April 15, 2020
The magnitude of emotional load together with ethical and clinical questions puts us in a total “terra incognita” state. I think that the need for coherence in external chaos is indeed universal, yet to us are both a demand and praxis of psychoanalytic practice engaging intrapsychic chaos.
When external and internal meet in loss of coherence—the inability to foresee, plan, and manage the near and far future—indeed, trauma is the exo-endogenous state of going on being.
From reading what is experienced around the globe, it may be hypothesized that our mutual task is to hold the emotional human existence within new therapeutic boundaries constructed by the ethical principles of psychoanalytic theory and practice.
I suggest that to meet or not to meet, to treat by new methods or not to treat, to reach out to suffering communities and burned-out health care professionals, should all be negotiated within the theoretical and ethical matrix of each and every one of us.
We will come up with divergent and even conflictual answers that reflect the diversity in psychoanalysis around the globe. Although we are part of the same profession, diversity does not mean chaos; rather, it signifies freedom to think and implement within analytic boundaries.
For instance, seeing patients in the room and on the couch: some told me it is crossing the line because it is exposing oneself to life-threatening danger. Others feel that analytic care is also about emotional and physical risk to the therapist, as much as MDs are risking themselves.
I suggest the answer is not organizational yea or nay, but rather an intimate cultural and moral dilemma that has to be answered separately by every therapist—and maybe time and again for every patient.
Yehuda Fraenkel, MD, is a psychiatrist, psychoanalyst, member of the Israeli Psychoanalytic Society and IPA, and on the faculty in the Department of Family Medicine at the Hebrew University, Jerusalem.
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