A Multiple Birth: Psychoanalysis and Narrative Medicine

Abstract

Chance and the prepared mind. This aphorism favored by the great psychologist Henry Murray best captures the serendipitous set of circumstances that led to the "Psychoanalysis and Narrative Medicine" conference I organized at the University of Florida on February 19-22, 2004. A long-standing interest in psychoanalysis prompted me to propose a conference on this topic to the Thomas H. Maren Foundation, which responded with a munificence that allowed me to build my field of dreams without cutting any corners. Although I am not a scholar of narrative medicine, it seems to me that in proposing a conjunction with psychoanalysis, I was inviting this exciting new discipline to claim an insufficiently acknowledged portion of its own history. For whereas narrative medicine, as I understand it, arose from a desire to bring "literary competence" (and the benefits of literary study generally) within the purview of the medical-school curriculum, it is, of course, psychoanalysis that is known as the "talking cure," and thus distills the essence of what narrative medicine is all about. From the standpoint of psychoanalysis, conversely, an alliance with narrative medicine offers the prospect of basking in the reflected glory of this revival of humanism within the bastions of science, and thereby strengthening its own beleaguered position both intramurally within the mental-health profession and in American culture at large. In tracing the psychoanalytic genealogy of narrative medicine, three prominent names come to my mind. The first, of course, is Freud. Freud's fundamental theoretical contribution is to have elucidated the influence of unconscious mental processes, and the defenses against them, on the whole of human life, while his greatest invention is of a new kind of human relationship, that between analyst and patient, in which people can seek a "soul cure" through exploring the meaning of [End Page 252] their (often painful) experiences with a trained professional in a secular context. Strikingly, although Freud was himself a neurologist before he became a psychotherapist, he insisted that "psycho-analysis is not a specialized branch of medicine," but rather belonged to psychology; and that the education of future analysts should "include branches of knowledge which are remote from medicine and which the doctor does not come across in his practice: the history of civilization, mythology, the psychology of religion and the science of literature."1 Without Freud, there would have been no psychoanalysis, but in at least one important respect he impeded rather than abetted the contemporary rapprochement with narrative medicine. I refer to his notorious recommendation that the analyst should cultivate an "emotional coldness" and model his or her technique on that of "the surgeon, who puts aside all his feelings" while performing an operation.2 For whereas it has been a principal thrust of narrative medicine to encourage physicians genuinely to listen to their patients, and in doing so to learn to look upon them not simply as a collection of symptoms but as fellow human beings, Freud's own espousal of a surgical model of psychoanalytic therapy paradoxically steered his movement in the opposite direction, a wrong turn from which it is only now, nearly a century later, definitively being rescued. The other two psychoanalysts who can be regarded as progenitors of narrative medicine, Georg Groddeck and Michael Balint, are central figures in the relational tradition that has, in my understanding, succeeded in rectifying many of Freud's mistakes, including his minimizing of the need for genuine compassion and empathy on the part of the analyst in order for emotional healing to take place in the patient. Both Groddeck and Balint were closely associated with Sándor Ferenczi, Freud's great Hungarian disciple, who, as Paul Stepansky has shown in his outstanding study of the vicissitudes of the surgical metaphor in Freud's work, effected the "only bona fide transformation" in Freud's conception when Ferenczi redefined the analyst not as a surgeon but as an obstetrician: The doctor's position in psychoanalytic treatment recalls in many ways...