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The psychoanalytic historian Paul Stepansky has created a thoughtful and scholarly work in which he explores the rise and fall of Freud's surgical metaphor. By “surgical metaphor,” the author refers to the description of “psychoanalysis as a surgical procedure with the psychoanalyst in the role of a surgical operator” (p. xiii). Stepansky, managing director of The Analytic Press, has written or edited eight previous volumes on the history of psychoanalysis. In this book, he begins his narrative with a quotation from Freud's 1912 paper, “Recommendations to Physicians Practicing Psychoanalysis.” Freud advised colleagues to “model themselves … on the surgeon,” who puts aside all feelings, including “sympathy,” in order to perform “the operation as skillfully as possible” (p. 1).
As the author traces the ascent and decline of this analogy, he examines the history of surgery, as well as Freud's exposure to surgery as a medical student, as a physician, and ultimately as a patient. A fine historian and narrator, Stepansky uses the book's themes to underscore the intertwining of psychoanalysis and surgery from past to present.
In Part I, “The Metaphor Ascendant,” Stepansky chronicles the history of surgery, beginning in the twelfth century. He notes that “medieval and Renaissance surgery was anathema to the metaphor of deep penetration” (p. 23). It was only after “the discovery of the anesthetizing properties of nitrous oxide, ether, and chloroform in the 1840s [that] surgeons envisioned an era of deep and painless surgical penetration as a godsend to suffering humanity” (p. 27). But it was to be four more decades before there was acceptance of Lister's antiseptic methods, and surgery became safer for the patient. As part of his wide-ringing exploration, Stepansky discusses Freud's troubled relationship with the surgeon Wilhelm Fliess during the 1890s, including Irma's injection dream and the treatment of Emma Eckstein.
In Part II, “The Metaphor in Retreat,” Stepansky observes