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All doctors are involved in transference reactions from their patients and countertransference reactions to them. Excepting psychoanalysts, and perhaps most psychiatrists, other specialists, general practitioners, and surgeons are totally or insufficiently aware of this unconscious interrelationship. Its therapeutic importance cannot be exaggerated. Valabrega calls it an 'intersubjective process' with deep emotional implications. Full awareness of the psychic factors involved in this interrelationship inevitably leads to much more competent management of every patient.
In the physical illness, the author agrees with Freud that there is a narcissistic investment of the ego and of the body. This, he says, does not constitute a complete withdrawal of the libido from the object; rather, there is a regressive redistribution of the libido, which has been partly withdrawn from objects previously cathected and reinvested in new objects in accordance with the sick person's dependent needs. The secondary narcissism is a regression to a state of primary love which involves introjection of the object.
Valabrega discusses at length the significance and importance of the Oedipus complex, particularly its displacement into the doctor as father and, in turn, the partial identification with the doctor which includes an element of aggression. Illness is equated with death, evil, and punishment, and therefore unconsciously connected to each patient's feeling of guilt. Disease in some instances may be conceived as a 'substance introduced into the body' or as a 'theft of the soul'. Magical thinking is conspicuous; a wish to contaminate others may derive from the wish to protect oneself; also, the person of the physician and the 'medical ceremony' are heavily invested with magic. The author reminds us the physician is not so far removed from the shaman and medicine man as we like to believe.