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This book consists of seventeen papers, with discussions, the proceedings of the 1951 annual meeting of the American Psychopathological Association. The psychoanalyst, who shares with the psychiatrist an interest in the etiology and diagnosis of mental disorder, may well feel that only lip service has been paid to the editors' reiterated emphasis on the value of etiological rather than phenomenological diagnosis, and on careful clinical observation. The trend (noted in Stainbrook's historical review) to abandon monistic etiological theories in favor of theories of 'meaningful interaction' and 'multiple causation' has often seemed to deny the complexity of the problems, and lead to oversimplification. The resulting eclecticism does not answer the question 'What interacts?' (as Hoch points out in his discussion), and evades rather than employs Freud's discoveries of the etiological role of instincts. The statistical studies of the accuracy of diagnosis (Hunt, Wittson and Hunt) and prognosis (Clow, Rennie) show little recognition of the necessity for painstaking observation of the individual patient's behavior. Instead of intense, sustained curiosity into human motives, there seems always to be a pressure toward quick disposition of problems.
Diethelm's suggestion of discarding the concept of 'psychosis' as fallacious and leading to loose thinking seems unlikely to abolish the loose thinking. A borderline, however broad, must be drawn somewhere between neurosis and psychosis to facilitate communication without doing injustice to our knowledge of ego psychology. Borderline conditions receive no attention in this volume.
Rennie, in his twenty-year follow-up by letter or interview of discharged hospital patients, finds confirmation of the well-known fact that clinical symptoms change as the patient's external and internal conditions change, and as a result diagnoses shift about within the psychoneuroses and across the boundary of psychosis. He concludes that neuros