LETfERS TO THE EDITOR

ble, task. However, whether this hypothetical patient is stuck its of any theory, as Beahns demonstrated so clearly in Limits
in a symbiotic stage or a practicing stage is not simply a ofScientific Psychiatry
(2), only makes the theory more use-
matter of theoretical interest. It has significance for how we ful. Strengths and weaknesses, it seems to me (3), are often
would structure separations and what tasks we might assign two sides of the same M#{246}bius strip; or is it the same side?
to prompt further development, albeit with appropriate cau-
tions to avoid a sense of failure in the patient or the treat-
ment team. REFERENCES
We are no closer to a unified theory in psychiatry than we 1. Hamilton NG, Ponzoha CA, Cutler DL, et al: Social networks
are in physics. It would be foolish to ignore the contributions and negative versus positive symptoms of schizophrenia.
of biological, psychological, and social psychiatry. It would Schizophr Bull 1989; 15:625-633
be a hindrance to treat the variety of patients and conditions 2. Beahrs JO: Limits of Scientific Psychiatry. New York, Brunner/
with only one view of development. I’d bet that Dr. Hamil- Mazel, 1982
ton integrates more than is readily obvious from this one 3. Hamilton NG: Self and Others: Object Relations Theory in
article. I certainly plan to read his book Self and Others to Practice. Northvale, NJ, Jason Aronson, 1988, p 107
find out.
N. GREGORY HAMILTON, M.D.
Portland, Ore.
REFERENCE

1. Hamilton NG: A critical review of object relations theory. Am

J Psychiatry 1989; 146:1552-1560 Janet and Psychological Trauma

SIR: Bessel A. van den Kolk, M.D., and Onno van der
JAMES ALPERT, M.D.
Albany, N.Y.
Hart, Ph.D., deserve our appreciation for their erudite review
of Janet’s investigations into the mental processes that trans-
SIR: Dr. Hamilton states that object relations theory is form traumatic experiences into psychopathology (1). It
“not a complete psychology for general psychiatry,” imply- seems to me, however, that their association ofJanet’s think-
ing that a complete psychology is within the realm of possi- ing with posttraumatic stress disorder (PTSD) is labored.
bilities. In 1931 Kurt G#{246}delpublished his incompleteness J anet was concerned with early life trauma only subcon-
theorem, which proved that no axiomatic system whatsoever sciously retained. PTSD relates to more recent near catastrophe.
could be complete unless it were an inconsistent one (1). Dr. It is all too vigorously remembered with conscious and shock-
Hamilton is trapped in an intellectual M#{246}bius strip if he ing clarity in the contemporary atmosphere of entitlement.
continues to hope for and compare psychological models to
a forever nonexistent “complete psychology.”
REFERENCE

1. van der Kolk BA, van der Hart 0: Pierre Janet and the break-
REFERENCE
down of adaptation in psychological trauma. Am J Psychiatry
1. Hofstadter D: G#{246}del,Escher, Bach: An Eternal Golden Braid. 1989; 146:1530-1540
New York, Vintage Books, 1980
JOSEPH D. SULLIVAN, M.D.
STEVEN A. ORNISH, M.D. New York, N.Y.
San Diego, Calif.

Dr. van der KoIk and Dr. van der Hart Reply
Dr. Hamilton Replies
SIR: To readers familiar only with Janet’s translated works
SIR: I thank Dr. Alpert for his astute comments. He sug- on hysteria, such as The Major Symptoms ofHysteria (1), it
gests that it may not be a weakness of object relations the- might appear that Janet was mainly interested in “early life
ones that cognitive and perceptual-motor factors have been trauma only subconsciously retained,” as he identified trau-
relatively ignored. He goes on to state that assessment of ego matic childhood events at the origins of that disorder. How-
functions is part of a thorough assessment by psychiatrists ever, throughout his work, Janet extensively described adults
influenced by these theories. He clearly indicates how knowl- with acute traumatic reactions. Space allows just a few ex-
edge of self-other relatedness can help clinicians structure the amples of Janet’s cases that described adults with posttrau-
world around such impaired individuals to their benefit. matic psychopathology: Madame D. (2), who developed am-
I entirely agree with his clinical point and hope that more nesia after being the victim of a practical joke in which she
authors will write down and publish their thoughts about was told that her husband had died and that his corpse
how to help brain-impaired individuals manage and cope would arrive shortly at hen home; Achille, who developed a
with their internal and external relationships. For example, hysterical psychosis after an illicit affair in which he thought
this set of understandings may have much to offer those who he had caught an incurable venereal disease; and Irene (3),
work with persons considered to have chronic mental ill- who developed amnesia and behavioral reenactments of
nesses on, more specifically, negative symptoms of schizo- deathbed scenes after the traumatic death of her mother.
phrenia (1). Other examples of patients with PTSD-like symptoms after
Dr. Onnish’s comments are based on the assumption that adult trauma include the cases of Vof, Bre (4), and Nicole.
to state that something is not complete implies that it should Dr. Sullivan’s assertion that “recent near catastrophe . . . is

or could be complete. I did not intend any such thing; quite all too vigorously remembered . . . in the contemporary at-
the contrary. Object relations theory’s strengths can only be mosphere of entitlement” ignores Janet’s own tribute to his
appreciated in light of its limitations. Recognition of the lim- predecessors, cited in our article: “All the famous moralists

962 Am J Psychiatry 147:7, July 1990