Do today's busy psychiatrists still read Freud? Sadly, the answer – unless like curious agnostics familiarising themselves with the Bible or Koran – is probably no. Expected to master ever-expanding Diagnostic and Statistical Manual of Mental Disorders (DSM) categories, cutting-edge neuroscience and latest psychopharmacology, not to mention clunky computers and managerial mandates – why immerse oneself in the arcane byways of questionable theories? Infantile sexuality? Hmm. Dreams as wish fulfilments? Almost certainly not. Vaginal orgasm trumping clitoral? Come on! Castration anxiety as explanation for homosexuality? Forget it.
And yet … without exposure to psychoanalytic ideas, including close reading of at least some of the founding father's key texts – the Introductory Lectures, Dora, Papers on Technique – something vital to the art of psychiatry is lost. After all, complacency about our role and societal respect would be misplaced. Ousted by clinical psychology from our previous leadership position, we are, not entirely unfairly, sometimes accused of being mere ‘pill pushers’. When it comes to interpersonal competence, not a few of us appear overpaid and under-skilled.
The premiss of this intriguing book is that, questions of outcome and evidence-based practice aside, Freud just won't go away. He remains an essential companion if we are to understand ourselves, others and the contours of the modern world. To that end, Blauner has assembled a potpourri of established writers, all of whom, whether through personal therapy, trauma or genetic link (two of artist Lucian Freud's daughters, Esther Freud and Susie Boyt, and thus Sigmund's great granddaughters, contribute) have a Freud story to tell. Only one of the 25 contributors, Peter Kramer (Listening to Prozac) is a psychiatrist. He movingly describes how a period of psychoanalysis at the Tavistock Clinic opened his mind and changed his career from first anthropology then dermatology, to our very special speciality.
A literary collage such as this inevitably fails to make up a coherent or cogent case. What these essays have in common however is that, unlike the average psychoanalytic text – Goethe but not Nobel-prize winning Freud the exception – most are extremely well written: witty (Floyd Archives cartoonist Sarah Boxer), angry (Jennifer Boylan, an psychoanalytically invalidated trans), painfully honest (poet and undertaker Thomas Lynch on his daughter's suicide). Some are a little disappointing – merely using the opportunity to promote their latest projects (Colm Toibin on Henry James and Thomas Mann; Mark Solms on his new Freud translation).
As an unabashed psychotherapy ‘common factors’ enthusiast I was most moved by those who describe their experiences as psychoanalytic patients. The consensus, almost without exception, was as follows: (a) therapy helped and (b) interpretations and psychoanalytic theory had little if anything to do with what it was that helped.
Back then to the question: why read Freud? On the basis of these authors, a number of answers emerge. Freud teaches us to listen intensely to our patients, to learn from them, to listen to ourselves listening, to be kind, to survive not-knowing, to acknowledge that the mind is a complex and sometimes warring composite of differing impulses and phenomena and to accept that effective helping entails being consistent, human, watchful guardians of continuity of relationship and setting. Sadly these simple truths are in danger of being lost in the protocol-driven maelstrom of modern medicine. Embracing Freud helps return us to the heart of our healing mission.
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