Book review, Charles B. Strozier, Heinz Kohut : The Making of a Psychoanalyst (Biography)

A book review and a chapter-by-chapter synopsis,
Charles B. Strozier,
Heinz Kohut : The Making of a Psychoanalyst,
Biography, first edition, hardcover, 495 pages,
published by Farrar, Straus and Giroux, April 2001, ISBN 0374168806

Historian Charles B. Strozier, previously the co-author of Trauma and Self (1996), has written a biography of Austrian-American psychoanalyst Heinz Kohut (1913-1981). It is the comprehensive story of the birth of the Kohut's "Self Psychology" movement. It's also a spotlight on the personality of the movement's founder -- his humanity, his sense of humor, and his obsessions.

As a student and later a staff member at the esteemed Chicago Institute for Psychoanalysis, Kohut dared to overthrow the orthodoxy of Sigmund Freud and revolutionized psychiatry.

The Nazi holocaust began only days after Kohut received his medical degree in Vienna. He and his mother fled separately and joined in Chicago. After his internship and residency in Chicago hospitals, he was only beginning his struggle for acceptance in a field where Freud's theory was considered the final word. With the help of a circle of followers, he gradually rose to prominence as one of the leading psychoanalysts in America.

Kohut is best known for introducing the principle that empathy should be the primary factor in psychoanalysis. Today, for example, when a patient says "That event was painful," and the analyst reflects back "Yes, it hurts when that happens," the doctor is practicing a Kohutian technique. Kohut realized that empathy, looking within another person's mind, is the vicarious form of introspection, looking within one's own mind. Empathy reduces the patients' fear of repressed ideas and their resistance to analysis, so that introspection can proceed. [Pages 144-145] More significantly, the "formalism" in psychoanalysis should be replaced with "humanism." [page 349]

Kohut continued to modify his theory throughout his life. By the time he had finished reworking Freud, the old master's concepts of drives and the stratification of the id, ego and superego had been through an epochal revolution.

I found the first forty pages of the book, covering Kohut's youth, to invoke an average degree of interest for a biography, but the rest of book was suspenseful and I couldn't put it down.

495 Pages. 19-page 2-column index. Two glossy inserts with 44 black-and-white photographs. 85 pages of the author's notes provided as an appendix. The frontispiece is a facsimile of Kohut's personal shorthand notation. The photo on the jacket shows Kohut working during a visit to Switzerland in 1970.

- - - - - - Book review by M.L. for crimsonbird.com, April 29, 2001

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The following is is a chapter-by-chapter synopsis prepared by the editor of crimsonbird.com.

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Synopsis
Charles B. Strozier,
Heinz Kohut : The Making of a Psychoanalyst

Numbered headings are Strozier's chapter titles.

1. Prehistory

Heinz Kohut, son of Else and Felix Kohut, was born in Vienna, Austria on May 3, 1903. (Eight pages discussing Viennese Jewish culture.) [Pages 3-10]

2. Beginnings

Young HK developed closeness with his mother while his father was away for four years fighting the war. When HK was five years old, his father returned home from the war traumatized and depressed, and was never the same again. [15] The marriage was unstable. (Description of early parental images which are invoked later in life when adult Kohut performs introspection.) [16-20]

3. The Tutor

During HK's grade school years, many tutors came to the house. He had a homosexual interaction with one of them named Ernst Morawetz [24] and the relationship between the two boys was "deeply empathic." [25] (Note: the term "empathy" is significant in Kohut's future work in psychiatry.)

4. Young Man Kohut

Felix and Else exposed Heinz to music and art. [28] (Note: Later in life, he wrote several scholarly articles about the psychological significance of music.) Several teachers favorably influenced him [28] and he did well in various subjects in school. [31] He increasingly appreciated art museums [33] and the ancient Greek classics. [34] During adolescence he decided to become a doctor. [37] He was bar mitzvahed in 1926. [38] (Discussion of his religious life.)

5. In the University

Kohut became a student at the University of Vienna in 1932, but found that the university environment was becoming imbued with Nazi activities. [41] At home, his sense of humor was characterized by describing his dissection of a human cadaver while he and his mother were at the dinner table. [42] He and several friends often spent time in coffeehouses. [43] He continued to enjoy music, especially jazz. [45] In 1936 Kohut went to Paris for half a year to perform medical internships at two hospitals. [45] His father Felix died in 1937. He reacted so strongly to the death of his father that he had to undergo psychotherapy. [49] Anti-Semitism was increasing, and the Nazis burned the books of Sigmund Freud. [50] Kohut met Elizabeth Meyer, whom he later married. [52]

6. A Crumbling Universe

Kohut called the increasing Nazi power in Austria a "crumbling universe." [35] (Nazi violence described.) [36] On June 3, 1938 Freud fled the country. [37] Kohut was still undergoing therapy, and this helped him cope with the Nazi oppression. [38] Despite the Nazi rise to power, Kohut was permitted to take his medical school exams. On November 3, 1938 he received his M.D. degree from the University of Vienna. The violence of Kristallnacht took place only a few days later, November 8-9. [60] In March 1939 Kohut fled Austria and went to England. [62]

7. The New American Self

In England, Kohut was confined in a refugee camp. [65] He suffered from "survivor guilt" since he was alive while he didn't know the whereabouts of his mother. [67] Suffering from pneumonia, he received permission to leave England. He went to Chicago and had no money. [68] He developed a friendship with Robert Wadsworth. [68] Else escaped from Austria and arrived safely in Chicago. [70] Kohut improved his knowledge of English by studying Alice in Wonderland. [71] He got a job at Chicago South Shore Hospital to satisfy his internship requirement. [71] In 1941 he began his residency in a neurology program (lasting through 1948) at Billings Hospital in Chicago. [73] HK, Else, and Wadsworth heard the news about the bombing of Pearl Harbor. [74] Kohut converted from Judaism Unitarianism [75] He decided to switch his career from neurology to psychiatry. [76]

8. Psychoanalysis, At Last

In 1942 Kohut applied for the psychiatry training program at the Chicago Institute of Psychoanalysis. [78] His application was rejected because his "fluid sexual boundaries" didn't satisfy the "heterosexual standards." [80] In 1943 he began dating Barbara Bryant, but never introduced her to his mother. [81] He continued to work at Billings Hospital, and formally changed his career path from "neurology" to "neurology and psychiatry." [84] Bryant and Kohut ended their relationship ended in 1945. [87] Else gradually converted to Catholicism. [86]

9. Candidate at the Chicago Institute

In 1946 he reapplied to the Institute. [92] While a candidate, he was made an assistant instructor of psychiatry and continued to work with patients. (Descriptions of several patients' problems.) [93] In 1950 he published a paper entitled On the Enjoyment of Listening to Music. The paper postulated that music duplicates soothing mechanisms experienced at birth. [97] In 1950, inspired after reading the novel Death in Venice by Thoman Mann, he wrote an article about society's taboo against homosexuality, but didn't publish it until 1957. [98] Kohut and Elizabeth Myer fell in love and were married in 1948. [100]

10. Domesticity

Their only child, Thomas August Kohut, was born in 1950. [102] Marriage and family life were a stabilizing influence on Kohut. [102] Relatives and friends were considered part of the family, and there were many family functions. [104] While working prodigiously, he managed to make time for socializing and going to the symphony. [110] Heinz and Elizabeth bought a small house in Carmel, California and spent their summers there. [111] In the winters, they enjoyed cross country skiing. [112] In 1949, Kohut, who was "moderately liberal", opposed the anti-Communist hysteria at the University of Chicago. [114]

11. The Couch

In 1949 Kohut began treating patients with psychoanalysis on a full time basis. [117] He developed a style in which the patient would set the agenda, and the doctor shouldn't be "too eager to offer explanations." Other psychiatrists of the day quickly confronted patients with the "meaning of unconsciously controlled behavior." [118] (Discussion of his interaction with several patients.)

12. Mr. Psychoanalysis

Kohut graduated from the Chicago Institute of Psychoanalysis in 1950, and in 1953 he was made a full staff member, which would be his job for the rest of his life. By 1956 he was recognized a a leading psychiatrist in Chicago, and acquired the nickname "Mr. Psychoanalysis." [127-128] The University of Chicago offered him a job as chairman of the psychiatry department, but he turned down the offer. [127] He became active in the American Psychoanalytic Association, and became acquainted with the prominent psychiatrists Anna Freud, Kurt Eissler, and Heinz Hartmann. [127, 137] He developed several deviations from Sigmund Freud's methods. [130] During 1964-1965 he served as president of the American Psychoanalytic Association. [133] During the U.S. presidential election of 1964, Kohut criticized other psychiatrists who publicly questioned the mental health of Barry Goldwater. He pointed out that they lacked "carefully evaluated psychological data" and insisted that psychiatrists must never claim that their own political views are "scientific inferences." [135]

13. On Empathy

Kohut studied empathy, a subject which Freud had left dangling by merely defining it and never considering how it developed, or its possible value in analysis and recovery. [141] He rejected Freud's assumptions that emotional dependence can be traced to childhood experiences, and that clinging is associated with the oral instinct. [146] Kohut redefined "drives" as abstract categories of tendencies which cannot be further specified upon introspection, e.g. wishing. [147] Kohut believed more fully in free will, as contrasted with the determinism in Freud's theory of motivation. [147] Kohut reflected on his own youth as a Jew under the Nazi regime. He studied Hitler's psychosis. He also analyzed the guilt of the victims who regretted that they had not spontaneously risen up in rebellion against Hitler. [148]

14. New Forms

Kohut did most of his writing at his summer home. [153] He developed a theory of how creativity, grandiosity, narcissism, humor and religion are interrelated. [156-159]

15. The Death of Else

Kohut's mother died in 1972. (Discussion of how her death affected his work.) [162]

16. Family and Other Struggles

Elizabeth worked part time and no longer gave all her time to her husband. [164] Kohut strove to be close to his son Thomas but was oppressive at times. [165] Thomas joined the counterculture and went to the Woodstock music festival in 1969. [167] Kohut was preoccupied with his study of narcissism while Thomas, now in college, became active in the opposition to the Vietnam War. HK was "appalled" when his son sought Selective Service classification as a conscientious objector. [167] Kohut's friend, Wadsworth, became seriously ill. HK was active in the "politics" of the International Psycho-Analytic Association (IPA) and corresponded frequently with Anna Freud. [172] He ran for president of the IPA but was defeated. [174]

17. On Courage

In 1970 Kohut went to Germany to deliver several lectures. [178] He became fascinated with leaders, especially Winston Churchill, and the concept of heroism. Affected by earlier experience with Nazi oppression and resistance to it, he wrote an essay entitled On Courage. He never published it. [179]

18. The Group Takes Shape

While deeply involved in writing his book The Analysis of the Self, Kohut formed an "inner circle" of seven "disciples" to discuss his revolutionary ideas about psychoanalysis. They were to "speak for him and spread the word." [181-183] The criticism he received from the group caused him to improve his manuscript. [191]

19. The Analysis of the Self

In 1971 Kohut published his first book, The Analysis of the Self. The self was no longer described as fragmented into the id, ego, and superego. What is important is self-esteem and how we relate to other people. [194-195] (About 35 pages of discussion of the theory.)

20. Death and the Self

In the 1970s and early 1880s Kohut underwant treatment for lymphatic cancer. [231] He insisted that his family keep his illness a secret. [233] Afraid of death, he became more self-absorbed and difficult to live with. [234] He stopped corresponding with his friend Wadsworth. [233] Public knowledge of his illness leaked out. [236-238] The possibility of death inspired him to work harder to complete his theoretical work. [241] His theory and that of psychiatrist David Terman moved closer together. [245-248].

21. On Rage

Critics charged that Kohut didn't explain aggression, cruelty and anger, after he had rejected Freud's id explanation. The reason for this false criticism was that Kohut hadn't discussed the subject in his bestseller The Analysis of the Self but treated the subject only in a lesser-known lecture, Thoughts on Narcissism and Narcissistic Rage, in 1971. [249-250] The reason for rage is that the subject, lacking empathy, exaggerates a minor or perceived wrong and then places no limits on the revenge that is supposed to correct the wrong. [251] Suicide is related to the "rage response." [253] Empathic therapy can treat the condition. [254] Charismatic leaders rise to power by their skill at invoking guilt in followers. [257]

22. Self and Theory

Kohut's cases with numerous patients led to his theory of the normal "nuclear self" and "sense of cohesion", as contrasted with schizephrenia, in which the patient doesn't know the boundaries of the self. [267]

23. The Group Redux

Kohut and Anna Freud ceased to appreciate each other's work. [269-270] Kohut was shunned by several conservative-thinking colleagues. [271] In response, he reacquainted himself with childhood friends. [272] The harmony of his discussion group was shattered. [274] His followers reorganized their group into a workshop with a more exclusive group of invited guests. [277]

24. The Restoration of the Self

In 1977 Kohut published his second book, Restoration of the Self. [248, 278] It was written to be accessible to the general public instead of the medical community. [279] The publishing company's editor disliked his playful use of words and required him to make many revisions, "section by section and line by line." [279-280] The book contains continual disagreement with Freud. [283-285] It elaborated on the 'who am I?' question of the "nuclear self" [277-278] Kohut amended Freud's theory of the Oedipus complex and other sexual factors. [274-275] The book reconsidered the meaning of dreams. [296-297]

25. Heroes and Gurus

There is a long tradition among leading psychoanalysts to view their theories as social movements, to form groups of disciples, and to oppose dissidents. Kohut was no different in this respect. [303-304] He felt uneasy about relying on his charismatic influence, since psychiatry is supposed to be science. [306]

26. The Autobiography of Mr. Z

In 1977 Kohut published a case study entitled The Two Analyses of Mr. Z. Only after his death it was discovered that he had been analyzing himself in the paper. [308-309] It was the only one of his writings that he never permitted his wife and son to read. [309] His son Thomas believed that the paper was a "prank" because his father was a "trickster." [310] Some have charged that Kohut fabricated a case to support his own theory. [312] Perhaps Kohut believed it was unsafe for his career to expose too much of himself. [313] Freud had also merged his own experiences into his writings. [313]

27. The Waning Years

In 1979, still suffering from lymphatic cancer, Kohut also developed heart trouble and underwent bypass surgery. [317] Soon afterward he was bedridden due to vertigo. [318] (Excerpts from Correspondences with friends.) [319-321] His "new heroes" were classic authors, including Franz Kafka, Marcel Proust, James Joyce, Eugene O'Neill, Thomas Mann, and Fyodor Dostoevsky. [324-326]

28. God and Religion

In the last years of his life, Kohut, a Unitarian, became more interested in religion. [327] He felt that Freud had overlooked how religion sustains people and meets their needs. [328-329] (Discussion of the connection between his psychological and religious beliefs.) [330-333]

29. The Healing of Psychoanalysis

Kohut last writing, How Does Psychoanalysis Cure? was published after his death. [334] He made further amendments to his theory of "self", "selfobject", and the "self-selfobject relationship." [335-336] He emphasized that the basis of psychoanalytic healing is the "introspective-empathic method." [337] What is "normal" isn't determined by "prevalences or percentages." [339] Kohut became more willing to recommend specific clinical techniques. [341-342]

30. The Clinical Directions

Kohut didn't accept all of the rules that psychiatrists practice, e.g., he stayed in touch with patients after their treatment was concluded. [350-351]

31. Gentle into That Good Night

Kohut knew he was dying when he delivered his last address in 1981 to 500 people in a Berkeley lecture hall. Audience members cried when he told them that "... this will be the last self psychology meeting that I will attend." [377] He died on October 8, 1981. [379]