Joel Kovel's aim is to combine “Marxism's grasp of historical reality [with] psychoanalysis's contact with spontaneity and the roots of imagination.” That is, Kovel wants to recast psychoanalysis along the lines of radical social thought. The idea of linking Marxist theory organically with Kovel's own work as a psychoanalyst promises to help analysts troubled by the lack of social and historical perspective in psychoanalytic theory and practice. Kovel's attempt at integrating Marx and Freud at the level of praxis is undercut, however, by his fictionalized clinical material. His cases reflect not the desire of the real individuals they dimly represent but the author's attempt to make them embody his own ideas.

The book begins with an autobiographical introduction in which the author, a doctor who has become an analyst, is looking for a guide amidst the welter of conflicting ideologies. He quotes Levi-Strauss on a shaman named Quesalid who began by exposing all shamans as charlatans and then became