Slicing through Thin Layers of Humanity: Narratives of the Abject.

This essay examines narratives about cadaver dissection through the lens of psychoanalytic theory in order to better understand the nature of medical students' socialization into medicine and its implications for physician-patient communication. The theoretical framework provided by Julia Kristeva focuses attention on the nature of subject-formation in relation to abjection - that which reveals the contingent nature of the speaking self. Analysis of memoirs and other narratives by medical students demonstrates that students encounter the abject in the process of dissecting a corpse, but are rigorously trained to map over this experience using the technical tools of biomedicine. Other students rely on dark and morbid forms of humor to develop a sense of emotional distance from their cadaver. This analysis reveals new insights about the nature of the gap between physicians and their patients. In particular, it indicates that this gap is not fixed or static but fluid and malleable. Physicians are always shifting between the symbolic realm of biomedicine and the affective, semiotic mode of encountering the abject. This malleability provides the key to training and educating medical students, socializing them in such a way that they are reflexive about this process of oscillation. How physicians handle the reality of their fluctuation between the semiotic and the symbolic is what will determine their ability to engage with patients.