Abstract
This interesting title suggests important contemporary issues such as the licensing of psychotherapists, medical versus non-medical psychotherapy and medical rebates for therapy. The list of contributors was similarly promising, including notable psychoanalysts and philosophers of psychoanalysis and even more notable critics of psychoanalysis. Overall, however, the text did not deliver.
Much of it is quite parochial, focused on the politics of psychoanalysis in Britain and North America with an entire chapter on the politics of psychoanalytic institutes in New York State. These political struggles are interesting and provide an insight into the interdisciplinary struggles with which we have some familiarity in Australia and which appear to be universal.
The first chapter dealswith a 1943 debate in the psychoanalytic literature and started this reviewer off with something of a groan about its relevance. That theme/groanwas repeated many times through the book. To be debating in the twenty-first century, whether Freud meant this or that certainly smacks more of religion than of science. This tendency is one of the less attractive aspects of psychoanalysis. Similar was Anne Casement's historical essay about the 1929 report of the BritishMedical Association's Psychoanalysis Committee.
Perhaps because they are psychiatrists, the views of British psychoanalysts, Hinshelwood and Pokrony seem most relevant to Australian psychiatry. Hinshelwood focuses on the construction of the professional identity through training and issues of professional skills and consumerism. Pokrony argues that the profession has two functions – academic and practice in the real world of external political choices – and they must be kept separate. If placed under one authority, conflicts inevitably develop that will destroy both. This, he argues, is occurring in British psychoanalysis. It has become stuck like a church in a particular view that is held in place by what are really external political considerations. It has become paralysed both politically and theoretically. A salutary lesson perhaps.
Another such lesson regarding licensing authority is provided by Lacanian analyst, Nobus. He describes the scene in France where legislation was introduced in 2003 to define which types of psychotherapy would be legally sanctioned and under what conditions its practitioners would be licensed. The context is very different from Australia but the issues are relevant.
Pearl King, a British psychoanalyst, presents one of the best chapters on a very topical and relevant issue, the difficulties of attracting new trainees to the field of psychiatry and how unattractive is the model of spending a few minutes with the client and writing a prescription. Psychoanalysis can contribute in making the field more attractive by providing an insight into more fundamental aspects of people's problems. She discusses some of the political difficulties of analysis and likens it to the consequences of trade unionism.
Elisabeth Roudinesco, a French historian and psychoanalyst, challenges the notion that psychoanalysis can be owned as a discipline but considers some of the vexed problems about its ownership as a form of psychotherapy. She identifies three fronts on which psychoanalysis is under attack: from the outside by the various sciences of cognition and behaviour; from within by the bureaucratic rigidity of its institutions; and at its very borders by the schools of psychotherapy.
Peter Fonagy and Mary Target present an interesting synthesis of the various contributions to our current understanding of psychopathology and argue that it is necessary for psychoanalysis to work with other disciplines.
Mark Soames will be well known to psychiatrists and psychotherapists in Australia having been guest speaker at the 2004 conference of the Section of Psychotherapy. He provides an excellent chapter on the brain/mind interaction.
Szasz provides the briefest chapter in the book and although the style is typically iconoclastic, his description of psychoanalysis as ‘secular treatment for souls’ has some appeal. I was dismayed to see that Szasz continues to use the masculine pronoun. Grünbaum's critique is delivered with characteristic surgical and deadly precision. He is perhaps one of the most formidable critics of psychoanalysis but for those who have read his major text there will be nothing new here.
Eagle and Wakefield provide one of the most thoughtprovoking chapters, examining the efforts of psychoanalytic theorists in dealingwith Grünbaum's critiques. They highlight the shortcomings of counterarguments, particularly the relativist constructive account and the notion of the truth being in the patient's mind. They reject this response and suggest that relativism as a remedy is worse than the damage done by Grünbaum.
There are some highlights in the book but some of the best contributions were from critics of psychoanalysis like Cioffi, whose chapter ends the text with a caustic but soundly argued rejection of Freudian theory. The editors provided an excellent balance by including such critiques but I am sure that it was not their intention that the critiques should be the highlight of the book.
I found this text very hard going with much of it only marginally related to Australian psychiatry in which, I understand, only 1% is the practice of psychoanalysis. Few outside of that tiny group would find enough to interest them here.