Through an intensive study of "Aaron Green," a Freudian analyst in New York City, New Yorker writer Janet Malcolm reveals the inner workings of psychoanalysis.
"Miss Malcolm asks the questions that every patient has ever wanted to ask but knew it was hopeless...More momentous still, Miss Malcolm's questions get answers." -- Christopher Lehmann-Haupt, The New York Times
"Malcolm provides an elegant, precise summary of the history and development of Freud's ideas...She has drawn a provocative portrait of one physician in Freud's impossible profession." -- Jean Strouse, Newsweek
"Her treatment of the subject is original, rich and will reward anyone interested in the science or business of changing minds." -- E. James Lieberman, The Washington Post Book World
By 1982, starting in the 1960s, various new forms of therapy emerged in competition with psychiatry and although Malcolm gives these a nod for her classic Freudian analysis was the King, the Father, and the center.
This father is now as spectral as Hamlet's Dad, and even New Age therapies are beginning to fall into disrepute.
The sort of personality able to play the role of analyst who himself does not buy in to whatever malarkey the patient is laying down is in decline these days, for more and more people including medical doctors do not have anything like Freud's 19th century confidence in the validity of an *haute* bourgeois biography. Starting in the 1960s, analysts were not so confident that boys wanted to grow up to be what we now would think are stuffed shirts, and of course the story failed to fit women's aspirations.
However, as Robert Bly as pointed out, no new narrative replaced the old narrative with the result that psychiatrists can be as threatened or in general as dysfunctional as their patients.
Another problem lies in the fact that in 1982 and today, Americans pay their doctors (including their head shrink) using Someone Else's Money.
The best way to save for being physically sick in a laissez faire society is to have a 401K, and also to live a healthy lifestyle, including exercise, alcohol in moderation and tobacco not at all. This way you have at least a chance of paying the bill even if uninsured, perhaps by making time payments and getting the caregivers to give you a break. Or, you can use (disappearing) public institutions.
However, note that with regards to mental illness, the "system" that is preparing for the future by saving and leading a healthy lifestyle is by definition dysfunctional, and mental illness builds up over time. Except for narrowly defined disorders, mental illness is a slow train coming and its onset often includes behaviors at odds with the norm recommended by laissez-faire. There are exceptions, but for every head case who compulsively oversaves, taking the laissez-faire ideal to extremes, there are tens of nutbars who waste their money and engage in substance abuse.
This means that almost by definition societal provision has to be made for the mentally ill but almost by definition a laissez-faire society is unwilling to do so. And to the extent that HMO and insurance companies internally resemble Socialist societies (in that they have the open-ended duty to care for the people who've paid premiums, as socialist states precommitt themselves to cradle-to-grave care for citizens) they are reluctant to pay for extended mental care.
However, as Malcolm points out, classic analysis is open-ended and difficult to terminate. It seems to contemporary culture to be an iatrogenic time-waster, that causes wimped-out Woody Allen clones to acquire problems from the process itself.
Janet writes before developments in cognitive neuropsychiatry and drugs that have regressed the psychiatric profession to about the time of the phrenology that so outraged Hegel, by so reifying mental states in the sick and the normal as to be absurd. It does appear that some cognitive neuropsychiatry gains explanatory power at the expense of ignoring interactions just as phrenology was attractive in the early 19th century, and Dr Peter Breggin has pointed out that the known effects of Prozac and similar concoctions are known only empirically in the form of success rates, and absence of side-effects.
The success rates of Prozac are reified as the explicit rates for the people studied. The absence of side-effects can be refuted by a single toxic side-effect traceable to Prozac but can never be disproved, and the field of neuropharamacology is littered with miracle cures such as Valium which turned out over time to be highly dangerous and addictive.
At the same time Janet published PSYCHIATRY, a character in the early Madonna movie Desparately Seeking Susan was exclaiming "take a Valium like a normal person!" We need to be skeptical of miracle cures and ask what was wrong with the Woody Allen syndrome, apart, of course, from Woody Allen himself.
The Hippocratic oath, to which the MD psychiatrist subscribes, says above all, do no harm. Compared with Valium, psychiatry did little harm and the harm it did has to be proven by psychiatric hermeneutics themselves. Sexual abuse of patients is not this kind of harm since it is malpractice. Heavily headshrunk people do not appear to be psychotic, and although the sorts of individuals who committ spectacular crimes often have psychiatric histories these appear to be somewhat mandated by previous run-ins with the law, or casual encounters with no follow-through. The spectacular crimes can be in many cases in recent years ascribed to a lack of follow-through, which is caused by lack of access to Woody Allenesque abilities to talk things through without religious boundaries.
The best reason to read this book is to learn about a world destroyed by economics, in which ordinary people of the upper middle class were able to talk to shrinks and convert misery into ordinary unhappiness. This does not sound like much, but it is better than forced conversion of misery into extreme misery, whether that misery is internal or visited upon the kids.