Psychoanalysis and the Pre-Med

by Harris Avgousti

As a junior at the University of Pennsylvania, I study biology and chemistry, and I plan to pursue a medical degree after graduation. Throughout my education, I’ve been very STEM-focused, doing research in radiation oncology, tutoring for organic chemistry and physics, and so on. But a recent course on psychoanalysis helped me begin thinking in new ways about what I’m learning now and how I might someday practice medicine.

In the fall 2018 semester, I enrolled in “Psychoanalysis: History, Theory, Practice,” with Professor Max Cavitch and Dr. Susan Adelman. To be honest, I took the course simply because it would fulfill my English requirement for medical school; but the experience proved to be a whole lot more. We studied the writings of many psychoanalytic thinkers—including Freud, Klein, Winnicott, Lacan, and Mitchell, to name just a few—whose ideas continued to draw my rapt attention to what was, for me, an entirely new field.

Eight months later, I got my first glimpse of how some of these psychoanalytic ideas might be applied in the “real-world” setting of oncological research and patient care.

I was enrolled in the 2019 Summer Undergraduate Program for Educating Radiation Scientists, an intensive program for some of the best science students in the U.S. We were given the opportunity to shadow physicians at the Abramson Cancer Center, and I was assigned to Dr. Harding, whose main clinical focus was acute palliative radiotherapy. He treated patients with late-stage malignant disease, solely with the purpose of improving the quality of whatever life they had left. We spent most of our time analyzing CT/PET scans and making dosimetry calculations in order to figure out the best course of action. But the most enlightening part of each day was physician-patient interaction.

One day, Dr. Harding and I visited a couple in their late 50s. Dr. Harding greeted the patient and his wife soberly and showed them a CT scan of the man’s lungs; malignant tumors filled the image. The patient and his wife began to weep, and Dr. Harding whispered to me to grab a box of tissues from the room next door. Upon my return, the room remained silent for almost five minutes, as Dr. Harding gave the couple the time they needed to begin to process the terrible news. Then, when they were ready to talk, Dr. Harding did something I’d never seen before in any of my clinical shadowing experiences. He asked the couple questions that, seemingly, had nothing to do with their cancer diagnosis—questions like: “Are you content in life?”; “What is your daily routine like?”; and “How do you sleep at night?” I felt as though I’d been transported to a psychotherapeutic session from Alison Bechdel’s Are You My Mother?, one of the analytic memoirs we’d read in my psychoanalysis course. It was as if I were no longer watching an oncologist and patient, but an analyst and analysand. Some of the same subjective experiences I’d read about in the psychoanalytic literature were being given space to unfold, including what were very clearly transferential and counter-transferential communications between the patient and Dr. Harding—a dialogue that ended up helping to shape the further discussion of his diagnosis and treatment plan. After about 30 minutes, the couple left, and Dr. Harding started writing up his clinical notes in the Epic database (which allows physicians to upload highlights from patient appointments onto a central server for later access).

When I asked Dr. Harding if the interaction I’d witnessed was typical of his clinical routine, he answered with a very abrupt “no.” But, after a moment’s reflection, he said that merely sharing technical medical details isn’t always the best way to treat such a patient. He told me that talking with patients about their thoughts and feelings hadn’t been part of his formal medical training, but that he had discovered, through experience, how beneficial doing so could be. Then it hit me: Dr. Harding was employing his own version of what I’d previously studied as Freud’s “talking cure.” As a palliative care physician treating a late-stage cancer patient, he understood that his patients’ priorities were often very different from those of other patient-cohorts. For them, the most effective treatment might not always be the most efficient treatment. Instead, listening to the patient’s broad range of thoughts and feelings helped Dr. Harding better understand what his patient wanted and needed in order to live whatever life remained to him in the ways that mattered most to that particular patient.

This was actually the last time I shadowed Dr. Harding. Yet the experience has stayed with me. As I compile my applications for medical school, I’m frequently tasked with answering the question: “Why medicine?” Formerly, I would have talked about my passion for science—those late nights in the lab peering through my microscope at blood vessels in tumor samples. Now, however, my answer extends beyond the purely scientific. I see much more clearly now that the successful practice of medicine will require not only the knowledge of biology, chemistry, and physiology I’ve been pursuing so intensively, but also the knowledge of interpersonal dynamics I’ve begun to acquire from my study of psychoanalysis. The practice of medicine appeals to me now more than ever as a uniquely human science—a science not only of cells and disease processes, but also of the unique qualities of each patient’s subjective states.

Medicine is generally regarded as a very technical field—and it is. But I’ve come to see how crucial it can be to pay close and informed attention to the psychodynamic relationship between physician and patient, in order best to meet the demands of proper diagnosis, prognosis, and treatment. I now believe that understanding each patient as a full human subject should be every medical doctor’s goal, and I’ve learned that psychoanalysis provides a powerful set of theories and techniques that I can use in my own pursuit of that goal. The intersection between psychoanalysis and medicine might not currently be at the forefront of modern clinical practice, but I hope my experience sheds light on what I hope will become a more and more common convergence of these fields, in medical schools, hospitals, and private consulting rooms. And, as a patient as well as a physician-in-training, I hope that each time any of us steps into a doctor’s office, we’ll be able to make, and reflect upon, the same sort of vital human connection that I witnessed in Dr. Harding’s consulting room.

 

5 Replies to “Psychoanalysis and the Pre-Med”

  1. Bravo Harris! The insights you provide were very much in the minds of ancient Greek healers. Have you study the practices of physicians such as Hippocrates and the healers at the ancient temple of Asclepius at Epidavros? Full circle my friend!

  2. Very thoughtful and well-articulated article. As the spouse of someone with acute and multiple chronic illnesses, when my husband’s Dr. asks the simple question, “Hey buddy, how are you doing?” It means much more to him and helps encourage a meaningful dialogue regarding what the patient wants vs. what the medical community might initially recommend.

  3. The best doctors I have take a few minutes to understand me and not just the illness they are looking to treat.
    Keep that mindset- youR patients will appreciate that in your. It’s the human element.

  4. This article is very well-written, Harris! Your perspective will give you a terrific advantage as you enter medical school! Good luck with your summer internship and senior year!

  5. Thank you for sharing your thoughts and experiences. We definitely need more doctors with an empathetic and personal touch. Being treated for serious conditions creates enough stress and indignities on the patient. Doctors, nurses and medical staff have to deal with many difficulties too, but none can surpass the patients’ stress. Understanding and empathizing and connecting with patients makes an incredible difference to the patient . Best wishes as you pursue your medical career!

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