Becoming a Doctor

We had a lecture on psychological defense mechanisms in PPS a few days ago. Defense mechanisms are ways our psyche uses to cope with an adverse event, for example recieving bad news or coping with an illness. Denial, acceptance, humor, projection, or splitting are all subconcious or concious efforts to transform reality into a more palatable alternative. Dissociation is commonly found in the medical setting, especially in situations wherein the physician's emotions might otherwise compromise judgement; commonly we refer to this as being 'dispassionate' or 'professional.' The separation of emotion from analysis of the present is something we learn very early in medical school. For most, it probably begins with the first dissection in anatomy, where the expectation is that you will not be repulsed by the cadaver, but rather to just begin to treat the cadaver in a 'clinical' way, devoid of emotional overtones. Dissection, for me, was not the watershed event that many first years claim it to be, rather, in my dissociative way, I simply began the dissection. Most medical students I imagine, pretend to a greater degree of dissociation than they truly feel, since somewhere long before medical school we knew that doctors are not emotionally wrapped up in the illness, diagnosis, analysis, or treatment of the patient. The fact that most doctors probably aren't like this is irrelevant; what is important is that medical students think they ought to be dissociative in order to be a 'good' doctor.

I realized the frailty and insincerity of my dissociative defense mechanisms during our lecture on the pathology of head trauma. The lecturer was a forensic pathologist who spoke to us about the various injuries that can occur to the skull and how that injury affects the underlying brain tissue. She explained, with graphic pictures, just what happens when the head is run over by a tire, shot with a high velocity bullet, low velocity bullet, shotgun shell, stabbed, crushed with a hammer, crushed with something blunter, crushed from a low fall, high fall, and many other gruesome injuries. I could barely look at these images when looking up from my notes. The lecturer herself was pretty blasé, which I guess is understandable since this is what she does for a profession. It's curious that we strive to cultivate a degree of dissociation to normalize what would otherwise be repugnant.