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Dr. Sperling's expertise in the psychodynamics of psychosomatic disturbance is well known. She has been an especially strong contributor to our understanding of dynamics in ulcerative colitis and migraine. This current paper extends her psychodynamic hypothesis about migraine into a profound but difficult conceptual arena—namely that of instinctual theory. She uses the concept of the death instinct as a central explanatory theme. Herbert Marcuse and N. O. Brown, among many others, have taken up the issue of the death instinct in their extensive critiques of Freudian theory. There is surely no need to belabor the controversy here except to indicate that correlation of patients' behavior and symptoms as “indications of the acuteness and intensity of the struggle between the life and death instincts” will strike many readers as gratuitous and probably even somewhat anachronistic. For many of our colleagues in sociology, philosophy, and psychology, the concept of a death instinct is thought of more as a psychoanalytic relic than a viable theoretical construct.
Abraham Myerson once said that the truth of a belief and its usefulness usually have nothing to do with one another. Thus for those to whom the concept of death instinct is not “indispensable for theoretical and clinical orientation in work with patients in whom self-destructive tendencies are an outstanding pathological feature,” Dr. Sperling's discussion assumes an eerie quality of conjecture. This is unfortunate since it obscures the real constructive value of her contribution—namely interweaving of well documented emotional components into the fabric of the migraine syndrome. This perspective is most important with regard to therapy.