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Book Forum: Case Histories   |    
The Mummy at the Dining Room Table: Eminent Therapists Reveal Their Most Unusual Cases and What They Teach Us About Human Behavior
LESLIE M. LOTHSTEIN, Ph.D.
Am J Psychiatry 2004;161:1316-1316. doi:10.1176/appi.ajp.161.7.1316
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Hartford, Conn.

By Jeffrey A. Kottler and Jon Carlson. San Francisco, Jossey-Bass (Wiley), 2003, 325 pp., $24.95.

Kottler and Carlson have provided us with a "Ripley’s Believe It or Not" approach to case histories. This may be a new low point in the publishing of clinical material on patients since Khan’s viciously conceived, ill-tempered, and spiteful book (1) was published. At times Kottler and Carlson’s running commentary sounds like cheerleading and exhibitionistic narrative, a kind of "show and tell." At other times it is more like a Siskell and Ebert argument on the fantastic aspects of the cases rather than on substantive learning. I found myself wishing, more often than not, that they would stay out of the fray and let the narratives speak for themselves.

There are 32 chapters in this book, each one an interview with a therapist who is asked to reveal his or her most unusual cases. Because of the constraints of the book, only a fragment of each case is provided. It is a setup for the therapists and the readers. For some therapists it was an invitation to focus on a problematic case that stayed in their memory and caused conflict in their lives for decades. Their stories reflect the deep intersubjectivity that empathic therapists may experience with their patients. For others, the offer struck a chord of drama to bring on the freak show. For yet others it became an excursion to their most enigmatic, unusual, or outlandish patients whose narratives became yarns to be displayed at conferences, cocktail parties, or trainee workshops.

In our post postmodern world of psychotherapy one may view the model of inquiry employed as a kind of co-constructed narrative between two subjectivities, in this sense involving the needs of the editors for something entertaining and the needs of the therapists to unburden something unforgiving. In the final analysis (if I may use such a phrase), the editors’ emphasis is on the smoke and mirrors approach to the narrative. At every turn we find the patient taking the therapist down a strange path of disbelief if not despair. Some of the therapists seemed naive about what the tide can bring in; many of the therapists tell stories that go back to their early days of training or first years as a therapist when they were most naive and impressionistic. Some of the narratives are undoubtedly contrived or wrangled by memory, but we all remember our first love with more exquisite detail than others. So it is with clinical memory.

The titles of the chapters are advertisements of what’s inside, as in the following: "The Urge to Eat From Garbage Cans," "The Penis That Needed Permission From the Church," "Therapy With a Gopher Snake and a Horned Lizard," "The Medicine Man Who Never Had a Vision," and "The Woman Who Hanged Herself to Check Her Husband’s Response Time." There are others, but I do not want to spoil the plot. Although the chapters are mostly developed from interviews with the therapists, the editors take the poetic license of setting up the reader for either a laugh or a cry. In this book therapists are deceived, tricked, cajoled, lied to, manipulated, teased, thrown about, and heckled by their patients. What else is new? But there is something to be learned. Every patient or family has a story, a secret, that becomes a yarn and is worth telling, if but in fragments, to whet our appetite for the deeper issues that leave us, like "the mummy at the dining room table," propped up at the dining room table so that conversation can take place. This is a readable book, but it is also a coffee-table book, something to glance through and be entertained by, without ever being transformed.

Khan MMR: The Long Wait and Other Psychoanalytic Narratives. New York, Summit, 1989
 
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References

Khan MMR: The Long Wait and Other Psychoanalytic Narratives. New York, Summit, 1989
 
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