The Writer's Insight

"Imaginative writers," Sigmund Freud once wrote, "are valuable colleagues; in the knowledge of the human heart, they are far ahead of us common folk." That view is accepted at Brown University in Providence, R.I. For the past three years, the university has been offering a unique course in psychiatry that uses the insights of gifted playwrights to teach premedical students about emotional disturbances they may some day encounter in their patients.

In alternate weeks, the course replaces conventional classes with professional performances of excerpts from such plays as O'Neill's Long Day's Journey Into Night, Williams' A Streetcar Named Desire and Ibsen's Hedda Gabler. Before each 15-to 20-minute performance, the students are briefed by an English professor on the theme of the play and by a psychiatrist on psychological traits to be observed in the characters. Afterward students, faculty and the actors themselves take part in a two-hour discussion.

Defense Mechanisms. One recent session centered on Martha and George, the savagely quarrelsome couple in Edward Albee's Who's Afraid of Virginia Woolf? "While watching the play," Psychiatrist George Vaillant told the audience, "imagine yourself an intern several years from now. George would enter the hospital yellow with jaundice and with cirrhosis of the liver, the results of his alcoholism. Martha would come in for her third operation for adhesions resulting from stab wounds." During the discussion, Vaillant prompted the students and actors with questions. What were George and Martha angry about? What defense mechanisms did they use to conceal their difficulties?

What would Martha look for in a doctor?

With Vaillant's guidance, the class tried to analyze Martha. She was in deep psychological trouble because, at 52, she was immersed in fantasy instead of reality. She was hurt and angry over the early loss of her mother and was still hoping, unrealistically, to find someone to replace her. Vaillant pointed out that she was also "still very involved with Daddy" and had never, in imagination, stopped "trying to give him a son." Martha, Vaillant warned, "is a good example of a character type you are going to come up with again and again among patients: hysterical, orally aggressive, exhibitionistic, egocentric, emotional and sexually provocative. Such people will want your attention, not simply a medical response."

As for George, the class concluded that he was a masochist who often tried to conceal his aggressiveness behind a facade of passivity. Explained Vaillant: "George presents himself as a martyr, but he manages to torture everybody. His indifference is provocative, and that's one of the ways you diagnose someone as what we call 'passive-aggressive' and not indifferent."

Emotionally Sick. Many of the premedical students at Brown are skeptical about the value of psychiatry. But they admit that the theatrical approach helps them recognize and remember patterns of disturbed behavior. As Vaillant sees it, drama offers "a sense of immediacy, a real encounter with the foibles, strengths, warpings and obscurities of human nature," and it lets students "experience emotions at very high pitch" without being frightened, as they often are when they see their first emotionally sick patients.

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