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Karl Menninger and his associates, Martin Mayman and Paul Pruyser, show in a straightforward style how, through the centuries, the number of diagnostic categories has dwindled from thousands to a mere four or five. They propose at the very start of the book that “perhaps there is only one class of mental illness—namely mental illness.” But here their deceptive simplicity ends. As one proceeds through the remaining 400 and more pages, a concept of human nature emerges that for all its unitariness is as complex and many-layered as life itself. And this is as it should be.
Partly because of its multiple authorship, The Vital Balance is, in a sense, several books in one. It contains what probably is the most scholarly history of psychiatric classification. It introduces a novel method of diagnosing psychopathology by defining five levels of “dysfunction” ranging from “simple nervousness” to suicide—the ultimate negation of life, with the neuroses, impulse disorders, and psychoses occupying the intermediate positions; it presents an instinct theory of behavior from which it derives the astounding (and to this reviewer questionable) proposition that every symptom is an expression of man's basic destructive drive; it outlines a functional and comprehensive psychosocial approach to treatment which is firmly grounded on realities. It ends with an eloquent plea for social, political, and economic reform that rings penetratingly true. Underneath these several layers of the book, the reader soon discovers a curiously successful blend of many polarities. Book learning (“Caelius Aurelianus … translated into Latin some of the works of Soranus of Ephesus”) merges with down-to-earth Midwestern pragmatism (“Our concern is not so much what to call something as what to do about it”).