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The Nature of Ego
BOOK REVIEWS
RESEARCH ON THE ETIOLOGY OF SCHIZOPHRENIA. By Prof. G. Yu. Malis. (Authorized translation from the Russian). International Behavioral Sciences, Joseph Wortis, M.D., Editor, Consultant's Bureau, New York. 195 pages. 1959. $9.50. The author reviews past and current research in schizophrenia. He presents evidence that the serum of schizophrenics contains a toxic factor, but is unalterably convinced that this finding is correlated with a filterable virus origin of the disease. Numerous hematological investigations are considered in which changes in the leukocytes and the erythrocytes have been noted. Eosinophilia had been reported to be the result of "a defensive reaction to toxic protein products." Later reports indicated that it was a "sign of improvement." The contradictory nature of these findings are then related to the "stage of disease, the patient's condition and diet and the technique of investigation of the blood." The effects of schizophrenic blood on the larvae of amphibia point up its toxicity; a retardation in growth and development and a lowered vitality are noted. The use of plant seeds (first suggested by Macht, an American) , as a method of studying toxicity, is confirmed by Soviet workers, after they first "simplified his techniques." As pointed out by Dr. Hudson Hoagland in the Preface, the possible relation of an unusual plasma globulin is ignored, despite its confirmation in many centers of the U.S.A. Despite the fact that the author's data do not correlate nor coincide with western views, his data nevertheless are well represented. W.D.
CURRENT PSYCHIATRIC THERAPIES. Vol. II. Edited by Jules H. Masserman, M.D. 289 pages. New York: Grone and Stratton, 1962. Doctor Masserman's efforts to create an authoritative and comprehensive treatise on current practices have been rewarded by this excellent companion to Volume 1". Eight major topics are considered and include (l) Principles of Psychotherapy; (2) Childhood and Adolescence; (3) Techniques of Psychotherapy; (4) Treatment of the Psychoses; (5) Legal Psychiatry; (6) Part-time Services; (7) Full-time Hospital Therapy; (8) Psychiatry and the World Order. Dr. C. H. Hardin Branch leads off with a most invigorating essay on psychotherapy, in which he points out that it is not the only therapeutic tool. Goals of the patient and the reasons for incapacity may not be related to the psychopathology. Neither the patients' needs nor the reasons for the incapacity may be accessible to psychotherapy. Dr. Gert Heibrunn, a psychoanalyst, also offers a refreshing point of view in indicating that analysis is not the exclusive treatment of choice. He indicates that the use of drugs might accelerate the treatment pace. "Reviewed in PSYCHOSOMATICS, 2:396, Sept.-Oct., 1961. May-June, 1963
Dr. Sidney Margolin, in discussing the "analytic" factor in the practice of medicine, points up that this relates to the doctor's ability to support a patient's regressive reaction to his disease and to gratify the needs appropriate to the regression. Dr. Hilde Bruch casts doubts upon the efficacy of the "inactive" blank mirror attitude of the therapist. When the therapeutic approach was changed from an interpretative to a fact-finding one, with a direct focus on helping the patient become aware of "seH-initiated" feelings, thoughts and behavior it was proven to be effective in patients with phobias, obesity, anorexia nervosa and other psychosomatic conditions. Traditional psychoanalysis and other forms of therapy had been unsuccessful. The "Treatment of the Dying" is considered by Drs. Hackett and Weisman, in which they indicate the importance of telling the patient the truth rather than trying to deceive him as to his imminent death. Dr. Wahl presents the contrary point of view so that the reader is left to his own devices. Dr. Walter Bonime discusses the dynamics and psychotherapy of depression. He considers "manipulation of others" as the cardinal element in the patient's behavior. Minor depressions ("sulks") as well as intense involutional depressions are all related to failures in manipulative effectiveness. The genetic matrix is to be found in the highly competitive Western culture. The psychotherapy is visualized as most difficult in that the patient seeks desperately to manipulate the therapist into therapeutic bankruptcy. It is essential for the therapist to explore the denial of anger as well as the manipulative maneuvers. Doctor Bonime handles the threat of suicide during P~J' chotherapy by pointing up that it "cannot change the nature of the activity in which the patient and analyst are engaged." (The author nevertheless justifies the use of convulsive and drug therapy as ancillary measures to psychotherapy). The treatment of psychopaths by Dr. Melitta Schmideberg is considered to be quite opposite to the passive, detached, nonjudgmental therapy of the neurotic. All in all, this volume affords the reader a penetrating glimpse into the very latest therapeutic attempts to influence psychiatric problems. W.D.
THE NATURE OF EGO. A Study. By Benjamin Meynard. 211 pages. New York: Philosophical Library. Cloth, $4.50. The author undertook a study project on "Ego," has surveyed the literature and produced a reference guide on the complex subject matter. The book concludes that ego, or awareness, commences at about age four, and, as an awareness organ, mediates data to the psychic background which then assumes responsibility for appropriate response. Ego may utilize memory access, inhibit voluntary muscles, symbol (i.e., words) recognition and manipulation, and possibly "trigger" attitudes. Its main function, however, is observation, collation, and feed-back for the psychic background or matrix for action. "Ego" is classified as primary, false, and secondary. The primary ego is the "true seH"; the false ego denotes colored or biased observation influenced by learning, status, or 187
PSYCHOSOMATICS prejudices. Second
THE CHEMISTRY OF BRAIN METABOLISM IN HEALTH AND DISEASE. By J. H. Quastel alld David M. J. Quastel. 170 pages. Springfield, Ill.: Charles C Thomas, 1961. $6.50. This book provides a good survey of the chemical reactions that occur during health and cerebral disease. Energy metabolism of the brain is reviewed. Its vulnerability to oxygen lack is noted; also the degree of impairment of consciousness in organic dementia, brain damage, hepatic coma, hypoglycemia, etc. is seen to correlate with the degree of reduction in oxygen consumption. Glucose is the main fuel of the brain; a significant disease in the blood glucose level is consistentlv correlated with disturbances in behavior. . Psychotic symptoms associated with pellagra arc relieved by the administration of nicotinic acid or its amide; thiamine rt'!ieves the depression, anxiety, irritability and loss of memory of beri-beri. Wernicke's encephalopathy also responds to thiamine. Pyridoxine (Vitamin B.) deficiency can produce convulsions. Serotonin and catecholamines are reviewed, as is the evidence for the importance of acetylcholine as a central synaptic transmitter. Cerebral dysfunction in Wilson's disease is seen to be related to high amounts of copper deposits in thc brain; the etiology lies in a deficiency or ceruloplasmin (a protein). Phenylketonuria, maple syrup disease and Hartnup disease all demonstrate disorders in the body chemistry. The neurolipoidoses (Gaucher's diseaSe, NiemannPick disease, amaurotic family idiocy and PfaundlerHurler's disease (Gargoylism) all show aberrations in lipoid metabolism. An excellent chapter reviews the biochemical aspects of schizophrenia. The authors note that both electroshock therapy and drug treatment of mental disease with the amine oxidase inhibitors or tranquilizers have one feature in common-an interference with oxidative events. This excellent review of biochemistry in relation to organic and possibly functional disease of the brain should be of interest to every physician interested in the possible role of chemical dysfunction as a root for mental and emotional illness. W.D.
188
SEXUAL PLEASURE IN MARRIAGE. By Jerome and Julia Rainer. 251 pages. New York: Julian Messner, Inc. $4.95. The authors of this book are a husband and wife team of medical writers who have managed to produce a book on sex with a different approach and with an engaging and literate style. The usual exposition on anatomy and physiology which occupies the major part of most books on this subject has been relegated to the appendix. The major emphasis is on the emotional aspects of sex in modern marriage. The authors exhibit a thorough understanding of the subject, and they present their material unusually well. This is a book which any doctor could well recommend to his patients, particularly those who need more than the usual pedestrian approach of most books on this subject. F. W. GOODRICH, JR., M.D.
PSYCHOANALYSIS OF BEHAVIOR. Vol. II. By Sandor Rado, M.D. New York: Grone & Stratton 1962. ' The present volume includes further contributions to the "Development of Adaptational Psychodynamics." It represents various lectures given hy the author during the period of 1956-196l. Doctor Rado, a pioneer in psychoanalytic education, has constantly tried to place psychoanalysis in the framework of hiology, insisting on a scientific rather than a mystical approach. The approach to schizophrenia, as outlined by Rado, considers genetic as well as environmental influences. The anhedonia of the schizophrenic, with its associated "pleasure deficiency" is compared to the deficiency created by the lack of an essential enzyme which slows down or hinders a complex biochemical process. Psychotherapy is differentiated into reparative and reconstructive techniques. The importance of the alleviation of fear, guilt and rage is emphasized, because once these "emergency emotions" are under control, the "welfare emotions" have an opportunity to emerge. He differentiates hetwen the treatment of psychoneurosis and schizotypal disorders. He points out that the adaptational technique seeks to help the patient ohtain the highest attainahle level of selfreliance and mastery, preventing regression to a parent-seeking level. Doctor Rado's concept of depression considers the retroflexion of rage and the fear of inescapable punishment. Expiatory behavior is the result of an attempt to "placate parental figures." The depressive spell is related to the "cry for love"; the loss of appetite is likened to the fasting seen in many forms of religious atonement. An excellent chapter on obsessive behavior relates this disorder to the conflict between guilty fear and defiant rage, or obedience versus defiance. Most interesting is his description of the new graduate school ... The New York School of Psychiatry ... as a pilot center for the psychiatric education of Volume IV
RESEARCH ON THE ETIOLOGY OF SCHIZOPHRENIA. By Prof. G. Yu. Malis. (Authorized translation from the Russian). International Behavioral Sciences, Joseph Wortis, M.D., Editor, Consultant's Bureau, New York. 195 pages. 1959. $9.50. The author reviews past and current research in schizophrenia. He presents evidence that the serum of schizophrenics contains a toxic factor, but is unalterably convinced that this finding is correlated with a filterable virus origin of the disease. Numerous hematological investigations are considered in which changes in the leukocytes and the erythrocytes have been noted. Eosinophilia had been reported to be the result of "a defensive reaction to toxic protein products." Later reports indicated that it was a "sign of improvement." The contradictory nature of these findings are then related to the "stage of disease, the patient's condition and diet and the technique of investigation of the blood." The effects of schizophrenic blood on the larvae of amphibia point up its toxicity; a retardation in growth and development and a lowered vitality are noted. The use of plant seeds (first suggested by Macht, an American) , as a method of studying toxicity, is confirmed by Soviet workers, after they first "simplified his techniques." As pointed out by Dr. Hudson Hoagland in the Preface, the possible relation of an unusual plasma globulin is ignored, despite its confirmation in many centers of the U.S.A. Despite the fact that the author's data do not correlate nor coincide with western views, his data nevertheless are well represented. W.D.
CURRENT PSYCHIATRIC THERAPIES. Vol. II. Edited by Jules H. Masserman, M.D. 289 pages. New York: Grone and Stratton, 1962. Doctor Masserman's efforts to create an authoritative and comprehensive treatise on current practices have been rewarded by this excellent companion to Volume 1". Eight major topics are considered and include (l) Principles of Psychotherapy; (2) Childhood and Adolescence; (3) Techniques of Psychotherapy; (4) Treatment of the Psychoses; (5) Legal Psychiatry; (6) Part-time Services; (7) Full-time Hospital Therapy; (8) Psychiatry and the World Order. Dr. C. H. Hardin Branch leads off with a most invigorating essay on psychotherapy, in which he points out that it is not the only therapeutic tool. Goals of the patient and the reasons for incapacity may not be related to the psychopathology. Neither the patients' needs nor the reasons for the incapacity may be accessible to psychotherapy. Dr. Gert Heibrunn, a psychoanalyst, also offers a refreshing point of view in indicating that analysis is not the exclusive treatment of choice. He indicates that the use of drugs might accelerate the treatment pace. "Reviewed in PSYCHOSOMATICS, 2:396, Sept.-Oct., 1961. May-June, 1963
Dr. Sidney Margolin, in discussing the "analytic" factor in the practice of medicine, points up that this relates to the doctor's ability to support a patient's regressive reaction to his disease and to gratify the needs appropriate to the regression. Dr. Hilde Bruch casts doubts upon the efficacy of the "inactive" blank mirror attitude of the therapist. When the therapeutic approach was changed from an interpretative to a fact-finding one, with a direct focus on helping the patient become aware of "seH-initiated" feelings, thoughts and behavior it was proven to be effective in patients with phobias, obesity, anorexia nervosa and other psychosomatic conditions. Traditional psychoanalysis and other forms of therapy had been unsuccessful. The "Treatment of the Dying" is considered by Drs. Hackett and Weisman, in which they indicate the importance of telling the patient the truth rather than trying to deceive him as to his imminent death. Dr. Wahl presents the contrary point of view so that the reader is left to his own devices. Dr. Walter Bonime discusses the dynamics and psychotherapy of depression. He considers "manipulation of others" as the cardinal element in the patient's behavior. Minor depressions ("sulks") as well as intense involutional depressions are all related to failures in manipulative effectiveness. The genetic matrix is to be found in the highly competitive Western culture. The psychotherapy is visualized as most difficult in that the patient seeks desperately to manipulate the therapist into therapeutic bankruptcy. It is essential for the therapist to explore the denial of anger as well as the manipulative maneuvers. Doctor Bonime handles the threat of suicide during P~J' chotherapy by pointing up that it "cannot change the nature of the activity in which the patient and analyst are engaged." (The author nevertheless justifies the use of convulsive and drug therapy as ancillary measures to psychotherapy). The treatment of psychopaths by Dr. Melitta Schmideberg is considered to be quite opposite to the passive, detached, nonjudgmental therapy of the neurotic. All in all, this volume affords the reader a penetrating glimpse into the very latest therapeutic attempts to influence psychiatric problems. W.D.
THE NATURE OF EGO. A Study. By Benjamin Meynard. 211 pages. New York: Philosophical Library. Cloth, $4.50. The author undertook a study project on "Ego," has surveyed the literature and produced a reference guide on the complex subject matter. The book concludes that ego, or awareness, commences at about age four, and, as an awareness organ, mediates data to the psychic background which then assumes responsibility for appropriate response. Ego may utilize memory access, inhibit voluntary muscles, symbol (i.e., words) recognition and manipulation, and possibly "trigger" attitudes. Its main function, however, is observation, collation, and feed-back for the psychic background or matrix for action. "Ego" is classified as primary, false, and secondary. The primary ego is the "true seH"; the false ego denotes colored or biased observation influenced by learning, status, or 187
PSYCHOSOMATICS prejudices. Second
THE CHEMISTRY OF BRAIN METABOLISM IN HEALTH AND DISEASE. By J. H. Quastel alld David M. J. Quastel. 170 pages. Springfield, Ill.: Charles C Thomas, 1961. $6.50. This book provides a good survey of the chemical reactions that occur during health and cerebral disease. Energy metabolism of the brain is reviewed. Its vulnerability to oxygen lack is noted; also the degree of impairment of consciousness in organic dementia, brain damage, hepatic coma, hypoglycemia, etc. is seen to correlate with the degree of reduction in oxygen consumption. Glucose is the main fuel of the brain; a significant disease in the blood glucose level is consistentlv correlated with disturbances in behavior. . Psychotic symptoms associated with pellagra arc relieved by the administration of nicotinic acid or its amide; thiamine rt'!ieves the depression, anxiety, irritability and loss of memory of beri-beri. Wernicke's encephalopathy also responds to thiamine. Pyridoxine (Vitamin B.) deficiency can produce convulsions. Serotonin and catecholamines are reviewed, as is the evidence for the importance of acetylcholine as a central synaptic transmitter. Cerebral dysfunction in Wilson's disease is seen to be related to high amounts of copper deposits in thc brain; the etiology lies in a deficiency or ceruloplasmin (a protein). Phenylketonuria, maple syrup disease and Hartnup disease all demonstrate disorders in the body chemistry. The neurolipoidoses (Gaucher's diseaSe, NiemannPick disease, amaurotic family idiocy and PfaundlerHurler's disease (Gargoylism) all show aberrations in lipoid metabolism. An excellent chapter reviews the biochemical aspects of schizophrenia. The authors note that both electroshock therapy and drug treatment of mental disease with the amine oxidase inhibitors or tranquilizers have one feature in common-an interference with oxidative events. This excellent review of biochemistry in relation to organic and possibly functional disease of the brain should be of interest to every physician interested in the possible role of chemical dysfunction as a root for mental and emotional illness. W.D.
188
SEXUAL PLEASURE IN MARRIAGE. By Jerome and Julia Rainer. 251 pages. New York: Julian Messner, Inc. $4.95. The authors of this book are a husband and wife team of medical writers who have managed to produce a book on sex with a different approach and with an engaging and literate style. The usual exposition on anatomy and physiology which occupies the major part of most books on this subject has been relegated to the appendix. The major emphasis is on the emotional aspects of sex in modern marriage. The authors exhibit a thorough understanding of the subject, and they present their material unusually well. This is a book which any doctor could well recommend to his patients, particularly those who need more than the usual pedestrian approach of most books on this subject. F. W. GOODRICH, JR., M.D.
PSYCHOANALYSIS OF BEHAVIOR. Vol. II. By Sandor Rado, M.D. New York: Grone & Stratton 1962. ' The present volume includes further contributions to the "Development of Adaptational Psychodynamics." It represents various lectures given hy the author during the period of 1956-196l. Doctor Rado, a pioneer in psychoanalytic education, has constantly tried to place psychoanalysis in the framework of hiology, insisting on a scientific rather than a mystical approach. The approach to schizophrenia, as outlined by Rado, considers genetic as well as environmental influences. The anhedonia of the schizophrenic, with its associated "pleasure deficiency" is compared to the deficiency created by the lack of an essential enzyme which slows down or hinders a complex biochemical process. Psychotherapy is differentiated into reparative and reconstructive techniques. The importance of the alleviation of fear, guilt and rage is emphasized, because once these "emergency emotions" are under control, the "welfare emotions" have an opportunity to emerge. He differentiates hetwen the treatment of psychoneurosis and schizotypal disorders. He points out that the adaptational technique seeks to help the patient ohtain the highest attainahle level of selfreliance and mastery, preventing regression to a parent-seeking level. Doctor Rado's concept of depression considers the retroflexion of rage and the fear of inescapable punishment. Expiatory behavior is the result of an attempt to "placate parental figures." The depressive spell is related to the "cry for love"; the loss of appetite is likened to the fasting seen in many forms of religious atonement. An excellent chapter on obsessive behavior relates this disorder to the conflict between guilty fear and defiant rage, or obedience versus defiance. Most interesting is his description of the new graduate school ... The New York School of Psychiatry ... as a pilot center for the psychiatric education of Volume IV