Book Review: The Examined Life: How We Lose and Find Ourselves

The Examined Life: How We Lose and Find Ourselves

Stephen Grosz (2014). London: Vintage.

Grosz, an American who trained in London, has worked here as a psychoanalyst for 25 years. In the same number of pages as Yalom, he publishes 31 'episodes' covering a wide range of issues including change, loss and alienation from self. His presentation style is the mirror of Yalom's in that his ratio of dialogue to commentary is about 20/80, with much shorter but still satisfying case histories describing the understanding gained through the to and fro of client/therapist conversation.

Like Yalom he doesn't refer explicitly to theory or diagnostic categories, rather each story illustrates individuals with unique histories and reasons for how they are now. He says he was gripped early in his career with the idea that we can become disconnected from ourselves, something he discovered initially about himself during training therapy and finds here with some of his patients.

Grosz also makes occasional references to a book or quotation prompted by something in the client's story. One which caught my imagination being the short story of Bartleby by Herman Melville first published in 1853 (page 126). With the unwitting collusion of his over-caring employer, Bartleby gradually stops working and gives up all effort and responsibility for himself. He increasingly responds to entreaties to action with 'I would prefer not to' while his employer becomes increasingly anxious for him. Eventually, he even prefers not to eat and dies of self starvation. For Grosz it's a gripping illustration of how if someone else takes responsibility for our anxiety they risk taking away our motivation for change. This story also illustrates something we all experience when two competing inner voices say 'let's do it now' and 'I would prefer not to'. Such procrastination may be about something vitally important to explore, as happened with Grosz's client in this episode.

I particularly appreciated Grosz's penultimate episode where he challenges the notion of bereavement closure and 'the tyranny of shoulds' (p 208) derived from the proliferation of self-help books. This so often causes the bereaved person to suffer more because they're stuck on the idea of closure, which mostly doesn't happen. He points out that Kubler-Ross's grief stages were originally about the process of dying, only later becoming the inspiration for the widespread notion that we can permanently end our sorrow while we continue to live. This idea has taken hold even though we know it seldom accords with our experience of bereavement. We have the possibility to suffer the pain of loss repeatedly until we die. It may return less frequently but can still be as raw (or more raw) when it returns, often unbidden like a thief in the night. And it can change, as for example when we are old and feel deeply sad in a different way for someone who died tragically when they were young. I find clients are hugely relieved when I suggest this alternative view of bereavement and encourage them to accept the loss into their life story – making it 'mine' – written deep inside for ever like Blackpool rock.

In his final episode Grosz talks about remembering long gone patients and yearning to reach out to them, to say one more thing, to get it right this time. I know that feeling!

In conclusion, I enjoyed both books and recommend them for anyone doing psychotherapy, whether psychodynamic or existential. They relate recognisable tales of the everyday situations we encounter with clients and our struggles to help them. Both writers discuss things they have found bothersome which is always interesting and instructive. Neither focuses on theoretical framework, they use simple everyday language which is a good model in itself. What came across for me was their passion and commitment to being as good a therapist as possible for each client, and their wisdom in acknowledging we never really know what that means.

Their presentation styles are different, such as their choice of dialogue/commentary splits. So that Yalom's longer and dialogical chapters provide

Diana Pringle