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BOOK REVIEWS
indebtedness to Freud, Erikson and Hartmann. Shedefines values as "preferred goals" which are part ofthe self which she defines, in tum, as a "process having direction" (Erikson), and a "system (whose)direction is toward fulllllment via integrated operation of the four basic tendencies" (p. 81).
On the basis of the foregoing constructs, the authorapproaches various technical problems encounteredin psychotherapy from the initial contacts with thepatient until its termination. She expresses herseHwith a warmly empathic understanding of both thepatient and his therapist which consistently pervadesall that she has to say, especially in her clinical examples. There is a tendency to be repetitious and,at times, somewhat ambiguous, but these are minorcriticisms. The "discussions" of each member of agroup of psychologists who participated in a seminar, with the author, which was devoted to the subject of the book's title, represent no meaningful additions to the volume. An exception would be thelengthy section written by Rudolf Ekstein on changing values in psychoanalytic treatment as related tothe social matrix out of which it evolved and inwhich it has been practiced.
In the main, the author succeeds in her stated goalsand, thereby, makes a meaningful contribution tothe psychotherapist's problem of making insightfunctional. This is a book which must be digestedslowly, but the rewards make the effort worthwhilebecause of the productive mental stimulation provided. This reviewer believes that the book will beof greatest value to psychiatrists and those other physicians who have made it a practice to acquire ameaningful understanding of the psychological needsof their patients.
SIDNEY L. GHEEN, M.D,
EPIDEMIOLOGY OF MENTAL DlSORDER-ASymposium to commemorate the centennial of thebirth of Emil Kraepelin, co-sponsored by theAmerican Public Health Association and held atthe New York meeting, December 27-28, 1956.Edited by Ben;amin Pasamanick, Washington, D.C.:American Association for the Advancement ofScience, 1959. 295 pages.
This book contains a considerable wealth of material mostly concerned with various etiological factors in mental disorders. It is introduced by an extensive presentation of Kraepelin's biography andcontributions, which certainly should attract interest.
A number of original studies offer many challenging conclusions and give good insight into methodology of psychiatric research. We find here a study ofvarious factors affecting mental health of adolescents,including family mobility, broken homes, affiliationwith community organizations, place of residence, etc.Other studies are concerned with the occurrence ofschizophrenia in different social groups. The economicfactor and place of residence is stressed again andbasic findings agree with some similar investigationsin pointing out the prevalence of this condition inthe lowest social and economic groups. Here again,however, the basic question of distinguishing between the cart and the horse presents a challenge.Some positive relationship is found between the his-
September-October, 1963
tory of early nervousness and premature birth rate.Epidemiological studies of mental disorders in smallcommunities and in larger centers are also reported.An excellent table is prepared by the authors of thepaper on epidemiological aspects of prognosis, analyzing the prognostic value of a number of the premorbid factors and those observed during the courseof illness. Such statistics may be of value for theauthors of current textbooks on clinical psychiatry.An ingenious study of the deaf population concludesagainst an increased prevalence of schizophrenia inpeople deprived of hearing. A peculiar seasonal variation has been found in mental hospital admissionsfor old-age psychoses. The summer months, froml\1ay to August, appear to provide a considerablylarger percentage of admitted cases. An unusual historical flavor has been added to this conclusion bycomparing it with findings of Dr. Esquirol in hisarticle prepared in France in 1816. In spite of thedifference of 150 years, identical conclusions are observed.
A conclusion of the paper on intellectual potentialin infant population is worth quoting here: "At thepresent time the most useful theory is that whileman's fundamental structure and consequently hisbasic functioning is genetically determined, it is hissocio-cultural milieu, affecting biological and psychological variables, which modifies his behavior and,in the absence of organic brain damage, makes oneindividual significantly different from the next."
A research minded psychiatrist and many othermedical practitionf'rs will find this hook well worthstudying.
VICTOR SZYRYNSKI, l\I.D., Ph.D.
TEST SCORES AND WHAT THEY 'MEAN. ByHoward B. Lyman. 223 pages. Englewood CliDs,N. ].: Prentice Hall, Inc., 1963.
This paperback book should be entitled, "TestScores and Their Statistical Meanings." The authorstates that his intentions are "to meet the needs ofthose with Iimitf'd training.... Without a specialstudy of test scores, anyone is likely to confuse percentage-correct scores with percentile ranks, percentile ranks with standard scores, standard scoreswith normalized standard scores, normalized standardscores with I.Q.s, et cetera."
The hook covers such topics as: maximum-performance vs typical-performance tests and statisticalbackground material for interpreting quantitativeresults. The author discusses test information andthe communication of results. A limited though selected bibliography is presented, as well as an excellent glossary of terms, and very valuable conversion tables for derived scores.
This is an excellent book for students who arestudying psychology in the statistical-experimentallaboratory tradition. It should be required readingfor the clinician who very often uses a psychologicaltest without examining its statistical construction forstrengths and weaknesses.
Unfortunately for its potential readers, it is alsothe kind of book that frightens the practitioner because it is directed toward the understanding of num-
307
PSYCHOSOMATICS
bers rather than patients. The author assumes unjustifiably that a lay reader can plunge through thishighly technical material with "little or no trainingin measurements." He does make a substantial contribution and he has much to teach, but this worthwhile book will only reach students because of required reading, researchers who evaluate tests for thegeneral market and mature professional workers whohave a vigorous curiosity about the tests they use.
BENJAMIN KOTKov, Ph.D.
PHYSIOLOGICAL CORRELATES OF PSYCHOLOGICAL DISORDER. Edited ~V Robert Roessler,M.D. and Norman S. Greenfield, M.D. 281 pages.Madison, Wise.: University at Wisconsin Press,1962. $6.50
The papers presented in this volume provide anexcellent opportunity for the exploration of interdisciplinary problems.
Dr. William Malamud, in the Introduction, discusses major trends in current psychiatric research.He stresses the need for emancipation from the dualistic mind-body concept.
The biochemical considerations in schizophreniaare considered by Doctors Tourney, Frohman, Beckettand Gottlieb. Their investigations in intermediarycarbohydrate metabolism have demonstrated thatchronic schizophrenics manifest an inability to mobilize adenosinetriphosphate (ATP) as an adaptiveresponse. The factor has been identified as an alphaglobulin. They present the hypothesis that certainpatterns of life experiences may activate a dormantinborn metabolic defect.
Dr. Albert F. Ax discusses interdisciplinary researchmethodology. He offers the possibility that the utilization of proprioceptive information is impaired insome schizophrenics.
Cortical excitability in psychiatric disorders is considered by Shagass and Schwartz. By recording cortical potentials, it is noted that the phase of recoverywas delayed in patients with psychotic depressionand showed a return to normal after successful treatment.
J. "V. Lovett Doust reports on "Consciousness inSchizophrenia as a Function of the Peripheral Microcirculation". Much of the thought disorder, as wellas the ambivalence, catatonia, loss of ego boundariesand the perplexity evidenced by the patient is relatedto a disturbance of consciousness. The author summarizes the results of neurophysiological rescarch bystating that the neural lesion in schizophrenia is amidline one, subcortical rather than neocortical, lyingprincipally in the brain stem and extending upwardto the midbrain.
A most significant contribution is offered by Dr.William Pollin. His paper considers questions ofmethodology, especially the use of so-called "normalvolunteers". The relationship of the subject to theresearch environment and the investigator receives amost penetrating analysis.
"Adrenocortical Function During Anxiety" is another significant paper. Presented by Dr. HaroldPersky, evidence is again provided that the plasmahydrocortisone level, urinary hydroxycorticoid and17-ketosteroid excretion and blood corticotropin level
308
are all significantly increased in emotionally disturbed patients.
Dr. Donald Oken, in a most stimulating paper, explores the role of defense in psychological stress.Novel or ambiguous stimuli are potent. "Maturity",he states, "has sometimes been defined as the abilityto tolerate ambiguity".
Studies in obesity are reported by Dr. AlbertStunkard. The author points up the need to searchfor different types of obesity rather than for theircommon characteristics. In some, obesity is closelyinterrelated with their neurosis. Night-eating is associated with poor prognosis; it is difficult to influenceby psychotherapy but does respond to some degreeto anti-depressants. "Binge eating" is apparentlybetter influenced by psychotherapy.
These above-mentioned references fail to do justice to the many significant contributions of otherinvestigators. They are only a sample of the richfund of information found in this most valuable contribution to psychosomatic medicine.
W.O.
EXPERIMENTAL FOUNDATIONS OF CLINICALPSYCHOLOGY. Edited by Arthur ]. Bachrach.641 pages. New York: Basic Books, 1962. $10.10.
In this major attempt to bring together the experi-mental bases for clinical practice, we meet 21 contributors representing nearly every aspect of the field,from history and theory, learning and communication,to psychophysiology and psychotherapy.
Certain sections deserve special attention. Thechapter on psychophysiology by P. B. Dews encourages communication between the experimentalists andthe clinicians, and offers criteria which, if violated,should lead the non-expert to question the research:
1. The results of studies conducted in the behavorial frame of reference should be described in behavorial and not neurophysiological terms. Conversely, thevalidity of conclusions about behavior drawn fromneurophysiological studies is limited by the validity ofthe behavorial technique used-which he says has generally been poor.
2. Since probably all drugs have more than onetype of action, inferences from studies based on assumption of specificity of effect must always considerthe possibility that other actions of the drug areinvolved; as an example, the author traces the multiplicity of effect of d-tubocurarine chloride, which hashad considerable use as a tool in such studies.
3. If the effect of a drug is stated in categoricalterms to be on a certain gross anatomical region ofthe brain, the reader is justified in being skeptical.
4. The same terms used by both psychologists andphysiologists frequently do not have the same meaning; it is important to find out in which sense the termis used in a given context.
In short, he cautions mistaking plausible theoriesfor proven explanations.
One of the more unusual chapters is Karl Pribram'sprovocative attempt to put Freudian theory back intoits neurological cradle and to trace its developmentfrom that point. He notes that one of the majorproblems of concern to Freud, one whose unsatisfactory outcome led him to turn in other directions, isalso one toward which current research is being directed; this is the problem of the organism's need to
Volume IV