ILLNESS IN THE ANALYST:IMPLICATIONS FOR THE TREATMENT RELATIONSHIP
Harvey J . Schwartz, M.D. and Ann-Louise S. Silver, M.D.,
Editors International Universities Press, New York 1990, 347 pp., $42.5

Gerstman, D.O., Robert Neil

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Walking in One\u27s Own Shoes

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Jefferson Journal of PsychiatryVolume 11 | Issue 2 Article 14June 1993Walking in One's Own ShoesRobert Neil Gerstman, D.O.Thomas Jefferson University HospitalFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationGerstman, D.O., Robert Neil (1993) "Walking in One's Own Shoes," Jefferson Journal of Psychiatry: Vol. 11 : Iss. 2 , Article 14.DOI: https://doi.org/10.29046/JJP.011.2.012Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol11/iss2/14Walking in One's Own ShoesILLNESS IN THE ANALYST:IMPLI CATIONS FOR THE TR EATM ENT RELATI O NSHIPH arv ey J . Schwartz , M.D. and Ann -Loui se S. Silver, M.D. , Edit orsIn tern a tional Univ ersities Pr ess, New York1990, 347 pp., $42.50.Robert Neil Gerstman, D.O.Medi cal stude nts are taught ba sic scien ces and clini cal scie nces during th eirundergraduate training. Psychia t r ists and other ph ysicians a re tau ght pa t ient ca re inth eir resid en cy programs. In medical ed ucat ion, th e topi c of illness in th e physician israrely di scussed . The differences between doct ors who have personally expe rience d aserious medical illn ess a nd those who have not usu all y go un exam ined. It is as ifwa lking in our patient 's shoes is a topic so overwhelming that it has becom e tab oo.Psychiatry differs from other di sciplines becau se th e psychi atrist is more dep en -dent upon his own life expe rie nce a nd it s rol e in th e t ran sferen t ial re lat ionship. InIlln ess in the A nalyst, Drs. Schwartz and Silver, both survivors of se r ious illnesses,explore how th is expe rie nce ca n affect both ph ysician a nd patient. The book is acollec t ion of articles writt en by different au t hors exa mining a va rie ty of aspect s ofthis rarely explore d topi c.The first sec t ion, Personal Reflections, explores how serious illness affect s th eanalyst. This sect ion is divided in to three chap te rs, t he first bein g "T he Ana lyt icAttitude in th e Servi ce of Denial " byJacob A. Arl ow, l\-LD., wh ere he rep ort ed:How life-threatening illn ess in th e a na lyst may affe ct pat ient s const itu tesa se rious issu e of techniqu e .. . keeping in mind th e effect up on th etransference , th e a nalyst ha s to decid e how , wh at , and when to tell th epatient of his illn ess. (page 2 1)Similarly, No rmund Wong, M.D. , discu ssed in his cha pte r, "Acute Illn ess in th eAnalyst, " t he effect of an exte nde d hospitaliza tion with no adva nced warn ing uponhim:I acce pte d how close I had come to death a nd was in touch wit h myfeelings of emotiona l pain and suffer ing whi ch I had stoica lly suppressed. . . I acknowledge d my mix ed feelings of dependen cy, di sappoint men t,Robert Ger stman, D.O. IS a PGY-III psychiatry residen t a t Th om as J effer son Univer sit yHospital in Phil adelphia.6970 J EFFERSO N J O URNAL OF PSYCHIATRYand anger at my gast roe n te ro log ist at th e ou tco me of a seemingly beni gnprocedure gone awry . (pp. 38-39)Francoise Davione, Ph .D . did not tell a ny of her patients about her an ergy a nda norexia but her patients picked up on her det eriorating health a nd incorpor a ted itinto th eir delusional systems as a way of maintaining a bond with her. She discussedin her cha pte r, " Delusion as a way of Knowled ge ," how a part icula r patient 'schanging delusions coincide d with th e di scovery a nd th en surgical in tervention forher ovarian cyst despite her not discu ssing a ny spec ifics with hi m. These chapte rsserved as introduct ory sta te me n ts for th e th eme of this book ; that th e personalex pe rie nces of th e a nalyst may have far greater in fluen ce on t he course of th erapyth an expecte d .The second secti on , Clinical Implications, con t inues this theme on a broad er level ,di scu ssin g different scenarios over seven chapte rs. Paul A. Dewald , M.D ., wrote in hischa p te r, " Se rious Ill ness in the An alyst : Transferen ce, Cou nt ert ra nsference & Real-ity Responses- & Further Reflections," how his own denial of th e ex te nt of his illnessaffected th e way his abse nce was announced to his patients whil e he was away:I as ked my secre tary to ca ll a nd inform th em I was ill in the hospital buthop ed to be back to work in th e following wee k . . . whe n it became obviousth at I would not be going back to work I as ked her to again call eac hpatient with th e message th at I was st ill in th e hospi tal but hoped to beback a t work th e followin g wee k . .. th e increasin g se riousness of myilln ess mad e it manifestly impossibl e to maintain t he denial an d at thatpoint th e messa ge to th e patients was th at I would be away from mypracti ce ind efinitely a nd would con tact th em whe n I was read y to ret u rn.(page 77)By his ac knowledgeme nt of his resist ance to th e sever ity of illness he was abl e tobett er underst and th e torment of his patients. Simi la rly, Sa nder M. Abend, M.D.,di scu ssed in "Se rious Illness in th e An alyst : Countertransference Considerations"th e issu e of how mu ch information to tell th e patien t about one 's leave of absen ce foran ind efinite peri od of time:The esse n t ia l argument to be cons ide re d asse r ts th at while too muchfac tua l information may inhibi t th e range of express ion of pa tients'reactions . . . too litt le information may, for so me patients a t least , provetoo burdensome, thus serving to limit th e a na lysis of tran sferen ce fa nta-sies. (page 105)The remaining chapte rs in thi s secti on ce n te re d on how the illn ess es of th ea na lysts directl y affec te d th eir patients. H a rvey J. Schwartz, M.D ., repor ted in hischa pter, " Ill ne ss in th e Doctor: Implicat ion s for th e Psych oa nalytic Process," th at forpatients, " becoming se rious ly ill ac t iva tes powerful fantasies of punishment , mutila-tion a nd aba ndo nme nt." (page 115) Ann Loui se Schles inge r Silver, M.D., in herchapte r " Res uming th e Work with a Life-Threat ening IIIness- & Further Reflections,"remarked that " people a re seeking me out for a na lyt ic t reatment because they haveheard th at I had come through a harrowing expe rie nce of illn ess." (page 169) In th eBOOK REVIEWS 71cha pte r by Richard Lasky, Ph .D. , " Keeping th e Analysis Intact When The AnalystHas Suffered a Catastrophic Illness: Clinical Consid erations," regarding the limitingof information told to his patients, he wro te, "one of my concerns was that givingpatients the spec ific information th at I was ill would channe l (or even dictate) theirfantasies too narrowly." (pag e 182) Susan G. Lazar, M.D. , reflect ed on the effect thather multiple pr egnancies , which unfortunately included multiple miscarriages, hadon her patients. Sh e acknowled ged th at her situa tion was differen t from the otherlife-threatening sce narios dis cussed in this book , however she likened her situationsto th eirs because " it is nonetheless an unwelcome intrusion on the patient whilebeing a de eply person al meaningful event for th e analyst." (page 199)The last chapte r in thi s sect ion was by Amy Lichtblau Morrison, M.S.S .W.,en t itled, " Do ing Psychotherap y While Living with a Life-Threatenin g Illness," whereshe qu estioned whether a new patient sho uld be told of her cancer history beforesta r t ing treatment. "W hat if th ere 's a hist ory of a nd vulne rability to loss as occurredrecently with a prospective new patient who at an early age lost his mo ther to breastca nce r?" (pp. 246-247) Sh e answered her own qu esti on by making th e observationthat "we need to conside r a nd balance what is gaine d or lost in t he adherence to astance of analyt ic a nonymity when th e th erapi st is dealing with a serious orlife-threatening illn ess." (page 248)The third a nd last section, Death ofthe A nalyst, ex plores how the death of ana na lys t affects analysands who were in th erapy a nd those who have already completedth erapy. David A.S. Garfi eld , M.D. , wro te in " Manifes tat ions of Grief a nd Grievance:A Therapi st 's Response to a n Analyst 's Death" about t he difficulty he had mourningfor his analyst becau se of th e father transferen ce he placed up on him. (page 265)Thom as Wolman, M.D. , wrot e in "T he Death of the Analyst in the Post-termination Phase of Analysis : Impact and Resolution" th at th e death of the analysthighlights th e importance of th e post-t ermination ph ase of a na lysis, which is gener-ally characte rized by a work of mourning for th e analyst. This resolu tion requires thepatient to give up th e analyst as object a nd to repl ace him or her with the formalfun cti on design ated by th e title 'analyst'. H e discusses how th e dea th of the analyst inth e post-termination phase can serve to promote th e final det achment from him orher as an obj ect. (page 296) Similarly, Abraham Freedman , M.D., discussed theseth em es in " De a th of th e Psych oanalyst as a Form of T ermination of Psychoanalysis."Finally, Ste phe n K. Firest ein, M.D. , in his chapter, " Death of the Analyst:T ermination, Interruption , What?" , a tte mpte d to sum marize the pr eced ing chaptersby compa ring the illn ess of th e analyst to th e surgeon colla psing in th e middle of theope ra t ion. "W ha te ver is done for th e surgeon, no one for a second can forge t theplight of th e patient , and colleagues immediately ste p in to substitu te an d meet thepatien t 's need for ca re ." (page 337) H e al so remarks on th e worst case scenario of anana lyst dyin g is th at of one who has no family or staff to quickly advise pat ients of thenews. (page 338)The on e shor tcoming of this text is th at th e various a uthors mak e references toeach othe r' s chapte rs which mak es for difficult read ing a t t imes. O th erwise, Drs.Schwa r tz and Silver mak e a valua ble cont ribu tion to the psychoanalytic litera ture byorganizing a collec t ion of articles on a topi c se ldo m discussed.

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Walking in One\u27s Own Shoes

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