- Email: [email protected]
Captain Newman
162
PSYCHOSOMATICS
influencing the basic pacemaker pattern by centripetal autonomic and sensory centripetal impulses from the muscles and glands, which is reminiscent of the autonomic nervous system's control of the sino-auricular node of the heart. At the time this book was written there was less interest in understanding psychic energy than there is now with the widespread use of the MAO inhibitors and other anti-depressives. Anyone who is interested in neuro-anatomy and physics will flnd Dr. Colby's book very interesting-, but may also flnd the book difficult, perhaps because of Dr. Colby's own thorough grasp of the basic sciences. As a psychiatrist, Dr. Colby has temporarily departed from the id-ego-superego tripartite system of Freud in proposing this operational concept that embodies a new hypothesis of the meaning of psychic energy. Freud himself had once attempted to translate the meaning of psychic energy into a diagram that would also have R. neuro-anatomical meaning, but he was never able to do this to his own satisfaction. Dr. Colby's attempt does seem to be more meaningful than Freud's earlier attempts, but it must be taken as an hypothesis only, since no one can quite grasp exactly what psychic energy is, just as the mathematician uses the term infinity without being able to conceive of it. In the framework of this book, psychic energy is conceived of as never varying, either in depression or elation, which is somewhat analogous to the first law of thermodynamics which holds that the total amount of energy in the universe is always con· stant without ever any loss or gain. It would seem that Dr. Colby has cautioned us not to assume that there is any relationship between psychic energy and either physical activity or the ability to concentrate. The text presents a rather complex diagram, shOWing the hypothetical pulse pattern rising from the pacemaker and then passing through an unconscious "storage center," where all memory is stored from birth forward. Those pulse patterns that have proved useful to the individual in the past are augmented and coordinated, the reverse occurring if the pulse pattern drive has not proved useful. These electrical pulses then are cycled through the only two conscious areas, perception and thought, and then must re-enter the storage centers to record the emotion just experienced. If the pulse pattern emerges coordinated and augmented, it enters the motor outflow tracts and useful activity is begun. As long as the pulses remain uncoordinated, they must cycle again and again through the two con· scious areas, and this is felt as depression even though there may be a normal amount of psychic activity. It is hypothesized that this reo
MARCil-APRIL
peated "spinning of the wheels" in the thought and perception areas eventually weaves the pulse pattern into a coordinated one that may enter the motor areas resulting in a gradual return of normal muscular activity during recovery, even though there may have been no increased psychic energy. In this context depression might be compared to a car stuck in the snow where the wheels are spinning. When the wheels have worn the snow away down to firm ground, the car moves off without there being any change in the engine's energy output. In our ignorance about the very nature of psychic energy it is suggested by this reader that we avoid the term itself. To many patients (often those with a psychosomatic illness), a psychic energizer is seen as a "jaZZing up" drug, or if it is labeled as haVing an effect on mood or depression, a certain personal taboo may also be encountered. Such a drug is apt to be rejected or taken irregularly as a result of this psychologic rejection. Most people are willing to ascribe an illness to over-work, but not to depression, and it may be wisest not to tamper with this face-saving device. An appeal to the strong, realistic side of the personality is basic in psychotherapy, and this principle may well apply to the terminology of psychotropic drugs. A medication given a patient with the implication that he is "strong but overworked" may be more effective than if he is made to feel "weak and depressed," and the latter is implied by the prescription of a psychic energizer. The use of such terms as psychic energizers and tranquilizers does seem to promote the attitude that the personality is "weak." These drugs might be much more effectively employed if their nomenclature were designed to appeal to the stronger and more realistic part of the personality. Walter EraWl, M.D.
CAPTAIN NEWMAN, M.D. Leo Rosten, Harper & Bro••, N. Y. 331 page•• $4.95. The author, a leading social scientist and most versatile writer, has produced a stimulating story of a psychiatrist at an Air Corps base during the war. The doctor, analytically trained, is a "genius at therapy" but a genuine thorn in the hide of his military superiors. Although the book is labeled as fiction, many readers of Psychosomatics will qUickly find themselves in their Army Camps. Captain Newman is brilliant and intuitive as a psychiatrist, but shines even brighter as a human being. He constantly reserves the right to have feelings of his own, a role often denied to healers of the psyche. Although accused by nonbelievers of giving "every feather-merchant and
1962
PSYCHOSOMATICS
malingerer a year's therapy," he proves himself to be a competent officer rather than a wet nurse. Although gentle, he can be firm; even when angry he cannot be hostile. There is humor in this book as well as pathos. Excellent clinical descriptions of psychiatric illness and clear examples of psychotherapeutic skill prOVide an educational experience in the midst of hilarious comedy. W.D.
THE PRACTICAL APPLICATION OF MEDICAL AND DENTAL HYPNOSIS. Milton H. Erickson, M.D., Seymour Hershman, M.D., and Irving I. Sector, D.D.S. New York: The Julian Press, 1961. $12.50. This textbook is compiled from material presented at the Seminars on Hypnosis conducted around the country for the past several years. They have been transcribed from tape recordings, revised and edited. These seminars, conducted at the post-doctoral level for physicians, dentists, and psychologists, go into some detail about the inductions and other technics used in hypnotherapy. The authors state that "the full fiow of conversation has been preserved as transcribed from tapes, so that the reader may capture the entire sequence and interplay of events." Fortunately, the authors further state that "seminars and texts can only serve as beginnings in the training of individuals for the employment of hypnosis in their specialties. Beyond that point, it is essential for each student to practice, analyze, discuss with others, and gain as extensive and intensive experience as possible. Clearly, no seminar or single text can provide basic training for the internist, obstetrician, gynecologist, anesthesiologist, dentist, oral surgeon, psychologist, or psychiatrist. It is necessary to assume that each specialist has his basic training and then to demonstrate methodb and approaches by which he can apply his special training to the areas benefited by the employment of hypnosis. Inevitably, the various discussions of problems in any given specialty have overtones that also apply to others. Each specialist who seeks to employ hypnosis is dealing with people and with the problems of human nature." This textbook is unique, is well presented, and the detailed instructions are clearly brought out. Dr. Erickson has been in the field of hypnosis for many years and has had much opportunity to use it in its many ramifications. The co-authors, Drs. Hershman and Secter, are cognizant of the problems of practice, and their case records are well presented. The eleven chapters: "Outline of History and Theory of Hypnotism," "Suggestion and Hypnotizability," "The Phenomena of Hypnosis," "In-
163
duction Techniques," "Clinical Applications of Surgical Anesthesia," "Hypnosis in Obstetrics," "Hypnosis in Children," "Clinical Applications of Hypnosis to General Medicine," "Clinical Applications of Hypnosis to Psychiatry," "Hypnosis in Dentistry," and "Hypnosis in Psychology:' show the scope of this book. One hundred thirty-four references are given. The volume is well indexed and will be a ready reference to anyone interested in the use of hypnosis. James L. McCartney, M.D.
TEXTBOOK OF NEUROLOGY. H. Houston Merritt, M.D. Lea and Febiger, Philadelphia, 1959 (Second Edition), pp. 765. The preface to the first edition (1955) pointed up the author's conviction that neurology had "returned to the fold of internal medicine" because biochemical studies offered some promise to the solution of many degenerative or heredodegenerative diseases. The rapid recent advances in the etiology and treatment of diseases of the nervous system, especially in metabolic concepts and correlations, are featured in this second edition of a classic in neurology. Mental symptoms accompanying organic disease of the nervous system are discussed with the appropriate diseases, but purely functional disease is not considered. The book is divided into ten chapters dealing with infectious disease, vascular lesions, tumors, trauma, developmental defects, degenerative and heredo-degenerative diseases, diseases due to toxins, metabolic disease, demyelinating diseases and paroxysmal disorders. Each chapter is complete and considers etiology, pathogenesis, pathology, symptomatology, signs, laboratory data, complications and sequelae, differential diagnosis, prognosis and treatment. The book is profusely illustrated; each chapter has an excellent bibliography. This reviewer recommends the book to all who seek the very latest in neurological advances. It should meet the needs of generalists as well as neurologists in search of a comprehensive, detailed review of diseases of the nervous system. W.D.
CLINICAL ELECTROENCEPHALOGRAPHY. By L. G. Kiloh, M.D., and J. W. OSMlton. Butterworths, London, 1961. 135 pages. $10.00. This is a short book of eight chapters produced mainly for the clinician. It is well written, clear and comprehensive. The very numerous illustrations are excellent, and easily understood. The recording techniques are adequately de-
PSYCHOSOMATICS
influencing the basic pacemaker pattern by centripetal autonomic and sensory centripetal impulses from the muscles and glands, which is reminiscent of the autonomic nervous system's control of the sino-auricular node of the heart. At the time this book was written there was less interest in understanding psychic energy than there is now with the widespread use of the MAO inhibitors and other anti-depressives. Anyone who is interested in neuro-anatomy and physics will flnd Dr. Colby's book very interesting-, but may also flnd the book difficult, perhaps because of Dr. Colby's own thorough grasp of the basic sciences. As a psychiatrist, Dr. Colby has temporarily departed from the id-ego-superego tripartite system of Freud in proposing this operational concept that embodies a new hypothesis of the meaning of psychic energy. Freud himself had once attempted to translate the meaning of psychic energy into a diagram that would also have R. neuro-anatomical meaning, but he was never able to do this to his own satisfaction. Dr. Colby's attempt does seem to be more meaningful than Freud's earlier attempts, but it must be taken as an hypothesis only, since no one can quite grasp exactly what psychic energy is, just as the mathematician uses the term infinity without being able to conceive of it. In the framework of this book, psychic energy is conceived of as never varying, either in depression or elation, which is somewhat analogous to the first law of thermodynamics which holds that the total amount of energy in the universe is always con· stant without ever any loss or gain. It would seem that Dr. Colby has cautioned us not to assume that there is any relationship between psychic energy and either physical activity or the ability to concentrate. The text presents a rather complex diagram, shOWing the hypothetical pulse pattern rising from the pacemaker and then passing through an unconscious "storage center," where all memory is stored from birth forward. Those pulse patterns that have proved useful to the individual in the past are augmented and coordinated, the reverse occurring if the pulse pattern drive has not proved useful. These electrical pulses then are cycled through the only two conscious areas, perception and thought, and then must re-enter the storage centers to record the emotion just experienced. If the pulse pattern emerges coordinated and augmented, it enters the motor outflow tracts and useful activity is begun. As long as the pulses remain uncoordinated, they must cycle again and again through the two con· scious areas, and this is felt as depression even though there may be a normal amount of psychic activity. It is hypothesized that this reo
MARCil-APRIL
peated "spinning of the wheels" in the thought and perception areas eventually weaves the pulse pattern into a coordinated one that may enter the motor areas resulting in a gradual return of normal muscular activity during recovery, even though there may have been no increased psychic energy. In this context depression might be compared to a car stuck in the snow where the wheels are spinning. When the wheels have worn the snow away down to firm ground, the car moves off without there being any change in the engine's energy output. In our ignorance about the very nature of psychic energy it is suggested by this reader that we avoid the term itself. To many patients (often those with a psychosomatic illness), a psychic energizer is seen as a "jaZZing up" drug, or if it is labeled as haVing an effect on mood or depression, a certain personal taboo may also be encountered. Such a drug is apt to be rejected or taken irregularly as a result of this psychologic rejection. Most people are willing to ascribe an illness to over-work, but not to depression, and it may be wisest not to tamper with this face-saving device. An appeal to the strong, realistic side of the personality is basic in psychotherapy, and this principle may well apply to the terminology of psychotropic drugs. A medication given a patient with the implication that he is "strong but overworked" may be more effective than if he is made to feel "weak and depressed," and the latter is implied by the prescription of a psychic energizer. The use of such terms as psychic energizers and tranquilizers does seem to promote the attitude that the personality is "weak." These drugs might be much more effectively employed if their nomenclature were designed to appeal to the stronger and more realistic part of the personality. Walter EraWl, M.D.
CAPTAIN NEWMAN, M.D. Leo Rosten, Harper & Bro••, N. Y. 331 page•• $4.95. The author, a leading social scientist and most versatile writer, has produced a stimulating story of a psychiatrist at an Air Corps base during the war. The doctor, analytically trained, is a "genius at therapy" but a genuine thorn in the hide of his military superiors. Although the book is labeled as fiction, many readers of Psychosomatics will qUickly find themselves in their Army Camps. Captain Newman is brilliant and intuitive as a psychiatrist, but shines even brighter as a human being. He constantly reserves the right to have feelings of his own, a role often denied to healers of the psyche. Although accused by nonbelievers of giving "every feather-merchant and
1962
PSYCHOSOMATICS
malingerer a year's therapy," he proves himself to be a competent officer rather than a wet nurse. Although gentle, he can be firm; even when angry he cannot be hostile. There is humor in this book as well as pathos. Excellent clinical descriptions of psychiatric illness and clear examples of psychotherapeutic skill prOVide an educational experience in the midst of hilarious comedy. W.D.
THE PRACTICAL APPLICATION OF MEDICAL AND DENTAL HYPNOSIS. Milton H. Erickson, M.D., Seymour Hershman, M.D., and Irving I. Sector, D.D.S. New York: The Julian Press, 1961. $12.50. This textbook is compiled from material presented at the Seminars on Hypnosis conducted around the country for the past several years. They have been transcribed from tape recordings, revised and edited. These seminars, conducted at the post-doctoral level for physicians, dentists, and psychologists, go into some detail about the inductions and other technics used in hypnotherapy. The authors state that "the full fiow of conversation has been preserved as transcribed from tapes, so that the reader may capture the entire sequence and interplay of events." Fortunately, the authors further state that "seminars and texts can only serve as beginnings in the training of individuals for the employment of hypnosis in their specialties. Beyond that point, it is essential for each student to practice, analyze, discuss with others, and gain as extensive and intensive experience as possible. Clearly, no seminar or single text can provide basic training for the internist, obstetrician, gynecologist, anesthesiologist, dentist, oral surgeon, psychologist, or psychiatrist. It is necessary to assume that each specialist has his basic training and then to demonstrate methodb and approaches by which he can apply his special training to the areas benefited by the employment of hypnosis. Inevitably, the various discussions of problems in any given specialty have overtones that also apply to others. Each specialist who seeks to employ hypnosis is dealing with people and with the problems of human nature." This textbook is unique, is well presented, and the detailed instructions are clearly brought out. Dr. Erickson has been in the field of hypnosis for many years and has had much opportunity to use it in its many ramifications. The co-authors, Drs. Hershman and Secter, are cognizant of the problems of practice, and their case records are well presented. The eleven chapters: "Outline of History and Theory of Hypnotism," "Suggestion and Hypnotizability," "The Phenomena of Hypnosis," "In-
163
duction Techniques," "Clinical Applications of Surgical Anesthesia," "Hypnosis in Obstetrics," "Hypnosis in Children," "Clinical Applications of Hypnosis to General Medicine," "Clinical Applications of Hypnosis to Psychiatry," "Hypnosis in Dentistry," and "Hypnosis in Psychology:' show the scope of this book. One hundred thirty-four references are given. The volume is well indexed and will be a ready reference to anyone interested in the use of hypnosis. James L. McCartney, M.D.
TEXTBOOK OF NEUROLOGY. H. Houston Merritt, M.D. Lea and Febiger, Philadelphia, 1959 (Second Edition), pp. 765. The preface to the first edition (1955) pointed up the author's conviction that neurology had "returned to the fold of internal medicine" because biochemical studies offered some promise to the solution of many degenerative or heredodegenerative diseases. The rapid recent advances in the etiology and treatment of diseases of the nervous system, especially in metabolic concepts and correlations, are featured in this second edition of a classic in neurology. Mental symptoms accompanying organic disease of the nervous system are discussed with the appropriate diseases, but purely functional disease is not considered. The book is divided into ten chapters dealing with infectious disease, vascular lesions, tumors, trauma, developmental defects, degenerative and heredo-degenerative diseases, diseases due to toxins, metabolic disease, demyelinating diseases and paroxysmal disorders. Each chapter is complete and considers etiology, pathogenesis, pathology, symptomatology, signs, laboratory data, complications and sequelae, differential diagnosis, prognosis and treatment. The book is profusely illustrated; each chapter has an excellent bibliography. This reviewer recommends the book to all who seek the very latest in neurological advances. It should meet the needs of generalists as well as neurologists in search of a comprehensive, detailed review of diseases of the nervous system. W.D.
CLINICAL ELECTROENCEPHALOGRAPHY. By L. G. Kiloh, M.D., and J. W. OSMlton. Butterworths, London, 1961. 135 pages. $10.00. This is a short book of eight chapters produced mainly for the clinician. It is well written, clear and comprehensive. The very numerous illustrations are excellent, and easily understood. The recording techniques are adequately de-