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Psychosomatic Medicine, 1946, Vol. VIII, No. 3, pp. 195–199.
The completely passive cadaver is the ideal object of many sublimated, active libidinal drives, as well as those of mastery and power. In certain respects, the cadaver becomes the student's ideal of a patient. The initial relationship of the student with this first medical object is not at the level of a human identification, but of a relationship to a passive object. Sublimation of the wish for a cadaver as a patient has led to the invention of anæsthesia and the use of antiseptics. Therapeutic nihilism is a complete fixation on the wish for a cadaver-patient. The transition to a humanistic identification with the patient as a live, suffering individual is best achieved when the physician can dissociate himself and identify himself as the needs of the patient's illness demand.
The physician must cope with the infantile aggressions of the patient. The normal doctor does not take his patient's aggressions personally; yet he registers them unconsciously. The physician's counter-transference aggressions are sublimated by prescribing drugs and by the surgical removal of parts of the patient's body. A common counter-transference defence technique is placation. The guilt for the doctor's counter-aggressions is often cleared by the taking of the history, since there the doctor succeeds in throwing the blame back on to the patient. Malpractice insurance is the rational expression of the fear of the patient's aggressions. The healthy physician comes to terms with his own counter-transference tendencies, but there is no substitute for conscious insight such as is obtained during the analysis and supervised training of the student analyst.