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Book Forum: Literature   |    
The Treatment
GLEN O. GABBARD, M.D.
Am J Psychiatry 1998;155:1791a-1792.
View Author and Article Information
Topeka, Kan.

by Daniel Menaker. New York, Alfred A. Knopf, 1998, 288 pp., $23.00.

Depictions of psychoanalytic treatment are scattered throughout twentieth century American fiction. With occasional exceptions, such as the sympathetically drawn protagonist of Judith Rossner’s August (R3315512CHDBCCAF), the analyst is portrayed as an ineffectual buffoon or a faceless narrative device to allow the reader to learn about a character’s internal conflict. In Daniel Menaker’s new novel, however, we encounter a truly unique psychoanalytic figure, who is deeply dedicated to his work but totally outrageous. Meet Dr. Ernesto Morales, a devoutly Catholic, sternly authoritarian, Castro-hating Cuban who describes himself as "the last Freudian." His patient (or some might prefer "victim") is Jake Singer, an anxiety-ridden underachiever who teaches in a prestigious New York preparatory school. The centerpiece of the novel is the intense, sarcastic, antagonistic, and often hilarious exchanges between the two of them in a rather extraordinary analytic treatment.

In an era in which the analyst’s authority is systematically deconstructed, Dr. Morales is dead certain about his formulations of Jake’s unconscious. He is also blunt to the point of rudeness. A few examples may serve to illustrate his notion of analytic tact: "You know, Mr. Singer, you are a gigantic pain in the ass." "If you joke, I shall kill you and spare you the effort of this slow suicide." "Listen to your ignorant prattle. You think you can size me up and dress me down!" Jake finds him impossible and talks endlessly of quitting to escape his torment. Nevertheless, he goes back for more and finds himself increasingly invested in the hostile banter with his analyst. As Jake’s life steadily improves, Morales demands credit for himself, complains bitterly that Jake does not discuss every decision with him before acting on it, and humiliates his patient at every turn. The treatment finally ends when Jake walks out in open defiance of his analyst.

The reader will undoubtedly find Morales a preposterous character. Yet there is something compelling about him. Menaker has constructed him so deftly that the reader can actually empathize with Singer’s continued involvement in the analysis. He is fiercely devoted to his patient despite being a tyrant who wants absolute control of Jake’s life. In spite of the sadomasochistic nature of their relationship, Jake somehow gets better and makes profound changes in his life. In a dust-jacket comment, Janet Malcolm, an astute commentator on psychoanalysis, notes, "I am still brooding about the mysterious, over-the-top psychoanalyst Dr. Morales, and wondering whether he is Ariel or Caliban." I share her perplexed reaction. The characterization is almost too farfetched to be a complete fiction, so one begins to imagine what sort of treatment the author himself has endured. The outcome resonates with a frequently observed clinical phenomenon—namely, that a patient can make considerable gains from a highly problematic and countertransference-ridden treatment. Attenuated sadomasochistic enactments, for example, may have undeniably therapeutic aspects to them. The mode of therapeutic action in this case may also involve what Wallerstein (R3315512CHDCJDBH) called the antitransference cure, in which the patient gets better in defiance of the therapist.

Menaker’s complex and absorbing novel is about more than an unorthodox treatment, however. It is also a contemplation of the role of fate in determining the direction that our lives take. The author ponders the imponderable:

Leading or knowing about lives into which chance intrudes unignorably, with an untimely death or oil under the backyard or finding her phone number in your wallet when you thought you’d lost it or a bullet bouncing off a dog tag, helps you to understand where at least some of the impulse to make things up—to give form and meaning to what lies beyond our control—comes from. Our brains seem to require us to try to account for everything, to transmute the brute happenstance of our lives into logical, explanatory narratives. (p. 95).

Hence the "treatment" of the title has a double meaning. Life is also a treatment to which we are subjected. Indeed, the fabric of the novel is a dialectical tension between the awful randomness of the universe and the unconsciously motivated choices that determine the course of an individual’s life. While Dr. Morales insists that there are no accidents, life is teaching Jake otherwise. Menaker believes we all are desperately constructing meaning—whether theological, philosophical, or psychological—to make sense out of chaos. Although his point is well-taken, he sometimes veers into melodrama to illustrate the cruel hand of fate.

Menaker is clearly concerned about our tendency to forsake meaning as well. In the last scene, in which we see Dr. Morales struggling to preserve his island of practice in a sea of competing treatments, the analyst sounds like Tieresias warning of the impending demise of meaningful therapy: "Treatment will no longer consist of explorations of significance and spirit and mystery, but quick fixes, twelve steps, behavioral adjustment, and pills" (p. 261). One finishes the novel with the conviction that one’s inner world can be fruitfully understood whatever the vicissitudes of chance. The author has created a story for our time that will both move and tickle the reader while confronting fundamental existential issues.

Rossner J: August. Boston, Houghton Mifflin, 1983
 
Wallerstein RS (ed): Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York, Guilford Press, 1986
 
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References

Rossner J: August. Boston, Houghton Mifflin, 1983
 
Wallerstein RS (ed): Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York, Guilford Press, 1986
 
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