Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis (review)

Edward Dolnick. Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis. New York: Simon and Schuster, 1998. 368 pp. Ill. $25.00.

Time passes, and the era of the 1950s and 1960s has become a subject of history rather than of journalism. Edward Dolnick, formerly the chief science writer for the Boston Globe, has taken up the subject of American psychoanalysis in this period, and, in particular, the energetic and zealous advocacy and use of psychoanalytic methods for treating the severely mentally ill. The illnesses he discusses are schizophrenia, autism, and obsessive-compulsive disorder. His stated goal is to explain how psychoanalytic therapies for these disorders became predominant, and to review the results. He first reviews Freud's contributions, then describes the heyday of American psychoanalysis as the historical context, then takes up each of the three disorders, and finally states some conclusions.

In general, Dolnick expresses himself in two modes: as a historical scholar presenting a narrative, and as an advocate of conclusions. As a historian, his task is quite formidable, given the breadth and diversity of the literature on these issues. On the whole he is remarkably successful in this role. His description of the emotional and intellectual appeal of psychoanalysis in this era is superb (middle-aged psychiatrists who ask themselves why they entered this field in the first place have only to read chapters 3 and 4 to find the answer). Together with an extensive and highly relevant collection of contemporary written sources, he wisely uses interviews with prominent psychiatrists who were powerfully influenced by the appeal of psychoanalysis. This approach helps to keep the tone compassionate and humane. Throughout the book, his scholarship is excellent. As an outsider to theoretical and technical quarrels, he largely manages to avoid becoming bogged down in them. His descriptions of the history of the theory and treatment of each of the three disorders are very cogent and well researched. A broad array of prominent and influential psychoanalysts are described here, from Frieda Fromm-Reichman, Harold Searles, and Helen Flanders Dunbar to John Rosen and Bruno Bettelheim.

I could find only one minor error. Dolnick reports that "Freud's only direct experience with schizophrenia was a three-week stint early in his career" (p. 39). This has been the standard view, but it ignores a 1993 account of Freud's five-year psychoanalysis of a schizophrenic man in the 1920s.¹ Here, the author is attempting to show that Freud warned psychoanalysts to avoid using the method with schizophrenics (which is true enough), and that Freud himself avoided using psychoanalysis on these patients (which is not entirely true). Some discussion of how Freud himself was drawn into using psychoanalysis in a case of schizophrenia might have been useful in understanding how later American psychoanalysts took up this effort, even though these analysts were not aware of the case.

As an advocate of particular conclusions, Dolnick may lose those readers who have an emotional investment in Freud or in psychoanalysis. He does not seem to have any loyalties to psychoanalysis, nor to have any investment in it as a practitioner or even as someone who has made a career of criticizing it. His conclusions about Freud are rather well supported, but many of the psychiatrists and psychoanalysts who would benefit most from reading this book may make the mistake of dropping it after the first two chapters. The blaming of patients and their families, especially mothers, in the period of the 1950s and 1960s is a subject that will also be painful, but very relevant, for some clinicians. Readers who are more neutral toward the historical issues taken up by this book will find themselves fascinated and well informed.

David J. Lynn
St. Francis Medical Center
Pittsburgh

Notes

1. David J. Lynn, "Freud's Analysis of A.B., a Psychotic Man, 1925...