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Eder, M.D. (1925). The Nervous Patient: By Millais Culpin, M.D. (Lond.), F.R.C.S. (Eng.). (H. K. Lewis & Co., London. Pp. viii. + 305. Price 10 s. 6 d.). Int. J. Psycho-Anal., 6:351-352.

(1925). International Journal of Psycho-Analysis, 6:351-352

The Nervous Patient: By Millais Culpin, M.D. (Lond.), F.R.C.S. (Eng.). (H. K. Lewis & Co., London. Pp. viii. + 305. Price 10 s. 6 d.)

Review by:
M. D. Eder

Protean are the disguises assumed by the manifestations of any mental disorder; the unmasking of these disguises, the diagnosis of the patient's illness, requires more than ordinary acumen and care on the doctor's part; it demands some understanding of the workings of the unconscious; a recognition that to label a sufferer as a neurasthenic and the prescription of a rest-cure do not comprise the whole are and science of psycho-therapy. Appreciating the difficulties of the practitioner in diagnosing a psychoneurosis in the possible absence of obvious nervous symptoms, for the patient 'may have most disabling phobias, but will state them in terms of popular cardiology: he cannot go on a tube, train or in a crowd because it affects his heart', Dr. Culpin has succeeded in his task of lessening these diagnostic difficulties. It is no doubt altogether unwarrantable to mistake a case of differentiated sclerosis for hysteria, but it seems at first sight a little odd why the inverse error should be almost accounted as a virtue; anyway those aspiring to this kind of virtue must eschew Dr. Culpin's book, for he puts his points with commendable crispness, clearness and in technical language. Whilst quite emphatic as to the disguises assumed by the sufferer from an anxiety state, Dr. Culpin abandons something of his usual caution when he claims that it is diagnostic of an obsession that the patient 'knows its unreality and feels that it is derived from something apart from his real self'. In a number of persons with obsessional neurosis there is no such insight; such patients may use words implying something of the kind—'awfully silly, I know', 'quite futile', but these words arise from a superficial rationalization which soon breaks down.

Dr. Culpin is very properly much concerned with our nomenclature, which is certainly unhappy; the term neurasthenia seems fortunately to be succumbing to the onslaughts of the last twenty years. The author proposes to replace psycho-neurosis by minor psychosis. Psycho-neurosis is etymologically as objectionable as Dr. Culpin makes it, but its etymology is blanketed by now and the literature seems to have given the term a sufficiently clear connotation.

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