Biobehavioral aspects of aggression

350 ing violence, is merely "an expression of functioning (possibly dysfunctioning) brain.' In view of the definition of psychosurgery presented by the U.S. National Commission's report, the proposition that there might be an understandable relationship between brain and behavior even in the absence of structural or functional defects (detected by accepted diagnostic methods), is critically reviewed by several contributors. Some multidimensional aspects and 'explanatory models' of mental disorders are discussed by Valenstein in chapter 15. Some authors, considering our deplorable ignorance, must be commended to avoid fruitless polemics and ask for constructive research work intended to provide solid information concerning the benefits a n d / o r hazards of psychosurgical treatment. The pilot- and follow-up studies pertinent (chapter 9: A Prospective Study on Cingulotomy by Corkin, and chapter 10: Two Retrospective Studies of Psychosurgery by Mirsky and Orzack) are admittedly far from complete and do not withstand the critique by Choreover in chapter 11. Nevertheless they do show that appropriate further research may help to illuminate the question as to which patients may receive benefit from which type of psychosurgical intervention. An excellent and concise chapter by Perkoff is dedicated to the analysis of The Meaning of "Experimental.' This contribution. which leads over to the legal (part V) and ethical issues (part VI) discusses the motives of the physician and the question, how far the outcome of a procedure can be predicted, as important factors. Using three models (The Practical Governmental Model, the Medical Investigative Model and the Legal Model) the author enters also the knotty problem of clinical research and experimentation and mixed motivation. In the same chapter the view is expressed that even in the absence of an orthodox therapy it is the physicians' duty to try and offer the help the patient is seeking for. Within the Legal Issues the chapters of Pizzulli, Shuman and Carnahan and Mark are found most instructive, especially for discussing in detail the concept (and the legal doctrine) of 'Informed Consent'. Annas, like others, promotes an approach which protects the individual's right of self-determination. The chapter of G r i m m on the Regulation of Psychosurgery lists the detailed U.S. National Commission's Recommendations as issued in 1977. It must be helpful, especially for European readers, to learn that in some Western U.S. states legislative regulation on psychosurgery virtually ended the practice by 1980 and that the spilling-over of the debate on psychosurgery from traditional psychiatric and neurosurgical circles into the public forum had a general inhibiting effect. Faced with an antipsychiatric/antipsychosurgical movement, which aims at extreme restrictive measures against neurosurgical interventions, the question of some authors as to the risk of withholding such treatment is pertinent. Some of the chapters dealing with Ethical Issues are obviously written by spokesmen of this antipsychiatric movement. While to some of these authors respectable intentions may be attested it is hard to find justification (other than the will to heat the controversy) for reprinting Breggin's chapter on Brain Disabling Therapies. This simply turns out to be directed against all major somatic therapies for mental disorders with the

BOOK REVIEWS statement that "the somatic therapies produce brain damage and dysfunction and thereby comprise the personal sovereignty and personal freedom of the individual.' On the background of such and similar demagogic common places, which completely scotomize the progress of the past thirty years it surprises that the opposite view namely that there might be a limit to the 'right to be unhealthy' is only mentioned incidentally. The most difficult problem, namely whether or not organic treatment of locked up patients is justifiable, is discussed by Brown in the last chapter. Delgado. as a final step, asks the question that consequently arises in "successfully' operated captives: What shall we do with such 'technologically rehabilitated' individuals if their disposition to commit violent crimes may have been reduced to normal or even below normal levels? The best way to close these comments may be the statement that the messages conveyed in this volume, dealing with an area so controversial and often lacking in hard data, cannot be considered a complete analysis of this complicated and important subject: no one exposition could be. But this volume helps to organize and advance existing thoughts in a way that might serve as a catalyzer and therefore as a useful basis for future public forum discussions, which we shall likely to be confronted with. Furthermore it will be helpful for physicians who are obliged to make decisions since they are the ones who have to grapple with the daily problems of mental disorders, such as suicid, depression, paranoia or self-mutilation, and generally deal with the complex realities of human misery. H.G. WIESER

Neuroh)gical Clinic/EEG. Universi(v Hospital, Zurich (Switzerland)

Biobehavioral aspects of aggression. - - D.A. Hamburg and M.B. Trudeau (Eds.) (Liss, New York, 1981, 288 p., U.S. $38.00) Violence is a topic that should interest each reader of this Journal, since the phenomenon is increasing in incidence and touches each of us in some direct or indirect way. For clinical electroencephalographers whose specialty is also epilepsy, the possible relationship of temporal lobe epilepsy to aggressive behavior is a topic of considerable interest, as is the 'episodic dyscontrol syndrome.' However, the present book will not summarize for our readership all of the relevant papers on the latter two questions, but instead will better present the related psychological and sociological aspects of the problem. Nearly 75% of this book is devoted to behavioral aspects of aggression. The chapter by Barchas is a brief presentation of the conceptional approaches to aggressive behavior, followed by Trudeau et al. who deal with the chimpanzee who exhibits responses roughly similar, to h u m a n anger and aggression. Tinklenberg and Ochberg call attention to the rising incidence of reported violent crime in U.S.A. and present an interesting study emphasizing the importance of guns, alcohol and time of assault. Berger and Gulevich deal well with the time-honored

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problem of relationships between mental illness and violence. The antisocial personality, episodic dyscontrol syndrome and paranoid schizophrenia are the three psychiatric diagnoses that have been associated with violent behavior. The most important aspect of this chapter is the one-page (only) discussion on the episodic dyscontrol syndrome, a phenomenon viewed by the authors as requiring further investigation. A clinical study on alcohol and violence follows by Rosenbaum and colleagues who report no significant differences in the EEG of violent and non-violent drinkers. However, the authors conclude that a subtle form of brain damage exists in the violent drinkers in the form of visual scanning, retention and spatial orientation problems. J.T. Gibbs reports a clinical study involving therapeutic interventions in family conflicts and the last chapter by Blumenthal deals with the attitudes toward violence in American society. The middle fourth of the book is of greatest interest to readers of this Journal. For example, Haber addresses the problem of amygdalectomy in modifying behavior and the use of amphetamines to change behavior. Eichelman et al. in their chapter on biochemical and pharmacological approaches conclude that (1) no single regulator is a unique signal for aggression, (2) neuroregulators controlling aggression also influence other behaviors, and (3) each neurotransmitter influences multiple behaviors. In a chapter on pharmacology of violence, Leventhal and Brodie expertly discuss the use of lithium, anticonvulsants, antipsychotic, antidepressant and anti-androgen agents for pharmacological intervention. One section on electrical dysfunction will be somewhat disappointing to the reader who wishes to see all of the relevant studies summarized on the topic of EEG abnormality and violence and also on the possible relationship to temporal lobe epilepsy. Hays summarizes well the psychoendocrinology of puberty and adolescent aggression. For the reader who is already acquainted with the EEG and epilepsy literature relating to aggressive or violent behavior, this book will provide an excellent summary of the psychological and sociological aspects of the problem. Also, for the reader who wishes a good summary of the pharmacological data relating to aggression, this book will be useful. JOHN R. H U G H E S

University of Illinois Medical Center, Chicago, Ill. 60612 (U.S.A.)

Recent advances in EEG and EMG data processing. - - N. Yamaguchi and K. Fujisawa (Eds.) (Elsevier/North-Holland Biomedical Press, Amsterdam, 1981. X ! I ! + 4 2 1 p., Dfl. 148.00) This book covers the papers of a Conference on EEG and E M G data processing, held in Japan in September 1981 as a Satellite Symposium to the Kyoto International Congress. The idea of such a publication - - a comprehensive review of recent advances in a particular research field - - is certainly satisfied by this volume, since a wide field of appli,zation, for the clinical and the experimental researcher as well, is covered.

Apart from some articles, which deal with rather complex mathematical problems in a sometimes superficial way, I found some very good reviews, which not only give an insight into the mathematical background, but also direct examples for applications. However, after having read the book, I have the feeling, that various methods of biological data analysis are often used with no regard to a well formulated scientific question. Nevertheless this book can be recommended to all those who are interested in automatic data analysis for EEG and E M G and who wish to keep up with some of the newest trends in this field. H. P O C K B E R G E R

Institute of Neurophvsiologv, University of Vienna, Vienna (Austria)

Febrile seizures. - - K.B. Nelson and J.H. Ellenberg (Eds.) (Raven, New York, 1981, 360 p., U.S. $38.00) This excellent symposium volume comprehensively reviews most aspects of febrile seizures. The reviews are clinically oriented and uniformly scholarly, up to date, and written by persons eminently qualified to discuss their topic. The epidemiologic, pharmacologic and prognostic aspects of febrile seizures are covered especially well. The chapters contain sufficient original data, references and formal discussion by other participants to make them valuable to medical researchers. In addition, each chapter has a summary, and there is a consensus statement on febrile seizures at the end of the book. The clinical orientation of the book's material and the availability of summaries make this volume extremely valuable to the busy practicing physician. The one disappointment this reviewer had concerned the coverage of EEG in the management of febrile seizures. There is no chapter devoted to EEG in this otherwise complete volume. Moreover, the consensus statement concludes'. 'The role of the EEG in the work-up of febrile seizures remains controversial. Abnormal EEGs do not reliably predict the development of epilepsy in patients with febrile seizures.' While an objective review of the available studies could result in this conclusion, the available studies may be misleading. The book's conclusion about the unreliability of EEG apparently stems from the high incidence of transient postictal slowing after febrile seizures and the high reported incidence of 'spikewave' EEG abnormalities in patients with febrile seizures. The latter finding may be the result of confusion of normal sharp and slow activity (hypnagogic bursts, sharp vertex waves, posterior slow waves of youth, etc.) with paroxysmal activity. There is also recent evidence that spike-wave activity in association with childhood hypnagogic bursts may have a different prognostic significance than waking spike-wave activity. The EEG may be a valuable tool in identifying focal cerebral lesions and high risk of afebrile seizures in patients with febrile seizures if postictal slowing and normal sharp and slow activity are ex-