Book Review

Thoughts without a Thinker: Psychotherapy from a Buddhist perspective

N Engl J Med 1995; 333:132July 13, 1995

Article

Thoughts without a Thinker: Psychotherapy from a Buddhist perspective
By Mark Epstein. 242 pp. New York, BasicBooks, 1995. $22. ISBN: 0-465-03931-6

Since the end of the Second World War, Buddhist thought (especially its Zen version) has become an increasingly familiar aspect of American secular life -- that of our upper bourgeois segment, at least. The so-called Beat writers of the 1950s introduced their readers to certain Buddhist principles, especially sustained meditation as a means of self-knowledge, and self-detachment (whereby one glimpses oneself at sufficient remove to be aware of a life's accumulation of petty -- or all too important -- conceits and deceits). More recently, such meditation, often stripped of its Eastern origins and spiritual connections, has become a mainstay for insistently self-conscious (and sometimes self-absorbed) men and women who are convinced that the mind exerts more influence on the body than medical science is prepared to acknowledge. Hence, the desirability of plumbing the depths of our thinking in the hope of gaining authority over it -- the focus and control that systematic concentration and introspection may provide.

Of course, Western culture has its own long-standing tradition of relentless, even systematic, self-examination -- from St. Augustine's confessional writing to Freud's willingness to probe his dreams and to share them and his thoughts about them with others. Psychoanalysis, this century's contribution to that tradition, is an effort of two people to attend to the workings of a particular mind (that of the analysand, the patient) with the kind of closeness, intensity, and persistence of the Eastern meditational practitioners. In that regard, Mark Epstein, this book's author, has committed his intellectual and personal life to the important task of straddling the East and the West. He has studied Buddhist thinking devotedly and now connects it to the psychiatric and psychoanalytic knowledge he acquired as an American physician.

The title of this book tells a lot about its author and subject matter. Dr. Epstein is a well-trained American psychiatrist who understands the struggles of today's psychoanalysts (and social theorists) to figure out the sources of so-called narcissism -- a kind of self-preoccupation that can shape an entire life. Buddhists have long warned against such egoism and, ironically, have challenged it on its own turf: through constant meditative efforts and through daily attention to a self-directed moral and philosophical inquiry, one learns to let go of oneself -- to give up a hitherto unyielding self-regard and tenacious insistence on one's singularity -- in favor of a decisively distanced sense of who one is and where one stands emotionally and ethically. If the foregoing sounds vague or elusive, so it goes in the realm of the spiritual and, not rarely, the psychological -- all our wordy efforts to be conceptual notwithstanding. Nevertheless, Dr. Epstein tries bravely and earnestly to make such matters of the mind and heart as clear as possible. He tells us of his own life and of his patients, and he teaches us about Buddhist beliefs and practices even as he tries hard to find common ground for them and our Western psychoanalytic mode of viewing human experience.

Particularly instructive and impressive is Dr. Epstein's clinical interest in harnessing a meditative spirituality to the task of achieving a psychologically interpretive awareness. In a way, he is addressing his Buddhist colleagues (he has spent years with them in Asia as well as here) as much as his professional confreres in hospitals, clinics, and private offices, reminding them that a meditative tradition can fail to address the kinds of emotional conflict the child psychoanalysts Anna Freud or D.W. Winnicott, for instance, observed in English families for so many years. Dr. Epstein's evident mastery of psychoanalytic ``direct observation'' (Miss Freud's term) makes his case all the more comprehensible and convincing to his presumed audience, Western psychotherapists. Freud's writing constantly informs this book's discussion -- indeed, is given a new life as it is compared, with attentive respect, with ideas not so fundamentally different, which have, however, been given another culture's language, tone, and manner of expression. It is no small feat for Dr. Epstein to have labored so long in a vineyard at such a metaphysical remove from that inhabited by most of us doctors, and to have returned not as a polemicist, a propagandist, or even an apologist, but rather as a healer determined to call upon all possible sources of understanding, not to mention inspiration.

Robert Coles, M.D.
Harvard University Health Services, Cambridge, MA 02138