Psychoanalytic Sociology and the Medical Encounter: A Reply to Pilgrim

Abstract

In replying to David Pilgrim, it might be useful first briefly to outline why it was that I, as a sociologist, turned in the first place to psychoanalytic accounts relating to the medical encounter. It was my continuing interest in the dynamics of the doctor-patient relationship that incited me to return to Parsons’ writings on the psychodynamics of this relationship and to seek out others who had written on this subject. A recent empirical research project that I undertook, involving interviews with patients and doctors and analysing representations of the medical profession in the media (with a particular focus on the Australian press), found that the emotional aspects of the ways in which the medical profession is thought about, encountered and culturally portrayed were a particularly important feature. Love, caring, gratitude, dependency, respect and trust as well as anxiety, hatred, anger, frustration, hostility and fear were apparent in patients’ accounts of their experiences and opinions of doctors and in the cultural representations of the medical profession. Above all, a high degree of ambivalence about doctors appeared to characterise attitudes towards them (see Lupton 1996, 1997, 1998; Lupton and McLean 1998). It seemed to me that a psychoanalytic perspective might be able to contribute to a deeper understanding of the sociocultural nature of the doctorpatient relationship, going beyond the mainstream sociological emphasis on power, social control and rational action or the insights offered by phenomenological accounts, which often identify the presence of strong and conflicting emotions in patients and doctors but do not necessarily provide a convincing explanation for them. I found when delving into the psychoanalytic literature that its accounts of unconscious psychodynamic processes, operating on the part of both patients and doctors, offered some further explanation for the presence of these emotions, particularly those that might appear to be ‘irrational’ in the context in which they are experienced. Psychoanalytic theories of course, as Pilgrim is at pains to point out, have their deficiencies and failings, as does any theoretical perspective. These deficiencies and failings have received much scholarly attention ‐ Pilgrim references some of the critics of psychoanalytic theory in his rejoinder. Given this, and also bearing in mind that space was short, it seemed to