PubMed · 11640663
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H Weiss. 1991. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11640663/
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Freud's metapsychology of dream formation has implicitly been discarded, as indicated in a brief review of trends in psychoanalytic thinking about dreams, with a focus on the relationship of the dream process to ego capacities. The current bias toward exclusive emphasis on the exploration of the analytic relationship and the transference has evolved at the expense of classical, in-depth dream interpretation, and, by extension, at the expense of strengthening the patient's capacity for self-inquiry. This trend is shown to be especially evident in the treatment of borderline patients, who today are believed by many analysts to misuse the dream in the analytic situation. An extended clinical example of a borderline patient with whom an unmodified Freudian associative technique of dream interpretation is used with good outcome illustrates the author's contrary conviction. In clinical practice, we should neglect neither the uniqueness of the dream as a central intrapsychic event nor the Freudian art of total dream analysis.
The clinical encounter is structured hierarchically: explicit technical action is embedded in levels of organization that reflect the personality and biography of the clinician, which in turn, are embedded in a larger matrix of cultural values or ethos. Systems of medicine can be compared at each of these levels. Shamanism and other elementary systems of medicine are built on an ethos that identifies healers' calling, authority and effectiveness with their own initiatory illness experiences. The Asklepian religious cults of ancient Greece also drew from the image of the wounded-healer. This essay argues that ethos of the wounded-healer remains relevant to contemporary medicine, psychiatry and psychotherapy. Developmental changes in the relationship of the healer to his wounds during psychiatric training are illustrated by a series of dreams. The ethos of the wounded-healer has implications for the training of clinicians, as well as for the ethics and pragmatics of clinical work.