Plying the Steel: A Reconsideration of Surgical Metaphors in Psychoanalysis

Among the metaphors that Freud used to describe psychoanalysis, the surgical is possibly the most deplored. It is considered an anachronistic remnant of a dubious medical ideology that psychoanalysis has largely renounced. However, while analysts today avoid surgical analogies, their patients continue to produce surgical fantasies about analytic treatment. This fact alone requires a serious consideration of the meanings that surgical metaphors have for them. A second reason for reconsidering the role of the surgical metaphor, from the analyst's perspective, lies in its creative revival by W. R. Bion. Disregarding the shift away from surgical analogizing, Bion employed the metaphor to vividly portray various aspects of the analytic situation and the patient's experience of them. A brief historical overview of the surgical metaphor in psychoanalysis is provided, followed by an account of the reasons for its demise and by a review of the criticisms that continue to be leveled at it. Bion's use of surgical metaphors toward the end of his life is then explored. Finally, illustrations are given of the various ways in which patients use spontaneous surgical metaphors to depict transference and the analytic process. Though the analyst should not deliberately adopt surgical metaphors, it is important to remain open to these transference portrayals.