MS-1 · psychiatry

I just got back from the psychoanalysis conference. It was pretty fascinating, and it was wonderful to meet other students who are interested in psychiatry. (We had a day-long student session, followed by a general talk about the history of psychoanalysis.)

What I liked most about psych (-iatry? -oanalysis?) was its focus on story and narrative. As a literature major in college, I’ve been searching for something that gives me the same sort of thrill I got when immersed in a character or a plot. Some of the speakers shared stories from their own practices (properly disguised, of course) that really brought me back to that place. The focus on the past and the iceberg of the Unconscious — really just the concept that a person’s motivation is deep rather than superficial — are also appealing, as is the interdisciplinary synthesis that informs much of psychoanalysis. But most of all, I really enjoy the prospect of getting to help make sense of this crazy arena we call Life. As one of the speakers put it, psychoanalysts “help people create cohesive narratives of their lives.”

Unfortunately, psychoanalysis is an additional four years of training after a psychiatry residency. Although the traning is part-time, the opportunity cost is high: you could be seeing and helping your own patients in that time. Also the elitism aspect of it, the notion that psychoanalysis is for neurotic rich housewives on the Upper East Side. One of the speakers said he uses a sliding scale, but I’m not sure I like that idea (although it’s better than shutting the poor out entirely).

And lastly, my god, did they adore Freud. I was surprised, because Freud’s theories, while obviously influential in creating the field, are a century old by now. I know, from my literature training, that a lot more work has been done in psychoanalytic theory — there’s Lacan, and Derrida, and a whole slew of feminist psychoanalysts — that were just trampled on in the rush to worship at Freud’s altar. To analyze the analysts a moment: it’s almost as though they are using the approbation of a dead master to cover the disrespect that psychoanalysis gets from just about every other field.

Honestly, though, if psychoanalysis is discredited as “not real science,” it is at least partially their own fault. I’m not talking about the historical lack of evidence-based studies that psychoanalysis actually helps — those are coming out recently, with support from neuroscience, fMRI, etc — but rather the apparent disowning of any attempts at progress in the field. Can you imagine medicine practiced as it was circa 1905? “Here you go, Farmer Jones, have a poultice for your infected boil, and we’ll have to amputate next week. If you’re still alive, that is.” So why is psychoanalysis so adamant that Freud Got It All? That’s practically dogma.

I think that psychiatry is just about the most fantastic thing I’ve considered right now, and especially in minority communities, where psychiatric disorders carry a stigma that “regular” medical problems do not. And one can certainly use psychodynamic thinking and “talk therapy” in regular psychiatric practice (i.e. it’s not just about Xanax and Zoloft). Although psychoanalysis is kinda cool, I’m not convinced that the extra time and training are worth it.


4 thoughts on “

  1. i think you should just stick with “regular” psychiatry” should you opt for that area…although it seems few psychiatrists do actual therapy any more, thanks to the stupid insurance companies who would rather reimburse other therapists (“cheaper”) for their time. it’s a shame. i would tons rather go to an md for therapy than any other type of therapist and in fact am seeing a 4th year resident now, he is fantastic…unfortunately, he will be leaving to do a fellowship at the end of June 😦 i feel so fortunate to have been able to see him for the time i have (it will be about 9 months). anyhow, thanks for listening to my rambling and for answering my comments on your last post.
    best always

  2. Big decisions. I’m glad that you had a positive experience at the conference. This is a weird place that we’re in right now, what with the getting in and succeeding in medical school. I was looking forward to lots more time before I had to make any other decisions, but it seems that as soon as you start, you are inundated with questions about the next step. Luckily, while we have lots of decisions to make, we still have a bit of time before we’re forced to make them.

    Good luck with all that! And, of course, I’m looking forward to reading all about your decision making process over the next few years!

  3. Yeah, I’m very, very glad that we don’t have to make any decisions soon, and we have time to explore just about everything before committing. Hopefully my third year will be the clincher either for or against psych!

  4. Have you read the sequel to “House of God”, “Mount Misery”? it’s all about psychiatry (one of my favorite topics!) and very good. thanks for a most interesting entry.
    “In a House of Dreams and Glass” is also very good. wish i could remember the author’s name . it is by a psychiatrist about his residency. (i know you probably don’t have much time for “fun” reading right now, but for when you do…).
    take care, tracy

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s