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P&S Journal

P&S Journal: Winter 1996, Vol.16, No.1
Doctoers in Print: Restoring the Damaged Self

Review by Peter Wortsman

Illness breeds a double ache, a mental complement to physical trauma, and who's to say that the psychic reverberations of disease are any less real or relevant to the cure?

Conceived as a guide for psychiatrists treating medically ill patients, "The Psychology of Illness" abounds with wisdom. Author Richard Druss'59, clinical professor of psychiatry at P&S and former associate director of the Psychoanalytic Center for Training and Research at Columbia, transcends the strictly scientific, stepping across the transom of objectivity into the heart and mind of his subject. What he discovers in this sensitive reading of psychological studies of patient behavior, popular memoirs such as Norman Cousins' "The Healing Heart," and case studies based on his own work with seriously ill patients, is that resilience and courage are as vital as pharmaceutical agents. No doctor can promise a cure, but what the physician can help foster in the patient is a viable modus vivendi, an ability to cope.

"Privileged to have both the medical and the psychological training," the psychiatrist, according to Dr. Druss, plays a special role as a kind of informed companion "on the difficult journey through illness." In a seminar he has taught to first-year psychiatry residents at Columbia for the past nine years, Dr. Druss has sought to present the patient's point of view. "Humankind's struggle is toward greater independence and individuation, greater mastery and control," he writes, whereas "illness, insofar as it mimics the helplessness of childhood, exerts its regressive pull." Furthermore, he insists, "each person has his or her own way to cope with and master chronic illness... Therapists must respect each pathway..."

To Dr. Druss, "the key word is sharing," to help the patient oppose the debilitating infantilization of disease. "A description of the disease in the patient's own words is a useful starting place because it is what is on his or her mind."

The author argues for "the body's natural power to heal itself when unencumbered by either medical insult or neurosis." Citing the case of Robert Louis Stevenson, whose tuberculosis served as an organizing principle of his life and literature (and who, P&S alumni will be interested to learn, consulted and was helped by the famous phthisiologist, Edward Trudeau, an 1871 P&S graduate), Dr. Druss finds the exemplar of courage as a therapeutic principle. "It is the first part of intelligence to recognize our precarious estate in life," wrote Stevenson, "and the first part of courage to be not at all abashed before the fact..."

The doctor steps in when the patient can't go it alone. "The physician's role," Dr. Druss concludes in this profound assessment of the therapeutic partnership, "is ultimately to facilitate self-healing."

copyright ©, Columbia-Presbyterian Medical Center

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