Maureen O'Reilly Landry
Maureen O’Reilly-Landry, Ph.D. is assistant clinical Professor of Medical Psychology (in Psychiatry), Columbia University College of Physicians and Surgeons, New York, USA. She is editor of, and contributor to, A psychodynamic understanding of modern medicine: Placing the person at the center of care, London: Radcliffe Publishing, 2012. She received her education and clinical training at New York University and Harvard University, with postdoctoral training both in psychoanalysis and in couple therapy at New York University. She works clinically with patients on chronic dialysis and their caregivers, with an independent practice consisting of individual, couple and group therapy.
In the century since Freud developed his profoundly insightful and influential ideas that plumbed the depths of the human psyche, other theorists, researchers and clinicians have extended his work. Psychoanalytic theory has seen a shift from an emphasis on sexual and aggressive drives as primary motivating factors, to an emphasis on relationships and emotional attachment. Relational and interpersonal psychoanalysts believe that there exists an innate need to emotionally attach to caregivers, and that this need is even more fundamental than the need to gratify basic drives. A large body of research demonstrates that the nature and quality of these early attachment relationships from infancy and childhood governs a great deal of our behavior, even later in life. Whether these attachment relationships are secure or insecure, for example, has very recently been shown to predict the presence of inflammation-based illness in adulthood. Other studies show adult attachment styles to influence the nature of the medical patient’s relationship to medical care providers, various elements of medical behavior, and even to predict glucose levels in diabetics. The present paper describes various ways in which ideas from modern psychoanalysis can be utilized to better understand and conceptualize the medical patient’s experience and behavior within the context of modern medicine. Areas of focus will include coping with the psychologically disruptive experiences of organ transplantation, physical dependence on life-sustaining machinery, impaired mobility, chronic illness and confrontations with death.