138 CORRESPONDENCE

I wrote last time on the basis of over nine years' as a human being. We have to avoid such a situation
work in the industrial North of England—very in Britain by ensuring that academic medicine in
different from Dr. Mawson's sheltered workshop general is firmly anchored in community needs.
conditions. At this moment, I am the only psychiatrist I believe that this should involve, amongst other
for an island with more than ioo,ooo people; there things, a greater respect for the therapeutic openings
has rarely been a trained psychiatrist here in the which are made by practising clinicians, such as
past, and none for at least two years. There are Dr. Kelly and his colleagues.
many urgent problems of psychiatric morbidity I agree, of course, with the quotation from Sir
in this area, but the most inescapable is that of Denis Hill and wish that more evidence of such
schizophrenia. It seems as plain as a pikestaff to ‘¿partnership'came from the university departments
me that in a situation like this, where primary themselves.
medical care and social services are almost non HUGH FREEMAN.
existent, the best way to help these people is to get General Hospital,
nurses to give them regular long-acting phenothiazine St. George's,
injections. Grenada, West Indies
Whether I know I believe this or believe I know it is
REFERENcES
a semantic point I will leave to the sages of Denmark
i. Bi@cxwzu., B. (i@7o). Lancet, ii, 875.
Hill. What I know and believe is that if I do not 2. HOENIG, J., and HAMILTON, M. W. (ig6g). The
take this action now, and persuade other doctors Desegregation of the Mentally Ill. London,
to do the same, thousands of unfortunate people Routledge and Kegan Paul.
will languish unnecessarily in the snake-pit conditions 3. Dusos, R. (1970). PsychologyToday. February.
of Caribbean mental hospitals, or perhaps in even
worse circumstances elsewhere. If Dr. Mawson [This correspondence is now closed. Ed.]
still considers this a piece of self-deception, he could
come and try for himself. DEPERSONALIZATION AND
RenéeDubos has pointed out (@) that while we ESTRANGEMENT: INDIVIDUAL
concentrate so much of our resources on acquiring OR SOCIAL PROCESSES?
new knowledge, we fail to make practical application DEAR Sm,
ofexisting knowledge which, even though incomplete, The organic, psychological, psychoanalytical, and
would be capable of solving most of our currently general clinical psychiatric theories of depersonaliza
pressing problems. This is certainly the case in tion, recently surveyed by Dr. Sedman ( z) have
psychiatry today. In the course of several visits this in common : they concentrate on the individual
to the U.S.A. I have seen untold wealth poured person, using concepts of a more mental or of a
down the drain in the name of ‘¿research',whilst more structural functional model, as the case may be.
the most crying human needs are ignored. If the Accordingly, depersonalization is contrasted against
NIMH had never existed, if not a single American the conditions and processes effective in the growth
psychiatric journal had ever been published or any and maintenance of personality and in establishing
thesis written, if there had been no conferences, the perceived, or self-perceived, coherent personal
‘¿workshops',
seminars or evaluative meetings, if identity.
not a single dollar had been spent on any form of One would wish, however, to take into considera
non-commercial research, would any patient have tion that the sense of self-identity and the reliable
been really worse off? On the other hand, if the whole feelings of a quasi-permanent image of the own
of this immense investment had gone into the actual coherently consistent person, together with their
provision of clinical facilities and services, would impairment in depersonalization and estrangement,
not the American public have benefited immeasur all point close links with the transpersonal processes
ably? of communication. Expressive-interpretative inter
This apparent digression is very relevant to the changes proceed at all levels: verbal, pre-verbal,
difference of attitude between Dr. Mawson and and non-verbal (e.g. postural or autonomic
myself. In the U.S.A. the fact that resources are vegetative, as in blushing, paleing, or missing a
dictated by intra-professional goals (and whether heartbeat); interpersonal identification phenomena
these are financial or intellectual makes little play a discernible role in shaping the features of
difference) has resulted in the creation of what has the individually and personally sensed self image.
been called with some justice a ‘¿professional
mafia'. For this reason, observations about communication
Enormous sums, both public and private, go into processes could serve to supplement and reconcile
the system, but little emerges to help the patient some seemingly opposed views: on the one hand,

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 CORRESPONDENCE I 39
the descriptive approach, exploring a structural infant interactions serve as preconditions for the
organismic origin, and on the other, the more proper initiation of the non-verbal, pre-verbal,
intuitive interpretation, reflecting a more psychologi gestural and postural communication flow, since,
cal mental imagery of both the ego feelings and their ‘¿.. . from the very beginning, the baby appreciates

impairment in depersonalization states. In the the aliveness of the mother . . .‘¿

(k). Furthermore, a
communication processes, a shared context is estab detailed analysis of clinical manifestations in certain
lishedbetweenparticipantsbytheir common language. estrangement states demonstrates the intimate
Now, their individual ego-feelings, corresponding connexions between feelings of self identity and the
to a mood-like inward state subjectively perceived reciprocal identification processes. This allows us
as a sense of self-identity, are accessible to the to distinguish the depersonalization and derealization
confronting observer only through his own sensitive states from experiences of ‘¿dc-animation',a specific,
intuition; but during a communication they become separable clinical picture (5).
externalized, expressed and objectivated within The prospects of unifying and integrating these
the group and through it. By a multiple interplay concepts from neurological, psychoanalytical and
of stratified expressive-interpretative interactions, communication theory have been considerably
the communication process takes its course from improved by introducing objective records of expres
one participant to the next, and links the subjects sive functioning, through linguistic-kinesic (L-K)
to one another. The merging of individual selves research under observational conditions of repeatable
within their group, or again their seclusion and measurement and controlled time-flow (6, 7).
exclusion through estrangement and loss of identity, Phenomena of self-synchrony and of interactional
all show the fluctuations of the displayed self image, synchrony are recorded; they can then be compared
as reflected in the microsocial phenomena of group with those of dys-synchrony and other disruptions
interaction. of the individually integrated co-ordination of cx
The multiple configurational, complex patterning pressive motility or of the interpersonal ordering
of both the productive and the receptive language of communication processes. Some of these observa
performance was stressed by Freud already in tions concern a case of multiple personality; their
1891 (2). Radio, TV and the various stereophonic relevance to variations in the perception of self
and stereoscopic audiovisual display techniques, all identity may point the way to an objective elucidation
unknown at that time, furnish today useful paradigms of depersonalization phenomena also (8).
for this many faceted ‘¿gestalt'
approach. In communi Self-estrangement and depersonalization were
cation technology and information theory, the correlated to the phenomena of social estrangement
concepts of multiplex processing and multichannel as far back as 1952 by Federn (s). There is a historic
transfer of message patterns have confirmed the line here, from the Vienna of i 89 I, when Freud
contrast between stably set structures and processes stressed the configurational, functional unities of
subserving transmission and reproduction, on the one ideational symbolic imagery—to that of the 1930's,
hand, and the creation of the transient expressive of Civilization and its Discontents, of Aichhorn's
patterns of meaning proper on the other. Wayward Touth, and the later concepts of ego psy
From the neurological field, among the agnostic chology, for instance Federn's ‘¿Enffremdung'and
disturbances, we find in prosopagnosia an impaired ‘¿Ent-ichung'.These trends, I feel, reflect the anxieties
ability to relate properly to the meaning of facial caused by the threatened loss of social coherence,
expression, even to one's own: ‘¿...the affected by the recession of common aims and purposes, and
person is incapable of recognizing his own face the concomitant crisis of identity, tradition and
in the mirror... (it) appears to be strange and values in the civilized communities.
unknown...' (s). In my own observations I have These signs are still with us today. Isolation and
noticed prosopagnosia persisting as a permanent loneliness have cast a veil of doubt on the very reality
disability in concentration camp survivors, following of individuality and its values. The general dis
diffuse organic damage due to starvation and severe engagement from shared mutal commitments have
exposure. In these cases familiar faces could only made of estrangement and depersonalization a
be recognized after hearing the respective person's hallmark of the contemporary human condition.
voice, as if monitoring the visual image by way of the A challenge beyond the merely clinical aspects
appropriate sound impressions. calls for our renewed interest in the ‘¿dynamicsof
Similar observations of stranegness phenomena personalization', using measurable objectivated
have been noted in psychoanalytically informed observations of the communication processes in
description of clinical findings. There is strongly dyadic, triadic and polyadic human groups. This
suggestive evidence that early perinatal mother may shed new light on the malaise of social fragmenta

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 140 CORRESPONDENCE

tion through violence, hostility, suspicion, inter communication', and that,withoutcare,theconcept

group tensions, and the ‘¿generation gap' phenomenon, of communication ‘¿for all practical purposes will
and could even conceivably help to contain the cease to mean anything'. (Journal, October, 1970.)
pugnacious aggression that besets the growth of UnfortunatelyI regard ‘¿Attempted Suicideas
civilization in our days. It may help us to understand Language' at fault precisely on this issue, and even
the widespread but feeble yearning for a well-nigh the amended form of ‘¿AttemptedSuicide as Non
unattainable ‘¿togetherness'
amidst growing disengage verbal but culturally-determined Communication'
ment, and the anguish of increasingly impersonal is mistakenly ascribed ‘¿characteristics
of communica
human relations in an epoch of depersonalization tion at the level of language.'
and estrangement. At the risk of repetition, may I restate my views,
J ANOSA. SCHOSSBERGER. which are held to be in need of clarification: non
!Cfar Shaul Work Village, verbal communications, such as winks, ceremonial
Jerusalem, Israel. bows and self-poisonings, are not language.
J. A. THOMPSON.
REFERENcES Department of Child Psychiatry,
1. SEDMAN, G. (1970). ‘¿Theories of depersonalization: Guy's Hospital,
a re-appraisal.' Brit. J. Psychiat., ivy, 1—14. London, S.E.i.
2. Faauu, S. (i8gi). On Aphasia. (Transl. by E. Stenzel,
I.v.P., N.Y. 1953.)
3. BORNSTEIN,B. (i@6@).In DynamicXeurology,L. Halpern
ed. N.Y.-Jcrusalem: Grune and Stratton. SHORTCOMINGS OF SCIENTIFIC
283—318. PSYCHIATRY
4. WINNIcorr, D. W. (i@@7). Mother and Child. Basic DEAR SIR,
Books, N.Y. Dr. R. Denson's reply (Journal October, 1970,
5. ScHOSSBERGER, J. A. (1963). Deanimation. Communication I 17, 457) to my previous letter (Journal June, 1970,
of Meaning by Transient Erpressive Configuration. ii6, 68o) calls for a withdrawal of any suggestion
Psychoanal. Quart., XXXII : 479—532, (csp. p. that the authors of the paper A ControlledStudyof LSD
522 if.) Treatment in Alcoholism and Xcurosis (Journal April,
7. BROSIN, H. W. (ig66). Linguistic-minesic analysis using
1970, I i6, 443—5) have been in any way negligent.
film and tape in a clinical setting. Supplement,
Amer. J. Psychiat., 522, 33—7. They discharged their responsibility for their patients'
7. CcornoN, W. S., and OorroN, W. D. (i@6'). ‘¿A safety by providing pleasant surroundings, the
segmentation of behaviour.' 3. psychiat. lies., attendance of a nurse and by frequent visits ‘¿to
5, 221—35. discuss his (the patient's) reactions to the drug'.
and PACOE, L. V. (1969). ‘¿Three faces of This admission does not, however, affect the basic
Eve revisted.' Psychol.,Vol. 74, No. 5, 6i 8—20. criticism which is not personally directed against
g. FEDERN, P. (1952). Ego Psychology and the Psychoses. an@ psychiatrists or research workers, but against
Basic Books, N.Y. the underlying premise.
Science is objective and must, in the case of sub
ATTEMPTED SUICIDE AS LANGUAGE jective, psychic states, convert these into objective
DEAR SIR, data in order to arrive at objectively valid results.
I am glad that N. Kreitman (Journal October, 1970) The friendly, enthusiastic approach during the
now accepts my view (Journal July, 1970) that to LSD experiment does not affect the basic principle
attempt suicide is not to indulge in linguistic be of objectivity.
haviour, and that by placing it in his category 2 From my own LSD experience and from having
of ‘¿Non-verbalbut culturally determined communica shared LSD experiences with many patients, I am
tion, such as a ceremonial bow or the raising of an convinced that the quality of such an adventure
eyebrow' he is also in agreement with my description cannot be expressed in any objective quantifiable
way. Many people have expressed to me and to my
of it (Journal July, 1970) as being in the category
of ‘¿thepre-syntactic learning of a one-to-one link colleagues at the Marlborough Day Hospital their
at the conceptual level of a meaningful sign or appreciation of their unique LSD experiences and
gesture'. have thus themselves objectified the therapeutic
Indeed, we are equally in agreement that there result in a non-scientific way.
is a wider issue here (which may explain our interest E. K. LEDERMANN.
in the matter) in that some psychiatrists view ‘¿much Marlborough Day Hospital,
of the behaviour of most patients as some kind of London, .W.W.8.

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