Personality and Mental Illness
An Essay in Psychiatric Diagnosis
- Type:
Book Reviews :Author: By Dr John
Bowlby. Kegan Paul. Pp. 280. 10s. 6d.
It is not easy to give a fair and adequate survey of this book within the compass of a short review. It embodies an ambitious attempt to endow concepts of mental illness with accuracy and precision. It also illustrates the more independent attitude adopted by some of the younger members of the psycho-analytical school.
The author takes as the two basic personality types the Schizoid and the Syntonic, and when one or other is involved in mental illness, he holds that the psychic mechanisms employed will differ. But for a proper diagnosis, he postulates that there are four general questions that will need to be considered: A, the genetic type as above; B, the personality sub-type of which he mentions eleven varieties; C, the degree of stability; D, the present state and how it developed.
His first approach to the patient will not be, is he normal neurotic or psychotic, but is he a Schizoid who is normal, neurotic or psychotic, or is he a Syntone who is normal neurotic or psychotic ? And he goes on to say:
” I am not chiefly concerned to prove that the psychoneuroses and psychoses are indivi- sible, but to demonstrate the relation of particular types of neurosis to particular psychoses.”
And again, the patient ” must be thought of as an individual of certain potentialities, a unity of which the particular traits and symptoms shown at any one time are but fleeting expressions”. In fact, the reader would not be surprised to hear that the Life Style was of more significance than the Oedipus Complex.
The book is mainly a study of 65 patients. These were diagnosed in accordance with con- ventional psychiatric practice, and orthodox labels were attached. In all cases?and this is, of course, important?the diagnosis was attested by competent judges. There were 36 Psychotics and 29 Psychoneurotics in the series. Of the Psychotics, 32 were seen at the Maudsley Hospital and 4 in the Department of Psycho- logical Medicine at University College Hospital. The supply of Psychoneurotics was drawn presumably from the same sources. In a few instances the differential diagnosis was doubtful. The subsequent histories of these cases are recorded.
Each patient was then analysed according to the presence or absence of 105 different traits. These traits were first grouped as follows: Work and Interests, 22. Social Relations, 19. Attitute to Authority, 10. Attitude to Family, 3. Mood, 16. Temper, 9. Sex, 7. Habits and Obsessions, 12. Health, 7. In the tables that show the results of the investigation, the traits are arranged differently. First come 33 classified as Schizoid?then 45 Non-specific (Depressive) and 27 Non-specific (Hyperthymic). The ” credentials ” of these traits are discussed in the two Appendices which together constitute about one-quarter of the book.
The author adopts a reasonably detached attitude to the whole research. When 5 or more of the first 33 traits are present, ” the likelihood of that person being Schizoid I believe to be enormous “. Actually 8 of these traits were not found at all in any of the 13 Schizophrenics investigated, and less than 5 traits were present in 3 of them. On the other hand, in one of the Syntones (a Depressive), 6 of the Schizoid traits were found. Again among the Schizophrenics, there were only 10 of the 72 Non-specific traits that were not found in one or another.
Normal individuals do not apparently respond to this form of personality analysis or, at any rate, to the traits here selected, as their tendencies are not usually sufficiently exaggerated. So Psychoneurotics were analysed partly to assess their personality grouping, and partly to serve as controls and comparisons. They were labelled: Anxiety States and Neurasthenia, 7; Conversion Hysteria, 11; Obsessional Neurosis, 5; Hysterical and Psychopathic Personalities, 3 each.
Ten of the 29 Psychoneurotics qualified as Schizoids with 6 or more Specific traits. These were distributed among all forms, the lowest proportion being among those in the Anxiety State and Conversion Hysteria groups. Here conversely the Non-specific, i.e. Syntonic traits were much in evidence. Some of the conclusions arrived at are briefly:
” Anxiety States and Neurasthenia are believed usually to be mild forms of the Affective Psychosis.”
” Hysterical and Psychopathic Personalities are usually Schizoid.” . ” Conversion symptoms and Obsessiona symptoms may appear in either Schizoid or Syntonic Personality.”
” In all cases of sexual, neurotic or persona- lity disorders, it is believed that it is of ‘a more value to diagnose to which main typ and sub-type of personality the patien belongs, than to try and settle the diagnosi between the traditional groups, anxiety state, hysteria, obsessional neurosis, psychopathic personality, etc.”
For the rest, the book itself should be studied? not to try out a stereotyped and mechanical form of diagnosis, but just to consider the suggestions and ideas put forward in sober language free of the jargon of any particular school of psychological thought. H.C.S.
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