The soul, the mind and the psychoanalyst.

The creation of the

psychoanalytic setting in patients with psychotic aspects
by David Rosenfeld, London, Karnac Books, 2006, 264 pp., £19.99 (paperback).
This book brings together eight chapters by David Rosenfeld originally published
separately in collections concerning topics from child psychoanalysis totrauma and
psychosis. These themes run through this book so that taken as a whole these previously
separate chapters form a whole communicating Rosenfeld's ideas in such a way
that repetition and revisititation of his concepts in relation to different cases make them feel
familiar and understood.
The book has a Foreword by Thomas Ogden who expresses his regard for Rosenfeld's
courageous work with psychotic patients. He himself chooses two of the chapters to discuss
and goes on to describe them as representing – ‘two of the most important contributions of
the past decade to the understanding of the psychoanalytic treatment of psychotic patients’
(p. xvii).
While the book feels immediately modern (one subheading is ‘Sega versus Nintendo’),
Rosenfeld traces the foundations of his work back to Freud and refers to subsequent
seminal figures through the decades constantly weaving a theoretical framework from
which he presents his captivating clinical material. Each of the first four chapters revolves
around an individual patient and the exploration of their difficulties while attempting to
generalize resultant hypotheses. The first chapter concerns a young man recovering from a
psychotic episode in the context of earlier family trauma in Chile and subsequently
in other South American countries when fleeing military dictatorship. Rosenfeld moves on
to describe ‘Julie’ who has an eating disorder, ‘George’ with substance misuse problems
and ‘Lorenzo’ and hisaddiction to video games.
It is Rosenfeld's own very personal explanation of his approach and the work that he
undertakes with these patients in their late teens or early twenties that make the
clinical material so moving. He says ‘Psychoanalysis, besides interpreting, tries to teach
patients to be epistemologists of themselves’ (p. 5). He regularly makes reference to his
experience in child psychoanalysis and the ways in which his observations and techniques
have been informed by this.
This is linked to one of Rosenfeld's central concepts – ‘autistic encapsulation’ and
Chapter 6 is devoted to this. The similarities and differences in his theories with Frances
Tustin surface frequently through the book. This chapter together with chapter 5 –
‘Listening to and interpreting a psychotic patient’ and chapter 7 – ‘Psychotic body image’
draw together and
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expand on Rosenfeld's ideas from earlier chapters again illustrated with rich fragments of
clinical work.
The final chapter is ‘Dialogue with Shakespeare and Jean-Paul Sartre about
psychoanalysis and scientific methodology’. The title belies a keen discussion regarding
Freud's ‘Analysis terminable and interminable’. This is in the style of a seminar led by
Rosenfeld with occasional contributions from the ideas of Sartre and the writings of
Shakespeare. It also attempts to address the future of psychoanalysis and research thus
adding another layer of interest to the book.

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 As the title suggests, Rosenfeld places central importance on the work of the
psychoanalyst in creating and maintaining the psychoanalytic setting while adapting to the
needs of psychotic patients. His description of his work in Buenos Aires sounded quite
exotic to me and provides a window onto work happening elsewhere in the world. He
emphasizes the importance of working within a team. This team includes a psychiatrist and
psychologist so that prescribing and family work can occur simultaneously. The work is
intense with patients being seen daily sometimes for several sessions a day and encouraged
to telephone in between times during the early stages of treatment. The techniques he
employs feel unconventional – meetings in coffee shops, singing lullabies together and
going to arcades to play video games. Rosenfeld, however, assiduously follows these
descriptions with an emphasis on his maintenance of a psychoanalytic stance wherever he
is – ‘No one can stop me from thinking like a psychoanalyst, even when I am walking
through the hospital with a patient or going to a shopping mall and playing video games’
(p. 137).
As well as the book's clinical and theoretical applications it is Rosenfeld's descriptions
of his experiences and training that I feel would hold special interest for students. The
influence of his life on his counter-transference and utilization of theory is discussed in
addition to the facets of a training analysis. Perhaps in connection with this he also gives
space to the patient's experience of analysis – quoting ‘George's’ report to other patients
about his treatment, writing – ‘in a way, it is as if the patient is co-operating in a scientific
work, giving his own version of his disease, his treatment, and his hospitalisation’
(pp. 108–110).
In the Preface Rosenfeld writes ‘This book is intended to be felt and thought about … I
hope that what I have written will become an emotional dialogue between me and my
reader’ (p. xx). The book did raise questions for me about Rosenfeld's concepts and use
of interpretation but it feels as if these are invited and encouraged. He suggests that when
working with the most disturbed individuals the areas of psychotic transference and
resultant counter-transference should be studied and at the forefront of research.
The individual chapters had previously been translated into English and apart from a
few mistakes and sentences that finished abruptly I felt that this
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seemed to have been done well. The book is also very well referenced and has a good
bibliography.
Rosenfeld touches on many different areas. He draws upon his years of experience
while also reaching out into new territory. I think therefore that this book would be of
interest to many people, probably for many different reasons. It is hard to believe that a
book which covers so much of the personal, clinical and theoretical aspects of
psychoanalysis in a developing field can manage to do so in such an accessible way.
Katy Wheeldon
Ferguson Rodger Clinic, Southern General Hospital, Glasgow
Email:
© 2008 D. Rosenfeld
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Article Citation
(2008). The soul, the mind and the psychoanalyst. The creation of the psychoanalytic
setting in patients with psychotic aspects. Psychoanal. Psychother., 22:143-145