BOOK REVIEWS

then presented further research on the psychophar­macology of total behavior. He pointed out that the"observations of rats in mazes, cats in cages ormonkeys in ataractic hazes" gave no full glimpseof what goes on in the human. Dr. W. Mayer-Crossspoke about methodology of drug trial in the human.He defended the often maligned uncontrolled trial,pointing up that this method could produce valua­ble information. The difficulties in obtaining aproper matching of control and experimental groupswere also described.

A comparison of drug-induced and endogenouspsychoses in man was the theme of the fourth sym­posium. M. Bleuler stressed the fact that the psy­chopathological features produced by LSD and otherdrugs did not correspond to the usual picture ofschizophrenia. Joel Elkes felt that the comparisoncan only be valid within very narrow limits.

The impact of the psychotropic drugs was consid­ered in a plenary session. Dr. Brill of New Yorkindicated the marked reduction of the mental hospi­tal population in New York State and pointed upthe increasing need for rehabilitation services. Dr.Ewen Cameron anticipated that the new drugs wouldbe used by general physicians and would find aplace in the psychiatric divisions of general hospi­tals. Doctor Freyhan advocated the need to treattarget symptoms rather than the illness; he re<.'Om­mended the development of psychopharmacologicaltherapeutic units in mental hospitals, mental healthclinics and in general hospitals. Dr. Elsie Kris notedthat the new drul/:s were of great value in helpingto maintain former hospitalized mental patients inthe community. The third plenary session consideredthe current status of neurochemistry. Doctor Ansell'sconclusions were succinct: "to search for the bio­chemical lesion in schizophrenia might be comparedto looking for a needle in a haystack, where theshape and the size of the needle is unknown andthe position of the haystack undetermined."

Part 2, consisting of <.'Ommunications, covered manyareas of research. Most interesting wert' reports ofhealthy rt'aetors to dummy (placebo) treatment; theeffects of endocrint' status on the action or lack ofaction of drugs; the "apparent" depression after re­serpine, in which the authors felt that it was relatedto the excessive tranquilization in patients who werethreatened by this situation. As for this last state­ment, this reviewer can only comment that some ofthese "apparent" depressions have been sick enoughto require electroshock therapy.

This book, despite the fact that it is a report ofa meeting which occurred in 1958, should he ofvalue to all physicians seekinl/: fundamental knowl­edge in the rapidly growing field of psychopharma­cology.

W.D.

THE NATURE OF PSYCHOTHERAPY. By WalterBromberg, M.D. New York: Grone and Stratton,1962.

The analysis of the meaning of psychotherapypresented in this volume differs from the usual clini­cal descriptions of the process. The author con-

January-February, 1963

fesses to his being a "seeker for connections, analog­ies and symmetries," rather than a "hunter for dis­tinctions, differences and dissimilarities." His goalis to analyze the fundamental reason why psycho­therapy of any type is successful, despite the factthat there are so many schools. He states that themain emphasis in the literature on psychotherapy hasbeen on the study of psychological content of thepatient and the rationale of the therapeutic methods,to the neglect of the relational aspects of the thera­peutic transaction between patient and therapist.

Theories held hy therapists developed as a con­sequence of a physiologic need to explain whatwas being accomplished in therapy. A satisfactorytheory acts to enhance the security of the therapistand to order his thinking and planning.

The author neglects the role of emotion in thetherapeutic process because it "intensifies and colorsthe therapeutic process, but does not determine itsnature."

Doctor Bromberg's dissection of the nature ofpsychotherapy can hardly be classified as light read­ing. It explores psychotherapy in depth in an at­tempt to produce a further understanding of theprocess. It is recommended for those who seekquestions rather than answers as to the meaningof psychotherapy.

W.D.

HYPERTENSION: RECENT ADVANCES. TheSecond Hahnemann Symposium on HypertensiveDisease. Edited by Albert N. Brest, M.D., andJohn H. Moyer, M.D. Philadelphia: Lea andFebiger, 1961.

This conference, held in May 1961, included 117authorities from this country and abroad. The naturalhistory of the disease, etiological mechanisms, arterio­sclerosis and hypertension, the pharmacology ofhypertension, catecholamine metabolism, and thera­peutic considerations, all received adequate coverage.

Of particular interest to the readers of PSYCHOSO­MATICS is the chapter dealing with "The NaturalHistory of the Disease" by Sokolow and Harris,in which personality characteristics of prehyperten­sives are such as to suggest that they experienceemotional stress more often than normal personsand respond with greater frequency, magnitude andduration of sympathetic discharge and vaso-pressorepisodes.

Neurogenic factors are mnsidered by CliffordWilson who cites the difficulty in determining wheth­er the over-reaction to stress, when measured bypressor tests, might not be the result of hypertensionrather than the cause.

H. Keith Fischer considers "Hypertension and thePsyche." He quotes the late Dr. Edward Weiss,a pioneer in psychosomatic medicine, who stated thatpsychic factors played an important role in manycases of essential hypertension. He reviews the con­cept of repressed hostility as expressed by Saul andAlexander and the work of Binger. Doctor Fischerreports on the personality structure of these indi­viduals; their early sense of insecurity. He quotesthe work of Reiser who pointed out the lack of

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PSYCHOSOMATICS

evidence of specificity of psychological stress andalso noted that the transition from benign to malig­nant hypertension was <:orrelated with an emotionallysignificant life situation. He also quotes Weiss,who in a long term study, had concluded thatpsychotherapy could remove "blood pressure phobia"but did not necessarily lower the blood pressurefigures. The anniversary reaction, described byWeiss, was common in patients whose fathers hadhypertension and who died when the patient wasin his teens.

In a discussion of reserpine therapy, the possi­bility of the occurrence of depression is emphasized.

The etiologic role of the catecholamines in es­sential hypertension is considered by Wilhelm Raab.It is suggested that vascular over reactivity to neu­rogenic epinephrine contributes to the pathogenicbackground of essential hypertension. This mecha­nism is mediated by corticord-induced intracellularsodium accumulation. Liberation of norepinephrineis related to the neurogenic maintenance of elevatedsystolic and diastolic pressure levels, while epine­phrine is involved under conditions of stress and"sympathetic storms." Urinary catecholamine excre­tion is seen under emotional strain.

This text, with its wealth of material, representsthe very latest concepts of the etiology, pathogenesisand treabnent of hypertension. The general physicianwill find that it offers an excellent comprehensivereview of hypertension.

W.D.

HUMORS, HORMONES AND NEUROSECRE­TlONS. BII Chandler McC. Brooks, Jerome L.Gilbert, Harold A. Levll and David R. Curtis.313 pages. New York: University Publishers,1962. $7.50.

The authors present a most readable summary ofcurrent research in this area. The fact that humor­ally transmitted agents control body function andthat specific substances control behavior points upthe growth and development of modern physiology.

Modern endocrinology is seen to evolve as aninterdisciplinary science, shaped by the observationsof anatomists, biochemists, physiologists and clini­cians. Its evolution is traced historically back tothe earliest concept of body humors. The hormonesof the digestive system and pancreas as well as thevarious endocrine glands are considered in detail,both as to the historical aspects as well as currenttheory and clinical implications. Excellent diagramsillustrate the mechanisms involved in their action.

A special chapter considers the chemical transmis­sion of neuronal activity. Although there is muchstill to be learned about the formation and fate ofacetylcholine and its associated adrenergic transmit­ter, norepinephrine, considerable information is avail­able to the reader.

The role of the nervous system inclusive of hypo­thalamic control of the endocrine glands reviewsanatomical, histochemical, biochemical and neuro­physiological evidence. The authors point out theareas where specific information is still lacking;despite the bewildering complexity of various inter-

60

relationships they succeed in producing a most lucidpicture of current concepts.

This book is recommended to those who believethat an understanding of body and mind is aninterdisciplinary affair requiring a broad and com­prehensive approach.

W.D.

A SEARCH FOR MAN'S SANITY. The SelectedLetters of Trigant Burrow. 615 pages. New York:Oxford University Press, 1958. $8.75.

Dr. Trigant Burrow was one of the most controver­sial figures in the early days of psychoanalysis in theU.S.A. Early in his career he diverged from themain stream of psycho-analysis, becoming increas­ingly aware of the social implications of neurosis.In 1927, he organized the Lifwynn Foundation, tofurther his research into group analysis. DoctorBurrow carried on a most intensive correspondencewith leaders in many disciplines; this book containsmany of his exchanges with Freud, Jung, HavelockEllis, Walter B. Cannon, Adolf Meyer, Alfred Kor­zybski, Smith Ely Zeliffe, Paul Federn, A. A. Brill,Harry Stack Sullivan and others.

Doctor Burrow's thesis points to the long recog­nized truth that "man is not a detached particleof life, but that we are part of one another"; theanalysis of the individual can never be completedwithout a consideration of the group of which heis an integral part. Later, he became increasinglyinvolved with the organic foundations of personality,making "bold use of the tenns biology and anatomy";however, this reviewer cannot find any tangible,concrete contributions to this concept in these manyletters.

This book should be of interest to all those inter­ested in the early struggles of psychoanalysis. Theinevitable fate of the renegade is depicted in fullclarity.

W.D.

DAS NERVENSYSTEM DES MENSCHEN. ByDr. Med. Max Clara. Third Edition. 808 pages.Leipzig: Johann Ambrosius Barth Verlag, 1959.78.00 DM.

The third edition of Professor ~Iax Clara's text­book on neuroanatomy contains a systematic de­scription of structures and their functions in themanner in which nowadays morphologists andphysiologists have integrated their fields of inquiry.Sequentially, the tasks of the central nervous system,its component parts, division and architecture areelaborated. This then is followed by major chaptersconcerning medulla, spinal nerves, autonomic nervoussystem and segmental distribution of the peripheralnerves. The remaining two-thirds of the volumeare concerned with anatomy and neuro-physiology ofthe brain. The superhly illustrated volume repre­sents German teaching in its best tradition and isrecommended to student and physician alil<e.

K.W.B.

Volume IV