Freud, Surgery, and the Surgeons (review)

Paul E. Stepansky. Freud, Surgery, and the Surgeons. Hillsdale, N.J.: Analytic Press, 1999. xix + 260 pp. $39.95.

In my recent book Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery (1998), I devote two chapters to Freud and the beginnings of a psychological theory of aesthetic surgery at the turn of the century. I was struck not only by the intensity of Freud's reaction to the problem of aesthetic surgery as a means of altering the psyche (through altering the body), but also by his complex and rather uncomfortable association with the very notion of surgery. I was clearly not the only Freud scholar to be fascinated by this question.

Paul Stepansky, the author of a series of first-rate books on the history of psychoanalysis, carves a parallel though broader path than I did in the narrower world of aesthetic surgery's relationship to psychoanalysis. He shows how Freud's interactions in the 1890s with Wilhelm Fliess, the ear-nose-and-throat specialist whose surgical procedures placed Freud and his patients in jeopardy, also shaped his idea of the surgeon. He shows the impact on Freud of World War I and the continuation of the rise of the surgeon as hero, which had begun at the close of the nineteenth century (with the introduction of anesthesia and antisepsis). This was the technical basis for the rise of modern aesthetic surgery. Stepansky traces the debate within psychoanalysis over the notion of organic pathology (which I show lies at the root of the major model for the psychology of aesthetic surgery), Alfred Adler's notion of the "inferiority complex." He then (as I did) takes the story with Adler to America and shows how Karl Menninger placed psychoanalysis at the hand of the aesthetic surgeon with his notion of "polysurgical addiction."

Stepansky's book exceeds my own, as my own focus is with aesthetic surgery and its psychological theories, which in the 1940s separate from psychoanalysis as their point of departure. His book explores the powerful metaphor of surgery in Freud's work. He is able to show that Freud (like Fliess) saw the surgeon as the most invasive and the most active of physicians at the turn of the century. This becomes a model for both the strengths and the weaknesses of medicine. Before World War I Freud begins to wrestle with whether this is an appropriate model for his new science. With the coming of the war, he becomes convinced that the surgeon is not the appropriate model. Indeed, he looks at the war experience, and specifically the question of war neurosis, as a psychological rather than a medical problem, as we know from the debate with his Viennese colleague Julius von Wagner-Jauregg.

The question of Freud's use of the metaphor of surgery and the surgeon is clearly tempered by his buccal cancer, which led to a constant relationship with the various surgeons (such as Hans Pichler) who were removing bits and pieces of his palate and jaw to ameliorate the cancer but also to constantly refit his prosthesis. Freud's life-long sense of the reality of the surgeon, more than any other subspecialist in medicine, is due to his odd role as a patient first of Fliess and then of the wide range of surgeons who operated on his body. Stepansky recognizes the importance of this and details it here in ways that make clear the complex relationship between Freud's models of thought and his personal experience. He has provided a very strong argument for knowing both the cultural context and the personal life of a great thinker--for these are, as he elegantly shows, inseparable.

Sander L. Gilman
University of Chicago

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