Abstract
This paper is concerned with the role and the consequences of anxiety during psychiatric training in relation to three fundamental factors: a) The personality of the resident. b) The clinical and theoretical aspects of psychiatry itself. c) The teaching and training centres.
The psychiatric resident has already made a first decisive choice by becoming a physician. This orientation seems to be determined mainly by unconscious drives as narcissistic, sadistic, voyeuristic impulses, fear of dependency and castration feelings. The medical profession offers ego-syntonic defence mechanisms like reaction-formation, denial or sublimation. Psychiatry introduces a new possibility: The use of the patient's problems as a dress-rehearsal for personal difficulties in an effort of integration. The choice of pre-genital defence mechanisms obscures the therapeutic understanding, becoming anxiety-provoking. The same is true for the exploitation of the patient in order to obtain vicarious satisfactions. The personality of the resident, in terms of level of maturity, is also responsible for the handling and understanding of counter-transference reactions. The positive and negative aspects of counter-transference, its role in anxiety formation, the contribution of the supervisors are discussed and clinical examples are presented in relation to anxiety.
The second factor studied is the clinical and theoretical aspect of psychiatry itself in its interaction with the resident's personality. The emphasis is laid on the premature case-load, the sudden and total investment of the resident's energy and time on mental patients and related theories, the stress caused by the treatment of psychotics in terms of reactivation of early infantile conflicts.
Some criticism is directed towards the policy of training-centres. It is noted that pragmatic needs — such as keeping wards and O.P.D. active — are of paramount importance in the choice of the program. Little time is left for reading and research. The method of teaching relies heavily on seminars, often poorly prepared and given by foreign students with language problems. The approach to the special branches of psychiatry, like psychoanalysis, is rather dogmatic and rigid. The resident is stuffed (often with incomplete notions), but not oriented to a critical and creative mental activity.
The result is the production of standardized psychiatrists. The same holds true for psychoanalytic education, which aims at the formation of a special S.E. (Ferenczi's “S.E. intro-pression”) in order to avoid criticism or secessions.
The sad consequence is the poverty in psychiatric and psychoanalytic research, for, in order to discover something new, one needs a strong, curious and plastic Ego and a tolerant, friendly S.E., able to accept the alteration of the old paternal order.