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suggested a systematic way for testing rival psychoanalytic hypotheses - by
predicting clinical consequences and then getting blind raters to judge
the course of each therapy.
Why does it matter whether psychoanalysis is an art instead of a sci–
ence, the reader may ask. Hale documents that such a designation, in
turn, determined psychoanalysis' place within the larger culture. By the
early 1960s, psychoanalysis was attacked as anti-feminist, elitist, and unable
to deliver mental health care to communities and clinics; deemed an
"unproven luxury" for the well-to-do. Also, psychoanalysts were losing
their medical identity. Moreover, by 1980, psychoanalytic explanations
of neuroses no longer were accepted as insurance-reimbursable diagnoses.
Dynamic therapies, combining various types of care, and which were
more cost-effective, became the dominant modes of treatment.
While Griinbaum and others were producing ever-more sophisticated
arguments aimed to discredit what the Europeans call "American ego
psychology," other theoretical conceptions had moved to the center.
For instance, Heinz Kohut, a member of the Chicago Psychoanalytic
Institute, who also had become dissatisfied with classical modes of treat–
ment, held that psychoanalysis was not a science of "causes," but of
"empathic-introspective immersion of the observer into the inner life of
man." His self-psychology was close to Kleinian object relations theory
insofar as parental behavior is subjectively perceived and experienced by
the infant. Otto Kernberg, who was trained in Chile (where Klein's and
Lacan's influence was strong), attributed narcissism, primarily, to
borderline cases - that is, to patients suffering from chronic anxiety,
obsessive-compulsive symptoms, dissociations, hypochondria, and more.
These conceptualizations and accompanying therapies infused
psychoanalysis with new life.
Yet ironically, the proliferation and nearly universal acceptance of
psychoanalytic ideas have themselves contributed to the decline of its
practice. As Hale states, the current crisis is "in part the product of too
great, too embarrassing a success," and of the therapeutic optimism,
especially from the 1940s to the 1960s. He has traced its complex
trajectory, its innate dynamism, and its internal contradictions, most
brilliantly. And he is to be commended for avoiding the now-common
endless polemics and for drawing on the most meticulous references and
wide-ranging data he culled from many disciplines. No wonder it took
twenty-four years to complete this book.
EDITH KURZWEIL
