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The eye
BOOK REVIEWS
167
Principle II: Adaptation. Every organism reacts not to ari absolute “reality” but to its own interpretation of its milieu in terms of its uniquely developed capacities and experiences. Principle III: VersatiZity. When frustrated in pursuit of some needed satisfaction, organisms modify or substitute either their technique or objectives, and thus maintain a necessary level of overall gratification. Principle IV: Neurotogenesis. When two or more urgent motivations are in sufficiently serious opposition SO that the adaptive patterns required for each become mutually exclusive, the organism experiences a mounting internal tension (“anxiety”) . . . [and develops neurotic, psychosomatic and psychotic symptoms]. Despite the limitations imposed by its brevity, this is a valuable book. For those who are able to keep up with the ethological, anthropological and psychological literature as well as the psychiatric literature, this is a useful summary and mnemonic aid. For most psychiatrists whose work and interest is limited to the human clinical situation, it is another glimpse into an important, highly relevant scientific world which must be explored.-Frederick H. Lowy, M.D. THE EYE. By J. AI. Heaton,
&{.A., ld.B.,
B.&T.,
D.O. London,
Tavistock
Publications,
1968,
336 pages. This book is one in a series of STUDIES IN EXISTENTIALISM AND PHENOMENOLOGY, edited by R. D. Laing. The author’s preface explains his intention “. . . to redress some of the lack of balance in modem ophthalmology, in whcih the Hippocratic habit of observing all the phenomena of disease and their attendant circumstances has been dropped, and instead only facts that can be measured and observed directly are seriously studied.” Thus the author, with training in ophthalmology and psychological medicine, with special knowledge and interest in the existential approach, is addressing himself primarily to ophthalmologists. In fact, I feel the book would be of little interest to most psychiatrists since the pearls present require so much searching for, few but reviewers would have tbe patience. In regard to those ophthalmologists who have sought a definitive treatise on a more holistic approach to their specialty, I fear their quest has not ended. The author has used buckshot where an elegant, well designed and executed arrow would have put the point across.
The book gives a hint of what it could have been in the generally competent introductory chapters in Parts I and II, in which he explores in an integrative way the psychological and physiological aspects of normal vision and eye function. In the latter sections of his hook, in discussions on eye strain, glaucoma, and blindness, the author draws on his experience and makes best use of his existential orientation. In these and in the final theoretical section, “The Foundations of the Phenomenology of Vision,” he provides the most stimulation to this reader. Here he goes into some detail to explain the thesis that full and complete object perception and object relations require the unity and permanence of our body image. This basic postulate of psychoanalytic ego psychology is given greater depth and new perspective by the existential approach in regard to visual experience, which Dr. Heaton is able to present with expertise. This final section would have been better placed early in the book, as he alludes to this orientation frequently throughout. In the final chapter, he again shows excellence in the promise of his windup, but unfortunately fails to follow through. He gives a brief case history to elucidate an existential approach to diagnosis and therapy, but fails adequately to take the space to make his point: that, an existentially based therapy could help his patient see that her wasted efforts to please others had led to an unauthentic life. In most of the book, Heaton takes one eye condition after another, and, having exhaustively explored all pertinent and at times non-pertinent data, then refers to this or that study or this or that classical philosopher in his admirable crusade “that physiology, not critically Thus,
pathology, selected
on page 211,
and psychology
should not be split apart.
and their relevance on interstitial
keratitis,
is generally he refers
. . .” These references
not commented
are
upon by the author.
to a paper by W.
S. Inman
(1965),
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
167
Principle II: Adaptation. Every organism reacts not to ari absolute “reality” but to its own interpretation of its milieu in terms of its uniquely developed capacities and experiences. Principle III: VersatiZity. When frustrated in pursuit of some needed satisfaction, organisms modify or substitute either their technique or objectives, and thus maintain a necessary level of overall gratification. Principle IV: Neurotogenesis. When two or more urgent motivations are in sufficiently serious opposition SO that the adaptive patterns required for each become mutually exclusive, the organism experiences a mounting internal tension (“anxiety”) . . . [and develops neurotic, psychosomatic and psychotic symptoms]. Despite the limitations imposed by its brevity, this is a valuable book. For those who are able to keep up with the ethological, anthropological and psychological literature as well as the psychiatric literature, this is a useful summary and mnemonic aid. For most psychiatrists whose work and interest is limited to the human clinical situation, it is another glimpse into an important, highly relevant scientific world which must be explored.-Frederick H. Lowy, M.D. THE EYE. By J. AI. Heaton,
&{.A., ld.B.,
B.&T.,
D.O. London,
Tavistock
Publications,
1968,
336 pages. This book is one in a series of STUDIES IN EXISTENTIALISM AND PHENOMENOLOGY, edited by R. D. Laing. The author’s preface explains his intention “. . . to redress some of the lack of balance in modem ophthalmology, in whcih the Hippocratic habit of observing all the phenomena of disease and their attendant circumstances has been dropped, and instead only facts that can be measured and observed directly are seriously studied.” Thus the author, with training in ophthalmology and psychological medicine, with special knowledge and interest in the existential approach, is addressing himself primarily to ophthalmologists. In fact, I feel the book would be of little interest to most psychiatrists since the pearls present require so much searching for, few but reviewers would have tbe patience. In regard to those ophthalmologists who have sought a definitive treatise on a more holistic approach to their specialty, I fear their quest has not ended. The author has used buckshot where an elegant, well designed and executed arrow would have put the point across.
The book gives a hint of what it could have been in the generally competent introductory chapters in Parts I and II, in which he explores in an integrative way the psychological and physiological aspects of normal vision and eye function. In the latter sections of his hook, in discussions on eye strain, glaucoma, and blindness, the author draws on his experience and makes best use of his existential orientation. In these and in the final theoretical section, “The Foundations of the Phenomenology of Vision,” he provides the most stimulation to this reader. Here he goes into some detail to explain the thesis that full and complete object perception and object relations require the unity and permanence of our body image. This basic postulate of psychoanalytic ego psychology is given greater depth and new perspective by the existential approach in regard to visual experience, which Dr. Heaton is able to present with expertise. This final section would have been better placed early in the book, as he alludes to this orientation frequently throughout. In the final chapter, he again shows excellence in the promise of his windup, but unfortunately fails to follow through. He gives a brief case history to elucidate an existential approach to diagnosis and therapy, but fails adequately to take the space to make his point: that, an existentially based therapy could help his patient see that her wasted efforts to please others had led to an unauthentic life. In most of the book, Heaton takes one eye condition after another, and, having exhaustively explored all pertinent and at times non-pertinent data, then refers to this or that study or this or that classical philosopher in his admirable crusade “that physiology, not critically Thus,
pathology, selected
on page 211,
and psychology
should not be split apart.
and their relevance on interstitial
keratitis,
is generally he refers
. . .” These references
not commented
are
upon by the author.
to a paper by W.
S. Inman
(1965),
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