Death and Fallibility in the Psychoanalytic Encounter: Mortal Gifts by Ellen Pinsky (review)

Ellen Pinsky has written an extraordinarily insightful and at times surprisingly personal book, a perambulating, lively, and very literary exploration of the psychoanalytic encounter, its unique intimacy, and most especially its attendant risks. Leaning on the writings of not only psychoanalytic thinkers, but also poets, novelists, and even songwriters, Pinsky meditates with great subtlety on the fact of human fallibility as it affects the clinical encounter between two people alone in a room, a situation intentionally structured to arouse in both therapist and patient strong feelings deriving from the transference. The unconscious projection of past relations onto the present situation, transference, as Pinksy writes, is the crucible in which the clinical treatment occurs and the most potent force in determining its outcome, its success or failure. Yet I think it may be precisely the power of transference in Pinsky's personal relation to the subject of her book that may create a problem for the reader, primarily its repetitive elaborations of the effects of analytic fallibility and mortality on both patient and analyst. And as Pinsky tells us, she has occupied the position of each.

Significantly, it is the analyst's role in the transference rather than the patient's, the dangers of counter-transference, that she emphasizes, calling upon a host of classic articles beginning with Freud's "Observations on Transference-Love" (1915b). In five chapters of beautifully evocative prose, each entitled with a literary allusion that serves as a dominant metaphor for the chapter's principal subject, Pinsky extensively examines various aspects of the relationship that develops between analyst and patient, underscoring the ways in which the analyst's fallibility, his or her human limitations, can result in a therapeutic failure that is a kind of psychic death.

As the book's title indicates, however, Pinsky is concerned with more than psychic death. She wants to explore "the therapist's mortality, in at least two senses of that word. The therapist is fallible, and also can die" (p. 1). While the therapist's fallibility continues to be the primary focus of her analysis throughout the book, the effects on the patient of the therapist's actual death is the more potent motive behind its writing. We get a hint of this when, after dedicating Death and Fallibility in the Psychoanalytic Encounter to "all the good guardians through the generations," Pinsky adds another dedication—to the memory of Dr. S. Joseph Nemetz, who, we learn in her introduction, was Pinsky's therapist. Briefly describing her response to her analyst's sudden death, it was, as she writes, "a painful but peculiar loss, like no other […] amplified by confusion and isolation" (p. 4). She mentions this traumatic experience again in the body of the book and returns to it more fully in the book's final chapter and epilogue. The intervening chapters focus on the problematics of transference and countertransference as a risky invitation to love, a theme which Pinsky elegantly and incisively elaborates in all its intricate variations, showing how transference in the artificial situation of the clinical encounter "provides, brilliantly, both possibility of cure, in real life, and a necessary safety for the doctor: a protective distance" (p. 9). As she explains in the final chapter, indicating the book's underlying teleology, by knowing what the therapist means to the patient, one can better understand the suffering of a patient who loses her analyst to death.

Pinsky's first chapter, "Physic Himself Must Fade," its title a line from a poem by Renaissance poet Thomas Nashe, initiates a shrewd discussion of the paradoxes inherent in the psychoanalytic venture. It contains the themes she returns to in the subsequent chapters, among them, the psychic as well as actual loss of a uniquely significant figure and the techniques for managing its transferential consequences. Calling attention to the extraordinary boldness of a treatment that depends upon the heightened emotions induced by the transference, Pinsky persuasively defends the much maligned but essential concepts...