There is no modern use for a physician who sits all night holding a
patient’s hand while the patient dies of pneumonia for want of a shot of
penicillin. As author after author points out in Science and Sensibility,
what was good practice 50 years ago would today have the lawyers baying
for blood.

Patients want technologically superior care but they do not want it
delivered in a cold and mechanical manner. It is not hard to see how technology
reduces interactions between physicians and patients, yet is this a sufficient
explanation for the ‘squeezing out’ of empathy from modern medicine? The
trappings of high science allow physicians to distance themselves, but do
they necessitate it? Does an urgent need for, say, ‘aggressive’ antibiotic
therapy require a terse and unsympathetic attitude on the part of the prescriber?

The challenge, says one contributor, is to integrate technology into
the established empathic doctor-patient relationship. It is also, though
this is not said, to re-integrate empathy into the physician’s sense of
prestige, which today may be perceived as founded on technological mastery
rather than on character and insight.

Despite a coherent discussion of how the form of medical tuition and
institutional policies imparts lessons about patient care, the book largely
fails to ask fundamental questions about why the medical hierarchy has become
so anti-empathic. This may not be entirely unconnected with its provenance
from Yale University School of Medicine.

As much as any inherent antipathy between science and empathy, these
questions concern the organisational and academic pressures on doctors,
the structure of the medical career ladder and, particularly, the nature
of medical training, whose shocking brutalisation is the same the world
over.

This is a potentially profound book struggling to break free of gratuitous
philosophising and sloppy editing. We do not need multiple and repetitious
dic-tionary definitions of empathy. The best, albeit likely to hit home
largely with molecular biologists, clearly comes from personal understanding:
empathy occurs when two people have the same ’emotional receptor sites’.

Some contributors have been allowed to become too incestuously academic.
On occasions, writing styles shade into pompousness, overt sentimentality
or pretentious sociobabble. Two of the authors even hijack their chapter
by proselytising their neurobiological view of psychological illness, which
is at best of tangen- tial relevance. They insultingly imply that any reader
who does not accept their interpretations can lay no claim to personal
empathy.

Fortunately, other contributions shine. Jodi Halpern succinctly explains
why curiosity is more clinically useful than detachment, while psychiatrist
Peter Kramer contributes a sophisticated assessment of empathy in psychotherapy.
He disputes Freud’s recommendation that analysis be conducted ‘in the emotional
equivalent of a sterile field’, yet shows that empathy is not always a positive
experience for the recipient, nor does attunement with the patient have
to be soothing to be useful.

Shimon Glick’s outstanding chapter neatly summarises the doctors’ dilemmas,
and points out that people like to do what they are good at, yet most medical
training encourages empathic incompetence. As dean of Ben Gurion University
Faculty of Health Sciences in Israel, he describes the success of that institution’s
novel procedures to select empathic students and design training to enhance
rather than compromise this quality. Effective empathy, incorporating technology
and personal considerations is the goal: it is just as much poor science
to ignore psychosocial factors as to miss vital details in laboratory results
or tomography scans.

A tip; read the book from back to front.

Sheena Meredith is a science writer specialising in health, psychology
and social issues.

Today’s managers, executives and policy makers routinely and recklessly
drive the human body beyond its design specifications. Our technology,
infrastructure, emergency services, international commerce and global
communications demand 24-hour operations, which may exceed the capac-ity of
the operators’ biological clocks.

We have failed to recognise the inherent dangers of a world which never
stops, according to Martin Moore-Ede, associate professor of physiology at
Harvard Medical School. He compares the advent of the 24-hour society with
the Industrial Revolution, and says we have yet to realise its full impact
on our lives.

You do not have to be one of the 4 million people in Britain working
outside regular hours to be at risk. Small errors by tired workers can also
have major ramifications. The Clapham Junction rail crash in which 35 people
died was attributed to a simple safety measure overlooked by a signal
repairman working excessive hours. The Exxon Valdez oil spill that polluted
about 2000 kilometres of Alaskan coastline and incurred a
multibillion-dollar liability for Exxon was put down to fatigue and
inattention among the crew.

This makes for fascinating, if somewhat ghoulish, reading, and the point is
well made that it is not just the front-line troops – the doctors, pilots or
maintenance engineers – who are working on the dark side of the clock.
Financiers, politicians, diplomats or generals may suffer potentially dire
‘decision-maker fatigue’. More mundanely, shift workers have twice the
average rate of traffic accidents. Moore-Ede claims that falling asleep at
the wheel is at least as great a problem as driving while drunk.

He is scathing about the ‘mind sets’ of managers who ignore human factors,
and of designers with no experience of the environment in which their
hardware will be operated. His solutions are backed by practical experience
as founder of Circadian Technologies, a worldwide consultancy dedicated to
improving alertness in the workplace. Most of the advice relates to
organisations, but some of Moore-Ede’s personal tips are relevant to anyone
working long or irregular hours. Particularly intriguing is the finding
that multiple short naps (between twenty and thirty minutes every four hours
or so) can reduce total sleep to two to three hours in the 24 for weeks on
end without detriment to your overall performance.

With its anecdotal, proselytising tone, this is not an academic work, but it
is an enjoyable collation of chronobiology and sleep research that
maintains interest throughout. It is clear that the author is not against
shift work – indeed he believes that round-the-clock operations are vital
to modern economies – but he does urge the need for human-centred rather
than machine-centred design. He estimates that the global costs of failing
to employ such design run to £377 billion per year in
accidents, lost productivity and health care.

Sheena Meredith is a science writer specialising in health, psychology and
social issues.

Peter Breggin has been described as ‘the conscience of American psychiatry’.
In that analogy, the profession is suffering an unholy split between its
id and its superego.

Breggin is Professor (Adjunct) of Conflict Analysis and Resolution at
George Mason University, Virginia, and former consultant to the US National
Institute of Mental Health. He declares that ‘all of the major psychiatric
treatments (surgery, drugs, electroshock) work by producing brain dysfunction’.
He is sincere, erudite and very, very angry.

His position is that psychiatry has become dominated by the biopsychiatric
perspective, which alleges that mental ‘diseases’ stem from genetic propensity,
neurological lesions or biochemical imbalance. This stance, for which there
is not a shred of real evidence, is then used to justify treatments claimed
as specific remedies but which simply mute mental function to make patients
docile and easier to control – electroconvulsive therapy (ECT) and neuroleptic
drugs are merely electric and chemical lobotomies.

In Breggin’s view, it is the drugs that produce true biological lesions,
‘an epidemic of brain damage’, and patients – from schizophrenics to anxious
housewives – are not being warned of the dangers, in particular the risks
of tardive dyskinesia, or told about more humane alternatives.

The current dominance of biopsychiatric tenets is self-serving, since
psychiatrists would be out of business if they admitted socioenvironmental
causes of human distress that require remedies beyond their remit.

His arguments are not new. The study of psychiatric abuse is a much
explored speciality, with a long and distinguished history of dissent both
within and without the profession, from Thomas Szasz and R. D. Laing to
Elaine Showalter and Phyllis Chesler. The selective infliction of psychiatric
damage on women and children, the tendency to scapegoat the victim, and
the worrying implications of wider social control of vulnerable or dissident
groups are well-rehearsed criticisms. Breggin is not the first psychiatrist
to tackle the issue in an academic forum, but he does claim precedence
as the first to ‘roll up his shirtsleeves and get into the trenches’.

Having spearheaded the revolt against the resurgence of lobotomy and
other psychosurgeries in the 1970s, he has carried his confrontational stance
into the courts as a patient advocate in malpractice suits and federal legislation,
lent his support to the psychiatric reform movement, and founded the Center
for the Study of Psychiatry in Bethesda, Maryland, to monitor the misdeeds
of his profession. He is now at the forefront of the campaign against the
plans of the US Federal Violence Initiative to select (largely black) children
with ‘criminal potential’ from ghettos and ‘treat’ them with drugs and behaviour
modification.

Toxic Psychiatry is a hands-on, practical, patient-oriented protest
as well as an academic treatise. The book undermines claims for specific
drugs in detail; hammers pharmaceuticals companies and questions the research
claims of their advertisements; cites the dubious allegiances, misleading
publications, cover-ups and sometimes downright lies of named psychiatrists;
and uncovers the tactics of various government and other agencies in the
biopsychiatric propaganda war. It is not a conspiracy, he says, because
it is so blatant and institutionalised.

While Toxic Psychiatry has an obvious US perspective this, the British
edition, has a foreword and interspersed notes from psychologist Dorothy
Rowe detailing the situation in Britain. She shows that the temptation to
dismiss some examples as extreme or irrelevant is not generally justified.

Breggin reveals that the use of ECT is actually increasing, especially
among elderly women, and he is particularly concerned about current trends
to label energetic, precocious, inquisitive (that is, intelligent, nonconforming)
children as hyperactive, and thence to drug them. Britain is catching up
with the US and there will be far more drugged English children in the next
ten years, he warns.

His blunt antipathy and evangelical sincerity in the crusade against
psychomanipulation are understandable in the context of his concern over
wider social and political implications. The alliance between toxic psychiatry
and toxic parents has the hidden agenda of relieving parents of responsibility
for their children’s distress, he suggests.

Organisations of parents of patients, promoting a biopsychiatric stance
and attempting to subvert investigations into psychosocial factors, have
promoted a backlash against psychiatric reform in both the US (NAMI, the
National Alliance for the Mentally Ill) and Britain (SANE, Schizophrenia
A National Emergency). Their covert rallying cry is ‘we are not to blame’.

Only a biopsychiatric perspective justifies treating people against
their will. Breggin neatly turns the liberal argument for keeping ‘mentally
disordered’ offenders out of prison on its head, claiming that locking people
up should be seen as a police activity and not a therapeutic one. Enforced
medication or incarceration is a power that no other medical speciality
has; it corrupts, encourages brutal and oppressive treatments and makes
psychotherapy or other attempts to help nearly impossible.

‘There is no place for the political institution of psychiatry in a
free society, and it should be abolished,’ Breggin says. Whether this book
will help in the attempt is a moot point. Social change is an ambitious
goal, even for the conscience of a nation.

Sheena Meredith is a science writer specialising in health, psychology
and social issues.

Why should more women than men be ‘mad’? Many women are responding to
what are, literally, maddening circumstances, and to label their distress
or anger as mental illness is to describe their behaviour as pathological,
control and silence them: the madwoman’s ramblings may be safely dismissed.

Jane Ussher, a lecturer in psychology at the University of Sussex, believes
women are poorly served by the swelling ranks of competing experts in ‘the
marketplace of madness’, and that the whole rhetoric of madness is highly
questionable. It is useless to treat a woman for agoraphobia when the real
problem is a marriage she cannot or will not leave.

Ussher’s style is lucid, compelling, empathic and personal, with the
minimum sprinkling of academic psychobabble. She opens with a harrowing
tale of her mother’s madness, or rather, her excruciating unhappiness, and
her own realisation that psychological training offered neither explanations
nor solutions.

She is not the first to highlight the misogyny of psychiatry, nor to
view its strictures within a wider frame of abuse and control of women.
What makes the book dramatic is the direct lineage she draws between past
cruelties, present barbarisms and therapeutic abuse, set within a social
framework where mysogyny is deeply ingrained.

‘Madness has become the heir to witchcraft,’ she says. From suttee (Indian
widow-burning) to electroconvulsive therapy, chastity belts to tranquillisers,
fear and hatred of women are depressingly wide-ranging across time and geography,
‘a misogynistic jigsaw which is horrific in its magnitude and extent’.

Men are ‘mad’ too, but more often act, or are labelled as, bad. Statistics
on female depression and mental illness parallel those on masculine crime,
violence and imprisonment. ECT, insulin shock and lobotomy are all practised
more often on women. Ussher cites a note on ECT that ‘its disabling effects
are deemed less problematic in women’.

Tellingly, little girls are less ‘mad’ than little boys. ‘It is evidently
only in post-adolescence that women become notably mad,’ Ussher points out.
It is then only particular women who are at increased risk – the married,
mothers and those without paid employment.

On the subject of marriage she is fierce and unequivocal: it is tyranny
– at best, a cruel deception and at worst, a cross between prostitution
and slavery. ‘The married relationship acts to make women subservient and
mad’. Yet since legalised marriage is on the decline but mental illness
is not, the problem is presumably wider than the legal contract per se.

The crucial questions of why misogyny is so prevalent, and why women
en masse put up with it so placidly, are scope for another book. But one
question she leaves hanging deserves more attention, especially as she implies
that men know they are on to a good thing and will not change unless forced.
Why do women often act as instigators in enforcing submission on their daughters,
whether in insisting on footbinding or clitoridectomy or promoting corsets
and virginal purity?

Ussher seems despairing of change coming from women. ‘What does a woman
do when she realises her father/husband/boss is a prime mover in her misery?
Leave him? Change him? Most women . . . cannot simply leave the luxury of
the consulting room and change their worlds’. She accepts that they do not
have the range of options open to white, middle class, self-supporting feminists,
but tacitly ignores their option at least to offer their daughters an alternative
range of responses, and the experts’ option to suggest that they can.

Of course to do so would be to accept their own lives as futile, and
to come face to face with the hatred and the con tricks that underpin women’s
lives. If this is too painful, it exposes the ultimate flaw of both therapy
and academic debate.

There are no simple answers, but Ussher’s crisply pessimistic analysis
of the past and present is not matched by clarity and optimism for the future,
without which the book ultimately raises another profound question. ‘Is
it better to be cognisant and in pain, or senseless and serene?’ she asks
– the same dilemma as physical or pharmaceutical salves for depression which
may help women to live less painfully on their barbed pedestals.

Against this background it becomes surprising that women are not ‘madder’
than they are, in many senses. So what help is there for women in distress?
Even feminist therapy may merely increase women’s awareness and sensitivity
to their misery and powerlessness and, as Ussher’s own story demonstrates,
such knowledge makes little practical difference.

The implication that the dualism of misogyny and submission have become
self-sustaining makes the book ultimately depressing – at least, for women.
It is men who should read Women’s Madness: Misogyny or Mental Illness?,
and it is part of misogyny that most will dismiss it for its title alone.

Sheena Meredith is a science writer specialising in health, psychology
and social issues.

Erich Fromm, claims the flyleaf, was perhaps the most widely read psychoanalyst
after Sigmund Freud, yet Daniel Burston’s aim is ‘to rescue him from relative
obscurity’. This is the first of many contradictions about all three men.

Fromm was a successful populariser, yet largely ignored by academic
psychologists. Like many contemporaries, his work is permeated by ambivalence
towards Freud. He disliked orthodoxy and described Freud as an emotionally
impoverished, self-centred man, yet he exhibited the classic attitude of
reverence towards the master which Burston delightfully terms ‘Freud piety’.

Burston, a psychologist at York University, Ontario, betrays a similar
ambivalence. He maintains a straightforward cynicism (believing loyalty
to Freud engendered ‘falsifications of truly Stalinist proportions’), while
accepting many of Freud’s tenets, such as the oedipal doctrine, without
question. His snatched glimpses of Freud the man paint no prettier a picture
than those of Fromm, and he takes a fairly glum view of psychoanalysis and
its internecine antipathies.

Burston’s attitude towards Fromm resembles that of Fromm to Freud,
a curious admixture of objectivity with cosy adulation. In many ways he
mimics Fromm’s more endearing aspects, including his inconsist-encies.
He has a flair for writing and is at his best as a biographical raconteur,
which more than compensates for occasional lapses into pompous phraseology.

Fromm was temperamentally a humanist whose writings were pervaded by
his early religious influences (he once wanted to be a rabbi), yet who professed
to be an atheist and a Marxist existentialist. He was an unorthodox radical
often charged with being doctrinaire, and even his clinical results were
inconsistent, some patients benefiting from his approach and others, perhaps,
being harmed.

Burston ably allows Fromm’s contradictory character to enhance rather
than detract from the flavour of his work, yet while he dwells at length
on Fromm’s estrangement from his peers, he is curiously silent on his popular
appeal. Fromm’s writings have a humanity and common sense generally lacking
in coolly psychoanalytic work, so that when he ascribes psychological problems
to interactions between temperament and social conditions, he is closer
and more accessible to the public view than Freud’s notions of arrested
development. As Burston notes, even when writing in a psychoanalytic frame,
his views on evil have a literary and philosophic quality.

To Fromm, emotional life was critical, and he railed against the impoverished
and flattened thinking of a society in which to be emotional is to be unbalanced.
Psychiatry conspired in this, he claimed, with its pictures of the normal
personality which is never too sad, too angry or too excited.

Where Burston discusses his attitude to sex, Fromm himself was as likely
to refer to love, and said that the popularity of psychology in Western
culture was a reflection of the lack of love in human relationships. He
reasoned, sanely, that capacity for self-love and love of others are complementary
and not, as Freud had claimed, antithetical.

While occasionally capable of absurd extrapolation, Fromm does leave
a profound legacy, and Burston does him justice in reviving his predictions
of the consequences of materialistic society. Notably, his research on conformity,
obedience and the authoritarian character predicted the rise of fascism
in the 1930s. His distinction between being and having modes of human existence,
his concern at the manifestations of ‘automaton conformity’ (later called
the ‘marketing character’) and the lack of fulfilment of essential emotional
needs in a consumer age, plus his environmental awareness, are precursors
of much current awareness.

This profile of a flawed, inconsistent but profoundly advanced thinker
may help others to emulate Fromm’sown achievement, according to Burston,
of ‘living as well as can be expected in a mad and ailing world’.

A flavour of Fromm’s sanity, prophetic ability and empathy can be obtained
from the reissue of Fear of Freedom (Routledge, pp 272, £8.99, pbk).
Written during the Second World War as a response to the rise of Nazism,
it is a thoughtful analysis of man’s love-hate relationship with freedom.

Fromm argues that while man has an ability to accept self-determination,
he also has a strong propensity to mould himself into the role set out
for him by society, with a consequent, unconscious longing for totalitarian
control. The ultimate danger is the loss of self and its substitution by
an insecure, doubting, conformist, panic-stricken and approval-seeking pesudo-self.
This automaton product of modern society is ready to accept new authorities
offering security and relief from doubt, even if they be evil ones. Fromm’s
assessment remains relevant today – perhaps more so than ever.

Sheena Meredith is a science writer specialisin in health, psychology
and social issues.

Parents used to worry what their kids got up to on the streets. This
Christmas little Johnny could be led astray in your own living room. Succumb
to demands for a video game and you risk more than your sanity from teeth-grinding
electronic ditties. Before long your son could be talking like a demented
megalomaniac. And it will be a son rather than a daughter.

‘I can almost get to the world I can’t get to, because I need one more
bomb to open the Hudson River,’ says a six-year-old. This little boy was
convinced that whether people were good or evil depended on how they were
programmed.

Eugene Provenzo cautions that video games, dominated by the Japanese
giant Nintendo (which gave the world the video game Mutant Ninja Turtles),
are neither trivial nor morally neutral. He spent six months boldly going
where no professor of education – and few parents – had gone before: into
the world of Nintendo, where men are macho, girls are victims and foreigners
are enemies to be zapped and burnt.

Nintendo commands a staggering 23 per cent of the total toys market
in the US, claims at least 15 per cent of the British market, and aims to
have games in a million British homes by Christmas. They outsell all other
computer games by at least eight to one, according to the London toy store
Hamleys.

‘Video games are part of an invisible culture which receives little
attention from the adult world,’ says Provenzo. Yet evidence suggests that
they may promote aggression, become addictive or detract from schoolwork
and sociability.

His analysis is a curious mixture of shock-horror and reassurance. In
children’s fantasy worlds, confronting the evil ruler Wart or rescuing Princess
Zelda sound harmless enough. So, perhaps, do the B-movie plots. For example,
in Communist Mutants from Space, the Earth is attacked by swarms of Marxists
hatched on the planet Rooskie and filled with irradiated vodka.

But the violence is no longer just abstract blowing up of spaceships.
Children can fight a villain who ‘kills cops slowly, as a hobby’. Double
Dragon, for instance, boasts that it is ‘about violence, pure and simple’.
It begins with ‘thugs punching your girlfriend in the stomach and carrying
her away unconscious’.

In Rampage you are invited to ‘pick a monster and attack as many US
cities as you can stomach. Smash the buildings, eat the people, and wreck
any of the helicopters, tanks or cars that get in your way’. In Custer’s
Revenge (now withdrawn), the ‘prize’ for guiding the General was to watch
a sexual assault on a staked and bound (but still smiling) native Indian
woman.

The prime audience for all this is eight-to eleven-year-old boys. Not
surprisingly, girls play less. Female characters are passive or nonexistent.
Of 47 games studied by Provenzo, 14 featured kidnapped women, and 11 others
were devoted to sports presented as exclusively masculine.

Provenzo tries to offer balance, citing both benign and damning studies,
but this comes across as forced and contradictory. He has clearly made up
his mind: this is a two-dimensional world with few rewards for initiative
or independent thought, which allows no community, no teamwork and no conscientious
objectors. It’s each player for himself and may the most aggressive win.
Eat him, kick him, burn him, zap him.

His plea for someone to ‘reinvent the world of Nintendo, to make it
a world that does not cripple our capacity to act creatively’ is sobering.
Parents, be warned.

Sheena Meredith is a science writer who has reached level 6 of Starglider.

David Hodgson believes consciousness evolved as a useful function which
makes a difference in ways not explicable by purely physical laws. He is
antimechanistic and antideterministic (humans are not computers run by an
inevitable series of programmed commands), and abhors reductionism, which
asserts that all sciences are ultimately reducible to physics: sociology
becomes psychology becomes biology becomes chemistry becomes physics.

Mind Matters is a well argued and extremely important book, but it is
not for the nonintellectually inclined. This is unsurprising, since the
author is addressing the eternal mind-matter question (whether the brain
functions purely as a series of logical and physical processes, or whether
mental events and consciousness can causally influence physical events),
drawing on fields as diverse as philosophy and quantum mechanics.

The causal chain from biology to physics is, says Hodgson, the subject
and success of contemporary science. Yet it is palpably obvious (at least
to him and to me) that science has so far failed to reduce sociology to
psychology to biology. So the chain of causation of the mechanist argument
is fundamentally incomplete when considering the mental, rather than the
physical world. A riot on a housing estate traced back to submolecular events
is truly reductio ad absurdam. Hodgson contends this reduction will never,
and can never, be achieved.

As a biological scientist, I have little trouble with many of his arguments;
obviously humans, and probably many animals, have a consciousness that is
more than a mere by-product of subatomic events and neuronal firings. How
else to explain choice, sensation or volition? But physical scientists at
the extreme, such as those now working at the frontiers of artificial intelligence,
often disagree. According to Hodgson, their mechanism has formed the consensus
view that has largely shaped 19th and 20th-century science.

Hodgson is a judge of the supreme court of New South Wales, Australia,
who claims to have compiled much of the material for this work while commuting
by train to his chambers in Sydney. His scholarship is prodigious but his
opening prose is of the dry, pedantic, dense style preferred by academic
philosophers, but perhaps unfamiliar to scientists.

He ranges between assertions that stretch the concentration and those
which seem to be circular or state the obvious. Take, for example, the ‘disquotation’
theory of truth, according to which the statement ‘ravens are black’ is
true if and only if ravens are black. Well, quite.

Somehow he conveys the impression that, while scientists are sometimes
imprecise in the way they use language, but very precise in the conclusions
they draw from it, philosophers do the reverse. This may partly explain
the propensity of the two to misunderstand and irritate each other. Sceptical
scientists may prefer to start with section two, covering Hodgson’s arguments
against mechanism, while philosophers (and perhaps biologists and so on)
might leave to last the pithy but thorough section on quantum mechanics
(which comprises about a third of the book), although Hodgson may hate this
suggestion.

All this is a pity. Any knowledge should be amenable to a style which
requires less concentrated effort, but given the startling breadth of his
undertaking the difficulty is understandable. The likelihood that most people
will struggle with some parts of the book reflects the reason for his effort
– the discrepancy between attitudes to the world based on mechanism and
those based on the value of human consciousness and plausible reasoning.
For both sides, much is well explained once one acclimatises to the writing
style, and Hodgson can on occasion be both humorous and prone to insights
of startling clarity, particularly in dissecting the ultimate absurdities
of the mechanistic position.

Overall, the scoreboard reads nature 10, mechanists 0, but finally he
reverts to philosophy. His implications for morality, the soul, God and
the purpose of life, and his inferences about a universal consciousness,
may not be to everyone’s taste. But, if he is right that the prevailing
mores of mechanism are conducive to materialism and hostile to both spiritual
and moral values, such questions deserve sober contemplation.

Sheena Meredith is a science writer specialising in health, psychology
and social issues.

It takes a certain amount of courage for a psychoanalyst publicly to
accuse Freud of ‘moral cowardice’. To do so as the newly appointed projects
director of the Sigmund Freud Archives, and to choose as one’s medium the
New York Times, might be seen as a poor career move.

Unlike others who have niggled at the edges of Freudianism, Jeffrey
Moussaieff Masson was never likely to be perceived as a mere reformer. Ten
years after his outburst in the New York Times, the profession still vilifies
him as the man who launched a broadside attack on the very foundations of
psychoanalysis and its primogenitor.

His worst sin, perhaps, was to go public. One reason offered for his
abrupt dismissal from the Archives was that he had shown ‘poor judgement’
in expressing his opinions to a non-professional audience.

Final Analysis is the third volume of a trilogy which began with The
Assault on Truth, the follow-up to the New York Times interviews. According
to Masson, Freud’s unpublished documents and letters show that he deliberately
suppressed material supporting his early ‘seduction theory’ of the origins
of neurosis.

Initially, Freud had accepted as real his patients’ revelations of childhood
sexual abuse. Later, he abandoned seduction and turned instead to the Oedipal
complex and its notions of sexual fantasising by children. Instead of exposing
abuse, Freud began what Masson suggests has become a pervasive trend of
‘blaming the victim’.

Masson went on, in Against Therapy, to conclude that all forms of psychotherapy
are an abuse of power and trust. The prevalent doctrine that the victim
fashions his or her own torture does incalculable harm, he says, and may
create even greater miseries than those it is supposed to help.

In Final Analysis, he returns to the roots of his life as an analyst.
He describes his orthodox Freudian training, admission to ‘the men’s club’
of analysis and a brief flirtation with the inner circle of international
Freudians. His insider’s view is a sorry tale of progressive disillusionment,
as he dissects the ethics and personalities of those who uphold the Freudian
doctrine.

Final Analysis is ultimately about one man’s hindsight. Although built
upon the historical foundations of the other books, it could stand alone
as a disturbing account of contemporary analytic mores.

To numerous petty but revealing incidents, Masson adds more serious
charges. Analysts are sexist, crude and cruel; they break confidences, tell
lies and steal others’ research. Analysts boast of sexual relations with
patients and solicit funds from former clients. One analyst wooed and won
his son’s wife (and was then made chairman of an ethical committee). Another
continued to analyse a man with whose wife (also a patient) he was living.

Analysts assume omnipotent control of the interpretation of anything
which the vulnerable client does, says or thinks. Masson describes several
patients, past and contemporary, whose stories of childhood abuse were disbelieved
despite objective verification, with who knows what traumatic results. They
include Marilyn Monroe.

Freud himself emerges as a man with only one friend, who never hugged
or kissed his children, or discussed sexuality at home – that was ‘not for
the family’, said his daughter Anna.

Masson writes well and develops persuasive arguments. He is often intensely
personal and emerges as a complex and at times contradictory character:
part introspective lost soul looking for salvation in analysis, and part
outraged rebel deeply disappointed at what he finds there.

Are his criticisms justified, or is this one man’s revenge for his unfortunate
experiences? Masson is a brilliantly perceptive scholar and has had access
to documents (and people) which many analysts would do all but abandon their
complexes to see.

He is not the first to level the accusation that Freud ignored the reality
of sexual abuse of children. Swiss analyst Alice Miller has made the same
point, but attracts less hostility, perhaps because she is more respectful
of analysis generally. She is also less obviously dangerous than the reprobate
that Masson portrays – glamorous, clever, insistent and deft at turning
analysts’ tricks against themselves.

It is understandable that much of the controversy has attached to the
personality of Masson, his motivation and supposed psychological flaws.
It is not surprising, given his sharp eye for the techniques that therapists
adopt when threatened (‘Why do you ask?’ . . . ‘Do you not see the connection
with questions you asked as a child?’); to the analyst, all objections are
due to ignorance, lack of insight or ‘resistance’. It is ironic, given his
contention that psychologists trawl the unconscious to uncover the flaw
in the victim, while paying scant attention to the motives of the perpetrator.

But it is not forgiveable, because Masson raises important questions,
in particular of the likelihood of a woman who has been sexually abused
getting help by analysis.

‘People often accuse me of throwing the baby out with the bathwater,’
he said on television recently. ‘I have come to believe, reluctantly, that
there is no baby to throw out.’

Sheena Meredith is a science writer specialising in health, psychology
and social issues.