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Portrait of an impaired physician.

Since its inception five years ago, The Medical Society of Virginia's Impaired Physician Program has evaluated 140 physicians. Of these, 60 have completed treatment and aftercare monitoring, and 80 are being followed. Who are these physicians? the Editors asked Dr. David G. Fluharty, Jr., the program's medical director. What are they like? How about some case reports? The program's confidentiality prevented him from divulging any identifying information, Dr. Fluharty replied. He could say, however, that within the Virginia program's experience, impaired physicians fall into two distinct age groups. About a quarter of them are 28 years old +/- a few years; these younger doctors usually are dysfunctional due to "hard" drugs. The remaining three-quarters are 42 years old +/- a few years; in this group impairment is due most often to alcoholism. As for case reports, Dr. Fluharty continued, the program's compelling experience is that one case is pretty much like another, so similar are the historical patterns of birth, background, and behavior. To illustrate, he drew the following composite picture of an impaired physician in the larger, older, alcoholic group.

Adult↗

A portrait of the adenosine triphosphate synthetase-hydrolase.

It is proposed that the ATP-synthetic and ATP-hydrolytic activities of energy-transducing mitochondria, chloroplasts and bacterial membranes are due to different enzyme systems. It is suggested that the alpha-subunits of the oligomycin-sensitive coupling factor catalyze synthesis and the beta-subunits catalyze hydrolysis. Evidence is assembled from the literature in support of this concept.

ATP Synthetase Complexes↗

Mother and child. A psychobiographical portrait of Mary Cassatt.

The noted American impressionist, Mary Cassatt is remembered for her intimate portrayal of women, children, and the mother-child relationship. In this paper I have attempted to highlight some of the psychological forces impinging upon the artist, feeling that the artist's work is highly overdetermined. Mention was made of some of the difficulties that a psychobiographical study engenders. Nevertheless, it is hoped that such a study leads to enhanced understanding and appreciation of the artist, her work, and her rich inner world. An examination of the artist's life indicates that difficulties in the family of origin impinged upon her and deeply influenced her work. The loss of several siblings during critical developmental subphases may have produced intense survival guilt in Mary, motivating her to "recreate" her siblings on canvas and to devote her life to care of survivors. Lack of confirmation of Mary's talents by her father may have hindered her development, propelling the child toward a profoundly libidinalized and enmeshed relationship with the mother. Mary's intense relationship with her mother may have led the artist to develop particular stylistic nuances in her productions, contributed to her inability to become a wife and mother herself, and led to frequent episodes of depression. A case was made that Mary suffered from narcissistic disturbance, never completing the recognition of herself as a person outside of the orbit of her mother. Finally, the role of Edgar Degas in the artist's life was described. He seems to have played a major role in the evolution of Mary's style as well as being an important influence in her making a partial separation from her mother in adulthood. In spite of Mary's deep personal suffering, she was able to epitomize in her paintings the most tender and nurturant of relationships. By painting the mother-child theme, she sublimated her own wishes to become a mother as creator of art. Within her family system, she appropriated the position of mother; as the artist, she became the interpreter of this experience. By developing her talent, she communicated her wish to be a mother, and expressed the need to find, if only on canvas, a more truly empathic mother. In essence, her work allowed her to conceive of a life different from the one external reality imposed upon her. It also served as an indispensable adaptive function, allowing the artist to communicate with others, achieve recognition, and play.(ABSTRACT TRUNCATED AT 400 WORDS)

Art↗