Beyond the couch

Psychoanalysis and the human talent for unhappiness.

A nineteenth-century chaise lounge.
With consciousness comes context – a sense of past, present and future. Photograph: Getty Images

The Examined Life: How We Lose and Find Ourselves
Stephen Grosz
Chatto & Windus, 240pp, £14.99

What, exactly, is an “examined life”? One that is worth living, according to Plato’s Apology, in which he records Socrates, on trial for his life, arguing that “the unexamined life is not worth living”.

The American-born psychoanalyst Stephen Grosz borrows the philosopher’s aphorism-in-extremis for the title of his book of case studies or “episodes”. For Grosz, the psychoanalytic examination of a life is a joint “quest” (his term) between practitioner and patient to find the hidden insights that might restore or save a damaged psyche.

Classically, the psychoanalyst is the blank surface on to which the client’s anxieties are projected. As the archaeological layers of ancient psychic damage are gradually revealed, the analyst exposes nothing of his or her own inner life. There are excellent clinical reasons for this therapeutic reticence, which also casts the analyst somewhat in the mould of an author, imagining his troubled clients from catastrophe into composure.

Grosz, true to type, relays a minimum of personal information. He was born in Indiana in 1952 and educated at Berkeley and Balliol College, Oxford. He does not specify his academic discipline – an omission significant only because of the question of “scientific” rigour that is one of the formative anxieties of psychoanalysis. He has practised as a psychoanalyst for the past 25 years, during which he has spent more than 50,000 hours with child, adolescent and adult patients. He teaches at the Institute of Psychoanalysis and University College London and writes a column on psychological matters for the Financial TimesMagazine, in which versions of some of the case studies in this book originally appeared.

In his preface, Grosz writes that the book is about “our desire to talk, to understand and be understood. It’s also about listening to each other, not just the words but the gaps in between. What I’m describing here isn’t a magical process. It’s something that is a part of our everyday lives.” This is slightly disingenuous, for the psychoanalytic sessions from which his case studies – or “stories”, as his publisher calls them – are drawn are not part of universal everyday experience. However, it is certainly the case that the habit of self-reflection, of turning a life into a narrative, with scarcely a breath drawn between the experiencing of an event and its transformation into anecdote, is now more widespread than at any time in history.

At its most primitive, the act of self-examination is what makes us human. With consciousness comes context – a sense of past, present and future. Rub those three together and the genie of narrative instantly appears, attended by its balefully fascinating outriders of regret, wishing and the entrancing desire of an individual to shape the story of his or her life.

The writer and philosopher Julian Baggini has argued that the Socratic maxim about the examined life is profoundly elitist. “The bulk of humankind, today and in history,” he writes, “has been far too busy struggling for survival to engage in lengthy philosophical analyses. So if an examined life is one in which more than just a little investigation takes place, by implication, huge swaths of humanity are ignorant beasts.”

In a time and place in which education and leisure are the preserve of a privileged minority, this might be a persuasive argument. It is true that we have no verbatim record of the inner lives of Athenian slaves, though they are a significant presence in classical literature and history. And the servant who cured the Renaissance essayist Michel de Montaigne of his fear of death by causing the 16th-century equivalent of a near-fatal, high-speed car crash when he galloped into his master’s horse left no account of his version of the incident. It might be that the collision that inspired Montaigne to write so eloquently about his acceptance of mortality left his servant in a lingering state of mortal dread; we shall never know.

Now, however, anyone with access to the internet (and that is a vast number of even the otherwise most severely impoverished members of the world’s population) can indulge in public acts of self-examination, whether blogging clandestinely from a country in the grip of a tyrannical political regime, or soliciting sympathy on Facebook for what might once have been an anxiety or grief too intimate to mention to any but the closest of friends, or tweeting updates on one’s changing frame of mind. Self-examination has become one of the most democratic of all activities.

Psychoanalysis, however, has not. Pro bono and NHS work notwithstanding, its image remains decidedly that of a therapy available mainly to people with plentiful reserves of time and money: a cure for unhappiness, in short, that resembles a rather luxurious pastime – albeit one that demands an unusual degree of emotional and intellectual commitment.

The ostensible purpose of Grosz’s book is not to present an apologia for psychoanalysis in the manner of, say, Adam Phillips’s Terrors and Experts (though it touches on many of the conundrums and ambiguities that Phillips addresses). Its format is familiar from the work of Oliver Sacks and other authors who write about highly specialised disciplines in an anecdotal style that a general reader can comprehend and enjoy.

The book is arranged in five parts: Beginnings, Telling Lies, Loving, Changing, and Leaving. Under these headings, Grosz groups lapidary, essay-length narratives of his encounters with individual patients, each given an explanatory, Montaigne-like title: “On Laughter”; “How We Can Be Possessed by a Story that Cannot Be Told”, and so on.

Sometimes it appears as though an entire course of treatment is compressed into the space of a few pages; in other essays, a single vivid incident is described. Often the stories conclude with an ingenious, quasi-fictional twist or surprise revelation. Grosz tells them in the first person and in doing so becomes a shadowy figure in his narrative: the psychoanalyst bemused, astonished, confounded, saddened, occasionally triumphant – and invariably in possession of the last word.

In his preface, Grosz writes, “What follows are episodes drawn from day-to-day practice. While I’ve altered some details in the interest of confidentiality, I’ve stayed close to the facts: these stories are true.” That intriguing oxymoron – in what sense can a story be “true”? – is the conundrum at the heart both of this book and of psychoanalysis in general. To present case studies in a format intended to beguile and entertain, as well as to inform, is a psychoanalytic practice that began with Sigmund Freud.

Ernest Jones, who was present when Freud gave his account of the case of the Rat Man to the international congress of psychoanalysts in Salzburg in April 1908, wrote that the case history was “both an intellectual and an artis - tic feast”. Freud remarked that: “The poets and philosophers before me discovered the unconscious. What I discovered was the scientific method by which the unconscious can be studied.”

What Phillips called the “mystique of expertise” still veils the practice of psychoanalysis, although when the veil is partly lifted, as in this volume, the mystery seems to occupy a terrain closer to that of literature than science. Grosz writes: “When I teach psychotherapeutic technique, I often include Charles Dickens’s ‘A Christmas Carol’ on the reading list. I do this because I believe it’s a story about an extraordinary psychological transformation, and that Dickens teaches us something essential about how people change.” In a later essay, a client who repeats the phrase “I’d prefer not to” when presented with the possibility of love, reminds Grosz of the title character of Herman Melville’s short story “Bartleby, the Scrivener”, whose catchphrase this is. “Negativity – this ‘I would prefer not to’ state of mind – is our desire to turn away from the world, repudiating normal hungers,” Grosz writes. He does not explain how this insight differs from one that a general reader of Melville’s fiction might achieve for him or herself.

Repeatedly, the book returns its reader to the question of what psychotherapy is for. As individual stories, his essays, though elegantly structured and written, are oddly unsatisfying. To read several of them in sequence is to experience a curious form of literary vertigo, as one follows the story of the boring Graham, who uses his remarkable talent for tedium as a way of controlling the world, or Francesca, who resolutely refuses to acknowledge the obvious reality that her husband is having an affair, only for the account to end just at the moment when a fictional narrative would begin its development.

The overwhelming impression is of the analyst as an all-powerful mediator of secret information. These characters are “real” and their stories are freighted with the heft of “truth”, yet we may know of them only the fragments that Grosz chooses to reveal – exactly as though he were a novelist and they his constructs, though unlike most novelists he closes down their story at the very moment when it starts to become most interesting. (Did they, one wonders in passing, agree to be written about? And how would their accounts of their treatment differ from Grosz’s?)

There is an urgent and unmistakable sense in these stories of a writer grasping for signi - ficance. In his recent volume of essays, the novelist Julian Barnes writes, “Fiction, more than any other written form, explains and expands life . . . Novels tell us the most truth about life: what it is, how we live it, what it might be for, how we enjoy and value it, how it goes wrong and how we lose it.” Yet the essence of successful fiction (as of successful memoir) is that it does all this as a by-product rather than the object of the story it tells. Narrative with a didactic purpose is almost a definition of imaginative failure.

More than a decade ago Phillips wrote, “Most psychoanalytic theory now is a contemporary version of the etiquette book.” This was prescient, given the subsequent development of what one might call “psychoanalysis lite” – the dilution of the hermetic, private intensity of individual therapy into a more appetising and popular fusion of self-help and entertainment. Examples of the tendency include the successful television drama series In Treatment, in which the actor Gabriel Byrne plays a troubled psychoanalyst; the flourishing of such ideas nurseries as Alain de Botton’s School of Life, which offers, among other opportunities for self-examination, a “Life MOT” with a “highly qualified psychotherapist” for £100; and, indeed, some of Phillips’s more light-hearted publications. Yet etiquette books, though despised by those who think they already know how to behave, can offer considerable reassurance and consolation to those who think they might not.

As literature, Grosz’s book is intensely readable but lacks the depth of humanity that makes the very best memoir and fiction writing, from Montaigne to Melville, so resonant. As an account of psychoanalytic treatment, it largely ignores the problematic question of the therapist’s role as – on some level – the star of his or her encounter with a patient. Grosz confesses, “A psychoanalyst can envy his patient. Sometimes our patients are younger, brighter and financially more successful than we are.” This is about as close as he gets to addressing the matter. Yet as a reminder of the strangeness of human existence, the myriad ways we find of making ourselves unhappy and the perplexing resourcefulness of the unconscious mind, Grosz’s book is a worthwhile addition to the literature of the examined life.

Jane Shilling is the author of “The Stranger in the Mirror” (Vintage, £8.99)