‘‘The Medical Self’’ 57
In addition, physicians appeared to ‘‘put on’’ the role of doctor without
always fully integrating it into their lives and deepest senses of self. These
doctors saw illness as residing in the patient. Hence, since it was in the
patient, it could not also reside in these doctors themselves. Thus, they did
not feel sick or at risk for disease. These implicit attitudes indicated a
significant degree of distancing or projection. Though generalizing about
psychodynamic defenses among a large group is difficult, these patterns of
responses appeared common.
The Medical Self: Self-prognosticating
Many physicians looked at the worst possible outcome—the prospect of
death—as if they were observing another patient rather than themselves.
In essence, many saw themselves as if they were a third person. Physicians,
when they became ill, often faced prognoses as physicians rather than
as patients. For example, Nancy, the endocrinologist, stated matter-of-
factly, ‘‘I have metastases in my head.’’ Her cancer had now spread to her
brain, and hence was beyond treatment. She reported:
My physician said, ‘‘We’ll just keep doing drugs. Eventually they
will stop working and that will be it.’’ I’ve stopped thinking about
the future as much as I can. It’s a weird feeling not to have any idea
if I’m going to be living next year. When I discovered that I had
brain mets, I spent this very funny weekend, thinking, ‘‘This is the
last weekend with my brain.’’
Nancy’s comments indicated a wide distancing from oneself—a surreal
otherworldliness evoking profound, existential quandaries. After all, it is
not clear what it means to have one’s ‘‘last weekend’’ with one’s brain;
what happens the following weekend; whether one is then no longer
‘‘with one’s brain,’’ and if so, what it means to be one without one’s
brain—who and what the ‘‘one’’ is in each case; and what one’s identity is
without one’s brain. Nancy suggested she would encounter mental defi-
cits, but she raised questions as to whether and at what point one was no
longer oneself. Is one still one if one has one’s body, but not one’s mind?
In some ways, the answer may be ‘‘yes.’’ These questions, which have
plagued philosophers for millennia, plumbing the very depths of philo-
sophical inquiry, now confronted many of these doctors daily.