Kramer, the author of Listening to Prozac, breaks fresh ground in his psychiatric writing. His courage in tackling the issue of whether an individual's personality is fundamentally altered by taking an anti-depressant drug kept his Prozac book on the US best-seller lists for months.
Now he departs from the standard hands-off, psychotherapeutic approach to enter the sticky territory of dispensing advice on marital relationships. But this is a far cry from such bland and patronising self-help bibles as Men are from Mars and Women are from Venus or Women Who Love Too Much, with their cosy language and behavioural check-lists. Instead, Kramer uses fictional portraits of individual marriages to weave a comprehensive theory of how couples relate to each other, and where things go wrong between them.
En route, he suggests tools for self-analysis and understanding, with signposts for further reading. There is much nourishing food for thought here.
Kramer suggests that, with couples, the real workings of the relationship are often hidden. But, despite the despair they can invoke in each other, couples are often a far better psychological match than they care to admit or are able to recognise.
He attempts to find ways of helping people to stay together, in the belief that to end a marriage and seek another partner leaves you in danger of repeating destructive patterns. "The solution is not to leave the other nor to strive to change the other," writes Kramer. "The solution is to grow."
Even in what might appear to be obvious cases, in which a couple should end a tortuous relationship, there may be other important dynamics at work. A fictionalised client, Iris, appears in Kramer's office seeking advice after she comes across a bundle of e-mails on her PC from her lover, Randall, to Bunny, a female friend. In these messages he describes Iris as impossible and oversensitive, "a prickly pear", and reveals the most intimate details of their relationship. Iris responds to the betrayal by driving to his flat, shoving a cactus in his disk drive and baking his modem. Should she leave?
After her rage subsides, however, Iris comes to realise that Randall's actions and her reaction might be a bizarre form of courtship. They are acting out patterns familiar to them, invariably bequeathed by their respective parents. The challenge for the therapist is to separate the behaviour the couple unconsciously perpetuates from the behaviour they desire to change.
Kramer offers a list of maxims: "You are not far from where you ought to be. Your choice says much about you. Change enough. Change yourself. Use the relationship as a place in which to grow. Expect discomfort."
There are situations, of course, where maxims are not enough. If Kramer detects an undiagnosed depression or anhedonia (an inability to experience pleasure), he dismisses a couple's claims of incompatibility.
In such cases, therapy should target the depression and not the marital discord. "In those predisposed to anhedonia, a modest strain in a marriage may result in a solid impediment to ordinary pleasure and then to all sorts of compensatory behaviours."
If this goes undetected, families may be torn apart and the root cause will never be addressed.
But there are also abusive relationships where there is no hope of growth. In many instances, the abused partner can only end their enslavement through a sudden flash of insight which gives them the courage to leave. This "gift", as Kramer calls it, cannot simply be handed over as advice, because this would ignore the client's problem: the inability to see beyond her situation. Only she, alone, can decide when and how to leave.
Perhaps Kramer's book marks a moment in our culture when we have come full circle.
In an age when it appears that couples find it increasingly easy to leave, his advice to stay and fight it out, to embrace the idiosyncrasies and maddening habits of your lover, appears a radical suggestion.
Whether you agree with his optimism or not, Should You Leave? is a vital contribution to a debate which rarely gets the intellectual attention it deserves.Reuse content