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This collection of 30 ‘essential papers’ is divided into six sections, under the respective rubrics of Historical Papers, Drive Theory, Ego Psychology, Object Relations Theory, Self Psychology, and Issues and Techniques in Treatment. As an American publication, it is hardly surprising that the sections on the application of ego and self psychology take up half the book, and interesting to compare these perspectives with the more familiar orientation of British writers.
The historically-minded reader has here the opportunity of surveying the evolution of clinical attitudes to the addicted patient, as early ‘moral hygienic’ stances develop into something deeper and more complicated. The Freud papers do not deal directly with alcoholism per se, but rather with addiction generically (‘Masturbation as the Original Addiction’) and compulsive gambling (the Dostoievsky study). It is salutary to remember that Freud's addiction (to cigars) eventually killed him.
The psychopathology of addiction is particularly overdetermined, and these papers offer a wide range of approaches that in turn examine and emphasis different factors involved in the selection and maintenance of this way of life. As a result I sometimes felt that it suffers from the perhaps intrinsic drawback of anthologies, a sort of incoherent heterogeneity, but on the whole the impression is of a useful inclusiveness that allows the reader to think around the central issues and examine them from a multiplicity of viewpoints. Early polemical papers on the status of alcoholism as a disease, an approach which can help the patient to begin to come to terms with his guilt and which insists on the need for sobriety if progress is to be achieved (Jellinek is of this type) are complemented by those dealing with the syndrome as a symptom so that the underlying conflicts can be addressed. This ‘bifocal’ or ‘binocular’ consideration is implicit throughout.
The classical analysts tend to discuss the abuse of alcohol as an initiat