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THERE ARE TWO WAYS to read this complex and interesting book. One approach to it, in keeping with its open-ended title, is as a free-wheeling, wide-ranging, biographical narrative. This reading encompasses attitudes of Freud and his close analytic collaborators toward the field of surgery, and their own and their intimates' personal experiences with surgery and surgeons. It also includes Paul Stepansky's selected history of ways in which the fields of psychoanalysis and modern surgery generally have influenced each other over the course of their roughly contemporaneous hundred year history. Read this way, it is absorbing.
Another way to read it is narrower, in line with its carefully articulated plan and organization of chapters. This reading focuses on the way Freud conceived of and practiced psychoanalysis. Specifically, Stepansky proposes that until the conclusion of the First World War, Freud held surgery as a primary metaphor for his conception of psychoanalytic treatment, and thereafter abandoned it. Hence, his volume's two main sections are titled “The Metaphor Ascendant,” comprising eight chapters, and “The Metaphor in Retreat,” comprising nine. This proposal is controversial, and students of psychoanalysis may well have reservations about it.
Stepansky tells a fascinating story. His book's dramatic jacket, depicting five surgeons of several generations ago grouped around a patient upon whom they are preparing to operate, typifies its aliveness. His writing is excellent: sophisticated, yet seemingly effortless. In novelistic style, he uses snippets from the text for his chapter headings. His historical discussions are meaty and compelling, and he enhances his narrative's authenticity by explicating heady technical medical and surgical issues throughout.