On completing his psychiatry rotation as a 1960s medical student, your reviewer was presented by his consultant with a valedictory book. Not Freud or Jung, let alone Bleuler or Jaspers, but Bernard Hart's 1912 Psychology of Insanity.
Kuhn, an independent historian, has unearthed an all-but ablated group of British psychiatrists, of whom Hart was the outstanding example. At the turn of the century, dissatisfied with the dominant ‘physiological’ school, Hart and others – Eder, Mitchell, Rivers – turned to the psychological approaches of Janet, Jung and Freud. They were especially drawn to Jung's amalgam of scientific measurement (reaction times and skin conductance) with Freud's free association. They deployed a mixture of hypnosis, suggestion and free association with their mainly ‘hysterical’ (i.e. somatising) patients. While respectful of Freud, they had reservations: psychoanalysis took exorbitant time and money; eclecticism rather than psychoanalytic purity was needed; sex was important, but so too, were ‘equally fundamental primary conative tendencies such as positive and negative self-feeling, curiosity, fear, disgust etc’ (Mitchell 1913 – a century pre-Panksepp).
Here were the potential founders of a British school of psychotherapy, integrative, scientifically sceptical, influenced by psychoanalysis but not prepared to swallow it wholesale. Malan, Ryle, Hobson, Bateman, Fonagy are their heirs. Enter Ernest Jones, brilliant, controlling, ingratiating; quick to plug the gap created by Freud's expulsion of Jung; Freud's official biographer; founder of the British Psychoanalytical Society; Anna Freud's suitor; host to Melanie Klein. Jones, always ready to bend history to his own ends, is Kuhn's diabolis ex machina. Claiming to be the first to bring Freud to the English-speaking world, he shows how by 1906 psychoanalysis had already been championed by Hart, Eder and Mitchell. Jones' flight to Canada following accusations of sexual abuse of two adolescent girl patients was shamefully glossed over.
Kuhn's historical research is convincing and detailed. This is a story that needed telling. Jones set the tone for the elitism and sequestration of psychoanalysis within British psychiatry. The continuing uncertain status of psychoanalytic psychotherapy within psychiatry is in part due to his arrogant disparagement. Sadly, Kuhn's book itself is a mess: no clear narrative structure; tendentiously lapsing into speculation; replete with typos. The reader is left to pick the wood from the trees. The whole enterprise needed a good editor with well-honed polemical skills – a latter-day Jones perhaps?
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