BOOK REVIEWS

of the formative elements of the personality. Theindividuality of the personality starts in fetal life,in all probability, as early as the zygote or fertil­ized ovum to continue on through the vegetative- somatic embryonic development. Then followsthe influence, of the birth event, with the possibletraumas, on SUbsequent development. The mor­phological structures are also susceptible totraumas and foci of fixation during the early yearsof extrauterine life.

The concept of individuality development in­cludes the affective states from their beginning inthe infant and the development of the body imageas the basis of the margin between the ego ("I")and the world. The primitive hereditary - con­genital rellexes with their biological- physiologi­cal character do not determine directly the psycho­logical rellexes but in combination with these areinvolved in habit formation and education.

The motives and demands of modern man, theillnesses, the types of symptoms, and which symp­toms are determined by psychological componentsof the personality are given special consideration.

References to the literature are limited to Ger­man and Hungarian authors. The text is well or­ganized and interestingly presented. For thosestudents of psychology who read German it shouldserve as an orientation in the subject.

NOLAN D.C. LEWIS, M.D.Frederick, Marlyland

"ANNUAL REVIEW OF PHARMACOLOGY,VOLUME XI, 1971" (Eels.: Elliot, H.W., Okun,R., and Dreisbach, R.H.), Annual Reviews Inc.,Palo Alto, Calif. 11. 1-560.

This eleventh (1971) volume of the AnnualReview of Pharmacology compares very favor­ably with its predecessors although the currentvolume has articles of an esoteric ring to theaverage psychiatrist ("circadian chronopharma­cology"; "Marine toxins"; "Amines and pclype­petides of amphibian skin," etc.).

The introduction by Nobelist Von Euler empha­sizes his philosophical approach to research,noting that in the future freedom of scientific re­search may be non~xistent. Actually this is anunfortunate fact now. One can infer that hehad the usual quota of problems in his earlieryears, something not unknown to many scientists.A lengthier description of the early work withprostaglandins and norepinephrine would havebeen interesting.

Albert gives a partiCUlarly lucid non-technicaldiscussion of a highly technical SUbject, "Rela­tions between Molecular Structure and BiologicalActivity: Stages in the Evolution of Current Con­cepts." The account of cyclic AMP was much toobrief.

January-February 1972

Anders discusses enhancement and inhibitionof drug metabolism and emphasizes these possi­bilities which may result from multiple drug ad­ministration in humans. For instance, diphenylhy-'dantoin metabolism is inhibited by disulfran andisoniazid. With many physicians tending to use"polypharmacy," a better knOWledge of the basicpharmacology might avoid future problems.

I. and J.A. Izquierdo consider the effects ofdrugs on deep brain centers making relevant criti­cisms concerning the newer techniques for deliver­ing drugs directly into the central nervous system,and stressing the local damage that ensues. Onewonders if these experiments are actually relevantto the in vivo state, and the exact meaning of thelarge amount of data generated by this approach.

Sulser and Sanders-Bush discuss the "Effect ofDrugs on Amines in the CNS" elaborating on somenewer work concerning biochemical pharmacologyof amphetamines and tricyclic anti-depressants.They consider the possibility that the catecho­lamine hypothesis for affective illnesses mayreally be a disorder of 5HT neurons, somethingnot impossible.

The paper by Lewis, Bentley, and Cowan on"Narcotic Analgesics and Antagonists" mighthave benefited from a more thorough treatmentof the factors i nlluencing relapse to addictivedrugs. The bulk of their report concerns struc­ture-function relationships of newer drugs. Davisand Fann have made a broad review of the litera­ture concerning Lithium, which will interest thosedesiring a general perspective of the subject. Thearticle on circadian chronopharmacology by Rein­berg and Halberg may have some relevance topsychopharmacology for it is an unquestionablefact that biological rhythms inlluence many psy­chological events. The authors discuss studies byvarious workers on rhythmic enzymatic activityin rat and mouse. The cyclic behavioral events inschizophrenia and depreSsion in this context mightbe worthy of more close attention.

There are many other articles of greater in­terest to pharmacologists such as "The Pharma­cology of the Estrogens," "Cancer Chemother­apy," "Toxicology: The Respiratory Tract," andetc.

The volume is recommended.

HERMAN C.B. DENBER, M.D. Ph.D.New York

NEUR081818 A PAINFUL 8TYLE OF LIVING.By 8amuel r. Greenberg, M.D., 8ignet Books,New American Library.

This little paperback packs a tremendousamount of information and is truly a readableaccount of the psychodynamics of daily liv­ing. The author, with wide experience as

65

PSYCHOSOMATICS

a teacher and psychiatrist, describes the manyfears, defenses and strategies utilized by the suf­fering neurotic. Although many books have beenwritten to provide self-help, this is clearly one ofthe most practical. The avoidance of psycho­analytic jargon and the relative simplicity of thelanguage account for this result.

This book can thus help the many who aresufficiently motivated to discover their real fearsby stopping to look at their problems realistically.Worrying about the wrong things prevents con­structive action.

The author points out that a book cannot re­place competent professional help; nevertheless,it can certainly help one to understand some oftheir inner fears and repetitive futile attemptsto cope with them.

The book can also by of value to therapistsof varying persuasions and degrees of training tohelp clarify some of the intricacies of the neuroticprocess.

W.D.

THE PSYCHODYNAMIC IMPLICATIONS OFTHE PHYSIOLOGICAL STUDIES ONDREAMS. By Leo Madow, M.D. and LaurenceH. Snow, M.D. Charles C. Thomas, Springfield)Ill. 1970.

This volume is a step in the direction of whatis obviously needed at this stage in the history ofdream research, namely, the recognition of theneed for an integrative approach. The presentseries of papers is based on a symposium held atthe Women's College of Pennsylvania in 1966 andare authored by six of the leading investigatorsin what might be truly called the new and modernera of dream research. The chapters are, for themost part, summary statements of work previous­ly pUblished, but several, notably the ones byWhitman et al and Dement et al, go beyond 1966and introduce both new experience and new theo­retical concepts. The dream scene is reviewedfrom the point of view of neurophysiologicalmechanisms (Jouvet), the pharmacology ofdreaming sleep (Hartmann), the function andclinical significance of REM sleep (Dement etal), the varying uses of the dream in clinical psy­chiatry (Whitman et al), the phenomenology ofdreaming (Snyder), and finally, a considerationof dreaming and dream research from the pointof view of classical psychoanalytic theory(Fisher) .

Jouvet has been among the foremost exponentsof the dual sleep theory. His work, based on ani­mal studies, has led him to conclude that thereare two distinct states of sleep which appear atdifferent levels of the phylogenetic scale and whichalso manifest differences ontogenetically acrossspecies. His studies support the view that sero-

66

tonin may be responsible for slow wave sleep(SWSj and the catabolism of serotonin may bethe triggering mechanism for some of the phasicactivity (parietogeniculate-occipital spikes) thatprecede paradoxical sleep (PS). In both an ex­perimental and theoretical extension of this workDement offers a number of interesting newthoughts concerning the correlation of neuro­humoral mechanisms and psychotic behavior. Re­nouncing earlier views on the significance of theREM state, his current emphasis is on the roleof phasic events such as the PGO (parieto-genicu­late-occipital) spikes that herald and character­ize the REM state. There are, therefore, two sys­tems involved in the REM state, one a tonic sys­tem maintaining the state itself and the otherphasic systems governing the PGO spikes, muscletwitchings, etc. Concerning earlier discrepanciesin experiments involving REM rebound, he nowconcludes that the important factor is the depri­vation of phasic events such as PGO spikes, ratherthan REM time per se. He suggests that psycho­sis is related to the failure to confine phasic eventsto the REM period and their consequent spillageinto waking life. Cats receiving p-chlorphenyl­analine (PCPA) show this dispersal and at thesame time display exaggerated drive behavior.Rebound fails to occur in theSe cats followingREM deprivation. Dement noted a similar absenceof rebound in acute schizophrenia and argues that,as in the PCPA cat, this may be due to the dis­charge of phasic events during the waking state.Considering such discharges analagous to whatgoes on during dreaming he concludes that theywould be psychotic events by definition. He re­gards REM sleep as a safety valve for a driveenergy accumulator system.

Hartmann reviews our present limited stateof knowledge concerning the influence of drugson the REM state and offers evidence in supportof the hypothesis that the build-up and meta­bolism of serotonin in the brain is essential inregulating the sleep-dream cycle. Snyder's p~per

summarizes a broad investigative program YIeld­ing much basic normative data concerning dreams.His effort to track and objectify the "typical"dream leads him to the conclusion that dreams aremuch more prosaic, much more banal and muchmore like waking thought than we generally con­ceive them to be.

Whitman et al offer the only direct clinicalapplication of REM research. They have in~

geniously integrated the laboratory-monitoreddream into treatment and into various aspects oftheir teaching and training program. The dreamsof a resident are monitored, for example, the nightbefore he is to make a clinical presentation sothat counter-transferential effects can be noted.Fisher, in a brief concluding chapter notes theways in which current research supports classical

Volume XIII