Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis

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EDwARD DOLNICK: Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis. Simon & Schuster, New York, 1998, 348 pp., $25.00, ISBN 0-684-82497-3.

Censoriousness is not an attractive quality, even though it can have short-term advantages, including gaining readers and converts. Edward Dolnick, a professional journalist, has written an excellent book about some of the key missteps, mainly in the last half-century, which led a large group of psychoanalytic writers to blame patients and bash families. Paradoxically, Dolnick's own moralism leads him to start off by being so harsh about Freud that I suspect many might be put off by the first section of his book. Dolnick does not mention the existence of Freud's spittoon, but there is not much else unattractive that he overlooks.

The book has so many merits that it is unfortunate that Dolnick could not restrain himself from some easy potshots. We are not living in an era when, at least in America, psychoanalysts are wielding major psychiatric power. As Dolnick points out, biological psychiatry is now clearly in the saddle. Lord Acton was correct: power corrupts, and absolute power tends to corrupt absolutely. While Acton's aphorism helps explain what went wrong among analysts, Dolnick does not seem adequately aware of the need also to challenge some of the dangers inherent in present-day psychiatric thinking.

Instead Dolnick does a trenchant job of showing, especially in the areas of schizophrenia and autism, how analysts missed the boat in the period after World War 11. 1 do find it unfortunate how Dolnick has chosen to single out for blaming some of the pioneers (if not heroes) of the treatment of schizophrenia. I am more familiar with the writings of Paul Federn (whom Dolnick skips) than those of Frieda Fromm-Reichmann, but it seems to me unfair to reduce her to the promotion of the concept of "schizophrenogenic" motherhood. She died in 1957, and as late as the mid- 1960s Donald Winnicott was denying that schizophrenia was organic or biochemical rather than an "environmental failure." Dolnick does not seem to realize that he has been trashing some of the most enlightened figures in twentieth-century psychiatry-Harry Stack Sullivan, Harold Searles, Gregory Bateson, among others, even Hilde Bruch.

By chapter 8, "Ice Picks and Electroshocks," Dolnick does discuss the alternative school that started from reasoning about the brain. …