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Through paediatrics to psychoanalysis
Book Reviews Through Paediatrics stated. 350 pp.
to Psychoanalysis.
D. W. WINNICOTT. New York:
BrunneriMazel.
Price
not
I WAS pleased to be asked to review this new paperback version of Winnicott’s famous book, which I last read before training as a child psychiatrist. In the 1960s there was apparently a debate between Winnicott and Sir Aubrey Lewis as to whether the best training path to child psychiatry was through paediatrics (Winnicott) or adult psychiatry (Lewis). Lewis prevailed then, but there is now at least a partial shift towards Winnicott’s view, which will possibly be reflected in the new accelerated post-1995 training structure. Winnicott was a practising paediatrician and psychoanalyst. He therefore had the unusual opportunity of observing very many ill and healthy children with their mothers. as well as studying some children in depth through psychoanalysis. The book was certainly worth re-reading. We are fortunately no longer confronted with chorea, rheumatic fever and tuberculosis, all of which loomed large in Winnicott’s time. Our understanding of hyperactivity informs our reading of the chapter on fidgeting, and our awareness of sexual abuse informs our reading of almost everything. Winnicott’s simple style has led to confusion about some of his ideas, and has also led to a lazy and misinformed application of those ideas, especially the concepts of good enough parenting and of transitional objects. The original paper on transitional objects is in this book, and should be read by all those who wish to use the term properly. The paper on Hate in the Countertransference is also essential reading for all those who work with chronic patients, as well as being invaluable in thinking about the plight of parents with difficult children. Overall, still a good read.
Camberwell
“Make
Believes”
in Psychiatry.
HERMAN M VAN PRAAG. New York:
Dr MARK BERELOW~IL Child Guidance Centre Lister Health Centre London SE15 5LA
BrunrleriMazel,
1993. 304 pp.
PROFESSOH van Praag’s opus is the product of over 39 year’s experience in psychiatric practice and research. It consists of a critique of several tenets and issues in the field, perhaps his main bone of contention being with DSM-III-R diagnosis. Professor van Praag’s own views are supported by wide reference to the literature, including his own research. The book is generally full of interest and well set out with useful tables and figures, summaries and side headed paragraphs. Professor van Praag argues strongly against a categorical nosology raised on expert opinion and proposes his own view of the usefulness of a syndromal approach, particularly linking this to his amine hypotheses of psychopathology. He is against the atheoretical nature of the DSM-III, the unitary classification of schizophrenia. and the ever increasing plethora of new diagnoses such as ‘children-of-holocaust-survivor-syndrome’. One felt that Professor van Praag’s suggestions on alternatives, e.g. syndromal multi-tiered diagnosis, could be confusing in ordinary clinical practice as most psychiatrists rub along reasonably happy with the current system, but perhaps we ought not to. At times, I felt that Professor van Praag was taking an overly biological stance, for instance in the first chapter where he outlines his concerns about dualism, analytic psychotherapy and the status of in places he asserts strongly that one cannot divorce abnormal psychiatry in medicine. However, behaviour from its psychological and social context, and it occurred to me that he was trying to ‘have his cake and eat it’. Professor van Praag has strong opinions which he articulates well, but such assertions as targeted psychopharmacological treatment of behaivoural syndromes rests on hypotheses supported only b] circumstantial evidence at the current time. Empirical research on this approach is badly needed. Professor van Praag makes determined and refreshing attempts to debunk depression as a mood disorder and the validity of the positive-negative dichotomy in schizophrenia. The latter made me feel particularly uneasy however since the positive-negative dichotomy is the only attempt to dissect schizophrenia. Psychopathology that has stood the test of time. Professor Praag’s alternative-to find biological markers of six separate syndromes-seems somewhat unrealistic at present. Occasionally the writing appears judgemental and uncharitable, e.g. ‘pitiable data, to be so twisted in order to salvage a theory that eventually appears to be untenable’. Such contemptuous treatment of a colleague’s research may only serve to antagonize the reader. Despite my reservations, I would warmly recommend this book to psychiatrists engaged in research
to Psychoanalysis.
D. W. WINNICOTT. New York:
BrunneriMazel.
Price
not
I WAS pleased to be asked to review this new paperback version of Winnicott’s famous book, which I last read before training as a child psychiatrist. In the 1960s there was apparently a debate between Winnicott and Sir Aubrey Lewis as to whether the best training path to child psychiatry was through paediatrics (Winnicott) or adult psychiatry (Lewis). Lewis prevailed then, but there is now at least a partial shift towards Winnicott’s view, which will possibly be reflected in the new accelerated post-1995 training structure. Winnicott was a practising paediatrician and psychoanalyst. He therefore had the unusual opportunity of observing very many ill and healthy children with their mothers. as well as studying some children in depth through psychoanalysis. The book was certainly worth re-reading. We are fortunately no longer confronted with chorea, rheumatic fever and tuberculosis, all of which loomed large in Winnicott’s time. Our understanding of hyperactivity informs our reading of the chapter on fidgeting, and our awareness of sexual abuse informs our reading of almost everything. Winnicott’s simple style has led to confusion about some of his ideas, and has also led to a lazy and misinformed application of those ideas, especially the concepts of good enough parenting and of transitional objects. The original paper on transitional objects is in this book, and should be read by all those who wish to use the term properly. The paper on Hate in the Countertransference is also essential reading for all those who work with chronic patients, as well as being invaluable in thinking about the plight of parents with difficult children. Overall, still a good read.
Camberwell
“Make
Believes”
in Psychiatry.
HERMAN M VAN PRAAG. New York:
Dr MARK BERELOW~IL Child Guidance Centre Lister Health Centre London SE15 5LA
BrunrleriMazel,
1993. 304 pp.
PROFESSOH van Praag’s opus is the product of over 39 year’s experience in psychiatric practice and research. It consists of a critique of several tenets and issues in the field, perhaps his main bone of contention being with DSM-III-R diagnosis. Professor van Praag’s own views are supported by wide reference to the literature, including his own research. The book is generally full of interest and well set out with useful tables and figures, summaries and side headed paragraphs. Professor van Praag argues strongly against a categorical nosology raised on expert opinion and proposes his own view of the usefulness of a syndromal approach, particularly linking this to his amine hypotheses of psychopathology. He is against the atheoretical nature of the DSM-III, the unitary classification of schizophrenia. and the ever increasing plethora of new diagnoses such as ‘children-of-holocaust-survivor-syndrome’. One felt that Professor van Praag’s suggestions on alternatives, e.g. syndromal multi-tiered diagnosis, could be confusing in ordinary clinical practice as most psychiatrists rub along reasonably happy with the current system, but perhaps we ought not to. At times, I felt that Professor van Praag was taking an overly biological stance, for instance in the first chapter where he outlines his concerns about dualism, analytic psychotherapy and the status of in places he asserts strongly that one cannot divorce abnormal psychiatry in medicine. However, behaviour from its psychological and social context, and it occurred to me that he was trying to ‘have his cake and eat it’. Professor van Praag has strong opinions which he articulates well, but such assertions as targeted psychopharmacological treatment of behaivoural syndromes rests on hypotheses supported only b] circumstantial evidence at the current time. Empirical research on this approach is badly needed. Professor van Praag makes determined and refreshing attempts to debunk depression as a mood disorder and the validity of the positive-negative dichotomy in schizophrenia. The latter made me feel particularly uneasy however since the positive-negative dichotomy is the only attempt to dissect schizophrenia. Psychopathology that has stood the test of time. Professor Praag’s alternative-to find biological markers of six separate syndromes-seems somewhat unrealistic at present. Occasionally the writing appears judgemental and uncharitable, e.g. ‘pitiable data, to be so twisted in order to salvage a theory that eventually appears to be untenable’. Such contemptuous treatment of a colleague’s research may only serve to antagonize the reader. Despite my reservations, I would warmly recommend this book to psychiatrists engaged in research