Psychopathology

THE juxtaposition of Karl A. Menninger’sMan against Himself (Harcourt, Brace, $3.75) and Matthew N. Chappell’sIn the Name of Common Sense (Macmillan, $2.00) is purely fortuitous. It would be unfair to essay a comparison between these authors and their work. Dr. Menninger is a physician, an experienced clinician, and a gifted psychiatrist; Dr. Chappell is a Ph.D. with no clinical background and no medicopsychological experience. In the Name of Common Sense is as presumptuous as its title: most complex psychopathological problems are here simplified to the extent that their true meaning becomes as tenuous as the argument is desultory. As if surprised at some of his own conclusions, the author exclaims: ’It is as simple as that!’
Some traditions die frightfully hard; to-day it is persistently assumed in certain quarters that a neurosis is a matter of common sense gone astray — the mediæval scholars assumed that it was a matter of will gone astray. This point of view is as scientific as it would be to say that a solar eclipse is due to the sun frowning on the sins of mankind. Common sense is not a definite, immutable thing — not any more than political justice.
The will to believe is very potent in these matters. What Dr. Chappell wishes us to believe is that without any medical knowledge and with a little uncritical reading of various books one can learn to treat the mentally ill. The illnesses he chooses to discuss he bunches together under the neologistic title ’Worriers’; among these ‘worriers,’ a moderately experienced psychiatrist would easily recognize a variety of psychopathological conditions which are far removed from each other. These various clinical groups require different medicopsychological approaches and different management — but there is little clinical discernment to be found in Dr. Chappell’s pages.
As a practising psychiatrist I can only express my persistent hope that the enlightenment of the general public will continue to grow so as to make it unprofitable and even undesirable to publish books which neither promote a better understanding of neurotic reactions nor increase the sense of responsibility for the management and treatment of the neurotic individual. It is not ‘as simple as that.’
In view of the above, such books as Man against Himself are doubly welcome. Here is a serious contribution to medical journalism, a convincing exposé of the depth into which current psychiatric investigation is delving by means of therapeutic endeavors. The basic idea expressed in Dr. Menninger’s book is both sound and clinically demonstrable: man is the bearer of a number of destructive drives which he turns against himself.
The clinical illustrations cited from the author’s vast experience are apt, poignant, and very telling; whatever his theoretical predilections (many of them are debatable), his empirical, clinical data are of indisputable value. They demonstrate how little our purely intellectual activity, our so-called common sense, has to do with many human ills; they leave no doubt, for instance, that the urge to commit suicide does not always connote a wish to die and that to kill one’s self and to be killed does not always mean (to the victim) complete self-annihilation. There is orderliness, a sequential play of instinctual forces; there is a system of psychobiological laws in man’s propensity to disease and his ever-present proclivity to hurt himself. There is keen natural method in one’s madness. The better this basic truth is understood, the less confidence will be placed in such metaphysical concepts as will and common sense, which have never cured a single illness.
The book is written with dramatic élan and true brilliance. Unfortunately one is inclined to question the wisdom of its construction. Menninger’s point of departure is the assumption that there is a death instinct. He then proceeds to find its manifestations in suicide, in some physical illnesses (‘focal suicide’ he calls them), in the tendency to be repeatedly operated on, which he calls ‘polysurgery’ (years ago the German psychiatry more aptly called it Opera-tionssucht — addiction to be operated on), and in some antisocial behavior. Menninger’s method is obviously deductive; this is not in accordance with the most scientific medical tradition, which is properly empirical and inductive. Moreover, it is a little dangerous to postulate the existence of new, independent instincts; traditional psychology of the Middle Ages and the seventeenth century and even of later days floundered just because of this tendency.
The part on various techniques of dealing with the problem of our self-destructive drives is either too simplified or too general, or both. It is apt to be rather confusing to the average reader and inconclusive to the professional. One might say in a general way that the exposition of medicopsychological techniques is of no greater usefulness than that of surgical techniques; the beginner will have to learn by practice under the guidance of the experienced performer, while the uninitiated will derive little benefit from the description, which is of necessity too abstract.
But despite this and certain minor lapses, the book is stimulating. It represents an interesting effort to discuss lucidly a subject which is recondite and so thoroughly misunderstood by the majority of intelligent readers.
GREGORY ZILBOORG, M.D.