- Email: [email protected]
Fidelity and infidelity and what makes or breaks a marriage
168
BOOE
REVIEWS
wherein it is suggested “that the glass-like cornea may have symbolic value in some patic‘rlts SO that anxiety regarding loss of virginity may cause cornea1 disease.” Again, in the section on oculogyric crisis on page 240, without critical comment he states “. . . it has been suggested that the upturning of the eyes is a substitute for the emergence into consciousness of repressed wishes” (Jelliffe, 1929). This kind of content is not likely to stimulate ophthalmologists to lay aside their tangent screens and slit lamps even temporarily to explore their patients’ psyches, let alone their “being-in-the-world.” More disturbing to this reviewer are questionably pseudo facts sprinkled throughout. Thus, on page 204, on psychogenic itching of the eyes, it is categorically stated that this is a masturbation substitute used by children “when feeling depressed after being blamed and made to feel wicked.” On page 187, on delirium tremens, he does not differentiate between illusions and hallucinations; and, states what seems to him strange, that despite gross distortion of visual reality testing, the unfortunate is “usually fully oriented as to who and where he is.” In fact, in delirium tremens one is generally totally disoriented to time and frequently to place and situation, and the visual distortions are most frequently illusions. On the same page, he states that in schizophrenia the distance mode of vision is less involved by hallucination than the more proximate auditory and tactile modes. The point he tries to make is that the schizophrenic, desiring distance and not wanting to be involved with the world, distorts the more proximate modes of hearing and touch. He strains excessively here and in many other areas. Tactile hallucinations are not common in schizophrenia and visual hallucinations are at least as common. On page 63, in regard to flicker fusion, he states that persons requiring a high rate before reporting fusion are more normal, more discriminin that, on the average, schizoating, and have higher “ego strength.” This is interesting phrenics
require
a higher
rate than normal controls.
Many of the conditions he brings up to discuss and provide psychologically significant references to are conversion reactions. These are listed and explored rather exhaustively. Heaton might better have written a more brief, pithy monograph had he elaborated on two aspects in his book. First, he might have given the reader his concise and critical overview of the significant literature on the phenomenology and psychology of function and disorder of the eye. Second, he might have expanded his creative attempt to integrate various approaches, i.e., the psychological, physiological and pathological with an existential emphasis, using examples from interest areas. This would have resulted in a more brief, more integrated monograph fulflling his self-stated goals with much greater impact.-Thomas Rusk, M.D. FIDELITYAND~NFUJELITYAND WHATMAKES OR BREAKS A MARRIAGE. By Leon J. Saul, A1.D. Philadelphia, J. B. Lippincott Co., 1967, 244 pages, $5.95. The goal stated in the preface to this book is to examine “the interplay of motivation and reaction in marriage, as seen by one practicing psychoanalyst . . . giving men and women a professional perspective on their marital problems by recounting the pertinent experiences of others.” Saul’s faithfulness to this end, albeit in an unfortunate soap opera style, is the book’s only recommendation. For a comprehensive and penetrating study of infidelity or of the institutions of marriage and the family, the reader will have to look elsewhere. The book’s limited goal would excuse its failure if it did not also purport to examine the broader problems of the world. Saul’s final chapter entitled “Marriage, Hostility and History,” concludes with this missionary sentence: “By making every child a wanted child, by assuring every child of love, security, and respect that he needs as much as he needs food and shelter, we can prevent tormented marriages, mental illness, crime and war. ‘If we had one generation of properly reared children, we might have utopia itself.“’ The book’s organization reflects its author’s medical orientation. The first section, “The Nature of Marriage,” deals with the anatomy of healthy marriage. In it, Saul draws on recent ethological writings to support his assumption that human nature is basically good. The corruption and degradation of humans are seen as the results of “a warping in the development caused by grossly injurious influences on the young during their earliest, most formative period of life.” Saul repeatedly invokes these early injurious influences to explain later marital discord. He draws solely from his middle- and upper-middle-class practice
BOOK
REVIEWS
169
prior to World War II. A cross-cultural or even an American cross-class perspective on marriage and the family would have provided a better frame for Saul’s accounts. His limited scope excludes the “fatherless families” of the lower socio-economic classes and neglects the new American phenomenon of divorce and remarriage which has been called “serial polygamy.” This lack would again be acceptable if he were not also addressing himself to the more encompassing issues of “war, crime, mental illness and tormented marriages.” The second section, “Common Problems in Marriage and Their Causes,” deals with the patho-physiology of marriage. This is a rather arbitrary choice of four “common” situations of marital disturbance which I will not comment upon. It does suggest to me, however, two major points of controversy between family and psychoanalytic psychiatry. Is the relevant unit of observation and treatment the family or the individual? Saul was courageous in the 1930s in his seeing the spouses of his patients, albeit in separate consultations. Repeatedly he observed the impact a severely impaired person can have on a spouse. Had he taken the further step of conjoint family interviews, he would have noted the profound contribution of each member of a family no matter how “ill” any one of them may be. For example, in the chapter dealing with the passive husband, “the perennial child,” he mentions the “reluctant” support of the husband by his parents. Conjoint interviews with the entire family would undoubtedly reveal the continued infantilization of the husband by the parents, perhaps with the collusion of the wife. This illustration brings up the other point of controversy. Are past or present forces more relevant in the understanding of psychopathology? In the previous example, Saul emphasizes the “spoiling” which occurred in the first years of life rather than the continued infantilization in the present. What one focuses upon and later rationalizes into theory is in large part a function of the method of observation or treatment. The “couch and free association” leads the investigator to the significant early life experiences and naturally deals with intrapsychic forces. Conjoint family interviews reveal the powerful present forces in an interpersonal setting. Saul’s approach which falls between these two, results in confusing levels of observation. The third section, “Sex Outside Marriage: Extramarital Sexual Regression and Other Types of Infidelity,” deals with the overt symptoms of marital pathology. In this part and in the remainder of the book, Saul becomes increasingly the moralist. Where the preacher sees infidelity as the fall into sinfulness, Saul sees it as a “regression” to an expression of infantile wishes which persist due to some mishandling in childhood. One can open the book randomly and find such sentences as “The turning of a may away from his wife and children to another woman is seen at all ages. Sometimes, as with Len, it strikes like lightning. With others it is slow, creeping, insidious, and almost imperceptible slipping into an emotional quicksand.” Such a mixture of scientific theory and melodramatic renderings illustrates most convincingly Szasz’s point that psychiatrists are promulagating value systems disguised within the medical model. Saul’s values, however, are so religiously outspoken that he is hardly guilty of hiding his ethics behind a scientific facade. A chapter subtitle will indicate this missionary trend: “Infidelty in the 40’s; a husband who in this ‘dangerous age’ remains effective in his work, but acts out a childhood pattern that spells desertion of wife and children in favor of a young girl and a lower calibre of associates, although he saw there was a problem and sought psychiatric help.” In addition, Saul’s almost total preoccupation with the childhood roots of adultery not only oversimplifies Freud’s views but also ignores the extraordinary contemporary pressures placed on the mid-twentieth century family. The increasing isolation of the nuclear family from the supports of extended kin is further aggravated by developments in the economicoccupational spheres which foster frequent relocations of families. Advancing technology with its radical transformation of leisure time and the changing role of women also contribute to increased strains. He fails to mention these sociological factors as possible influences on the motivations of adultery and divorce. When almost all society’s institutions are being stressed by unprecedentedly rapid changes in technology and communications, a plea for “more love” of children misses the point.
170
BOOK REVIEWS
It is apparent that social scientists must study how the family can carry out most effectively its two remaining and defining functions: the stabilization of the adult personality and the socialization of its chldren. Clinical studies will be of limited help. The study of pathological and “normal” families preferably seen in their natural settings and in their interrrelations with the wider communities may help guide us toward more rational solutions to the crisis of the modern family. Such an endeavor requires the participation of the disciplines of anthropology and sociology, since the family lies at the juncture between the individual and his culture. As a testimony of what one psychiatrist has seen and believes during a lifetime of practice, the book stands as both an historical and personal document. Unwittingly it reflects the moral and conceptual dilemmas of twentieth century psychiatry. The book might find its readership among psychiatrically-oriented marriage therapists but its unprofessional language may well offend them, Psychoanalysts and social scientists will find little use for this book which is unfaithful to each of their outlooks.-Fred Bf. Sander, M.D. THE EVOKING POTENTIALS. Edited by William cephalography and Clinical Neurophysiology. Publishing Co., 1967, 218 pages.
Cobb and Cristoforo Morocutti. ElectroenSupplement No. 26. New York, Elsevier
This book contains the results of studies on cortical potentials evoked by sensory stimuli reported at an international meeting held in Sienna, Italy, in 1966. Experts from eight countries describe various aspects of visual, auditory and somato-sensory evoked potentials, including those recorded through intact scalp in normal humans and in patients with neurological disorders. The theory, mathematics and electronics of computer techniques applied to the study of evoked potentials are presented. Comparisons of the potentials evoked by visual, somatosensory and aditory stimuli are made, and some of the associated physiological and clinical properties, including effects of sleep, are noted. The physiologic aspects of visual evoked potentials (VEP) including their variability and the effects of binocular rivalry are detailed. Studies on man, including comparisons of the VEP in normal and schizophrenic patients and some exploratory efforts using evoked potential techniques in clinical neurology, are reported. The use of depth electrodes in patients during streotoxic operations for epilepsy, pain or Parkinsonism is described together with the electrophysiologic properties of the recorded thalamic and cortical somato-senory evoked potentials. A number of studies of evoked potentials in cats are included. Among these are reports on drug induced changes of cortical and subcortical evoked potentials, click-evoked responses awake and asleep, interhemispheric transmission of evoked potentials and cerebellar system evoked responses. This volume will be of particular value to the specialist dealing with electroencephalography and clinical neurophysiology, and to those interested in the application of advanced electronic techniques to the study of the electrical activity of the brain--Joseph G. Chid, M.D.
BOOE
REVIEWS
wherein it is suggested “that the glass-like cornea may have symbolic value in some patic‘rlts SO that anxiety regarding loss of virginity may cause cornea1 disease.” Again, in the section on oculogyric crisis on page 240, without critical comment he states “. . . it has been suggested that the upturning of the eyes is a substitute for the emergence into consciousness of repressed wishes” (Jelliffe, 1929). This kind of content is not likely to stimulate ophthalmologists to lay aside their tangent screens and slit lamps even temporarily to explore their patients’ psyches, let alone their “being-in-the-world.” More disturbing to this reviewer are questionably pseudo facts sprinkled throughout. Thus, on page 204, on psychogenic itching of the eyes, it is categorically stated that this is a masturbation substitute used by children “when feeling depressed after being blamed and made to feel wicked.” On page 187, on delirium tremens, he does not differentiate between illusions and hallucinations; and, states what seems to him strange, that despite gross distortion of visual reality testing, the unfortunate is “usually fully oriented as to who and where he is.” In fact, in delirium tremens one is generally totally disoriented to time and frequently to place and situation, and the visual distortions are most frequently illusions. On the same page, he states that in schizophrenia the distance mode of vision is less involved by hallucination than the more proximate auditory and tactile modes. The point he tries to make is that the schizophrenic, desiring distance and not wanting to be involved with the world, distorts the more proximate modes of hearing and touch. He strains excessively here and in many other areas. Tactile hallucinations are not common in schizophrenia and visual hallucinations are at least as common. On page 63, in regard to flicker fusion, he states that persons requiring a high rate before reporting fusion are more normal, more discriminin that, on the average, schizoating, and have higher “ego strength.” This is interesting phrenics
require
a higher
rate than normal controls.
Many of the conditions he brings up to discuss and provide psychologically significant references to are conversion reactions. These are listed and explored rather exhaustively. Heaton might better have written a more brief, pithy monograph had he elaborated on two aspects in his book. First, he might have given the reader his concise and critical overview of the significant literature on the phenomenology and psychology of function and disorder of the eye. Second, he might have expanded his creative attempt to integrate various approaches, i.e., the psychological, physiological and pathological with an existential emphasis, using examples from interest areas. This would have resulted in a more brief, more integrated monograph fulflling his self-stated goals with much greater impact.-Thomas Rusk, M.D. FIDELITYAND~NFUJELITYAND WHATMAKES OR BREAKS A MARRIAGE. By Leon J. Saul, A1.D. Philadelphia, J. B. Lippincott Co., 1967, 244 pages, $5.95. The goal stated in the preface to this book is to examine “the interplay of motivation and reaction in marriage, as seen by one practicing psychoanalyst . . . giving men and women a professional perspective on their marital problems by recounting the pertinent experiences of others.” Saul’s faithfulness to this end, albeit in an unfortunate soap opera style, is the book’s only recommendation. For a comprehensive and penetrating study of infidelity or of the institutions of marriage and the family, the reader will have to look elsewhere. The book’s limited goal would excuse its failure if it did not also purport to examine the broader problems of the world. Saul’s final chapter entitled “Marriage, Hostility and History,” concludes with this missionary sentence: “By making every child a wanted child, by assuring every child of love, security, and respect that he needs as much as he needs food and shelter, we can prevent tormented marriages, mental illness, crime and war. ‘If we had one generation of properly reared children, we might have utopia itself.“’ The book’s organization reflects its author’s medical orientation. The first section, “The Nature of Marriage,” deals with the anatomy of healthy marriage. In it, Saul draws on recent ethological writings to support his assumption that human nature is basically good. The corruption and degradation of humans are seen as the results of “a warping in the development caused by grossly injurious influences on the young during their earliest, most formative period of life.” Saul repeatedly invokes these early injurious influences to explain later marital discord. He draws solely from his middle- and upper-middle-class practice
BOOK
REVIEWS
169
prior to World War II. A cross-cultural or even an American cross-class perspective on marriage and the family would have provided a better frame for Saul’s accounts. His limited scope excludes the “fatherless families” of the lower socio-economic classes and neglects the new American phenomenon of divorce and remarriage which has been called “serial polygamy.” This lack would again be acceptable if he were not also addressing himself to the more encompassing issues of “war, crime, mental illness and tormented marriages.” The second section, “Common Problems in Marriage and Their Causes,” deals with the patho-physiology of marriage. This is a rather arbitrary choice of four “common” situations of marital disturbance which I will not comment upon. It does suggest to me, however, two major points of controversy between family and psychoanalytic psychiatry. Is the relevant unit of observation and treatment the family or the individual? Saul was courageous in the 1930s in his seeing the spouses of his patients, albeit in separate consultations. Repeatedly he observed the impact a severely impaired person can have on a spouse. Had he taken the further step of conjoint family interviews, he would have noted the profound contribution of each member of a family no matter how “ill” any one of them may be. For example, in the chapter dealing with the passive husband, “the perennial child,” he mentions the “reluctant” support of the husband by his parents. Conjoint interviews with the entire family would undoubtedly reveal the continued infantilization of the husband by the parents, perhaps with the collusion of the wife. This illustration brings up the other point of controversy. Are past or present forces more relevant in the understanding of psychopathology? In the previous example, Saul emphasizes the “spoiling” which occurred in the first years of life rather than the continued infantilization in the present. What one focuses upon and later rationalizes into theory is in large part a function of the method of observation or treatment. The “couch and free association” leads the investigator to the significant early life experiences and naturally deals with intrapsychic forces. Conjoint family interviews reveal the powerful present forces in an interpersonal setting. Saul’s approach which falls between these two, results in confusing levels of observation. The third section, “Sex Outside Marriage: Extramarital Sexual Regression and Other Types of Infidelity,” deals with the overt symptoms of marital pathology. In this part and in the remainder of the book, Saul becomes increasingly the moralist. Where the preacher sees infidelity as the fall into sinfulness, Saul sees it as a “regression” to an expression of infantile wishes which persist due to some mishandling in childhood. One can open the book randomly and find such sentences as “The turning of a may away from his wife and children to another woman is seen at all ages. Sometimes, as with Len, it strikes like lightning. With others it is slow, creeping, insidious, and almost imperceptible slipping into an emotional quicksand.” Such a mixture of scientific theory and melodramatic renderings illustrates most convincingly Szasz’s point that psychiatrists are promulagating value systems disguised within the medical model. Saul’s values, however, are so religiously outspoken that he is hardly guilty of hiding his ethics behind a scientific facade. A chapter subtitle will indicate this missionary trend: “Infidelty in the 40’s; a husband who in this ‘dangerous age’ remains effective in his work, but acts out a childhood pattern that spells desertion of wife and children in favor of a young girl and a lower calibre of associates, although he saw there was a problem and sought psychiatric help.” In addition, Saul’s almost total preoccupation with the childhood roots of adultery not only oversimplifies Freud’s views but also ignores the extraordinary contemporary pressures placed on the mid-twentieth century family. The increasing isolation of the nuclear family from the supports of extended kin is further aggravated by developments in the economicoccupational spheres which foster frequent relocations of families. Advancing technology with its radical transformation of leisure time and the changing role of women also contribute to increased strains. He fails to mention these sociological factors as possible influences on the motivations of adultery and divorce. When almost all society’s institutions are being stressed by unprecedentedly rapid changes in technology and communications, a plea for “more love” of children misses the point.
170
BOOK REVIEWS
It is apparent that social scientists must study how the family can carry out most effectively its two remaining and defining functions: the stabilization of the adult personality and the socialization of its chldren. Clinical studies will be of limited help. The study of pathological and “normal” families preferably seen in their natural settings and in their interrrelations with the wider communities may help guide us toward more rational solutions to the crisis of the modern family. Such an endeavor requires the participation of the disciplines of anthropology and sociology, since the family lies at the juncture between the individual and his culture. As a testimony of what one psychiatrist has seen and believes during a lifetime of practice, the book stands as both an historical and personal document. Unwittingly it reflects the moral and conceptual dilemmas of twentieth century psychiatry. The book might find its readership among psychiatrically-oriented marriage therapists but its unprofessional language may well offend them, Psychoanalysts and social scientists will find little use for this book which is unfaithful to each of their outlooks.-Fred Bf. Sander, M.D. THE EVOKING POTENTIALS. Edited by William cephalography and Clinical Neurophysiology. Publishing Co., 1967, 218 pages.
Cobb and Cristoforo Morocutti. ElectroenSupplement No. 26. New York, Elsevier
This book contains the results of studies on cortical potentials evoked by sensory stimuli reported at an international meeting held in Sienna, Italy, in 1966. Experts from eight countries describe various aspects of visual, auditory and somato-sensory evoked potentials, including those recorded through intact scalp in normal humans and in patients with neurological disorders. The theory, mathematics and electronics of computer techniques applied to the study of evoked potentials are presented. Comparisons of the potentials evoked by visual, somatosensory and aditory stimuli are made, and some of the associated physiological and clinical properties, including effects of sleep, are noted. The physiologic aspects of visual evoked potentials (VEP) including their variability and the effects of binocular rivalry are detailed. Studies on man, including comparisons of the VEP in normal and schizophrenic patients and some exploratory efforts using evoked potential techniques in clinical neurology, are reported. The use of depth electrodes in patients during streotoxic operations for epilepsy, pain or Parkinsonism is described together with the electrophysiologic properties of the recorded thalamic and cortical somato-senory evoked potentials. A number of studies of evoked potentials in cats are included. Among these are reports on drug induced changes of cortical and subcortical evoked potentials, click-evoked responses awake and asleep, interhemispheric transmission of evoked potentials and cerebellar system evoked responses. This volume will be of particular value to the specialist dealing with electroencephalography and clinical neurophysiology, and to those interested in the application of advanced electronic techniques to the study of the electrical activity of the brain--Joseph G. Chid, M.D.