Psychoanalysis and Hiv Disease

SINCE ITS BEGINNINGS, PSYCHOANALYSIS has been concerned not only with individual psychology, but with many of the major issues faced by man and society in modern times. Freud addressed the question of "Why war?" Erich Fromm studied the causes of human destructiveness. Sullivan took part in studies of how to avert further wars. Psychoanalysis has similarly studied special social problems such as runaways, drop-outs, and abuse within the family. Groddeck gave much attention to the relationship between psychoanalysis and physical illness, studies that have been extended by Alexander, Eissler, Weinberg, and others. Considering this history, it seems surprising that it is now more than ten years into the AIDS crisis, the most serious medical crisis of this generation and likely to become the most lethal epidemic of the century, yet psychoanalysts, with some exceptions, have taken relatively little action. Is it due to lack of knowledge? Is it fear? Is it some sort of prejudice? In this paper, I would like to discuss some of the basic psychological issues involved in the AIDS epidemic and to suggest some of the ways that psychoanalysts are specially equipped to help out in direct clinical service and in providing insight and understanding.

AIDS is a horrible illness that gradually debilitates the body's normal immune system. Consequently, the person with AIDS suffers a sequence of varied and unusual illnesses, known as "opportunistic infections." These include, most commonly, pneumocystis carinii pneumonia (PCP), various herpes infections, a heretofore rare form of cancer known as Kaposi's sarcoma, cytomegalovirus infection, oral candidiasis, various lymphomas and parasites; the entire list is quite a bit longer, and new opportunistic infections are continually being discovered.

The medical treatment of AIDS usually proceeds on two tracks: 1) In the first track of treatment, the Human Immunodeficiency Virus (HIV), which is presumed to cause AIDS, is attacked di