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Writing a professional retrospective, or the professional portion of an autobiography, is not easy, especially if the intended readers are diverse in background and interests. One does not want to “dumb down” the material by oversimplifying to the point of caricature, nor does one wish to overawe and confuse by excessive focus on jargon-laden abstract theorizing. When case material is presented, the additional balance to be struck
is between literal accuracy and the overriding obligation to preserve the confidentiality of former patients.
Douglas Frayn has successfully met these challenges, providing a highly readable, personal, clinical retrospective. He has packed a lot into 230 pages. Frayn begins with an introduction, in which he promises a book with “no bullshit, no illusions of grandeur, but rooted in reality.” He concludes with three brief, largely autobiographical chapters. Between are 12 clinical chapters that roughly follow his own professional trajectory: medical school, internship, training in psychiatry and neurology, and finally, psychoanalytic training. Each of these chapters begins with an explanatory introduction of the topic, but the highlights are the case descriptions that follow. They illustrate myths about mental illness; schizoid and regressive defences and character traits; mood disorders; personality disorders; non-verbal communication; and suicide, among other issues. The longest “clinical” chapter deals with love, its many manifestations and meanings, as well as aberrations that are often classified as “the perversions.”
Clinical case descriptions used to be frequent in psychoanalytic and psychiatric journals but are now not nearly so common. This is not totally surprising, since today there is much lower tolerance for the former generalizations from insights gathered from one case—or a very few cases—to whole categories of disorders and syndromes. Nevertheless, it is refreshing to read Frayn's vignettes that reflect the excitement, poigna