Freud, Surgery, and the Surgeons
Routledge – 1999 – 280 pages
In this fascinating excursion into medical and psychoanalytic history, Paul E. Stepansky charts the rise and fall of the "surgical metaphor" - Freud's view of psychoanalysis as analogous to a surgical procedure. Approaching Freud's understanding of surgery and surgeons historically and biographically, Stepansky draws the reader into the world of late nineteenth-century "heroic surgery," a world into which Sigmund Freud himself was drawn.
In examining the relinquishment of medicosurgical models in the years following World War I, Stepansky brings fresh historical insight to a number of disparate but interrelated topics. Stepansky is among the very few scholars to explore the implications of Freud's own surgical tribulations of the 1920s and 1930s, which resulted in his ambivalent and enduring dependency on surgeons, on Freud's subsequent theorizing about the psychoanalytic method and its therapeutic limitations.
Stepansky then turns to topics seldom mentioned in the literature, such as the psychoanalytic "deconstruction" of organic pathology in the 1930s and 1940s. These varied inquiries have a surprising denouement, as Stepansky concludes his study by reversing field and exploring the "thematic counterpoint" to his preoccupations: the evolution of modern surgical consciousness in America and the ways in which it has struggled with a contemporary psychodynamic sensibility.
An absorbing work of historical scholarship, Freud, Surgery and the Surgeons is no less important for the fundamental questions it poses about the temperament of care-givers and the techniques of care-giving. Clinicians, historians, and lay readers alike will find much to admire in this finely crafted narrative, and they will no doubt be stimulated to reflection by Stepansky's startling, even unsettling, conclusion -- that medicosurgical analogizing based on the insights of modern surgery and immunology still has something valuable to offer contemporary "doctors of the mind."
"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
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"
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.