Conversation with a young psychiatrist, Rob, at the Maudsley. He is alive with the intellectual energy and commitment of a man setting out down a road that is driven by ideals and doomed to disappointment. When I first met him he was uncertain whether he was in the profession in order to help people; but now that his clinical experience has begun, hearteningly, he is impassioned by the challenges it throws at him — despite the resolute dreariness of that reality, and the chaos into which it throws his ideas. We discuss the constant stand-off between psycho-dynamic and psycho-biological approaches. He talks about how Robin Murray, the big professor at the Maudsley, gave lectures attempting to draw the lines from (potential) genetic influences and (potential) environmental ones.
But where, even then, does that leave you, confronted by the chronically psychotic, deeply depressed, or resolutely addicted personality? The map has a big empty space in the middle. The conceptual frames of references can’t explain the brute, distinctive reality of each patient. We are all created out of a sperm and an egg; so we are all genes and biology. Equally, we are all made by the world we are born into; so we are all culture and memory. These two facts constantly collide and intermingle.
There shouldn’t be a stand-off, but there is. Nature and nurture should be inseparable, but we can’t help separating them. We are fated, but we are also self-created.
Rob is working with an experienced consultant; not a theorist, but someone who knows how to manage people. This consultant tells him that, for all the flourish of new neuroscience and genetics, the psychiatric profession has done little for his patients. Why not?
DYAD: The dictionary defines a dyad as “A pair of units treated as one; a bivalent atom or element.”
Rob points out that psychoanalysis comes down to exploration of a single relationship, usually with a mother or father. It is an exploration of the dyad.
Biology begins with a gene, psychoanalysis begins with a dyad
