The Psychoanalyst at the Medical Bedside

Consultation-liaison psychiatry is now a subspecialty recognized by the American Board of Psychiatry and Neurology. The presence of the psychiatrist as a member of the medical team is the result of contributions by psychoanalysts in the 1930s, 1940s and 1950s who studied the psyche acting on the soma. Psychoanalysis, from its theoretical inception, was holistic, and brought together biological, psychic, and social-ecological perspectives to unravel the mysteries of somatic illness. The early psychoanalysts were retracing a biopsychosocial model whose origins could be found in ancient Greece. A patient who is medically ill is more than an illness. Subjective experience, experiences before the onset of illness, losses, and the triad of helplessness, hopelessness, and giving up all became areas for psychoanalytic study. Some medically ill patients present degrees of complexity that puzzle physicians. These patients require a psychiatric consultation and treatment. The alliance with the psychiatrist unravels the problems complicating their cases and results in a collaborative treatment with the treating physician. The psychoanalyst training residents in psychiatry during their period in a consultation-liaison service is able to teach transference and countertransference issues that arise with patients and nonpsychiatric physicians. The creation of such an alliance can be a difficult task for the authoritarian resident who may be culturally conditioned to a rigid doctor-patient relationship. With the guidance of the psychoanalyst-teacher, residents change, and patients benefit.