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The Therapeutic Revolution: From Mesmer to Freud.

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The Therapeutic Revolution: From Mesmer to Freud.

Auteurs : Alex H. Kaplan

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<meta-value> BOOK NOTICES 82 1 the cultural nexus from which they emerged, to show their conflicts and interconnections and to demonstrate the course through which they passed on their way to semiotics, which, its proponents promise us, will at last truly unlock the secrets of human knowledge and communication. We'll see. Aaron H. Esman, M.D. New York City REGARDS LA PSYCHANALYSE. NOUVELLE SUR REVUE PSYCHANADE LYSE. Edited by J.-B. Pontalis. Paris: Gallimard, Fall 1979, 301 pp., 45 F. It was with a certain degree of apprehension that I approached the task of reviewing Regards sur la Psychanalye, roughly translated as Perspectives on PsyAoanalysh in France. What I found, somewhat to my surprise, was, for the most part, a fascinating series of essays, some theoretical, others clinical, providing the reader with a clear overview of the French psychoanalytic scene, including some enlightening historical perspectives. What factors have determined the particular attributes of French psychoanalysis: a tendency to constant polemic, a quasi-revolutionary attitude, a mistrust of organization and an involvement with other disciplines, particularly literature and philosophy? There are first some national characteristics. By nature (and I am aware of the danger of any attempt to speak of a national character), the French are very fond of individualism, mocking toward outsiders, infatuated with language and discourse, highly mistrustful of any organization be it the government o r the local council, and drawn to endless polemic and argument. As Rosolato, in “L`Analyse des Resistances,” makes clear, psychoanalysis in France is not conceived of in any way as having a special connection with medicine, but rather maintains mutual bonds with five disciplines from which it needs to keep its distance: biology, politics, religion, philosophy, and art. This attitude is more than just theoretical, for in France analysis is very much a lay field-any constituent society with too high a percentage of physicians is looked upon with considerable suspicion of having sold out! I n the lead article, Pontalis highlights what he sees as the major preoccupations of the current scene-concern with “the writing,” the 822 BOOK SECTION problem of conveying an experience through words. Some analysts experiment and choose to write in a form halfway between scientific discourse and the novel; R. hiajor is a leading figure of this movement called “psycholiterature.” T h e French take very seriously the statement made by Freud that his cases read more like novels than scientific products; also evident is the interest in the dream book and the problem of conveying dreaming experience in words. Having reviewed a number of hlajor's books, I must expressgrave reservations on the potential of the movement. Another basic tenet of French analysis at present is its clear opposition to what it considers the American hegemony in analysis, particularly ego psychology. I greatly suspect that this passionate distrust of what the French consider the sellout of Americans to medicine and the exact sciences was fueled by Lacan's personal rivalries with R. hl. Loewenstein, a leading figure in the 1930s emergence of analysis in France, both in its theoretical aspects (a number of Loewenstein's papers from that period, particularly on the topic of masochism, are brilliant and have yet to be translated into English) and in its training aspects (Loewenstein was the analyst of many leading figures, including Lacan); unfortunately the extreme opposition to so-called ego .psychology leads the French to throw out the baby with the bath water. Rosolato, in his article on resistances, comes to condemn Greenson's approach (Greenson typifies the American approach and has become the bEte noire of the French) and claims that analysis of resistances as practiced by Greenson is “rigid, unnecessary, and dogmatic.” T h e ego is seen as “imaginary” as defined by the Lacanians. T h e need for French analysts to find their own identity by opposing a major force is perhaps a necessary developmental step. T h e French have had more than their fair share of splits, the major one being centered around the charismatic Lacan. T h e latter's quasi-religious autocratic stance led to further splits. It is unfortunate that Lacan's obscurity and bizarre technical innovations have interfered with a n appreciation of his real contributions. T h e most controversial technical innovations, that of the shortened session (the extreme example being: Patient: “Finally”; Analyst: “Our time is up”) and the strange extreme democratization of the training procedures are not taken seriously by the large majority of analysts in France. In trying to understand the current functioning of an individual, a developmental approach is mandatory. T h e same is true for a movement. I n a very erudite article, “From Vienna to Paris,” V. Smirnoff emphasizes the very ambivalent attitude of Freud in the 1920s toward the early French pioneers, Pichon and Laforgue. T h e subsequent BOOK NOTICES 823 leaders were all imported, first hiarie Bonaparte, then Loewenstein. T h e French were particularly concerned not to be the recipients of an analytic hlarshall Plan after the Second IVorld IVar, and well might they have been, as their analytic community had neither major theoretical positions nor charismatic figures. Under the banner of “Return to Freud,” that is, particularly the early Freud who had not yet been critical of the limits of the French, Lacan spearheaded a loyalty to the opus-the work, not the man-claiming for himself the role of the “true disciple.” T h e Freudian text became somewhat of a passionate fetish. Smirnoff reminds us that even now there are no equivalents of the Strachey translations; hence the lack of an authoritative text underlies the search for the true Freud. This is dramatically highlighted by the inclusion in this journal of a 1925 text by Freud, “Resistance to Psychoanalysis,” first published in French in La Revue Juive in 1925 (some six months ahead of its appearance in German!) and not available in French since then. This return to the texts has produced valuable innovations both in terms of form and content. “Our theory is our mythology,” wrote Freud. T h e French have pursued the process of this development, reading the metapsychological texts with a structuralist-clinical point of view, considering for. example the repetitions, omissions, imagery, as data for interpretation o r rather for reconstruction of a dialogue between the author and himself, revealing a hidden text with its own peculiar dynamics. This same approach is characteristic of the attitude of the French toward their analytic institutions. It is possible to trace many of Freud's papers as outgrowths of polemics o r discussions with the early pioneers (Adler, Jung). Likewise, the French, according to a scholarly article by Fedida (,`A Propos du Retour a Freud“) feel that the true history of analytic theory is that which engages the analyst in his relation to other analysts and to the conflicts of their institutions. This concern with the personal lends a certain presence to French writings. T h e majority of the authors regard Lacan as the pivotal force in French analysis. A final paper by hi. Enriquez, a member of the ”Fourth Group,“ the latest Lacanian split-off, is titled ”On Forme un Analyste [An Analyst Is Being Trained].“ It examines in a surprisingly candid way the current methods of training in France. T h e author makes an interesting comparison between the structure of ”A Child Is Being Beaten“ and the hypothetical fantasies underlying the training process as seen by the candidate. Both ”fantasies“ include elements of exclusion of the subject and an obscure area of paternity. These can be 824 BOOK SECTION resolved via an oedipal scar or by way of a paranoidal development. Under the influence of Lacan this writer is very sensitive to issues of origin, family romance, and fatherhood as they play a role in analytic training. hfy overall impression of Regards sur la Psjchanaljse is that French analysis is currently struggling with Lacan the way he struggled against the Americans. His influence and charisma fuel submission o r defi'ance which complicate a realistic assessment of his work. I n fact, there %re certain similarities between this state of affairs and the current polemic in this country over the psychology of the self. I n both cases, a charismatic figure has attempted to dethrone the centrality of the drives, in the case of Kohut by introducing the self, in the case of Lacan by introducing language as the primary experience-near given. A major difference, as I see it, is that Kohut's contributions have increased our sensitivity to certain clinical constellations and their management, whereas Lacan's main thrust is in the direction of theory and the enlightened reading of psychoanalytic texts. Francis Baudry, h1.D. New York, Neiv York THE THERAPEUTIC REVOLUTION: FROhf hlEshlER TO FREUD. Leon By . Chertok and Rajmond de Sawsure, trans. from the French by R. H. Ahrenfeldt. Neiv York: Brunner/hlazel, 1979, 226 pp., $17.50. T h e intellectual background of Freud's seminal theories of psychoanalysis has already been intensively explored. They include 19thcentury concepts which advocated an intuitive understanding of natural phenomena, mechanistic and physicalistic postulates of chemical and physical forces within the individual, concepts of energy as a force, the theory of evolution, understanding of the central nervous system as a passive structure, the organic point of view in psychiatry, and finally the social, philosophical, and cultural milieu in Germany during the same period. But in addition to all of the above, Freud's visit to Paris from October 1885 to February 1886 to study with J. hl. Charcot at the Salp&trii?reand his subsequent brief visit to Nancy, France, in July 1889 to work with A. A. Likbeault and H. Bernheim, have also been singled out as significant in Freud's theoretical and clinical development. I n this enjoyable, thoughtful, and well-researched psychohis- 824 BOOK SECTION resolved via an oedipal scar or by way of a paranoidal development. Under the influence of Lacan this writer is very sensitive to issues of origin, family romance, and fatherhood as they play a role in analytic training. hfy overall impression of Regards sur la Psjchanaljse is that French analysis is currently struggling with Lacan the way he struggled against the Americans. His influence and charisma fuel submission o r defi'ance which complicate a realistic assessment of his work. I n fact, there %re certain similarities between this state of affairs and the current polemic in this country over the psychology of the self. I n both cases, a charismatic figure has attempted to dethrone the centrality of the drives, in the case of Kohut by introducing the self, in the case of Lacan by introducing language as the primary experience-near given. A major difference, as I see it, is that Kohut's contributions have increased our sensitivity to certain clinical constellations and their management, whereas Lacan's main thrust is in the direction of theory and the enlightened reading of psychoanalytic texts. Francis Baudry, h1.D. New York, Neiv York THE THERAPEUTIC REVOLUTION: FROhf hlEshlER TO FREUD. Leon By . Chertok and Rajmond de Sawsure, trans. from the French by R. H. Ahrenfeldt. Neiv York: Brunner/hlazel, 1979, 226 pp., $17.50. T h e intellectual background of Freud's seminal theories of psychoanalysis has already been intensively explored. They include 19thcentury concepts which advocated an intuitive understanding of natural phenomena, mechanistic and physicalistic postulates of chemical and physical forces within the individual, concepts of energy as a force, the theory of evolution, understanding of the central nervous system as a passive structure, the organic point of view in psychiatry, and finally the social, philosophical, and cultural milieu in Germany during the same period. But in addition to all of the above, Freud's visit to Paris from October 1885 to February 1886 to study with J. hl. Charcot at the Salp&trii?reand his subsequent brief visit to Nancy, France, in July 1889 to work with A. A. Likbeault and H. Bernheim, have also been singled out as significant in Freud's theoretical and clinical development. I n this enjoyable, thoughtful, and well-researched psychohis- BOOK NOTICES 825 torical monograph, Chertok and de Saussure have set out to demonstrate that developments in France in animal magnetism and hypnotism had more of an impact than has been recognized on Freud's understanding of hysteria, the unconscious, object relations, transference, the sexual etiology of neuroses, repression, and regression. Raymond d e Saussure, who died in 1971 prior to the publication of the original French text in 1973, is described as the first Frenchspeaking analyst in Europe. It'hile he practiced in Geneva, Switzerland, he was one of the founders of the Paris Psychoanalytic Institute and the Revue Francaise de P s y h a n a l p . Leon Chertok, a French psychoanalyst with roots in eastern Europe, had an earlier interest in hypnosis, hysteria, and the unconscious. T h e co-authors met in 1955. They developed a common research bond to study 18th- and 19thcentury developments in animal magnetism and hypnosis in France to re-evaluate their influence on Freud and psychoanalysis. It was Chertok who had the final responsibility for the original French manuscript, Naissance du Psyhanal-yste, De lllesmer ci Freud. In addition to some minor changes in the English translation] there are several new articles cited in the bibliography. T h e book is better organized, but a number of interesting photographs of the early magnetists and hypnotists have been omitted. T h e authors first surveyed the prehistory of object relations in animal magnetism, tracing the evolution of the understanding of the dynamic affective relationship in the magnetic treatment from F. A. hlesmer in 1778 to J. P. F. Deleuze in 1819. Despite the fact that the convulsive crises or trances brought on by physical stroking of the patient were explained in physiological terms by the transfer of an actual fluid in magnetic therapy, much like in psychoanalysis, the magnetists saw their patients in isolation, rapport was considered essential] and a commitment to treatment was required. IVhile magnetic therapy seemed to operate within a sadomasochistic or, better still, an authoritarian relationship with regression and catharsis, the unconscious genital equation of the fluid was emphasized although the preoedipal breast milk connotations for the dependent patients seems even more significant. With the advent of the hypnotists who were mainly physicians, beginning with James Braid in 1843, the “nervous sleep,” which was by then understood as the result of a psychological involvement with the patient, was still explained in- neurophysiological terms as a physico-psychical stimulation of the retina leading to a hypnotic trance. While the early hypnotists'made no mention of feelings, Bernheim, working with LiCbeault, later asserted that there was no hyp- 826 BOOK SECTION notic theory, only “suggestion.” Nevertheless, their work at Nancy and the use of posthypnotic suggestion paved the way for the advent of an affective psychology and Freud's discovery and elucidation of the unconscious. From hlesmer to the hypnotists, object relations, although clearly recognized and frequently described, had because of the affective and erotic implications encountered such a degree of distrust that therapists were unable to become more aware of the therapeutic implications. T h e authors feel that hlesmer, the first magnetist, may have been impotent and that his techniques, while unconsciousl), gratifying his underlying erotic drives, prevented the conscious recognition of these feelings while he asserted control over the patient. Ernest Jones supports the author's thesis that the revolution from hypnosis to suggestion in the waking state and then to autosuggestion was related to the therapists' ambivalence as regards the affective and erotic dependence which developed. T h e same factors applied to Josef Breuer, who in 1882 discontinued his hypnotic treatment of Anna O., a so-called case of hysteria, because of his countertransference difficulties with the erotic feelings that were displayed. Freud was fascinated by the syndrome ofhysteria and by Breuer's discussion of his hypnotic treatment failure with Anna 0. Because of the lack of recognition of hypnotism and hysteria in Vienna, Freud subsequently obtained a grant to study with Charcot at the SalpEtri6re. He learned a great deal about hysteria from Charcot and later was the first person to explain clinical symptoms by psychic mechanisms, demonstrating that hysterical symptoms were symbolic expressions of unconscious fantasies. But, as with Mesmer, Breuer, and others, Freud's ambivalence and unease concerning his own sexuality may have had a significant effect on his understanding of neurasthenia, actual neuroses, and, later, transference phenomena. It has been recorded that treatises on sexuality were not uncommon in the 19th century. Freud must have been aware of them, but he was described as sexually continent prior to his marriage. However, while in Paris, he expressed great unease about the sexual openness of the French, especially his colleagues at the SalpCtriCre. Complaining of migraine headaches and fits of depression, he was said to have taken small doses of cocaine to relieve the pain. It is the author's interesting hypothesis that Freud's inner erotic life was highly stimulated not only by the Paris scene, butalso by the obvious erotic characteristics of the hysterical attacks he observed at the SalpCtrierc. This led in turn to solitary and guilt-producing masturbatory practices, internal conflict, and the development of migraine, depression, BOOK NOTICES 827 and other physical symptoms4efenses subsequently described as neurasthenia. In his description of neurasthenia, Freud was to write that men seduced by women at an early age escaped neurasthenia, giving further weight to the authors' thesis. In fact the sexual etiology of neurasthenia resulting from masturbation or other deviant sexual practices constituted the first link in the chain of Freud's theory of the sexual etiology of all neuroses. Later these concepts led to the description of infantile sexuality which caused a real public scandal. After returning to Vienna on October 18, 1886, Freud gave his Paris report to the Society of Medicine in Vienna on male hysteria and the hysterical nature of the post-traumatic neurosis which was actively contested by his colleagues. This led Freud to feel he was forced into the oppsition, but he continued his interest in hypnotism from the summer of 1887 to 1894. IVhile enthusiastic about it at first, he later felt hypnosis was a “temperamental and mystical ally.” In July 1889, he took a patient with him to Nancy, France because he could not develop in her a state of somnambulism with amnesia. There he found that only a small percentage of outpatients were hypnotizable, but he did learn about posthypnotic suggestion, which he later used as a proof of the unconscious. At one point in the hypnotic treatment of an unknown woman, she awoke and threw her arms around Freud's neck. From that point on, there was a tacit understanding that such treatment would be discontinued. T h e authors feel that after this hypnotic treatment experience, Freud began to grasp the nature of the mysterious element behind hypnotism, and in order to exclude it and isolate it, it was necessary to abandon hypnotic treatment. IVhile Freud never admitted he had extracted the concept of transference from hypnosis, the authors feel that Freud's discovery of the transference followed from his defense against the possible emotional and erotic actions of his female patients and consequently against the eventuality of his own personal temptations. In fact, the authors think Freud's repressed sexual feelings, which emerged when the unknown patient flung her arms around his neck, stimulated not only the discovery of transference, but the idea of the sexual etiology of the neuroses. Indeed, this second discovery (transference being the first) of the sexual etiology of the neuroses may have been a great shock to Freud, increasing his inner conflicts. With the development of neurotic symptoms, in 1897, Freud decided to undertake his self-analysis, which seemed to bring him increased stability. It was during this period (1897-1900) that Freud carried out his most original work. From their detailed study of the unconscious as it was elaborated 828 BOOK SECTION in France, the authors come to the conclusion that Freud invented nothing new in the principal elements of his theory of the unconscious. T h e concept of an unconscious memory, repression, the role of sexuality, the significance of dreams and childhood memories were all more or less known at the close of the 19th century. Freud's greatness lies in his having succeeded in relating all of these facts to one another in a true understanding that passes beyond the descriptive approach of his predecessors. “While only the basic premises of the book have been alluded to here, the authors are also interested in evaluating the nosology of hysteria, especially as it relates to modern-day diagnostic concepts and to a better understanding of the biopsychological character of hypnotic trances. I n addition, the difficulty with psychohistorical research is discussed. Since much material concerning Freud is still not available for study, obviously a great deal of what authors have written about Freud cannot be validated and depends on their preconceived attitudes about Freud and psychoanalysis. Nevertheless, this monograph adds convincing psychohistorical data emphasizing the influence of the evolution in France of animal magnetism and hypnosis on Freud's affective and intellectual development leading to the birth of psychoanalysis. Alex H. Kaplan, M.D. Saint Louis, Missouri </meta-value>
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