A Psychodynamic Understanding of Modern Medicine: Placing the Person at the Center of Care 1st Edition

This is a terrific book and a must-read for all of those who interact with our increasingly sophisticated and technologically complex medical system, or who have family, friends, clients, and patients who do so. In short, it is a book relevant to all of us. It begins with two exceptional chapters that set the stage for what is to come. First, Dr. O'Reilly-Landry provides an historical overview that traces how our medical system has developed to provide medical care that requires high levels of technical expertise on the part of medical practitioners and, at the same time, makes complex psychological and emotional demands on the recipients of this care. Her book is designed to address and to ameliorate the psychological disconnect between practitioner and patient that can result. The chapter that follows by Dr. Ellen Luborsky is essentially a primer in psychodynamic theory that introduces the jargon-free and lucid discussions of psychodynamic issues that permeate the rest of the book. The chapters to follow are organized into four sections. The first section plumbs the personal subjective experiences and meanings that are associated with a wide range of medical conditions, from chronic illnesses of different types, to mobility issues of those who suffer from multiples sclerosis, to orofacial pain. Included in this latter chapter is an amazingly clear discussion of the mind-body problem that is remarkable for its breadth and acumen. In this section, as is true throughout the book, appropriate and up-to-date references are provided for those who might want to pursue a topic in greater depth. The next section of the chapter tackles the ways in which an understanding of the relationship between the medical provider and the recipient of medical care can be improved through an appreciation of the complex relational dynamics of doctor and patient. As I was reading the chapter on the use of group processes to improve doctor-patient relationships, I wondered how physicians and other medical practitioners manage to function without such help. Since the doctor-patient relationship is, to some extent, an important conduit of care, problems in this relationship can compromise care. The next section on relationships born of technology encompasses organ transplant and assisted reproductive technology. I immediately copied one of these chapters to send to someone I know who recently received a lung transplant. The chapter on reproductive technology provides a superb overview of the many issues raised by the advances of this technology, all of which was encompassed by a profoundly empathic and humane reinterpretation of the meaning of family in the face of these advances. The final section of the book focuses on issues having to do with the illness of a family member, including dementia, premature babies in neonatal intensive care, LBGT patients, and elder care. I was particularly struck by the efforts of Dr. Pauline Boss, who wrote the chapter on caregivers of patients with dementia, to not pathologize those who struggle to care for loved ones with dementia. She clearly describes this ever-increasing population as struggling to deal with an overwhelming problem of ambiguous loss. Their complicated grief responses are not due to individual pathology, but rather to the psychological demands of the situation they face. While perhaps most explicit in the chapter on caring for relatives with dementia, I found the use of psychodynamic theory and practice to more deeply understand rather than to pathologize patient responses to medical issues and treatment one of the most valuable aspects of this remarkable book. It is matched by an understanding of medical practitioners who, in turn, are understood as doing their best to deliver highly sophisticated and technical medical care. By bringing together a disparate set of psychodynamic practitioners who work in widely diverse medical settings, Dr. O'Reilly-Landry has initiated a most timely conversation between psychological and medical practitioners that has great promise to contribute to the improvement of health care.

Medical results vary more than medical practitioners and public policy makerswould prefer. A significant amount of that variability occurs because ofinternal(psychological, mental)factors. Being able to acknowledge, understandand perhaps better account for and control these factors would in all likelihoodimprove the practice of medicine today.This collection of papers seeks to address these issues both in terms offacilitating more useful research as well as to improve medical practice. The variouschapters do this by helping us to become aware of the feelings and thoughts that oftengo unrecognized by conventional medical practice. For example, by asking what thoughtsand feelings the patient has been having about the upcoming procedure? And,how has having to have the procedure been affecting his life? His relationships? Hisview of the future?The two introductory chapters, by Drs. O'Reilly-Landry and Luborsky, provide auseful guide to key concepts helping us understand how the inner psychologicallife of doctors and patients interact to impact medical outcomes.We are not entirely( or perhaps rarely) rational beings who fully knowourselves. When an illness or a medical event strikes us it is not unusual forus to face stress, anxiety, fear and confusion. Most likely we won't be at ourbest to make crucial decisions. In such a moment doctors and patients are indeedparticipant observers. The articles in this book help us to understand and unpack these clinical momentsby making room for and inquiring into the often painful and anxious feelings thatare just beneath the surface in order to practically improve doctor-patientcollaboration.It is a great pleasure for me to highly recommend this bookedited by Dr. Maureen O'Reilly-Landry containing many articles which demonstratethe usefulness of psychoanalytic thinking and/or psychodynamic ideas to understand modern medicine at a deeper level.Paul H Feinberg, PhD, NYU Postdoctoral Program in Psychotherapy and Psychoanalysis