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Book Review   |    
Ego Development and Psychopathology
Daniel D. Storch,, M.D.
Psychiatric Services 1998; doi:
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by David P. Ausubel; New Brunswick, New Jersey, Transaction Publishers, 1996, 301 pages, $49.95

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This is a hard book to read. The nearly 300 pages are densely written, with no relief offered by case studies or illustrations, and only three tables. However, the author, as he promises, presents a "coherent, self-consistent, and comprehensive" theory of psychopathology and relates it to the current descriptive classification of psychiatric diagnoses. His is a developmental theory with ego preeminent. The central thesis of the book is that "the most significant and critical factors predisposing persons to various mental disorders are critical developmental defects . . . that arise at critical phases of ego development."

The book is divided into two main sections. The first part, Ego Development, expounds the theory. The normal progression is that the ego becomes omnipotent in the infant. In solving "the crisis of ego devaluation," the ego of the child "satellizes" (subordinates itself) to the parents and then others in authority, such as teachers. Then the ego must "desatellize" in preadolescence and adolescence in response to the individual's need for "emancipation from the home and preparation to assume the role of a volitionally independent adult in society."

The second part, Clinical Applications, is a bit easier to read. The author proceeds to discuss each of the "major"DSM-IVpsychiatric diagnoses within the context of his theory. Anxiety states fit best. Neurotic anxiety, the prototypical disorder, is "a form of developmental anxiety (occurring usually in a nonsatellizing individual with a history of failure in ego devaluation) in which the essential source of the threat to self-esteem arises from a severely impaired sense of adequacy." Other diagnoses follow. For example, depression, mania, reactive (as opposed to process) schizophrenia (schizophreniform disorder), and delusional disorders are the "four basic kinds of 'psychotic' complications" of neurotic anxiety.

Ego Development and Psychopathologyincludes interesting clinical points and observations. The need for moral values is repeated. Parents and therapists should lead the way. Parents should not be "overpermissive"; therapists cannot ignore the question of moral judgment. "Behavior and ethics are inextricably bound together." Delinquency is a "moral problem."

The author is not afraid of controversy. For example, he takes our culture to task for not providing children with opportunity for socially responsible participation and for discrepancies between "the professed (official) moral ideology" and "the simultaneous overvaluation of aggressiveness, prestige, and success at any price."

The book jacket identifies David Ausubel as distinguished professor emeritus at the Graduate School and University Center of the City University of New York, evaluating psychiatrist for the Catholic Archdiocese of New York, and also in private practice. The book "is addressed chiefly to . . . the primary diagnosticians and therapists of mentally ill individuals." The author also hopes other intellectuals will be interested.

I admit I am a pragmatic eclectic in my approach and concrete in my thinking. In reading a book such as this, I find my own psychological-mindedness exercised and stretched and, correspondingly, my work with patients showing more insight, with better results and mutual satisfaction. In summary, the book was hard to read, requiring time and serious study, but worth the effort.

Dr. Storch is clinical associate professor of psychiatry at the University of Maryland School of Medicine in Baltimore and medical director of the Riverwood Center of the Howard County Health Department in Columbia, Maryland.




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