Narcissism

Narcissism

Screen Shot 2017-07-14 at 9.07.51 PMThe legend is that Narcissus was a handsome Greek youth who rejected the desperate advances of the nymph Echo. As a punishment, he was doomed to fall in love with his own reflection in a pool of water. Unable to consummate his love Narcissus was said to stare at his image in the pool hour after hour and finally pined away and changed into a flower that bears his name Narcissus.Screen Shot 2017-07-14 at 9.12.22 PM

Screen Shot 2017-07-14 at 9.10.21 PMIn 1911, Otto Rank, a prominent psychiatrist, spoke of narcissism as being related to vanity and self-admiration. A few years later, Sigmund Freud thought narcissism was not necessarily abnormal. He distinguished between primary narcissism with self-love which is linked to self-preservation and secondary narcissism where there becomes limited ability to love others and the problematic development of megalomania.

In the 1970’s, Otto Kernberg wrote extensively on this subject and felt that there was a group of people who have an unusual degree of self-reverence in their interactions with other people. He noted that Screen Shot 2017-07-14 at 9.16.57 PMin these individuals, there was a great need to be loved and admired by others and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others. He believed that their emotional life is usually shallow and that they tend to experience little empathy for the feelings of others. Such people obtain very little enjoyment from life other than from the tributes they received from other people or from their own grandiose fantasies and they feel restless and bored when external glory wears off. Dr. Kernberg wrote about techniques for approaching such patients in psychotherapy.

 

Screen Shot 2017-07-15 at 10.54.33 AMThe latest version of the Diagnostic Criteria Manual (DSM-5) from the American Psychiatric Association stated that a Narcissistic Personality Disorder is a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and a lack of empathy beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following.

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognize as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that he or she is “special” and unique and can only be understood by, or should associated with, other special or high status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  6. Is interpersonally exploitative (i.e. takes advantage of others to achieve his or her own ends).
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  8. Is often envious of others or believes that others are envious of him or her.
  9. Shows arrogant, haughty behaviors or attitudes.

It is possible and in fact is often the case that other mental health conditions may be simultaneously occurring along with a narcissistic personality. This might be depression or other mood conditions, or variations of psychosis, et cetera. The criteria stated above are provided for mental health professionals to make a psychiatric diagnosis. Different professionals may disagree whether an individual meets a particular criteria. Also, it should be obvious that only five criteria are necessary to make the diagnosis. Therefore, people with the same diagnosis might be quite different from each other. For example, an individual theoretically could be quite empathic and not be arrogant or have haughty behavior and still meet the criteria.

Any diagnosis should not be a derogatory value judgment of an individual. It is true that some of the above-criteria deal with being self-centered and not relating well to others which usually makes a person unlikeable. This is not always the case, sometimes a person with these characteristics may be quite charming and liked by others, as well as having other positive and endearing characteristics.

From my experience, it is true that people with narcissistic personality do not seek therapy as much as others do. But certainly that is not always the case. In fact, such a person may be particularly susceptible and even devastated by a “narcissistic injury” which would be circumstances which gives the person insight into their weakness, faults and vulnerabilities. Such a person may very well feel that he or she need help in dealing with these overwhelming feelings. Nevertheless, it still requires a set of specific circumstances for a person with narcissistic personality to decide to seek psychotherapy. Treatment of such of individual is often difficult and requires special techniques.

 

 

What Might Prevent Psychiatrists From Speaking in Public About Their Opinion of the Mental State of a Public Figure? The so called Goldwater Rule

What Might Prevent Psychiatrists From Speaking in Public About Their Opinion of the Mental State of a Public Figure? The so called Goldwater Rule

In the United States the first amendment protects our right to free speech. Although I am not an attorney, I do believe that while you can’t be put in jail for expressing negative things about other people, there are laws that protect people from untrue damaging statements.. These laws provide recourse for people who believe that their careers reputations finances and/or health have been damaged by harmful statements. The Supreme Court has weighed in on this issue as recent as 1990 and the criteria involves whether the statements are true and the context in which they are made. Things get even more complicated when the object involves public officials and public figures who are in the public view because the law encourages free speech especially when it involves this category of people

What does all this have to do with psychiatry? In 1964 Barry Goldwater was running for President against the incumbent Lyndon Johnson. A magazine by the name of Fact published an article titled The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater . The magazine polled psychiatrists about American Senator Barry Goldwater and whether he was mentally fit to be President of the United States.Screen Shot 2017-07-07 at 11.24.30 PM In response to this question, 2,417 out of 12,356 responded. Of those, 657 said he was fit, 1,189 said he was not, and 571 said they didn’t know enough to answer the question. In response to the survey some of the comments that were made by the psychiatrists who responded were as follows (as reported in article in THE BLOG by Jonathan Moreno 8/26/16):

“The Presidency should not be used as a platform for proving one’s manhood . . .”

“Inwardly he is a frightened person who sees himself as weak and threatened by strong virile power around him . . .”

“Since his nomination I find myself increasingly thinking of the early 1930s . . .”

“Unconsciously he seems to want to destroy himself. He has a good start, for he has already destroyed the Republican party . . .”

Moreno in his article also made mention that in 1931 there was a debate at the annual American Psychiatric Association whether Abraham LincolnScreen Shot 2017-07-07 at 11.26.19 PM was a “manic schizoid personality whose depressive moods stopped short of mental illness.” The article went on to state that “analysis of the dead is not a legal violation, but nonetheless raises the question of fairness as the dead cannot defend themselves. He went on to say that to analyze a living person without data is not only bad practice, it also runs the risk of making the analyst look foolish if the individual later behaves in a way that was not predicted. The editor of that article about Goldwater was Ralph Ginzberg and he was sued for libel and lost the case and had to pay Goldwater $75,000 in damages which is approximately $579,000 in todays money value.

Several years later in 1973, the American Psychiatric Association issued the first addition of Principles of Medical Ethics which is still in effect as of 2017. I will list Section 7 , 1-5 but it is #3 that has informally known as the “Goldwater Rule” which is most relevant to the topic we are discussing. Screen Shot 2017-07-07 at 11.32.00 PM

Section 7

A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

  1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., “Psychiatrists know that”).
  1. Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness. Psychiatrists should always be mindful of their separate roles as dedicated citizens and as experts in psychological medicine.
  1. On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
  1. The psychiatrist may permit his or her certification to be used for the involuntary treatment of any person only following his or her personal examination of that person. To do so, he or she must find that the person, because of mental illness, cannot form a judgment as to what is in his/ her own best interests and that, without such treatment, substantial impairment is likely to occur to the person or others.
  1. Psychiatrists shall not participate in torture.

There are very detailed procedures for filing an ethics complaint and how such a compliant will be evaluated on the local district branch level and then up to the national level which are spelled out in detail and include an appeals process. Potential sanctions to a member of the American Psychiatric Association who has been found to be in violation of one of the ethical rules are reprimand, suspension or expulsion from the national organization.

In a article in the Journal of American Academy of Psychiatry and the Law about one year ago Kroll and Puncey concluded that while some third party assessments are reckless but they do not negate legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience. They concluded that the Goldwater Rule was an excessive organizational response to what was clearly an inflammatory and embarrassing moment for American psychiatry. A counter view with which I agree was expressed by  Paul Applebaum, Screen Shot 2017-07-07 at 11.44.22 PMM.D. , a past president of both  the American Psychiatric Association and the American Academy of Psychiatry and the Law in the current issue (2017) of the same journal. He said the following : “Weighing the real harms that can arise from psychiatrists’ comments on the diagnoses and personality traits of persons whom they have never examined against the likely inaccuracies and hence limited value of such endeavors to begin with, I am left with the conclusion that the Goldwater Rule remains a valuable component of the ethics of psychiatry. However, some modification of the Rule may be necessary, to indicate more clearly that it is not meant to cover analyses that are  intended to be shared with the public or works on deceased persons of historical interest.”

As far as I know there have been no sanctions by the APA regarding the Goldwater Rule thus far but this is still a topic which is being discussed both within and outside the psychiatric profession.

Any thoughts are welcome in the comments section below

 

What Should A Therapist Do in this Situation ?

What should a therapist do under the following circumstances?

A 40 year old patient male) comes for initial consultation because he is unhappy with his life situation in regard to relationships and his career. There is no evidence of psychosis, severe depression or suicidal ideation. The patient has mild obsessive symptoms and there are various personality traits related to his family experiences. The patient is well motivated for psychotherapy and appears to have capacity for good insight.

The patient has occasional drink on weekends and no drug issues EXCEPT that he smokes marijuana most evenings and enjoys the experience. He also acknowledges that he does “ drive stoned” but he believes he is a good driver and has never had an accident. When this is explored further he acknowledges that he understands that his reaction time might be minutely slowed but he knows he is a better driver than most people. He expects to come for weekly psychotherapy and will drive about ½ hour to my office for an evening appointment. He also drives to work daily for about 45 minutes and sometimes will have joint before he drives home.  search

Questions:

 

1- Would you insist that you cannot treat him if he is engaging in dangerous behavior by driving stoned? Explain

2- Would you make this a high priority issues to work on in therapy whether the patient bring it up or not ? Explain

3-Would you deal with this issue as you would any other topic depending on his associations  and current conflicts as well as transference issues?

4- Would the answer to any of the above question be different if the patient were a moderate drinker and frequently drives while “buzzed“ or intoxicated?

( Please give your opinions in the comments section below )    imgres

My Memories of “9/11” on the 15th Anniversary of September 11, 2001

... und explodiert nach dem Einschlag in das Gebäude. Beide Türme stürzten darauf zusammen. Kurze Zeit später prallte ein Flugzeug auf das US-Verteidigungsministerium in Washington. Die Flugzeuge waren zuvor gekapert worden. Vermutlich hat es hunderte Tote und Verletzte gegeben. (Foto: CNN)

My Memories of “9/11” on the 15th Anniversary of September 11, 2001

Introduction

If you have any memories of 15 years ago you certainly remember where you were, what you did and how you felt when terrorists took over two large airline planes filled with passengers and  crashed them into the World Trade Center in New York leading to the collapse one of towers and the death of thousands of people.

I would like to use this blog to recall my memories and thoughts about where I was, what I did and how I felt. As is often the case in recollecting traumatic events, I may not have every detail correct but this is how I recall things. I should state that I while I was in New York I was not near ground zero at the time and no one close to me was killed or injured.

As a psychiatrist, I previously had some experience in working with people who were traumatized. I was a consultant to a burn and trauma unit of a hospital and had written a book about this subject. A few years previously I was part of a team that studied the psychological effects of a major plane crash in Dallas and I had studied the psychological impact on emergency workers of doing their work, as well as the impact on members of the media who cover such events. I have had occasion to write and speak on related subjects before and after 9/11.

The Event

I was in my office at New York Medical College/Westchester Medical Center, which is a suburb of New York City. My secretary told me that she had heard that a plane had crashed into the World Trade Center. This immediately brought to my mind a childhood memory of when a small plane had crashed into the Empire State Building in New York City. My father was a New York City policeman at the time and called in the event to emergency services. He subsequently brought home, a small piece of twisted metal and wires that I was told were part of the plane. I was soon to learn that 9/11 was a much greater catastrophe than that event.

The nearest television to my office was on a closed psychiatric unit in the hospital not too far from where I was located. I made my way there and in the large day room all the patients and staff were watching a medium sized television. I quickly appreciated the magnitude of this event when shortly after I entered the room and focused on the TV, I saw pictures ofone of the tallest buildings in the world collapse on live TV. As I recall the experience, there was only a quiet murmuring or perhaps some groans coming from myself and the people viewing this together. I should point out that this was a closed psychiatric unit with acute severely mentally ill patients some of who would usually be in an agitated psychotic state, perhaps with hallucinations. I don’t remember any such manifestations being shown. It was almost as if many of the patients were jolted back to reality by this event. I didn’t study this phenomena but it reminds me of an experience that I had in my first year of psychiatric training. I was assigned to an inpatient unit at another psychiatric hospital in New York City when there occurred a highly unusual city wide black out of all power. As I recall, it was in the evening and the hospital basically went dark with no or very little emergency power for lights for several hours . I subsequently wrote one of my first papers examining the reactions of the various patients to this unusual circumstance.

While initially we had no idea of what was the cause of this plane crashing into the World Trade Center Building or that there were other planes involved. It was apparent that many people were killed although there was no indication initially that it would be in the thousands and that people were actually jumping out of windows to their death rather than being burned to death. As the magnitude became apparent, my natural instinct as was that of others, was to be concerned about my loved ones who worked in Manhattan. While I didn’t think that they would be at that location I made phone calls to assure that they all were safe. Many people did not receive good news as they checked with their family and friends. One man who I knew quite well, was director of clergy services at the hospital, lost his son at the World Trade Center. At that time I lived in one of many suburban communities outside of New York City where many people commuted to work by train. That evening there were many cars in the train station parking lot that were not picked up by people who had perished that day. Photographs of those cars that were not claimed by their owners that evening stands out in my memory.

The Aftermath

My wife who worked at a major hospital in Manhattan related how her hospital immediately had gone to it’s emergency plan waiting to receive large numbers of victims with injuries that were expected. Even the suburban hospitals such as mine went on to that mode where surgeons were called in and all personal were on standby expecting to deal with the overflow of casualties from this tragedy. But despite the approximately 3000 fatalities, I understand that there were very few injuries. The ash floating down on the city may have caused some minor medical problems.

Screen Shot 2016-09-05 at 11.01.40 PMIn the days and weeks following screen-shot-2016-09-10-at-12-08-59-amthis horrific event there was this very unusual phenomena of there being many posters on walls, trees, light poles etc not only downtown but in other parts of the city. The theme of these posters was looking for a lost relative. There would be a photograph and a brief description usually stating that the person worked in the World Trade Center and was missing. There would be a phone number to call if anyone knew about this missing person. The reality was that there were no missing people. The very few people who may have visited a medical facility were identified and all of these “ lost “ people had obviously died. However, understandably their loved ones in many cases could not initially accept what had happened and were trying to maintain hope . Over the ensuing days and weeks many of the posters remained in place but their makers had crossed out the word “ Missing” and there were words about how the poster was a memorial to them. Often there were flowers left next to them. I also recall passing a fire station from where many firemen had perished after they had entered the tower to save victims and had been inside when it collapsed. It was shrouded with black draping and an appropriate sign paying tribute to the lost heroes of that fire station.

I believe it was on Pier 92 in downtown that a massive social service outreach program was set up to assist the family and friends of people believed to be killed in the tragic event. There were places for people to register that they had lost a loved one. In many cases the remains of victims would not be found . There were psychological services offered to the distraught people many of whom were grieving lost loved ones.

I recall it was at this location that on the third or fourth day after 9/11 I was asked because of my previous experience in working with the media around traumatic events, to run a “debriefing group “ for members of the media who had been working day and night on this tragic news story. Many of them had spent hours interviewing grieving friends, relatives and the colleagues of the firemen who had died. They had seen and photographed the gruesome scenes of dead bodies and the partial remains. Some had photographed the falling bodies of the jumpers who chose to die this way rather than by fire. They spent hours talking on and off the air about all the details of news story, edited their material and in many cases went without or with very little sleep since the story broke. In the earlier days of “debriefing” victims of trauma the psychological approach had been to allow each person in the group to recount their experience. We had subsequently learned that such an approach often re-traumatized individuals who heard other people’s stories in the group. The approach now was more geared to explain to people about the symptoms which they might be having or might have in the near future and suggestions about how to deal with them as well as allowing them to ask any questions. We would also try to identify people having significant difficulties and offer them more individual help. In the course of running this group I mentioned how comforting members of the media particularly TV commentators might be to the public as they explain what is happening and try to keep the audience calm. Illustrating this point, I told them about a phone call I had just had with a family member who told me of a dream she had that Peter Jennings ( the ABC anchor) was talking and comforting her about the event. In the group I was speaking with was Peter Jenning’s TV producer who worked very closely with him and said she was sure that he would appreciate that story and she would tell it to him that evening. You can imagine how surprised my relative was when I called her and told her that Peter Jennings would soon know about her dream.

By coincidence I had been scheduled to do a Grand Rounds Presentation at a hospital in Manhattan not too far from ground zero 10 days after 9/11. It was pointed out to me that you could previously see the fallen tower from the room in which I was speaking. I don’t recall what the original topic was but we altered it to focus on that unforgettable event that had occurred in their backyard.

For many years   I have been a very small part of the large number of mental health professionals writing and teaching about how our profession can be helpful in dealing with mass traumatic events. As a therapist I realize that many people have their own individual traumatic experiences that impact them and often alter their lives. These personal traumatic events can be just as meaningful and life changing as a big event that affects large numbers of people .

While I was very fortunate not to have been  seriously traumatized by 9/11, but still the fear and worry that I had living through it along with millions of Americans  is obviously imprinted in my mind. Recounting it now in this blog relieves some of the pain  that is still associated with that memory.

 

Michael Blumenfield, M.D.

Mblumenfieldmd.com

 

Moving Images : Psychoanalytic Reflections of Film by Andrea Sabbadini ( Book Review by Dr. Blumenfield)

The following is a book review which I wrote and  appeared in Psychodynamic Psychiatry Volume 41 Number 3  Fall 2016 p 162-166Screen Shot 2016-06-10 at 3.49.26 PM

Moving Images: Psychoanalytic Reflections of Film, by Andrea Sabbadini, Routledge, London and New York, 2014, 140 pp.

While reading this book, I kept pondering the question of who would be the best audience for it. The author, Andrea Sabbadini, is a psychoanalyst who is extremely knowledgeable about film, especially classic European movies. His stated goal for the book is to offer discussion of films from a psychoanalytic perspective and in the process of doing so, to use the films in order to illustrate a number of psychoanalytic ideas and to convey a sense of what analytic work consists. Anyone who is familiar with many of the movies discussed in this book and understands psychoanalytic and psychodynamic theory would be the ideal audience for it. However, even knowledgeable psychoanalysts with out having seen these films would find it difficult to relate to the book. Similarly, students of cinema who may have seen the films mentioned, would probably get lost in the erudite psychoanalytic discussion presented in this book. Unfortunately, that would seem to leave a very small audience for this book. However, I do see an important value for it which I will discuss at the conclusion of this review.

This 140-page soft-covered book has six chapters which I will list below with two of the several movies discussed in each chapter.

Chapter 1: “A Young Profession: Films on Psychoanalysis” Spellbound (Hitchcock, 1945)
Il Postino (Radford, 1994)

Chapter 2: “…and the Oldest One: Films on Prostitution” Nights of Cabiria (Fellini, 1957)
Belle de Jour (Buñuel, 1967)

Chapter 3: “The Young Ones: Films on Children” The Spirit of the Beehive (Erice, 1973)
German Year Zero (Rossellini, 1948)

Chapter 4: “…and Slightly Older Ones: Films on Adolescents” Heavenly Creatures (Jackson, 1994)
City of God (Meirelles, 2002)

Chapter 5: “Between Eros and Thanatos: Films on Love” A Pornographic Affair (Fonteyne, 1999)
Amores Perros (Inarritu, 2000)

Chapter 6: “Watching Voyeurs: Films on Scopophilia” Rear Window (Hitchcock, 1954)
Peeping Tom (Powell, 1960)

The book opens with a discussion of films about psychoanalysis in which the author touches on how the psychoanalytic profession has been depicted in numerous movies, including a mention of the television series In Treatment (2010). There are several flms discussed in this chapter where Freud himself, and other well known analysts, were depicted. We also learned that Freud showed very little interest in the movies of his day and stated in a letter that he did not believe psychoanalytic ideas could be represented by cinema. Alfred Hitchcock’s Spellbound, which starred Gregory Peck and Ingrid Bergman, is described in this chapter as perhaps the most famous of all films about psychoanalysis. Sabbadini spends five pages discussing this film and how this whodunit movie included discussion of dream analysis, anxiety inducing situations, psychopathic devices of amnesia (repression), and guilt complexes. There is also a discussion of how the camera work, light effects, sound track, and editing create the dream-like psychological atmosphere that the director wished to achieve. In the movie Il Postino, Sabbadini justifies that while it is not actively about the psychoanalyst or analysand, the close relationships that gradually develop between Marino, the postman, and Neruda, the poet, shared many features with what normally takes place in our psychoanalytic consulting rooms.

In the chapter about films and prostitution, the author reviews the social complexities surrounding the selling and buying of sexual favors for money. He even considers a common fantasy that there is a close association between prostitution and psychoanalysis. He uses Fellini’s movie, Nights of Cabiria, to discuss the concept of a rescue fantasy. Fetishism and masochism are also analyzed in this chapter in some detail. Catherine Deneuve’s character Severine in Belle de Jour is examined and at one point the author even postulates that the house of prostitution is the metaphoric antithesis of marriage and has the unconscious function of keeping the latter alive and with it the normality it symbolizes.

Chapter three is the longest chapter and discussed fillms about children, which should not be surprising coming from a psychoanalyst who appreciates the importance of early life experiences. The Spirit of the Beehive was an internationally acclaimed film which was described as dealing with innocence, illusions, and isolation. It focuses on two young girls growing up in the Spanish countryside. This movie deals with the fantasy that they have of monsters which occurs after they see the classic horror movie Frankenstein. This certainly can be related to contemporary young women who are constantly bombarded with such horror films. The author examines how the two children’s fantasy world and magical thinking is skillfully explored by this movie movie. The film Germany Year Zero approaches children in a completely different manner. Rosselini visited postwar Germany in 1947 apparently without any story to tell but trying to answer his own troubled question, “The Germans were human beings like everyone else. What could have led them to this disaster?” Sabbadini describes how this film develops the answer to this question from the point of view of children as they find themselves forced by circumstances to behave like adults.

It is only natural that the author progresses to the next chapter and discusses films on adolescents. He tries to put a perspective on child development theory by noting that it is only in the course of the last 30 or so years that a radical shift has taken place in relation to our understanding of adolescence. One of the films which he focuses on in this chapter is Heavenly Creatures where two adolescent girls, when not immersed in their fantasies, would become obsessed with a plan to murder the mother of one of them. This movie is actually based on the diaries of a person in a real life event which took place in New Zealand. Sabbadini describes how the film attempts to show the conflict between adults and adolescent children. The Oedipus complex and “passing phases of homosexuality” are some of the themes analyzed in this movie. Another film discussed in this chapter is City of God which is also based on an actual event that happened in Rio de Janeiro in the 1960s and 1970s. It looks at the role of young people in the Brazilian slums and is described as a “part tender Coming of Age film and part Gang-Warfare Epic.” The author uses this film to further expound on Oedipus theory.

Chapter 5 tries to look how the cinema often tackles issues of love. The author notes how films have explored most variations of this theme often throwing new light on the more bizarre and unusual aspects of it rarely considered anywhere else. He also states that psychoanalysis has done likewise focusing more often on the pathological deviant or perverse side of it rather than the so-called normal one. Sabbadini uses A Pornographic Affair and the relationships of the two characters Elle and Lui to study the deeper emotional meaning of their liaison. He discusses psychoanalytic constructs to understand them such as triangular constellations, regressive tendencies, voyeuristic fantasies (of the audience), and the unseen pornographic components of the main characters’ love affair. Sabbadini returns to the concept of the rescue fantasy as he then analyzes the Mexican film, Amores Perros. This movie consists of three stories which he tells us involve transgressive passion and almost intolerable violence as well as profound humanity. He breaks down each story and explains and interprets the fantasies involved. He explains how he feels that there is a universal fantasy and an important emotional complex both in the conscious and unconscious and that it is often related to primary narcissism.

In the final chapter titled “Watching Voyeurs, Films on Scopophilia” perhaps the most interesting chapter in the book. Sabbadini recognizes the cinema goer or film lover as a voyeur and he quotes Freud stating that the scopophilia drive is autoerotic. Therefore the movie-going experience is a source of both voyeurism and exhibitionism. By bringing the viewers into the equation, he is in a sense recognizing one of the analyst’s most powerful instruments and that is a recognition and utilization of our countertransference. One of the examples that he uses is Hitchcock’s Rear Window. In this film, through one of the main characters played by James Stewart, we watch through his rear window, what goes on in an apartment house opposite his home. Sabbadini discusses that what we see through the voyeur’s eye is a projection of our own desires. He also describes this movie as a dream. He goes on to use Freud’s essays on the theory of sexuality to analyze the movie and also brings in the witch hunts of the McCarthy era which were occurring when the film was made and he believed may have influenced it. There is no shortage of films for Sabbadini to use to further explore this topic. He analyzes the film Peeping Tom which allows him to discuss an array of different forms of deviant sexuality, psychopathology, scopophilia, obsessions with pornography, and sadism, not to mention a further description of the presence of a deep depression underlying everything else.

I believe that the real value of this book will be as a textbook for the study of the cinema from a psychoanalytic point of view. A group of psychoanalytically minded people could choose one of the films mentioned in this book for each group discussion and view it individually or together prior to a discussion of it. They could consider the observations and the thoughts of Sabbadini as well as their own reactions and interpretations of the film viewed. One person could lead the discussion of each film. Since most members of such a group would likely not have previously seen most of these films, this would enable them to now view them and participate in a study of them. I am sure these films are readily available on Netflix.

A second group that may want to use this book as a guide to understanding the films discussed in it might be film students or people who enjoy classic films. Assuming that most of these people who join such a discussion group would not be psychoanalytically trained, the leader or guide for such a discussion group could be a psychoanalyst who is skilled at explaining these concepts as they apply to this film, to a lay audience. The students in such a class would already have a keen interest in how movies convey psychological issues and would value seeing this film again (or for the first time) and would most likely be very receptive to having the meaning put in a psychodynamic and psychoanalytic context. Once again this book would be a marvelous textbook for the leader and the group to use after they have seen the film under discussion.