The Fifty Thousand Hour Patient

Plases join me in a little sum. I have done analysis for 25 years. Let us say that I worked, roughly, 10 out of 12 months, once you take out vacations and flu's. My unhealthy schedule has rarely gone below 50 hours of clinical work per week. Thus we have 25 × 10 × 4 × 50. The result is 50, 000 hours. Fifty thousand hours talking and mostly listening to patients with an analytical stance and ear.

My ear has changed with time and so have my patients. This is one of the points of my paper, but first of all I want to take the 50, 000-hour period as a whole. I plan to see it as a huge unit of clinical presentation. Obviously I want to say a little more than to claim long experience. I want to turn that lump of time into an entity, a construct that could be called The 'Fifty Thousand Hour Patient' (the 'Patient', for short). I want to use the 'Patient' in my attempt to speak about analysis.

What have I learned from him?

At first I felt uneasy with my sum. The sensation was that I could not recapture anything, and the span of time in which millions of words had been said became a booming Tower of Babel. And in all fairness, my 'Patient' speaks many tongues, for he has been a child, a man, a woman, an old man, a group, a community1 dealing with a changing person—me. And yet some general inferences can be drawn from him.

First, a clinical verification. Only once in those 50,000 hours was I really hurt by a patient. I do not mean annoyed, upset or angry, but really hurt. Someone said the wrong thing at the wrong time. And if one considers that we analysts have at least a couple of Achilles heels, it is amazing that I did not get hurt more often. Besides our weak spots, life brings up situations in which we are particularly vulnerable: someone we love may die, for instance, and the patient may know about it (or, even worse, may not know about it and carry on as usual). On such occasions I have been repeatedly surprised by some sort of basic fair play in most p