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Like the first edition of Eric Marcus's Psychosis and Near Psychosis, this revised second edition makes important theoretical and clinical contributions that risk being lost because of unfortunate problems in how they are presented. One of the book's strengths, but also one of its weaknesses, is the complexity of thought that has gone into it. This
complexity is impossible to do justice to in a brief review; unfortunately, it is also likely to frighten away all but those who are particularly interested in the subject matter or intrepidly desirous of understanding the many applications of psychoanalytic thought. The book is essentially an attempt to integrate psychoanalytic understanding with cognitive neuroscience and psychopharmacology in order to apply that integration to general psychiatric notions about psychotic and borderline conditions.
Such an ambitious agenda, not surprisingly, can be at once both laudable and problematic. For example, many (though not all) practicing psychoanalysts would agree with Marcus's thesis that nonbiological etiological models of psychosis have proven problematic. But his efforts to forge an integration between biological and psychological factors can at times be off-putting to nonmedical analysts. In his introduction he notes the failure of general psychiatry to consider psycho-dynamic factors and emphasizes how his integration “makes the general psychiatric categories of illness richer and more understandable to the treating physician” p. (xii). It seems unnecessary and surprisingly out of date in the current psychoanalytic era to cede psychopathology to the discipline of psychiatry or to assume that treating analysts will be physicians. Such an assumption risks antagonizing nonmedical analysts, who have seen the equation of psychoanalyst with physician disappear in our professional literature over the past forty years. There are many nonmedical analysts who treat sicker patients and work with psychiatrists who prescribe medicat