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Book Review: Borderline and Narcissistic Patients in Therapy

Times of London (Monday, July 8th, 1985) stated "One American psychoanalyst, Judd Marmer, on reviewing the available evidence was forced to conclude that in retrospect psychoanalysis may have been oversold as a treatment. Its superiority over all other psychotherapeutic approaches, he added, is presently more an article of faith than a scientifically demonstrated fact." He further added "at the present time, psychoanalysis is irrelevant to the treatment of the severe forms of mental disorders, the psychoses of schizophrenia and manic depressive disorder, which are treated with drugs, social forms of rehabilitation and counselling, approaches whose similarity to Freudian psychoanalysis is slight. Such treatments, it is sadly true, are far from being as effective, but virtually every leading research worker looks to development in neurochemistry, neurophysiology, genetics and psychology for breakthroughs. No one seriously considers psychoanalysis." In chapter seven, Dr. Will discusses the relationship of psychopharmacology to schizophrenia. He wrote "a psychotherapist can do nothing about genetic defects. If such defects exist, they have not been evident in my patients, who have exhibited behavioural changes that appear to me to be a result of a variety of learning experiences. " This may be so in his selected group of patients but there is an impressive body of evidence that suggests inheritance plays an important part in schizophrenia, A recent editorial in the Lancet (4) reflects current thinking in this area. Dr. Will has emphasized the importance of psychotherapy in the treatment of schizophrenia. He has presented an excellent summary of socio-political factors that determine the form of treatment that will be provided for people suffering from disturbances labelled as psychiatric. I could not agree more with him when he says "in our society, they are a group of people who are not highly regarded despite some rhetoric to the contrary. In brief, we don't like them (psychiatric patients), particularily those who are psychotic and require long term care." On January 6, 1986 Newsweek magazine in a feature article The Chronic Mentally III observed "well meant reforms have shattered. our system for treating the chronic mentally ill and left thousands of them to scrape by in the streets." In chapter eight, Dr. Goldstein and Dr. Rodnick discuss the interaction of drug therapy and family treatment in schizophrenia. In chapter nine, Gerard Hogarty's article on drug and psychological treatment in the aftercare of schizophrenia, a research odyssey, was interesting. Through the life history of two fictitious characters, John and Mary, who suffer from chronic schizophrenia, he tried to review the current research findings of drug and social therapy in the treatment of schizophrenia. He compared the current situation with the days of alchemy, however he said "it was becoming clear from the work underway that one could stay on the tightrope of sanity and improve adjustment, as well, if the opportunity to learn slowly in a structured stimulus modulated environment was made available." In chapter 11 Dr. Gerald Sarwer-Foner gave an erudite and scholarly overview of combined psychopharmacology and psychotherapy. He said "in the treatment of schizophrenia, it behooves us to use all that is known about psychodynamics, life stresses and socially rehabilitative aspects of the disease as well as the action of neuroleptics since we do not have the specific pharmacological puritive agents. " Rehabilitation of schizophrenics demands a long term commitment to the individual patient. Dr. Sarwer-Foner pointed out that trained clinicians who know schizophrenia's clinical nature, its psychodynamic structure and the way it makes sufferers behave, know that schizophrenic patients attempt to minimize their own pain and use their character defenses and often their resulting lifestyle in this direction. However, we have to remember that about ten percent of schizophrenics need permanent nursing care and 35 % show long lasting mildly psychotic signs. About 35% of the patients appear cured or almost cured or a long period and 20 % are stable or cured for many years. Overall, the book is a valuable contribution to the field of psychopharmacology and psychotherapy. It would be especially valuable to eclectic clinicians. Some chapters can help medical students understand current thoughts on the relationship between psychotherapy and pharmacotherapy. I found this book to be an authoritative and useful survey of the rapidly developing field of psychotherapy and psychopharmacology of mental illness. Each chapter of the book has a bibliography and there are name and subject indexes. The printing is of the highest quality and the book is reasonably priced at $29.95.