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Healing The Soul in the Age of the Brain
Becoming Conscious in an Unconscious World
by Elio Frattaroli, M.D.
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Reviews:
Starred Review From Publishers Weekly
A decade after Peter Kramer's bestselling Listening to Prozac (also published by Viking)
refashioned cultural attitudes and beliefs aboutmental, emotional or personality disorders
and their treatment, psychiatrist and psychoanalyst Frattaroli reexamines the
"Medical Model" of psychiatry, according to which disturbances such as brain chemistry
imbalances are treated solely with psychopharmacology. Lamenting that the brain has
replaced the mind or the soul as the object of healing in psychiatry, he offers a clear
and comprehensive description of how the alternative "Psychotherapeutic Model" works
to bring the unconscious into consciousness, addressing inner conflicts that can't be
medicated and ultimately offering deeper and more permanent healing. Using case
studies from his own practice, Frattaroli makes a strong argument for the
effectiveness of and need for long-term psychotherapy. However, he is careful not
to condemn the use of drugs in treating mental and emotional disorders. Heavily
influenced by psychologist Bruno Bettelheim, with whom he trained, and borrowing
from Martin Buber's "I-Thou" vs. "I-It" principle, Frattaroli provides an unusually
lucid explanation of Freud's theories of personality, inner conflict, transference and
the therapeutic relationship. In view of the current "quick fix" culture and the "greed
of the managed care industry," which doesn't usually pay for long-term psychotherapy,
Frattaroli calls for an integration of biological and psychoanalytic approaches. His
insights are fresh, highly readable, informative, passionate and memorable.(Sept.)
Forecast: Ten years in the making, this thoughtful defense of the talking cure could
be important and influential for many years to come. A six-city author tour is
scheduled for January.
Copyright 2001 Cahners Business Information, Inc.
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Starred Review From Library Journal
To his first book, Frattaroli, a psychiatrist, psychoanalyst, and teacher (Univ. of
Pennsylvania), brings wide reading in science and the humanities, long experience
as a therapist, and remarkable self-analysis. The result is a discursive, challenging,
important meditation on the human process of helping others and ourselves
through a complex empathic awareness. Frattaroli critiques the ills of scientific
materialism, the medical model, and the culture of quick fixes, arguing that the
soul needs another kind of healing. In this regard, he both defends and improves
upon Freudian psychology with the help of Niels Bohr, Erik Erikson, John Searle,
and even Plato and Descartes and arrays it against neurological and pharmaceutical
evangelism. Yet while he crusades against a strictly materialist bias, Frattaroli does
not engage in New Age soul-flashing, instead respecting brain chemistry, the
conservative use of medication, and the tools of humane science. Ultimately, he
brings out what is best in the therapeutic procedure. It is only disappointing that
Carl Jung gets a mere footnote and that Otto Rank is not mentioned. A major
achievement, this is essential for all libraries.
— E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC.
Copyright 2001 Cahners Business Information, Inc.
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The Booklist Review
If Freud experiences a revival, he may thank Frattaroli for it.
Disagreeing with his profession's pattern of treating psychiatric patients
with prescriptions rather than psychotherapy, the author here advocates a
simple idea. Psychological problems arise from inner conflict, the symptoms
of which (anger, shame, anxiety, depression, etc.) need to be identified and
addressed rather than deadened with Prozac. Frattaroli declares he is not
opposed to medication, but at bottom he is calling for a return to Freud;
further, Frattaroli's ambition is greater than restoring the utility and
reputation of one whom he admires. Deploring "soullessness" in society, he
reaches into Descartes, quantum mechanics, and literature to pull together
his view that humans have souls separate from their bodies and must be
treated from this dualistic perspective. This seems far afield from what an
interested reader will expect from this book, namely, to gain some personal
insight from Frattaroli's accounts of psychoanalytical breakthroughs with
his patients. Instead, readers will find of utmost interest his call for a
deeper, more thoughtful approach to understanding psychological problems. (Gilbert Taylor)
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The Barnes & Noble Review
“Psychiatry today is in imminent danger of losing its mind,” writes psychiatrist and
psychoanalyst Elio Frattaroli. In this, his first book, Frattaroli confronts psychiatry’s
mania for medication by issuing a passionate, literate argument in favor of psychoanalysis.
Instead of treating patients as mere chemical configurations, Frattaroli proposes, we
should learn to recognize and find compassion for the feelings that inform our lives. For,
he argues, it is only by dealing with our selves and our souls that we can ever create true
healing. Frattaroli begins his argument with a full-tilt assault on the medical model of
psychiatry, which holds that emotions stem from brain chemistry, and brain chemistry can be
altered. “The medical model of psychiatry……teaches us to think of anxiety, shame, and guilt
as meaningless neurological glitches, not as urgent calls to self-reflection,” he opines.
“It promotes the pharmacological quick-fix, neglecting the deepest long-term needs of the
soul.” Frattaroli explains the issues that underlie this model, and then he explains why
he believes that psychoanalysis — that unscientific science, that ugly art — is
the only way to cope with the mysteries of human experience. In support of this argument,
Frattaroli offers us personal, quirky, revealing narratives of his own therapeutic practice.
As he explores one human story after another, we come to realize how crucial it is that we
see ourselves as people, driven by desires and needs and souls. In one instance, for example,
Frattaroli explains: “It took [Anne] two months in the hospital, meeting with me forty-five
minutes a day, five days a week, to tell me she had been raped.... Treating Anne’s depression
with medication might have made it easier for her to hide the emotional trauma of the rape
until it was too late.” With his own brand of literate, rambling intensity, Frattaroli
introduces us to the real people behind the case studies and shows us why we must recognize
them — and ourselves — as more than mere compounds. In Healing the Soul, Frattaroli
takes readers on a breathtaking ride through science, history, literature and art to lay bare
the complexity and significance of the human spirit. In the course of this ride, Frattaroli
considers the history of mind/body dualism as an idea; he tinkers with scientific and
mystical models of selfhood; and he translates Freudian lingo into cogent, meaningful
metaphors. But most important, Frattaroli brilliantly illustrates why becoming human —
conscious, emotional, and soulful — is a challenge we must accept. (Jesse Gale)
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Harvard Crimson, Friday, March 01, 2002
THE PSYCHIATRIC SOUL TRAIN
By Z. Samuel Podolsky, Crimson Staff Writer
Nearly a decade ago, psychiatrist Peter Kramer made a big splash with his
controversial "Listening to Prozac." Through descriptions of specific case
studies, Kramer displayed to his readers-and there were many-the potential
of the popular drug Prozac as an anti-depressant. But, to put it mildly,
there is no consensus among psychiatrists-or, for that matter, anyone
else-on the efficacy, safety, or propriety of Prozac and other Selective
Serotonin Reuptake Inhibitors (SSRI's) as medication for various forms of
depression.
Perhaps no one has released so creative, so audacious, and, ultimately, so
problematic a critique of contemporary society's love affair with
psychiatric medication as that offered by Dr. Elio Frattaroli in his new
book "Healing the Soul in the Age of the Brain: Becoming Conscious in an
Unconscious World." Frattaroli, a practicing psychiatrist and assistant
professor of psychiatry at the University of Pennsylvania, took his A.B.
from Harvard in English Literature before going to medical school. On
Tuesday, February 19, Frattaroli was in Cambridge and delivered a discussion
of his new work in a talk sponsored by the Harvard Book Store.
As its title may suggest, Frattaroli's book seeks to restore the
metaphysical soul as the primary target of therapy in what he sees as an
increasingly physicalist psychiatric profession. Frattaroli argues that
psychiatrists-and in particularly those trained in the past 15 years-have
(to the detriment of their patients) progressively blurred the line between
mind/soul and brain. The result has been that "quick-fix" physical and
chemical solutions, such as SSRI's, have come into vogue, while the more
involved and more important process of healing the metaphysical soul is
neglected. On this front, Frattaroli enjoys referencing the etymology of
psychiatry, which derives from the Greek meaning, roughly, "healing the
soul."
All this only begs the question: What, exactly, is the soul, as Frattaroli
understands it? Moreover, how is it distinct from the physical brain? In an
interview included in the book's press release, Frattaroli addresses these
questions, saying, "The body and brain belong to the domain of outer
knowledge. We know about them by seeing, touching and measuring them. Mind,
spirit, and soul belong to the domain of inner knowledge. We know about them
only through our personal conscious experience."
Frattaroli's arguments, then, rest on the premise that most (if not all)
mental illnesses usually attributed to the brain are at least in part
disorders of the soul. And, because the soul is not chemical or physical,
and indeed we can only know about it through our own conscious experience,
it is necessary for psychiatrists to approach their work not only as if they
are treating a concrete, physical entity with something concrete and
physical amiss in it, but rather "by viewing brain chemistry as only one of
several competing influences within the whole person-body, brain, mind and
spirit..."
Certainly, Frattaroli constructs a compelling case against the use of Prozac
as a easy way out; it is undoubtedly essential to cut depression out at its
roots rather than merely making its symptoms disappear temporarily. But in
order to "heal" mental disorders at their root rather than their branches,
do we really need a concept as abstract-and as contradictory to the belief
of most contemporary neuroscientists-as a completely immaterial soul?
There is no simple answer to this question. There can be no denying, on the
one hand, that the progress of contemporary scientists in understanding the
brain continually and inexorably pushes dualistic theories of mind and body
further towards implausibility. At the same time, though, neurologists,
psychologists, philosophers, and others who study the mind and the brain
still have miles and miles to go before achieving anywhere near an adequate,
let alone a perfect, knowledge of what goes on inside our crania. For the
time being, then, models of some of the more mysterious and difficult to
explain aspects of human consciousness like that offered by Frattaroli in
his "soul," (another example would be Freud's "id," "ego," and "superego,")
can serve quite a useful purpose in treating psychopathology-for they
provide an abstract and working, if crude and incomplete, model of what we
cannot yet understand in any other fashion.
In the final analysis, though, a conception of the soul that is irreducible
to physical properties seems naive. It seems that everywhere one looks,
there has been a new discovery of how a brain function-a physical, chemical
brain function-can account for a cognitive or bodily function that had
previously seemed obscure. Frattaroli's motives are for the best, to be
sure. And right now, his concept of "healing the soul" may just be the best
way of treating psychiatric patients. But it is difficult to imagine that
the concept of a soul will survive the barrage of evidence from neuroscience
that can explain the metaphysical in terms of the physical more plausibly
with every passing year.
Frattaroli might object that, as Freud put it (in a quote that introduces a
chapter of "Healing the Soul") "If it [a discoverable connection between
brain and mind] existed, it would at most provide an exact location of the
processes of consciousness and would give us no help towards understanding
them." And yet, it seems that we may concede this point and still not
abandon the expectation that a concept of the soul will eventually become
irrelevant in psychiatry.
Take, for instance, the case of pain as an example of conscious experience.
Distinguished philosopher of mind Jaegwon Kim writes, in the Oxford
Companion to Philosophy, that anti-physicalists have adduced the argument
that "even if, say, pain should turn out to have a single neural-physical
correlate across all organisms and other possible pain-capable systems, how
could the painfulness of pain be a neurobiological property? In moving from
the mental to the physical, we lose, it has been argued, what's
distinctively mental about mental properties."
This is certainly a strong point-and, probably, a correct one. But if, as
the remarkable progress of neuroscience continually indicates, we can pin
down (as Freud conceded might be possible) the exact physical location of
mental phenomenon like pain-then why can't we treat that physical location
and thereby alleviate the mental problem? We do not need to rob from mental
experiences, as Kim puts it, "their qualitative character, their special
accessibility to our awareness, and their privacy" in order to affect and
enhance them by chemically altering their corresponding physical locus.
In attempting to carve out a turf for the mental, Frattaroli goes too far in
his unqualified distinguishing of it from the physical. But again-until
neuroscience progresses much further than it has today, a concept of the
soul isn't such a bad idea-as long as we understand that some day in the
future-perhaps the distant future, perhaps not-it will become obsolete.
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Howard H. Covitz
Institute for Psychoanalytic Psychotherapies
24 Latham Parkway
Melrose Park, PA 19027
E-mail: Hhcovitz@aol.com.
With the lion’s share of copies of the Dream Book still on the publisher’s shelf, Freud was moved to write popular books for the lay public, notably the much lighter works on wit and parapraxes and, later, the two-part Introductory Lectures. Many since have tried to make the flavor of the psychoanalytic process accessible to the interested public.
Elio Frattaroli’s work stands in this tradition but is unique in the beauty of its writing and its cogent integration of a theory of treatment with models for the good life and for consciousness. Healing the Soul is further distinguished by its rich case material, including a demonstration of countertransference struggles; a closing section discusses the transference-like struggles that may arise in giving life to a volume such as this. Frattaroli, after presenting an original analysis of Freud’s battle to transcend materialist/positivist thinking, offers a solution to Freud’s dilemma by (1) tying Waelder’s theory of multiple function to Bohr’s theory of complementarity and (2) highlighting the distinction between Freud’s early libido model and the later and more encompassing Eros model. In the clinical centerpiece of this work (the treatment of Mary), Frattaroli demonstrates how an analytic relationship comes into being as an interweaving of the processes and processing of both members of the dyad and their separate but resonating feeling states. Here, he invokes Bohr’s discussion of the ubiquitous presence of the scientist in the structure and conclusions of all scientific experiments. Overall, this volume is a feast for the reader; it aligns analysis with various trends in contemporary scientific thought and assumes a comfortable middle ground between one and two-person psychologies.
Frattaroli’s intention, beyond providing a scientific basis for analysis that is neither mechanistic nor materialist, is to insist on the value, for analyst and analysand alike, of embracing the conflicts of life. These are seen to arise, to use Frattaroli’s terms, between the It, grounded in its biology, the I, functioning with its stereotypical patterns and repetition compulsion, and the I-that-stands-above, which imparts a transcendent and spiritual-moral function to what otherwise would be animal instinct. Frattaroli argues convincingly that in this choosing to take up conflicts between spirit and flesh, and in the acceptance of feelings and anxiety while understanding them from these three perspectives, a new form of consciousness arises. This consciousness, a product of this triocularity, moves us to love and empathize with at least certain others as subjects in their own right. Through case material, Frattaroli counterpoises this attention to conflict and feeling to the exclusive use of pharmacotherapy. He shows that drugs, judiciously managed, may be necessary if certain patients are to embark on a personal quest for the synthesis of conflicting forces that he describes.
Frattaroli’s book may well be appropriate for the educated general public. It is certainly a must-read for clinicians (trainees or seasoned practitioners) interested in the psychoanalytic conversation. The historical, clinical, and technical syntheses he presents may well inspire valuable dialogue; his willingness to present his work unshrouded by excessive technical language can only increase the prospects that such discussion will be fruitful. I can think of few works that have affected me so directly and profoundly, even if my own model may differ from his.
In this era of proliferating psychoanalytic models, it is common for reviewers to pick pedantically at broad works of this sort, as if in possession of some singular truth revealed to them alone; toward the end of the volume, in fact, Frattaroli openly describes his own need to quiet the penchant for being the alpha-male discussant. The one time, however, that I shared a podium with him—it was in1990—he was both thoughtful and respectful, an attitude I recognize both in his writing and in the treatments he reports. I will attempt to follow his example as I reflect on his work and join this conversation.
Toward the close of the volume (p. 432), the author implies, more directly than earlier, perhaps, that emotional wellness includes, or even centers on, a capacity for empathy with an increasing circle of others and, I should add, a related capacity for contributory membership in polities of mutual concern and interest (Covitz, 1998). Both of these psychic developments may be considered functions of the transcendent I-that-stands-above. However we conceptualize such growth (as the heir/precipitate of resolved oedipal dilemmas or, as Frattaroli argues, the result of permitting the internal expression of the three styles of apprehending consciousness to conjoin into a new consciousness), the question of what dynamics permit this development from narcissism to a limited ability for accepting the subjectivity and agency of another remains a central one for both psychoanalytic theory and technique.
Here, even fervent intersubjectivists (e.g., Maroda, 1999) stop short of reasoning how, if an intersubjective posture is deemed necessary to health, the analyst’s attitude and the unfolding transference-countertransference field are to be realigned in consonance with this view. If a common ground for psychoanalysis is seen in the methodological and technical choice to follow, in a given treatment relationship, an expectable unfolding of a specified developmental paradigm—drive mediated, ego psychological, multifocal (Pine), self psychological, or intersubjectivist—the explication of such a paradigm is central to presenting a theory of technique. I look forward to attempts by Frattaroli and others to articulate such a superordinate developmental unfolding process with regard to this capacity for embracing and cherishing the agency of others.
Most difficult for me is the author’s use of Bohr’s complementarity principle in arguing for the unique appropriateness of the listening/analyzing instrument that centers on the analyst’s ability to contain and process countertransference feelings and conflicts in coming to understand the subjectivity of another. Half a century ago, while bemoaning the replacement of men by machines, Lindner (1955) characterized analysis as “one area where no machine, no matter how complex ... can act for its maker .... [In] the area of understanding, of sympathetic comprehension, of intimate, knowing communication between one being and another ... now and forever, only man will fathom men” (p.xxiv).
Frattaroli goes further, however, in arguing that “Freud’s psychoanalytic method is the only legitimate scientific method for the study of human subjectivity” (p.166; emphasis added). I find this, as well as the reasoned views of others who take on any singular method for science—even one as general as Laudan’s reticulated model of scientific enquiry (1990)—overly limiting, and prefer to embrace a skeptical philosophy of science (see, e.g., Feyerabend 1993) that might allow a multiplicity of models, some comparable and others not. This multiplicity arises from the fact that in constructing a model we adopt certain postulates: change the axioms and a new model is born.
I offer a brief example of this unavoidable reliance on axioms. Despite Frattaroli’s admonition to never prejudge the meaning of therapeutic productions, in discussing Mary’s case he gravitated to a sexual interpretation of one of her dreams (p.262). He goes on to argue that an attachment paradigm would not have fit well with, or accounted for, the three central domains he discusses (pp. 358-359). Attachment theorists may well see things differently.
Moreover, the invocation of Bohr’s concept is unnecessary for those who embrace Frattaroli’s view, or any other analytic paradigm, and will fail to convince those whose notion of science demands a more objective instrument. This will presumably be the case even with scientists who accept that the investigator, who either calibrates and wields the measuring instrument or who is that measuring instrument, is inextricably involved in the results of the study.
A comment is in order regarding the applicability of Bohr’s Copenhagen School solution of the particle-wave dilemma in physics. This is all the more necessary after Sokal’s lively demonstration (1996) of the potential misapplicability of such theories to the soft sciences and critical theory.
In Bohr’s solution to the particle-wave dilemma, observations cannot leave the boundaries that the observer willfully imposes on the reality that he or she observes by way of a model—unless, that is, contradictory evidence appears that brings the utility of that model into question. If the scientist, for instance, comes equipped with a view of light qua photon following wave equations, that is what will likely be supported unless this view can be demonstrated to be inconsistent (self-contradictory) or proved untenable by an alternative system that supercedes its explanatory and predictive utility (external disqualification). As this is not the case with either the photon-wave view or the particle view of light, both models have utility in spite of the fact that they may speak against each other.
It occurs to me that there are two psychoanalytic situations in which thinking about complementarity might prove beneficial. The first occurs when a given analysand and analyst espouse differing models of reality; the second involves differing models held by competing schools of psychoanalysis. In either instance, I can imagine that embracing Bohr’s principle might impart a sense of humility and, consistent with Frattaroli’s model, the acceptance of another as a bona fide observer of reality, as a subject in his or her own right. Perhaps, beyond all theorizing, a central component of clinical psychoanalysis is the ultimate recognition by both parties, during an intimate and lengthy encounter, that in a way Bohr was right: neither one’s waves nor the other’s particles will ever fully represent what light or life is all about.
Finally, let me say that I much appreciated Frattaroli’s choice to neither deify nor crucify Freud, but rather to treat his work with critical deference. I have discovered, in my own attempts at such a reasoned view of Freud, that it stops neither the Freud bashers from cries of idolatry nor the orthodox from accusation of cavalier heterodoxy. I trust that others will find in Frattaroli’s book an evenhanded and fair-minded reframing of psychoanalytic methodology and history. Particularly pleasing is the manner in which he demonstrates Lindner’s remark that “the only medium employed by the analyst is the commonest instrument of all—his own human self, utilized to the fullest in an effort to understand its fellows” (p. xxiv). No mean task for an author and no mean task for an analyst working in the trenches! Frattaroli presents analysis as a quintessentially human and humane endeavor.
REFERENCES
Covitz , H. (1998). OEdipal Paradigms in Collision. Peter Lang Publishers, New York.
Feyerabend, P. (1993). Against Method. Verso/Norton, PA.
Laudan, L. (1990). Science and Values. University of California, CA.
Lindner, R. (1955). The Fifty Minute Hour. Rhinehart, New York.
Maroda, K. (1999). Seduction, Surrender and Transformation. Analytic Press, N.J.
Sokal, A. (1996) Transgressing the boundaries: towards a transformative hermeneutics of quantum gravity. Social Text 46/47, pp. 217-252.
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