Psychosis and Near Psychosis: Ego Function, Symbol Structure, Treatment, by Eric Marcus, M.D.,  Springer-Verlag, New York, 1992 Reviewed by Martin S. Willick, M.D.

Eric Marcus has written an important book. It is, to my knowledge, the first book by a psychoanalyst that tries to integrate recent advances in the neurobiology of psychotic, and what Marcus calls, near psychotic, illnesses with psychoanalytic theories of psychopathology. He believes that “a psychoanalytically based approach to an integrated treatment of psychosis and near psychosis can now be achieved which organizes psychotherapy, medication, and hospital and milieu interventions into a powerful therapeutic tool” (pp. xvii-xviii).

In recent papers, I emphasize that it is absolutely necessary for psychoanalysts to achieve such an integration. Without it we cannot maintain a credible position within the psychiatric community either in furthering the understanding of severe mental illnesses or in making a contribution to their effective treatment. In these papers (Willick, 1990, 1993) I criticize psychoanalytic formulations that emphasize psychogenic developmental factors in the etiology of schizophrenia and manic-depressive illness. I state that there is now sufficient evidence to believe that genetic and biological abnormalities are the primary causes of these disorders. I express the hope that psychoanalysts, who have to a large extent lost interest in the psycho-pathology of psychosis, will once again turn their attention to these illnesses, informed by the new neurobiological findings.

Now, Eric Marcus, who has worked with severely mentally ill patients both in and out of hospitals, has made a major contribution to this endeavor by encouraging psychoanalysts to return to the study and treatment of the psychoses. In his own words:

This book describes advances in descriptive theory and their integrative use in treatment by explaining the structure of psychotic and near psychotic states, the effect of psychiatric illnesses on that structure, the effect of medication on that structure, and the changes in technique of psychoanalytic psychotherapy and psychoanalysis mand