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Aspects of psychiatric research
PSYCHOSOMATICS their presentations the recent advances made in transplantation problems and discussed and speculated on the implications of these advances. Antigens, hemagglutinins, the immunological relationship between mother and fetus, tolerance and immunity of tissues, tumor immunogenetics, homograft reactions and sensitivity, and the role of the thymus were some of the subjects presented. LEO WOLLMAN, M.D.
ASPECTS OF PSYCHIATRIC RESEARCH. Edited by D. Richter, ]. M. Tanner, Lord Taylor and O. L. Langwill. 445 pages. New York: Oxford University Press, 1962. $14.50. Twenty contributors, all from England and Scotland, helped produce this excellent account of current research. Each chapter reviews the progress of the last decade and assesses the situation as it stands at present. The scope of the book ranges from "neurophysiology to sociology." Mental disorder is apparently as common in British culture as it is in America. There is, however, evidence that the British have been emancipated from some of the medieval concepts that are still present in America. ~Iost significant is the Mental Health Act of 1959, which enables any mentally ill person to be received and treated by any hospital. Mental illness has thus been officially classed as illness. The recent AMA recognition of psychiatry may be the forerunner of this eventuality in the United States. Coupled with the above is the fact that new empirical methods, involving chemical and physical procedures, have revolutionized the outlook for the patient with severe psychiatric illness. In considering environmental factors, four are considered: social isolation, the stress of migration, untoward experiences in childhood, and bad socioeconomic conditions. An interesting comment, in comparing psychiatric treatment in different countries, is the statement that "psychiatrists in America treat conflicts, whereas in Europe they treat symptoms" (page 118). A consideration of the mentally subnormal includes observations on cretinism, phenylketonuria and the use of glutamic acid to improve faulty cerebral circulation. Chromosome abnormalities, the techniques of chromosome study and the associated abnormalities are discussed. "Biochemical Errors" provides a lucid presentation of the problems of phenylketonuria, galactosemia, Hartnup disease, et cetera. An interesting chapter points up the relevance of animal studies to human neurotic disorders. The stereotyped nature of many neurotic symptoms, their persistence, and their apparent irrelevance to the underlying conflict, are apparently not without parallels in animal behavior. A fascinating chapter on childhood bereavement and psychiatric illness is contributed by John Bowlby. The main pathogenic agent is seen to be the loss of the mother-figure between the age of six months and six years of age. Bowlby offers an interesting point in the understanding of depression following the
202
death of the mother; he relates this to the need to recover the mother and the anger engendered by "her desertion." The repression of these feelings results in chronic depression. Delinquency and psychopathic behavior are seen to be correlated with parental loss in the early years; suicide attempts have also been linked with this loss. Psychoanalytical observations of chronic schizophrenic reactions point up the difficulties encountered in the treatment of these patients-especially those created by the advent of a negative transference. A chapter on psychophysiological problems of epilepsy considers various forms of psychiatric disturbance, ranging from neurotic reactions to the social disability created by epilepsy, to the "epileptic personality:' It is noted that as psychotic symptoms occur, attacks diminish. Control of seizures sometimes produces a paradoxical increase in behavior disturbances. The chapter on the biochemical factors in schizophrenia reviews recent research in detail. A disorder in carbohydrate metabolism is claimed by the findings of increase in the rate of turnover of adenosine triphosphate, the elevation of the lactate/pyruvate ratio, and the fact that an inhibition of uptake of glucose is related to a factor in alpha globulin of schizophrenic serum. The methodology of drug study is subjected to close scrutiny. The difficulties in evaluation are underscored. It is noted that a review of the voluminous literature on chlorpromazine revealed a "striking lack of specification and communication of what is being evaluated:' Electrolytes and their relation to ps)'chiatry certainly help to lessen the gap between medicine and psychiatry. Sodium depletion, hyponatremia, and magnesium deficiency are seen to have psychiatric sequelae. The final chapter, dealing with the treatment of depression, is concerned with three separate, but interrelated, problems: the abolition of the attack, the prevention of further attacks, and the symptomatic treatment and support of those patients whose attacks cannot be aborted. This book is a most readable account of recent research in psychiatry; it is written with clarity and can be read with profit by the non-psychiatrist as well as the psychiatrist.
W.D. LECTURE NOTES ON PSYCHOWGICAL MEDICINE. By T. Ferguson Rodger et oL. 105 pages. Edinburgh and London: E. S. Livi~ston, Ltd. (U. S. distributor, Williams c.nd Wilkins) 1962. $2.25 (Paperback). This short outline of lecture notes, intended to be supplemented by additional reading, is well organized and clearly presented. The chapter on the "Psychiatric Interview" states "... the clinical approach which is derived from the whole of medical training applies just as much when dealing with psychiatric cases as with physical:' Although a few sections (e.g. Legal and Forensic Psychiatry) are not applicable in this country, this is a good book to have on hand as a quick reference and guide. LEONARD J. SClUFF, M.D. Volume V
ASPECTS OF PSYCHIATRIC RESEARCH. Edited by D. Richter, ]. M. Tanner, Lord Taylor and O. L. Langwill. 445 pages. New York: Oxford University Press, 1962. $14.50. Twenty contributors, all from England and Scotland, helped produce this excellent account of current research. Each chapter reviews the progress of the last decade and assesses the situation as it stands at present. The scope of the book ranges from "neurophysiology to sociology." Mental disorder is apparently as common in British culture as it is in America. There is, however, evidence that the British have been emancipated from some of the medieval concepts that are still present in America. ~Iost significant is the Mental Health Act of 1959, which enables any mentally ill person to be received and treated by any hospital. Mental illness has thus been officially classed as illness. The recent AMA recognition of psychiatry may be the forerunner of this eventuality in the United States. Coupled with the above is the fact that new empirical methods, involving chemical and physical procedures, have revolutionized the outlook for the patient with severe psychiatric illness. In considering environmental factors, four are considered: social isolation, the stress of migration, untoward experiences in childhood, and bad socioeconomic conditions. An interesting comment, in comparing psychiatric treatment in different countries, is the statement that "psychiatrists in America treat conflicts, whereas in Europe they treat symptoms" (page 118). A consideration of the mentally subnormal includes observations on cretinism, phenylketonuria and the use of glutamic acid to improve faulty cerebral circulation. Chromosome abnormalities, the techniques of chromosome study and the associated abnormalities are discussed. "Biochemical Errors" provides a lucid presentation of the problems of phenylketonuria, galactosemia, Hartnup disease, et cetera. An interesting chapter points up the relevance of animal studies to human neurotic disorders. The stereotyped nature of many neurotic symptoms, their persistence, and their apparent irrelevance to the underlying conflict, are apparently not without parallels in animal behavior. A fascinating chapter on childhood bereavement and psychiatric illness is contributed by John Bowlby. The main pathogenic agent is seen to be the loss of the mother-figure between the age of six months and six years of age. Bowlby offers an interesting point in the understanding of depression following the
202
death of the mother; he relates this to the need to recover the mother and the anger engendered by "her desertion." The repression of these feelings results in chronic depression. Delinquency and psychopathic behavior are seen to be correlated with parental loss in the early years; suicide attempts have also been linked with this loss. Psychoanalytical observations of chronic schizophrenic reactions point up the difficulties encountered in the treatment of these patients-especially those created by the advent of a negative transference. A chapter on psychophysiological problems of epilepsy considers various forms of psychiatric disturbance, ranging from neurotic reactions to the social disability created by epilepsy, to the "epileptic personality:' It is noted that as psychotic symptoms occur, attacks diminish. Control of seizures sometimes produces a paradoxical increase in behavior disturbances. The chapter on the biochemical factors in schizophrenia reviews recent research in detail. A disorder in carbohydrate metabolism is claimed by the findings of increase in the rate of turnover of adenosine triphosphate, the elevation of the lactate/pyruvate ratio, and the fact that an inhibition of uptake of glucose is related to a factor in alpha globulin of schizophrenic serum. The methodology of drug study is subjected to close scrutiny. The difficulties in evaluation are underscored. It is noted that a review of the voluminous literature on chlorpromazine revealed a "striking lack of specification and communication of what is being evaluated:' Electrolytes and their relation to ps)'chiatry certainly help to lessen the gap between medicine and psychiatry. Sodium depletion, hyponatremia, and magnesium deficiency are seen to have psychiatric sequelae. The final chapter, dealing with the treatment of depression, is concerned with three separate, but interrelated, problems: the abolition of the attack, the prevention of further attacks, and the symptomatic treatment and support of those patients whose attacks cannot be aborted. This book is a most readable account of recent research in psychiatry; it is written with clarity and can be read with profit by the non-psychiatrist as well as the psychiatrist.
W.D. LECTURE NOTES ON PSYCHOWGICAL MEDICINE. By T. Ferguson Rodger et oL. 105 pages. Edinburgh and London: E. S. Livi~ston, Ltd. (U. S. distributor, Williams c.nd Wilkins) 1962. $2.25 (Paperback). This short outline of lecture notes, intended to be supplemented by additional reading, is well organized and clearly presented. The chapter on the "Psychiatric Interview" states "... the clinical approach which is derived from the whole of medical training applies just as much when dealing with psychiatric cases as with physical:' Although a few sections (e.g. Legal and Forensic Psychiatry) are not applicable in this country, this is a good book to have on hand as a quick reference and guide. LEONARD J. SClUFF, M.D. Volume V