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Although this book resulted from the celebration of the Austin Riggs Center's 75th anniversary, it honors another institution, the Tavistock Clinic. The influence of Melanie Klein and W. R. Bion is very much in evidence. Its theme, the inner world in the outer world, reflects the concern of the editor, Edward R. Shapiro, that attention to patients’ inner life as viewed by psychoanalysts may not survive even in attenuated form, unless they address the radical changes taking place in the outer world of health care reform. Shapiro, Riggs’ medical director bearing this burden, turns for help to his colleague, Anton Obholzer, who is chief executive at Tavistock.
The book is structured like a sandwich in which Shapiro's and Obholzer's chapters serve as the bread and butter of health care delivery issues, with the seven chapters between them covering a wide range of subjects including artists, adolescent girls, bureaucracy, conformity, discourse with an enemy, the private self, and traumatic dreams. Tied to a looser interface of the inner and outer world than Shapiro's, the papers stand alone and can be read in any sequence. A number of them reflect Klein's emphasis on the outer world as screen for projections of aspects of the self.
Shapiro's and Obholzer's chapters are no mere white bread enfolding these scholarly and thought-provoking contributions. Shapiro, for instance, suggests that because intimacy has become less available in this increasingly market-driven world, the intimacy of the psychoanalytic situation is viewed with envy by the general population and is reflected in policy. The Kleinian focus on envy is evident here, one that deserves extension to group motivation, not only in regard to differences in economic priorities, but to ethnic hatred.
Obholzer's succinct review of Bion's concepts about groups serves as a key to other chapters for those not familiar with Bion's work. Obholzer