The PANY Bulletin

Psychoanalytic Association of New York
Volume 43, #1 Spring 2005

The Professional Will Revisited

by Rita Clark, M.D.

Where There’s a Will There’s a Way
More than twelve years ago Dr. Steve Firestein encouraged the idea of professional wills based on his years of experience dealing with both the patients and relatives of deceased colleagues where no such provision was made. A professional will provides a structured guideline for survivors to follow in case of the death of any person who is responsible for the mental health care of others. The role of the psychoanalyst or anyone who is involved in the care of patients is complicated by ubiquitous transferences and other unconscious factors. These add to the burden of sudden separation. To ameliorate this burden and care for the suddenly abandoned patients, the professional will is an essential part of responsible practice. Why then, is this so rarely implemented? As Thomas Mann has written “A man's dying is more the survivors’ affair than his own.”

Much has already been written about the denial of disability and death so prevalent in medical and other mental health professionals. It is part of the ethos to be strong and well. Being ill is for patients, not for doctors. To maintain this magical state of omnipotence one must deny “thinking the unthinkable”. But the effect of denial is chaos when an analyst dies without a professional will. Everyone suffers. Families are excessively burdened at an already extremely stressful time. Colleagues have to step in with little information easily available and organized to make the tasks of informing and referring patients bearable. Patients feel deserted and have in fact been abandoned. This does not bode well for seeking out continued treatment and working out the trauma of an analyst's death. “Be there a will and wisdom finds a way” said George Crabbe. A readily available and well organized professional will makes everyone's task easier.

At a recent meeting I asked the assembly of professionals if any of them had made arrangements for the care of their families and the disposition of their assets in the event of death. Of course most had done this as it is considered a normal and necessary part of responsible living. When I put the question in terms of their professional life only a miniscule number could say that they had made such plans. Why is there this discrepancy? It may have to do with a distorted perception of one's professional role. It is acceptable to be a human being in the context of family and friends, but perhaps not in the role of great healer and omnipotent transference object. It is easy to become seduced by the transference distortions of patients when they are positive. Excessive narcissism may lead analysts into subscribing to patient's fantasies of having a great and immortal analyst. And this countertransference allows for the neglect of ideas such as a professional will. This idea needs to be implemented by individuals and supported by institutional structures.

One of the potential problems in maintaining a professional will is that it needs to be given to a trusted person or preferably, few people, who will act in case of the writer's incapacity or death. Not everyone has such people readily available. And it can be difficult to ask people to assume this responsibility, especially if it cannot be reciprocal. Younger people are always needed to do this favor for their elders. Older people cannot expect to be able to return the favor.

In Jewish law it is considered a great good deed to bury the dead. This is because the doers cannot expect reciprocity from the people they have buried. Their turn will come from younger generations who carry on the tradition.

In that same spirit the idea of collective responsibility would suggest that a home for professional wills be found in our institutions. Each individual would be responsible for depositing a sealed envelope in a designated place. These could be updated whenever necessary. They would be opened only in case of need and then the instructions would be followed either by the named executors, if they are still available, or by the PAC or some other committee as provided by the governing body of the institution. Persons who do not have available colleagues for reciprocal arrangements, for whatever reason, would not be left out. Thus everyone could fulfill this responsibility, without the welfare of one's patients being compromised in the expectable turmoil following an analyst's sudden incapacity or death.