The Autopsic Encumbrance—Some Remarks on an Unconscious Interference with the Management of the Analytic Situation

A few years ago certain typical stages in the development of the doctor's relation to his patient were outlined by B. D. Lewin1 and explained on the basis of the fact that the medical man's first 'office' is the dissecting room, and his first 'patient' the corpse. Confining his observations, except for an occasional reference, to the physician, the author writes: 'As a medical student, the doctor begins his professional training not on the analytic couch, but as a dissector in the anatomy laboratory. He immediately has a "patient", the cadaver. The cadaver, he recognizes, is not meant to be an individual but a type. The manual skill and knowledge he gains by dissecting are to be transferred later to living patients. The student is supposed to be emotionally detached from the cadaver and usually assumes uncritically that he is. But, psychologically considered, this is hardly possible. The student derives much satisfaction from his work. His relationship to the cadaver is an outlet for many sublimated, active, libidinal drives, as well as those of mastery and power. The cadaver, completely passive and unresistant to the dissector's intentions, is an ideal object for such satisfactions. Intended to be a prototype of all future patients in certain rational respects, the cadaver easily comes to be the student's ideal of a patient in all respects. … The preclinical studies prepare the student to apply laboratory knowledge and skills to his human patients, often directly. The scalpel he used on the cadaver is now to be used on his surgical patients; the digitalis he administered to his pharmacological laboratory "preparation"— —a frog or a cat—is to be prescribed for cardiac cases. … He must be as confident and as unruffled in using the knife or the drug clinically, as when he worked in the laboratory. … Unconsciously, along with skills and knowledge, much of the psychological relationship to the cadaver is carried over to living patients. …'

'… it was the