This book shows how contemporary psychoanalytic thinking can be applied in the everyday practice of medicine to enhance the practice of family medicine and all clinical specialties.
Dr. Steinberg analyzes his writings over the past 35 years—on psychiatry and family medicine, liaison psychiatry, and mentoring—based on developments in psychoanalytic thinking. Divided into sections based on different venues of medical practice, including family medicine clinics, inpatient medical and surgical units, and psychiatric inpatient units and outpatient programs, chapters illustrate how various concepts in psychoanalysis can enhance physicians’ understanding and management of their patients. A concluding section contains applications of psychoanalytic thought in non-clinical areas pertinent to medicine, including preventing suicide among physicians, residents, and medical students, sexual abuse of patients by physicians, and oral examination anxiety in physicians.
Readers will learn to apply psychoanalytic concepts with a rational approach that enhances their understanding and management of their patients and practice of medicine generally.
Table of Contents
Introduction Part 1
Introduction Part 2: A Little Theory
Part A: Learning from Liaison with Family Medicine
Chapter 1 "Problem Patients": Patients with Significant Personality Disturbance
Chapter 2 Interviewing the Patient
Chapter 3 "Are All My Patients Depressed?" The (Mis-)diagnosis of Depression
Chapter 4 "My Patient is Psychotic": Dealing with a Patient with a Paranoid Delusion about Her Disease
Chapter 5 Holding Patients with Medication: Using Neuroleptics as an Adjunct to Psychotherapy in the Patients with Severe Personality Disorders
Chapter 6 What Psychoanalysis and Psychiatry Offer to Medicine
Part B. Learning from Consultation/Liaison Psychiatry
Chapter 7 Psychoanalytic Approaches to Psychosomatic Medicine
Chapter 8 Psychiatry for the Masses: Broader Indications for Psychiatric Consultation
Chapter 9 Where Does My Patient Fit In? Organizing One’s Diagnostic Thinking In Differentiating Patients according to their Symptoms
Chapter 10 "The Most Unkindest Cut of All": Psychiatric Complications of Surgery in Men
Chapter 11 Psychiatric Diagnosis is not a Diagnosis of Exclusion: A Patient with Insulinoma Presenting for Psychiatric Assessment
Chapter 12 Differentiating Psychiatric and Medical Conditions: A Case of Hyperthyroidism Presenting as Delusional Disorder
Chapter 13 "My Patient is Hysterical": Adrenal Carcinoma and Hypertension Presenting with Catatonic Stupor
Part C. Learning from Inpatient and Day Hospital Psychiatry
Chapter 14 The Mother Who Couldn’t Name Her Child: Problems of Attachment, Identity and The Capacity to Think
Chapter 15 Freud on the Ward: Integration of Psychoanalytic Concepts in the Formulation and Management of Hospitalized Psychiatric Patients
Chapter 16 Psychoanalytic Approaches Integrated into Day Treatment and Inpatient Settings
Part D. Nonclinical Topics
Chapter 17 Attack of Nerves: Oral Examination Anxiety in Physicians
Chapter 18 Healers Caring for Themselves and Each Other: Preventing Suicide in Medical Students, Residents and Ourselves
Chapter 19 Professional Betrayal: Sexual Abuse of Adult Female Patients by Male Physicians
Paul Ian Steinberg, MD, is clinical professor, Department of Psychiatry, University of British Columbia, member of the Western Branch – Canadian Psychoanalytic Society, and assistant editor of the Canadian Journal of Psychoanalysis / Revue canadienne de psychanalyse.
"Finally!!! After 125 years of the great divide between the mind and body, a book that gets psychoanalysis up off the couch and into every day clinical practice. Combining his formal training as a psychoanalyst with his wealth of hands-on clinical experience and his years of practice as a psychiatrist in hospitals and outpatient clinics and as a dedicated teacher to medical learners, Dr. Steinberg illuminates the psychological factors that shape and influence patient presentations. Through a variety of eloquently described case discussions, interwoven with theoretical constructs, we are invited into the world of the unconscious, as a way of understanding that symptoms and behaviors not otherwise explained by medical models can be solutions to intrapsychic conflict. Dr. Steinberg shows us that, by integrating an understanding of the patient’s psychological make-up, we as clinicians can examine and manage the frustrations we may feel, and the therapeutic nihilism we may encounter, when treating people who have complex and unsolvable problems. Moreover, this book illustrates how we can achieve more satisfactory and effective clinical practices, and how we can protect our patients from the pitfalls of overmedicalizing symptoms. This book will have a profound influence on how we think about our patients and will enrich our approaches to helping people with medical and psychiatric disorders or ill-defined symptoms. Dr. Steinberg is the consummate scholar, and most of all, he teaches us to be curious minded and compassionate in our work with people who struggle in their lives."
David Kenneth Cochrane, MD, FRCPC, medical director General Psychiatry Services, North Bay Regional Health Centre, assistant professor University of Ottawa, assistant professor Northern Ontario School of Medicine
"Drawing on his in-depth knowledge of contemporary psychoanalytic theories and his extensive experience as a consultation-liaison psychiatrist, Dr. Steinberg provides a clear description of how early attachment experiences with caregivers become represented in children’s minds as unconscious images of self and others that influence their sense of self and the quality of their relationships throughout life. Adverse childhood experiences not only affect personality functioning, but also render individuals more susceptible to medical and psychiatric disorders. Dr. Steinberg applies these concepts to patients often described as "difficult" to manage by their family doctors or hospital specialists, making excellent use of selected case histories to illustrate the operation of defense mechanisms, as well as transference and countertransference phenomena. The book will be immensely useful to family physicians, medical and surgical specialists, and hospital-based psychiatrists."
Graeme J. Taylor, MD, FRCPC, MRCPsych, professor emeritus of Psychiatry, University of Toronto