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This “must read” book containing clinical monographs and therapeutic techniques for working with patients dying of cancer, is two books in one: a paradigm and a system of psychoanalytic approaches when facing a patient dying of cancer. The clinical chapters place the psychodynamic psychiatrist into an interpersonal dome that balances participation and observation. The “surgical,” classical psychoanalytic system does not work with patients living within the existential anxiety and terror of facing death.
Straker, a psychoanalyst at the bedside (Lefer, 2006), writes that “reports of treatments of dying patients by psychoanalysts are very limited in psychoanalytic literature.” The patient is living in the present; past and future time is no longer objective time. The patient is living in subjective time and the “here and now.” The analyst needs to be “flexible.” The goal is terror management.
I recalled listening to a paper given by Jacob Arlow. While treating an internist, Arlow had suffered a myocardial infarction. When he fell to the floor, the internist diagnosed his condition and called for an ambulance. While riding in the ambulance, Arlow said to himself that this experience would make an excellent paper. He studied his own dissociation from the events. The conclusion of the paper was that his experience with a near death event spoiled the transference. Dr. Theodore Lidz was in the audience and exclaimed, “Dr. Arlow, you are an idiot!”
Straker attempts to get away from this type of thinking. He quotes William James, “Death is the worm at the core of human existence.” Guidelines and advanced directives have become political struggles. Republican members of Congress called guidelines “death panels” to avoid paying for end of life discussions. Straker notes that medical students distance themselves from death through “intellectualization, splitting, and dissociation.” Many times, working as a consultation-liaison psychiatrist and being a presence on the medical floors