You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
I have tried to illustrate my experience that medical students can find certain difficulties in dealing with psychiatric patients that are not frequently experienced in other medical disciplines. While other patients are seen to harbour a well-defined cause for their pathology and, particularly, for being hospitalized, psychiatric patients will sometimes be seen as ‘normal people’ going through some personal crisis that, in the students’ experience of life, should not warrant the diagnosis of a medical condition. The educational setting in which these patients are met means that students may listen to what their seniors are teaching and memorize concepts and their definitions without, necessarily, comprehending the rationale for these. In the specific field of psychotherapy, this problem becomes even more difficult to spot, since so many psychoanalytic concepts have become part of everyday language. Projection, unconscious, transference and other such terms are used very often, even though the meanings and implications of each concept may elude the user.
I put particular emphasis on my finding that, fundamentally, learning demands the existence of a previous ‘not-knowing,’ where the new datum will fill a gap or explain a quandary. When this is not present, an intelligent student is well able to memorize what he is supposed to absorb, but this will only be translated into actual learning when that awareness of a gap is experienced by the student. This is why I believe that simply giving definitions of concepts does not equip the student to grasp where to fit in the new datum.
Another point made in the paper is a discussion of the relevance of trying to help the students to become aware of the feelings that patients bring out in them. This is especially important in psychiatry, where patients can sometimes produce a strong emotional impact on the student. Most students see such feelings as a sign that they are becoming personally involved or being judgmental and, therefore, they try hard to dismiss or deny these impressions. These feelings will influence the student's approach to the patient and, in a more subtle way, his capacity to assess the patient, hence it is important to discuss how any emotional reaction to the encounter with the patient must be acknowledged and scrutinized. I have argued that to categorize, ab initio, these feelings as ‘countertransference’ is not only wrong, but it deprives the student of an opportunity to learn about himself and his approach to patients.