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This book represents a synthesis of the author's studies on persistent enuresis, juvenile delinquency, and psychopathic personality published over eighteen years. He was impressed by the high incidence of enuresis among juvenile delinquents persisting beyond the age of twelve. The book reflects the changes in his assessment of the problem, in which he became interested in 1932. He regards persistent enuresis as a psychosomatic symptom of a biopsycho-social nature. He has found a strong indication for a constitutional factor apart from the triad of maleness, persistent enuresis, and psychopathic personality. He delimits a specific impulsive type of juvenile delinquents; their personality structure appears to lack maturity, the main characteristics being impulsiveness and selective lack of control. There are disturbances of object relations resulting from early unstable identifications. The ego is weak and has a low tolerance for anxiety. Superego formation is defective. Persistent enuresis in the juvenile delinquent indicates an unchanged perpetuation of an original urethral impulse influencing character formation. It reflects 'sphincter immorality' and foreshadows social immorality. The author stresses the need for closer studies of the significance of the urethral zone for character formation. Tentatively he expresses the view that impulsiveness as related to the urethral zone might form a counterpart to compulsiveness associated with the anal zone.
In elaborating the concept of persistent enuresis as a disorder of character Dr. Michaels suggests enlarging larging Freud's 'libidinal types' to include an 'impulsive character'. The inclusion of such a type would pay attention to the urethral zone and allow for the 'psychopathic personality' of clinical psychiatry being psycho-analytically characterized as the impulsive, urethrally rooted character type.
This is a most important comprehensive study of conditions very much in need of exploration. Everybody