Book Reviews

Review of Psychopathology: Its Causes and Symptoms by F. Kräupl Taylor. Quartermaine, Sunbury-on-Thames, 1979.

Journal of Biosocial Science, 12, 1980, p. 239

   The late Sir Aubrey Lewis, at least at one stage in his teaching career, maitained that, as physiology was the foundation science for medicine, su was psychology for psychiatry. The doctrine seems to be infected by Cartesian dualism. Nevertheless it supplied a motivation for establishing, against formidable odds, a Department and a Chair in Psychology at the Institute of Psychiatry in the University of London. Since then under Professor Hans Eysenck the Department of Psychology has gone its own independent way, and has made but little attempt to exert its disciplinary influence on the teaching of psychiatry; it has had other and more far‑reaching interests. In the book under review, Dr Kräupl Taylor gives just over one page to factor analysis, and regards its contribution to psychiatric nosology as 'rather academic…, and not very helpful'. Such quantitative tests of temperament as the MMPI, the MPI and the EPI he does not mention at all.

   It was Lewis's inspiration that created the Institute of Psychiatry in the University of London, with its splendid lecture hall, library and laboratories. His influence was mainly in a wide range of population studies and social psychiatry. His approach to psychopathology was sceptical and philosophical; and he never created his own school of psychiatric, let alone psychopathological, teaching. However, it was during Lewis's reign that a number of clinicians joined the staff of the Maudsley Hospital and the Institute whose background was strongly influenced by Freudian psychoanalysis. Kräupl Taylor was unique among these teachers in enjoying a far wider range of learning than the routine dynamics of Freudian metapsychology. The avenues he opens out to his readers extend in every direction.  The main part of the place which Lewis wished to reserve for psychology has been taken up by the Allgemeine Psychopathologie of Karl Jaspers.

   This field of enquiry was the dominant and germinal element in German psychiatry of the years before the second world war. This was at a time when the great majority of patients suffering from serious psychiatric illnesses, the schizophrenics and the manic‑depressives, were beyond the reach of effective medical treatment. They were equally beyond the reach of help from any of the psychotherapies, whether Freudian or of any other school. They were desperately ill, and often desperately destructive. All that could be done for them was by way of support and protection. They would have been the despair of the psychiatrists, as well as of their relatives and themselves, if the doctors had not been able to find an absorbing emotional commitment, both of compassion and curiosity, in an enduring endeavour to understa:id. Just how and what was it in the mental processes of their patient that was going wrong? How did it begin? Where did it lead? How did it differ from the quirky or unreasonable ways of thinking of 'normal' people? What is 'normal'? Kräupl Taylor decides this must be read, not in an ideal but a statistical sense: normal for the individual and/or for the population. This sustained communal effort was the Verstehende Psychopathologie, the beginning and the foundation of present day clinical psychiatry. Perhaps Dr Kräupl Taylor does not give it quite sufficient credit. It was a moral salvation for the humane physician, providing him always with an urgent and important task. It was the insight of the psychiatrist into his own mental processes, and those of disturbed but not radically altered minds, to delimit the far flung fringes of what the normal mind can experience under stress and to mark off the boundaries of states in which pathological processes are involved. The systematic application of disciplined understanding led to a descriptive phenomenology which can itself be systematised.

   The whole of this aspect of a modern psychopathology is accommodated in Part II of Kräupl Taylor's book, that is in about 140 of its 305 pages of text‑the part devoted to descriptive psychopathologies, subclassifled into nine chapters on the psychopathology of perception, the psychology and the psychopathology of intellect, of affect, of mobility, of memory, of consciousness. This links with Part III, with three chapters on the psychopathology of trance states (very fine), the dynamic psychopathology and the descriptive psychopathology of hysterical symptoms. These two parts together cover the main area of interest to students of psychiatry and psychology, nurses and non‑specialist doctors. Part I provides the theoretical toundation on which all the rest is based. It relates clinical phenomena to psychoneural processes, to 'endopathological changes' in the 'interneural pool'. Such metaphysical terms are given an empirical justification: 'It is a plausible assumption that the functions of the interneural cerebral pool are related to the emergence of psychological functions... Psychoneural processes may manifest themselves in three distinct ways. In the first place they may reveal themselves through physiological changes in the body.. . The second mode of manifestation is through the behaviour of the organism as a whole... The third mode... is composed of events which can be directly observed only by the person in whose brain the psychoneural processes occur. He has a specially private and unique awareness of those processes'. In Part I, accordingly, the line of thought derives from neurophysiology (with an unspecified neurochemistry in the background). The concepts of cybernetics are called on for the understanding of behaviour; and the reports which the co‑operative subject can give about his internal experiences, though not objectively verifiable, permit us to 'understand' him in his own terms by relating those terms to the ones we apply to ourselves. All ths is a long way from a scientific psychological theory for the substructure of psychiatry for which Lewis hoped. Instead we are taken again and again into organic substructures in the discussion of aetiology, particularly, for instance, in the genetical causes to which Kräupl Taylor gives great attention. We find this developed at length in Part IV, 'Recent Developments,' which has five separate genetical chapters, as well as short chapters on what one means, or should mean, by the term 'disease', and a very curious lively chapter on pseudohallucinations.

   This book is chiefly remarkable for the great richness of its contents. There are no themes of considerable current interest to psychiatrists which the author does not take up and illuminate by a lucidity of description and analysis that never flags. There are also many borderline subjects which are touched on, to one's surprise and pleasure, such as the logical and conceptual status of mathematics, Boolean algebra, psychokinesis, the Jumpers, Luria's work on hypermnesia, the need for abundant redundancy of information in communication, the section on pseudo­hallucinations, and many others. The account of sleep and the psychopathology of consciousness is outtanding. The section on emotional psychopathy, in which a great deal too much space is allowed to the primitive and unhelpful formulations of the law, is, on the other hand, disappointing. The aetiology, the clinical features and the life histories of psychopathic personalities are of profound theoretical and practical importance, and have been rather skimped.

   The first edition of this Psychopathology was published in 1969; it is, unfortunately, unknown to the reviewer. This, the second revised edition, is a powerful work of exposition and should have the widest possible circulation.