The American Psychiatric Publishing Textbook of Psychoanalysis

This very large and elegant book is not meant for reading from cover to cover but is more like an encyclopedia dealing with just about every conceivable aspect of psychoanalysis. The editors have assembled 36 articles by a large variety of authors, some of whom are quite well-known in the field, and they have included an excellent glossary of terms, a name index, and a subject index. The book is divided into six parts. Each part has a section editor different from the overall editors of this textbook.

We are told by the latter that this book “is intended for a wide variety of professionals, not only psychoanalysts but also psychiatrists, psychotherapists, academics, people from other disciplines, and students” (p. xiii). The articles are all of high quality, and, of course, some are better written than others. Each individual will have favorites; mine are those by Akhtar, Kernberg, Bergmann (a fine article written by a 90-year-old man), Eizirik and Seidmann de Armesto, and Fonagy. Probably the most controversial article is the chapter on “Gender and Sexuality.” This is especially true in the light of recent comments by the president of Harvard University. The articles are not easy reading; they are technical, have many references, and mercifully contain conclusion sections.

This book should not be confused with a number of books on the technique and practice of psychoanalysis. Instead of beginning with treatment and technique, a topic that is relegated to part three, it opens with quite theoretical material involving core concepts and developmental theory, also of a highly controversial nature. Were I editing the book, I would have put chapter 12, “What Is Psychoanalysis? What Is a Psychoanalyst?” first, but the editors have chosen to emphasize the “theoretical pluralism” that “dominates the psychoanalytic scene.…All these various views have yet to be integrated into a single overarching analytic theory” (p. xvi). Part 1, Core Concepts, attempts to introduce issues involving motivational systems and the dynamic unconscious. Part 2, Developmental Theory, describes several different kinds of developmental theory and stresses attachment theory. Part 3, Treatment and Technique, attempts to go over some of the standard aspects of psychoanalytic treatment such as transference, countertransference, the so-called real relationship, and various controversial and conflicting theories of treatment. Part 4, Research, describes what the editors call “burgeoning research in psychoanalysis” (p. xvii). Part 5, History of Psychoanalysis, reviews the development of the subject and covers psychoanalysis in North America, Great Britain, Continental Europe, France, and Latin America. Finally, part 6, Psychoanalysis and Related Disciplines, outlines the “interrelationships and reciprocal influences between psychoanalysis on the one hand and psychology, anthropology, philosophy, literature, the arts, politics and international relations, and neuroscience on the other” (p. xvii).

One of the weaknesses of the book as a textbook is that it does not contain much substantial clinical material, with the exception of two or three chapters such as “Psychoanalysis and Psychopharmacology” by Roose and Cabaniss. On the whole, therefore, the reader will not emerge from a study of this book with an idea of how to conduct a competent psychoanalysis or even what constitutes one and will perhaps be surprised to learn how much controversy and disagreement there is in the field not only about this topic but about everything else. Chapter 15, “Process, Resistance, and Interpretation” by Samberg and Marcus, does contain an excellent case example to which the reader should turn as soon as possible to get a better flavor of what goes on in the psychoanalytic process.

Let me look briefly at some of the other aspects of this textbook that I found interesting. One of the most important developments in the field since the time of Freud is the movement to a two-person psychology. The author of chapter 7, Robert Emde, tells us,

The difference between now and then is that Freud clearly knew this but did not emphasize it in his histories, concentrating primarily on the patient’s material, but today, in the age of intersubjectivity and relativism, it is much more at the foreground of discussions of treatment.

Fonagy (chapter 8) tells us that “in the classic psychoanalytic view, conflict is embedded in normal development. There is no escape from human weakness, aggression, and destructiveness, and life is a constant struggle against the reactivation of infantile conflicts” (p. 135). The theoretical orientation of the individual psychoanalyst, it seems to me, stands or falls on his or her acceptance of this statement. Fonagy concludes by raising the question of whether theories matter at all and whether they have any influence on clinical work with patients; he admits that “this is a difficult question to answer” and also that “we do not yet know what is truly mutative about psychotherapy” (p. 140). It is important to keep this in mind as one reads through this book because it makes it easier to accept the enormous amount of controversy that is contained in contemporary psychoanalytic theory.

Of course, one can take a very pessimistic interpretation of this, as Green (2), for example, did when he concluded that the compromise in the field today, a “pretense of tolerance, search for willy-nilly common sharings that are not very convincing and appear as life jackets to avoid sinking” (p. 126), prevents the collapse of the entire field. The editors of this textbook and the authors who present the material do not take such a dismal view of the intense pluralism and conflict in the field of psychoanalysis. For example, Harris, in “Transference, Countertransference, and the Real Relationship,” points out that “there is a sensitivity to the complex relation of particular theories and particular ways of practicing—a sense that people mostly work in multiple models and at multiple levels of awareness and abstraction” (p. 206).

Chapter 14, “Theories of Therapeutic Action and Their Technical Consequences” by Greenberg, is one of the most interesting and well-written chapters in the book. He says, “History suggests that there is something about the psychoanalytic process that makes it more likely that we will come up with interesting questions than that we will arrive at convincing answers” (pp. 220–221). He points out that the emphasis on technical flexibility is very appealing today because there is such an amount of questioning of authority throughout our culture, but he warns of the temptation “to view change as evidence of progress, a sign that we are moving toward more effective technique and toward a deeper understanding of therapeutic action. But despite historical ebbs and flows, there is still no consensus on the issue among contemporary analysts” (p. 222). He reminds us that holding fast and rigidly to a specific technique or theory as a matter of principle can be just as much an expression of the theorist’s unconscious fantasies as is the effort to modify technique: “The analyst’s personal motives—unconscious as well as conscious, fantastic as well as realistic—shape every clinical decision and every observation. No prescription can immunize us from expressing our own unconscious wishes in our technical choices” (p. 222).

The most polemical chapter, I believe, is by Kerr. He attacks a number of writers who in the past have been very idealistic about Freud and psychoanalysis. Some readers will certainly disagree. On page 455 Kerr notes a personal communication he received in July 1903, and I assume this is either a miracle or a misprint. The chapter on the arts by Spitz and the chapter on philosophy by Lear suffer from being too condensed, although they certainly are correct as far as they go. Spitz says little about current ideas regarding the springs of creativity (3, 4) and leans especially on the work of Kris. Lear focuses almost exclusively on Plato, and it is hard for me to understand a philosophical discussion about how to live and how to change that does not even mention the saintly Spinoza—one of the first to suggest mind and body as constituting different attributes of the same entity—and certain other famous philosophers who demonstrated it by their actual style of life. Conversely, why is it that some philosophers, like some composers and artists, produced great works but were quite personally repellant? The unusual work of Scharfstein (5) on trying to understand the lives and personalities of the great philosophers would have been worth mentioning.

In summary, this book is really an encyclopedia that contains essays on every conceivable aspect of psychoanalysis, all of a high quality, and definitely is to be recommended as a reference book to anyone who is interested in any of these aspects. It demands a certain level of sophistication from the reader and a willingness to concentrate on the material in the chapters. It will not inform the reader at any length about the specifics of the technique and practice of psychoanalysis or psychoanalytic therapy. Clearly, the editors, section editors, and authors have gone to a great deal of trouble to create this book and are to be congratulated on the excellence of their product.