On Transience

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On Transience

-an essay by Sigmund Freud

I.

2021: Browsing

For no particular reason

I lift my dusty volume of Freud’s

Standard Edition from a shelf,

pages falling open to a choir

of dark suited men surrounding

their seated Master. Cigar in hand

he considers the abstract

distance as if reading credits

from the end of a silent film

starring himself as The Psychoanalyst,

featuring Otto Rank, Karl Abraham,

and James Strachey as The Disciples,

with Anna Freud as The Analysand.

Remembering the essay from my early

days in training, I flip to On Transience.

II.

1915: First Publication

In the essay’s three elegant pages

we walk with Freud, his taciturn friend,

and a famous young poet who finds

summer’s beauty to be disturbing and sad

because he knows August ends in death

and decay, Freud responding empathically,

noting the poet’s enjoyment of beauty

and his mind’s revolt against the pain

of loss. And to explain the poet’s sadness,

Freud breaks new ground with a theory

of mourning and melancholia where

libido is diverted from the ego on to objects

which are thus in a sense taken into our ego,

psychodynamic jargon that dizzies me

like a Zen koan. Six decades later,

when I struggle to unpack Freud’s terms

for psych residents, they only give me grief.

III.

1980: DSM-III

The Freudians’ summer fades into fall,

and authority decays when the third

Diagnostic and Statistical Manual

of Mental Disorders discards their term

neurosis and creates a catalog of disorders.

Young men with slide shows and loosened ties

call themselves psychopharmacologists

and compete with psychoanalysts for leadership,

their theories of “chemical imbalance”

and neurotransmitters raising hope for cures

of schizophrenia, depression, and anxiety.

Psychotherapy devalued, Fifty Minute Hours

morph into Fifteen Minute Med Checks.

IV.

2022: Psychodynamic Psychopharmacology

Decades after ego and objects faded

from our jargon, I open a newsletter

and study the criteria for DSM-5’s

freshly minted Prolonged Grief Disorder.

And when I turn the page, I’m greeted

by a photo of a smiling young psychiatrist

on a mission to connect twelve hundred

early career colleagues with senior mentors

to learn old school principles like transference

and resistance, eager to integrate medication

management with psychotherapy, an approach

they call psychodynamic psychopharmacology.

Behind his couch, Freud senses summer’s

return, draws a puff, flicks the ash, smiles

as he studies his undying ember.

Dr Berlin has been writing a poem about his experience of being a doctor every month for the past 24 years in the Psychiatric Times™ “Poetry of the Times” column. He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is Freud on My Couch.