|
The first part of this guide to the most significant
psychoanalytic works of the last quarter century is divided into
5 sections containing topical reviews of the literature. It is followed
by a historical summary of 2 chapters. “The Conceptual Background”
begins with a chapter on epistemology dealing with the works of
A Gruenbaum, M Edelson, and M Polanyi. It is highly theoretical
and of interest to those involved in the philosophy of science and
psychoanalysis. However, it is neither immediately clinically relevant
nor easy reading for those unaccustomed to philosophical writing.
In Polanyi’s view, “modern societies tend to subvert science
into a merely utilitarian enterprise” that obstructs scientific
progress. He describes scientific innovation as “the replacement
of one set of normative beliefs by another that has aroused greater
credence”—a label that Gedo feels fits the history of
psychoanalysis well. Gruenbaum and Edelson claim that psychoanalysis
is a natural science because it postulates causal explanations.
The works of these 3 authors deal with what can be knowable and
what can be proven in psychoanalysis. I found this chapter rather
dry—not a particularly inviting welcome to an otherwise excellent
and clinically relevant book.
“The Philosophy of the Mind” is a readable account of
philosophers’ understanding of associations, dealing with the
body–mind question and the interface between psychoanalysis
and neurophysiology. In the following chapter, which discusses outcome
in psychoanalysis, Gedo criticizes the lack of stringency in Wallerstein’s,
Goldberg’s, and Fierstein’s criteria for analytic success,
pointing out issues that are never dealt with in their case reports.
Gedo also observes that the analytic work at the New York Psychoanalytic
Institute clinic was not affected by object relations theory or
the influence of the Kleinians. He concludes that his own methods
led to a higher proportion of terminations by mutual agreement than
are reported by these authors and that his analysands had much better
outcomes. He adds that good results are contingent on paying proper
attention to archaic issues but that Kohut’s specific prescription
for doing so is not necessarily the best.
Subsequent chapters challenge metapsychology and discuss the theory
of motivation. Freud’s metapsychology is critiqued—although
with no attempt to diminish his contribution—and an alternate
view presented. With regard to motivation, the focus is on the work
of J Lichtenberg. In a more personal and strongly argued chapter
than those preceding it, Gedo discusses “The Narrative Option
in Social Constructivism.” The discussion of semiotics is a
dense but fascinating introduction to the early development of protolanguage
and communication between infant and parent. A chapter entitled
“The Rise of the Relational Option” follows. Here, Gedo
examines the work of F Summers, J Greenberg and S Mitchell, and
H Bacal and K Newman. For Gedo, their insistence on reducing mental
life to dyadic experiences is reductionistic. He observes that none
of them are bothered by the fact that the specific hypotheses of
the various theorists they survey are mutually incompatible and
that clinical interventions seem to succeed, irrespective of the
hypotheses’ validity.
“The Theory of Development and the Yield of Infant Observation”
cogently summarizes observations of infant development and subsequent
theoretical developments. This chapter also describes how much of
classic psychoanalytic theory has been contradicted by infant observation.
A chapter on the application of neurobiology to psychoanalysis is
fascinating. I confess, however, that the next chapter, on cognitive
science, is so dense that without considerable background knowledge
it is hard to understand the significance of the points being made.
“The Evolution of Ego Psychology” describes the work
of P Gray, C Brenner, and J Weiss and H Sampson. Gedo observes that
these authors make no reference to the phase preceding the acquisition
of language and conceptual thinking or its legacies in adult life.
There is, as well, a chapter on Kohut’s legacy. For Gedo, Kohut’s
lasting contributions are his discovery that excessive ambitions
develop in early childhood as a result of emotional vicissitudes
unconnected with fantasies of incest or parricide, that failure
to establish stable ideals is related to early disappointment in
the caretakers, and that difficulties in self-esteem regulation
are generally based on a propensity to become either apathetic or
disorganized under stress. However, Gedo sees Kohut’s theory
as excessively focused on a selected portion of human psychology:
he believes Kohut’s emphasis on the need for empathy to be
overly one-sided, arguing that Kohut overlooked the importance of
making inferences about the analysand’s mental functions and
never alluded to the desirability of assisting the analysand’s
self-enquiry.
In the chapter entitled “The Relational Perspectives: New
Departures,” Gedo examines F Levenson’s observation that
the sharply differing interpretive schemata of various psychoanalytic
schools can all be effective, along with his conclusion that these
schools share commonalties in their therapeutic procedures. Gedo
also notes Levenson’s distinction between a genuine cure and
changes brought about by persuasion: symptom reduction is not enough;
analysis must be able to fill the scotomata in the patient’s
psychological competence. Turning to the work of O Kernberg, Gedo
agrees with that author’s construction of stable self- and
object representations as a process of integrating disparate nuclei;
however, he feels that Kernberg’s postulate that id, ego, and
superego structures are made up of internalized object relations
units confuses the terms. He adds that S Mitchell’s and O Kernberg’s
relational assumption is unacceptably reductionistic and notes that
Mitchell makes the unwarranted claim that “self” cannot
be conceived in isolation. In fact, Gedo feels that, by underemphasizing
sexuality, relational theories have been reductionistic. He praises
Mitchell’s repudiation of the common view that pathology results
from passive victimization, stressing that individual adaptation
is always the outcome of a series of active choices—a very
practical approach to take in psychotherapy.
Subsequent chapters review the Kleinian tradition, French psychoanalysis,
and the principles of therapeutics. Gedo criticizes inconsistencies
in the Kleinian position and points out unwarranted assumptions.
Similarly, he is not afraid to dismiss Lacan’s developmental
theory as “mere science fiction.” With regard to therapeutic
principles, and despite theoretical controversies, Gedo notes that
there has been little change in clinical application in the past
generation. Here, Gedo discusses F Pine’s ecumenicism regarding
4 clusters of issues which can play independent roles in pathogenesis.
For Gedo, Pine’s “scavenging” useful fragments from
various schools to be used in whatever manner suits his convenience
resembles anarchy. My own reading of Pine, however, leads me to
disagree (1). “Toward a New Technical Consensus” describes
the work of A Modell, T Jacobs, H Rosenfeld, D Ehrenberg, and H
Searles. Discussing Jacobs, Gedo writes that he missed the significance
of certain transactions because they had a bearing on some issues
the analyst himself did not wish to face. Gedo notes that, in analytic
work, to follow any widely accepted technical rule of thumb may
backfire if the analyst’s unthinking choice duplicates a pattern
of parental behaviour.
“Toward a Paradigm of Self-Organization” describes the
work of J Greenberg, T Dorpat and N Miller, and A Modell. Commenting
on Greenberg’s suggestion that endogenous motivations should
be reduced to 2 categories—the need for safety and the need
for effectance. Gedo questions how this could account for play or
sexuality.
The final section of this book is a historical summary that begins
with a chapter entitled “A History of Theoretical Innovation,”
which summarizes the previous chapters. For Gedo, the theoretical
revolution arose from the insight that the central nervous system
is primarily an information processor in which significant energy
transfers are not involved. He emphasizes that the hypotheses of
psychoanalysis must conform to contemporary knowledge in brain science,
cognitive psychology, and child observation. Gedo states that previous
hypotheses about early childhood have been excessively adultomorphic
and pathomorphic—that preverbal children are not comparable
to maladaptive adults. In “Recent Clinical Discourse,”
Gedo compares the rapid change in psychoanalytic theory with the
stability of its clinical propositions, asserting that a strong
ecumenical tendency may predominate in contemporary psychoanalysis.
For Gedo, analytic success to date has depended on analysts’
skills in overcoming the influence of the invalid theories that
were allegedly guiding them. The concluding chapter comments upon
the characteristic imperviousness of several psychoanalytic traditions
to fresh data—especially extraclinical data. Gedo observes
that this does not represent refuted scientific theory but, rather,
a philosophy of mind. Gedo follows the predominant views of the
monist position on the mind–body question, classifying psychoanalysis
as a biological science. He favours Modell’s emphasis on the
privacy of self and the importance of solitary experiences for autonomous
development, agreeing that memories of successful activity (rather
than benign internal objects) enable children to manage on their
own. Gedo concludes that the “curative factor in psychoanalysis
must be the acquisition of new procedural schemata by means of the
actions performed in the analytic situation.” Gedo believes
that psychoanalysis is in the midst of a metamorphosis, although
most practitioners continue their clinical work in the manner in
which they were trained. He concludes that “the most difficult
task facing the next generation of psychoanalysts will be to abandon
those of our traditional procedures, the rationales of which have
been invalidated by fresh evidence.”
Gedo’s command of this compendium of literature is impressive.
His writing is lucid, and his opinions are clear and well reasoned.
The chapters are very rich in meaning and dense in the amount and
quality of information imparted, but short enough to be digestible.
The author’s intentions and opinion are always clear. I found
a good deal of the content to be new, but the conciseness of the
chapters allowed me to absorb most of it without undue difficulty.
Despite the rigorous scholarly standard of the book, Gedo allow
his personality and sense of humour—slightly sarcastic at times—to
emerge. This text is an excellent rendering of the most significant
recent psychoanalytic writings, although I was surprised that he
did not refer to Mardi Horowitz’s work on cognitive psychodynamics.
Anyone interested in the intellectual underpinnings of psychoanalysis
will enjoy and benefit from this book; it admirably fulfils the
purpose for which it was written. The book is reasonably priced,
attractively laid out, and free from production errors.
Reference
1. Steinberg PI. Pine F, Diversity and direction
in psychoanalytic technique [book review]. Can J Psychiatry 2000;45:387–8.
|
