BOOK REVIEWS SYMPOSIUM ON THE PREVENTION OF OBE- SITY. SponsQ1'ed by the American Heart Associa- tion. RePrinted from BuU. New York Acad. Med., 36:5 &: 6, 1960. These eight papers contain a good deal of basic information about obesity. Doctor Powdermaker, an anthropologist, indicates some of the underlying cul- tural factors and raises several pertinent questions. Mr. Marks of the Metropolitan Life Insurance Com- pany documents the relationship of obesity to in- creased mortality and morbidity. The pathology of obesity and the lack of correlation between obesity and autopsy evidence of myocardial infarction is described by Doctor Hartroft. It is pointed out by Doctor Mayer that obesity may be genetic in origin. Several types of such obesity in experimental animals are described in detail. Doctor Buskirk outlines the many variables affecting daily caloric needs and the difficulties of measurement. Doctor Pollock emphasizes the importance of small changes in daily caloric balance. Mrs. Schur dis- cusses weight control and makes many practical sug- gestions. Finally, there is an excellent summation by Doctor Sebrell. This is a good basic monograph. However, although all of the papers make some reference to obesity prevention, the subject is not attacked directly. It is disappointing to see very little reference to psycholo- gical factors in the production of obesity and no mention of the psychopathology that may result from indiscriminate reduction. LEONARD J. SCHIFF, M.D. CURIOSITIES OF MEDICINE. Edited by Berton Roueche. 358 pages. Boston: Little Brown & Co., 1963. $5.95. literature is dramatically portrayed in this outstanding collection of medical essays. Several are classics, including Snow on cholera, Beaumont on digestion, Budd on typhoid fever, and Panum on the epidcmiology of measles. None of the stories are in- cluded because of scientific merit alone; each has in addition the capacity to excite and delight the reader. Notes on an "Unpleasant Female" has as its subject the black widow spider. "The Sweating Sickness," a peculiarly virulent form of influenza, is described by John Caius, an English physician of the sixteenth cen- tury. "Glue Sniffing in Children," published in 1962, a serious threat in some communities, is noted to carry with it a significant detriment to physical and emotional health. The story of "Consumption," related by Rene and Jean Dubos, relates the ancient belief of the association of tuberculosis with genius. "The Broad Street Pump" by John Snow relates how cholera was discovered to be a water-borne disease. "Immanucl Kant" the story of the tragic disintegra- tion of a great intellect under the blight of cerebral arteriosclerosis. "Stomach Cancer In Iceland" attempts to relate the higher incidence of gastric cancer to smoked salmon. In "Two Outbreaks of Typhoid Fever," it is demonstrated that the disease is spread by water contaminated by the excreta of typhoid victims. A most fascinating item is that of "A Stricken Man July-August, 1964 and His Heart"; it relates the events and feelings which a man undergoes with the realization that he has suffered a heart attack. "Experiments and Obser- vations on Digestion" is the story of William Beau- mont, an army surgeon, and his patient with the gastric fistula, Alexis St. Martin. "The Case of the Perilous Prune Pit" is an autobiographical account of what can occur after swallowing such an item. Most interesting, and of special interest to the read- ers of PSYCHOSOMATICS, is "Solitaire" by Robert Lind- ner-the psychoanalysis of a particularly difficult pa- tient who is eventually helped. "An Account of the Foxglove" by William Withering is taken from the original report on the use of digitalis in dropsy. Other stories are included. One of the most fas- cinating is "Journey Around My Skull," an auto- biographical account of what it feels like to undergo brain surgery for a tumor. A most interesting account of what it feels like to have Meniere's Syndrome provided by Berton Roueche. This interesting series of essays is most dramatic. They are well written and indicate that medicine can be exciting as well as scientific. W.D. THE CASE AGAINST PSYCHOANALYSIS. By An- drew Salter. 179 pages. New York: The Citadel Press. Paperback, $1.50. The writer is a psychologist. His purpose in pre- senting this book is as the title indicates, a critical attack on psychoanalysis, especially its therapeutic aims. Salter's comments are embodied in six chapters. He provides a glimpse into psychoanalytic theory and the power of the unconscious; he discusses analytic results, dream interpretation, the psychoanalytic con- cept of normality and the termination of treatment. The author writes well. But, like others abusively critical of Freudian contributions, he resorts to name- calling, rhetorical questions and quotations out of context. Criticism of Freudian thought, like that in any science is welcome, but this effort adds nothing. It is a literary excursion and is sadly innocent of clinical material and demands. The book includes references and an index. GEORGE J. TRAIN, M.D. NEURO-PSYCHOPHARMACOLOGY, Vol. 2 PRO- CEEDINGS OF THE SECOND MEETING OF THE COLLEGIUM INTERNATIONALE NEURO-PSYCHOPHARMACOLIGICUM (BASLE, 1960). Edited by E. Rothlin. 521 pages. New York: Elsevier, 1961. Distributors in U.S.A.: D. Van Nostrand Co., Princeton, N.]. and New York. This book points out at the very beginning that the new field of neuro-psychopharmacology has many un- solved problems. From a clinical point of view, it readily admits that there is often a discrepancy be- tween objective basic investigation and subjective therapeutic success. The opening session, dealing with "Psychophysiol- ogy and Psychopharmacology" is most adequately 267
Transcript
BOOK REVIEWS
SYMPOSIUM ON THE PREVENTION OF OBESITY. SponsQ1'ed by the American Heart Association. RePrinted from BuU. New York Acad. Med.,36:5 &: 6, 1960.
These eight papers contain a good deal of basicinformation about obesity. Doctor Powdermaker, ananthropologist, indicates some of the underlying cultural factors and raises several pertinent questions.Mr. Marks of the Metropolitan Life Insurance Company documents the relationship of obesity to increased mortality and morbidity. The pathology ofobesity and the lack of correlation between obesityand autopsy evidence of myocardial infarction isdescribed by Doctor Hartroft.
It is pointed out by Doctor Mayer that obesity maybe genetic in origin. Several types of such obesity inexperimental animals are described in detail. DoctorBuskirk outlines the many variables affecting dailycaloric needs and the difficulties of measurement.Doctor Pollock emphasizes the importance of smallchanges in daily caloric balance. Mrs. Schur discusses weight control and makes many practical suggestions. Finally, there is an excellent summation byDoctor Sebrell.
This is a good basic monograph. However, althoughall of the papers make some reference to obesityprevention, the subject is not attacked directly. It isdisappointing to see very little reference to psychological factors in the production of obesity and nomention of the psychopathology that may result fromindiscriminate reduction.
LEONARD J. SCHIFF, M.D.
CURIOSITIES OF MEDICINE. Edited by BertonRoueche. 358 pages. Boston: Little Brown & Co.,1963. $5.95.
~fedical literature is dramatically portrayed in thisoutstanding collection of medical essays. Several areclassics, including Snow on cholera, Beaumont ondigestion, Budd on typhoid fever, and Panum on theepidcmiology of measles. None of the stories are included because of scientific merit alone; each has inaddition the capacity to excite and delight the reader.
Notes on an "Unpleasant Female" has as its subjectthe black widow spider. "The Sweating Sickness," apeculiarly virulent form of influenza, is described byJohn Caius, an English physician of the sixteenth century. "Glue Sniffing in Children," published in 1962,a serious threat in some communities, is noted tocarry with it a significant detriment to physical andemotional health. The story of "Consumption," relatedby Rene and Jean Dubos, relates the ancient belief ofthe association of tuberculosis with genius. "TheBroad Street Pump" by John Snow relates howcholera was discovered to be a water-borne disease."Immanucl Kant" i~ the story of the tragic disintegration of a great intellect under the blight of cerebralarteriosclerosis. "Stomach Cancer In Iceland" attemptsto relate the higher incidence of gastric cancer tosmoked salmon. In "Two Outbreaks of TyphoidFever," it is demonstrated that the disease is spreadby water contaminated by the excreta of typhoidvictims.
A most fascinating item is that of "A Stricken Man
July-August, 1964
and His Heart"; it relates the events and feelingswhich a man undergoes with the realization that hehas suffered a heart attack. "Experiments and Observations on Digestion" is the story of William Beaumont, an army surgeon, and his patient with thegastric fistula, Alexis St. Martin. "The Case of thePerilous Prune Pit" is an autobiographical account ofwhat can occur after swallowing such an item.
Most interesting, and of special interest to the readers of PSYCHOSOMATICS, is "Solitaire" by Robert Lindner-the psychoanalysis of a particularly difficult patient who is eventually helped. "An Account of theFoxglove" by William Withering is taken from theoriginal report on the use of digitalis in dropsy.
Other stories are included. One of the most fascinating is "Journey Around My Skull," an autobiographical account of what it feels like to undergobrain surgery for a tumor. A most interesting accountof what it feels like to have Meniere's Syndrome i~
provided by Berton Roueche.This interesting series of essays is most dramatic.
They are well written and indicate that medicinecan be exciting as well as scientific.
W.D.
THE CASE AGAINST PSYCHOANALYSIS. By Andrew Salter. 179 pages. New York: The CitadelPress. Paperback, $1.50.
The writer is a psychologist. His purpose in presenting this book is as the title indicates, a criticalattack on psychoanalysis, especially its therapeuticaims.
Salter's comments are embodied in six chapters.He provides a glimpse into psychoanalytic theory andthe power of the unconscious; he discusses analyticresults, dream interpretation, the psychoanalytic concept of normality and the termination of treatment.
The author writes well. But, like others abusivelycritical of Freudian contributions, he resorts to namecalling, rhetorical questions and quotations out ofcontext. Criticism of Freudian thought, like that inany science is welcome, but this effort adds nothing.It is a literary excursion and is sadly innocent ofclinical material and demands.
The book includes references and an index.GEORGE J. TRAIN, M.D.
NEURO-PSYCHOPHARMACOLOGY, Vol. 2 PROCEEDINGS OF THE SECOND MEETING OFTHE COLLEGIUM INTERNATIONALENEURO-PSYCHOPHARMACOLIGICUM (BASLE,1960). Edited by E. Rothlin. 521 pages. NewYork: Elsevier, 1961. Distributors in U.S.A.: D. VanNostrand Co., Princeton, N.]. and New York.
This book points out at the very beginning that thenew field of neuro-psychopharmacology has many unsolved problems. From a clinical point of view, itreadily admits that there is often a discrepancy between objective basic investigation and subjectivetherapeutic success.
The opening session, dealing with "Psychophysiology and Psychopharmacology" is most adequately
267
PSYCHOSOMATICS
handled by W. R. Hess (Zurich) and Paul H. Hoch(New York). Dr. Hcss' paper defines the field of"Psychophysiology" as an area dealing with problemsof integrating normal psychic mechanisms with theirfunctional substrate in the brain. Dr. Paul Hoch dealswith the problems arising from the use of psychotropicdrugs. He notes that their greatest contribution liesin the treatment of acute schizophrenia. The ambivalence displayed in the litcrature as to the efficacyof these drugs is discussed. Some of the therapeuticresults reported may perhaps be related to the betterorganization and more intcnsive milieu therapy ofmental hospitals. As for depressive states, the efficacyof the anti-depressants is probably overestimated;electroshock therapy is still a valuable agent. Inthe use of tranquilizers in the neuroses, as compared with the psychoses, much less is known. Itis difficult to appraise the different factors which mayinfluence neurotic symptomatology; it is also difficultto discern to what extent results are due to the drugsor to the concomitant psychotherapy. Proper indications should be present before any drug is utilized; itis essential that the emotional complaints arc firstassessed and evaluated. Many psychoneurotic patientsshould be treated without drugs; in others, their uscincreases their accessibility to psychotherapy. As forthe effect on the transference relationship, this is notnecessarily impaired; in many instances this relationship is enhanced.
The "First Symposium," dealing with the problemof antagonists to psychotropic drugs, <.'Ontain reportsby J. H. Gaddum and H. C. B. Denber. The firstspeaker points out the problem of competitive inhibition. The latter approaches the problem by a specificexperiment-the measurement of changes in variousblood chemical elements amI gross clinical behavior inchronic psychotics. Through the use of mescaline,followed by a variety of phenothiazines administeredas antagonists, amelioration of the mescaline effect isnoted in most instanccs.
The "Se<-'Ond Symposium" considers the effects ofpsychotropic drugs on conditioned reflexes in animalsand man. Drs. Leonard Cook and Leo Alexander citethe results of applying Pavlovian methods of graphicrecording. In Dr. Cook's report, the action of certaindrugs c-an best be described with regard to theireffects on positively motivated behavior. In the discussion period, Dr. W. ~Iayer-Gross (England) feltthat clinical observation, applied with caution, couldstill stand by itself, objecting to the establishmentof a "new pharma<.'Ological cerebral mythology."
The "Third Symposium" has as its theme, "TheInfluence of Specific and Non-specific Factors on theClinical Effeds of Psychotropic Drugs." Dr. FritzFreyhan (USA) states that only in recent years havepsychiatric concepts been subjected to the examination and critique of other disciplines. Emphasis isplaced on the effect of particular drugs on specifiedpsychopathological phenomena rather than on "schizophrenia" or "psychosis." As for "depression," he notesthe inadequacy of the present classification of thetypes of depression. The fact that depressive syndromes respond quite differently to the various currentanti-depressants, indicates the need for rating scales,such as the Hamilton Scale. His closing remarks are
268
quoted: "We may now be in a better position toreturn to a truly unbiased evaluation of both thepsychological and pharmacological effects of drugtreatment."
In the discussion period, Dr. M. Bleuler (Zurich)points out that the action of a "psychotropic drug"depends on the nature of the drug, the illness, thecircumstances of the patient, behavior, and underlying <.'Onstitution. Among the individual communications is included a report by A. Hormia (Finland) on the relationship of the patient's subjectiveneed for treatment and the success or failure of ambulatory treatment with psychotropic drugs. Hestresses the importance of the cooperation of thepatient, indicating the value of the combination ofdrug treatment with psychotherapy.
The "Fourth Symposium" concerns itself with measurement of changes in human behavior under theeffects of psychotropic drugs. The problem of the"placebo reactor" is considered by C. Klerman( USA). Problems of methodology are stressed byF. J. L. Letemendia (Oxford). In his remarks on"double-blind" studies, he points up that the "blindness reminds one of the traditional blind beggar, whoat 6 o'clock looks at his watch and stops work forthe day." An active drug apparently often revealsitself by its secondary effects. Dr. C. J. Sarwer-Foner(Canada) reports on the interaction of a particulardrug with transference and <.'Ounter-transference situations in psychotherapy. A patient can improve, orbccome worse, depending upon the meaning and interpretation of the use of the drug in terms of the"total situation." A drug may remove defenses whichare needed to maintain current level of functioning,and may then feel less adequate. The personality ofthe patient and his interaction with his physician andmilieu are highly significant. The patient may feeluncomfortable if his symptoms, which express inneruncontrollable conflicts, are under pharmacologicalcontrol. The attitude and motivation of the doctorusing these drugs are also of considerable importance.The patient may interpret the doctor's use of drugsas a means of keeping the patient at a distance, or asan overly aggressive need for active intervention.
"Biochemical Mechanisms" are discussed in thefifth symposium. Derek Richter (Great Britain) considers the ability of a number of drugs to intervenein a specific way in metabolic processes of the cell.By blocking enzymes or influencing the transport ofmetabolites across a membrane, biochemical effectsare produced. It is reported that chlorpromazine inhibits cytochrome oxidase; it also inhibits ATP andun<.'Ouplcs oxidative phosphorylation, causing a decrease in ATP (adenosine tri-phosphate) levels inbrain slices. Reserpine reduces the serotonin andcatecholamine <.'Ontent of the brain; MAO drugscounteract this action. In the discussion period Dr.H. Waelsch (New York) suggests that in vitro effectsdo not necessarily explain in vivo effects.
This review cannot provide adequate coverage ofthe wealth of information provided. The book shouldbe read by everyone concerned with the impact ofpsychopharma<.'Ology at both experimental and clinical levels.
