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Neurosis and Psychosis
1962
PSYCHOSOMATICS
411
Book Reviews NEUROSIS AND PSYCHOSIS. By Bosselman, B. C., M.D. Charles C. Thomas, Springfield, III. 2nd Ed. 1961. 181 pages. $4.00. This small book, based on a series of lectures given at the U. of Illinois, is not intended as a comprehensive textbook of psychiatry. It was written primarily for the psychiatric resident and the general practitioner who requires some understanding of psychiatry. Discussing the nature of symptoms, the author states, "The individual's symptoms are the expression of his striving for reconciliation of diverse elements within himself, as well as his striving for compromise with the demands of the outer world." Repression, over-compensation and reaction-formations are discussed; also the parts they play in normal and in neurotic behavior. It is emphasized that all types of reaction were originally formulated for self-preservation. In the anXiety state there is the simplest expression of neurotic disorder; the patient reacts as if to a dangerous or threatening situation. No clue appears as to the meaning of the conflict. The patient is disturbed and is trying to bring up defenses against an unknown danger. Since such a state becomes intolerable it must be resolved, and a phobic state may follow. In the phobic state the anxiety is projected or fixed on some external situation. This limits the conflict and some specific defenses can be brought up to deal with this more limited situation. Anxiety may be expressed in somatic symptoms of a symbolic nature. The conflictual situation is transformed into a somatic symptom, with the loss of the original disturbing anxiety (conversion hysteria). All neurotic syndromes are basically defenses against anxiety which tend to overwhelm the ego. These defenses may circumscribe anxiety or convert it into somatic symptoms. A more elaborate and regressive expression of this process is the compulsive-obsessive neurosis. Here the forces in conflict involve more of the personality. The character patterns that develop are of a poor adaptive type, with regression or retreat to earlier childhood patterns, to a pattern of functioning designated by Freud as the anal character. The fixation of personality or its regression to the anal stage brings the patient back to the problems of anal conflicts. Ambivalence is greater in this neurosis than in all others; ideas rather than emotions are seen more in the symptoms expressed and reaction-formation is a common mental mechanism. Isolation and undoing are other frequently used mechanisms. In the psychopathic personality, the patient
acts out his conflict in an anti-social manner, not influenced by moral, social, or realistic codes. It is essentially a weakness in the superego. The environment becomes the battleground; the patient is ruthless in his efforts to attain his ends. He has no feelings nor remorse for his deeds, no sense of responsibility, and usually very little to no sense of guilt. Sexual perversions are considered as neuroses because there is a conflict of forces within the personality. Exhibitionism, voyeurism, sadism, masochism, bestiality, fetishism, necrophilia, satyriasis and nymphomania are all included. Alcoholism is also considered a neurosis because there is repetitive use of alcohol for satisfaction of basic personality needs, the alcohol becoming a substitute for realistic, socially integrated satisfaction of these needs. The psychoses differ from all the neuroses in the basic loss of reality sense or Insight. The struggle in the psychotic to adjust in the real world is so intense that he finally gives up and escapes into fantasy through detachment, denial, projection, misrepresentation, distortion, etc. T'le manic-depressive state is considered in some detail. Schizophrenia and its various typ.zs are sketched very briefly. Paranoia and paranoid states are also described in a very abbreviated way. Despite this condcnsation the essential features of the psychoses are well presented. Case reports illustrate the salient points and tie together theory and practice. Joseph Joel Friedman, M.D.
THE MOLD OF MURDER-A PSYCHIATRIC STUDY OF HOMICIDE. By Walter Bromberg, M.D. Grune and Stratton, New York and Lon· don, 1961. Pp. 230, $4.75. The author has contributed extensively to crim· inal psychiatry for better than a ql~arter of a century as practitioner, writer and teacher. He is a member of that courageous breed of psychiatrists who explore the sociopath and attempt to translate current psycho-dynamic thought into legal concepts. In ten chapters Bromberg gives meaning to the act of murder, evaluates the contributions of psychiatry and offers an interesting preventive suggestion. He defines the broad spectrum of functional and organic conditions which have a common display of aggression eventuating in murder. This act is either a direct resolution of emotional conflict or its symbolic. representation. Repressed hostility and its release is dynamically traced from the "normal" to the deviate. The law-abiding betray aggressive impulses in dreams and anecdotes, the immature
PSYCHOSOMATICS
411
Book Reviews NEUROSIS AND PSYCHOSIS. By Bosselman, B. C., M.D. Charles C. Thomas, Springfield, III. 2nd Ed. 1961. 181 pages. $4.00. This small book, based on a series of lectures given at the U. of Illinois, is not intended as a comprehensive textbook of psychiatry. It was written primarily for the psychiatric resident and the general practitioner who requires some understanding of psychiatry. Discussing the nature of symptoms, the author states, "The individual's symptoms are the expression of his striving for reconciliation of diverse elements within himself, as well as his striving for compromise with the demands of the outer world." Repression, over-compensation and reaction-formations are discussed; also the parts they play in normal and in neurotic behavior. It is emphasized that all types of reaction were originally formulated for self-preservation. In the anXiety state there is the simplest expression of neurotic disorder; the patient reacts as if to a dangerous or threatening situation. No clue appears as to the meaning of the conflict. The patient is disturbed and is trying to bring up defenses against an unknown danger. Since such a state becomes intolerable it must be resolved, and a phobic state may follow. In the phobic state the anxiety is projected or fixed on some external situation. This limits the conflict and some specific defenses can be brought up to deal with this more limited situation. Anxiety may be expressed in somatic symptoms of a symbolic nature. The conflictual situation is transformed into a somatic symptom, with the loss of the original disturbing anxiety (conversion hysteria). All neurotic syndromes are basically defenses against anxiety which tend to overwhelm the ego. These defenses may circumscribe anxiety or convert it into somatic symptoms. A more elaborate and regressive expression of this process is the compulsive-obsessive neurosis. Here the forces in conflict involve more of the personality. The character patterns that develop are of a poor adaptive type, with regression or retreat to earlier childhood patterns, to a pattern of functioning designated by Freud as the anal character. The fixation of personality or its regression to the anal stage brings the patient back to the problems of anal conflicts. Ambivalence is greater in this neurosis than in all others; ideas rather than emotions are seen more in the symptoms expressed and reaction-formation is a common mental mechanism. Isolation and undoing are other frequently used mechanisms. In the psychopathic personality, the patient
acts out his conflict in an anti-social manner, not influenced by moral, social, or realistic codes. It is essentially a weakness in the superego. The environment becomes the battleground; the patient is ruthless in his efforts to attain his ends. He has no feelings nor remorse for his deeds, no sense of responsibility, and usually very little to no sense of guilt. Sexual perversions are considered as neuroses because there is a conflict of forces within the personality. Exhibitionism, voyeurism, sadism, masochism, bestiality, fetishism, necrophilia, satyriasis and nymphomania are all included. Alcoholism is also considered a neurosis because there is repetitive use of alcohol for satisfaction of basic personality needs, the alcohol becoming a substitute for realistic, socially integrated satisfaction of these needs. The psychoses differ from all the neuroses in the basic loss of reality sense or Insight. The struggle in the psychotic to adjust in the real world is so intense that he finally gives up and escapes into fantasy through detachment, denial, projection, misrepresentation, distortion, etc. T'le manic-depressive state is considered in some detail. Schizophrenia and its various typ.zs are sketched very briefly. Paranoia and paranoid states are also described in a very abbreviated way. Despite this condcnsation the essential features of the psychoses are well presented. Case reports illustrate the salient points and tie together theory and practice. Joseph Joel Friedman, M.D.
THE MOLD OF MURDER-A PSYCHIATRIC STUDY OF HOMICIDE. By Walter Bromberg, M.D. Grune and Stratton, New York and Lon· don, 1961. Pp. 230, $4.75. The author has contributed extensively to crim· inal psychiatry for better than a ql~arter of a century as practitioner, writer and teacher. He is a member of that courageous breed of psychiatrists who explore the sociopath and attempt to translate current psycho-dynamic thought into legal concepts. In ten chapters Bromberg gives meaning to the act of murder, evaluates the contributions of psychiatry and offers an interesting preventive suggestion. He defines the broad spectrum of functional and organic conditions which have a common display of aggression eventuating in murder. This act is either a direct resolution of emotional conflict or its symbolic. representation. Repressed hostility and its release is dynamically traced from the "normal" to the deviate. The law-abiding betray aggressive impulses in dreams and anecdotes, the immature