The basic thesis of this remarkable and densely written book—that biography is destiny—requires us to glance at its author before considering his text. Dr. Chessick is a psychoanalyst, editor of several psychoanalytic journals, a gifted writer, a much-honored teacher, and a lifelong student and longtime professor of philosophy, in which he holds a doctorate. Such a scholar cannot disavow his own creativity by discussing his topic as an abstract concept. What he knows about the processes of analysis and synthesis fixes him in a spotlight of his own devising and demands something far more complex than any cold statement of theory might allow. Citing more than 600 wide-ranging references for what must be considered a life work, he both summarizes and exemplifies those guiding principles of greatest personal importance. Emotional Illness and Creativity is a Chinese puzzle of books hidden within books, a Möbius strip of a highway through and around some of the issues that have been Chessick’s life.

Two clinical stories form the armature around which this sculpture is built. The life of Ezra Pound serves as an example of a great poet whose creativity was all but stifled by madness, and the life of "Barry" (a composite or synthetic patient drawn from Chessick’s life experience as a psychoanalyst) demonstrates what similar stresses can do to the creativity of a lesser mind. Chapter by chapter, the stepwise development of these two individuals is interleaved with psychoanalytic citations and well-articulated philosophical concepts. One has to know a patient from the inside to evoke him so perfectly that another person can "see" him, much in the way a seasoned supervisor knows that a clinician cannot really understand a patient unless able to "be" that individual for the purpose of role play. Chessick’s ability to write mediocre prose and poetry in Barry’s voice is itself a literary and psychoanalytic tour de force. The two life stories blend with scholarly material and neatly justify the author’s contention that illness interferes with rather than impels creative work. A book this complex also offers subtexts that deserve our attention and that do not yield to analysis until it has been read fully and savored.

The opening words, a paragraph of but one sentence ("Underneath it all is being-towards-death."), is so disagreeably blunt an assault on the sensibilities of the reader that one is still off balance when a paragraph later Chessick nods pleasantly at Nietzsche’s celebration of art and aesthetics to state, "This includes artists who have created or at least elaborated the innumerable myths we call religions as well as other mythologies and ideologies that found cultures" (p. 1).

Chessick’s philosophy is as pathomorphic as his psychoanalysis—not only does he restrict his theory of the mind to systems based purely on the investigation of deeply disturbed adults, but he also labels poets and patients with diagnoses ill supported in the text and controversial for many of us. "Although his father came the closest to fulfilling this [nurturing] function, Barry did not develop homosexual proclivities, but remained in search of the beloved one who never comes, as described by another narcissist, Rilke" (p. 55). Foreign words are rarely translated, Greek phrases are left in that alphabet and to the imagination of the average clinician, passionate love is caricatured as a vehicle "for a time enabling one to escape the constraints of reality" (p. 131), and the ability of loving others to soothe our ruffled affects is not cheered as a major joy of interpersonal intimacy but is consistently demeaned as a mere "selfobject" function worthy only of children or the child within the adult. "But no generalizations can be made about the function of falling in love beyond the fact that it tends to occur when there is a serious problem to be solved" (p. 140). As one reads the work of this truly gifted thinker, one becomes increasingly sad that he seems to believe that a fully mature human must live alone, fulfilled only by the pursuit of philosophical studies, which he proves must always be unsatisfying. No single work in my experience has so clearly explained the degree to which Freud’s great work was locked into and limited by nineteenth-century German philosophy.

More than a third of the way through the book, Chessick describes Pound’s "imagist method" as writing in which unexplained and detached images become the poetry and the reader of the poem is left with the hard work necessary to make the narrative coherent (p. 147). "The idea is that a specific image will present an intellectual and emotional complex in a brief moment of time, which, when experienced, instantaneously gives a sudden sense of liberation" (p. 148). On reading this, I found that this dense and complex book suddenly became lucid and far more approachable. The author has taken from the deeply disturbed poetic genius a system of exposition that maximizes the reader’s affective reaction. Now it became clear that Chessick has used Pound’s technique to amplify his own quite reasonable thesis: each of us has certain deeply affecting core concerns, matters that Chessick calls our "project" and analogous to what Tomkins (1) defined as a "nuclear script." Through these scripts we evaluate all the problems of life that cannot be abolished by mere thought (life and death, the family romance, the limitations of personal equipment, etc.) and are handled best by acceptance within some form of personal maturity that limits our proclivity to find everywhere analogues of that reality and repetition of the affective sequences associated with it.

What are the affects Chessick finds most troublesome, most important? Shame, usually characterized in terms of drive theory as the result of a narcissistic wound, looms largest as the source of both psychopathology and the project of everyman. "The problem of life lies in the necessity to withstand the inevitable narcissistic wounding which occurs…in a surrounding world of barbaric, unempathic, and hostile" others (p. 185). Not one of his references deals specifically with the psychology of shame, despite the great extent to which it figures in his work and the rapidity with which that literature has grown in importance (2, 3). And excitement? Degas said that the proper affective attitude of a painter about to put the first brushstroke on a canvas should be approximately that of a criminal about to perpetrate a crime. Even if we accept Chessick’s decision that true creativity need not imply illness, within psychoanalytic theory the excitement that animates artistic expression must be attributed to libido, which a well-trained clinician understands as energy that would not be released in a more enlightened or less conflicted adult. Between the lines of this superb book is authentic despair that the tools of psychoanalysis and philosophy are inadequate to advance our understanding of the everyday experience of creativity.

Inexcusable in a modern book about creativity (especially given the excitement/lassitude seesaw described throughout it) is the absence of reference to Jamison’s demonstration that the biology of affect has been a critical element in the creative work of so many geniuses about whom we have valid biographical data (4). Most theories work not because of the data on which they are based but because of what they exclude from consideration. Chessick’s brilliant exposition of creativity from a broad-based psychoanalytic stance excludes far too much for me to accord it a status higher than that of a crystal-clear vision of the past history of our field. I would turn attention from this vision toward theories of the mind based more on affect than drive, theories that link the mind with neurobiology rather than eschew reference to it.