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Braasch, L.K. (1990). Integration and Self-Healing: Affect—Trauma—Alexithymia: By Henry Krystal, M.D., with a contribution by John H. Krystal, M.D. Hillsdale, NJ: The Analytic Press, 1988. 383 pp.. Psychoanal Q., 59:157-159.

(1990). Psychoanalytic Quarterly, 59:157-159

Integration and Self-Healing: Affect—Trauma—Alexithymia: By Henry Krystal, M.D., with a contribution by John H. Krystal, M.D. Hillsdale, NJ: The Analytic Press, 1988. 383 pp.

Review by:
Lesley K. Braasch

If reading a book is like traveling down a road, with the author as your guide to a destination that he knows and you are to discover, then the journey through this book is analogous to a road with varying surfaces and many detours. Our vehicle is the author's prose. Krystal's prose at times resembles a fine machine, smooth and well-functioning, but at other times we are traveling in an Edsel. Detours on a trip of discovery are not always to be discouraged. However, many of them in this text distract and detract from Krystal's stated purposes and destinations. If the reader can overlook the potholes, unimproved pavement, and poorly banked turns, she or he will be enriched by the intermittently smooth asphalt and beautiful vistas.

Krystal contends that in order to understand and treat difficult patients, psychoanalysts must go beyond issues of phallic identification to identification with the preoedipal mothering parent and issues of self-regulation. He sees the recognition of alexithymia as the key element for facilitating integration and self-healing:

Alexithymic patients' impaired ability to utilize emotions as signals to themselves is based on the "form" that their emotional responses take. The reactions are basically somatic, consisting of the "expressive" or physiological aspect of affects with minimal verbalization. In addition, their emotions are often undifferentiated; they are vague and unspecific … (p. 243).

Alexithymia is observable, to varying degrees and intensity, in many psychosomatic patients, addictive patients, and patients in severe post-traumatic states. For Krystal, the understanding of alexithymia grows out of the study of the development of affects and psychic trauma.

The book is divided into three sections. The consistency of organization within these sections is variable. Part 1, "Emotions," is by far the most cohesive section. Particularly readable are Chapters 2, 3, 4, and 7. In part 2, "Trauma," only Chapter 9 can be highly recommended. Part 3, "Alexithymia and Post-Traumatic States," is disturbingly unclear and poorly organized.

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