Can the Impossible Profession Help the Impossible Patient—is Freud Relevant in the South Bronx?

Over the past two decades, the general hospital has emerged as the central setting for treating patients suffering from a wide assortment of psychiatric disorders; disorders ranging from major psychopathology to character disorders, frequently complicated by substance abuse. Moreover, the treatment of psychiatric patients has moved not only to the general hospital, but also through the general hospital. Patients now receive psychiatric treatment in a variety of hospital settings, including psychiatric emergency services, inpatient units, outpatient clinics, substance abuse services, and in consultation on medical-service wards. Significant in themselves, the challenges posed by the myriad settings in which psychiatric patients are now treated are magnified by the fact that many of these patients would be considered “impossible” by traditional professional standards. Finally, because the health care delivery system is shaped by the economic and ideological climate in which it exists, the current climate of economic duress and ideological emphasis on deinstitutionalization and home health care have shaped the contemporary practice of medicine, including the specialty of psychiatry, to the demands of our times. Consequently, many of these seemingly “impossible” patients are treated on an acute or short-term basis. Taken as a whole, then, these changes in the setting and length of treatment, as well as in the type of patients requiring psychiatric treatment, have raised a critical concern in psychoanalysis today: namely, whether or not psychoanalysis has relevance to contemporary psychiatric treatment