Psychotherapy for Medical and Developmental Conditions
July 6, 2005

Fifteen years ago, as a psychotherapist on an inpatient ward in the South Bronx , I worked with individuals with various serious medical conditions and AIDS. With one young Hispanic woman (whom I still feel indebted to for allowing me in to her world), we dealt with issues of mourning, mortality, planning for her children, etc., due to her impending death from AIDS. It was a psychiatric ward that was beginning to feel the burden of the AIDS epidemic in the Bronx . I still have the drawings of one young male who died from AIDS. He was trying to draw the luminous beings who visited him in his hospital room at night. One of these beings was pointing to a ship and a voyage this young man had to soon take. Like Winnicott, I prefer to not ask the question, did he hallucinate these luminous beings or did he find them. Autoimmune illnesses, cancer, heart disease, etc, are all worsened by a sense of despair, isolation, profound anxiety, etc. Psychotherapy (as demonstrated in melanoma and breast cancer patients, etc.) can lead to a better quality of life and even greater longevity. European anthropological psychiatrists and physicians centered on the links between soma, psyche and culture. A good source for learning of this tradition is Martti Siirala's excellent, humanistic volume on the transfer of burden/trauma/collective splitting (including the split between mind and body) through culture, families and the individual (Siirala, M. (1983). From Transfer to Transference: Seven Essays on the Human Predicament. Helsinki University Press). Martti goes to great lengths to elucidate how our bodies are more than the medical soma, i.e., to challenge the idea that the body is nothing more but the sum total of our observations concerning our bodiliness.

In regard to pervasive developmental delay, Valerie Sinason, poet and psychotherapist and ISPS member, has published on her work at the Tavistock, Mental Handicap and the Human Condition (1992). Maud Mannoni wrote her impressive volume The Backward Child and His Mother in 1972. Freud's quote has some relevance to what I am trying to convey here about serious medical and developmental conditions: "Auntie, speak to me! I'm frightened because it's so dark.” “What good will that do? You can't see me.” “That doesn't matter; if anyone speaks, it gets light."

A group of psychoanalysts have been meeting in Europe ( Belgium , Paris ) for several day conferences to exchange ideas about psychoanalysis, therapeutic community and pervasive developmental delay and mental handicap. One interesting collection of these papers can be found in Psychoanalysis and Mental Handicap edited by Johan De Groef and Evelyn Heinemann in 1999 for Free Association Books.

Brian Koehler
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687

brian_koehler@psychoanalysis.net