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In this two-volume work John Frosch undertakes the ambitious task of laying out the psychodynamic foundation of general psychiatry. Volume I is devoted largely to defining principles of psychodynamic formulation. The end of Volume I and all of Volume II present a survey of psychiatric clinical disorders and attempt to explicate the psychodynamic factors essential to each. In this era of descriptive psychiatry, when psychodynamic theory and practice are commonly devalued in residency training, this work is a landmark attempt to fill an important need: to salvage the skills and wisdom necessary to understand and treat the whole patient.
There are many high points in these two volumes and there are also some problems. Probably the richest element of the two volumes is Frosch's ability to present excellent critical and synthetic reviews of the history of psychoanalytic theory and practice. A wonderful example is his chapter on character disorders. The DSM-III-R definition of personality traits is contrasted with the evolution of the concept of character in psychoanalytic thinking. (Frosch elects to use the terms "personality" and "character" interchangeably.) One recognizes, on reading this lucid, thorough, discerning synthesis, that the author was an active participant in the unfolding of theory and practice.
Clinical vignettes are another extremely valuable aspect of the work. One becomes acquainted with several of Frosch's patients if one reads straight through because some of them are used several times to make relevant points. The "pigeon lady" (my term) serves as an elegant example of phobic behavior in Volume I (p. 346) and as an example of zoophilia in Volume II (p. 603). Pearls of clinical wisdom, such as the association of severe obsessive-compulsive symptomatology in latency with schizophrenia at a later age (p. 357), are also plentiful. They enrich our knowledge of the phenomenology of mental illness and they can be filed away for future use.
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