An Encomium for Jonathan Lear....and Other Books

I did not mean to leave so large a gap on here, having posted nothing since March. I have several times gestured wanly in the direction of my laptop and the piles of books which sit uneasily near it at all angles and with varying degrees of instability, and on at least two occasions sat down to draft posts (one of which is nearly done and will focus on 3 or 4 books on mentalization I have been wrestling with this year). But for reasons I will not bore you with, my energy this year has been reduced and taken up with other things, and thus every time I sat down to write something the desire vanished almost instantly--until now. 

Anyway, in no especial order, here are some thoughts on books that you might find beneficial, edifying, and even enjoyable to some degree. 

Jonathan Lear: 

I begin with Jonathan Lear, whose death in September occasioned grateful commentary as well as mourning and melancholia in the worlds of academic philosophy and clinical psychoanalysis. I read his Imagining the End: Mourning and Ethical Life in early 2023 and before that his Freud, published in the Routledge Philosophers Series. It is, I submit, the best philosophical treatment of Freud since Ricoeur's 1977 landmark book Freud and Philosophy: An Essay on Interpretation. 

Therapeutic Action: An Earnest Plea for Irony (2003) is a languid book that showcases Lear as a philosopher asking question after question in service of, and search for, an answer to his central question, which is: what is the therapeutic action of psychoanalytic treatment? Since this book was published more than two decades ago, there has been an increasing body of literature investigating this question and not just in psychoanalytic circles either. It remains a question that continues to fascinate me and will be the focus of some attention in my next book: what is the action of psychotherapy that provokes change by and in and with the patient? 

Lear's contribution to this is based on a wonderful and close re-reading not just of Freud but also of Lear's own mentor, Hans Loewald. He begins by reminding all of us that "therapeutic action does not describe a process, like getting a tattoo, which has a fixed end point. Once you've gotten a tattoo, you've got a tattoo; indeed once you've had an analysis, you've had an analysis, but therapeutic action goes on and on. Analysis has a termination: therapeutic action does not. Ideally one continues one's own process of therapeutic action as a lifetime project" (p.33). In this Lear very much reminds me of one of Adam Phillips's aphorisms that "the cure can only begin once the treatment has ended." 

Later on Lear briefly discusses termination in treatment, and the need to have that firmly in mind as a clinician from the moment treatment begins. (My first supervisor taught me that in introducing the question of goals, he often used the question "What would done look like?" as a way to get the new patient thinking about how their life would have to be changed for them to feel justified in letting treatment be done, be finished.) Lear compares this to good parenting, saying that both, to be healthy, have to consist in a progressive withdrawal because "psychoanalysis is aimed at promoting a person's freedom [and] part of the freedom is freedom from the need to keep coming to the analyst" (p.56), a key principle both Erich Fromm and D.W. Winnicott have previously articulated. 

Lear's compatability with the thought of other clinicians shows up in numerous points in the rest of the book. When he turns to a discussion about whether a psyche can be said to have a "core," he notes, in a vein that strikes me as very similar to Philip Bromberg's incredibly rich and important book, that "the core is the elementary capacity of the psyche to hold itself together" without resorting to a ruthless superego-induced attempt at purging or synthesizing (p.118).

He returns to this issue at the end of his third chapter, "Internalization," where he seems to nod clearly in the direction of mentalization (as Fonagy and Bateman have famously called it) or the creation of a "psychoanalytic mind" (as Fred Busch has called it) by saying that "while superego internalizations may well occur at various levels of sophistication and primitiveness, even in the termination phase of the analysis, one is also fostering the internalization of a capacity for analyzing these unconscious forms of internalization." In other words, if the analyst has been internalized as a good object (a "benign superego figure" in Lear's phrase) then ipso facto the patient will have also internalized the analyst's mentalizing capacity for use after the analysis has ended, and such a process "properly constitutes the therapeutic action of psychoanalysis" (p.133).

The next chapter, "Love as a Drive," contains some fascinating reflections that could too easily be dismissed as insider baseball, or as reviving old controversies nobody has cared about for decades, but in line with Bettelheim and Laplanche (on whose Freud and the Sexual see below) Lear insists that swapping out "instinct" for "drive" in translating Freud's German is misleading and unhelpful. Lear insists, with ample documentation from Freud, that this is a bigger issue for him than any of his biographers or scholars and clinicians after him have been willing to allow, and that it remains a great unsolved issue: the drives, especially of sex and death, have been rather quickly and quietly bundled off the stage so as to allow our genteel and ever so much more socially respectable conversations about developmental, relational, and now traumatic challenges to take over the entire show. 

In the context of this discussion, Lear calmly revisits the old polemics--from enemies and defenders of Freud alike--about the role the "sexual" drive occupies in Freud's writings, noting that both sides miss a crucial philosophical point that Lear explicates: his understanding is not focused on copulation and he denies that the sexual drive and the sexual object have a more intimate connection than they actually do. To this extent, then, Freud is not saying--Lear argues--that at our most sexual we are also at our most animalistic. Au contraire: human sexuality has so many features, expressions, and pecularities that it is here more than anywhere else that we are not like other animals. In Lear's by-now familiar refrain, "human sexuality makes us all candidates for irony" (p.156).

Additionally, drawing on Plato, Freud noted in 1924 ("The Resistances of Psycho-Analysis: SE 19: 213-224) that when psychoanalysis refers to sexuality, it "had far more resemblance to the all-inclusive and all-embracing love of Plato's Symposium." Lear the philosopher leaps on this and spends the rest of the chapter wondering aloud about why Freud, having said this, then spent the rest of his life running away from serious sustained reflection on love as a drive. In doing so, Lear charges, Freud fails to develop a crucial line of reflection that would have a direct bearing on therapeutic action. We cannot, Lear implies, understand efficacious therapeutic action except as being a process motivated by love (as Freud first conceded in that off-hand comment to Jung in a letter of December 1906). 

What might this love look like and how might it be a driver (if not the driver) of therapeutic action? What might a "loving" treatment result in? Lear suggests--but does not really develop the thought--at a couple of points that loving therapeutic action will result in the analysand's enlarged capacity for "greater psychological complexity" (p.170). (Once again there are clear echoes of this in others, including Phillips, Busch, Bion, and many others.) But the analyst does not impose this on the patient, or demand that he develop or "perform" complexity. The analyst merely provides a place to do so without getting pushy about it. Indeed, Lear defends fairly traditional understandings of neutrality at this point, saying that "the analyst's holding herself in this 'neutral' position is itself an act of love."

Towards the end of this chapter and nearing the end of the book, Lear asks a question that I have not seen anyone else do: is the fear Freud had about discussing a "love drive," a fear that virtually every clinician since him has replicated and never challenged, born out of a philosophically impoverished understanding of what "science" is and does? (Contemporary psychology's ignorance of the philosophy of science remains a constant source of serious vexation to me.) "One reason Freud's theory of love has been ignored is that it seems ridiculous to take seriously the idea that love is really a basic principle of nature. Surely we need to turn to natural scientists to find out what the basic principles of nature are. But what if we think about second nature?" (p.172). 

At this point Lear the philosopher emerges to the fore again, and he reminds us of our need to return to moral philosophy in Plato and especially Aristotle, but also in our own time the works of such as Bernard Williams and Alasdair MacIntyre. The development of our second, more properly human nature--our nature as philosophers, one might say, over and above our animal nature--cannot avoid questions of "character, personality, and psychological structure" (p.173). These can only have a chance of developing well if they do so in the context of relationships motivated by love that abjure moralizing while insisting on asking what Lear terms the ethical question: "How shall I live?" (174). 

Analysts, finally, cannot avoid such questions, either in themselves, or in their work with patients. In pursuing such questions with love they propel the therapy forward to successful action, defined as "structural change" understood not as a "once-and-for-all achievement" but instead a "perpetual undermining of rigidifying and thereby alienating pretenses" incapable of ironic reflection on oneself (p.177). 

For this rich and important book, and for his others, it is certain that Jonathan Lear's memory will remain a blessing.  

Memory of and Desire for more Bion?

We seem to be entering an era in which books about W.R. Bion, who died in 1979, are emerging at an ever increasing pace. I know for many of us he has been a difficult read, and our feelings about him are suitably ambivalent. His claim that each session should unfold with the clinician refraining from "memory and desire" has often been seen as a problematic counsel of perfection, but there are very solid reasons for striving to do this as I have learned the hard way more than once. In fact, I would say that mistakes I have made in a recent case are almost entirely because I failed to refrain from memory and desire and instead been too keen to demand the patient discuss certain things he is manifestly not ready to discuss. Pacing remains a crucial technique still in need of refinement.

Beyond his reflections on attention, memory, and desire, I have long found Bion enormously useful for his two essays on the psychotic mind. Using Bion, I built my chapter, "Men and Schizophrenia," which I was asked to write for the forthcoming Oxford Textbook of Men's Mental Health, part of the Oxford University Press imprint Textbooks in Psychiatry. The better known of Bion's essays, "Attacks on Linking" (1959), I now believe, is really the second part of, or a continuation of, his 1957 essay “Differentiation of the Psychotic from the Non-Psychotic Personalities.” The two really must be read together, and both are to be found in several places, but conveniently reprinted together in E.B. Spillius, ed., Melanie Klein Today: Developments in Theory and Practice, Vol. 1 (Routledge, 1988). 

But now we have new books on Bion, and in this case Donald Meltzer as well, with whom I was completely unfamiliar prior to reading Avner Bergstein, Bion and Meltzer's Expeditions into Unmapped Mental Life (Routledge, 2019). This is a very useful introduction to the two authors in the title, rendering Bion especially much more accessible than he was himself in some of his writings. The chapters on obsessionality, as well as on the psychotic personality, render Bion's thinking on both topics lucid and accessible without any dilution of their explanatory power. 

The final chapter, "The Ineffable," looks briefly at Bion's familiarity with both Christian and Jewish mysticism before arguing that "Bion seems to present us with non-religious mysticism": p.172), a judgment I would agree with. Part of what Bion appears to have taken from both of these mystical traditions is captured in his famously misunderstood phrase about refraining from memory and desire: "The psychoanalytic attitude, much like the mystical one, is a deliberate conscious act of discipline which depends on an active suspension of memory and desire" in order to exercise an "act of faith" that "truth exists" and can be discovered in the clinical encounter (p.166). 

Psychosis and Schizophrenia: 

While on the topic of psychosis, I must mention the following books which I have found not merely edifying but actively encouraging in what is so often a bleak landscape of poor and inadequate treatment and resources for psychotic patients: David Garfield and Daniel Mackler, eds., Beyond Medication: Therapeutic Engagement and the Recovery from Psychosis offers a number of essays from scholars and clinicians around the world looking at a range of options, while Therapeutic Communities for Psychosis, John Gale et al., eds., is looking at non-medical, quasi-institutional, but voluntary and community-based outpatient options for residence and care. 

Perhaps the best known (relatively speaking) example of this are the Soteria houses, which have fascinated me for some time. Only in September did I get around to finally reading Soteria: Through Madness to Deliverance. I find that I read all such books with a mixture of awe and respect for what was attempted but also some regret and amazement at how poorly supported such initiatives seem to be--and also with a wish that we might continue to build such places for there is a long track record and very impressive evidence base that they work. (See below for the evidence.)

I have a number of must-read books I recommend to other clinicians when they consult with me about working with psychotic and schizophrenic patients, starting with Michael Garrett and Andrew Lotterman's books. To that I will now insist on adding a third which, despite being the oldest of the three, is still incredibly relevant, timely, and useful: Michael Robbins, Experiences of Schizophrenia: An Integration of the Personal, Scientific, and Therapeutic.

Finally for books in this category we come to Courtenay Harding, Recovery from Schizophrenia: Evidence, History, and Hope. Please, please, please buy this book! I get nothing for saying that, and have never met the author, but I will hope for some small satisfaction that by encouraging a wide reading of this book then perhaps the long-standing, deceptive, indolent, and destructive narrative about schizophrenia that I first encountered in 1991 as an undergraduate, and which seems still to be propagated today to the detriment of many, may eventually die an overdue death. That narrative, of course, is the one that tells patients and their families that schizophrenia is a lifelong sentence of suffering for which there is no cure and which can, at best, be only partially ameliorated by neuroleptic medications (with notorious, intolerable, and sometimes irreversible side-effects). The fatalism and hopelessness in this narrative is just crushing to patients and their families, but it is infuriating to those of us who know that with the right treatment patients can and do get better!

That is not just an anecdotal claim based on a tiny, non-representative sample of one clinician, but has been backed up by empirical studies of hundreds of patients in different countries going back 75 years. It is to Harding's everylasting credit that she has tracked down patient records and long-forgotten studies of schizophrenic patients, including some of the most rigorous longitudinal studies we have of any psychiatric population, and published them in one place. In rendering so important a service to scholarship and patients alike, she has allowed us to see that, with multi-modal treatment, many patients have recovered. That is, three-quarters of a century ago now we already knew that merely medicating a patient is far from sufficient. Medication might be useful, but so too is intensive psychotherapy (see, e.g., Frieda Fromm-Reichmann's practice, or Harry Stack Sullivan) combined with vocational counseling, social supports, access to supportive, low-cost, outpatient housing, and a team of people (psychiatrists, nurses, therapists, social workers, dieticians, and others); but who today is willing to fund such treatments? 

How to Listen:

Salman Akhtar's short book, Psychoanalytic Listening: Methods, Limits, and Innovations is a wonderful addition to the literature, filling a gap that goes back at least thirty years. 

My debts to, gratitude and affection for, and frequent quotation of Nina Coltart are no secret. I have long maintained that nobody, in my experience, has surpassed her cogent description of therapeutic listening as a process of: 

sharply focusing, and scanning; complex involvement in feelings, and cool observation of them; close attention to the patient, and close attention to ourselves; distinguishing our own true feelings from subtle projections into us; communicating insight clearly, yet not imposing it; drawing constantly on resources of knowledge, yet being ready to know nothing for long periods; willing the best for our patients and ourselves, yet abandoning memory and desire; a kind of tolerant steadiness which holds us while we make innumerable, minute moral decisions, yet steering clear of being judgmental (Slouching Toward Bethlehem, 119). 

A little later in that unforgettable book she returns to all that is going on when the clinician is listening therapeutically:  

the need for consistent scanning and judging, not only of what the other person says, but of what we are about to say, and are saying; and with this scanning, the need for rapid continuous thinking, which may be only half-conscious; the need for repeated moral and technical decision-making; and yet if it is to convey truth, and more importantly, authenticity, in our style of speech we must also master intuitive, unlaboured spontaneity. This is an extremely demanding and complex requirement...[and]...it depends, for success...on...the combination of unselfconscious self-forgetfulness with deep self-confidence (Ibid., 145). 

Since reading this description of listening more than 30 years ago, I have found nobody who unpacked these dense descriptions until Akhtar's book, which is a gem. I now regard it as required reading for my students. 

It is not especially long, and it is written in clear, cogent, accessible prose with good but not overwhelming use of clinical illustrations. In addition, there is a commendable modesty in the author, who freely and frequently confesses his own errors about listening in the wrong way, or tolerating silence when speech was called for, or vice versa. He also notes, with admirable restraint, the difficult circumstances under which listening might and even should be refused--not least when outside of clinical contexts, when psychotherapeutic listening could be used manipulatively or destructively (he gives examples of doing this early in his marriage and watching how frustrating his family members found his doing so). 

In keeping with Coltart, he writes appreciatively on types of and purposes for silence, and he recognizes the degree of "faith" (also a concept Coltart explored in a non-theistic way) required to sit and wait, confident that if something is important, it will show up, and not once but repeatedly. Finally, he has some throwaway comments on several topics, including supervision ("supervision is more than teaching and less than treatment" he quotes A.J. Solnit's 1970 article in the International Journal of Psychoanalysis as saying). 

Laplanche, Freud and the Sexual. 

I have not read Laplanche nearly enough, and so on my last research trip to the library of the Cincinatti Psychoanalytic Institute, with less than an hour before I was to leave, I pulled all his books off the shelf, and slightly manically tore through them to decide which I really needed to read in a ranked order of urgency or importance. Apparently (this was 18 months ago now at least) I decided it was going to be Freud and the Sexual at the top of my list. Having just finished it, I must say frankly that I'm not sure what I saw in it. The book is a collection of articles on several topics, many of which feel quite like unfinished first drafts; much space is given to arcane arguments with translators of Freud from German into French and English; and when Laplanche finally turns to the topic of the sexual, his main insight seems to be confined to insisting that we should stop fighting over whether "instinct" or "drive" is the best translation for Freud's Urtriebe and recognize the utility of both terms in English.

On Buddhism and Philosophy:

Todd McGowan, Embracing Alienation: Why We Shouldn't Try to Find Ourselves is a new book that I read in January as presidential transition was taking place and a sense of alienation was mounting. 

I came upon McGowan close to a decade ago now in reading his book on the death drive. Enjoying What We Don't Have is one of the richest and most rewarding reflections on the death drive I have read in English. 

His new book on alienation makes the simple point in several places that by abandoning quests to find ourselves, or our "true" selves, we stop wasting time and energy that could be better put to projects of solidarity with each other in challenging the myriad instances of injustice in the world today. Embracing our alienation, in other words, has an "emancipatory quality" (p.7). In this way, then, McGowan manages to avoid the problem of a paralyzing despair at being alienated, and to avoid the temptation to fantasize about some prelapsarian paradise from which we are estranged but which we should struggle to find out way back to. There is no such paradise, McGowan says, and a good thing too.

The "alien" that we need to embrace is not some vague existential angst or a sense of estrangement we have from scrolling on social media and reading about all the horrors of strangers being snatched off the streets by fifth-rate opéra bouffe thugs in masks. The alien, rather, is within: it is our unconscious mind. As Freud first argued, and McGowan heartily agrees, each of us is alienated from ourselves. Our minds are divided and we live in a state of perpetual psychic alienation. If we stop fixating on "solving" this problem, and instead learn to forget our alienated selves, we will not only have more time and energy to work toward a better world, but we will also discover freedom and even some measure of happiness by focusing on helping others instead of chasing after our own "identity." 

And that word, in McGowan's hands, is clearly (and rightly) to be regarded as a bogus, deceptive, self-indulgent idol of our time, perhaps more than ever thanks in part to social media. Being preoccupied with finding and then defending our true "identity," McGowan shows through a close reading of Hegel, is actually a form of slavery we must emancipate ourselves from by learning self-forgetfulness. In doing so, he says in conclusion, "becoming reconciled to one's alienation is not a way of accepting oppression as inevitable" (p.148). McGowan's welcome book, then, is not a counsel of despair or an example of pietism or quietism, but instead a call for a new kind of politics. 

McGowan's theme of forgetting ourselves is also treated in several of Mark Epstein's books, which I have read over the past year, but these deserve a post of their own, so before Christmas I hope to offer some thoughts on Advice Not Given: A Guide to Getting Over Yourself and at least two other of his books. I have been propelled into an unexpected exploration of Buddhism and psychotherapy because of Nina Coltart's own immersion in that tradition as seen in her wonderful concept of "bare attention," an ascetical discipline (so I would say) we must all cultivate moment by moment and hour by hour with each patient. More on that anon. 

Some Thoughts on the Death Drive

 I was moderately heartened to see that as the centenary of the publication, in 1920, of Freud's most neglected and professionally disliked book, Beyond the Pleasure Principle, approached, we saw a renewed interest in its most controversial idea: the death drive. The sputtering bewilderment proffered by psychoanalysts and others in the face of this theory finally seemed, after a century, to be giving way to some actual substantial engagement with Freud's text--albeit mostly by non-clinicians. The fact that anyone, clinician or otherwise, reacted so strongly to this theory has long been itself bewildering to me for evidence of a human propensity towards repetitive self-destruction (and the unconscious pleasure, or at least purpose served by such destruction) seems constantly on offer in consulting rooms around the world, and in so many other places.   

I do concede the point that part of the reaction may have been to Freud's suggestion that the death-drive might in fact be an actual "biological" drive. Unlike some, I think you can leave that out of Freud's theory without fatally (!) weakening its overall claims. 

The fact that discussions of Freud's notion of a death drive, which were few and far between even while Freud was alive, and were often politely ignored by much if not most of the psychoanalytic establishment for decades after his death, have taken off nearly 80 years after his death puts me in mind of Adam Phillips' argument from some time ago that the best time to re-examine Freud is precisely now, when nobody thinks much of him anymore and there are fewer and fewer professional establishments rushing to "protect" him from being critically scrutinized, or rushing to enforce some orthodox line or other:

This is certainly a good time for psychoanalysis: because it is so widely discredited, because there is no prestige, or glamour, or money in it, only those who are really interested will go into it. And now that Freud’s words are so casually dismissed, a better, more eloquent case needs to be made for the value of his writing ("After Strachey," London Review of Books vol. 29 no. 19, 4 October 2007, p.36) 

So scrutiny is returning to several parts of Freud's project, but noticeably his late-period "cultural works." Thus, earlier this year, as I discussed here in some detail, there was Benjamin Fong's fascinating new book Death and Mastery: Psychoanalytic Drive Theory and the Subject of Late Capitalism.

And before him, in 2013, in one of the most richly provocative books I've read in a long time, there was Todd McGowan's Enjoying What We Don't Have: The Political Project of Psychoanalysis, which I discussed in detail in three parts when I was attempting to demonstrate that much psychoanalytic thinking should be welcomed by theologically minded Christians, especially Catholics. 

In addition to Fong and McGowan, nobody has written as much about the death drive as Todd Dufresne, whose works I have enjoyed and through whom I discovered the wonderful work of his Doktorvater, the late Paul Roazen.

Roazen's Meeting Freud's Family is a thoroughly charming book. His Freud and His Followers was a groundbreaking and controversial work which fills in very important gaps in the historiography. And I have found his Encountering Freud: The Politics and Histories of Psychoanalysis useful in surveying what religious and theological responses were made over the history of psychoanalysis to the 1990s.

Dufresne's work on the death drive is found first in his Tales from the Freudian Crypt: The Death Drive in Text and Context and then, more recently and succinctly, in his introductory essay to the Broadview translation of Beyond the Pleasure Principle. It is the Broadview translation that I require of my students when I assign this text in classes. 

To my enormous surprise and puzzlement, neither of these books shows up anywhere in one of the heftiest recent books devoted to the topic, Repetition, the Compulsion to Repeat, and the Death Drive: An Examination of Freud's Doctrines, co-authored by M.A. Holowchak (a philosopher) and Michael Lavin (a clinician) (Lexington Books, 2018, viii + 163pp.). It is a very useful, crisply written, and largely clearly argued work.

 There are several virtues to this book, including its relative brevity, and the arrangement of each chapter, which aids in reading. More broadly the book will be useful if it is received as the history it is, tracing out the trajectories of the concepts of repetition, compulsive behavior and thinking, and the death drive across the Freudian canon. As such it goes back to 1895 and Studies in Hysteria, co-authored by Freud and Breur, and then forward past Beyond the Pleasure Principle to works in the last period of Freud's life, often referred to as his "cultural" or "meta-psychological" period. Along the way it also notes such "watershed" publications as Freud's 1914 paper, "Remembering, Repeating, and Working Through" as well as his essay on anxiety from 1932, by which point he seems to have moved from the very tentative and speculative writing of Beyond the Pleasure Principle 

Further virtues include the fact that this is neither an attack on Freud--though it advances important, serious, and considered criticisms of his theory--nor a glorification of him enforcing a certain "orthodox" line. It agrees with Freud in places, argues with him in others, and gives evidence in still others for where Freud may have been wrong, or subsequent research does not bear out his often highly tentative and speculative claims in Beyond the Pleasure Principle. 

On the latter score, it notes problems with Freud's attempting to find phylogenetic evidence for a death drive and compulsive repetition. The question remains: can his theory be rescued if the evidence he claimed to find for it in the biological sciences does not exist, or can be explained by other theories? In answer to that question the authors diverge somewhat, and candidly acknowledge this in the conclusion. For my part, I see few problems in separating out and sustaining most of the theory from insufficient "natural" evidence, and again the authors seem--albeit somewhat uneasily--inclined to agree, especially in a clinical setting, noting that clinicians rarely take their theory pure and whole.

All that having been said, the drive to destroy, including the self, is often a repetitive one, and we are faced with the question of why that is when such a drive brings terrible anguish, suffering, and consequences to the self and to others. Part of the answer may lie in the fact that the drive for pleasure and the death drive are not always operating in mutual and exclusive opposition. As the authors admit flatly, "eros and the death drives do not function independently of each other" (85). In fact, one of Freud's key insights here and in other areas was the admixture of experiences and emotions. In this light, one can, as he himself wrote, find in destructive repetitions the "pleasure of mastery or revenge," including against childhood traumas, enemies, or frustrations.

Such an understanding also goes some way towards accounting for what is perhaps Freud's clearest clinical evidence for compulsive repetitions and self-destructive behaviors: the regularly observed fact that patients get bogged down in treatment, and come actively to undermine the very thing that may help them get better through attacks on the therapist and the therapeutic alliance. In this regard, as D.W. Winnicott put it, attacks on a therapeutic analysis may be understood to reflect the fact that for many of us, "health is much more difficult to deal with than disease." In our perverse ways, we like being sick, we like being punished, and though we do not always admit this to ourselves consciously, our unconscious repetitions-in-action bear this out.

By chapter 6, it seems the authors' patience is wearing a wee bit thin, as they sum up the "view in the secondary literature...that the death drive creates more problems than it solves" (98). I think this overstates the case and the authors themselves have not provided absolutely conclusive evidence to support this judgment. Moreover, they fear that Freud's insistence on the death drive runs the "risk of throwing his metapsychology into a state of chaos" (108).

Here is precisely the point where an engagement with Todd Dufresne, mentioned above, would have been crucial. Dufresne's argument is that BTPP is a deliberate act of sabotage on Freud's part, undermining his theories of sexuality and much else. As Dufresne puts it, "metapsychology subverts psychoanalysis," whether "playfully or otherwise," inflicting from a position within the movement a "trauma" on psychoanalysis. 

Dufresne does not elaborate much on why he thinks Freud may have done this, but I would speculate--following Adam Phillips--that this may have been done precisely to keep the analytic movement from becoming a closed, rigid ideology with enforced orthodoxies and a putative epistemological omniscience. Already there were clear signs of this (some of them demanded, or at least supplied, by Freud himself!) before the great man's death in England in 1939. Alas, they seem only to have gotten worse after his death. If psychoanalytic institutes today complain (as they have for years) of their declining fate, much of the responsibility for that is entirely their own for they have too long been hidebound places demanding loyalty to certain orthodoxies that Freud himself was more open to questioning. (One of the virtues of Roazen's scholarship is the documentation it supplies whereby Freud was often rather free-wheeling in his own clinical practice, but often much more strict in what he recommended in writing.) 

Freud was certainly aware of the dangers in this direction (and had himself on occasion contributed to it), especially if analysis remained in the hands of psychiatrists or other medical doctors alone. He was forced to address this problem in 1926 in The Question of Lay Analysis, a work I would also see (as, again, Adam Phillips has) as pushing back against analysis becoming a closed system with a closed caste of expert "professionals," especially if those medical professionals were Americans, of whom he thought very little and whom he regarded with enormous skepticism. Such a resistance reflects Freud's own compulsive concerns in some ways, for he was clearly desperate for respect and acceptance for most of his life, but late in life seems to have come to regard such desires with disdain and begun to resist them and call for others to do likewise.

In the end, Holowchak and Lavin conclude there is not a lot that can be salvaged from Freud's death drive, but they do themselves a great service by noting that many other prominent analysts, including Klein, Lacan and Laplanche, disagree with them. Laplanche, it seems to me, takes the most sensible route forward by arguing that if the theory is stripped of biological concepts, if it is seen as exclusively human, and if it is seen as operating not independently but bound up with other drives and desires, it can be rescued. This remains my own view (for whatever that's worth). I will say more about it in later reviews of some of the other books on the death drive that have been helpfully published in the last 3 or 4 years.