The Cult of Doctors: Harvey Cushing and the Religious Culture of Modern Medicine

Harvey Cushing had an extraordinary life in medicine as an innovative brain surgeon and a pivotal figure in the biomedical revolutions taking place at the turn of the twentieth century. Expressions of sincere devotion from Cushing’s patients often rely on distinctly religious language to capture the meaning and impact of the doctor in their lives. If these devotional sentiments from former patients were the only traces of religious meaning associated with the life of Cushing, they could easily be discounted as an all-too-common, and some might say particularly confused, infusion of personal spirituality into the realm of medicine and health. But these expressions of adoration and veneration may be only the proverbial tip of a deep, wide, and largely unseen religious iceberg. Cushing’s extraordinary accomplishments did inspire both patients and the public in this era, but it is proposed that his life is embedded in a much larger and more significant religious movement driving the cultural success and power of biomedical science: the cult of doctors. Gary Laderman, Ph.D., is a cultural historian who has written two books on death in America, Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America (Oxford UP, 2003) and The Sacred Remains: American Attitudes Toward Death, 1799–1883 (Yale UP, 1996). His PhD is in Religious Studies from the University of California, Santa Barbara. He is working on a new book project that explores the intersections of religion and medicine in the twentieth century. This is the first article from that project.     

The indissociable unity of psyche and soma: A view from the Paris Psychosomatic School1

Depending on whether or not psyche/soma is seen as singular or dual, one may construct different systems explaining man and the world, life and death. In the author's view, the discoveries of psychoanalysis offer a perfectly cogent and unique solution to the famous mind/body problem. In transferring the duality psyche/soma on to the duality of drives, psychoanalysis places the origin of the thought process in the body. In Beyond the pleasure principle, Freud discusses the drastic effect of a painful somatic illness on the distribution and modalities of the libido. He provides a starting point for the Paris Psychosomatic School's psychoanalytical approach to patients affl icted with somatic illnesses. To illustrate the technical implications of this theory the author relates two clinical cases.     

Epicureanism About Death and Immortality

In this paper I discuss some of Martha Nussbaum’s defenses of Epicurean views about death and immortality. Here I seek to defend the commonsense view that death can be a bad thing for an individual against the Epicurean; I also defend the claim that immortality might conceivably be a good thing. In the development of my analysis, I make certain connections between the literatures on free will and death. The intersection of these two literatures can be illuminated by reference to my notion of a Dialectical Stalemate.     

Between memory and destiny: Repetition1

This essay focuses mainly on the topic of repetition (agieren)—on its metapsychological, clinical, and technical conceptions. It contains a core problem, that is, the question of the represented, the nonrepresented, and the unrepresentable in the psyche. This problem, in turn, brings to light the dialectical relation between drive and object and its specific articulation with the traumatic. The author attributes special significance to its clinical expression as ‘destiny’. He points out a shift in the theory of the cure from recollection and the unveiling of unconscious desire, to the possibility of understanding ‘pure’ repetition, which would constitute the very essence of the drive. The author highlights three types of repetition, namely, ‘representative’ (oedipal) repetition, the repetition of the ‘nonrepresented’ (narcissistic), which may gain representation, and that of the ‘unrepresentable’ (sensory impressions, ‘lived experiences from primal times,’‘prelinguistic signifiers,’‘ungovernable mnemic traces’). The concept‐the metaphor‐drive embryo brings the author close to the question of the archaic in psychoanalysis, where the repetition in the act would express itself. ‘Another unconscious’ would zealously conceal the entombed (verschüttet) that we are not yet able to describe‐the ‘innermost’ rather than the ‘buried’ (untergegangen) or the ‘annihilated’ (zugrunde gegangen)‐through a mechanism whose way of expression is repetition in the act. With ‘Constructions in analysis’ as its starting point, this paper suggests a different technical implementation from that of the Freudian construction; its main material is what emerges in the present of the transference as the repetition of ‘something’ lacking as history. The memory of the analytic process offers a historical diachrony whereby a temporality freed from repetition and utterly unique might unfold in the analysis. This diachrony would no longer be the historical reconstruction of material truth, but the construction of something new. The author briefly introduces some aspects of his conception of the psyche and of therapeutic work in terms of what he has designated as psychic zones. These zones are associated with various modes of becoming unconscious, and they coexist with different degrees of prevalence according to the psychopathology. Yet each of them will emerge with unique features in different moments of every analysis, determining both the analyst's positions and the very conditions of the analytic field. The zone of the death drive and of repetition is at the center of this essay. ‘Pure’ repetition expresses a time halted by the constant reiteration of an atemporal present. In this case, the ‘royal road’ for the expression of ‘that’ unconscious will be the act. The analyst's presence and his own drive wager will be pivotal to provide a last attempt at binding that will allow the creation of the lost ‘psychic fabric’ and the construction, in a conjectural way, of some sort of ‘history’ that may unravel the entombed (verschüttet) elements that, in these patients' case, come to the surface in the act. The analysand's ‘pure’ repetition touches, resonates with something of the new unconscious of the analyst. All of this leads the author to underline once again the value of the analyst's self‐analysis and reanalysis in searching for connections and especially in differentiating between what belongs to the analyst and what belongs to the analysand. A certain degree of unbinding ensures the preservation of something ungraspable that protects one from the other's appropriation.     

Two faces of Thanatos: Broken flowers (2005) and Ai no corrida (1976)1

Since Freud formulated the death instinct concept, it has received widely diverse interpretations. Even Freud advanced two versions. The concomitant analyses of two films, Ai no corrida (1976) [ In the realm of the senses (1977)] and Broken flowers (2005) evince Thanatos's two faces: the cold death of decathexis of an object, in the case of Don (in Broken flowers) and the hot death of the subject‐object fusion in Sada's case ( Ai no corrida). In our analysis, we elaborate two possible vicissitudes of the death instinct: in Broken flowers, the main character finds an ‘analyst’ and is cured. In Ai no corrida, the protagonist meets a complementary object and goes mad.     

死后生殖问题的生命伦理学思考

生物科学和医疗技术的发展使死后生殖成为可能,但是,面对世界不同地域所发生的死后生殖案例,伦理和法律的争议层出不穷。试图从生命伦理学的基本原则入手,以尊重人、行善以及公平原则为基点,结合相关问卷调查结果,探讨争议的焦点及成因,希望可以引发各个层面对相关问题的关注和讨论。     

On boredom: A close encounter with encapsulated parts of the psyche

The psychoanalytical literature has numerous scattered references to the analyst's experience of boredom, especially amongst writers working with primitive mental states. In the present paper, the author tries to gather some of these references in an attempt to integrate the various facets of this widespread phenomenon, and reflect on some clinical issues and dilemmas it raises. It is suggested that the experience of boredom in analysis may be a reaction to an encounter with a hidden, encapsulated part of the psyche, a bidimensional area of experience in which mental activity has been suspended, and experience remains meaningless. This is a barren area of lack, an encounter with the autistic core of the psyche. However, boredom may also be an experiential expression of despair, a re-living of primitive object relations with an emotionally non-existent primary object. Through bringing the emptiness and desolation into analysis, the individual makes room for the empty, blunt, dead inner object which resides within him, and that needs to be integrated into the psyche. This inner object is a vital part of the patient's inner world, part of his history, and can neither be erased nor filled in order to eradicate the emptiness. This is illustrated by clinical material from patients along the spectrum of autism, autistic reaction following trauma and autistic barriers in neurotic patients.     

Conceptual framework from the Paris Psychosomatic School: A clinical psychoanalytic approach to oncology1

This article presents further clinical material from the Paris Psychosomatic School ( Aisenstein, 2006 ). The Freudian foundations of psychosomatics are detailed and post-Freudian developments focusing on the contribution of the Paris Psychosomatic School are outlined, in particular, the somatizing process as a result of regression and the somatizing process as a result of drive unbinding. The authors argue that the latter possibly gives rise to progressive and serious illness leading to death. The relationship of classical psychoanalysis to psychotherapeutic treatment from the angle of the Paris school is commented on. The authors then turn to two clinical presentations of women suffering from breast cancer. The method of evaluating the patients’ capacities for undergoing psychotherapeutic treatment and their mental capacity for healing is discussed. The face-to-face psychoanalytic treatment undertaken with the second case is discussed. Finally, the authors recall Freud’s insistence after 1920 on the opposition of the life drives and the death drives, which placed self-destruction at the centre of psychic functioning. They conclude that current research in biology and medicine, notably research concerning programmed cell death, will converge with psychoanalytic psychosomatics to illuminate somatizing processes and demonstrate the relevance of psychoanalytic treatment to patients who are capable of mental reorganization in the course of their illness and medical treatment.     

Decomposing coronary-prone behavior: Dimensions of type a behavior in the Videotaped Structured Interview

This study examined the factorial structure of data generated in the Videotaped Structured Interview for assessment of Type A behavior. Based on the literature, it was argued that there are at least three distinct concepts of Type A behavior, focused on competitiveness and pressured drive, speech characteristics, and hostility, respectively. These three concepts were clearly represented among the factors from factor analyses based on data from 282 subjects. Three factors represented speech and psychomotor characteristics, where the first reflected interactions between subject and interviewer (e.g., response latency, interruptions), the second tempo of speech (accelerating, dysrhythmic and rapid speech), and the third oral gestures (e.g., expiratory sighs). Hostility was reflected in two factors, one defined by emotional intensity (e.g., anger when recalling paat event) and the other hostility expressed towards the interviewer. Pressured drive dominated a content factor reflecting self-awareness of Type A behavior. Finally, there was one factor related to psychomotor tension. Through further factor and item analyses, it was possible to combine these factors into three homogeneous and moderately intercorrelated subscales of Type A behavior reflecting Hostility, Speech Characteristics, and Self-Awareness of Type A behavior. These scales showed good interrater agreement and stability over two years. The Self-Awareness Scale was highly correlated with self-report measures of Type A behavior. The Hostility Scale, on the other hand, was moderately related to measures of Type A behavior, anger and hostility, but was unrelated to anxiety. The Speech Characteristic Scale, finally, was virtually unrelated to psychometric measures.     

Capital sentencing and neuropsychiatry

The neuropsychiatric contribution to capital sentencing proceedings has grown substantially in recent decades as the consideration of neurological and psychiatric factors in criminal behavior has been increasingly accepted as relevant to the quest for justice. This review article will focus on the legal theories underlying neuropsychiatric input into capital sentencing decisions, as well as some of the investigative techniques and resulting data which may be offered by forensic neuropsychiatrists in this context. The death penalty is unique in its severity and irreversibility, as the courts, including the U.S. Supreme Court, have noted repeatedly. “Death is different,” and the recognition of this has generated a set of court decisions and statutes pertinent specifically to capital proceedings, both procedural and substantive.