Book Review

Care of the Psyche: A history of psychological healing

N Engl J Med 1999; 341:1860December 9, 1999

Article

Care of the Psyche: A history of psychological healing
By Stanley W. Jackson. 504 pp. New Haven, Conn., Yale University Press, 1999. $45. ISBN: 0-300-07671-1

A brilliant book, this carefully detailed account is intended by its author to be “a study of the history of psychological healing in the care and cure of human ailments.” Stanley Jackson is a psychiatrist, medical historian, and all-around scholar at the Yale University School of Medicine. Since I worked at that school for 44 years, bias might seem to lead to overdone praise, but Jackson's masterpiece will have a life of its own, a long one, regardless of plaudits. Its main failings come in the enormous amount of detail crammed into its 504 pages (including the index) and the reiteration of some data and opinions owing to the grouping of themes into narrow categories with intriguing titles such as “Confession and Confiding,” “Consolation and Comfort,” “Suggestion,” “Persuasion,” and “Conditioning and Reward or Punishment.” These topics get a very close treatment; the difference between confession and confiding, for example, resides in the overtones of sin and confession. Who would have thought to write a medical book about the use of the imagination? He praises suggestion and persuasion, two powerful therapeutic tools that modern doctors, fearing that, as physicians, they are only conduits of technical prowess, hesitate to use with their patients.

This wide-ranging study will enlighten those who regard psychoanalysis as one of many attempts to lighten psychological burdens, as well as others who hew to Freud's way. The dispassionate reader may come away, as I did, with the idea that Jackson believes that the personal relationship between a doctor and a patient (whom he calls “healer” and “sufferer”) is what most advances psychological healing, regardless of how the therapeutic theories are articulated.

In analyzing “modern psychotherapeutics,” Jackson stresses that the central elements of psychoanalysis are talking and listening, which are even more important than interpretation and insight; to the psychoanalytic 50 minutes he would admit consolation and solace. After a review of other psychological approaches, including existential therapy, which examines the present and stresses “self-observation,” Jackson returns to his faith in the healer–sufferer relationship as the basic element of human nature that is strengthened and affirmed by many different approaches. In his words, “Healing is, at its root, a natural phenomenon.”

Jackson has read widely and deeply, not only about psychotherapy but also cultural history; his historical range takes the reader from ancient Egypt to the classical worlds of Greece and Rome, from medieval byways to modern highways. There can be few modern psychiatrists who can write confidently about Benedict of Nursia (who flourished circa a.d. 500) and Cassiodorus, his contemporary, and who shows equal familiarity with the Tusculan Disputations of Cicero and the Encyclopédie of Diderot. Most topics get that same full treatment: we learn that “catharsis” (a favorite term of mine) had its origin in the Greek word for purification and that it was credited by Plato with helping “diseases of the soul”; it found a large place in Aristotelian philosophy and flourished again with John Milton, who praised the power of tragedy to purge the mind. Freud, too, had an early fascination with purging the mind of “pathogenic recollections.” The reader will discover detailed accounts of the disputations of eminences of the 18th, 19th, and 20th centuries whose arguments may not stand the test of time as well as those of the earlier masters already mentioned. One will not often encounter such erudition in a medical history.

Jackson shows a strong interest in the history of religion throughout the book; despite his many allusions to the Judeo–Christian tradition, however, Jackson seems surprisingly unaware of Martin Buber, the German Jewish exponent of the “I and Thou” relationship between God and man, sometimes made explicit in the metaphoric wrestling of doctor and patient that in itself may be healing. Still, the reader will admire the author's command of so much of the Western canon — of Plato, Aristotle, Cicero, the Stoics, Petrarch, and Dante, along with a myriad of lesser figures.

Harried physicians may ask how reading this book will help their work. Mainstream physicians, bound to the neurobiologic notions of brain and mind, as well as holistic physicians, buoyed up by the hubris of what they take to be innovation, will learn much about the webs that tie them to a past they may never have imagined. Looking for common elements among the many different approaches, Jackson finds that psychological-healing practices are often culture bound; he concludes that human nature is as confined by rules, however uncertain, as the human body is constrained by its DNA. After putting the book down, many readers will suppose that psychological healing has been rationalized as ritual, a language between doctor and patient. Jackson makes much of the idea that the healer offers an explanation of what is going on, one that provides the patient with the strength to endure the otherwise unbearable.

Underlying all is the message for practitioners and teachers of medicine alike that physicians can still be therapeutic agents, that the triumphs of biomedicine should not obscure the importance of human passions, and that hope, trembling still in Pandora's box, helps relieve human suffering. I loved the book and will return to it again and again.

Howard Spiro, M.D.
Connecticut Gastroenterology Consultants, New Haven, CT 06510