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Over the years Arthur Epstein has brought to our attention a thoughtful integration of neurology and psychoanalysis, particularly with regard to the
nature of dreaming. In the current volume he has cast a wider net and has attempted to highlight the common neurophysiological thread linking the manifestations of obligatory mentation in nominal aphasia, epilepsy (in its manifest and latent forms), dreams, fetishism, phobias, and obsessive-compulsive disorder. In this slender volume he has offered a reminder that all is not psychological as he spells out the way the brain, as the substrate of consciousness, exerts a determining influence on the way mentation arises in each of these states. His argument is most cogent in his consideration of the various clinical syndromes he describes. I will consider its application to dreams separately.
The common thread in each of the circumstances noted is the appearance of imperative ideas. Mentation in this form is subserved by neuronal networks which, under certain conditions, reach a state of excitation leading to “neuronal excessive discharge” and a resultant dominance. Ontogenetic influences leading to this include the encoding of an earlier catastrophic event. “In childhood particularly an event is more likely to be significantly arousing, and acting on brain tissue of some immaturity, memory of the event achieves vividness and may develop into an imperative idea” (p. 139). The author believes this is particularly true of phobic and fetishistic ideas. I found his discussion of both of these syndromes a needed counterpoint to the many different psychodynamic theoretical formulations offered to account for them. Epstein believes, and I think rightly so, that genetic factors based on phylogenetic influences are also involved.
The phylogenetic influence is drawn from the nature of temporolimbic seizure content and from typical dream content. This content indicates a primacy of survival concerns; concerns of meeting external physi