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'He found me very well; for me, I was still feeling sick': the strange worlds of physicians and patients in the 18th and 21st centuries.
It is commonplace today to deplore the dissatisfaction of patients with the physician-patient relationship. Furthermore, historical investigation shows that this problem is not really new. We investigated an important source of patients' views in the 18th century, namely the letters of patients received by the famous Swiss physician, Samuel Tissot, and noted remarkably similar feelings of frustration. Yet the medical paradigms of today and of Tissot's times are considerably different. We propose that the persisting problems in the physician-patient relationship are due to a basic dissonance between the patient's ordinary modes of perception and the systematic way of perceiving reality characteristic of the physician. In addition, they reflect the unavoidable chasm between the ultimately private and singular nature of the illness experience, and the general and anonymous stance of medical theory. This chasm is therefore a permanent feature of the patient-physician relationship, predating the advent of scientific medicine, even if the latter reinforced it. In line with the current medical humanities movement, we believe that the engagement of physicians and medical students with literature and the arts helps them explore, and to some extent overcome, the existential divide between the patient's experiential self knowledge and the systematic, impersonal knowledge that plays a central role in medicine. We suggest a few examples of contemporary fiction that may be relevant and useful in this respect.
[Don Quixote and prevention's bad reputation].
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History of clinical research on the sleep apnea syndrome. The early days of polysomnography.
This article gives a brief historical overview of the literature on the sleep apnea syndrome (SAS), including initial case reports of the Pickwickian syndrome and its treatment with tracheostomy. It also highlights the beginnings of early clinical neurophysiology and describes the breakthrough in the understanding of the pathophysiology of SAS by performing polysomnography.
Pinocchio - a psychosomatic syndrome.
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Sleepers wake: André Gide and disease in Travels in the Congo.
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Frankenstein, Pickwick, and Ondine.
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The psychopathology of Silas Marner.
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Narcolepsy and the strange malady of Silas Marner.
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Dr. Jekyll and Mr. Hyde: a primer on substance dependence.
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Doctor Iago's treatment of Othello.
The article presents Shakespeare's Iago as Hell's master therapist. Illustrated with excerpts from the play, the reader is shown how with consummate psychological skills, Iago bends his victims to his will. Step by step he awakens Othello's jealousy, and makes use of the hero's basic insecurity on account of his blackness. Once Othello has determined to take revenge, Iago makes sure to prevent a "relapse", by slyly administering small doses of doubt and pity. Predictably, Othello violently rejects these suggestions, thus becoming even more rigidly bent on his plan.
The image of the psychotherapist in literature.
The current study explores the image of the psychotherapist as he/she is portrayed in literature in an attempt to broaden the perspective of existing research on this topic. In the past, studies and surveys on the image of psychotherapists have mainly been conducted among the general public and fellow colleagues rather than among the patients of psychotherapists. It is suggested that psychotherapists shy away from being the subjects of study. Moreover, it is proposed that research on the image of the psychotherapist suffers from a one-way gaze, whose bias stems from the asymmetrical nature of therapist-patient relationships. The present study explores the image of the psychotherapist through an analysis of nineteen literary works featuring twenty-six figures of psychotherapists. The literary image was examined by means of a questionnaire and content analysis. The profile that emerges suggests that psychotherapists and the psychotherapeutic process are well understood by authors representing both individual patients and the general public.
The knight as patient of the squire.
Many types of non-professional, non-credentialed relationships are seen by laypersons as analogous to those occuring in psychotherapy. This paper takes a leap backwards several centuries and describes two examples of one such type of interaction as portrayed in artistic masterpieces. In Miguel de Cervantes' novel, "Don Quixote," an elderly, depressed man pursues a restitutive and grandiose delusion of being a heroic knight errant. In Ingmar Bergman's film, "The Seventh Seal," a disillusioned knight returns from the Crusades to face the lethal bubonic plague, and he uses obsessional means in an attempt to outwit death. Both men are accompanied by squires who try, with varying degrees of success, to help their masters relinquish their infantile needs for omniscience and omnipotence, accept their human limitations, and deal more appropriately with their surrounding realities. The powerful and inspiring insights of both works have much to teach contemporary therapists whose patients wear more metaphorical suits of armor.
Ernest Jones in Toronto.
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Flaubert and Madame Bovary: an intimate courtship.
The process by which Gustave Flaubert created the character of Emma Bovary is examined, as are various of the author's sources for the heroine and their transformation in the course of composing the novel. Certain aspects of the authors psychic makeup, including his bisexuality, are discussed in this light, as are Flaubert's early traumatic losses and their influence on his way of working. Finally, it is suggested that writing had multiple functions for the author and that the creation of Emma Bovary served as a partial solution to unmet needs.
Tennessee Williams: the uses of declarative memory in The Glass Menagerie.
Tennessee Williams called his first great work, The Glass Menagerie, his "memory play." The situation in which Williams found himself when he began writing the play is explored, as are the ways in which he used the declarative memory of his protagonist, Tom Wingfield, to express and deal with his own painful conflicts. Williams's use of stage directions, lighting, and music to evoke memory and render it three-dimensional is described. Through a close study of The Glass Menagerie, the many uses of memory for the purposes of wish fulfillment, conflict resolution, and resilience are examined.