Book ReviewsINTESTINAL BIOPSY. Edited by G. E. W. Wol­

stenholme and Margaret P. Cameron. 120 pages.Boston: Little, Brown, 1962. $2.95.

The purpose of the volume is to permit readersin various centers of the world to gain easy refer­ence to the latest advances on intestinal biopsy. Theone day study group met on May 23, 1962, at thoInstituto de Investigaciones Clinicas y Medicas inMallrid. The group was convened in honor ofProfessor C. Jimenez Diaz and the subject discussedevolved around his work. The informal exchange ofideas and differences of approach to problems andinterpretations of solutions are gathered in the book­let. ~Iany clear microscopic views of the intestinalmucosa in health and in disease, and numerous il­lustrative tables and charts are shown.

Among the subjects discussed are electron micro­scopy studies of fat absorption in steatorrhea, biopsystudies on the pathogenesis of celiac sprue; intestinalbiopsy in tropical sprue; and the significance of mu­cosal damage. Research on the morphological char­acteristics of normal and abnormal small intestinalmucosa studied by histological and histochemicalmethods with the light microscope, by the electronmicroscope, and by the dissecting microscope areprcst-nted.

LEO WOLLMAN, M.D.

LECTURES IN DYNAMIC PSYCHIATRr. Editedby Milton Kurian, M.D. and Morton H. Hand,M.D. N. Y.: International Unicersities Press, 1963.

This text consists of a series of lectures which wasorganized by the Committee on Postw-aduate Edu­cation for Psychiatrists of the Brooklyn PsychiatricSociety. The essays were originally recorded on tape;the laborious transcription and final editing was thework of the Editors.

The lectures include the following topics: "SomeBasic Concepts of the Dynamics of Therapy" (San­dor Lorand, M.D.); "Child Psychiatry and the AdultPersonality" (Richard M. Silberstein, M.D.); "Anxietyand Phobias" (Irving Bieber, M.D.); "The Psycho­pathology and Management of Paranoid States" (Wil.liam G. Niederland, M.D.); "Obsessional Neurosis"(Ludwig Eidelberg, M.D.); and "Family Diagnosisand Treatment: Some General Principles" (NathanW. Ackerman, M.D.).

~Iost noteworthy was that all of the lectures wereoriented towards technique and practical manage­ment. Theory was held to the barest minimum; suf­ficient time was available for audience participationafter each of the lectures, so that these "lectures"were really seminars.

This hook is of value for those psychiatrists whoare interested in improving their own techniques. Thelecturers, all authorities in the field of psychoanalysis,are to be congratulated on their ability to communi­cate so effectively in an area that is ordinarily filledwith ambiguity.

W.D.

May-June, 1964

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CLASSICS OF CARDIOLOGY. By Fredrick A. Wil­lius and Thomas E. KelJs. 2 Volumes. XXXI+858pages. 103 illustrations. 2 incIexes. Bibliography.Table of CorrelatiOns with Contemporary Events.New York: Dover Publications, 1962 (Paperback re­print).

As medicine progresses in a logarithmic increase,and in reading, the physician like Lewis Carroll'sAlice "has to run, as fast as he can just to stand stilland still faster just to move ahead," there is an under­standable if regrettable tendency to take the past forgranted. There is no looking back, only onward andupward. Perhaps the path would prove less treacher­ous, and perhaps less formidable, if one could reviewin their own words, the experiences of the earliestmedical pioneers as they sought out paths, burningand hacking through the thickly intertwined under­brush of superstition, fear and ignorance or climbingover the granite walls of dogmatic authoritarianism.

In these two volumes, two eminent members of theMayo Clinic have gathered 52 classic papers on theheart by 57 European and American physicians andresearchers. These papers were originally publishedfrom 1628 (Harvey) to 1912 (Merrick). Many ofthem are relatively unobtainable. Here, we findthem, some in their entirety, the rest in major ex­cerpts, and all in English.

Here are Harvey's epochal essay on the Motion ofThe Heart and Blood, Reverend Hales paper onBlood Pressure, Heberden on Angina Pectoris, Laen­nec on Mediate Auscultation, Morgagni and Adamsand Stokes on Heart Block. Here are Senac onQuinine in Arrhythmias, Withering on the Foxgloveand Brunton on Amyl Nitrate. Here are Waller andEinthoven on the Electrocardiogram and Mackenzieon Auricular Fibrillation and Herrick on CoronaryOcclusion . . . and many others.

Each of the essays is preceded by a portrait of theauthor and a more than casual biography. There aremany illustrations.

This is an excellent pair of books which belong inany physician's library. No internist should be with­out it.

SAMUEL L. SWILLER, M.D.

THE THERAPIST'S CONTRIBUTION TO THETREATMENT PROCESS. Hugh Mullan, M.D. andIris Sangiuliono, Ph.D. 280 pages. Springfield, Illi­nois: Charles C Thomas, 1964. $8.50.

This penetrating and most unusual hook concen­trates on the therapist rather than the patient. It isa searching and most apropos re-evaluation of psycho­therapeutic methods in view of contemporary con­ditions and needs. The problems of the therapist inhis own needs for satisfaction; the continuous strug­gle to relinquish strivings for omnipotence are scrut­inized in detail.

The authors make no attempt to create a new

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brand of psychotherapy, but in~-tead most convincing­ly bring to the reader methods of re-orientation thatare constructive, meaningful and educational. Psy­chotherapists will find much here that will help themin their management of "resistant" patients.

The image of the passive, anonymous psychotherap­ist as an amorphous blank screen, where omnipotenceis thus maintained, is seriously questioned. The needfor "engagement" of therapist with the patient is ex­plored in individual, group and multiple therapy.Orthodox psychoanalysis is seen to neglect the totalperson of both therapist and patient as well as thefull meaning of their moment-to-moment engagement.Although Freud recognized the presence of counter­transference, the authors dissect its ramifications andnuances.

Existentialism is seen as a fresh approach to theproblems of psychotherapy by requiring a genuinechange in the therapist himself. The latter is no long­er obsessed by an exclusive search for childhoodtrauma; he experiences and responds to the presentand his encounter with the patient. The personalityof the thearapist, and not that of the patient, is con­sidered the most vital ingredient of effective therapy.Most critical is the need for self-questioning andcritical evaluation of all of psychotherapy.

It is noted that the patient comes to therapy inorder to maintain (or obtain) a rationally conceivedexistence; it is the therapist's task to provide an evengreater realization that life is full of paradoxes intowhich one must fit. Successful therapy removes theneed for a magic formula to produce order from dis­order and corrects the individual's feeling that it is alldue to a defect or weakness.

The authors conceive of the psychotherapeutic ex­perience as the emergence of a meaningful philosophyof life which is based upon the uniqut'I1l'SS of each in­dividual.

This book should be required wading for all psy­chotherapists, regardless of their special training oraffiliations. The authors, in focusing on the therapist,have extended the frontiers of psychotherapy. Boththe dynamically oriented as well as the organicists mayfind areas that conflict with their respective orienta­tions; nevertheless, the basic premise of a need for are-evaluation of what goes oil-or should go on­during the patient-doctor relationship should he mo~-t

provocative.w.o.

THE TERMINATION OF INTENSIVE PSYCHO­THERAPY. By MarshaU Edelson, .\I.D., Ph.D.Edited by Howard P. Rome, .\I.D., .\Iayo Clinic,Rochester, Minnesota. 84 pages. Springfield, Il­linois: Charles C Thomas, 1963.

This short, 84-page book is a dist'ussion of psycho­therapy that is psychoanalytically oriented. Theauthor describes the transference situation and at­tempts to indicate when and how the therapy can beterminated. It is one of a series of lectures on clin­ical psychiatry edited by Howard P. Rome of theMayo Clinic. In the preface, the author states: "Inthe follOWing chapters, the experience of terminationwill be considered, first, as a universal human experi-

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ence to which the therapist must be open in order tounderstand its impact upon himself and the patientencountering separation and loss in therapy; andsecond, as an experience which has specific signifi­cance in therapy, in which many themes in the in­dividual patient's life, in his character, and in thework of therapy, come together and find resolution."

There are seven chapters, a bibliography, and anindex, but the discussions are not very well organizedand are somewhat disjointed. Certainly it is not abook that would be found of much help to the be­ginner.

On page 14, the object of the author is well stated:"The problem of termination is not how to gettherapy stopped, or when to stop it, but how toterminate so that what has been happening keeps on'going' inside the patient. The problem of termina­tion is not simply one of helping the patient toachieve independence in the sense of willingness tofunction in the physical absence of the therapist.More hasically it is a problem of facilitating achieve­ment hy the patient of the ability to 'hang on' to thetherapist (or the experience of the relationship withthe therapist) in his physical absence in the form ofa realistic intrapsychic representation (memories,identification-associated with altered functioning)which is conserved rather than destructively or venge­fully abandoned following separation, thus makingmastery of this experience poSSible. The therapistclarifies all distortions of himself by the patient, inter­preting transference phenomena or parataxic distor­tions as these are manifested in the patient's be­havior, vcrbal productions and dreams, to help guar­antee the integrity of the patient's intrapsychic repre­sentation of the therapist and his relationship with thepatient. The therapist is willing to present himself asa real pt·rson. not as an impersonal shadow-even ifthis were possible-and is willing that the patientidentify with and remember him, processes by whichthe patient may master the pain of separation andloss. This willingness is indicated by the therapist'sawareness and acceptance of his own identificationwith the patient."

JAMES L. MCCARTNEY, M.D.

PROCEEDINGS OF THE SECOND COLLO­QUIUM FOR POSTGRADUATE TEACHING OFPSYCHIATRY. (Los Angeles, 1963). 116 pages.Washington, D. C.: American Psychiatric Associa­tion, 1963.

In the introduction, Dr. Philip Solomon. chairmanof the APA Committee on Psychiatry and MedicalPractice, indicates the rapid growth of courses in theteaching of psychiatry for the general practitioner andthe non-psychiatrist. What to teach, and how to teachit are the major concerns facing those involved in thiseducation; attempts are also made to evaluate thevalue of these teaching efforts.

Dr. Jackson A. Smith spoke on "What the Non­psychiatrist Does Not Want" and emphasized that ifpsychodynamics cannot be explained in a lectureseries, it should not be taught. Dr. Beverley T. Meadpointed out that those physicians interested in post­graduate programs are already more skilled than their

Volume V