Outbidding

To the Editors:

I found the fact of your printing P. B. Medawar’s review of I. S. Cooper’s book, The Victim Is Always the Same [NYR, January 23], under the heading “Victims of Psychiatry” even more disturbing than Medawar’s review itself. I think that it will be clear to most fair-minded readers that Medawar is using his article to grind a personal axe against psychoanalysis and psychiatry. I do not know what injuries he feels he has incurred at the hands of my colleagues, but it does seem to me from the tone of his article that he feels closely akin to those “psychiatrists who attempt physical remedies” and have come off looking so badly in the “Gothic caricatures” of “Those fashionable psychiatrists (mainly English).”

Medawar’s article quotes M. H. Stein, not “Stern” as your paper reported it, incorrectly and out of context. The quotation in my edition of The International Journal of Psychoanalysis, 53, p. 13, 1972, which was part of Dr. Stein’s introduction to a panel discussion on “Aggression” at the International Psycho-Analytical Congress in Vienna, July 26, 1971, reads:

Psychoanalysts have a unique contribution to make [to the study of human aggression] owing to their privileged access to the psychological processes of human functioning, through the study of the unconscious processes, particularly transference phenomena.

This statement, properly quoted and in proper context, with its declaration that the method of psychoanalytic investigation offers the potential of a (not The, Dr. Medawar) special perspective of man’s psychological functioning is a far cry from the implications of the misquote in Medawar’s article.

As a psychoanalyst and a human being, I truly regret the suffering caused by misdiagnosis and misapplication of therapeutic techniques in physical or psychological medicine and rejoice at the success of Dr. Cooper’s cryosurgical technique for treating DMD. I also recognize that there is a place for “physical remedies” in psychiatry and considering the limitations of all current psychiatric treatments, I am not inclined to throw out any baby with the bath.

I will not, however, pick up the gauntlet that Dr. Medawar has, in my opinion, so irresponsibly thrown down in his “book review” by detailing cases of patients who have been exposed to the pain and trauma of needless surgery, because a psychiatric consultation was not obtained to help diagnose what proved to be the psychogenic origin of their symptoms. That would seem to me to be the kind of senseless argument that Medawar himself resorts to and which ironically his article, quoting from Camus, calls a “disgusting attempt at outbidding.”…

Howard B. Levine, MD

Cambridge, Mass.

P.B Medawar replies:

I am glad Dr. Levine’s letter gives still further prominence to what I described in my review as the “impudent” pretensions of psychoanalysts. Dr. Stein does indeed claim on behalf of psychoanalysts that they enjoy a privileged access to the psychological processes of human functioning, with the clear implication that their access is to the truth about these difficult and obscure matters—a claim which I described in my review, and take this opportunity to describe again, as “impudent.”

If only psychoanalysts could learn enough humility to direct a long cold stare at themselves instead of delivering each other with these little bouquets, there is a hope that one day psychoanalysis will achieve the stature of a branch of scientific medicine.

It was my fault, not the printers’, that Dr. “Stein” was referred to as Dr. “Stern.” But instead of complaining about these trivialities why does not Dr. Levine or some other psychoanalyst make an attempt, however feeble, to rebut the fundamental and, in my view, very damaging criticisms of psychoanalysis contained in my The Hope of Progress (Doubleday, 1973).

I must make one correction in my review: I described “mainly English” the fashionable psychiatrists who had made such a good thing about writing imaginative literature on the psyche. In reality one of the worst offenders is Scottish so “English” should strictly read “British.”