The Shadow of the Object

Dinner conversations in medical families can be less than ordinary. Tonight we were talking about how to choose antidepressants for different types of patients. My wife, who worked side by side with me for many years as a Nurse Practitioner, is now doing other things, and her time away from practice has heightened her awareness of how clinicians often reach for their prescription pads very quickly when faced with patients, whose lives have presented them with more losses or sorrows than they can handle in the moment.

As we talked more, we realized that it was this very weekend – Columbus Day – eight or nine years ago that we attended probably the most profound Continuing Medical Education event of our careers. It was one of several parallel seminars offered by Harvard Medical School and Massachusetts General Hospital’s Department of Psychiatry.

The title of the course was “The Shadow of the Object”, which is a quote from an enigmatic passage in “Mourning and Melancholia” by Freud. It was held in an old, slightly run-down family resort in the Catskills in upstate New York, very similar to the setting of the movie “Dirty Dancing”. In its heyday, this resort was a summer haven for middle class families from New York City – a chance to experience nature and participate in organized activities while mingling with people of their own kind.

The central idea of the conference was that we never “get over” loss or trauma – we just have to find ways to carry it with us in a fashion that makes sense for us. It is a simple notion, but it has profoundly affected how I have counseled patients from that moment on. There is such a tendency in our society to focus on the “positive”, to downplay the importance of sadness in a healthy and balanced life.

One particular thought we brought with us from “The Shadow of the Object” is the concept of moving through grief by finding ways to honor the legacy of the lost loved one. I have found that to be one of the most healing things you can teach those left behind after someone they respect and love passes away.

On our way home from the course, we spent one night at the Equinox Mountain Inn in Manchester, Vermont. It was another magical experience, dining and sleeping high above the clouds in a quirky 1960’s building at the site of an old charterhouse, or Carthusian monastery. It only seemed fitting that we ended our Continuing Medical Education weekend there – high above the ordinary places we usually frequent for such affairs, a place for quiet contemplation before stepping back into the normal practice routine, albeit a little bit changed.

3 Responses to “The Shadow of the Object”

  1. 1 isaac October 13, 2009 at 2:35 am

    Shadow of the object – I like that phrase as deep grief becomes a companion, not something that goes away.

  2. 2 Christine October 16, 2009 at 2:35 am

    I just want to say that when I read your blog, I thought to myself: That is so true! Very enjoyable.

    Keep writing!

  1. 1 Control « ∞ itis Trackback on October 15, 2009 at 7:58 pm

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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