It is possible that this lack of a broad psychological view point— this example chosen is far from isolated—is connected with a specific, and most definitely serious, defect in the book. The treatment of the psychoses is distinctly unsatisfactory. Apparently the author has had to rely on the literature for his preparatory experience and has been fortunate only in some cases, if we may judge by his references. The most satisfactory group he describes is that of the traumatic psychoses and there he follows Meyer's admirable study. On the other hand, in introducing the Dementia praecox group, he makes no specific mention of any one of the cardinal symptoms of disassociation or shallowness of affect, scattering of thought, and delusions or hallucinations. His nearest approach is when he says: "Variations in the way of excitement, with dullness and paranoidal excitement are seen during the course of the disease." This is followed by the description of a case which he says contains the symptoms typical of the psychosis but in which no pathognomic abnormality is mentioned except negativism— a vague term whose meaning varies with the observer.
Not unnaturally with such unfamiliarity, the psychosis is a "dispensation of Providence." There is no evidence that to him psychiatry is as much a problem of every day life as it is of institutional care of the insane. We can, therefore, find such a statement as this:
"The mental findings and the conduct determined the fact of aberration and that is all that should be necessary for immediate court purposes. Further business of diagnosis should be left to a psychopathic hospital."
It is true that responsibility may and should be evaded when the psychosis is full-blown; but how about the innumerable cases of incipient psychotic disturbance which grade over into the "mental conflicts?"
In harmony with this diffidence is the repeated hope for aid from the
Abderhalden. or some similar reaction. For instance:
"The newer methods of diagnosis of Dementia praecox we look forward to for help in one place where discrimination is important."
But surely a psychologist cannot hope to predict conduct by physical findings! If Dementia praecox postulated criminality, the situation might be different, but, as it stands, the reaction would only be of value in the doubtful cases— cases which are so many of them non-institutional.
With this vague conception of the psychoses it is not surprising to find that diagnosis used faute de mieux. For instance, in describing Case 169, of "pathological lying," he says:
"We could not in any way find evidence of mental peculiarity but we did question his story because of intrinsic improbability." Rather conflicting statements! Later on, he explains, the case was diagnosed as one of "epileptic psychosis" because the subject developed convulsions, although there is no evidence, or even claim, presented that the lying was an equivalent, or in any way correlated with the epilepsy except as a coincidence!
Such faults in a book of this sort are serious but only in so far as the work is theoretical. The main object of the book is to present facts in an unbiased way and for the first time we have them in anything like completeness. The importance of Dr. Healy's labors cannot, then, be overestimated. His publication will be eagerly welcomed by the army of workers who see a few cases at various stages of delinquency and who long to know authoritatively what the types are, how they develop, what the outlook is, and how that may be modified by appropriate treatment. We owe him much. JOHN T. MACCURDY.