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This volume is Elizabeth Zetzel's psychoanalytic legacy, for she died shortly after its appearance. It is something more than a collection of papers. Although most of the chapters represent papers that have been previously published, many have new introductions to fit the special point of view of the volume and some are completely new contributions.
The book is divided into two sections, sections that closely parallel Zetzel's own career: Psychoanalysis and Psychiatry, and Clinical Psychoanalysis. Zetzel was an analyst for whom clinical psychiatry never lost its fascination.
Zetzel's experience as a british Army psychiatrist during World War II confronted her with the observation that soldiers who in their previous history were more obviously anxious, proved better able to cope with the stress of battle than those who appeared to be more 'normal'. This led her to the broad consideration of the ego's capacity to tolerate anxiety (later she added the capacity to tolerate the other painful affects of guilt and depression). This criterion of mental health contrasts paradoxically with the criteria of physical health—for mental health consists not in the absence of pain but in the capacity to experience and tolerate pain. Zetzel integrated these observations with Freud's concept of primary and secondary anxiety, a point of view that is very much in the mainstream of contemporary psychoanalysis. It is an ego structural point of view implying that the appearance of secondary anxiety reflects the successful outcome of an earlier stage of ego development. Later in her thinking Zetzel linked this ego development to the area of object relations, in that she acknowledged the significance of the early mother-child relationship in the development of the capacity to tolerate painful affects. She described what Winnicott called the experience of 'good enough mothering' and what Erikson understood as a capacity for basic trust. The capacity to tolerate painful affects is als