I just got back from the psychoanalysis conference. It was pretty fascinating, and it was wonderful to meet other students who are interested in psychiatry. (We had a day-long student session, followed by a general talk about the history of psychoanalysis.)

What I liked most about psych (-iatry? -oanalysis?) was its focus on story and narrative. As a literature major in college, I've been searching for something that gives me the same sort of thrill I got when immersed in a character or a plot. Some of the speakers shared stories from their own practices (properly disguised, of course) that really brought me back to that place. The focus on the past and the iceberg of the Unconscious -- really just the concept that a person's motivation is deep rather than superficial -- are also appealing, as is the interdisciplinary synthesis that informs much of psychoanalysis. But most of all, I really enjoy the prospect of getting to help make sense of this crazy arena we call Life. As one of the speakers put it, psychoanalysts "help people create cohesive narratives of their lives."

Unfortunately, psychoanalysis is an additional four years of training after a psychiatry residency. Although the traning is part-time, the opportunity cost is high: you could be seeing and helping your own patients in that time. Also the elitism aspect of it, the notion that psychoanalysis is for neurotic rich housewives on the Upper East Side. One of the speakers said he uses a sliding scale, but I'm not sure I like that idea (although it's better than shutting the poor out entirely).

And lastly, my god, did they adore Freud. I was surprised, because Freud's theories, while obviously influential in creating the field, are a century old by now. I know, from my literature training, that a lot more work has been done in psychoanalytic theory -- there's Lacan, and Derrida, and a whole slew of feminist psychoanalysts -- that were just trampled on in the rush to worship at Freud's altar. To analyze the analysts a moment: it's almost as though they are using the approbation of a dead master to cover the disrespect that psychoanalysis gets from just about every other field.

Honestly, though, if psychoanalysis is discredited as "not real science," it is at least partially their own fault. I'm not talking about the historical lack of evidence-based studies that psychoanalysis actually helps -- those are coming out recently, with support from neuroscience, fMRI, etc -- but rather the apparent disowning of any attempts at progress in the field. Can you imagine medicine practiced as it was circa 1905? "Here you go, Farmer Jones, have a poultice for your infected boil, and we'll have to amputate next week. If you're still alive, that is." So why is psychoanalysis so adamant that Freud Got It All? That's practically dogma.

I think that psychiatry is just about the most fantastic thing I've considered right now, and especially in minority communities, where psychiatric disorders carry a stigma that "regular" medical problems do not. And one can certainly use psychodynamic thinking and "talk therapy" in regular psychiatric practice (i.e. it's not just about Xanax and Zoloft). Although psychoanalysis is kinda cool, I'm not convinced that the extra time and training are worth it.

Career development?

I just attended a talk about trauma surgery. It was less about what it's actually like being a trauma surgeon (though he addressed that during the Q/A at the end) and more "This is what you need to do to pass your surgery boards."

He also had a ton of frightening pictures of people with mangled body parts and poles sticking through them and whatnot. It was not a pleasant sight. Trauma surgery certainly sounds kind of cool, and I'm sure it's incredibly rewarding, but I'm not exactly thrilled at the thought of gashes across faces.

There were several pictures of failed suicide attempts (slit wrists, one throat cut so deeply that they were able to intubate directly through the wound, etc.) which just reminded me of something a friend of mine, who used to work with a crisis hotline, told me. They got several calls about suicidal ideations, and once they established that it wasn't an imminent danger and that the person really just needed to be talked out of it, they would "de-glamorize" suicide by talking about what would happen if it went wrong. Such as, "If you slit your wrists, you could end up with necrosis or sepsis in your fingers and would have to have them amputated." Apparently it worked quite well.

What interests me more than the immediate surgical intervention is the longer-term psychiatric implications that would lead someone to suicide. As a matter of fact, I am going to the student section of a psychoanalysts' conference on Saturday. Although of course I don't know that I want to become an analyst, or even that I like psych that much (though on paper it sounds fascinating), I figure it can't hurt to explore a little before third year. Also, this is New York City, where even analysts have analysts. It should be a good program.