This essay is a review of Joe Schwartz's 'Cassandra's Daughter: A History of Psychoanalysis' (New York & London: Penguin Books, 2001).

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BOOK REVIEW
Joseph Schwartz (2001). Cassandra’s Daughter: A History of Psychoanalysis (New York
and London: Penguin Books), pp. 339.
Joseph Schwartz trained as a particle physicist at UC-Berkeley before turning to
psychoanalysis. Schwartz is both a psychoanalyst and a writer on physics and
psychoanalysis.
This book is a full-length history of psychoanalysis and covers the birth, growth, and
spread of psychoanalysis in Europe, Britain, and the United States.
Schwartz’s interest is not restricted to Freudian psychoanalysis. It encompasses the
relationship between psychoanalysis and the schools that split from Freudian
psychoanalysis.
Schwartz also explores the differences between psychoanalysis and contemporary
psychiatry and the role played by psycho-pharmacology in the history of
psychotherapy in the United States.
This is one of the few expository histories of psychoanalysis that try to integrate the
roles played by both psychoanalysis and analytically-informed approaches to
psychiatry in hospitals and institutions.
There are twelve chapters in this book. It also has a section on notes to the main text
and a useful bibliography for those who wish to read further on the history of
psychoanalysis.
It is important to note at the outset that there is a difference between books on
psychoanalysis and the history of psychoanalysis.
The former are mainly meant for those who are either reading about analysis for the
first time or who have an advanced knowledge of analysis.

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The latter is usually aimed at readers who are already acquainted with the
rudiments of analysis, but are also interested in exploring the institutional
underpinnings of analysis.
Books on analysis are mainly preoccupied with explaining the different aspects of
analytic theory and practice.
Books on the history of psychoanalysis however are preoccupied with the ‘socio-
historical determinants’ of the discourse and the practice of analysis.
The basic challenge then for Joseph Schwartz was to write a book that can introduce
the reader to the history of psychoanalysis; that is not easy to do for the reasons
mentioned above.
While it would be acceptable for a historian of psychoanalysis to presuppose a
considerable understanding of analytic theory in his readers, Joseph Schwartz is
writing for a popular audience rather than for fellow historians of science.
He therefore finds it necessary to build in an exposition of analysis to the extent that
it is possible to do so in a history of psychoanalysis.
Before exploring the beginnings of psychoanalysis in Sigmund Freud’s analytic clinic
in Vienna in the late 19th century, he considers the four narrative approaches that
might be appropriate for a history of psychoanalysis.
These four approaches are the following:
1. Focus on the role played by, Sigmund Freud, the founder
2. Relate psychoanalysis to the history of the natural sciences
3. Concentrate on the discovery of the analytic hour
4. Analyse the splits in the analytic movement
These approaches are also related to the fundamental conflict between conceiving of
the human subject as primarily preoccupied with the satisfaction of the instinctual
drives as opposed to exploring different forms of object relations.
It is akin to the difference between asking ‘who the subject is’ and ‘who or what the
subject seeks to relate to.’
In other words, should analysis pitch itself as a discourse that has discovered the
relentless need for instinctual satisfaction in human beings?
Or, should it think of itself as an attempt to delineate the modalities of how human
beings seek to relate to themselves and others in their lives?

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This may not seem that much of an existential or theoretical dilemma to the lay-
person who might quickly conclude that it should do a bit of both and move on.
But all analytic theories and theorists can be classified as belonging mainly to either
one of these two approaches to theory building.
What Joseph Schwartz does in this book is to use all the four narrative approaches
listed above in constructing the sequence of chapters in this book.
The reason that Schwartz is able to do so is that this is an expository history of
psychoanalysis and not an attempt to pitch for any of these narrative approaches to
the exclusion of others.
The expository part of the book begins with a fairly thorough depiction of the
scientific career of Sigmund Freud. Schwartz discusses both his early career as a
neuro-anatomist and his subsequent career as a practicing neurologist and as a
psychoanalyst.
Freud’s early struggles to make a living and support his growing family (while
attending to the demands of his research papers and patients) are also well-
described.
Schwartz is mainly preoccupied with Freud’s relationship to a senior physician in
Vienna named Josef Breuer.
It was Breuer – rather than Freud himself - who made some of the early discoveries
on how to treat hysterical patients in his clinic. The phenomenon of the transference
was first discovered in his case of Bertha Pappenheim (who is better known as Anna
O in the case named after her).
Breuer however did not specialize in hysteria or patients with nervous problems, but
treated such patients only as a part of his general practice. Sigmund Freud however
decided that there was enough clinical potential in these nervous patients to make it
his life’s work.
The main reason that Breuer did not take up this area was the fact that the Viennese
Medical Society was reluctant to accept that hysteria could afflict both men and
women. Furthermore, Breuer felt that hysterical patients would take a toll on his
marriage.
Nonetheless the collaboration between Breuer and Freud led to the publication of an
important study on the theory of hysteria with a number of actual case studies. The
publication of their Studies on Hysteria during the period 1893-95 paved the way for
the theory and practice of psychoanalysis in Vienna.

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The theoretical insights on meta-psychology that were implicit in the studies on
hysteria were unpacked by Freud later on in a number of papers on hysteria, meta-
psychology, and in his remarks and arguments in support of the sexual aetiology of
the neuroses.
These theoretical insights constitute the basic rudiments of the analytic doctrine.
The basic assumption on the part of the historian in giving equal recognition to Josef
Breuer along with Sigmund Freud for the invention of psychoanalysis is that a great
deal of the analytic doctrine is available in an embryonic form in the theory of hysteria itself
and in the therapeutic interventions that were thought to be necessary in the case of
Anna O.
So even though Breuer moved back to general practice in Vienna – leaving Freud to
grapple with the psychoneuroses on his own – Breuer’s early insights into hysteria
were powerful enough to implicate him as a co-founder of psychoanalysis.
If the Vienna Medical Society had been more receptive to analysis, Breuer would
have got more deeply involved with Freud.
Schwartz also analyses Freud’s relationship to an ENT surgeon named Wilhelm
Fliess. There was a huge exchange of letters on scientific matters between Freud and
Fliess. They also met every now and then in Berlin to take their exchanges on
scientific matters further.
Though Fliess was not an analyst and his speculations on the role of periodic
phenomena in physiology and psychology have not survived into the medical
mainstream, his support and friendship were important for Freud in the early years
of analytic theory.
Another important question that Freud was thinking through during these early
years was on the problem of the sexual aetiology of the psychoneuroses.
The main question was whether the cause of the neuroses was related to the sexual
traumas of childhood or whether they were related to the sexual fantasies of
childhood.
What Freud meant by a sexual trauma was an actual event that happened; a sexual
fantasy however was an event that was unconsciously desired by the subject, but
which did not actually happen in the empirical sense of the term.
Freud started off with the trauma theory but later moved to the fantasy theory as the
main cause of the psychoneuroses when he wrote his Three Essays on Sexuality in
1905. That is because Freud had a better understanding of the ubiquity of oedipal
phenomena when he wrote his essays on sexuality.

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This transition in his model of causation was to prove unnecessarily controversial
because the fantasy theory actually subsumes the trauma theory even though Freud
himself was not clear about it during his early years as a clinician.
In fact, it can be argued that in the Freudian model of causation, both traumas and
fantasies are traumatic since what is ultimately traumatic for the subject is the inability
of the psyche to work-through libidinal excitation in excess of what is normally the
case - rather than on whether the source of the trauma was internal or external to the
subject.
That is why Freud found it necessary to invoke the ‘shield’ against excessive stimuli
in his model of trauma in Beyond the Pleasure Principle.
There Freud’s argument was that every subject is protected by a filtering mechanism
so that he does not have to work-through more stimuli from the external world than
was absolutely necessary in accordance with the requirement of homeostasis.
If this model is applied to the sexual aetiology of the neuroses then it doesn’t really
matter whether Freud locates the source of the trauma inside or outside the subject.
What is traumatic is actually the amount of excitation that has to be worked-through
and not from where the sexual excitation originates in the life of the subject.
Schwartz then moves on to the political attempts made by Freud to co-opt his fellow
psychiatrists, Alfred Adler and Carl Justav Jung, into the analytic movement. He
analyses the reasons why Freud initially believed that they ought to be a part of the
analytic fold and why they subsequently went their own way during the years 1911-
13.
The main reason that Freud found Jung’s participation heartening was because he
was afraid that analysis might be misconstrued as a Jewish science.
This Freud feared would prevent analysis from being assimilated into the natural
sciences given the endemic anti-Semitism of the war years in Austria and Germany.
That is why Jung was encouraged by Freud to take up positions of administrative
responsibility in the analytic movement. Jung even accompanied Freud to Clark
University in the United States in 1909 and delivered a lecture of his own on
psychoanalysis.
However both Adler and Jung wanted to start their own schools of analysis, and
eventually disagreed with Freud on matters pertaining to the causation of the
neuroses. Their reasons (or excuses) for doing so are given below.

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Adler located psychic causation at the level of ‘organ inferiority’ in the body or the
mind of the subject - rather than sexual trauma or sexual fantasies relating to the
oedipal matrix - which he believed leads to an ‘inferiority complex.’
Neurotic behaviour was then explained as an attempt to overcome this problem.
So, for Adler, organ inferiority was always the ‘cause’ of the neurosis and the
inferiority complex was the ‘effect’ of the neurosis. The effect however made the
patient dysfunctional; hence the need for treatment.
Adler’s school - after he broke away from Freud - was described as ‘individual
psychology.’
Jung also disagreed with Freud but his disagreement was related to the definition of
the libido. For Freud, the libido was necessarily in the form of ‘sexual energy’ albeit
one that could be sublimated in higher activities.
Freud would even use the phrase ‘sexual chemistry’ to make his point about the
function of libido clear to his readers.
Jung, on the other hand, thought that the Freudian definition of the libido and the
unconscious were both reductive.
Jung preferred to locate both the unconscious and the libido at the ‘collective’ level.
For him, the Freudian unconscious was nothing but the localization of the collective
libido in the individual subject.
The individual unconscious was symptomatic of the collective unconscious and
could not be understood without invoking the archetypes that constituted the
collective unconscious; hence Jung’s interests in areas like Buddhism, Hinduism, and
comparative religion.
Neither Adler nor Jung was willing to engage with those aspects of the analytic
doctrine that Freud explained in his Three Essays on Sexuality because they were
afraid that would make it difficult to explain or practice analysis (given the
inhibitions of bourgeois society).
These aspects of psychoanalysis related to the following:
The ubiquity (at least in Freud’s view) of infantile sexuality; the model of individual
development along the lines of the oral, anal, phallic, and genital phases; the role
played by sexual traumas and phantasies of early childhood in the causation of the
neuroses; the diphasic onset of sexuality and the symptom; the role of sexual
curiosity in awakening the subject’s interest in learning and on inhibitions pertaining
to learning; and, finally, the demands of individuation within the Oedipus complex.

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Schwartz is particularly good in the chapters that he devotes to the expansion of
psychoanalysis in the United States.
He not only discusses the role played by the analysts like Stanley Hall and James
Putnam who were the first to accept analysis at Clark and Harvard universities, but
also on how psychoanalysis subsequently became a form of ego-psychology in the
United States.
While I do not have sufficient space to go into details here of why psychoanalysis
became ego-psychology, the main problem was that in the United States analysis
could only be practiced by those who were trained as physicians. That is a different
model altogether from what prevailed then in Britain and Europe.
Freud himself had written eloquently about the need to keep the discourse of
psychoanalysis open to those with a humanistic background and not restrict it to
those who belong to the medical profession in his polemical tract, The Question of Lay
Analysis which he wrote in support of a fellow analyst, Theodore Reik, in 1926.
Freud took this position in his text on lay-analysis because he wanted to differentiate
between what analysts do and what psychiatrists do.
Since analysts do not administer any medication whatsoever, Freud did not see any
justification for conflating the different forms of psychotherapy with psychiatry, and
impose the kind of requirements that are imposed on the psychiatric profession.
It is not possible furthermore to work without medications like lithium in the case of
psychotics.
So it is easy to come to the false conclusion that neurotics ought to be subject to
medication as well, and that therefore there is no need for including lay-analysts in
the analytic profession since they are not authorized to administer or even prescribe
psychiatric medication.
Besides, those who insisted on a medical degree to practice analysis did not seem to
realize that analysts work mainly with neurotics and psychiatrists with psychotics.
Sometimes analysts work in conjunction with a medical practitioner or only after
organic causes for a specific instance of mental illness have been ruled out to
alleviate the kind of concerns mentioned above.
It is also important to remember that the psychiatric profession is heavily regulated
in the United States, and had to survive the ‘anti-psychiatry’ movement of the 1960s.
The reverberations from this movement were not restricted to the psychiatric

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profession in the United States, but spread world-wide and even percolated into
French psychiatry, psychoanalysis, and continental philosophy.
The works of Gilles Deleuze and Félix Guattari titled Anti-Oedipus and A Thousand
Plateaus represents the culmination of the anti-psychiatric movement in France.
My doctoral thesis at Cardiff University, for instance, was an attempt to delineate
how some of the arguments against Oedipus (which symbolises psychoanalysis) that
are invoked in the work of Deleuze and Guattari are ‘prefigured’ in the theoretical
works of D. H. Lawrence on the unconscious.
The books that D. H. Lawrence wrote on these themes include Fantasia of the
Unconscious and Psychoanalysis and the Unconscious. While it is true that these works
are not a scientific critique of psychoanalysis, the term ‘fantasia’ is applicable not
only to the spirit of what Lawrence was up to, but also to that of Deleuze and
Guattari.
Literary critics have also pointed out that Lawrence’s preoccupations with these
romantic themes of a fantasia are not only specific to his theoretical work, but are
intrinsic to the thematic concerns and the plot structures of his novels, poems, and
short stories as well.
It should be clear then that the attempt to differentiate between the neuroses and the
psychoses was not just a matter of differential diagnosis in the analytic clinic, but
had important implications for how the profession of psychoanalysis would be
organized and practiced in different parts of the world.
These approaches to the unconscious also had important consequences for what an
acceptable theory of the subject would be for students of literature. So the problem
of whether characters in literary constructs should be treated like real people is a
question that is not easy to answer.
And, if yes, does it make sense to analyse them as though they were on the couch?
If all these analytic approaches are acceptable – under carefully delineated
circumstances – who learns from whom when psychoanalysis is applied to literary
texts? It is important to remember that Freud believed that even dreams reported in
literary texts like Jensen’s Gradiva can be subject to interpretation.
For Freud there was no conflict between literature and psychoanalysis because the
latter only makes explicit what was implicit in the former.
Should we apply psychoanalysis then to literature like Sigmund Freud was given to
doing? Or should we apply literature to psychoanalysis like Jacques Lacan taught us
to do?

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The roots of psychiatry (and by implication anti-psychiatry as well) go back to the
State Care Act of 1890 in New York.
The anti-psychiatry movement is related to the fact that the improvements that were
sought to be made in 1890 by the state legislature in New York could not be
therapeutically realised in the history of psychiatry.
The Act of 1890 made it necessary to move patients deemed mentally ill from being
subject to mere ‘custodial care’ to psychiatric institutions or psychiatric hospitals
where they would be given the requisite treatment in a bid to cure them.
It also led to the establishment of what is now known as the New York State
Psychiatric Institute which is affiliated to Columbia University.
The significance of these events is related to ‘the beginning of the modern
administrative phase of US psychiatry.’ That is, it led to a phase when psychiatrists
have to deliver a cure in state-funded hospitals and were willing to try any
therapeutic method if it looked promising.
Schwartz also evaluates the work done by Weir Mitchell, William James, William
Alanson White, Smith Ely Jelliffe, Stanley Hall, James J. Putnam, Harry Stack
Sullivan, and the hospital systems in New York and Washington, and the range of
psychiatric treatments in common use then and why they have fallen into disuse
now.
This is the best part of the book because histories of psychoanalysis usually do not
provide much information on the institutional history of psychoanalysis or the
attempts made to integrate psychoanalytic and unconventional approaches to
psychotherapy with that of psychiatry.
Schwartz also worries about the ideological beliefs that might have mediated these
attempts to cure patients pro-actively. Schwartz even provides a number of
caselettes of patients who were treated at St. Elizabeth’s in Washington DC. Most of
these patients were suffering from routine ailments like anxiety, depression, mania,
and phobias.
These types of psychiatric hospitals were preoccupied with finding an organic cause
for mental illness. They also did a number of autopsies of dead patients to see if they
could find any difference between the cerebral tissue of those who suffered from
mental illness and those who didn’t.
An interesting episode from those years was the ‘focal infection theory’ of mental
illness. The psychiatrist who propounded this theory was Henry A. Cotton.

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Henry Cotton believed that mental illness was related to parts of the body like ‘teeth,
the tonsils, and the colon.’ This false belief led to the large-scale extraction of teeth
from mental patients; it was almost as though all mental patients had dental
problems. That is why psychiatric hospitals were full of patients without any teeth.
These patients were supposed to have been provided with dentures (after all their
teeth were extracted) but somehow that was not done. Cotton’s approach did a lot of
damage to the reputation of psychiatry; it was subsequently satirized in movies
based in psychiatric hospitals and institutions.
Patients were also subject to colectomies; electro-convulsive therapy; histamine and
insulin shock therapies; and different types of lobotomies. This is only a
representative list of psychiatric treatments and not an exhaustive list.
None of these treatments was actually curative; they were only frustrating attempts
to cure any number of psychiatric illnesses because of the enormous pressure on
psychiatrists to perform; they eventually fell into disuse.
And, finally, Schwartz considers the work of A. A. Brill in New York; Franz
Alexander in Chicago; the part played by analysts who came to the United States as
European refugees; and the growth and establishment of ego-psychology through
the efforts of Heinz Hartmann, Ernst Kris, David Rapaport and, ironically, Rudolf
Lowenstein (who was Jacques Lacan’s trainee analyst); before describing the theories
of Karen Horney and Heinz Kohut.
Ego-psychology, needless to say, became the dominant form of psychoanalysis in the
United States. The theoretical controversies in France were related to the fact that
Jacques Lacan began to deviate from the forms of orthodoxy that constituted ego-
psychology in the United States.
There were two important points that came up in the conflict between Jacques Lacan
and the ego-psychologists. Lacan’s critique of ego-psychology related to the fact that
he thought the ego had become reified in the structural model of the psyche. This was
tantamount, for Lacan, to the repression of the discovery of the unconscious itself.
Furthermore, ego-psychologists do not differentiate - as Lacan does - between the
‘subject of the unconscious’ and ‘the ego.’ This leads them to conclude that the ego is
the seat of reason and rationality.
But, for Lacan, the ego represents the ‘irreducibility of narcissism’ and the
prevalence of the imaginary in the constitution of the human subject. It is therefore
incorrect to posit identification with the analyst as the main gain of an analysis.

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This would amount to a form of social conformity even if the analyst was not
coercive with the patient in his personal capacity. However useful the concept of
‘adaptation,’ that Heinz Hartmann pushed for might be in the context of
evolutionary biology, it was not the right way to define the aims of analysis.
The main problem that the International Psychoanalytic Association had with Lacan
had less to do with his approach to theory than with his practice of variable sessions.
They preferred to enforce the standard analytic hour per session in all parts of the
world because they felt that variable sessions can be misused by the analyst.
So, for Lacan, it was a matter of a theoretical disagreement; but for the authorities, it
was a matter of enforcing the same regulatory standards in all their national
associations.
That is why the meta-psychological implications of Lacanian innovations like
‘variable sessions’ and the ‘passe’ were taken up seriously in France when the
Lacanian movement went its own way with the founding of the Ecole de la Cause
Freudinenne and the Ecole Freudienne de Paris.
There were theoretical controversies not only in France but also in Britain.
During the war years, for instance, Ernest Jones and Marie Bonaparte helped
Sigmund Freud to settle in London with his family. The career of his daughter Anna
Freud was subsequently to be associated with the British Society for Psychoanalysis.
The main conflict in London was on whether Anna Freud or Melanie Klein was right
about the theoretical implications of analysing children, and in working out the
implications of doing so for a theory of the subject. After Freud’s death of cancer in
1939, there was also the question of who would lead the analytic movement.
Anna Freud’s self-effacing ways were acceptable to the British Society but it made it
increasingly difficult for her to compete with Melanie Klein who insisted that the
Oedipus complex had to be located in early childhood and not during the period in
which Freud had done so.
Klein went on to introduce a conceptual structure that seemed at odds with the over-
all feel of analytic theory as practiced by those trained by Freud himself or those
who partook of the paediatric tradition of analysis in English medicine.
Besides, it is important to remember that Freud himself did not analyse children. The
case study of Little Hans did not require Hans’s presence in Freud’s clinic since the
analysis was done by his father under Freud’s guidance rather than by Freud
himself.

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So clearly there was a huge gap that had to be filled in the theory and practice of
analysis. This gap related to the analysis of children.
A number of important questions came up in this context:
Do children really have an unconscious? Wasn’t it too soon to study the effects of
primal repression? If children do not have an unconscious, are they capable of
having a transference to the physician? Furthermore, will they be able to free-
associate on the couch?
If none of the conditions given above obtains in the sense that they do in the analysis
of adults, then, does it make sense to ‘describe’ treating children as ‘psychoanalysis’?
Is the analysis of children not rather a case of being treated by a psychoanalyst (as opposed to
being treated through the method of psychoanalysis)?
That then was the question that came up for a decision in the British Society for
Psychoanalysis at London.
This theoretical question however had to be answered amidst the push-and-pull for
power and control by those affiliated to Anna Freud and Melanie Klein.
Both these analysts had done pioneering work and were positioned as authentic
intellectual successors of Sigmund Freud in their own way.
The ‘controversial discussions’ in the British Society during the war years led to an
institutional compromise.
The essence of the compromise was that every new trainee would be exposed to the
theories of Anna Freud, Melanie Klein, and the Independent School.
As the years went by, a Scottish paediatrician named Donald W. Winnicott became
the de facto head of those who considered themselves independent of the two
dominant schools in the British Society.
The main difference between the dominant schools which were both European in
their orientation and the independent school was that the former were preoccupied
with drive theory, while the latter were trying to put together object relations theory
and were basically preoccupied with forms of attachment and the modalities of
mothering.
A great deal of the research that came out of the British School eventually took on an
empirical cast.
The main focus in training analysts was known as ‘infant observation.’ Most trainee
analysts had to write up a paper with their observations of infant behaviour in

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addition to the usual demands of a trainee analysis and course work in all the
analytic traditions that constituted the British School of Psychoanalysis.
Compare this with the French orientation for instance.
There is no need for any infant observation at all in the French tradition of training analysts.
French analysts who specialize in child analysis, or who have at least engaged with it
theoretically like Octave Mannoni, Maud Mannoni, and Serge Leclaire have however
written extensively on how children cope with the trauma of being excluded in early
childhood from parental care (and other instances of the symbolic order from the
locus of Lacanians).
They however do this on the basis of their analytic practice. The French make
inferences about childhood; they are not interested in actual observations.
There is no reference whatsoever to infant observations in Lacan’s work as a source
of theory with the sole exception of the pioneering work that he did on the mirror
phase.
That is because the French approach is to recuperate the events of childhood as
discursive entities that are mediated by oedipal fantasies and not as pure empirical
entities.
In his attempt to conclude this book, Joseph Schwartz points out how much he has
had to leave out. That no doubt is a thought that I experience as the reviewer as well.
So let me conclude with what Schwartz has to say about the future of
psychoanalysis.
The future of analysis depends on whether science can finally locate an organic
cause for mental illness or not. The role of psycho-pharmacology, he argues, will
increase and not decrease.
That is because the use of sedatives like chlorpromazine and variants of this
medication in treating schizophrenia has reduced the need for hospital beds in
psychiatric hospitals by as much as 75 percent.
Furthermore, even for less severe disorders like depression, the use of fluoxetine has
become ubiquitous in the United States. It is hard to imagine that these psycho-
pharmacological approaches can be reversed even if it were necessary to do so.
There has also been a revival of neuro-anatomical and neuro-imaging studies to
study samples of brain tissue for a range of psychiatric ailments.

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While most of these attempts have been for either common ailments like depression
or schizophrenia, it remains an open question whether such an approach makes any
sense for the neuroses.
While most of us might think that Sigmund Freud and Jacques Lacan would be
opposed to such studies or think that the neuroses are not subject to forms of organic
causation at all, a careful reading of their work reveals that they do not rule out such
a possibility.
Sigmund Freud would often say that his analytic theories were the best that he could
come up with in his life-time, but that he cannot categorically rule out an organic
cause.
Likewise, Jacques Lacan points out in his seminar on the fundamental concepts that
‘sooner or later, something would have been found’ and that they could take the
form of ‘humoral determinates.’
It is therefore difficult to say what the future holds for psychoanalysis, psychiatry,
and for those involved in the area of mental health.
SHIVA KUMAR SRINIVASAN