The Examined Life: How We Lose and Find Ourselves

A Book Review by Dr. Lloyd Sederer

Posted Jul 21, 2014


“How can I help?” asks Stephen Grosz as he receives a new patient in his psychoanalytic office in London. The answers he receives and the problems he encounters in those who turn to him for help are the material for Grosz’s book. The subjects unearthed for the reader include envy, loss, hate, boredom, winning (as losing), making contact and being present, pain, negativity, betrayal, gratitude, and wanting the impossible – to mention a few.

Grosz is an American who long ago moved to England where he trained as a child and adult analyst. He sees his work as enabling patients to find their way when they feel “…unable to go forward.” If his writing is a measure of the humanity, compassion, and intelligence he provides in his consulting room then his patients are a fortunate lot.

An Examined Life is a compilation of over 30 case stories, each brief and illuminating. While most are about his patients, a few take us into the world of his family and friends. His vignettes reveal what makes us vulnerable and thereby human, how relationships sustain (and frighten) us, and how symptoms and problems both serve our needs and make us suffer.

It is a rare mental health professional who can write like a storyteller–with simplicity, pathos, and suspense. He reminded me of Allen Wheelis, MD, a San Francisco analyst whose many books (most notably The Quest for Identity) I devoured decades ago. Wheelis was a clinician with the mind and writing skills of a fine novelist. He used himself over time as a subject in his books, a courageous choice that revealed truths about his own troubled side, which so many of us share. I wouldn’t be surprised if that is where Grosz’s future work goes: In An Examined Life he begins to peel back his own veils, which makes him all the more accessible as a writer and trustworthy as a counselor.

As lovely a book as this is, I was also left with reservations. The greatest stemmed from how little Grosz said or implied about how he believed people actually change. There are hints about understanding, putting into perspective, and working through problems encountered in the analysis as the ways by which a person can act differently off the couch. But even as a psychiatrist who was in classical psychoanalysis four times a week for six years, early in my career, I still don’t understand how psychoanalysis works (for me, my best guess is that it was largely about having a wise man guiding and enabling me to face what I did not want to see).

What’s more, I would have liked Grosz to be explicit about the limits of psychoanalysis. It is not what I would suggest for people with serious mental illnesses, disabling symptoms or agonizing (and suicidal) psychic pain. His work also is remarkably open-ended: The treatments he chronicles go on for years, and four to five times a week at that, before much relief or change seems to happen. Few can endure such a long a therapeutic process, or afford the actual time and money it involves every week.

Finally, I missed a sense of how spiritual hunger drives so many people, and how spiritual faith can sustain them at the darkest of times. But Grosz’s faith in his patients and the process of analysis is clearly present in the work he describes. Too often we in the mental health community eschew speaking of faith–maybe because we confuse it with religion?

To liberally paraphrase Phillip Roth, if you want truth, read fiction. Stephen Grosz has, remarkably, given us tales full of insight and truth through his non-fiction stories. His gift is to use words that turn the human encounters of analytic practice into what seem like fables. In doing so, he leaves us moved and curious about a clinical technique, psychoanalysis, that has endured despite its orthodoxy, critics, psychological and financial burden to undertake, and (still) largely only anecdote to claim its effectiveness.


Dr. Sederer’s book for families who have a member with a mental illness is The Family Guide to Mental Health Care (Foreword by Glenn Close).

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

Copyright Dr. Lloyd Sederer