The Brain, the Mind and the Self: A psychoanalytic road map aims to clarify misconceptions about these three key concepts using psychoanalytic examples. The author argues that there has been a gradual separation of psychoanalysis from psychiatry and that there is a unique place for psychoanalysis beyond the confines of the medical realm.  The author Dr. Arnold Goldberg was trained in psychoanalysis and has seen firsthand this changing trajectory as well as the separation of the two.

The book is organized into three parts. Part one, “Distinguishing the brain, the mind and the self” aims to provide an understanding of these concepts. It encompasses chapters 1 to 5. Chapter 1 outlines the concepts, the brain, the mind and the self, and argues why each is discrete, but connected.  In this chapter, the author does identify the challenge associated with defining these concepts as they have multiple interpretations depending on the philosophical standpoint one takes. To support his argument and to provide clarification of the terms, he provides helpful examples.  The second chapter argues that psychoanalysis has a place within neuroscience as a way to understand the reasons people present as they do.  In chapter 3, the author argues that psychoanalysis cannot be thought of in the same way as other scientific approaches in medicine, but instead as a way to understand individuals and their experiences within the world. It is at this point that he furthers his argument that psychoanalysis is a hermeneutic science.  Although the reader begins to develop a sense of what is meant by psychoanalysis as a hermeneutic science, it is not until later in the book that it is more fully characterized.  In chapter 4, the author begins to outline the separation of psychoanalysis from psychiatry. Moving into chapter 5 he argues that unlike contemporary psychiatry, which defines presentations diagnostically with a focus on psychopathology, the goal of psychoanalysis is to understand individuals.  As such, he posits that such a separation makes sense as psychiatric diagnoses may not align with psychoanalysis. His argument is that psychoanalysis does not aim to treat individuals like other forms of therapy, but to understand them.

The middle part “The newer models of the mind and the self” encompasses chapters 6 to 8. This section aims to locate the concepts of mind and self beyond biochemical brain function. In chapter 6, the author argues that the mind is needed for therapeutic interactions.  He argues that for therapeutic relationships to exist, both the patient and therapist need to be active within the interaction; that the interaction involves thinking about one another and is reciprocal.  Chapter 7 follows on this argument by discussing the complexity of empathy.  The author argues that empathy exists as a concept beyond neurochemical brain activity, within a philosophical sphere. In chapter 8, introducing self-empathy furthers the concept of empathy. This is the idea that our own understanding of ourselves is important for understanding others and thus is important for a psychoanalyst.

The third part, “Clinical examples of the special role of psychoanalysis” encompasses chapters 9 to 13.  This section provides examples of how psychoanalysis can provide a complementary yet different approach to mental health and its care, compared to psychiatry.  The author begins chapter 9 by recognizing ways in which psychoanalysis risks further division. He argues that this is due to the diverse nature of psychoanalytic theory. He suggests that finding some unifying elements would assist in strengthening the profession. In chapters 10 and 11, the author suggests that enthusiasm and anger are important aspects of the human experience, which could be a focus for psychoanalysis.  The final two chapters, 12 and 13, argue that psychoanalysis and psychiatry are different entities and thus psychoanalysis likely needs to further the gradual separation which has been taking place for years, in order to further grow. The argument is that the focus of psychoanalysis is on complex understandings, whereas psychiatry is shifting towards diagnosis and psychopharmacological treatment.

What begins with the goal of defining concepts and locating them within the space of psychoanalysis largely reads as an argument as to why psychoanalysis should exist, and appears to attempt to recruit interested individuals into the field.  It is likely not a coincidence that the author chose to write this book at a time when, as he identifies, enrollment in psychoanalytic societies/organizations is declining. Within the first chapter, the author does briefly describe the importance of the concept of understanding using philosophers such as Martin Heidegger.  Although brief, it is fitting in that he explicitly states the book is intended for individuals without a philosophy background.

This book is an interesting read on the author’s perspectives of how the world of psychoanalysis has changed over time. Some of the examples used to illustrate points are at times questionable, in that some are examples of physicians having inappropriate relationships with patients and how psychoanalysis could assist in understanding this. It is unclear if these examples are used because perhaps this is the author’s area of expertise/interest or as a way to further separate psychoanalysis from psychiatric medicine. For me, it weakened the author’s arguments at times, as it was distracting from the overall arguments being made.

Overall, this is an interesting book addressing the course and trajectory of psychoanalysis. Despite a complex subject area, the writing within this book is clear and concise while making important arguments about the unique nature of psychoanalysis and its movements away from psychiatry.

© 2016 Katherine McKay,

Katherine McKay, MD, Psychiatry Resident Year 4, McMaster University, Hamilton, Ontario, Canada. Supervised by: Abraham Rudnick, MD, PhD, Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada