There is nothing "modern" about psychiatrist Mark Warren, despite the title of his book, nor about the state hospital in which he spends his first year as a resident. It's still Bedlam (the author even calls it that, to hide the hospital's real name) and our hero seems to have no idea how to treat his wildly deranged patients.
We follow him from his first day in the ward ("I am introduced to my patient, a 70-year-old lying naked in a puddle of pee") through the first time he is attacked and beaten (by a woman -- an ax murderer). We observe his anger, depression and fears. Above all, we share his abysmal confusion.
Many of his patients are so psychotic and so dangerous that they clearly need medication. But Max, the budding psychiatrist who is the author's alter ego, resists his new role. He would like to do "insight-oriented therapy." Even when he realizes that his patients are not getting better without drugs -- the major tool of modern psychiatry, which teaches that most psychoses are related to chemical disturbances in the brain -- he hates to prescribe them.
Most of all, he cannot bear to force these "meds" on patients who don't want to take them. Throughout the book he keeps confronting this dilemma: "Is it better for patients to be mad and locked up and have their rights not to take drugs observed, or is it better to force meds and get them out of the hospital fast? Which takes away more freedom?" Meanwhile new patients keep coming in -- babbling or mute, murderous or suicidal, each in his own way incomprehensible.
Warren writes in almost comic-strip style as he describes Max's frustrations on the job ("AARRRGGGGHHH!") and his relief through happy encounters with his sexy, all-knowing wife. Both become tiresomely repetitive. We are expected to see how much Max has matured and grown at the end of a year of dealing with patients, nurses, colleagues, supervisors and the reality of craziness. Yet what has he learned? It's not clear -- and from the point of view of people who may need psychiatric care someday, s that's not at all reassuring.
In "A Psychoanalyst's Quest," we enter a different world. It's not too reassuring, either -- Richard Robertiello warns that "choosing an analyst is perhaps even more crucial than choosing a mate . . . ' " But at least the author presents a coherent view of what he is doing, as well as a lively account of the controversies in his field.
Robertiello started out as a classically trained Freudian in the 1950s. Although he has gone through many different stages since then, he firmly believes in the value of theory. He has a solid grounding in what he calls "the science of psychoanalysis: that what happens in one session is predictable from the previous one; that dreams involve a sequential unfolding of the unconscious; that a session has a central theme that makes it cohesive."
Now that he supervises other analysts, Robertiello says, "I will never accept the statement from a supervisee that the patient is getting better, but he has no idea why this is happening." In his view, conducting analysis without a strong theoretical base is "analogous to performing surgery with a dull spoon."
Nevertheless he has changed his technique -- and some of his theories -- radically in the past 30 years. In the 1960s he rebelled against the cold, impersonal stance of classical analysts which, he believed often produces "dead, conforming people." He began to develop his own style of dealing with patients -- face-to-face, rather than from behind the couch, and without fear of revealing his own personality. "If Freud had been Italian, he might have held every patient in his arms," he writes. He dabbled in Zen Buddhism. He had a transcendental experience. He divorced his wife.
At the same time, he "discovered" the English psychoanalysts and the Object Relations school led by Melanie Klein, Donald Winnicott and others who emphasized the infant's need for attachment to the mother and the lasting impact of experiences during the earliest, pre-Oedipal years. He became an admirer and leading interpreter of Heinz Kohut, whose studies of narcissism also focused on mother-child relations in the first year of life.
Robertiello believes that over the years his patients got well -- regardless of his changing technique -- largely because of "my commitment to an attention that was riveted on them" and his fundamental understanding of their psyches. Of course, like other analysts, he has had the luxury of dealing with people who are not very sick. Not for him the miserable, raving psychotics who appear in the wards of state hospitals. Instead, he writes, he chooses his patients from among "bright, interesting, creative" people, many of whom are actors, artists or analysts.
"I ask myself during the first session, 'Do I wish to spend a part of my life with this person?' " he writes. "Is he (or she) interesting enough for me to make an emotional commitment to?" This kind of choice is a luxury few mortals are in a position to enjoy, and Robertiello realizes it. The rewards of psychoanalysis, he declares, "cannot be matched by any other profession."