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Book Forum: Psychotherapy   |    
The Inward Eye: Psychoanalysts Reflect on Their Lives and Work
Am J Psychiatry 1998;155:1618-1619.
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edited by Laurie W. Raymond, and Susan Rosbrow-Reich. Hillsdale, N.J., The Analytic Press 1997, 504 pp., $55.00

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The last word in this remarkably good book is given to Janine Chasseguet-Smirgel, training analyst at the Paris Psychoanalytical Society: "There exists a struggle against psychoanalysis which is one with the struggle against thought itself. A denial of the unconscious is in keeping with the dehumanized world in which we live. A postgraduate student in cognitive sciences, after a presentation of mine on hallucination was over, told me: ‘We can’t measure it.’ Another added, ‘Dreams do not interest us since computers don’t dream.’ It was not a joke" (pp. 462–463).

I approached this book with considerable trepidation for a number of reasons. It was written by two women, a psychiatrist and a psychologist, who shared the same analyst and consists of interviews they carried out 8–10 years ago with a number of noted psychoanalysts, most of whom were approaching or into their 80s. The editors’ choices of whom to interview "were idiosyncratic and highly personal" (p. ix). They describe their work as "an effort to learn more about that inner dialogue, to see the world from the analyst’s inner eye.…We undertook this study both as a complement and an antidote to our training analyses" (p. ix). The editors do not explain in their introduction why they felt that their training analyses required an "antidote," and I was at first concerned that the whole project represented some kind of neurotic enactment based on issues that had not been worked through in their training analyses with their shared analyst: "The project enabled us metaphorically and actually to get up off the couch, meet the analyst person to person, and formally discuss the psychoanalytic process rather than live it" (p. xvi). In addition, I wondered why these well-known analysts agreed to be interviewed in this fashion, speculating on the narcissistic roots of such an agreement and anticipating that the responses and reminiscences would be repetitious and boring.

I am happy to report that the work of these two faculty members of the Psychoanalytic Institute of New England East and staff members of Harvard University Health Services turned out to be an excellent contribution and of great interest in spite of the fact that both were in training at the time. The correct common denominator of these 500 pages of interview material is presented by the editors in their introduction: "The qualities of these persons that affected us most have to do with character. They include honesty and integrity, a commitment to learn from one’s experience, a deep respect for another person no matter how ill, and a fundamental kindness and generosity toward others" (p. xvii). Allowing for the rhetoric in this statement, on the whole I think the book presents a good introduction to how reputable and skilled psychoanalysts think and conduct their practices, so the editors may indeed conclude, as does Rosbrow-Reich (the psychologist), "I look at the body of psychoanalytic literature now less as gospel than as reflecting each individual contributor’s highly subjective, carefully crafted, unique way of expressing what is most true and important for her or him, each with an imagery shaped by life experience" (p. xx).

The best way to read this book is to savor it by studying one interview and then putting the book down and picking it up at another time to read another interview, rather than trying to read it all the way through at once, as one does with most books. In those few psychiatric residencies which still teach psychodynamic psychiatry, this makes the book a good choice for a monthly seminar for advanced residents, covering one interview each time. Read in this way, it avoids the problem that the book tends to be somewhat repetitious in the questions asked and could have used further editing; for example, the editors present the same substantial quotation from Ferenczi a number of times to different people they interviewed, and I see no point to repeating the entire quotation in the transcript of each of the interviews.

There is not time in a brief book review to discuss all 15 interviews, so I will just mention a few high points that I found exceptionally interesting. It is impossible to read this book without learning quite a bit. For example, Arlow tells us, "Everything that the analyst thinks and feels in the course of listening to his patient is some commentary on the patient’s material" (p. 53), and he emphasizes how the patient’s production, in form and mode of presentation, "resembles the creative process" (p. 53). He even compares analytic sessions to works of art (p. 62). I was delighted to read that the French psychoanalyst Green maintains, as I do, that Freud’s concept of "drives" conveys something metaphorically that should not be considered obsolete or old-fashioned. Green reports that Lacan’s work has led French psychoanalysts to "pay enormous attention to the words of the patient" (p. 91).

Curiously, Rangell requested that his wife be present for the interview. He emphasizes the issue of the patient’s responsibility in psychoanalysis, so that once insight is achieved, he leaves it up to the patient whether to use the insight or not. He cleverly calls this "the responsibility of insight" (p. 194). Rangell is very conservative and betrays only a foggy understanding of self psychology but, like Green and me, he also wishes to retain Freud’s concept of "drives." He adds, "There is too much myth formation, cultism, and ‘follow the leader’ in analysis" (p. 153). In contrast to those analysts who try to interpret all the patient’s material in terms of the transference, Rangell stresses the "extra-analytic present," a field of observation and data pertaining to the patient’s outside life and having an important effect on the treatment.

Solnit and others emphasize the importance of the analyst as a real person and the danger of pretending that the analyst’s behavior regarding such matters as the presentation of the bill or the arrangement of the office has no significance or existence. Gardner concentrates on the role of friction between the patient and the analyst in stirring up capacities for adaptation, cooperation, and collaboration rather than the perfect harmony that is searched for in an idealized vision of empathy. He speaks of what one might call "optimal friction" as playing an important role in development and in the analytic process.

Many of the authors, even though they are of an older generation of psychoanalysts, are aware of, as Gardner puts it, "the complexity of the ways in which conscious and preconscious observations, insight, and corrective experience interact" (p. 415). This awareness has led to a much more profound understanding of the psychoanalytic process than is often presented in the foolish stereotypes of Freud’s work that are tendentiously attacked in the literature. It also has led to a greater tolerance for differences, although Gardner suggests that this is more characteristic of the French analysts than the American analysts, at least at the time of his interview. He also suggests something that I have advocated for a long time—namely, making the core of the training program tutorial rather than a series of seminars. I have advocated this even for psychiatric residents in order to, as Gardner says, "shape our teaching with fuller regard for the specific needs and strengths of our candidates and our teachers and their individual ways of learning and teaching" (p. 433).

I hope that this little sampling gives the reader of this review a taste of the many fascinating concepts, discussions, and disagreements that are presented in this excellent book. It deserves careful reading and, as few books do, careful rereading. I believe it will be more useful to those who have at least a basic familiarity with psychoanalysis, because some of the issues raised are quite sophisticated and presuppose a knowledge of psychoanalytic terminology.




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