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It is a great honor to have had my paper “Loss of Self-Cohesion in Terminal Illness” selected to celebrate the 50th year of the journal's publication, especially since this paper was written in late 1981 when I was only a few years out of residency and before starting psychoanalytic training. This was my first attempt to write a paper based on a clinical application of psychoanalytic theory. Kohut's seminal book, The Analysis of the Self, had been published just 10 years before and was not widely known outside of psychoanalytic circles. Even within the psychoanalytic world it was considered quite controversial. My training analyst, Rebecca Solomon, who was president of the American Psychoanalytic Association, had, to my potentially somewhat transference-tinted view, a skeptical opinion to say the least.
Paul and Anna Ornstein, though, among the first generation of “Kohutians,” were major teachers and mentors of mine during residency. Even before my analytic training, I was steeped in the latest theory tug of war between Kernberg, representing the object relations team, and Kohut, representing his own team. I felt the positive publication decision perhaps signified I'd be able to wend my way through all the voluminous psychoanalytic theorizing.
When I was in residency, Kubler-Ross's On Death and Dying was not even a decade old but already had revolutionized treatment for the terminally ill. During our last year of residency, I did a clinical rotation at the Cincinnati Cancer Family Care. This was a forerunner to hospice programs but focused only on providing psychological support to the patients with terminal cancer. So, having studied Kubler-Ross, but also armed with Kohutian theory, I undertook the care of the patient described in the article and his family. In those days, this type