Freud, Surgery and the Surgeons

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. 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. 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. 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. Stepansky then turns to topics seldom mentioned in the literature, such as the psychoanalytic "deconstruction" of organic pathology in the 1930s and 1940s. These varied 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, 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."