The author is dismayed by the failure of the existential viewpoint to pervade American psychiatry. In order to demonstrate the similarities and differences between the psychoanalytic and existential approaches, he presents the case of a woman seen four times weekly for six months. The existentialist uses psychoanalytic concepts and interpretations but these are peripheral and preliminary to the core problem of helping the patient accept the inevitability of anxiety

and the need for making decisions. 'In freudian theory, anxiety means that something is wrong. It is a danger signal that defense mechanisms are failing. The mechanical apparatus of the brain is somewhere lacking. The freudian regards anxiety as a sickness that has to be treated until the apparatus of the brain has repaired the breaks in the defense system. The existentialist, in contrast, accepts anxiety as a basic problem of human existence.' In spite of the paper's obvious shortcomings, it is one of the best clinical presentations of 'existential psychiatry' to be published in an American journal.