Psychosis and near Psychosis: Ego Function, Symbol Structure, Treatment,1 by Eric R. Marcus

This book is full of brilliant observations, distinctions, and clarifications about how to better treat two difficult mental conditions with psychoanalytic methods: the psychoses, and what the author calls the near psychoses—a range of subtle disturbances that include, among other symptomatology, borderline phenomena and pseudodelusions. The author also has important observations about patients with “different” wiring, including those with learning disabilities and Attention Deficit Disorder. It is not an easy book, but rather one to be studied; for the most part, the difficulties it presents lie in the fact that it is one of the most probing books on psychosis ever written by anyone in any field, and one of the most important books in psychoanalysis in the last fifty years—a true classic.

Analysts have made important theoretical errors in thinking about psychosis in the past, leading some in the field to swing away from Freud's cautions and toward an overly keen furor therapeuticus— and, when that failed, to delegate its treatment to biological psychiatrists. This is unfortunate because, as Marcus shows, modified psychoanalytic treatments have a significant amount to offer patients with such conditions; new medications can actually repair or ameliorate damaged ego functions, so that some psychotic patients can now benefit from psychoanalytic approaches as never before. The irony is that medication, properly used, can actually widen the scope of psychoanalytic practice rather than narrow it, as many have feared.