In this excursion into psychoanalytic history, the history of medicine and surgery, and Freud biography, Paul E. Stepansky charts the rise and fall of Freud's "surgical metaphor", his description of psychoanalysis as a surgical procedure, with the psychoanalyst cast in the role of a surgical operator. Approaching Freud's understanding of surgery and surgeons both historically and biographically, Stepansky draws the reader into the world of late 19th-century "heroic surgery" - a world in which Sigmund Freud, through his facinating relationships with Theodor Billroth, Carl Koller, Ernst Fleischl von Marxow, Josef Breuer and Wilhelm Fliess, was led to participate. In examining the relinquishment of medicosurgical models in the years following World War I, Stepansky brings fresh historical insight to a humber of topics, including the psychoanalytic contribution to the understanding of "war neuroses", the controversy surrounding "lay analysis", and the medicosurgical experiences, both professional and personal, of Sandor Ferenczi, Ernest Jones and Karl Abraham.
It explores the implications of Freud's own surgical tribulations of the 1920s and 30s, which resulted in his lifelong dependency on surgeons, on the development of psychoanalytic theory. In considering the fate of medicosurgical analogizing in psychiatry and psychoanalysis in the years following Freud's death, Stepansky turns to topics seldom mentioned in the literature: the psychoanalysis "deconstruction" of organic pathology in the 1930s and 40s; Karl Menninger's elaboration of a "transmedical model" of psychoanalysis in the 1940s and 50s; and, most intriguingly, the relationships among psychiatry, psychoanalysis and surgery in the era of shock treatment and lobotomy. He concludes his study by turning to the "thematic counterpoint" to his preoccupations: the evolution of modern surgical consciousness in America and the ways in which it has struggled with the pychoanalytic sensibility. A scholarly contribution to both psychoanalytic and medical history, "Freud, Surgery and the Surgeons" is no less important for the fundamental questions it poses about the techniques of care-giving and the temperament of care-givers.
Table of Contents:
Introduction: "I Cannot Advise My Colleagues Too Urgently"
I. The Metaphor Ascendant
"It May Make the Same Claims as Surgery"
"Let Us Do Battle With Knife"
"Surgery Was Different"
"I Wish I Were a Doctor"
"I Never Did Any Harm With My Injections"
"These Abdominal Matters Are Uncanny to Me"
"Much Skill, Patience, Calm, and Self-Abnegation"
"Midwifery of Thought"
II. The Metaphor in Retreat
"German War Medicine Has Taken the Bait"
"I Have Been Through Hell"
"I Am No More What I Was"
"A Refractory Piece of Equipment"
"The Surgeons Very Nearly Killed Him"
"Neither Medicines Nor Instruments"
"Not Primarily Operative Interferences"
"A Panic Application of Magic"
"One Is Partner, Sometimes Rival, to the Knife"
About the Author :
Paul E. Stepansky received his doctorate in European intellectual history from Yale University, where he was named the first Kanzer Foundation Fellow for Psychoanalytic Studies in the Humanities. One of the foremost psychoanalytic editors in the country, he served as the Managing Director of Analytic Press until 2006. He is the author of numerous books on Sigmund Freud as well as The Memoirs of Margaret S. Mahler.
Review :
"Freud, Surgery, and the Surgeons was a profoundly moving experience for me and an astonishing education. Brilliantly conceived, the book traces the fatal twining of Freud's life and ambitions around the changing image of the surgeon, and ingeniously shows how shifts in both psychoanalysis and surgery affected their views of the other's terrain. Stepansky has written an intensely moving and unfamiliar history of familiar icons and treatment motives. Absorbing in its dramatic details and thoughtful in its subtle, tragic meditation on treatment in general, this book sheds such immediate light on the origin and evolution of psychoanalytic technique and bears so directly on the sharpest controversies of our day that it demands consideration in any future exegesis of standard technique. One wonders why the project wasn't undertaken before but grateful that it waited for Stepansky's therapeutic passion and wisdom."
- Lawrence Friedman, M.D., Clinical Professor of Psychiatry, Cornell
"This original and stimulating study charts the rise and hitherto little known fall of the surgical analogy in Freud and psychoanalysis - the notion that psychoanalytic treatment works like the surgeon's sure removal of morbid tissue, an analogy used to bolster psychoanalytic claims to cure. Stepansky's extraordinary medical and psychiatric erudition bristles with new insights about Freud's gradual abandonment of the analogy, owing partly to his growing disillusion with analytic outcomes, his espousal of lay analysis, and his personal experience with endless, sometimes bungled surgery. Stepansky is justifiably caustic about the hubris of some of Freud's followers, Americans among them, who tried nothing less than to subordinate all of medicine to psychoanalysis. Rich with new medical and historical perspectives, Freud, Surgery, and the Surgeons includes important reassessments of the role of psychoanalysis in World War I, American analysts' attitudes toward psychosurgery, and Freud's and his major disciples' personal experiences with surgery, including its effects on their changing views of psychoanalysis as a curative science. Stepansky raises issues that no one interested in the history or practice of psychoanalysis should neglect."
- Nathan G. Hale, Jr., Ph.D., Professor Emeritus of History, University of California - Riverside
“This is a splendid scholarly book, meticulously researched, beautifully written, absorbing from the first to the last page. . . .With this book, the author is not only answering questions about the surgical metaphor but making us think about this cultural, intellectual, and therapeutic adventure called psychoanalysis. He does this with a sense of impartiality and proportion that is the hallmark of the quintessential historian that he is.”
- Zvi Lothane, M.D., JAPA
