times even be hard to hear, because of the common human dilemma of wishing to deny our own mortality, or, as Margaret Little (1981) has said, our acceptance of the "less than total cure." There has been much speculation regarding the etiology of illness. Thomas Mann (1924), who was deeply influenced by Freud, in The Magic Mountain has the Psychiatrist in residence at the tuberculosis sanitarium state in his lectures to the patients: "Symptoms of disease are nothing but a disguised manifestation of the power of love; and all disease is only love transformed, " which remind one of the words of Father Zossima in Dostoevsky's (1880)The Brothers Karamazov: "Fathers and teachers, what is hell? I think it is the suffering of one who can no longer love" (p. 390).

On the other hand, today we may think of illness as part of the human condition, as an etiology in itself of many realistic and psychological events. Thinking of it in this way it is sometimes harder to talk about, since it is less under our control, often not under our control at all, and involves a greater degree of uncertainty. Frieda Fromm Reichmann (1952) writes:

Life ends with death, the timing and causes of which are unpredictable. This fact is, actually and symbolically, the last expression of the fact that there are unknown forces which govern our lives. A psychotherapist who does not know and integrate this fact and who dreams about complete emotional security, an unreal attainment in life, cannot guide his mental patients to wholesome, constructive testing and evaluation of reality or to a constructive adjustment to it. In