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relationships to pleasure and desire butequally those we have with knowledge andpower. When, she says, like Freud, weexpress our scientific appetites for parsi-mony, consistency and precision, we stripaway something vital. For accounts of con-nectedness to be anything like true they are,of necessity, diverse.

Sexuality, Intimacy, Power is a remarkabledocument of recent Western intellectual andpolitical histories. Via psychoanalysis, fem-inism and social theory, it attempts no lessthan to make some honest sense of what it isto be a person amongst people and howmuch we can know of such things. It isreadable, brave, witty and in places, quitefunny. Put simply, you’ll struggle throughshelves on these subjects to find anythingbetter. Check it out!

Phillips A. Reasons for Living. London Review ofBooks, 12 November 1998.

Totton N. Psychotherapy and politics: a crucial link.Psychodynamic Practice 2003; 9: 3.

James Taylorjames.taylor@ntlworld.com

PSYCHOTHERAPY AND POLITICS

Psychotherapy and Politics. By NickTotton. London: Sage Publications, 2000.186pp. £18.99 pb.

This is one of the most comprehensivebooks that I have read that addresses therelationship between therapies, the socialand the political. Comprehensive in thesense that it covers many areas in short butsuccinct chapters that focus on particularrelationships in the field. It is, in some way,a textbook, rather than a monograph and Iwould imagine that students of the f ieldwould find it a useful source of reference

that they would return to time and again. The book is organized around four clear

but often overlapping relations betweenpsychotherapy and politics: psychotherapyin politics; psychotherapy of politics; poli-tics of psychotherapy and finally politics inpsychotherapy. Thus the first section dealswith psychotherapy in politics, which is, toquote Totton:

A range of interventions by psychotherapists in thepolitical process itself. Some of these are by thera-pists acting as therapists rather than private indi-viduals: saying in one way or another, ‘Throughour clinical experience we have concluded that thefollowing political programme is desirable . . .’ Inother cases, the therapists are acting as citizens,and putting their therapeutic skills and understand-ing at the service of a political goal to which theygive priority. (Totton, 2000, 6)

So, in the f irst part of the book Tottonexamines the work of psychotherapists whoare activists as citizens, those who arepoliticized as therapists, and those whojustify politics and therapy each in terms ofthe other. Examining the work of ‘right’and ‘left’ therapists up until the postwarperiod, Totton provides an interestingoverview of the work of Wilhelm Reich anda useful summary of Reich’s career con-trasting left and right political positions viaFreud and Jung. Totton specifically con-centrates on Jung’s anti-Semitism and hisrelationship to the National Socialist Partyin Nazi Germany arguing that ‘If only Jungcould have “openly admitted” his ownerrors, and asked himself how they cameabout, something useful might haveemerged from this sad tale’ (Totton, 2000,21). Following on from this, the chapter‘Alternative realities’ examines the eventsof May 1968 and the rise of Lacan andLacanianism in France. The thought ofJacques Lacan became highly influential inParis, and has remained so, spreading to

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areas as diverse as literary and cultural crit-icism, particularly in North America. Ofcourse, Lacan had his critics. As Lechte(1994) notes, Lacan was to change thewhole orientation of psychoanalysis inFrance and elsewhere in his celebratedSeminar. Lacan is also well known for thecontroversy that often surrounded him. Hewas expelled from the InternationalPsychoanalytic Association in 1953 for theuse of unorthodox methods in analyticpractice. Lacan re-interprets the work ofFreud through the lens of poststructuralism,emphasizing the relationship between ego,the unconscious and language. Lacanachieved international notoriety with thepublication of Ecrits in 1966 and The FourFundamental Concepts of Psychoanalysisin 1973 (Clarke, 2003, 107). Totton,notably, draws our attention to some of theother projects going on in Paris at the time,particularly Deleuze and Guattari’s Anti-Oedipe and the work of Jean Laplanche.

Chapter 4 provides an interesting intro-duction to hands-on therapy, or therapy forthe people through the work of MarieLanger who was regarded as a dangerousradical by the junta in Argentina for herwork with the poor. Under the threat ofdeath she moved on to Mexico, and thenNicaragua where she took a central role indeveloping the country’s f irst nationalmental healthcare system (Totton, 2000,31). Totton goes on to discuss socialtherapy and then the idea of neighbourhoodpsychotherapy in London, with reference tothe work of Hoggett and Lousada (1985) inBattersea, noting that Langer, Hoggett andLousada used a similar psychoanalyticframework with a strong Kleinian flavour.The f inal chapters in this section aredevoted to critiques of psychiatry throughanti-psychiatry and radical therapy in the US, conflict in the community, and the

influence of psychotherapy on governmen-tal agencies and social policy.

The second part of this book was of mostinterest to me. Totton demonstrates anability in his writing style to cover a widerange of perspectives, theorists and ideas ina fairly concise way without detractingfrom the centrality and importance of thework he is describing. ‘The psychotherapyof politics’ examines psychoanalysis as atheory of human nature and of a metapsy-chology, investigating the more philosophi-cal and societal application ofpsychoanalysis through Freud, Reich, Kleinand Norman O Brown. Chapters in thissection range from the psychohistory of thefamily, through ideas about gender and sexuality to the roots of hatred. There is aparticularly interesting section on theFromm-Marcuse debate and the ideas ofErikson and Reich. Following on from thisis a discussion of Lloyd deMause’s novelcontribution in the form of psychohistoryand the psychogenic theory of history.

Probably the most useful chapter in thissection, certainly from a psycho-social per-spective, is the ‘Roots of hatred’ in whichTotton explores numerous psychoanalyticideas around racism, ethnic hatred, conflictand power. Totton focuses on the psycho-logical mechanism of projection, which, heargues, ‘is a powerful concept for under-standing the form and function of sexistand racist beliefs, or indeed of any “ism”which identifies a dangerous and despica-ble “other”’ (Totton, 2000, 88). Tottonexplores the contrasting positions of Reichand Freud before going on to talk about theKleinian position and the emphasis placedon projection, or more specifically I wouldadd, the emphasis on projective identifica-tion (Clarke, 2000). There is a particularlyuseful discussion of sexism in which Tottondraws on the work of Dinnerstein (1978),

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Mitchell (1975) and Jukes (1993). Thechapter concludes with a brief look at the work of Frantz Fanon, someone who isundisputedly one of the most importantfigures in the psychoanalytic discussion ofcolonialism and post-colonialism and cer-tainly one of the first people to recognizethat there is both a political economy and apsychodynamics of racism.

Part three of this book confronts the poli-tics of psychotherapy addressing such variedissues as psychotherapy under totalitarian-ism, public conceptions of psychotherapy,the institutions of psychotherapy and chal-lenges to these institutions. Psychotherapyunder totalitarianism ‘brings togetheraccounts of therapy in Nazi Germany, LatinAmerican dictatorships, and the SovietUnion’ (Totton, 2000, 101). Totton followsthe path of psychotherapy under closed societies where he argues that it was able tocontinue with varying degrees of success andcompromise. For example the consciouslypunitive regime in Soviet psychiatry wasopposed by a small group of psychiatristswho were either imprisoned or had to leavethe country. The chapter on psychotherapy inthe public eye addresses psychotherapy asplaying an important role on behalf ofsociety. Totton discusses the relationshipbetween psychotherapy and medicine – orthe medical model, better still termed themedicalization of psychotherapy, whichalthough having political and economicundercurrents is driven by the numbers, orlack of numbers of clients who are able topay for therapy. Therefore, particularly in theUS clients need to be deemed ill, rather thanunhappy to satisfy insurance companies inorder to seek payment for treatment. AsTotton notes, the whole issue of diagnosisdemonstrates the huge differences betweenpsychotherapy and medicine and DSM IVhas become symptomatic of this polarity.

Managed care in the US has its own versionin Britain, argues Totton – the NHS. Hedoubts whether therapy can actually fit intothe rigid confines of the current medicalmodel.

The final two chapters of this section arededicated to the institutions of psychother-apy and psychoanalysis, including thestructures of the IPA and exclusions fromthe IPA, in particular the exclusion ofJacques Lacan in the early 1950s. In fact,Totton provides a useful history of thedevelopment of the French schools, thesplits and linkages and affiliations to uni-versities. As Totton notes, there are strug-gles between different practitioners andstruggles between different institutions –therapists are no less aggressive and powerseeking than any other human group.Charting the growth of the IPA and itsmassive expansion in the US, Totton high-lights some of the rifts and disagreementsbetween different individuals and schoolsand the more recent trend towards plural-ism and acceptance of difference. Tottonthen goes on to provide a history of psy-chotherapy and counselling in the UK sincethe 1970s, describing what Bob Youngtermed the ‘shenanigans’, denigration andremarkable feats of containment – it struckme on reading this book that this chapterand the one that follows it are by far themost political. I’ll let the reader judge.

The final section of this book, ‘Politics inpsychotherapy’ is important in that it high-lights the challenges that have been madeto basic assumptions in the psychothera-peutic model, particularly regarding whatconstitutes healthy/unhealthy – normal andpathological. Totton highlights feministand gay critiques of therapy as well associal and anti-racist critiques, noting thatthe core of this critique often centresaround the power, or the power relationship

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between analyst and analysand. He thengoes on to discuss some of the attempts toaddress this power imbalance throughmutual analysis, person centred theory andgroup work. The final chapter gives exam-ples of initiatives that have been inspired bytherapy but leave the therapeutic arena alltogether, developing, argues Totton, a newsort of political practice.

This book is quite diff icult to reviewbecause it covers such a vast area, and Isuppose this would be one of the criticismsthat we could level at Totton – too muchbreadth and not enough depth. I think thiswould be rather unfair. The book does offersoundbites in some areas and more depth inothers, but even the shorter chapters aresuccinct and to the point, offering thereader avenues for further explanation. The advantage of this of course is that itcan be used as a reference text as well as amonograph. The reader can dip in and outof subject areas and use Totton’s pointers tofurther research. This book really doesdeliver what it promises, it is political andit addresses all angles of political actionand awareness within the psychoanalyticand psychotherapeutic community and dis-cipline. As such, I feel that it will appeal toa wide audience, practitioners, academicsand lay readers alike, and is both a readablemonograph and a useful reference text.

Clarke S. Projective identification: from attack toempathy. Kleinian Studies 2000; 2: 1–30.

Clarke S. Social Theory, Psychoanalysis andRacism. London: Palgrave.

Dinnerstein D. The Rocking of the Cradle and theRuling of the World. London: Souvenir, 1978.

Hoggett P, Lousada J. Therapeutic intervention inworking class communities. Free Associations1985; 1: 125–52.

Jukes A. Why Men Hate Women. London: FreeAssociation Books, 1993.

Lacan J Ecrits: A Selection. London: Tavistock,1966.

Lacan, J. The Four Fundamental Concepts ofPsycho-Analysis. London: Tavistock, 1973.

Lechte . Fifty Key Contemporary Thinkers: FromStructuralism to Postmodernity. London:Routledge, 1994.

Mitchell J. Psychoanalysis and Feminism. London:Penguin, 1975.

Simon ClarkeCentre for Psycho-Social Studies

University of the West of England

A PSYCHOANALYTIC SOCIAL PSYCHOLOGY

Organisations, Anxieties and Defences:Towards a Psychoanalytic SocialPsychology. Edited by RD Hinshelwood,Marco Chiesa. London: Whurr, 2002;250pp, £22.50 pb.

Agoraphobia; anti-nuclear campaigners;bounded organism; dialectics of We; differ-entiated psychic space; Einstein; fraternity;household gods; human cloning; inner cityschools; intrahospital clubs; modernism;semi-permeable membrane; Oscar Wilde;World War II: all these words, whateverthey might mean, belong to the index of abook that is a prolegomena towards a psy-choanalytic social psychology.

Everyday talk has it that we can feellonely even in a crowd; psychoanalysissuggests we can feel crowded by ourselves.Organisations, Anxieties and Defences is adensely academic survey of psychoanalyticresearch into groupness since Freud’s 1929Civilisation and Its Discontents. Up untilthen, it is hinted, Freud dismisses the groupin favour of a ‘humanity’ metonymicallyreduced to the neurotic individual: modernman in his singularity, dispersed, repressed,alone with fake memories of parents whobetrayed him. With Civilisation and Its

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