I had a meeting this afternoon with my preceptor, the senior physician who tries to integrate my learning on this clerkship. And in the course of our discussion, I realized that despite all the frustrations, and the strange conclusions that Freud and Erikson seem to reach, when you actually get out and talk to people who are having a difficult time integrating in society, their schemas make a lot of sense. Some people don't get past Trust vs. Mistrust, or Initiative vs. Guilt. And when they get stuck at a given stage, they react to their environment in a socially unacceptable way.
That may not make any sense unless you have a some grounding in psychology. Basicallly, Erikson came up with the idea that people go through 8 stages of life, and that to react to the environment appropriately, to be "normal" you have to go through these eight conflicts. If they are successfully negotiated, the person is "well-adjusted" and if not, they have problems and may be mentally ill.
All this seemed a bit suspect to me until I saw it in practice. It may still be suspect, but it is an excellent way to frame the problem. And when you think in these patterns, a host of deductions can be made about people and what motivates them. It feels like playing Sherlock Holmes.
Most of medicine it seems is learning to think algorithmically, and once you understand the the algorithms of a given specialty, the third-year med student job gets much easier. I am, at the end of my psych rotation, finally grasping the algorithms of this specialty.
Also my preceptor made an hilarious comment. He said that "axis II patients we never forget. No matter how much we drink."