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Hamilton Rating Scale, eat your heart out! Here is a book that defines the miseries people describe when they show up in our offices, how to really understand them, and how to, by the way, treat them. Salman Akhtar, a gifted and prolific psychoanalytic scholar, has lately turned his interests to defining things. Since he published his magnum opus, A Comprehensive Dictionary of Psychoanalysis (2009), he has edited many books that aim to clarify definitions of concepts like Shame (2016), Greed (2015), Fear (2018a), and Arrogance (2018b).
Dr. Akhtar skillfully weaves examples from clinical practice, literature, and cultural phenomena. Also, much like Otto Kernberg and Vamik Volkan, he makes lists that illuminate many concepts that everyone, including psychoanalysts, may have taken for granted. People who consult us often complain of being “depressed” because they have not been able to solve their own problems. There is usually a more complex “web of sorrow” from which they cannot extricate themselves. Dr. Akhtar takes us on a journey through that web.
Section I deals with sorrow caused by external events. The first chapter is on mistrust. Dr. Akhtar quotes Isaacs et al. 1963 work: “… parental forthrightness in dealing with their child exerts a powerful impact on the child's developing sense of trust” (p. 5). He credits Kernberg's 1984 and Blum's 1980 and 1981 works for integrating the realities of a child's actual relationship with parents in the creation of basic trust and mistrust (p. 6). Dr. Akhtar lists the tasks of adulthood as described by Levinson et al. in their 1978 work: (1) forming a dream and integrating it into life, (2) finding a mentor, (3) making a vocational choice, and (4) establishing a mature love relationship (p. 7). Ironically, “As young adults, [people] … have recently mastered autonomy (from family of origin) and yet must now withdraw a little from the position of total autonomy” (p. 10). Parenthood and childrearing further interfere with autonomy