Estrangement and Relationship

THE existentialist approach to psychiatric problems has gained considerable popularity amongst some groups of European psychiatrists, notably in Western Germany, France, Spain and Italy. In Britain and America the few papers that have appeared on this topic have not always been enthusiastic. The problems of psychiatry and psychology are slowly being formulated in ways that lend themselves to the scientific approach and to begin afresh to re-formulate them in existentialist terms does not seem to be a profitable exercise to most psychiatrists. This does not mean that the existentialist approach is considered to be invalid; rather that it cannot be readily studied by methods at present available. The present book is a review and shortened version of a Ph.D. thesis. It is an attempt to link clinical psychiatry and theology by building a bridge from the latter to the former. The author has intensively studied a number of schizophrenic patients, and liberally quotes from group sessions to provide the background for an existentialist interpretation of schizophrenia, viz.-estrangement (an accumulating loss of confirmation of being-in-theworld), existence-at-a-distance, decisionless state and loss of the determining Centre (which gives meaning and coherence to the fundamental structures of being). Such terms can be applied to the effects of schizophrenia on the relationships of the individual to his environment, but not so readily as an explanation for its causation. There is much that is relevant in this book for all who strive to maintain the schizophrenic patients' contact with reality. Perhaps it is best summed up by the quotation from Tillich on p. 187: "Participation is essential for the individual, not accidental. No individual exists without participation, and no personal being exists without communal being". It is the reviewer's opinion that this book has much to say that is not confined within the limits of Existentialist Philosophy. It is possible that it may eventually reach a growing audience as clergy-doctor co-operation increases. J.G.G.