Freud Surgery and the Surgeons

Stepansky (managing director of the Analytic Press and member of the Section of Psychiatric History, Cornell U.) charts the rise and fall of Freud's view of psychoanalysis as analogous to a surgical procedure, with the psychoanalyst cast in the role of a surgical operator. He draws the reader into the world of 19th-century "heroic surgery" and examines the relinquishment of medicosurgical models in the years following World War I, thereby bringing fresh historical insight to a number of topics including the psychoanalytic contribution to the understanding of war neuroses, the controversy surrounding lay analysis, and the medicosurgical experiences of S<'a>ndor Ferenczi, Ernest Jones, Karl Abraham, and Freud himself.
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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, with the psychoanalyst cast in the role of a surgical operator. 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 through his fascinating relationships with Theodor Billroth, Carl Koller, Ernst von Fleischl-Marxow, Josef Breuer, and Wilhelm Fliess.

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, including the psychoanalytic contribution to the understanding of war neuroses, the controversy surrounding lay analysis, and the medicosurgical experiences, both as physicians and as patients, of Sndor Ferenczi, Ernest Jones, and Karl Abraham. 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.

In considering the fate of medicosurgical analogizing in psychiatry and psychoanalysis in the years following Freud's death, Stepansky turns to topics seldom mentioned in the literature: the psychoanalytic deconstruction of organic pathology in the 1930s and 1940s; Karl Menninger's elaboration of a transmedical model ofpsychoanalysis in the 1940s and 1950s; and, most intriguingly, the relationships among psychiatry, psychoanalysis, and surgery in the era of shock treatment and lobotomy. These 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, which brings historical insight to bear on a singularly timely issue: the differences and commonalities among healers with different professional backgrounds and specialties. 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.