SCHIZOPHRENIA: Schizophrenia—Current Concepts and Research.
The author takes the view that the manage ment of ambivalent object-relations is the core problem in schizophrenia, and that group discussions are the key to successful resolution of complications from transference to repulsive behaviour.
Abstract
elicits from Grinker the observation that the epony mous title lends itself to misrepresentation as the Penile Syndrome in a patient's ear, with under standable indignation!) Nevertheless, Altschule rightly underlines the importance of the steadily increasing body of evidence concerning subclinical biochemical abnormalities among close relatives of patients with metabolic disorders, quoting gout and phenyl ketonuria. To these one could add the analogous situation with blood sugar variation in relatives of diabetics, EEG variations in relatives of idiopathic epileptics, and thought-disorder patterns in relatives of nuclear schizophrenics, with the opportunities these or similar phenomena may offer for genotype identification. In a particularly fine chapter, which might almost rank as required reading for D.P.M. candidates, Arieti defends the orthodox concept of schizophrenia against attacks from three separate quarters within recent years-the psychodynamic school, the †̃¿ schizo phrenogenic family' school, and the schizophrenia neurosis continuity school. Grinker expresses concern with the current fashion for diagnostic neglect and nihilism, and urges a determined multidisciplinary effort to establish a nosological system based on improved definitions, measures of validity and statistical analysis. The second section is devoted to the indications for and value of hospital treatment, and British readers may be perplexed by its narrow interpreta tion and content. There is no extended reference to the role of physical or drug treatment, or the place of compulsory admission, and only passing reference to rehabilitative techniques. Active inter vention seems unacceptable to some of the analytical panelIsts, and in some hospitals at least nursing practices seem to be guided by this policy. One patient is described as spending two years in his room, unbathed and unshaven and permitting no one to enter. Gibson takes the view that the manage ment of ambivalent object-relations is the core problem in schizophrenia, and that group discussions are the key to successful resolution of complications from transference to repulsive behaviour. Otto Will bravely outlines the tribulations suffered by anyone undertakingintensivepsychoanalytical support, even in a society well disposed to the analytical approach, and advocates an intensity of care that few could maintain. Thus he has found it justifiable to sit with a highly disturbed, aggressive and self mutilating schizophrenic for up to four hours to work through her anxiety problems without recourse to drugs. Gruenberg contributes an excellent chapter to this section illustratingthe application of comparative epidemiological studies to patterns of hospital service with the object of establishing rational and positive indications for admission and treatment. His dis cussion of the value and importance of relief ad missions is particularly rewarding. He has studied widely in the U.K., and perhaps we should feel flattered that the therapeutic orientation and corn munity services which he urges on his colleagues should so closely resemble British practices. The final sections on †̃¿ Current Research' covers a random sample from speculative psychopathology to the implications of advances in genetic research. Holzman provides a closely-argued and attractive review of perceptual dysfunction, with particular reference to his special interest in the feedback stage. Rosenthal, with his customary clarity and persuasion, summarises the genetic evidence, and is convinced that it offers the more parsimonious interpretation of the consistent trends derived from consanguinity, twin and adoption studies. As to mode of inheritance, he favours a polygenic basis, since it offers a better explanation of †̃¿ the continuum of schizophrenicity', and at the same time leaves room for the operation of environmental stress or trigger factors. In the latter respect, one looks forward to the conclusions to be drawn from his current plans for surveying children oflsradi schizophrenics reared either in a conventional nuclear family or in a kibbutz. Distinctive motifs throughout the book are the mis givings in the face of the complexity of the problem to be tackled, counterbalanced by the united call for improved techniques and methodology, more data, better definitions and the more precise use of language.As Cancrowrites: †̃¿ much inpsychiatry isa struggle in combining the right idea with the proper word and the appropriate affect', and this is nowhere better illustrated than in the fascinating incompre hensibility of schizophrenia itself@ The individual papers may at times seem strange bedfellows, but perhaps this is symbolic of the more positive and sophisticated stage of interaction to which the nature nurture controversy has advanced.