Consistency and Flexibility in the Psychoanalytic Process

Growing up in brooklyn, I believed that there was only one illness and only one course of treatment. Dr. Goldstein, short, mustached, would open his black leather pouch and would ceremoniously listen to my chest, aim his pointed light deep into my ears and nose, and request that I say “ahh” in response to his triple-sized popsickle stick. Then he would give the inevitable command to my mother: “Boil the water!” Where I grew up, this command meant that the kitchen stove would soon be the temporary sterilization machine for a hypodermic needle. With studied wisdom, the doctor would utter the diagnosis, “Flu,” and pronounce the treatment, the penicillin shot. By the age of eight I already knew both diagnosis and treatment, so I wondered why the ritual of the examination.

Shortly after my eleventh birthday, when I learned the function of white and red blood cells, I believed that I had stumbled on a potential cure for all disease. Not long after, my brother contracted the ever-present flu. As soon as Dr. Goldstein solemnly pronounced “Boil the water,” I shared my “brilliant” theory with him. “If you take a person with leukemia and remove a pint of his blood, and then you take a person with another disease and remove a pint of his blood, and you then give each of them a transfusion with the other person's blood, the white blood cells will help the sick person and the red blood cells will help the person with leukemia.”

The seconds hung like hours as I anticipated my mother's delight when Dr. Goldstein would identify me as a future Nobel Prize winner. The words “That's impossible” rang in my ears for days. They silenced me. I still have not forgiven him. He thought as little of my theory as I thought of his diagnostic skills or bedside manner.

During the last ninety years, psychoanalysis, like medicine, has discovered many new techniques to combat illness. Beginning with an appreciation