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The Abyss of Madness (Psychoanalytic Inquiry Book Series), by George E. Atwood
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Despite the many ways in which the so-called psychoses can become manifest, they are ultimately human events arising out of human contexts. As such, they can be understood in an intersubjective manner, removing the stigmatizing boundary between madness and sanity. Utilizing the post-Cartesian psychoanalytic approach of phenomenological contextualism, as well as almost 50 years of clinical experience, George Atwood presents detailed case studies depicting individuals in crisis and the successes and failures that occurred in their treatment. Topics range from depression to schizophrenia, bipolar disorder to dreams, dissociative states to suicidality. Throughout is an emphasis on the underlying essence of humanity demonstrated in even the most extreme cases of psychological and emotional disturbance, and both the surprising highs and tragic lows of the search for the inner truth of a life – that of the analyst as well as the patient.
- Sales Rank: #1029382 in Books
- Published on: 2011-09-09
- Original language: English
- Number of items: 1
- Dimensions: 8.90" h x .60" w x 6.00" l, .75 pounds
- Binding: Paperback
- 240 pages
Review
"From the very beginning of his career, George Atwood has immersed himself in the world of madness, doing psychotherapy and psychoanalysis with the most difficult patients – those suffering from psychoses, deep depressions, suicidality, and multiple self-states. He has a unique gift for both understanding and working effectively with such individuals, and this book – primarily a series of case stories – brings them alive as individual personalities, as well as showing his special talents as a therapist. Written in jargon-free, poetic, and highly accessible style, one feels as though one is in a comfortable room, talking with George as psychological difficulties are unraveled, meaning revealed, and terrible and painful histories lived through. There is profound knowledge in this book." - Louis Breger, author of Freud: Darkness in the Midst of Vision
"At the heart of what is healing in psychotherapy lays a kind of humaneness, understanding, and compassion – one that dissolves the centuries-long barrier between madness and sanity and neutralizes the pathologizing effects of traditional diagnosis. In this volume, George Atwood masterfully recasts the workings of the so-called psychoses and the associated emotional suffering into an insightful and humane understanding of how we experience ourselves and the world in the face of trauma, deprivation, and personal annihilation. Grounded in phenomenological contextualism, his lifelong theorizing and moving clinical narratives clearly reflect his humanity, accessibility, and contemporary clinical sensibility. Understanding madness not as an aberration and diagnosable disease, separate and estranged from what is presumed to be "normal," his work underscores how emotional suffering and seemingly intractable delusions result from relational contexts centered on traumatic loss and the absence of understanding, responsiveness, and human connection. This volume is as clinically profound and insightful as it is personally accessible and emotionally engaging. It is a must-read for all contemporary clinicians concerned with deepening their understanding of therapeutic action, regardless of their patient population." - William J. Coburn, Editor of the International Journal of Psychoanalytic Self Psychology
"George Atwood explores with a clarity of vision and impassioned perspective the abiding and thorny arguments regarding the relative merit of medical and psychological perspectives on the etiology and treatment of extreme mental states. The real strength and contribution of [this book]are in Atwood's deep and far-reaching understanding and beautiful explication of the profound destructiveness inherent in the invalidation and discrediting of experience that can lead to the annihilation of a person's felt sense of being. The Abyss of Madness is successful at provoking and summoning the reader to clarify his or her own thinking regarding the use of diagnostic labeling, the use of medications, and the nature of so-called mental illness. Atwood's book is an important contribution in an age of biological psychiatry and waning interest in psychodynamic understanding and treatments. The Abyss of Madness is an engaging and thought-provoking book that will be of interest to advanced students, academics from many disciplines and clinicians." - Jennifer L. Stevens, PsycCRITIQUES
About the Author
George E. Atwood, Ph.D., is Professor of Clinical Psychology at Rutgers, the State University of New Jersey, USA. He is the author and co-author of numerous books, including Contexts of Being (Analytic Press, 1992), Faces in a Cloud (Jason Aronson, 1993), The Intersubjective Perspective (Jason Aronson, 1994), Working Intersubjectively (Analytic Press, 1997), and Worlds of Experience (Basic Books, 2002).
Most helpful customer reviews
22 of 24 people found the following review helpful.
Some Words on the Abyss
By David S. Klugman
Some Words on "The Abyss of Madness"
November 7, 2011
Reading (and re-reading) "The Abyss of Madness" has been a profound experience for me. In some ways it was like having an extended, deep conversation with its author in which mainly I listened to his voice as if the words on the page were merely vessels for the profound truths he was speaking. In other ways it was deeply affirming to hear the author challenge and shatter so many false idols that exist in our field, in the world, and that shadow the thinking and practice of what we call "modern psychiatry" (dominated as it is by the Medical Model).
The stories he tells are compelling; and the understanding of trauma and its effects that these stories illuminate come through with great (if sometimes disturbing) clarity and power. As a clinician this clarity and power, though often painful and difficult to bear (personally and professionally), has been and continues to be a great source of aid and inspiration to me in my life, in my practice, and in my own growing understanding of the human condition.
Standing out for me among all of the concepts and theories discussed in the book - many of them quite erudite, yet all of them stated in layperson's language - is the power of human understanding; and how this power is consistently underestimated by clinicians. In view of this, one of the thoughts that occurred to me while reading and reflecting on "The Abyss..." was this: one has not only to come to some kind of terms with one's own trauma, but also to have fostered a sense of self worth so that there is no longer anything like "just" listening - but that listening and responding and working to make sense of things with a patient "suffices."
In other words, if one's own self worth still suffers from the traumatic effects of being invalidated (as is the case with so many trauma victims, clinicians not excluded), then one will seek to do more than one is able to do, and reach for things (like medication, false promises, or abstruse theories) in an effort to feel like one is "doing something valid." This all takes place in the context of the analyst's struggle to ostensibly help the patient while actually, through treating others in the absence of having established for oneself a sense of self worth in simply Being, one is covertly seeking to validate oneself.
Conversely, if one's sense of self worth has more or less been established, one knows how sufficient and potent the power of human understanding and listening is, and what can be achieved by its rigorous application. Accordingly, being present with the patient in whatever way one can be is more than enough "doing." The idea I am highlighting here is that analysts must achieve (through their own trauma work) an honest sense of self worth in their own human being in order to avoid the trap of human doing (which so often results, as the author consistently teaches us, in a panoply of soul murder). This is just one of many notions, or ideas, that crystallized for me while reading and absorbing this profound and important book.
I must also admit that there were times when I felt like this volume should come with a warning label: "May induce terminal states of extreme emotional distress - especially for those who are devoted to the denial of their own and others' personal trauma." This is a joke, of course, but only partially so, as it expresses the depth and potency that I feel this book contains for those (myself included) who are willing to confront its content directly.
One saving grace, as I worked my way through its pages, was the sound of it's author (sometimes in my head, and often on the pages themselves) gently reminding me that we are not alone in our trauma, if only we can muster the courage (and have luck to find a good guide) to seek out the Truth of what our trauma may contain for us in our effort toward greater self-knowing and self-actualization as we learn how to bear it.
The idea of bearing the unbearable leading to something being borne at multiple levels is a metaphor that has deep meaning for me as I reflect on this book. This is especially so in the matter of the author's discussion of "ghosts," more rightly understood as the unlived potentials in all of us that call out for expression and life.
This potential notwithstanding, the bearing of trauma is no easy task and, as its author stresses, there is no quick fix either (in fact there is no "fix" at all). Nevertheless, in many profound and unexpected ways, this book is enabling me to put into perspective some of the ideas I have held close to my own heart, and have cherished for so many years. For example, while I have long championed the Power and meaning of Imagination, feeling, vitality and creativity, I now also see more clearly than ever that these resources actually "lose" their power and meaning when they are in any way used to diminish, avoid and/or sequester, rather than shed light upon and thereby magnify the nature of our innermost lives - including (though perhaps not exclusively) the trauma that has marked them.
Accordingly, the idea of an enlightened or "Golden Age," as its author projects for the future of our field, thrills me; yet this thrill is well tempered by the understanding that in order for this "Golden Age" to transpire, we must come as a Collective to realize how slowly such an age will be in the making, as it will entail the "containment" of trauma and not its elimination.
I would like to say that reading this book was a thrill ride, but it was not. It was difficult, potent, and humbling, as it forced me to re-think and re-feel my own deepest traumas and convictions.
As for any critics, if they come (and they always seem to come) - it is simply obvious to me that denial and a dogged adherence to the Medical Model, rather than any reasonable or genuine disagreement, is what powers their cause against it's author and his theories, ideas and methods. This is so because the truths that Dr. George Atwoood articulates in "The Abyss of Madness" are undeniable, three-dimensional, palpable, sensible and unavoidable.
David Klugman
8 of 10 people found the following review helpful.
Opening Your Eyes
By Melinda A. Wilp
This book has opened my eyes to the events and circumstances that can surround a live and slowly, but surely, piece by piece, remove structural foundations and beliefs to the point where an individual can simply slip into a state of madness. The real value is the heart and the soul of the author as he sought to understand the individuals he treated and broke new ground through his experience, analysis and hours of therapy with individuals. The author realized the value of the human connnection and sought with each patient to reach inside their "madness" to touch a part that still existed but had been tucked away so no one else could get to the remaining piece which was essentially keeping their soul alive. There are not many therapists who understand the connection the author sought with those he treated. Dr. Atwood could have simply followed existing protocol for treating patients, but instead, he sought to understand them and took the time to heal. He could have simply collected a paycheck, but instead he extended a hand of a real person who cared enough about each patient that if they responded, they could find their way back to an independent life, depending on the severity of their case. This is a must read book for each and every therapist practicing on the globe today. Your patients are more than just a job. You can literally save a life if you can understand the principles in this book. Thank you George Atwood for thinking, reaching, searching, trying new ways to reach your patients and finally for taking the time to write this book. It has saved a life and I am sure it will save many more! It is greatly appreciated. God bless you for your efforts.
5 of 6 people found the following review helpful.
A solid addition to the literature on madness...
By Brian C.
In this book George Atwood attempts to analyze, or understand, the various forms of madness that human beings are prone to. This includes what is usually called schizophrenia (Atwood does not like the label), as well as bipolar disorder, melancholia, and suicide, among other things. The book is full of case histories and they do not make light reading. Human beings are fragile creatures and the world is sometimes a very cruel place. Atwood does not shy away from portraying the reality of human tragedy, although, I should say, many of the case histories have hopeful endings. While many of the case histories are tragic and devastating, Atwood's goal is not to destroy our spirit by showing us all how horrible life can be. The goal is to better understand madness. One of the continuing themes of the book is that understanding and empathy are what people who are suffering from madness need most. Atwood is a strong critic of the medical model of madness. Atwood points out, rightly, that there is very little scientific evidence supporting the medical model, and the "treatments" that it proscribes are often quite harmful. Atwood provides a number of case histories of people who were treated in terms of the "medical model" often with devastating effects. Atwood believes that symptoms express existential truths and those truths need to be interpreted and understood. The medical model bypasses such understanding entirely and simply tries to treat the patient's body directly. While I am merely a layperson in the field of psychology I do agree with Atwood that the medical model of treatment can be quite harmful. Not only that, but I think it is based on a fundamentally mistaken ontology. Another excellent book on this topic is Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis by Paris Williams.
There is also a very strong focus on intersubjectivity in the book. Atwood rightly points out that people exist in social contexts and their symptoms are often responses to how people respond to them. This is why, I think, the medical model can be potentially harmful. The patient is treated as an object, sometimes even like a test subject, and then, when they react negatively to that intersubjective situation, and develop new symptoms, this merely confirms the doctor's original diagnosis, and there is a kind of downward spiral. We would all eventually go insane if people quit listening to us and taking us seriously and we were treated, instead, like test subjects. Whether one agrees with all of Atwood's critiques of the medical model or not it seems extremely important to me to create an intersubjective situation where the patient feels like they are being understood and treated with empathy. The medical model, I think, can stand in the way of creating such an intersubjective situation (I should briefly point out that, as a layperson in this particular subject, my understanding of the "medical model" is largely based on the critiques of it I have read, so it is possible the picture of the medical model I have is not entirely fair or accurate).
Atwood also emphasizes that the goal of therapy is not necessarily the reduction of pain. The goal is wholeness and living in the truth. The goal is to be able to express the existential truth of one's situation, even if that truth is the feeling of unbearable pain, and to live with it. Atwood claims that therapy may even increase a patient's pain particularly in the short-term. That is a hard truth. It is one that many people want to avoid. Some might call it a kind of masochism. If pain can be reduced why not reduce it? This is a claim that I cannot yet fully defend, because I do not fully understand the ontology behind it, but I think that human beings crave truth more than they crave happiness (somewhere Thoreau says that what human beings really crave is reality). There is a case study in this book about a patient who was afraid of happiness because she felt it would "endanger the validity of her early victimization" (155). In other words, it would be a sin against the truth. As a Buddhist I think, ultimately, the goal should be to find a way to be happy without sacrificing truth, but it seems the imperative of truth often outweighs the desire to be happy.
I do have some minor complaints about the book. I think that Atwood is often too hard on the people he is criticizing and he has a tendency to see sinister motives operating in the background of anyone who disagrees with him. Like I said, I agree with many of his critiques of the medical model, but the motivation behind the development of a "scientific psychology" was not an evil plan to objectify human beings. It is necessary to distinguish between objectification and objectivity. The goal of objectivity is a valid and important one and statistical methods, and diagnostic criteria, etc. have been effective in other areas in achieving objectivity and effective methods of treatment. Atwood ultimately replaces statistical methods with an interpretive method. It is possible that psychology, as a human science, is necessarily interpretive. However, it would be disingenuous to deny that an interpretive science leaves a lot of room for subjective invention and error. There were times in this book, especially in Atwood's interpretations of case histories that he was not personally involved in, or in his analyses of the biographies of Kierkegaard, Nietzsche, Wittgenstein, and Heidegger, where I felt like his interpretations were sort of being spun out of thin air. Scientific methods were not created in an effort to reduce human beings to third-person processes. They were created in an effort to overcome the perceived subjectivity of interpretation. Ultimately, everyone has the same goal: to understand madness and help people who are suffering from it. Sometimes, and this may be my own interpretation, it seemed to me like Atwood was sort of demonizing people who disagreed with him. On one hand, I understand that. Atwood has first-hand experience of the destructiveness of the medical model. I understand why he would be angry. I just do not think it does any good to demonize people.
Sometimes I also felt like Atwood was throwing the baby out with the bathwater. His critiques of the use of medication, for example. Now, I should be clear, Atwood does say that it is possible there are situations where medication might be useful. However, he is mostly critical of their use. In the case of depression, for example. Atwood believes that depression is simply the reaction to depressing things that happen in the world, period. He rejects the notion of "endogenous depression" and he rejects the notion that depression is an "illness". He has a point. The world can be a depressing place, and there are clearly times in life when depression is the only sane reaction. If someone's child has just committed suicide, and they show no signs of depression, we would probably take that as a sign of a serious problem.However, there are three critiques I would make in relation to what he says about the usefulness of medication.
First, he claims that medications are numbing and that they should be renamed "anti-intense feeling drugs" (163-164). Like I said, I am a layperson when it comes to psychology, so I can only speak from my own experience, but that has not been my experience with medications at all. In my experience depression was numbing and made the genuine expression of emotion and grief impossible (Atwood would say that the numbness was itself an expression of some existential truth that should be analyzed and interpreted which is certainly possible). What I will say is that medications did not numb me. It was only after I started taking medications that I was able to feel deep and genuine grief, although, I should add that I used medications in the context of pursuing Jungian analysis, so I was not just taking medications on their own. I was also actively trying to work through the numbness and depression in a psychoanalytic setting which I definitely think was very beneficial.
Second, I think Atwood is too hasty in rejecting the notion of a largely physical basis for depression at times. Think of the example of food. There have been days where I have gone too long without eating and fallen into extreme states of despair. I felt like that despair was about the world, and if someone had tried to cheer me up, or tell me that I should just eat something, I would have said "This has nothing to do with my not having eaten and everything to do with the fact that the world is just an inherently cruel and evil place." But, as soon as I ate something, the despair would dissipate. Would Atwood claim that my eating food was just a way of avoiding intense emotions? If not, why is that different from the case of taking medications? This does not prove the validity of "endogenous depression" or the chemical imbalance theory but the possibility that the brain might be deficient in producing some chemical and that this might effect a person's mood does not seem wildly implausible to me. I do not think that we should simply reject, out of hand, the possibility, simply because the theory currently lacks a fully adequate scientific basis. There is no doubt that the physical state of the body affects our moods and there is also no doubt that the body can "go wrong" without necessarily being induced by something external.
Third, I think that one of the tragedies of human life is based on the existence of self-reinforcing and destructive dynamics. This is not unique to human beings. It takes place in eco-systems and economies as well. If, for example, there is a shock in an economy, and people lose their jobs, that will decrease aggregate demand, which will lead to more people losing their jobs, to a further reduction in aggregate demand, and so on. These self-reinforcing dynamics are extremely destructive when they are not dealt with and they operate in human life as well. For example, our intersubjective situation effects our brains, and our brains effect our patterns of behavior, and our patterns of behavior effect our intersubjective situation, which effects our brains, and so on. A person can, in this way, get caught in a very destructive downward spiral. I will give an example from my own life. I suffered from extreme social anxiety for many years. I do not know what originally caused it but I feel it must have been some traumatic social events. These effected the way that I related to people. I perceived people as dangerous. This led to avoidance behavior and isolation. This led to loneliness and depression which led to low self-esteem which increased my fear of people and so on. It is necessary to intervene somewhere in that downward spiral and, I think, medications can potentially be useful in that regard. They can stop the downward spiral and allow the healing process to begin.
I had a few other complaints but this review is already quite long and I do not want my complaints to outweigh my praise. Despite the minor reservations I had I thought the book was ultimately an excellent addition to the literature on madness and well worth reading.
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