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Freud: Living and dying
68
Boot: REVIEWS
of date. Present medical knowledge and health care delivery services are being explored and reconsidered, studied and changed rapidly in many areas of North America. Perhaps it is time for social science to concede the positive social awareness of medicine and to outline the strengths of our health care systems as well as the abuses. While this book in esSence is “low-profile” it does yield to heavyhanded judgmental statements. there is still room for a constructive approach between the practice of medicine and the critique of social science. Questions which need to be answered are: What constitutes a “good deal” for the patient or what does he want? What is better medical care? How can our particular social system provide it? These questions go beyond the bland easy statementsofthe well-meaningcritic. The next ten years may answer questions relating to what the future holds for the patient. Perhaps social scientists and physicians together can help design the future through a variety of appropriate experimental models. Then describe them in a third edition of Jaco’s sourcebook. L. M. CATHCART Dept. of Family and Community St. Michael’s Hospital. Toron to, Ontario
Medicine,
Freud: Living and Dying, by MAX SCHUR. International Universities Press, New York, 1972, 587 pp. $20.00.
“Let the biographers chafe; we won’t make it too easy for them. Let each one of them believe he is right in his ‘Conception of the Development of the Hero’, even now I enjoy the thought of how they will go astray.” (S. Freud’s letter to Martha Bernay, April 28, 1885.) At the time of writing this humorous remark, Freud was a genius in search of a cause. By discovering psychoanalysis. hc not only unravelled the riddle himself. hc voiced an omen for this “fated to misfortune group of people” (his future biographers) who would dare make a guess at it. Max Schur was something more than a passer-by in Freud’s life. As his oersonal ohvsician from 1928-1939. he was an intimate eyewitness and a dedicated and constant companion in the declining years of this exceptional man. He could not help but be impressed by the unflinching fortitude shown by his patient in facing the “ultimate expression of human helplessness” that is death, and be lured into guessing at the riddle of Freud’s development. Schur felt that previous biographers, particularly Jones, had mistaken the true conception of the development of Freud’s personality and ideas by not having paid enough attention to the nature of “the Staff, the third leg mentioned by the Sphinx”. which helped him walk the last hours of his life. Schur was puzzled by two things: one was the emergence of the Theory of the Death Instinct and the over-riding Principle of Repetition Compulsion in the course of Freud’s psychoanalytical thought; the other was the extreme courage his patient showed in facing the reality of death, since, during his lifetime, he had been obsessed by it. He not only disagreed with Freud’s formulation of his Druth Instinct. but hc also felt that the reasoning behind it was not up to Freud’s standards.
ReJecting an essential part of psychoanalytic theory. and remaining true to psychoanalysis is. in itself. a difficult problem. but if the father of psychoanalysis happens to be one whom you revere. and to whom you feel indebted. this becomes a serious personal emotional conflict. Trying to solve this conflict seems to have been what Max Schur had in mind, when he started to write his book on Freud. How well he succeeded is something only the future will tell. The contribution of previous biographers has been to relate Freud’s personality and lifeexperiences to the development of his ideas. The role played by Freud’s self-analysis in the discovery of psychoanalysis is well statid. So far. no one has tried to demonstrate how the invention of psichoanalysis and the commitment to its cause served Freud as an adaptative measure in successfully coping with his rational and irrational fears of death and the problem of “the beyond”. Freud’s motto could well have been Si ris rirczm pcwtr morrem. Prolonging his life and living fully to the bitter end was one of his deepest concerns. To lose his composure. or to resort to denial in order to face death, would have meant not only disgrace for himself but also for psychoanalysis. On the contrary. bearing his hopelessness with heroism and awareness was the base of his dignity and self-respect. The author traces the development of Freud’s attitudes towards illness, dying and death to his earliest childhood experiences. Following the traditional path marked by previous biographers, he reviews Freud’s writings’ and personal correspondence and tries to extrapolate from these the inner workings and deeper layers of Freud’s mind. The book is divided into three sections. The first. Per Aspern ad Astra. discloses Freud’s struggle for discovering psychoanalysis through the unique feat of his own selfanalysisinanattempttoovercomehisneuroticsymptomsand obsessional preoccupation with death. This was prompted by the death of his father and his own “guilt of the survivor”. Schur considers Freud quite successful in his endeavour since most of his neurotic symptoms. such as travel phobia. fear of dying, doubts about ever finding the answer to his many questions and depressive letdowns were solved through analysis. All that persisted was a neurotic leftover related to his inability to work through his transference with Fiiess. He proceeds. however. in great length to clarify the organic nature of Freud’s cardiac episodes, which Jones mistakenly interpreted as neuroticism. In the
second section, Towrrrd CI Scientific We/runsthe main thesis of the book becomes obvious. Schbr claims that in treating death as a scientific problem and formulating it in metapsychological terms. Freud was able to overcome his natural and neurotic fears of death. The man. who all his life fought any illusion. religious or philosophic, concludes by upgrading his own scientific illusion in order to deal personally with mankind’s ultimate problem. For reason and love. Logos and Eros. and against destruction.“he findsit easier to subject himself to a remorseless law of nature. the Death Instinct he had discovered. than to sheer chance”. This discovery not only made the thought of death more bearable for him but also sustained him during the inevitable course of cancer. It also provided him with a kind of strength and human resourcefulness required to cope with the ordeals which illness and history had in store for him. chauung.
In parts one and two. we tind Schur. the scholar and psychoanalyst. with German obstinacy and Talmudic patience, going over details and obscure meanings in Freud’s writings and correspondence thus running the risk of exhausting the
&OK
REVIEWS
69
cial recompense”. This addenda would clearly differentiate the volunteer from the various government subsidized groups. who are neither employees nor true volunteers, and from those students performing required field work. An ancient recipe for Jugged Rabbit reads “First catch your rabbit,” a lesson Mr. Routh recognizes in his chapter on “catching rabbits”, noting “there is no tried and true method for recruiting volunteers. It is a hard job”. How true! In alphabetical sequence, he suggests multiple avenues of approach available in the community. The value of massmedia publicity is emphasized while the necessity for careful screening of those recruited is realistically noted. Not delineated are the techniques to discard undesirable applicants and yet retain their good will. On the basis of his obvious expertize his techniques would be interesting and helpful. The entire book is invaluable for assessment of staff attitude, but the chapter on “Desirable Qualities in a Volunteer”, could, in particular, provide prospective and active volunteers with an in-depth understanding of their clientagency-volunteer role. Seldom have the nuances of the demanding skills and attitudes required in the client-volunteer relationship been more graphically explored and explained. The working staff may develop acute professional indigestion when they encounter the statement that “The truth of the matter is that in such cases ‘(limited funds)’ the clients are as well or better served by volunteers”. Adequate training is the right and requirement for every volunteer. Routh states “If a volunteer is trained adequately he can perform a highly useful service, in many cases borz dering on the professional. If he has not been trained he should not be used at all”. He emphasizes the necessity for staff commitment to orientation and training and the basics to be included in such training including the nature of the program, agency goals to be achieved and job obligations and responsibilities. The agencies’ staff responsibilities do JUAN CAMPOS not end with a comprehensive training program but entail Office of Medical Education. Universidad Autononm de Barcelona, on-going supervision and performance review. He has Barcelona, Spain explained in detail the various facets of training designed to make the volunteer a valuable and productive team member. Routh’s experience with volunteers has been primarily with those working with Public Welfare clients, therefore, when he discusses specific assignments, they are those serving the client in his home. Assignments in institutions such as hospitals, blood banks, scouts, school lunchrooms would differ widely from the role of the friendly The Volunteer and Community Agencies, by THOMASA. visitor, but the basic human relationships between a client ROIJTW.Charles C. Thomas, Springfield, Illinois. 93 pp. and a volunteer remain constant. After adequate training $6.50. has been completed, an assignment should be made on the basis of the volunteer’s capabilities, desires, personal needs Thomas Routh has produced a superb handbook, valuable and available time. As a result, assignments will best meet to any agency contemplating the use of volunteers. It should the agency’s goals of extended service to the client and, ‘by be required reading for the professional staff of social agenso doing, assist the agency in overcoming some of the limicies presently involved with Volunteer Services. Many previous publications on volunteerism, which have issued forth ’ tations imposed upon it by an inadequate budget. Obviously no agency staff member has the available time from academe, have been scientifically researched and strucnor the expertize to initiate, publicize, recruit. train, supertured by academicians. Having no practical field experience, vize and review a volunteer program, therefore, Routh these have produced an academicism. Routh, however, has recommends the employment of a Volunteer Coordinator “labored in the vineyard. prest the grapes and sampled the more generally known as a Director of Volunteers. This vintage”-plus the occasional vinegar. paragon among women (Women’s Libbers should note that His book progresses in logical sequence from a definition in the book the coordinator is referred to as “she”) must of volunteers through their recruitment. desirable qualities, possess an awesome multiplicity of skills to perform her proper training. suitable assignments to the onus of record multitudinous duties. In addition to the sense of humor maintenance. which Routh feels is an essential part of the volunteer’s He utilizes the Webster Dictionary’s definition, “one who make-up. the coordinator requires a sense of the hysterienters into. or offers himself for service of his own free will” cally-ridiculous that is encountered in the operation of a to which. in my opinion. should be append&l “for no finan-
patience and interest of the reader. In the third section, Illness und Death, he becomes the dedicated doctor and true friend of Freud, which he undoubtedly was. He is no longer the writer and researcher. Drawing heavily on the personal experiences he shared with Freud, unconcerned with him as genius and hero. with touching gentleness he shows us the man, an aging human being afflicted with cancer, who with great dignity and courage faces inevitable death but continues to fight for reason, love and human freedom against oppression, madness and death. How far Schur has gone astray in his own “Conception of the Hero” is something which should not concern us too much. He certainly has succeeded in bringing us closer to Freud. and by so doing helps us to understand the man and his work. From now on, anyone interested in behavioral science must refer to Schur’s book if he more thoroughly desires to understand the background of psychoanalysis. What was originally intended as a last chapter to Jones’ biographical section has now become a volume in its own right, a source of reference one cannot do without. A psychoanalytical biographer, however. can learn a lesson from Schur’s work. Applying psychoanalysis to the writings of a man to whom one has been close is not advisable. Psychoanalysis is only good in understanding people when applied in the context of a psychoanalytic situation. Schur discovered that Freud was using his friend, Fliess, as a transference-like object in his self-analysis. If, instead of trying to psychoanalyze Freud. as he does in the first two sections of the book by interpreting the interpersonal cohtext qf Freud’s verbal productions, Schur had dared to draw more heavily on his personal experiences and work with his own counter-transferential feelings for Freud, he could have presented us with a clearer picture of him. Schur, in turn, would have possibly come closer to the truth in his “Conception of the Development of the Hero”.
Boot: REVIEWS
of date. Present medical knowledge and health care delivery services are being explored and reconsidered, studied and changed rapidly in many areas of North America. Perhaps it is time for social science to concede the positive social awareness of medicine and to outline the strengths of our health care systems as well as the abuses. While this book in esSence is “low-profile” it does yield to heavyhanded judgmental statements. there is still room for a constructive approach between the practice of medicine and the critique of social science. Questions which need to be answered are: What constitutes a “good deal” for the patient or what does he want? What is better medical care? How can our particular social system provide it? These questions go beyond the bland easy statementsofthe well-meaningcritic. The next ten years may answer questions relating to what the future holds for the patient. Perhaps social scientists and physicians together can help design the future through a variety of appropriate experimental models. Then describe them in a third edition of Jaco’s sourcebook. L. M. CATHCART Dept. of Family and Community St. Michael’s Hospital. Toron to, Ontario
Medicine,
Freud: Living and Dying, by MAX SCHUR. International Universities Press, New York, 1972, 587 pp. $20.00.
“Let the biographers chafe; we won’t make it too easy for them. Let each one of them believe he is right in his ‘Conception of the Development of the Hero’, even now I enjoy the thought of how they will go astray.” (S. Freud’s letter to Martha Bernay, April 28, 1885.) At the time of writing this humorous remark, Freud was a genius in search of a cause. By discovering psychoanalysis. hc not only unravelled the riddle himself. hc voiced an omen for this “fated to misfortune group of people” (his future biographers) who would dare make a guess at it. Max Schur was something more than a passer-by in Freud’s life. As his oersonal ohvsician from 1928-1939. he was an intimate eyewitness and a dedicated and constant companion in the declining years of this exceptional man. He could not help but be impressed by the unflinching fortitude shown by his patient in facing the “ultimate expression of human helplessness” that is death, and be lured into guessing at the riddle of Freud’s development. Schur felt that previous biographers, particularly Jones, had mistaken the true conception of the development of Freud’s personality and ideas by not having paid enough attention to the nature of “the Staff, the third leg mentioned by the Sphinx”. which helped him walk the last hours of his life. Schur was puzzled by two things: one was the emergence of the Theory of the Death Instinct and the over-riding Principle of Repetition Compulsion in the course of Freud’s psychoanalytical thought; the other was the extreme courage his patient showed in facing the reality of death, since, during his lifetime, he had been obsessed by it. He not only disagreed with Freud’s formulation of his Druth Instinct. but hc also felt that the reasoning behind it was not up to Freud’s standards.
ReJecting an essential part of psychoanalytic theory. and remaining true to psychoanalysis is. in itself. a difficult problem. but if the father of psychoanalysis happens to be one whom you revere. and to whom you feel indebted. this becomes a serious personal emotional conflict. Trying to solve this conflict seems to have been what Max Schur had in mind, when he started to write his book on Freud. How well he succeeded is something only the future will tell. The contribution of previous biographers has been to relate Freud’s personality and lifeexperiences to the development of his ideas. The role played by Freud’s self-analysis in the discovery of psychoanalysis is well statid. So far. no one has tried to demonstrate how the invention of psichoanalysis and the commitment to its cause served Freud as an adaptative measure in successfully coping with his rational and irrational fears of death and the problem of “the beyond”. Freud’s motto could well have been Si ris rirczm pcwtr morrem. Prolonging his life and living fully to the bitter end was one of his deepest concerns. To lose his composure. or to resort to denial in order to face death, would have meant not only disgrace for himself but also for psychoanalysis. On the contrary. bearing his hopelessness with heroism and awareness was the base of his dignity and self-respect. The author traces the development of Freud’s attitudes towards illness, dying and death to his earliest childhood experiences. Following the traditional path marked by previous biographers, he reviews Freud’s writings’ and personal correspondence and tries to extrapolate from these the inner workings and deeper layers of Freud’s mind. The book is divided into three sections. The first. Per Aspern ad Astra. discloses Freud’s struggle for discovering psychoanalysis through the unique feat of his own selfanalysisinanattempttoovercomehisneuroticsymptomsand obsessional preoccupation with death. This was prompted by the death of his father and his own “guilt of the survivor”. Schur considers Freud quite successful in his endeavour since most of his neurotic symptoms. such as travel phobia. fear of dying, doubts about ever finding the answer to his many questions and depressive letdowns were solved through analysis. All that persisted was a neurotic leftover related to his inability to work through his transference with Fiiess. He proceeds. however. in great length to clarify the organic nature of Freud’s cardiac episodes, which Jones mistakenly interpreted as neuroticism. In the
second section, Towrrrd CI Scientific We/runsthe main thesis of the book becomes obvious. Schbr claims that in treating death as a scientific problem and formulating it in metapsychological terms. Freud was able to overcome his natural and neurotic fears of death. The man. who all his life fought any illusion. religious or philosophic, concludes by upgrading his own scientific illusion in order to deal personally with mankind’s ultimate problem. For reason and love. Logos and Eros. and against destruction.“he findsit easier to subject himself to a remorseless law of nature. the Death Instinct he had discovered. than to sheer chance”. This discovery not only made the thought of death more bearable for him but also sustained him during the inevitable course of cancer. It also provided him with a kind of strength and human resourcefulness required to cope with the ordeals which illness and history had in store for him. chauung.
In parts one and two. we tind Schur. the scholar and psychoanalyst. with German obstinacy and Talmudic patience, going over details and obscure meanings in Freud’s writings and correspondence thus running the risk of exhausting the
&OK
REVIEWS
69
cial recompense”. This addenda would clearly differentiate the volunteer from the various government subsidized groups. who are neither employees nor true volunteers, and from those students performing required field work. An ancient recipe for Jugged Rabbit reads “First catch your rabbit,” a lesson Mr. Routh recognizes in his chapter on “catching rabbits”, noting “there is no tried and true method for recruiting volunteers. It is a hard job”. How true! In alphabetical sequence, he suggests multiple avenues of approach available in the community. The value of massmedia publicity is emphasized while the necessity for careful screening of those recruited is realistically noted. Not delineated are the techniques to discard undesirable applicants and yet retain their good will. On the basis of his obvious expertize his techniques would be interesting and helpful. The entire book is invaluable for assessment of staff attitude, but the chapter on “Desirable Qualities in a Volunteer”, could, in particular, provide prospective and active volunteers with an in-depth understanding of their clientagency-volunteer role. Seldom have the nuances of the demanding skills and attitudes required in the client-volunteer relationship been more graphically explored and explained. The working staff may develop acute professional indigestion when they encounter the statement that “The truth of the matter is that in such cases ‘(limited funds)’ the clients are as well or better served by volunteers”. Adequate training is the right and requirement for every volunteer. Routh states “If a volunteer is trained adequately he can perform a highly useful service, in many cases borz dering on the professional. If he has not been trained he should not be used at all”. He emphasizes the necessity for staff commitment to orientation and training and the basics to be included in such training including the nature of the program, agency goals to be achieved and job obligations and responsibilities. The agencies’ staff responsibilities do JUAN CAMPOS not end with a comprehensive training program but entail Office of Medical Education. Universidad Autononm de Barcelona, on-going supervision and performance review. He has Barcelona, Spain explained in detail the various facets of training designed to make the volunteer a valuable and productive team member. Routh’s experience with volunteers has been primarily with those working with Public Welfare clients, therefore, when he discusses specific assignments, they are those serving the client in his home. Assignments in institutions such as hospitals, blood banks, scouts, school lunchrooms would differ widely from the role of the friendly The Volunteer and Community Agencies, by THOMASA. visitor, but the basic human relationships between a client ROIJTW.Charles C. Thomas, Springfield, Illinois. 93 pp. and a volunteer remain constant. After adequate training $6.50. has been completed, an assignment should be made on the basis of the volunteer’s capabilities, desires, personal needs Thomas Routh has produced a superb handbook, valuable and available time. As a result, assignments will best meet to any agency contemplating the use of volunteers. It should the agency’s goals of extended service to the client and, ‘by be required reading for the professional staff of social agenso doing, assist the agency in overcoming some of the limicies presently involved with Volunteer Services. Many previous publications on volunteerism, which have issued forth ’ tations imposed upon it by an inadequate budget. Obviously no agency staff member has the available time from academe, have been scientifically researched and strucnor the expertize to initiate, publicize, recruit. train, supertured by academicians. Having no practical field experience, vize and review a volunteer program, therefore, Routh these have produced an academicism. Routh, however, has recommends the employment of a Volunteer Coordinator “labored in the vineyard. prest the grapes and sampled the more generally known as a Director of Volunteers. This vintage”-plus the occasional vinegar. paragon among women (Women’s Libbers should note that His book progresses in logical sequence from a definition in the book the coordinator is referred to as “she”) must of volunteers through their recruitment. desirable qualities, possess an awesome multiplicity of skills to perform her proper training. suitable assignments to the onus of record multitudinous duties. In addition to the sense of humor maintenance. which Routh feels is an essential part of the volunteer’s He utilizes the Webster Dictionary’s definition, “one who make-up. the coordinator requires a sense of the hysterienters into. or offers himself for service of his own free will” cally-ridiculous that is encountered in the operation of a to which. in my opinion. should be append&l “for no finan-
patience and interest of the reader. In the third section, Illness und Death, he becomes the dedicated doctor and true friend of Freud, which he undoubtedly was. He is no longer the writer and researcher. Drawing heavily on the personal experiences he shared with Freud, unconcerned with him as genius and hero. with touching gentleness he shows us the man, an aging human being afflicted with cancer, who with great dignity and courage faces inevitable death but continues to fight for reason, love and human freedom against oppression, madness and death. How far Schur has gone astray in his own “Conception of the Hero” is something which should not concern us too much. He certainly has succeeded in bringing us closer to Freud. and by so doing helps us to understand the man and his work. From now on, anyone interested in behavioral science must refer to Schur’s book if he more thoroughly desires to understand the background of psychoanalysis. What was originally intended as a last chapter to Jones’ biographical section has now become a volume in its own right, a source of reference one cannot do without. A psychoanalytical biographer, however. can learn a lesson from Schur’s work. Applying psychoanalysis to the writings of a man to whom one has been close is not advisable. Psychoanalysis is only good in understanding people when applied in the context of a psychoanalytic situation. Schur discovered that Freud was using his friend, Fliess, as a transference-like object in his self-analysis. If, instead of trying to psychoanalyze Freud. as he does in the first two sections of the book by interpreting the interpersonal cohtext qf Freud’s verbal productions, Schur had dared to draw more heavily on his personal experiences and work with his own counter-transferential feelings for Freud, he could have presented us with a clearer picture of him. Schur, in turn, would have possibly come closer to the truth in his “Conception of the Development of the Hero”.