Book Reviews

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On Freuds The Future of an Illusion edited by Mary Kay ONeil and Salman Akhtar. Published by Karnac Books, London, 2009; xix + 296 pp; 24.99 paperback.
Freud had a life-long interest in religion. In Totem and Taboo (1913) he drew attention to some apparent similarities between the mental life of savages and those of neurotics and children; and in his late work, Moses and Monotheism (1939), he offered an almost novelistic reconstruction of some of the repressed history that he believed underlay Judaism and Christianity. Between these publications came The Future of an Illusion (1927), his most passionate plea for scientic over religious ways of thinking. This pamphlet as Freud described it to Pster (Freud & Pster, 1963, p. 109) has now become the subject of a new volume in the IPAs Contemporary Freud: Turning Points and Critical Issues series, which seeks to approach Freuds work from a present and contemporary point of view (p. ix). Edited by Mary Kay ONeil and Salman Akhtar, who provide the Introduction and the Epilogue, it contains the Standard Edition translation of The Future of an Illusion and ten essays by an international group of psychoanalysts. For anyone interested in the current state of play between psychoanalysis and religion, this book is a gold-mine. Freud tends simplistically to be portrayed as a dogmatic atheist. This disguises the sophistication of his thinking about religion. In the second Prefatory Note within Moses and Monotheism, for example, Freud wrote that, from the time he published Totem and Taboo, he had:
never doubted that religious phenomena are only to be understood on the pattern of the individual neurotic symptoms familiar to us as the return of long since forgotten, important events in the primal history of the human family and that they have to thank precisely this origin for their compulsive character and that, accordingly, they are effective on human beings by force of the historical truth of their content. (Freud, 1939, p. 58)

In other words, religious phenomena are not meaningless: they enshrine truth, but what is this truth? The fact that Freud returned repeatedly to this question indicates that he never resolved the conundrum of religion. In his Introduction, Salman Akhtar suggests that the literary device adopted by Freud, in The Future of an Illusion, of having an imaginary religious friend with whom he is arguing, masks the fact that: The Illusion monograph is a literary battleeld where Freud, the Atheist is involved in a bloody combat with Freud, the Believer! (p. 3). Perhaps this is what gives Illusion its excitement even when we allow for its resonance with
The authors Journal compilation 2010 BAP and Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.

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current debates, and when we know (as none of the contributors to this volume seems to realize) that Freud had a real adversary in mind: his friend and early psychoanalytic colleague, the Revd Oskar Pster, to whom Freud wrote, on 16 October 1927: In the next few weeks a pamphlet of mine will be appearing which has a great deal to do with you (Freud & Pster, 1963, p. 109). The Future of an Illusion derives its power from the impassioned quality of these internal and external struggles. Satisfyingly, all the contributors to this volume are ready for the ght. In Deconstructing Freuds The Future of an Illusion: Eight Conceptual Strands, Ethel Spector Person notes Freuds comment, in Civilization and Its Discontents, that his concern in Illusion was much less with the deepest sources of the religious feeling than with what the common man understands with his religion (p. 66) an interesting qualication which, in some measure, balances what Person calls Freuds moment of grandiosity, at the end of Illusion, when he pictures psychoanalytically informed science replacing religion (p. 75): In the moment when he appears to be appreciating the immense success of psychoanalysis, [Freud] is also measuring himself against the Godhead (p. 78). Person does not believe that bringing negative ideas about religion into psychoanalysis was prudent in Freuds day, nor is it today. Nonetheless, Freud was agile enough to go back to the source of his authentic genius and to continue his explorations of the role of psychoanalysis in treating people (p. 79). Jonathan Lear agrees. In his philosophically informed essay, The Illusion of a Future: The Rhetoric of Freuds Critique of Religious Belief, he examines the prejudicial nature of Freuds arguments against religion, and challenges Freuds claim that there is no way one can both (a) believe in the principles of psychoanalysis and live according to them and (b) live a life that embodies religious commitment (p. 94). Against this view, Lear cites Maimonides, whose Guide of the Perplexed shows that there are sophisticated ways of living with (religious) stories other than forming straightforward empirical beliefs about their literal truth (p. 95); and that the problem of forming a non-idolatrous conception of Gods existence was not only extraordinarily difcult: it was itself a religious task (p. 95). In bracing contrast comes J. Anderson Thomson Juniors, The Past of an Illusion: An Evolutionary Perspective on Religious Belief, an avowedly Darwinian fundamentalist contribution, complete with genuections to Richard Dawkins, Daniel Dennett, Sam Harris and Christopher Hitchens, whose courage, clarity, and insights inspire (p. 123). According to Thomson, the world still needs the erce wisdom of Illusion, its objective analysis of religion, and its rousing defence of science (p. 99). Basing himself on the work of Gay, Thomson makes the questionable assertion that: The attempts of later psychoanalysts to reconcile psychoanalysis and religion would have been met with utter scorn by Freud and his early followers (p. 110) if nothing else, Freuds letters to Pster reveal that Freuds attitude to one

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profoundly religious psychoanalyst was innitely more courteous and complex than this. Against a useful survey of evolutionary psychology and the cognitive mechanisms associated with religious experience, Thomson concludes that Freud was both prescient and wrong about many things (p. 111). Yet he applauds Freuds stance: Religions usefulness now lies in the past. Religion is a man-made burden that remains the enemy of reason, science, and free inquiry (p. 121). In some ways, the next three essays demonstrate both the truth and the limitations of Thomsons thesis. Vamik Volkan writes about Religious Fundamentalism and Violence, George Awad addresses The Morality of an Oppressed Group , and Moisos Lemlij tackles Illusion, Disillusion, and Delusion: War and Faith in the Andes. In the current climate of fear about religiously and politically inspired terrorism these carefully focused papers, which bring psychoanalytic insights to bear on specic groups and situations, are a treasure-trove of information and reection. Alone, they might be sufcient reason to read this book. Reecting on our knowledge of transitional phenomena, Volkan shows that religious beliefs and feelings have progressive, healing, and creative aspects, as well as regressive, destructive, and restrictive potential (pp. 127f.). He uses the analogy of a lantern, with one transparent and one opaque side, to illustrate the way our capacity to look clearly at the frustrations of the external world alternates with our need for moments of rest, in which we do not have to distinguish between reality and illusion (p. 128). He then provides clinical material from religiously inspired individuals to illustrate ways in which this natural, benign process can become intensely pathological, and argues that, besides psychoanalytic understanding, we need to understand how large group identity can be manipulated: No scientic discipline alone can explain the horric sociopolitical abuse of religion (p. 141). In a paper completed just before his death, George Awad enlarges on these themes, questioning Freuds contention that civilization is threatened by the envy of underprivileged classes whereas it has little to fear from educated people and brain-workers (p. 142). A simplistic polarization, disproved by Awads careful examination of the beliefs of the radical Islamist followers of Sayyid Qutb and the actions of al-Qaeda. Here we nd a powerful complex of beliefs, driven by the illusory notion that the ideal Islamic society can be recreated on earth. Group psychology again operates powerfully to close minds in Volkans terms, to turn the opaque side of the lantern towards the outside world. Moisos Lemlij provides the third paper devoted to ideologically motivated terrorism, mounting a powerful challenge to Freuds call for the affective power of religious authority to be replaced by a rational foundation. In my opinion, writes Lemlij,Freud was the victim of the same illusion of which he accused religious believers (p. 161). He bases this claim on his analysis of the Shining Path terrorist group, which had a rational materialist basis for its

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actions, that brought terror to the Peruvian Andean highlands from 1960 2000. As Francisco Goya wrote: The dream of reason produces monsters (p. 162). Ironically for those who espouse the cause of non-religious reason it was the courageous and determined opposition of, among others, evangelical Christians that nally ousted the guerillas from their power bases. Lemlij is not an advocate of religion; he writes: In my opinion, religion is a disguised illusion of salvation that provokes catastrophes (p. 180). But he also shows that political ideologies that are the product of an idealization of reason are as perversely illusory as religions (p. 180). Returning to the clinical dimension, Jennifer Bonovitz notes Freuds omission of the maternal in God, and asks: Was he disillusioned with mothers? Here, Freuds dogmatic assertion that the God image always reects the primal father is dissolved by Bonovitzs review of divine mother imagery, drawn from all great religious traditions. She then provides four beautifully drawn clinical cameos (three children, and one adult), which illustrate Mother God as a source of solace in times of unmentalized pain (p. 190). As she says: The concepts of faith and trust are strongly associated with religion, but their place in psychoanalytic theory remains ill-dened (p. 202). In line with this observation is Mortimer Ostows paper, published since his death, Three Archaic Contributions to the Religious Instinct: Awe, Mysticism, and Apocalypse. Of course, he writes, there is no religious instinct, but he uses this term for the almost universal readiness of individuals to cohere into social units in which all participate in cultic practices and shared beliefs in a supernatural entity with parent-like functions (p. 205). Drawing on clinical material, Ostow examines the three religious universals of his title, suggesting their neurological underpinnings, psychodynamics, and developmental paths. This provides a possible framework for a religious system within which the three archaic components serve as a primary motivation and earliest affective expression of the need for attachment (p. 223). The last two essays offer personal reections on the ways in which the psychoanalytic and religious journeys can support and interrogate each other. Sudhir Kakar charts his development from the time when, at the age of 18, Illusion brought an exhilarating sense of personal liberation, through to his present position, deeply informed by Hindu philosophy and theology, where he can see how much of Freuds analysis of religion is determined by personal factors, and the subjective expectations of Freuds cultural historical background (p. 225). Many of Freuds ideas about God are inapplicable in a Hindu context, and Hindus are much more positively inclined towards illusion, which they tend to associate with playfulness, or benevolent deception (p. 233). Illusion contains partial truths that cannot be universalized (p. 236). The limitations of Freuds picture of God are equally apparent in Neville Symingtons essay, How Belief in God Affects My Clinical Work. Syming-

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ton draws on the mystical tradition, which nds meaning in the notion of Being rather than in the word God. Belief, for Symington, is not a psychological act revealing what could not be known through an act of intellect but, rather, something that transforms what is known through it (p. 240). It gathers him into a singularity. This leads to a thoughtful discussion of patients who lack a sense of subjectivity, and the idolatry of psychoanalysts who base their interpretations on xed criteria, instead of being grounded in essential being which alone enables us to relate to analysands in their uniqueness. Here Symington joins Bions later work with the insights of the author of The Cloud of Unknowing. The subject of religion remains divisive, as ever. But here, like grit in oyster-shells, Freuds treatment of religion has produced a string of pearls: ten strong essays, marked by clinical acumen and high-quality psychoanalytic thinking, which also reveal something of the passionate humanity and the religious or existential commitments of their authors. Thoughtful analysis and passionate commitment are both precious psychoanalytic contributions to our current debates.

Christopher MacKenna
British Association of Psychotherapists, London [cmackenna@stmarylebone.org]

References
Freud, S. (1939) Moses and Monotheism. SE 23, pp. 1137. Freud, S. & Pster, O. (1963) Psycho-Analysis and Faith: The Letters of Sigmund Freud and Oskar Pster, (eds) H. Meng and E.L. Freud. London: Hogarth Press and the Institute of Psychoanalysis.

On The Way Home: Conversations Between Writers and Psychoanalysts edited by Marie Bridge. Published by Karnac, London, 2008; 160 pp; 12.99 paperback.
Bion: Certain books like certain works of art, rouse powerful feelings and stimulate growth willy-nilly. (quoted in Waddell, 1998, p. 175)

The book is a record of four occasional events in a series entitled On the Way Home, put on at the Institute of Psychoanalysis since the year 2000. These are public dialogues between psychoanalysts and some well-known gures from different disciplines. We are given here four of the conversations between writers and analysts, drawn out by points made by members of the audiences present. The book may slightly be accused of

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publishers book-making and of having attened what must have been the original liveliness, but it does serve to introduce readers to the creative process of novel and biography writing, and to how imaginatively rousing powerful feelings stimulates our growth. If it seems slightly self-conscious, that may also be because of the setting. Yet all four writers the three novelists, A.S. Byatt, Philip Pullman and Rose Tremain, and the biographer Brenda Maddox place an emphasis on truthfulness as an attitude of mind. And all four analysts with whom they are in conversation are well versed in the literary. What we nd out on the way is how some writers view psychoanalysis, and in what ways psychoanalysts are curious about the writers creative processes. Also, as hosts, they are sensitive in attuning in the moment to bringing their subjects out. Marie Bridge, as editor, writes in her introduction:
Perhaps writers who are interested in dialogue with analysts are in some sense self-selecting . . . All participants share what Sodr describes as a very deep desire to know more about minds. Although one of Byatts themes is the opacity of her characters, nevertheless she comments that no matter how clever or post-modern the novelist is, the moment that the story starts moving as a tale, you start responding to the characters as people. (pp. 23)

Just as when the transference begins to take hold psychoanalysts are caught up in hearing and reecting on stories so writers invent and follow through with their stories. Is the adage right, that truth is stranger than ction? Imagination brings here enough ctional strangeness, and a commonality of interest rests not least in the fact that often, as Tremain puts it, the emotion is the action is the truth. The other action is the work of communication. The opening dialogue is between Rose Tremain and Margot Waddell. The analyst soon alights upon the marvellously used metaphor in Music and Silence of the group of musicians at the Swedish court of Christian IV who are made to play their music from deep down in a dark cellar to waft up to the ears of the courtiers. Waddell links this with the strains coming from the unconscious, as listened for by the analyst. She draws parallels between the historical facts Tremain uses as well as the imaginative, with those between outer and inner worlds, between actual facts and clinical facts. On her own creativity Rose Tremain spoke of how her childhood led her to taking refuge in interiority and inventing other worlds for herself. She said she needs to write in order to modify her melancholy. She also points out objectively that her novels usually include someone, often a touch idealized, who enables the protagonist to develop not unlike an analyst. Some writers have spoken of feeling when writing that a story or its characters are taking off on their own. Tremain nds that, in developing her characters, they acquire a kind of integrity which she as author has to recognize and honour. She tells of her special fascination with moments of

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epiphany, as, for example, in Sacred Country when a child suddenly discovers herself to be the wrong gender one illustration of Tremains sense of the self inside the self that we are. The follow-up chapter is the conversation between A.S. Byatt and Igns Sodr. In this exchange I felt a slight disappointment, a sense of conict perhaps, which is hard to tease out. Maybe it is because the book they earlier put out together, Imagining Characters, was so lively that there they brought out the best in each other. The problem here could be that they are in discussion about Byatts The Biographers Tale which is not one of her best. It is hampered by the one-time iron grip of post-modernism that Byatt seems to be both playing with and trying to escape. And she talks about this issue; about how it is not the readers business this time to imagine the characters as real; they are meant to be articial. Yet the point holds Sodr prevents it being intellectualized that we do nevertheless get involved in the characters, as if they were real. There is much meat in this. Perhaps the maelstrom that Byatt uses is an even better metaphor for the unconscious than Tremains music heard playing from a cellar. One gripping aspect of Byatts tale in a different way an imagined self inside another self is the protagonist biographers pursuit, via documents and strange archival objects, of another biographer who disappeared into the Maelstrom (quite real in the sense of having a geographical location) as an end to his pursuit of actual gures located in history: Ibsen, Linnaeus and Galton. So, a play between reality and ction. There was good discussion of the links between these three characters to do with ideas of drowning and other gruesomeness raised by an audience remark; furthermore Sodr brought emphasis to the central symbol via Poes short story of the maelstrom and metaphors of doubles, of fragmentation and bringing together in new forms. We consider Byatts fascination with scientists in part for being systematizers, and her aim in that novel to create a sort of mosaic form: juxtaposition rather than organic fusion as respect for science: importantly, I think, about not integrating too much. There is plenty to think about here of articulate unpacking of reality and non-reality and the recording or rendering in respect to any discipline whether art or science. Towards the discussions end Byatt elaborates her view thus: I think I write novels because I think the truth is a very, very complicated thing and only the constructed object of a novel can give you an inkling of how complicated (p. 78). (Philip Pullman, I felt sure later on, would doubtless agree.) This is followed by an amusing deux exchange with Sodr that illuminates more than one artists irritated suspicion that psychoanalysts believe they hog the truth ground. It was a nice sequential arrangement then to read the biographer Brenda Maddoxs dialogue with Helen Taylor Robinson, the latter dispelling this idea overtly when, apropos of specic approach to the meaning of material, she says:

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Thats the whole question isnt it, of truth and ction and illusion and what counts as meaning. A different discipline will take a different view on what counts as the meaning. What is the thing I am going to privilege? (pp. 856)

She has pointed to one element which instigated the post-modern dissatisfaction with xed-position literary criticism or pedagogy. In this new exchange there is more movement, more discussion of what it is psychoanalysts do, by way of trying to understand symbolic meaning, and this leads to some fascinating ideas about what the artist, in contrast, may be up to. I felt grateful to Taylor Robinson for making the point that psychoanalysts may want to come in too quickly with the conscious minds thought that it means this or that, thus making for the drying up of images. She also takes a refreshingly open view on whether the notion of depressive or paranoidschizoid functioning is actually very helpful when one is thinking about the artist absorbed in his or her work of creation. I had the idea at the beginning of the dialogue that Maddox was feeling somewhat swept along by the emphasis on the unconscious, and preferred sticking to concrete issues about her modus operandi in writing biography. If so, her discussants enthusiasm for creative disorder and, possibly, the sympathetic ambience eased the encounter into greater abstraction, especially once she read aloud some excerpts from her illuminating biographies of both Nora Joyce and D.H. Lawrence. These selected pieces show the way a writer evokes powerful feelings in the reader (and the patient in the analyst too). How conscious of this is the artist? Maddox is certain with her response: I dont think art is that unconscious. I think people know their craft. They may be trying to do something very different than other people have tried to do but they know what they are doing (p. 91). This point is subtly reinforced by something about Lawrence writing a scene with great sensitivity and the use of himself as a step-parent, and yet apparently ruthlessly cut off from this self in his engagement in an equivalent outer reality. It is a tremendous aside on artistic motivation, and on the inner as quite distinct from outer reality (pp. 824). A variant on this dichotomy is shown by Maddox to have existed in Joyces mother, and one painfully understood by her son James. This exchange shows, more than any other, how a dialogue pushed both parties understanding and exploration further into new avenues. Thus we are returned to issues of three variants of the transformative process: artist, biographer (both as writer and as mediatiator to other artists) and reader that are raised at the beginning of the book. Lots of these ideas were opened up and then left for further rumination.The arrangement of the four dialogues is expertly made, and inclusion of interventions from the audience are skilfully edited to keep the reader engaged. Philip Pullman talking with Marie Bridge was different.This author knows that he draws from his unconscious and relishes that. Clearly as is made

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clear in His Dark Materials trilogy he is fully conversant with negative capability, and Keats description of it 200 years ago. Indeed, it is as if he is ironically turning the tables on psychoanalysts, whilst making it clear that his abiding interest is in the way his child readers learn through experience, through not-knowing and knowing, and identifying. The lengthy journey he sends Lyra and Will through is one from which they learn much of what Bion might call K. In terms of writing style, Pullman speaks of his leaving ends dangling at times as later he may need to pick up a thread that was left, to push the story further as he did with his developing of the daemons: nding out that childrens daemons shift and change whereas adults remain the same. This is a direct comment on making half a link work towards a full link. It seems to me this is what the analysts mind does at the time of openly listening to the patient, then pulling links together on an unconscious level and arriving at what Bion calls the selected fact. Pullmans tale brings up many interesting bordering lands not only between the two disciplines, psychoanalysis and writing-storytelling as crafts, but also as modes for the transformative at the deepest level. Occasionally Marie Bridge draws parallels between Freuds notions of the life and death instincts, and Pullmans created world of good and evil. Then the evenings chairman suggests that listening with evenly-suspended attention is the analysts skill, as it is Lyras state of mind in interpreting her alethiometer. Pullman responds with a certain insouciance, yet very politely. I think one issue that both disciplines tackle is an opposition to authoritarian moralism as is passionately stated verbally by Pullman in relation to the C.S. Lewiss Narnia stories. This thorn was, maybe wisely, left to reverberate as one of the many powerful feelings raised by the book. It should be said that there are important differences between the two disciplines, or, to put it another way, we each take our differing ways home. One route is through the analysts thinking and expressed viewpoint, creatively interpretative but not a work of art per se. The writers route involves a creative dialogue with a pre-existing internal object, about one or more imagined characters and then through the written art to the imagined reader. One other strength of On The Way Home is all the other books that it inevitably leads one on to reading.

Harriet Thistlethwaite
London Centre for Psychotherapy, London [harrietthistlethwaite@btinternet.com]

Reference
Waddell, M. (1998) Inside Lives. London: Routledge.

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Mind Works: Technique and Creativity in Psychoanalysis by Antonino Ferro, translated by Philip Slotkin. The New Library of Psychoanalysis. Published by Routledge, London, 2009; 240 pp; 22.99.
Antonino Ferro could be read just for his truly inspiring clinical writing. This book is his fourth to be translated into English and contains an absolute wealth of fascinating clinical material, but the material is used to underpin and illustrate what Ferro calls a strong theoretical standpoint. This has implications for how Ferro believes clinical material should be listened to, and how it should be responded to. Ferro describes his theoretical position as a fruitful convergence of many concepts elaborated by Wilfred Bion and by William and Madeleine Baranger (1999, p. 157).1 First, the inuence of the Barangers, two French analysts working in South America since the 1960s. They described the analytic situation as a eld, and the notion of the bi-personal eld was rst described by Ferro in a series of articles in the 1990s and in The Bi-Personal Field (Ferro, 1999). The patient and the analyst in the setting create together a relational and emotional eld, and Ferro believes that all communications by the patient relate to the eld, which means essentially that the patient is constantly commenting on how he has received what the analyst has said. The analyst must be listening rstly to the response of the patient, but then, and this is the important point, moderate accordingly what he is saying in order to be better in tune with what the patient can take in.
The crucial point is the response to an interpretation. For example, if a patient responds to an increase in the interpretative dose by saying Yesterday my little boy cried all evening because my husband insisted on making him eat up all his food, although he had already had a snack not long before and he could not get any more food down, this can only be a signal of interpretative excess, for which no place can be found. If the same patient were to say Yesterday my husband exhausted me with his caresses and never-ending foreplay . . . she would be signalling her need for penetrating interpretative activity. (p. 19)

This is a different vertex from a usual psychoanalytical one in which the patients material being listened to is for what it is conveying about the transference relationship. The work of Ferro is also an elaboration of Bions conceptualization of thinking. It is familiar that Bion saw the mind as resembling a digestive apparatus that must be developed in order to enable it to digest sensory input, since what is digested will form the elements of the basis of thought. The work done by the mothers (or analysts) mind on the projected feelings of anxiety, or beta-elements, is crucial for the development of the capacity in the infant (or patient) to be able to transform beta-elements into alpha-

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elements, and then into thoughts. A sensory overload exceeds the minds capacity for digestion. Ferro often describes an alpha-element as a pictogram or visual ideogram which provides the basis of thought. Alphaelements are not directly accessible in waking life except through the phenomena of reverie and they become known by what Ferro describes as narrative derivatives. Narrative derivatives in the session are such things as a childhood memory, an account of something happening the previous day, a report of a lm, etc. It is by listening to these narrative derivatives that Ferro approaches the emotional truth of the patient. Reading Ferro does require mastering some of Bions language, but it is fairly easily picked up and certainly worth the effort. In fact Ferro is a very good way of approaching Bion for those who nd him difcult or too abstract. Ferro could be described as almost the opposite of Bion as a writer; his theory is absolutely rooted in detailed, clinical examples of patients who spring vividly to life in their particularity. Ferros strong theoretical position is that the principal work of an analyst is in developing the capacity of the patients ability to think (see, for example, p. 168). It is only when this capacity is well in place that direct interpretations of content or historical reconstructions are appropriate. This whole book is essentially a description of the technique Ferro believes is useful in increasing the capacity of the patient to think. It is an absolute maxim of Ferros, repeated over and over again in this and his other books, that it is the analysts job to serve up to the patient an interpretation that is at the right level, that can be taken in and digested; and this will then create a micro-transformation, an expansion of the container, an increase in the ability to be able to think, leading over time to macro-transformation. Ferro believes that an interpretation should be weak rather than strong, as unsaturated and as open as possible, leaving the maximum space for the patient to take what he will from it. A direct transference interpretation in most cases Ferro would consider too strong, risking a retreat by the patient. Describing a male patient, Ferro says:
He feels very persecuted by saturated, direct and transference-based interpretations (after one of which he said: My computer was struck by lightning and completely burnt out and it doesnt work any more!). Consequently, my style is very narrative, indirect and allusive, and will remain so until the eld signals the possibility of more precise interventions, which must not, however, break the container. (p. 69)

Ferro categorizes three types of psychopathology, which each impair the ability to think in different ways. (For this, see Ferro, 2005.) In type A pathologies, the most severe, there is a primal deciency in the formation of visual pictograms (alpha-function), the mind itself may even have failed to form. In type B pathologies, alpha-elements are formed, but the apparatus

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for processing them is missing. To explain this Ferro gives an analogy from lm. In type A pathology:
The situation may be likened to a cine camera with no lm stock: the basic frames out of which the eventual movie should be composed are lacking . . . in type B the lm is exposed, but then either it is not developed (there are no narrative derivatives) or the directorial function required to edit the vast number of frames shot the PsD is lacking. (2002, p. 2)

In type C pathology the quantity of sensory stimulation, due to accumulation and trauma, outstrips the capacity of the alpha-function to form alphaelements; there is a sensory overload, and a failure to be able to process into emotions and thoughts. The task of the analysis varies according to the type of pathology. It could be to activate for the rst time, or to reactivate the mental functions that enable the patient to be able to process thoughts or, in the language of lm, to be able to develop the lm. There are two chapters at the heart of the book, one on psychosomatics and the other on homosexuality, which Ferro describes as work in progress in which he gives an extended series of clinical examples which permit him to show a gradual emergence of a theoretical conceptualization, and the chapter on homosexualities is the most innovative and interesting of these. In Homosexualities: A Field Ripe for Ploughing, Ferro illustrates via multiple clinical examples his view that homosexuality should be considered as a way of relating that has nothing to do with biological gender; a male/ female gendered couple is capable of functioning in a homosexual way and a couple of the same gender can function heterosexually. Homosexuality is bound up with the functioning of minds and their interrelationships:
Psychoanalysis could in fact advantageously lead us to consider the existence of couples who are heterosexual on the phenotypic level but in reality substantially homosexual, or to investigate phenotypically homosexual couples who are in reality more heterosexual than ofcially heterosexual couples. This would provide us with a revolutionary vertex, from which we could think of psychoanalysis too as something genuinely capable of opening up scandalous vistas of thought that turned out to contain truths that were more true than they seemed . . . (p. 117)

Briey, a psychic heterosexual way of relating is illustrated by , whereas the two main types of homosexuality Ferro discusses are symbolized by and . represents a male form of homosexuality, in which the management of the hypercontents (. . .) becomes problematic as adequate containing capacity is lacking. Violent, destructive thoughts that cannot be contained by another mind have to be tranquillized and weakened in order that they do not leap out. In what Ferro is describing as a female homosexuality, :
The quest is for total harmony in order to avoid the leaping out of unmanageable hypercontents. This form is in a sense even more archaic and persecutory,

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because it involves phobic avoidance of the hypercontent , the leaping out of which must be prevented. In the male form, on the other hand, it has already leapt out, and the problem is how to manage it. (p. 115, italics in text)

There are two loose strands to the chapter Psychosomatic Pathology or Metaphor: Problems of the Boundary. First, as always, through clinical material he sets the limits of the psychoanalytic endeavour. All that an illness can be used for in a psychoanalytic session is to illuminate what is going on in the eld and the patients mind. That is the boundary that psychoanalysis has to accept and it can say nothing about the actual illness. In discussing a patient with haemophilia:
. . . does what the patient says tell us any more about the haemophilia or its pathogenesis, psychogenesis, and psychosomatic and somato-psychotic aspects? Or must we undertake a narcissistic renunciation, in the belief that, in our psychoanalytic laboratory, haemophilia means the patients tendency to bleed and to be vulnerable on an emotional level, so that he avoids traumas, conicts and ghts, which he forestalls by avoiding dependence? In that case, haemophilia would be regarded as the character of the session most capable of conferring narratability on what is happening in his internal world and relationships. (p. 76)

In the second half of this chapter there is a discussion of psychosomatic disorders as being evacuations of beta-elements into the body which happens when there is no container available to shift the balance towards what is thinkable (p. 86). By reading this book straight through, which I do recommend, you immerse yourself in Ferros particular way of writing and how he responds to his patients. Ferro has got better as a writer. Compared to his earlier book, The Bi-Personal Field (Ferro, 1999), this book is written more freely and is more enjoyable to read. You see his mind at work, which is to see his creativity and humanity at work. Again and again you are surprised at what he sees in the material, and the depth and subtlety of his response. Not unusually, he believes that creativity comes from being yourself and from being open to what comes into your mind, the narrative derivative created by the session. He gives several intriguing examples of something, seemingly unrelated, coming into his mind and spoken that shifts something in the mind of a supervisees patient. Unthinkingly following rules and too much overt transference interpretation are the enemies of thought and creativity, as is the superego of the therapist. Perhaps one of the problems of reading Ferro is that he can undermine long-held views, such as the importance of making a transference interpretation, and leave you unsure what it would be most helpful to put into words. Stay with the manifest content for a lot longer and see where it goes, he advises.

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I end with Ogden on Ferro:

It is principally in living with Ferro in various analytic situations created in his writing and in the experience of reading that the reader learns about Ferros analytic technique. More accurately, the reader nds that he or she has been transformed by the experience of reading these clinical accounts and that he or she no longer listens to or lives emotional experiences with patients in quite the same way as he or she had previously. (Ferro, 2005, p. xiii)

Ferro deserves to be more widely read than he is.

Linda Pethick
London Centre for Psychotherapy, London [Linda@bpethick.me.uk]

Note
1. For the work of Madeleine and Willy Baranger, see Baranger and Baranger (2009), Churcher (2008) and de Leon de Bernardi (2008).

References
Baranger, M. & Baranger, W. (2009) The Work of Conuence: Listening and Interpreting in the Psychoanalytic Field. London: Karnac. Churcher, J (2008) Some notes on the English translation of The analytic situation as a dynamic eld. International Journal of Psychoanalysis 89(4): 78593. De Leon de Bernardi, B. (2008) Introduction to the paper by Madeleine and Willy Baranger, The analytic situation as a dynamic eld. International Journal of Psychoanalysis 89(4): 77384. Ferro, A. (1999) The Bi-Personal Field. London: Routledge. Ferro, A. (2002) In the Analysts Consulting Room. London: Routledge Ferro, A. (2005) Seeds of Illness, Seeds of Recovery. London: Routledge.

Doubt, Conviction and the Analytic Process by Michael Feldman. Published by Routledge, London, 2009; 268 pp; 57.00 hardback, 22.00 paperback.
This is an unsettling and absorbing book. With painstaking detail Feldman takes you through his thinking about his patients. Not for a moment does the rigour of his thinking relax as he is not satised unless he has reached as far as he can into the details of psychic phenomena. This is done by constant and careful monitoring of his own and his patients emotional terrain. His interpretations, built upon this extraordinary attention to detail, are given to his patients without once losing sight of the analytic task of enabling psychic change. Few psychoanalysts are able to work with such precision and then go on to describe their work with both clarity and detail.

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Feldman is clear in his view that psychic change comes about through an alteration of the relationship between internal objects made possible by a lessening of projective processes, and that this is enabled by the study of these processes in the transference. Underlying all his writing is the preoccupation with how to bring about psychic change, and in this regard he is ever the physician concerned to diagnose and treat his patients illness. He has been a practising psychoanalyst for many years as well as having been a Consultant Psychotherapist at the Maudsley Hospital in London. Psychoanalysis is not, for him, an intellectual pursuit for its own sake but a deeply serious method of treatment for mental illness to which he applies great intellectual rigour. I think this is an important distinction and is in part what makes this book stand out from many of the seemingly endless papers and books about psychoanalysis and psychotherapy. A deep knowledge and awareness of the suffering of mental illness and the way it restricts individual development lie behind Feldmans writing. Mr K is just one clinical example of many that Feldman gives throughout this book. Mr K, a patient from a remote area of Eastern Europe with a controlling and intrusive mother, reports a dream followed by an association. Feldman notes his patients brighter mood compared to the previous week and his own relief at this, and makes a traditional dream interpretation in which he links the patients dream with himself as a transference gure. Feldman then observes his own reaction: For a few moments the formulation that I had arrived at was invested with a comfortable and gratifying feeling of conviction (p. 246). Mr K readily agreed with the interpretation and made a link to his relationship with his mother. Feldman then began to realize he had lost his earlier, gratifying feeling of conviction about his interpretation and also that Mr K was trying to nd something to talk about, as if trying to cope with his actual feelings of being stuck. The good interpretation had, Feldman observes, not led to further engagement. In his discussion of this clinical encounter, like so many in this book, Feldmans experience and acumen then take the reader into a new territory of clinical thinking. He writes:
With hindsight, I dont think my interpretation of the dream was incorrect, or that a different interpretation would necessarily have been more valid or useful. Initially I tried to consider whether my sudden loss of conviction might be the consequence of a hostile and/or envious attack by the patient, but I cannot nd any evidence for that. What I now think is the very fact of having, briey, had a sense of conviction at that point in the session should have alerted me to the possibility that I was in the wrong place. I had been induced into the activity of interpreting the dream . . . It was as if we (patient and analyst) shared a wish to move into a mode of interacting where we exchanged ideas and interpretations about his relationship with his mother. (p. 247)

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Feldman continues:
By contrast, when I subsequently commented to Mr K on what had happened in the session, how he seemed to get stuck, as if he found my interpretation of no use or actually harmful, I found I was neither convinced of this, but neither was I particularly doubtful about what I had observed. It seemed to me that something more real, more immediately valid followed. (p. 248)

From his discussion of Mr Ks session, Feldman concludes that a sense of conviction in the analyst is due to an over-valued idea (Britton & Steiner, 1994) or to a narcissistic over-valuation in his interpretation. This indicates that the analyst is out of touch with his patient. With his characteristic scrutiny and reection Feldman demonstrates that there is no place for complacency in the work of a psychoanalyst; there is no hiding in knowing or giving clever, or remote, interpretations being convinced. But he is saying much more than this as he demonstrates clinically that any such convinced moment is both meaningful in itself and also bound to be followed by something different. There is no xed emotional point in a session. While the work of an analyst is to arrive at some formulation of the patients mental state, that very formulation itself brings an alteration in the mental state of both the patient and the analyst which requires reformulation, time and time again, in an evolving emotional experience. Therefore, there is no endpoint of knowing. Convincing and helpful as this is, it is nonetheless uncomfortable reading for clinicians as we are inevitably driven to review, assess and think about our own work when reading such vivid and analytical clinical descriptions. Rooted in Freud and building on Kleins work, Feldmans practice is also heavily inuenced by his own teachers and colleagues, most notably Rosenfeld, Bion, Segal, Joseph, OShaughnessy, Britton and Steiner. He refers to their writings throughout the book and there is a profound continuity with their ideas, yet also a development that is Feldmans own. It is hard to really distil out the inuence of his different colleagues as the group, perhaps best known as The Contemporary Kleinians of London (for a book of this title, see Schaffer [1997]), is a melting-pot of ideas and mutual inuences. Notions of memory and desire, ideas of the psychotic and non-psychotic aspects of the personality, selected facts and overvalued ideas, analyst-centred interpretations, to name but a few of the concepts that have been developed by this group. Feldman builds, for example, on Josephs concern to understand and tease out the precise nature of the transference and her conviction that the careful elucidation of the interactions between the patient and the analyst reveal the patients history. Feldman then shows how a patients history can be illuminated for the patient by the analyst making meaningful links. Instead of history being used as remote knowledge to reconstruct the past for the patient, the patients own ego is engaged in an emotional experience by the analysts understanding. In the chapter on Grievance,

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Feldman beautifully synthesizes much of the psychoanalytic thinking to date. The understanding of aggrieved states is important for psychoanalytical psychotherapists because of the embargo it places on their patients development. Feldman explores, again with his clinical examples, the underlying dynamic of the pull of the omnipotent phantasy together with the hatred and attack on the oedipal couple and shows how, in the treatment situation, it is the analyst who comes to embody this couple. It is the careful unravelling of how psychic phenomenon play out in the relationship between patient and analyst that is, to my mind, the hallmark of Feldmans contribution. All the chapters were written from 1989 to 2009 and all, apart from three I Was Thinking . . ., Filled With Doubt and The Problem of Conviction in the Session have been previously published in earlier forms. This does not detract from the importance of reading Feldmans ideas together, as a body of work. Some chapters, principally the earlier ones (the chapters do not follow chronologically), seem to me more concerned to illustrate the use and application of ideas of projective identication, primitive emotional states and their defences following the work of Klein, Rosenfeld, Segal, Bion and Rey. These are lucid and helpful elaborations as Feldmans approach is so deeply clinical and it remains important to have these difcult concepts rened in new ways. But it is perhaps the chapters written later in time that for me have a particular freshness and wisdom. No longer is Feldman addressing some of the standard criticisms of Klein and her followers, trying to prove the clinical usefulness of the concept of the death instinct, the ubiquity of projective processes or the totality of the transference, for example, but seems freer to address his own clinical dilemmas and contemporary problems. How to think about patients who begin sessions with the statement I was thinking . . ., how to address the different aspects of the patient, what place does a patients history have in the day-to-day of their analysis, as well as what is happening if the analyst becomes convinced or paralysed with doubt and uncertainty are just some of the areas in which Feldman opens our eyes to new understanding. As such, this book is an important addition to the psychoanalytical literature and merits careful attention.

Anne Amos
British Psychoanalytical Society, London [anneamos@blueyonder.co.uk]

References
Britton, R. & Steiner, J. (1994) Interpretation: Selected fact or overvalued idea? International Journal of Psychoanalysis 75: 106978. Schaffer, R. (ed.) (1997) The Contemporary Kleinians of London. Madison, CT: International Universities Press.