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General practitioners have to think and act before all the information they need is available to them. No-where does this cause so much frustration as in emotional and psycho-somatic illness, where “information,” in the sense of the basic sciences taught at medical school, is elusive, often incomprehensible, always controversial.
Psycho-analytic activity requires the courage and the imagination to permit a marriage between art and science. When they are separated, both remain sterile. In combination, they complement one another in an enhanced desire to find meaning in the experience of being alive.
Concepts of normal emotional development in children, also help to clarify the structure of disturbance, and thereby modify ways of thinking about many problem illnesses. But the psychoanalytic method which reveals those structures — comparable to the pictures of electron microscopy — is not easy to follow.
As with that instrument, and others at present in use in body-brain medicine, for example computerised tomography and other types of scanning, the pictures require experience to interpret. Most difficult of all for general practitioners trained in scientific method, is to accustom themselves to a shift in perspective to one which is mind orientated. This split between the idea of scientific and imaginative activity, between brain and mind, is from the psycho-analytic point of view, defensive about the pain of responsibility for inner reality.
What follows is an attempt to address the need and the desire of many general practitioners for some “hard facts” they can use, while enjoying the opportunity to deploy their intuitive sensitivity.
Freud, working with adults, described three structures in the mind: Id, Ego, and Super-Ego, the latter capable of improvement into an Ego-Ideal. In London, the presence of