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This reviewer had a very mixed reaction to Freeman's book, which reports on a senior psychoanalyst's work with seriously ill, hospitalized
psychotic patients. The first half dozen chapters provide detailed descriptive material on the symptoms, primarily delusions and fantasies, of psychotics, together with some low-level clinical explanations of them. The remainder is a relatively brief miscellany of specialized chapters on organic mental states, developmental considerations, and the theory of neurotics, borderlines, and psychotics. They are less integrated than the first six chapters and seem almost deliberately minimal in their exploration of essential issues. But the writing is clear, well focused, free of jargon, and easy to read.
Freeman thinks reductionistically about psychopathology, although his ideas are internally consistent. His therapeutic approach tends to be parsimonious and low key, but somewhat categorical and abstract with respect to the content of interpretations. He uses a classical approach of facilitating regression to encourage a transference neurosis that can be examined and resolved. His ultimate aim is more than symptom relief; he attempts to reinstitute derailed libidinal development.
Freeman traces psychotic symptoms to vicissitudes in the development of the libidinal instinct, especially the oedipal experience. Thus, fantasies (and "actual" events) involving incest, castration anxiety, penis envy, primal scene phenomena, and other universals become the ultimate basis for explaining the steps that lead to a psychotic breakdown. The immediate precipitants of the breakdown are described, with but passing reference to vulnerable character flaws or unfavorable life circumstances. But the "final common pathway" for psychopathology remains unfavorable developments involving the oedipus complex.
Freeman states, in the Introduction: "Other benefits are to be gained by moving from the neurotic patient to the psychotic patient and vice ver