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Sacks, M. (1992). Multiple Realities in Clinical Practice: By John S. Kafka. New Haven, Conn.: Yale Univ. Press, 1989, 199 pp., $22.50.. J. Amer. Psychoanal. Assn., 40:944-946.

(1992). Journal of the American Psychoanalytic Association, 40:944-946

Multiple Realities in Clinical Practice: By John S. Kafka. New Haven, Conn.: Yale Univ. Press, 1989, 199 pp., $22.50.

Review by:
Michael Sacks, M.D.

Dr. Kafka views himself as a psychoanalyst, scientist, and philosopher whose office is a laboratory where patient and analyst struggle to resolve problems of recurring interest to philosophers and scientists. What is reality and how do phenomena such as depersonalization, déjà vu, estrangement, and psychosis, relate to it? The analyst's task according to Kafka is to reach "beyond understanding" to "comprehending, encompassing, and widening" the patients' perception of reality—certainly an acceptable standard for what analysts, scientists, and philosophers aspire to.

Traditional analysis regards reality as a somehow "objective" entity and focuses primarily on an internal "subjective" world that is shaped by the conflicting forces of the pleasure and reality principles. Errors in the mapping of the external onto the internal world result from conflict, and it is the job of analysis to enable the patient to rectify these misperceptions. More recent analytic thought is less certain about this. For example, many psychoanalysts would emphasize the interpersonal subjectivity of reality in the mother or analyst's perception of the patient. Kafka's approach to understanding "reality" is to emphasize the role of perception.

Kafka's major assertion is that the psyche originates in the process of perception. He sees this as an alternative to the familiar geographical-spatial model of the mind, which he dismisses as too static. If I understood him correctly, it is in the continuous, evolving, and latent process of perception that consciousness or mind is created and defined. Perception is the "fabric of the mind." Perception takes the data of sensory impressions and organizes them, but also discovers new data in impressions that do not fit preexisting schemes. Perception is thus both an instrument of receiving and moulding.

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