Book Reviews

A Beam of Intense Darkness:Wilfred Bions Legacy to Psychoanalysis by James Grotstein. Published by Karnac, London, 2007; 382 pp; 29.99 paperback.
This is an avowedly idiosyncratic work that refuses to dumb down Bions ideas or regularize them to suit established preconceptions. It is steeped in the authors long apprenticeship to Bion and his works, which began he tells us in the 1970s when, as an analysand of Bions, he rst became enthralled by his ideas. In line with this seminal identication, Grotstein takes fast hold of Bions Platonic emphasis on becoming and invites us to participate in his current phase of digestion of Bion as a life-changing phenomenon. From this vertex his book could perhaps have been subtitled Wilfred Bions legacy to an analysand. It is not intended to be a summary of the Bionic canon but, rather, a model for immersion in Bionic turbulence. Much of its vitality derives from the authors personal wrestling with the concepts, and he states frankly that, even after years of study, the conclusions presented here are still tentative in my mind:
This is one of the rewards and joys of dreaming that is, absorbing and transforming Bions works and maintaining the personal faith, not that I would understand Bion and his works, but that I would become as much of the wisdom, O, of his works as my mind can possibly progressively accommodate. (p. 329)

When confronted by a thinker of Bions magnitude, who disturbs the universe of our existing mentality, we are invited into regions where most of us absolutely cannot follow (Meltzer 1997, p. 63). We cannot develop his ideas, but we can develop ourselves through internal review and consolidation in response to them. Meltzer advised:
It seemed to me that the way to enjoy Bion was very much what he himself had advised: just read it; dont try to understand it, dont try to gure it out; just read it, enjoy it and if you are lucky you will be inspired by it. (Meltzer 1997, p. 65)

Grotsteins book makes Bion very real in the sense that we experience the impact of Bions ideas on his thinking: that is, not just his dogma or allegiance but his inner being and becoming, a process he calls incarnation of godhead or godhood which, in traditional Kleinian terms, would surely be introjection of the object in its dual capacity to both feed the internal baby and advance its capacity for mental digestion. Or, in traditional poetic terms, this is what is meant by inspiration by the Muse. Grotstein in fact
The authors Journal compilation 2008 BAP and Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.

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draws attention to this comparison (p. 77) and would, I am sure, accept the appellation of being one who has been inspired by Bion, both by his work and his person. In content, the book comprises a near-comprehensive survey of most of Bions major works and concepts, leaving aside the writings after Attention and Interpretation (Bion 1970) for reasons of space. It is a long book and owing to its structure continually returning to the core thesis of Bions vision from the perspective of most of his major works and theories has much cross-referencing and repetition. The author apologizes for this; all the same I think that if I were a psychoanalyst I would appreciate more space being devoted to the clinical applications whose message Grotstein clearly values (there are some clinical vignettes) and less to experiments in terminology, such as transidentication (p. 182). The qualities of tone and atmospherics to which he rightly draws attention here are ordinary features of the transferencecountertransference. It seems to me that new names should be reserved for new phenomena, and these can emerge only from clinical material. Possibly a distinction between practice and theory would help here. For example, if it were true that before Bion psychoanalysis was entirely a left-hemisphere technique (p. 82), it would have died out long ago; in practice, the method has always been intuitive. And while it may be the case that some Kleinians tend to talk as though psychoanalysis were a type of one-upmanship game of moral superiority (p. 175), this is certainly not in the spirit of Mrs Klein. Indeed it was not Bion who rst learned to see psychoanalytic meaning in the non-verbal as Grotstein suggests (p. 44), but Mrs Klein through her work with children and their phantasies expressed in play. Grotsteins truth drive (p. 52) is itself a reformulation of Kleins epistemophilic instinct rather than a substantially different phenomenon. Having said this, the book is a treasure-trove of interesting foci for discussion. One such point would be Grotsteins idea that projections can only be into an image of the object/mother/analyst (p. 181) and whether this takes due account of the suprasensuous nature of psychic reality. Another point might be the nature of the origin of mental problems which, in Grotsteins account of what Bion said to him, is ineffable so cannot be explained by environmental traumas (p. 55) and how this squares with the slightly Winnicottian bent that equates the external world with shared reality (p. 207), which in turn brings up the fundamental question: what is psychoanalysis? Grotstein frequently mentions that Bion in analytic practice was very Kleinian. He feels however that perhaps Mrs Klein did not sufciently analyse Bions war trauma from a time when the external world itself had gone mad. Yet one might say that, according to Bions denition of O, this was not her job, and might have deected her attention from her own beam of darkness. I would also suggest that Bions O itself is not a discovery as Grotstein interprets it (p. 114), just a formulation a shorthand for a variety of synonyms: origin, object, godhead, the unknown, inef-

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fable, etc. This leads to another interesting topic the roots of the religious mystical language that Grotstein adopts and adapts from Bions later years and that, far from being unsaturated like Bions mathematical language, comes trailing clouds of glory from time immemorial. The term transcendence, for example, has a long history as Grotstein points out (p. 129), as well as having current Jungian resonance, which gives it a validity that invented words cannot easily assume. On the other hand, there is a danger of the formulation of an evolved individual who is at one with O (p. 3) taking on a tinge of smugness. Grotstein insists (correctly in my view) that it is impossible to maintain an apartheid between Bions earlier and his later thinking; and Meltzer also has noted how Bion, unlike Freud, never changed his vision, only his metaphors. I have to say that, in terms of Bions model of the mind and its place in the organic evolution of psychoanalysis as a whole, none of the accounts of the past 30 years seem to me to add substantially to Meltzers clearly written Kleinian Development (Meltzer 1978). In that book and in Studies in Extended Metapsychology (Meltzer 1986), with its focus on the clinical application of Bions ideas, Meltzer shows how the linked emotions of LHK transform the drives; how thinking makes the mind, rather than vice versa, and is done by objects not by the self, hence the need for a theological model such as Kleins; how negativity supersedes the death-instinct as the enemy of mental development; how catastrophic change enhances the achievement of the depressive position; and how psychoanalysis is beginning to acknowledge its cultural roots. All this is also in Grotstein, though not necessarily using the same terminology. In the past two decades, however, much of the Bionic background has been lled in from the elds of philosophy, maths and science, and Grotstein is clearly familiar with these sources, just as he is deeply versed in Bions own works from the binocular perspectives of both indefatigable scholarship and personal transcendence that is, transcendence of his previous self or, in ordinary Kleinian terms, development. What gives this book its unique value is the unusual warmth and generosity of the authors personal portrait of Bion as analyst, which is inextricably bound up with his self-portrait on the couch-side of the transference caesura. Of his four analysts from different schools, we have the impression that Bion infuses them all with life. As the author puts it: With Bion, my pilgrimage was to acknowledge, with reverence and awe, the majesty and enormity of my mind and to recognise how cut-off I was from it (p. 39). Grotstein goes to the heart of the distinction between subjective and solipsistic. In lieu of many clinical examples he presents primarily Bions impact on his own mind, in what is essentially a type of autobiography, a paean to Bion-as-object and internalized supporter of his truth drive. Bions key exhortations were to dream the session, to suffer the meaning, and to listen to yourself listening to me (p. 30). And certainly in this book we get a most vivid picture of the analystanalysand in faithful pursuit of the

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evolutionary pilgrimage towards knowledge on which his mentor set him years ago.

Meg Harris Williams

[www.artlit.info]

References
Bion, W.R. (1970) Attention and Interpretation. London: Tavistock. Meltzer, D. (1978) The Kleinian Development. Strath Tay: Clunie Press [reprinted Harris Meltzer Trust, 2008]. Meltzer, D. (1986) Studies in Extended Metapsychology. Strath Tay: Clunie Press. Meltzer, D. (1997) The evolution of object relations. British Journal of Psychotherapy 14(1): 606.

Intimate Transformations: Babies With Their Families edited by Jeanne Magagna et al. Published by Karnac, London, 2005; 242 pp; 19.99 paperback.
This is an exciting, thought-provoking and ground-breaking book which takes a fresh look at aspects of Infant Observation. It is new in that it concentrates on the new-born in the family, looking at the dynamics that arise there, particularly the pressures of the older sibling, and how these may affect the personality development of the new baby. It is also new in that the book is the product of a seminar group that was unable to meet physically but worked by using a pioneering form of video-link, with discussions supplemented by the affective learning model an approach which looks at the dynamics of the group to support and enhance insight in the work. The book is written in three sections: rst, case-study papers written by the members of this remarkable seminar group on aspects of their own observations; then a section on the applications of infant observation in various institutional settings, describing the way infant observation can enhance skills in adult psychotherapeutic work. The last section describes the videolink technology used, and its impact on both the work and on the students themselves through the particular approach of the affective learning model. The students were based on two sites in different states of the USA and were led from the Tavistock Clinic in London by Jeanne Magagna, an experienced and thoughtful clinician, writer and seminar leader in the eld who herself had studied for three years with Esther Bick. Jeanne Magagna co-edits the book with the seminar members and also contributes a fascinating paper on the teaching of infant observation as well as co-writing two case studies. That such work should emanate from three sites thousands of miles apart is a tribute to the participants stamina and sensitivity in what one imagines must have been fairly daunting circumstances.

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Each case study in the rst section is used to illustrate a particular aspect of psychoanalytic theory so that we see this not in the abstract, but in the living baby bringing its own innate capacities to bear on its immediate environment and being itself dialectically formed by this environment. There are chapters on the origins of self-esteem; the role of the mother in the growth of the childs ability to bear emotional pain; the experience of self and others; oedipal anxieties in the new family constellation; and the role of the observer. And although each of the case studies in the book has a different emphasis and concentrates on different aspects of personality development, they all share the focus of examining the baby in the context of the family, in particular in the impact of the elder child. These are painful descriptions not just of the frequent states of intense rage and despair of the elder sibling but of the huge impact this has on the personality development of the new baby. This is an area of infant study, only recently opened up by Juliet Mitchell (2003) and Prophecy Coles (2003) in their books on sibling development. The connection between early infantile experience and later emotional difculty is particularly emphasized in Chapters 8 and 9, where the observed babies experience and adult case studies are linked. Many themes resonate throughout the book, particularly that of space in the mind of the other whether in the mind of the mother in order for the infant to develop the capacity to have a mind of its own, or in the mind of the observer to enable a mother to nd mental space for her new baby, or (Chapter 6) in the mind of a consultant working with desperate staff and parents in an Intensive Care Unit. Similarly, within the group itself, the ability to nd mental space for each one of the other participants and the infants they observe provided crucial containment, enabling individual group members to nd space for thought as opposed to projection concerning the infants and families observed. Indeed, the transformative function of space and containment in the generation of thought and personality (Bion 1962) could be said to be the central premise of the book. Another unusual emphasis throughout is the frequent reference to the ability of not-knowing the Keatsian negative capability of being able to bear acutely uncomfortable states without intervention or leaping after premature solution. Jeanne Magagna in her discussion of the value of Infant Observation sees this receptive attitude as inherently linked to transformation of feeling and the generation of thought, and as an indispensable part of a psychoanalytic stance. Receptive space in the mind of the observer can change things, even without interpretation, as Magagna describes in a painful observation of a mother, locked in an inability to attend to her little daughters needs, who comes to feel contained and is thus helped to be more responsive both to her new baby and to her other children. A major theme discussed in the book is the impact of the older sibling and the situation this creates a triangle into which the second baby is born and

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which Juliet Mitchell has described as being possibly of equal importance to the Oedipus complex. Freud described this as the family complex but looked at it far more in relation to the elder child than to the baby, whereas Mitchell makes the point that the baby can be thrust into a painful awareness of separation from the mother far more forcefully by the elder sibling than by the father. This idea is examined throughout the book but particularly in two of the case studies which focus particularly on sibling rivalry and displacement. Hope Cooper and Jeanne Magagna look at the development of self-esteem in the new baby, describing the painful and acute hostility felt by an elder child for the newborn, and his consequent regular and dangerous attacks. Because of the lack of separation between the rst child and the mother, the latter is unable to prevent these nor understand their impact on the new baby. Here the question is how the baby can come to feel any self-worth when under such regular physical attack and the impact of a mother who cannot sufciently bear her in mind? It is certainly only recently that such sibling issues have been given much attention in psychoanalytic writing, and yet it is clear how crucial they must be on the development of the new babys personality. The baby in the above observation was an infant with perhaps much innate determination, and was able eventually to demand her mothers attention and withstand her brother but the effect on more congenitally sensitive babies can be imagined. A link here is made with the origins of later shame and lack of self-esteem. The second chapter focuses on the elder siblings feelings and their effects in a case study of a young child supervised by Magagna and Adamo a highly complex study of the unmitigated, verbally explicitly murderous response of a 4 year-old girl to the awaited birth of a little boy. The childs at times almost psychotic reactions once again stemmed from a mother who was unable to allow space or containment or control into her relationship with the rst child, and was also compounded by the failure of the father to act as an acceptable transition from the mother because of his seductive relationship with the child. This observation also raised another interesting consideration the observer was directly requested to step outside normal boundaries of observation, and act almost as an active therapist to the child and mother and indeed did so. Although questionable in the rst instance, the authors justify this in the extreme circumstances of the situation, and describe it as the observer taking over the missing paternal role in the childs transference reaction, and providing a private (paternal) space for the little girl where she could work through her feelings. Together with the need for space in the mind of the mother for the new baby the case studies also speak of the need for containment. These twin themes run through the book, and reect the thought of Bick and Bion as particular inuences. Bick (who taught Magagna for three years) pioneered the technique and practice of infant observation current today (i.e. naturalistic observation of babies in their families, rather than in laboratories with

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stop-watches . . .) and was acutely aware of the primitive anxieties of the new-born, of the terror incurred in the baby when dropped from the mothers mind i.e. when the latter fails to be sensitive to the babys reactions. Mrs Bick suggests that for the tiny baby the infant skin feels as if it is only the most fragile container of the self (the reason for their distress when left defenceless and naked, or why they hate being changed) and the need is then for the close holding of clothes or wrappings but, above all, for the maternal mind that can intuit the babys feelings in this instance the need for containment (Bick 1968) She was acutely aware of the mechanisms babies might nd in order to provide some sort of distraction or protection from feeling dropped from the mothers mind sometimes silently freezing, stiff and immobile, the gaze unfocused (as in Hope Coopers description in Chapter 2, or Carolyn Shanks in Chapter 8) or sticking in adhesive identication (Bicks term) on lights or other objects a sort of symbolic clinging to protect against the feeling of uncontainment. Bicks concept of second skin formation is also described, when the baby later clings to premature intellectual or physical development to hold the self together (or like the infant in Chapter 2 who clenches all her musculature as she comes under a frightening physical attack from her older brother). Such vignettes appear throughout the case studies as the observers describe the interactions of the babies in their families. Thus the observations bring to life the insights particularly of Bion and Bick, but also of Winnicott, in relation to infant needs and terrors, particularly in relation to maternal containment and the capacity for providing the all important space in the maternal mind enabling mental and emotional growth. A further theme is that of the terric stresses placed on the mother as she attempts to share attention and emotional space with both children. The observers bring vivid accounts of the pain and rage of the elder child and the impact on the infant and his internal world, and of the various ways mothers handle sibling aggression. How this takes shape depends very much on the mothers own inner world and object relations, which in turn impacts on the personality development of her children. These are powerful case studies, and the book gives a vivid impression of the pressures and emotional impact on the observers of the primitive unmediated and conicting feelings aroused in the work of infant observation.The observers own infantile feelings and anxieties get stirred up (their own babies in the mind to use Magagnas phrase), and they need to be able to withstand both distressing material in the observations, and the resonances within themselves. This adds up to a considerable emotional weight, and support may be needed if they are going to be able to stay the course. Personal analysis, one would assume, must be vital, but more than that may be needed, and in the book this is described as coming from the group itself, so that the seminar members, while in one sense providing pressure in terms of possibly disturbing observational material, also function as a support.

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Section Three of the book is given over to the unusual form this support took that of the addition of the affective learning model to the ordinary observation seminars. This is an unfamiliar term on this side of the Atlantic at least, and appears to be essentially the processes of an experiential/ analytic group applied both to the interpersonal dynamics of the group itself and to the material brought in the observations all of this in the service of the work-group. The method looked at how each individual reacted emotionally to the specic mothers, babies and family situations described, in ways which reected their own internal object relations their own babiesin-the-mind in Magagnas phrase. In this way projected anger, condemnation, hostility or idealization within the group for a given observed family member could be analysed and understood before it disrupted the group. The papers in Section Three describing this aspect of the seminars emphasize the intense and primitive feelings evoked by the observations and point out that, if projections are not resolved, the observations and even the group itself might break down. Similar resonances and projections naturally occur within the group both between group members and between individual group members and seminar leaders, and these also were analysed, as described in Section Three. Jeanne Magagna, in her paper on the teaching of infant observation describes herself as needing to be sensitive both to the observed baby and to the internal world of the the observer participants too. It is clear from the different papers that the group members felt that this aspect of the work, although painful, enhanced their ability to relate to one another and to the babies and families observed and at a much deeper level than they had ever expected. They regarded it as one of the enormous bonuses in the four years of the seminar. Nancy Bakalar, in a paper on the group experience, describes this affective aspect as not only enormously enriching, but also healing for the observers themselves. Two papers in this nal section describe the difculties and the challenges imposed by the video-link technology used to link the two groups of students thousands of miles apart in the USA with a seminar leader even further away in London. Surprisingly, the outcome was a positive triumph over the problems, in that the video-link enabled the most high-quality and focused seminar work to take place in areas lacking in teachers of sufcient experience and calibre, and where students may have been few in number and geographically isolated. Clearly the authors of the book feel that this way of working could be a precedent elsewhere. Inevitably not all problems were resolved two papers describe how some students, arriving once the group was established, felt like second babies suffering the hostility of older siblings and nally left. Not everyone, says David Scharff, could cope with the intense and primitive material, nor with the powerful feelings elicited in the group affective model element of the group. Overall, the book provides a series of passionately lived and authentic, highly thoughtful and intuitive papers. It gives an unrivalled picture of the

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gripping nature of infant observation well managed and led, and demonstrates its immediate relevance to the understanding of the development of human personality and of how interactions between infants and their immediate family shape our inner world. Beyond that it demonstrates its power to inform and deepen analytic work in general, and its therapeutic and transformative inuence on the practitioners personal development. In addition, the book almost entirely avoids simplistic interpretations of the behaviour observed, and is a superb introduction to theory which can sometimes seem difcult, since we see the theory in action as it were brought to life. There is an excellent bibliography and index, and the odd editorial slip cannot detract from the importance of this exciting and stimulating book.

Judith Nesbit
London Centre for Psychotherapy, London [judithnesbit@blueyonder.co.uk]

References
Bick, E. (1968) The experience of the skin in early object relations. International Journal of Psycho-Analysis 49: 4846. Reprinted in: A. Briggs (ed.), Surviving Space: Papers in Infant Observation, pp. 15771. London: Karnac, 2002. Bion, W.R. (1962) Learning from Experience. London: Heinemann. Coles, P. (2003) The Importance of Sibling Relationships in Psychoanalysis. London: Karnac. Mitchell, J. (2003) Siblings: Sex and Violence. Cambridge: Polity Press.

You Ought to! A Psychoanalytic Study of the Superego and Conscience by Bernard Barnett. Published by Karnac, London, 2007; 173 pp; 14.99 paperback.
A comprehensive survey of the concept of the superego, one of those very familiar and yet elusive and complicated psychoanalytic concepts, is much to be welcomed, especially one by such a well-respected authority as Bernard Barnett, training analyst and teacher at the British Psychoanalytical Society. The rst chapter introduces the main features of the system superego, claried by examples from case vignettes, press reports and English literature. Here, as throughout the text, Barnett draws in the most illuminating manner on George Eliots last novel, Daniel Deronda (Eliot 1876), invoking this novelists stated aim to widen the English vision a little . . . and let in a little conscience and renement (p. 13). It is a novel particularly well suited to exemplifying Barnetts points, and his interweaving of its moments and personalities is one of the great strengths of You Ought To!

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Chapter 2, The Freudian Superego traces and expounds Freuds ideas from his early theoretical speculations, through his work on dreams to his further renement of his ideas in On narcissism (Freud 1914), the text in which he rst introduces the term ego ideal (a forerunner of the superego concept), the selfs formulation of how it wishes to be. It is in his work of 1923, The Ego and the Id, that Freud (1923) rst refers to the superego (Uber Ich, literally over the Ego), and it is here that he renes his ideas on identication, contending that a superego arises from the childs identication with parental gures, a formation occurring developmentally in the early oedipal stage when the ego is still in a weak state. Here Barnett considers Freuds thinking on the male and female Oedipus complex and its resolution, the process summarized in the sentence, The Superego is heir of the Oedipus Complex (p. 28). Freud also makes clear that the superego can be a malign force acting with great severity and cruelty towards the ego. In Freudian thought this cruelty derives from an unconscious sense of guilt, one also capable of impeding the individuals wish to recover. Barnett illustrates Freuds distinction between unconscious and conscious guilt by means of a compelling case history from his own work with a female patient whose extremely punitive superego resulted in a prolonged period of intensive suffering, both physical and mental. The application of superego theory to the state of hysteria is illustrated by a fascinating discussion of George Eliots ctional heroine, Gwendolen Harleth, from Daniel Deronda. The roots of the system superego lie early in infancy and in Chapter 3 Barnett traces its formation and development. He skilfully contrasts and informs his reader of varying views on superego development, structure and function for example, here, pointing out divergences between Kleinian and Winnicottian views. From 6 to 12 months the infant grows in terms of socialized morality, whilst from 12 months to 2 years the toddler is socialized. Between 2 and 3 years there are precursors of the superego, premoral manifestations of guilt; although, here, the author is careful to emphasize that the child at this stage does not yet have a superego structure that is stable and can be recognized as his own. 3 to 6 years is the period of oedipal development and in classical theory, at least in the case of the little boy, the superego is formed as a result of identication with the father to avoid castration. Barnett adroitly handles the issues of male and female oedipal identication, giving information on alternative views on the origins and nature of oedipal development in women: Gwendolen Harleth and Daniel Deronda himself are helpful examples; whilst issues of the superego in adolescence and early adulthood are discussed with reference to James Joyces Portrait of the Artist as a Young Man. Freuds formulation of the superego has been called the true beginning of sound object relations theory (p. 85; Coltart 1992, p. 50), and Chapter 4 deals with object relations focusing on the development of classical ideas by a few psychoanalysts working mainly in the UK. Barnett covers the Contempo-

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rary Freudian tradition in the work of the Anna Freud Centre, Anna Freud herself and that of Joseph and Anne-Marie Sandler and extends his discussion to the work of analysts such as Ann Hurry and Rose Edgcumbe who addressed superego issues in their work with children. Barnett points out that no unied theory ever emerged from the discussions of the Object Relations theorists but he does provide a most useful commentary on the most important disagreements among these clinicians, notably those centred around the function of objects, the nature of the internal world, and the relationship between the inner and outer worlds. Whilst key central psychoanalytic concepts were maintained, notably conict and anxiety, others were modied, even rejected. Crucial to these challenges was the work of Melanie Klein and her major revisions, in the light of her research into earliest infancy, to the classical theory of the superego, most notably her conclusion that a primitive form of superego existed in the rst year or life, a great deal earlier than had previously been assumed. Also, appreciably earlier than had hitherto been believed to be the case was the Oedipus complex: in Kleins view, Freuds view of a superego originating with the resolution of the Oedipus complex was the last stage of a more complex development. Before moving on to Post-Kleinian developments, Barnett gives an extremely helpful summary of the essential differences between Kleins theory and classical and, in particular, Anna Freuds theory. The following commentaries on Bion, and more recent Post-Kleinian theorists, are characteristically clear and informative as are his sections on the Independent Tradition, and, in particular, the work of Fairbairn and Winnicott. Admirably comprehensive, Barnett also includes here comment on the work of James Strachey and analysts such as Nina Coltart. Up to this point in the text, Barnett has addressed the ideas of theorists who have made valuable contributions to superego theory. Chapter 5 takes a different, much more sombre turn with its Freudian epigraph setting the tone: God has done an uneven piece of work, for a large majority of men have brought along with them only a modest amount of it [i.e. the individual conscience] or scarcely enough to be worth mentioning (p. 115, Freud l933). This section on the superego, the object and the Holocaust addresses some of the most serious effects than can result when superego guilt and the capacity for concern are absent in the group and when the external object may be attacked and destroyed, when, in short, deciencies in the superego system can give rise, under certain conditions and in the case of certain pathologies, to mass murder. Barnett uses the Holocaust to show how a murderous activity was directed against a hated object with the aim of total annihilation, the scale of the murder enacted with superordinary cruelty and sadism implying a corruption of the superego system, both group and individual. Barnett does not assume that psychoanalysis can provide the answer to these matters; he is never reductive but always questing for the truth.

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Ego ideal theory teaches of a situation whereby a group can submit individual will to the will of a leader by a process of substitution; the union of ego and ideal can submerge the individual superego. The section on the Nazi ego ideal and morality focuses on these matters before the book moves from the murderous attacks on the object and its splitting effects on the perpetrators superego functions to a second focus the effects on the survivors and their childrens superego systems. Particularly powerful is the authors consideration of the unconsciously transmitted effects on the second generation: signicant are accounts of second-generation children growing up with an awareness of a hovering presence of death in their own lives, and of how certain children of survivors are preoccupied by two central phantasies: rstly, that they can act as a replacement child for one who was lost in the camps; and, secondly, that they can carry out a special, reparative mission. Exemplied by the account given by the journalist Anne Karpf and a vignette from his own clinical practice, Barnett shows the reader the profound reverberations of second-generation Holocaust experience on the system superego. Barnetts nal chapter opens with an epigraph from David Lodge: The individual self is not a xed and stable identity, which heralds the central concerns of this section of the book as he looks at classical Freudian, and some British, post-Freudian psychoanalytic explorations of subjectivity focusing especially on ego self/superego interactions. His wide-ranging lens encompasses, among other areas, Freud and Modernism, Fairbairns critique of classical superego theory and the challenges posed to notions of a unitary self by the Post-Modernists. This is a very comprehensive and rigorous book of the greatest use to all in the eld. Informed and illustrated by an extensive knowledge of not only psychoanalysis but also of English literature and lm, its varied pace and stylistic lucidity make it a pleasure to read as well as a book from which to learn a great deal. It is also a text that demonstrates irrefutably that Freuds view on the aetiology of mental ill-health (as a disruption in the balance of ego, id and superego) is as relevant today as it ever was.

Emma Letley
Arbours Association, London [emma@letley24.freeserve.co.uk]

References
Coltart, N. (1992) Slouching Towards Bethlehem . . . and Further Psychoanalytic Explorations. London: Free Association Books. Eliot, G. (1876) Daniel Deronda. London: Everyman, 2000. Freud, S. (1914) On narcissism. In: SE 14, pp. 67102. London: Hogarth. Freud, S. (1923) The Ego and the Id. In: SE 19, pp. 366. London: Hogarth. Freud, S. (1933) New Introductory Lectures on Psychoanalysis. SE 22. London: Hogarth.

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Psychiatry and the Cinema by Glen O. Gabbard and Krin Gabbard. Second edition. Published by American Psychiatric Press, Washington, DC, and London, 1999; 399 pp; 24.50 paperback.
Our story deals with psychoanalysis, the method by which modern science treats the emotional problems of the sane. The analyst seeks only to induce the patient to talk about his hidden problems, to open the locked doors of his mind. Once the complexes that have been disturbing the patient are uncovered and interpreted, the illness and confusion disappear . . . and the evils of unreason are driven from the human soul. (1999, p. 55, emphasis added by the authors)

So begin the opening credits for Spellbound (1945), a lm directed by Hitchcock. Yet, despite or perhaps because of its portentousness, Hitchcock described the lm rather dismissively as just another manhunt story wrapped up in pseudo-psychoanalysis. Psychoanalysis and psychiatry have long fascinated lmmakers as becomes clear in the description of the many lms described and analysed by Glen Gabbard and his brother, Krin, in Psychiatry and the Cinema. This is the second edition of their earlier book rst published in 1987, and is a response to readers interest in the portrayal of psychiatry in American lm. The book incorporates an alphabetical list of lms depicting psychiatry, and 43 black and white stills. The authors draw on their separate expertise Glen Gabbard as an internationally known writer and teacher of psychoanalysis, and Krin Gabbbard, a teacher of lm, literature and cultural studies and the author of several books on jazz. The authors point out in their introduction that, although psychodynamic psychiatry originated in Europe, following its introduction to the United States it became rmly established within a few decades. They ask why lmmakers are so fascinated with the psychiatric profession, their discussion including all mental health professionals, while noting a prevalent confusion in understanding the differences between psychiatry, psychoanalysis, psychotherapy and psychology. They argue that both lmmakers and mental health professionals have an overwhelming interest in emotions, behaviour and human motivation, and that, although Hollywood reects certain attitudes about the mental health professional, it is also selective in how these are reected. In the rst part of their study, they ask how the profession comes to be represented in lm. In the second part, they consider how the psychiatrist at the cinema understands, from within the perspective of psychoanalytic theory, some dominant themes within American cinema. Much of the analysis is detailed, nuanced and well researched, sometimes incorporating a wry humour, and refers to both obscure and to well-known lms. They see lm as illustrative of how the American public struggled to understand what psychiatry was about, with all its subtleties, ambiguities and contradictions, and describe how this understanding changed over time in

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response to sociological and historical forces. The second part of the book adopts a different methodology. Using psychoanalytic theory as the basis for a lm critique, it is an in-depth discussion and an analysis of particular themes as, for example, narcissism and the cult of the celebrity. They dene the late 1950s and early 1960s as a Golden Age for psychiatry, since its practice was seen during that time as effective and benevolent. Prior to this, but especially in the early twentieth century, psychiatrists were confused with hypnotists, clairvoyants, and others with obscurely dened credentials. The authors refer to a number of lms as illustrative of their argument, many of which are obscure, but this enables them to identify some interesting and perhaps quirky material. For example, Ginger Rogers, the female dancing partner of Fred Astaire, played the role of analysand more often than any other actress (see In Person (1935), Free Love (1930), Reunion in Vienna (1933) and Lady in the Dark (1944)). And in Carefree (1938), Fred Astaire played the role of a dancing psychiatrist, with the coaxing, arm-waving gestures of the show business hypnotist, which together with their falling in love surprisingly enabled him to save his patient. It remains unclear what was the curative factor. The authors note with some amusement that When Astaire lends his aura to psychiatry, the profession becomes more than a little magical (p. 48). On a more serious note, it is of some interest to wonder why Ginger Rogers was cast in this role, given her screen persona of graceful elegance and beauty, her successful dancing partnership with Fred Astaire and, as the authors put it, her representation of wholesome screen normality. In Spellbound (quoted at the beginning of this paper) we are given the rst detailed discussion of countertransference, although tantalizingly this is not summarized by the authors (ibid., p. 54). The producers of Spellbound also enlisted the help of a psychiatrist for technical assistance. Despite this, the lms depiction of psychoanalysis does little to further understanding beyond seeing its practice as a cathartic cure. The authors note that, despite many of Hitchcocks lms presenting a view of psychiatry as rather positive, the subtext is rather more ambiguous. For example, in Hitchocks masterpiece Vertigo (1958) the main protagonist, Scotty, is cured by psychiatry, but for all this he appears empty and desolate. And other lms by Hitchcock such as The Wrong Man (1956) and Psycho (1960) reveal more complex ambiguities in the directors understanding and portrayal of psychiatry. They also refer to a little known lm on Freud called, rather prosaically, Freud (1962). Directed by John Huston, the script was written rather surprisingly by Jean-Paul Sartre, who is known more for his critical stance towards psychoanalysis. Montgomery Clift played Freud, and Susanna York a composite patient. The authors write that the lm is frank about Freuds work, in particular, the development of his theories of infantile sexuality, but concludes that it romanticized and sensationalized him. Freud is compared to Copernicus and Darwin because of the blows dealt us in our vanity. The

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lm is also given the full Hollywood treatment with an over-ripe narration and string crescendos. It was not a box-ofce success (one wonders why) and Callenbach, the editor of Film Quarterly, wrote that it would be impossible for any sophisticated person to sit through the lm without at some point bursting out laughing (p. 101). By the late 1950s psychiatrists were seen as the authoritative voices of reason, adjustment and well-being, which was typied by the success of the lm The Three Faces of Eve (1957), a lm which won Joanne Woodward, playing the psychiatrist, an Academy Award. Other similarly positive accounts of psychiatry can be found in The Interns (1962), Girl of the Night (1960) and David and Lisa (1962) where Howard da Silva plays the role of a compassionately competent psychiatrist. However, not all portrayals are so positive. A familiar theme in lm is the apparent belief in Hollywood that psychiatrists, especially women, have an inability to contain the countertransference. In a chapter devoted wholly to the representation of the female psychotherapist, the authors begin with an observation: that since the 1930s more than a hundred Hollywood lms feature a female psychotherapist. Rather typically the portrayal of women at work reect dominant beliefs found in the rest of society, i.e. women cannot have it all,that they have a biological function,and that sooner or latertheyll be tripped up by love. So, more often than not, a female analyst nds her true nature only when she falls in love with a male patient (Knock on Wood (1954) or Spellbound (1945)) or, alternatively, when she is nurturing a younger female patient, as in I Never Promised You a Rose Garden (1977). Even when a woman psychotherapist treats a female patient, she is presented as an unfullled spinster or divorcee, as in Three on a Couch (1966). In at least 29 lms identied by the authors, women analysts become romantically involved with their male patents, compared with less than half that number of male analysts with female patients. Yet, as the authors point out, in real life boundary violations of a sexual nature are far more likely to occur between male mental health professionals and female patients, rather than the reverse. The question remains, how do these cinematic images impact upon how our patients see us? Many of us will have had the experience of patients asking what we thought of, for example, the recent highly successful television series The Sopranos.1 Or, more dramatically, an experience I had following the release of the lm, Analyse That when a patient swept out of my consulting room at the end of her session, challenging me to do just that. In fact the authors advocate that, when a lm is brought into a session, it is useful to consider the clinical implications in relation to its depiction of psychotherapy. I would go further. It is useful to follow through all references to lm regardless of its narrative or the theme. Perhaps lms do accurately reect the ambiguity of our work and societys ambivalence towards this. As the Gabbards note, within lm culture, there is a widespread perception of analytic omniscience, and the apparent

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ability to mind read may therefore be envied and feared. But maybe it is possible to perceive these negative portrayals as reecting a healthy scepticism and iconoclasm, since they conclude by reminding us of the following denition, A psychoanalyst is someone who pretends he doesnt know everything (p. 185). *** Part Two begins with an overview of theories of lm criticism. Much of the authors discussion focuses on how Lacanian thinking has been adapted as a theory of lm criticism, although they write,It is . . . difcult to dene clearly the terms for Lacanian theory that have proved most useful for semiotic lm criticism (p. 192). Concepts which they see are of importance, are the Mirror stage, the Imaginary, and the Symbolic, noting especially the concept of suture, which is dened as the process by which cinematic gaps created by cutting or editing are sewed shut to include the viewers who identify themselves with some aspect of the cameras gaze (p. 194). Nevertheless, it is psychoanalytic theory which is their preferred mode of analysis and, notwithstanding that this perspective has come under sustained attack (p. 171), they advocate a pluralistic approach. Although the rest of their commentary is a rich and discursive approach to lm, including discussion on dreams, phallic women, horror, narcissism and the celebrity culture, for reasons of space I intend to limit this discussion to the authors discussion of Woody Allen, and to their analysis of Casablanca. It is clear the authors have an overriding interest in the whole oeuvre of Woody Allen. References to his many lms are scattered throughout the book. But apart from their interest in how he represents psychoanalysis, and how this has changed over time, and how his lms can be seen as a portrayal of narcissism, they express a curiosity in whether the various characters in his lm are in fact, in one way or another, portrayals of himself. Allen, unsurprisingly, denies this but, as the Gabbards point out, his characters consistently play as a disenchanted analysand. The authors quote many of Allens humorous one-liners, and write that until the 1990s one might assume that Allens own psychoanalysis was working. But in 1993 in Manhattan Murder Mystery we hear the character played by Diana Keaton, suggesting she returns back into therapy, only to be told by Allens character, You dont have anything that cant be cured by Prozac and a polo mallet (p. 126). And in Deconstructing Harry (1997), the protagonist tells one of his therapists that, although he has seen six different analysts, nothing has changed. As the authors comment, this has a chilling ring, given his quasiincestuous relationship with Soon-Yi Previn (p. 127). The question remains whether Allen is the characters he plays but, taking into account the complexities of the multitude of characters his lms portray, they observe it is likely that they represent fragments of himself. As they say,

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it is probable that, like all artists, Allens major subject is himself. They quote Allen who, when searching for the lead role player in Deconstructing Harry, went through more than half a dozen people, before nally deciding to play it himself. Allen stated in an interview with Martin Scorsese, Theyll think Im the character . . . but I dont care. That is one of the blessings of what I do. That is why they come or why they stay away (p. 248). In an interesting but too short commentary on what makes a cult lm, the authors consider Casablanca, directed by the apparently prolic Michael Curtiz. The lm was released in 1942 but it was not until the 1960s that it reached the status of a classic. They forward some possible explanations: the star presence of Bogart as Rick and his co-star, Bergman, the nostalgic music, the resolution of oedipal material, and the Hollywood message that the American outlaw as hero can survive. Although these are undoubtedly important, I will argue that it is the lms evocation of the unconscious, and the possibility that some lms are subject to different interpretations and can be understood as expressing different levels of the unconscious, that make a lm a classic. In fact their dominant analysis of Casablanca depends, rather predictably, on a Freudian interpretation of an oedipal triangle, which is played out between Ilsa, Rick, her erstwhile lover, and her present husband, Laszlo. And in this, as the authors point out, there would be a similarity to a Lacanian analysis. They write of Ricks desire to possess a blissful union with the all-good nurturing woman completely unattached . . . to a threatening paternal gure, and argue that no other woman could have fullled this lm role so completely as Ingrid Bergman. The authors point out Bergmans screen image projected an image of the most desirable qualities of mother and lover (p. 207). However, ironically in real life, Ingrid Bergman was reviled and attacked for leaving her daughter with her rst husband to live with her lover, Roberto Rossellini. In March 1950, in the American Senate, she was described as evil and her actions were seen as a powerful attack on the institution of marriage (Jackson 1994, p. 40).Thus to restrict the analysis of this iconic lm to the resolution of an oedipal triangle is, to my mind, to miss an alternative and possibly richer analysis, as I shall argue. The theme song of As Time Goes By in Casablanca denes the lms content. It is essential to the narrative and its location, and is evocative of the atmosphere of a sweet, sad nostalgia. It also powerfully expresses the characters preoccupation with loss, change, transformation and betrayal. Casablanca can be understood psychically as a transformational object (Bollas 1987).2 The action takes place during the early years of the Second World War, and we are told of Casablancas importance strategically; that, as an outpost of Vichy France, it was also a stopping off point between Nazi-occupied Europe and the Americas. It was therefore a centre for black market dealing, and for the buying and selling of transit visas. At the centre of this is Ricks saloon.

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The lm is shot in black and white, and is atmospherically stylish. Much of the action takes place at night, where Humphrey Bogart (Rick) as the saloon owner epitomizes cool. An outstandingly attractive man of few words, dressed in a white tuxedo and black bow-tie, he appears bitter, disillusioned and cynical. However, we learn that he was a gun-runner to Ethiopa and had fought against the Fascists in Spain, thus indicating that, despite his appearance, he is in fact a man of ideals and principle. Into this environment appears Ilsa, a woman representing to the Gabbards at least both sensuality and their fantasy of the look of motherhood. She is married to another outlaw, Laszlo, the organizer of a network of resistance groups in Europe. Where my interpretation differs radically from that of the Gabbards is how the lms ending might be understood. Whereas they point to the resolution of the oedipal triangle, it would seem to me that Rick ultimately betrays Ilsa, just as she had earlier betrayed him. Although each betrayal can be seen as consistent within a psychoanalytic and social convention (Ilsa was married), my argument is also consistent with an appreciation of the underlying tragedy of the three characters and the lms expressed romanticism both in its aesthetics, its characterization and its narrative. Ricks response to Ilsa when she realizes she is to leave Rick and Casablanca to accompany her husband, is Well always have Paris a reference to their brief love affair. It is a bittersweet moment and communicates the profound loss of what might have been. It is this profound ambiguity rather than any other explanation that may explain why the lm has become a classic, and why it has held the imagination of generations of lm audiences. *** This book is, as stated previously, in two parts, each with totally different methodologies. It is the second half which is the more successful since there is a sureness of approach; an overview of lm critical theory and a subsequent rich analysis of themes and lms from a pluralistic psychoanalytic viewpoint. The rst half of the book, although looking at many lms that portray the work of the mental health professional, is in actuality a discussion largely about psychiatry. It is presented as sociological, but lacks coherence in terms of any underpinning of sociological theory.There are too many references to too many lms without a clear indication of what the criteria were for their inclusion. If we take as an example: the authors dene the early 1960s and 1970s as a golden age for the portrayal of psychiatry. They dene their characteristics for this period, but seemingly the rest of the twentieth century is not so clearly characterized. Is this because the authors were unable to identify a pattern? The authors also note the publics confusion (prevalent even today)

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between the work of the psychiatrist and other professionals. A thoroughgoing sociological analysis could have tracked the increasing professionalization of psychiatry, from its early twentieth-century association with hypnotism and quackery, to its present position. The development of an occupation into a profession does not just happen. Some or all of the following is set in motion: the restriction of entrants via examinations, or class, initiation ceremonies and rituals (dining at the Inns of Court for barristers in the UK is a good example), dress codes, ways of speaking, income levels to subsidize a long training, the development of an arcane or highly technical language specic to that occupation, a code of ethics, and the established right to self-police. Such a development is usually the outcome of a small but active group of the self-interested. But perhaps to analyse these sociological changes and then to link them with the portrayal of psychiatry in lm is asking too much. However, as the book stands in the rst half, more questions are raised than answered. Having said that, the book is well researched with copious references not just to well-known lms but also to the obscure. It will be of interest to all lm buffs and hopefully will inspire mental health professionals to analyse their own patients references to lm. The authors conclude:
While the actor in the movie may be sublimating his exhibitionism, the psychotherapist in the privacy of his ofce sublimates his voyeuristic interests. While seemingly disparate in this respect, psychiatry and the cinema are both capable of offering a compelling glimpse into the human psyche. (p. 314)

Notes
1. Neither the television series The Sopranos (19992007) nor Analyse This (1999), and Analyse That (2002) which followed, the latter two lms focusing on a psychiatrist played by Billy Crystal and his misfortune in working with a patient, Robert De Niro, playing the now familiar role of a troubled gangster, are discussed here since they were released after the publication of this book. Although The Sopranos was shown on British television, it was only in the States that it developed a cult audience. A loyal and informed audience regularly gave their opinion to all media outlets as to how the analyst related to her patient (another Maa boss). The ending of the series in particular caused huge controversy, just as if it were real. A glance at You Tube on the Internet shows an alternative and humorous ending, as well as other vignettes from the series, and illustrates the hold this lm had on an educated and analytically sophisticated audience. 2. Bollas denes the transformational object as an experience that will be identied with processes that alter the self (p. 14). Bollas also associates this with an aesthetic experience, which enables the subject to feel an identication with the object. Hence the importance for a lms aesthetics in its appeal to the unconscious.

Marguerite Valentine
Arbours Association of Psychotherapists, Bristol [marguerite@12s.com]

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References
Bollas, C. (1987) The Shadow of the Object: Psychoanalysis of the Unthought Known. London: Free Association Books. Jackson, R. (1994) Mothers who Leave: Behind the Myth of Mothers Without Their Children. London: Pandora.