Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. K. R. Eissler observed that the therapeutic task in this case was almost impossible as there was no support from the patient's external or internal environment. While he agreed with the general principles of the handling of the patient, Eissler felt puzzled by Roose's disclaimer of knowing anything about death and wondered what the remark might have meant to the patient's unconscious. Eissler strongly opposes telling patients that they have fatal diseases. He emphasized that a sense of the future should be maintained. He added that one cannot treat a dying patient adequately unless one feels sorrow and pity, which do not preclude simultaneous admiration of the patient.

Dr. Bernard Brodsky felt that Roose's management of the devastating emotional problems of the patient was adroit and intuitive. In the analytic treatment of a young woman with leukemia, he found the mechanism of denial to be operating in such a way as to impede her collaboration with medical measures aimed at prolonging her life. In Brodsky's experience the patient never really abolishes denial and death itself is not viewed as nothingness but as an eternal fusion with the primal mother's breast.

Dr. Bernard C. Meyer agreed with Eissler that such patients should not be told the true diagnosis. Dr. Leo A. Spiegel said that the patient with knowledge of his imminent death is confronted with a predicament that analysts are well acquainted with in less severe degrees—the traumatic situation of helplessness. Dr. Max Schur felt that the main problem facing physicians treating dying patients is to know to what extent the patient wants to deny aspects of his reality situation. Some patients need to deny the gravity of their illnesses in any way possible; others do not need to deny the facts and meet death in heroic fashion. Dr. Samuel Atkin observed that the patient helps the physician with mechanisms of his own, such as denial and pursuit of the ego ideal. He felt that the capacity