Clinical Aspects of Aging

BOOK REVIEWS ing, in that all four papers related almost entirely to laboratory animals rather than man. The relevance of such studies to the psychodynamic complexities of anorexia nervosa is, in my view, extremely limited, to say the least. The section devoted to endocrinology is by far the largest; its relative size reflects the current preoccupation with endocrinologic cause and effect. A number of pronounced abnormalities were observed in patients when they were malnourished, but most of them reverted to normal on refeeding, although this can take considerable time, as in the LH response to estrogen. The final section, on treatment, is testimony to the old adage that when there is a large number of recommended therapies for a given condition it is likely that there is no really effective treatment. For example, while Russell (echoing Gull's view of a century earlier) emphasizes the need for inpatient treatment, Rosman and co-authors "de-emphasize" inpatient treatment. The current vogue for behavior therapy is reflected in three papers on this approach; contrary to earlier reports, the successes of behavior therapy are no greater than those with other more traditional approaches, although they are no less either. When it comes to drug treatment, confusion reigns supreme, with one group recommending the dopaminergic agonist levodopa and another group recommending the dopamine antagonist metoclopramide, albeit for its gastrointestinal effects. I would recommend the book to 850

all those who require an overview of this most perplexing of conditions; while perhaps not providing many answers, it does provide a most useful compendium of up-todate and stimulating findings. Trevor Silverstone, M.D. London

Clinical Aspects of Aging Ediled by William Reichel. 528 pp. $35. Baltimore. Williams & Wilkins. 1978.

• William Reichel has performed a remarkable feat in presiding over the Editorial Board of this comprehensive textbook, which was prepared under the direction of the American Geriatrics Society. In the preface, he indicates that the contributors were charged to keep their material "readable, practical and for a general medical audience." The book appears to have accomplished the task. It is not a textbook of geriatrics, since the diseases and problems of the aged cannot be totally isolated from those of other age groups. More than 40 authors have contributed chapters for the multidisciplinary readership. The fields of geriatrics and gerontology have expanded to embrace medicine, nursing, and psychological and socioeconomic problems; and all must be considered of value and importance. The elderly person is a historical and physiologic complex and the multiplicity of diagnoses clearly indicates that the "senior citizen" is not the simplistically defined inmate of a nursing home with chronic complaints, whining, and crippled to a point of total dependency. Each person must be considered individually with his entire range of prob-

lems, medical or socioeconomic. The book encompasses the total body and all the special systems, and covers most frequently occurring problems, including cardiovascular, pulmonary, neurologic, psychiatric, and metabolic disorders. Thirty-five chapters deal in a succinct but comprehensive manner with the various modalities of evaluation and treatment. A special chapter on drug-prescribing, written intelligently and without redundancy, describes briefly the pharmacodynamics in the older organism and is, to my knowledge, the first monographic presentation of such nature. This chapter is followed by a "Basic Pharmacopeia for Geriatric Practice," by the same authors, and, as in the previous chapter, the paper is concise and inclusive. Thromboembolic diseases are the subject of a brief chapter, with other chapters covering special cardiac problems, pacemakers, pulmonary pathology, and peripheral vascular disease. All are well presented, practical, and useful. The chapter on nutrition is, I believe, of prime importance. Nutritional problems have always been given mere passing mention in the various geriatric textbooks and manuals. Here a place of honor is reserved for nutrition, and the authors are careful to evaluate the causes of malnutrition while outlining remedial diets. They concentrate on the various psychological and mechanical causes and offer practical management plans. A subsequent chapter on fluid and electrolyte balance serves as a useful addition to the discussion on nutrition. PSYCHOSOMATICS

Dentistry in the aged, a subject frequently omitted in textbooks on geriatrics, is among the varied topics covered in the remaining chapters in this section. A diversity of medically related subjects-including physiologic and biologic aspects of aging, retirement, legal services, housing, sexuality, and the dying patient-comprise the 14 chapters of the book's second section. One comes out with the impression that the editors have exceeded their initial assignment and broken with the traditional limitations of a clinical textbook. This is fortunate indeed. The elderly person is as much part of society and the body politic as any other individual, and the problems of old age are not merely "clinical cases." The elderly belong also to the physical, intellectual, and socioeconomic sphere, and cannot and should not be compartmentalized. The book is a refreshing addition to the various texts on geriatrics and gerontology. The reading is easy, pleasurable, and the writing styles, though varied, have a certain unity. Paul Weinsaft, M.D. Metropolitan Jewish Geriatric Center Brooklyn, N. Y.

And a Time to Live By Robert Chemin Cantor. 280 pp. $9.95. New York. Harper & Row. 1978.

• And a Time to Live is directed toward cancer patients who want to live with the disease, not to those who wish to understand the dying process. The basic thesis is that acceptance of one's own feelings, no matter what they may be, is the DECEMBER 1979 • VOL 20 • NO 12

basis for finding personal meaning and faith following the crisis of cancer discovery. The author urges acceptance of the validity of one's emotional experience, not acceptance of a terminal illness. The false equation of cancer and death is the basis for evoking irrational fears of the unknown. Fear of death, as well as of medical intervention, conjures up the image of pain and abandonment. Cantor appropriately places Kiibler-Ross's stages of dying within the period of mourning but does not regard them as the major framework for understanding the patient with cancer. The next section is involved with how an individual can personally cope with the stress of neoplastic disease. The patient must gather information to allay anxiety, attempt to be independent, and maintain the sense of personal autonomy. The author cites older studies suggesting that most physicians do not tell the truth even when patients ask if they have cancer. The present interest in psychological aspects of neoplastic disease has, we hope, changed that pattern. The most useful part of this book is the discussion of four common patterns of marital relationships, how these affect the patient's adaptation to his illness, and how an understanding and awareness of the partners' roles can improve the situation for both patient and spouse. For example, the hare-tortoise relationship is essentially the union of an hysterical character type with an obsessive character type. Conflicts arise because of the hysterical partner's need for emotional display and caring while the

mechanical-appearing obsessive partner is bothered by the feelings of his spouse and his own inability to give support. In order to resolve differences, the author suggests interpretations that will minimize the false assumptions about each individual. The partners must learn that they do not share similar temperaments, and must respect their partner's temperament. The author skillfully weaves in the role of religion as well as psychological constructs. He notes that religion allows individuals a language in which to carry their thoughts and feelings. He goes further, however, to talk about the way that religion helps individuals accept themselves and prevent personal chaos. He concludes that a stress such as that produced by cancer can allow an individual to transcend his own personal existence to reach an existential recognition of his personal worth. This book is published at a time when traditionally oriented physicians have increasingly criticized the behavioral scientist's teaching regarding the emotional aspects of individuals with cancer. It is directed toward a popular audience in its use of reductionistic, often glib, concepts. The author, however, uses reasonable references and clinical examples to support his ideas. The book imparts hope to patients with cancer and suggests a rational framework in which an individual can understand his own reaction, as well as those of others, to an illness as serious as neoplastic disease. Thomas N. Wise, M.D. The Fairfax Hospital Falls Church, Va. 851