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Willick, M.S. (1994). Psychosis and Near Psychosis: Ego Function, Symbol Structure, Treatment: By Eric Marcus. New York: Springer-Verlag. 1992. Pp. 322.. Int. J. Psycho-Anal., 75:632-634.

(1994). International Journal of Psycho-Analysis, 75:632-634

Psychosis and Near Psychosis: Ego Function, Symbol Structure, Treatment: By Eric Marcus. New York: Springer-Verlag. 1992. Pp. 322.

Review by:
Martin S. Willick

It has become apparent over the last few decades that the treatment of the various psychoses, especially the more serious and chronic types, has been taken over by psychiatrists and other mental-health professionals who do not use psychoanalytic techniques as the primary mode of treatment. Psycho-pharmacological interventions have been repeatedly shown to be vitally important in the treatment of schizophrenia, manic-depressive illness and severe depression. In addition, psychosocial interventions and rehabilitation strategies, both of which include the active participation of family members, have also been demonstrated to be useful. Nevertheless, there are some analysts who now are willing to integrate these two approaches with a traditional dynamic point of view in order to conduct more comprehensive and effective treatments. Until now, however, psychoanalysts have not written a great deal about such an integration.

Eric Marcus's book appears to be the first book by a psychoanalyst that tries to integrate recent advances in the neurobiology of psychotic, and what Marcus calls 'near psychotic' illnesses with psychoanalytic theories of psychopathology. He believes that 'a pychoanalytically based approach to an integrated treatment of psychosis and near psychosis can now be achieved which organizes psychotherapy, medication, and hospital and milieu interventions into a powerful therapeutic tool' (pp. xvii-xviii).

In two recent papers (1990), (1993), I emphasised that it is absolutely necessary for psychoanalysts to achieve such an integration. Without it we cannot maintain a credible position within the psychiatric community, either in furthering the understanding of severe mental illnesses or in making a contribution to their effective treatment. In these papers I criticised psychoanalytic formulations that emphasise psychogenic developmental factors in the aetiology of schizophrenia and manic-depressive illness. I stated that there is now sufficient evidence to believe that genetic and biological abnormalities are the primary causes of these disorders.

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