"Behind his couch, Freud senses summer’s return, draws a puff, flicks the ash, smiles as he studies his undying ember."
-an essay by Sigmund Freud
For no particular reason
I lift my dusty volume of Freud’s
Standard Edition from a shelf,
pages falling open to a choir
of dark suited men surrounding
their seated Master. Cigar in hand
he considers the abstract
distance as if reading credits
from the end of a silent film
starring himself as The Psychoanalyst,
featuring Otto Rank, Karl Abraham,
and James Strachey as The Disciples,
with Anna Freud as The Analysand.
Remembering the essay from my early
days in training, I flip to On Transience.
1915: First Publication
In the essay’s three elegant pages
we walk with Freud, his taciturn friend,
and a famous young poet who finds
summer’s beauty to be disturbing and sad
because he knows August ends in death
and decay, Freud responding empathically,
noting the poet’s enjoyment of beauty
and his mind’s revolt against the pain
of loss. And to explain the poet’s sadness,
Freud breaks new ground with a theory
of mourning and melancholia where
libido is diverted from the ego on to objects
which are thus in a sense taken into our ego,
psychodynamic jargon that dizzies me
like a Zen koan. Six decades later,
when I struggle to unpack Freud’s terms
for psych residents, they only give me grief.
The Freudians’ summer fades into fall,
and authority decays when the third
Diagnostic and Statistical Manual
of Mental Disorders discards their term
neurosis and creates a catalog of disorders.
Young men with slide shows and loosened ties
call themselves psychopharmacologists
and compete with psychoanalysts for leadership,
their theories of “chemical imbalance”
and neurotransmitters raising hope for cures
of schizophrenia, depression, and anxiety.
Psychotherapy devalued, Fifty Minute Hours
morph into Fifteen Minute Med Checks.
2022: Psychodynamic Psychopharmacology
Decades after ego and objects faded
from our jargon, I open a newsletter
and study the criteria for DSM-5’s
freshly minted Prolonged Grief Disorder.
And when I turn the page, I’m greeted
by a photo of a smiling young psychiatrist
on a mission to connect twelve hundred
early career colleagues with senior mentors
to learn old school principles like transference
and resistance, eager to integrate medication
management with psychotherapy, an approach
they call psychodynamic psychopharmacology.
Behind his couch, Freud senses summer’s
return, draws a puff, flicks the ash, smiles
as he studies his undying ember.
Dr Berlin has been writing a poem about his experience of being a doctor every month for the past 24 years in the Psychiatric Times™ “Poetry of the Times” column. He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is Freud on My Couch.