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Book Reviews |
Dr. Volkan, a prolific psychoanalytic writer, has teamed up with Dr. Ast, a German analyst, to provide this worthy contribution to an underemphasized area in psychoanalytic theory and practice. The role of siblings in mental life may have first been underemphasized by Freud, who may have had his own reasons for such downplaying. For example, Freud as a child had a private bedroom filled with books while all of his siblings lived together in one other, crowded room. Whatever the reason, it has been said that siblings are the stepchildren of psychoanalytic theory, and there has been recent interest in exploring this rich region.
This book is based on a combined ego psychological and object relations perspective that provides a coherent framework for the deep discussion of clinical material. The first chapter introduces and reviews the concept of unconscious fantasies. This one brief chapter alone contributes significantly by building this concept with focus and clarity. The authors highlight the developmental perspective on fantasy and lay the groundwork for the deep interpretive approach found through the remainder of the book.
The meat of this book is a series of clinical cases illustrating common pathogenic unconscious fantasies about siblings. The case reports range in length from a few paragraphs to practically whole chapters, but each patient is vivified and compelling. The authors demonstrate their clinical expertise, but they do not make the role of the analyst the central point. Instead, the material convincingly illustrates the role of unconscious fantasy about siblings in the psychopathology of the patients.
Various themes on sibling relationships are presented. Variations on murderous and incestuous themes abound, but more complex and subtle fantasies are also described. Representation of sibling conflicts by animals, claustrophobia based on womb fantasies, and Christmas "neuroses" that are based on fantasies of the "blessed child" are all supported by the case material. The authors also offer material on the fantasies that may develop in more specific situations such as adoption, siblings of handicapped children, or the death of a close sibling.
Interestingly, younger siblings are presented more often as the stimulus to pathogenic fantasy for the older sibs. In this book, the older sibs seem to create problems for the younger sibs only if the older ones are handicapped, adopted, or deceased. Such a "protected" position for the youngest sibling would almost seem a testable hypothesis, yet in my own work, the majority of my analytic cases (as well20as myself) are youngest children with no handicapped, adopted, or deceased sibs. The role in fantasy for20older siblings might be further examined.
The book is very well referenced, reflecting a high standard of scholarship. As noted by the authors, the index of the complete standard edition of Freud's works has no reference to sibling (although Siberia is referenced). Another fascinating point, cited from Waugaman,1 is how the disclosure of a sibling's name can animate the conflicts over siblings. How often we hear patients refer to "my brother" or "my sister"!
The patients in the book are often seemingly more disturbed than the typical analytic patient, and a sidelight of the book is the representation of analysis with borderline cases, an interest of Dr. Volkan's. Dr. Volkan is generous in publishing his clinical material, and in an age of clamor for "data," he offers the raw data of a productive career. Dr. Ast's case material is equally forceful and informative. Such attempts to open up so much of their work to study by others enriches the field. Their effort to organize their data in an uncompromisingly psychoanalytic way is admirable, although we must continue to admit that those who are skeptical of the analytic perspective may remain skeptics until they can join us in our offices.
The book opens up a whole realm of unconscious organizing fantasies based on sibling relationships, and every clinician who reads it will likely begin to see more hints of such fantasies in his or her case work. The first chapter is highly recommended for all clinicians, perhaps especially those early in their careers, and the remainder of the book is recommended for all clinicians who are open to a new range of potential interpretation. All readers will be treated to many wonderful examples of masterful analytic work.
Footnotes
Dr. Hutto is Assistant Professor of Psychiatry and Director of Psychotherapy Education at the University of North Carolina School of Medicine, Chapel Hill, NC.
References
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