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Book Forum: History of Psychoanalysis and Psychiatry   |    
Commitment and Compassion in Psychoanalysis: Selected Papers of Edward M. Weinshel
RICHARD D. CHESSICK, M.D., Ph.D.
Am J Psychiatry 2005;162:202-a-203. doi:10.1176/appi.ajp.162.1.202-a
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Edited by Robert S. Wallerstein. Hillsdale, N.J., Analytic Press, 2003, 380 pp., $59.95.

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This well-organized and attractively produced book is essentially a memorial to the psychoanalyst Edward M. Weinshel, a series of his papers brought together by his good friends Robert Wallerstein and Edward Shengold. The book consists of 14 papers previously published from 1970 to 1992; six are primarily clinical case reports and eight are theoretical papers. Four of the papers were coauthored by Weinshel’s friend Victor Calef.

Weinshel was immersed in American psychoanalytic ego psychology. The creation of this volume was "to fix in an accessible and enduring place the full measure of Ed’s contributions to the mainstream American ego psychology paradigm within which he was educated and lived and worked lifelong psychoanalytically" (p. vii). Weinshel was born in 1919 and is still living but apparently has been unable to write because of Alzheimer’s disease. The book contains short laudatory notes by his daughter Julie, his wife’s daughter Denna Marshall Sorbo, and his granddaughter Caitlin Pittel Stark, something quite unusual in books of selected papers.

The papers are of uneven value for today, but they are all well written. Each of the two sections, Clinical and Theoretical, has a valuable editor’s introduction that briefly summarizes the papers in that section. However, the papers are written in the psychoanalytic jargon of ego psychology that was so popular until about 30 years ago and contain the old-fashioned types of generalizations that characterized the psychoanalytic literature of the first half of the 20th century. One might ask whether it would be possible to publish the case histories today; they are interesting and read, as Freud put it, like short stories, but they are rather detailed, and it has been my experience that detailed case histories are now rejected by journals out of their paralyzing fear of litigation. This is a profoundly unfortunate situation and results in a great loss of our understanding of patients and of how experienced psychoanalysts like Weinshel go about their work.

The detail and the jargon make this book not for primary reading by ordinary clinical psychiatrists, even if they are interested in psychoanalysis and psychodynamics. A considerable knowledge of the literature and of the controversies that took place in psychoanalysis during the period of 1970 to 1990 is required.

It is unfortunate that this information is no longer central to psychiatric training because buried in Weinshel’s papers are a number of clinical pearls and valuable bits of information that a practicing psychotherapist would be well advised to take into consideration. For example, Weinshel’s most frequently quoted paper, "Some Clinical Consequences of Introjection: Gaslighting," published in 1981 and written with Victor Calef, deals with the issue of driving a person crazy. The title is taken from the famous movie Gaslight with Charles Boyer and Ingrid Bergman, but the paper goes much deeper than that because it addresses the situation where one of the partners is unconsciously driving the other person crazy. It links up to Searle’s work on driving people crazy, a familiar milestone in the psychoanalytic literature depicting situations that are commonly seen in the psychiatric clinical consulting room today.

Another outstanding paper, also coauthored with Calef, is "The Analyst As the Conscience of the Analysis," published in 1980. This could well be mandatory reading for psychiatric residents and any psychiatrists who are still interested in what patients have to say rather than simply prescribing psychopharmacological agents. The authors write that the student

will have to learn to differentiate between "taking care of patients" and "a care for patients."…and he will learn to differentiate the "furor therapeuticus" from the more realistic physicianly attitude.…The demands on an analyst go beyond the ability to establish an adequate doctor-patient relationship, an ability which in itself requires that he operate within the bounds of an analytic relationship while simultaneously concerning himself with the patient and the patient’s illness. The "conscience of the analyst" includes that which is demanded by any other "healing" profession, but…he will recognize and be able to withstand, for example, the power of the transference…and thus maintain an optimal distance from the patient and the analytic material without becoming indifferent to either…and develop the capacity to handle appropriately the impulses which are stimulated by the analytic work; impulses which press forward from his own unconscious and from that of his patient. (p. 252)

An increasing aspect of humility creeps into the papers as they move from 1970 to 1992. For example, Weinshel points out, "It is extremely difficult to determine with any degree of certainty how much direct value all this material about ego strength and the strength of the various ego functions has for the day to day clinical work of the analyst" (p. 208) and "Psychoanalysis as a treatment…must best be viewed as a specific technical procedure which has therapeutic potential for a limited array of psychological disorders" (p. 230). The increasingly modest claims for psychoanalysis, a topic too lengthy to discuss in a brief book review, are outlined in chapter 12 and chapter 14.

Another valuable pearl is Weinshel’s emphasis on the hidden gratification of narcissistic and pregenital aims that interferes with good psychotherapeutic work. So, "Each analyst must differentiate…between those of his gratifications which do not interfere with the work and those which ‘exploit’ his patients and the analytic situation for the satisfaction of his irrational needs" (p. 254). This is a very difficult thing to do, and success in it is largely a function of one’s personal psychoanalysis. The problem has been dealt with at great length in the current psychiatric literature, but it should be noted that the quotation just given comes from a paper written in 1980.

Finally, in chapter 14, "Therapeutic Technique in Psychoanalysis and Psychoanalytic Psychotherapy," published in 1992, Weinshel points out, "The course of an analysis is not determined solely by the analyst’s interpretations or his general behavior" (p. 335). There are many patients who are unable to participate in the psychoanalytic process, and this failure may be the consequence of the analyst’s shortcomings, countertransference, etc., or technical blunders or inability to understand the patient’s problems. The patient’s inability to participate may also be a function of different psychic defenses that the patient has developed. Such patients usually end up in psychotherapy, often with another therapist. It is the mark of the analyst’s conscience, as Weinshel would put it, not to prolong a psychoanalysis with a patient who has this inability but to find a suitable psychotherapist for that patient and refer the patient to that therapist.

In summary, this is an excellent book, but it is not for the ordinary practicing psychiatrist. For those with a background in the field of psychoanalysis it will be valuable. I should only have such friends as Shengold and Wallerstein, who have produced a beautiful volume in honor of their colleague.

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