- Email: [email protected]
Homicidal threats
501
BOOK REVIEWS
The two studies on social acquiescence as a personality variable predictive of drug response still leave untranslated tbe clinical meaning of this scale, and the difficulty of relating scores on various scales to clinically observable phenomenon. Interestingly enough, the reports on nonspecific factors in the treatment of depression and schizophrenia have thus far not provided any clues that for these serious illnesses nondrug variables influence treatment results (attention again is directed to Beecher’s comment). These findings, especially with the schizophrenic patients, raise a number of important questions, for certainly there is a considerable body of data in the psychiatric literature which indicates that the physician’s personality is influential in outcome; for example, the classical studies of Whitehorn and Betz. Perhaps attitudes toward the treatment of these patients have changed with the advent of effective antipsychotic medication, so that the physician’s personality factors become obscured or are no longer relevant to treatment outcome. Equally possible is a premise that non-drug treated or patients with bizzare or aberrant behavior are poorly tolerated by hospital personnel unless they are being treated with “effective” medication so that the staff attitudes might minimize the ability of the physician to interact with the patient. In historical perspective, the effect of humanizing psychiatric treatment clearly had profound effects on helping patients improve, and this data should not be forgotten. This book does not provide answers or guidelines for choosing the proper drug for any particular patient, but instead provides a resource to the present state of knowledge, and the multiplicity of factors which might influence effective drug response in any patient. This alone seems to provide a valuable contribution to the knowledge about psychiatric drugs. This book is recommended for those who wish to obtain a fuller understanding of the complexity of psychopharmacology and in addition to obtain a background to evaluate subsequent drug literature.-Walter N. Stone, M.D., Cincinnati, Ohio HOMICIDAL THREATS. By John 1968, 12.3 pages, $6.50.
M. Macdondd,
M.D.
Springfield,
Ill.,
Charles
C Thomas,
Dr. Macdonald has presented a useful monograph on a very important subject, homicide. He gives an excellent overall coverage of this problem. Homicide rates in various countries and groups are summarized. However, the core of the book, a study of 100 patients admitted to a psychiatric hospital in Colorado, specifically because they had made homicidal threats, leaves something to be desired. A major criticism of the study is that 95 of the 100 patients were Caucasians. This is clearly not representative of the people who commit homicide in the United States since Negro men and women are the largest group of such offenders. The Southern states lead in the number of homicides, and a comparative study of offenders in that area would do much to contribute to an understanding of homicide in the United States. The United States is especially concerned with homicide because of the killing of President Kennedy, Senator Kennedy and Martin Luther King. Especially the presidential assassination has done much to focus public attention on the potential homicide offender. Peculiarly, Dr. Macdonald chooses to emphasize the multiple killing by a university student in Austin, Texas, as the source of this public interest. By so doing he fails to capitalize on some of the fascinating material reported in the psychiatric examination of Lee Harvey Oswald as a young adolescent in New York. Margaret Mead has a chapter which, in her inimitable style, emphasizes the clinical importance of a past history of killing or torturing living things in childhood. This would seem to be an important prognostic sign giving us information about the ability of the child to control his sadistic impulses. Though he included this chapter, Dr. Macdonald’s 100 patients did not support this hypothesis. Cruelty to animals and the additional findings of parental sexual seduction, childhood fire-setting, enuresis and parental brutality were not significantly higher in persons who committed criminal homicide than in those who made homicidal threats. But other important findings did emerge. Absence of suicide attempts indicates a higher risk of homicide. We therefore have a clinical pearl in this book: those who have attempted suicide are more likely to kill themselves than to kill others. Dr. Macdonald emphasizes that homicidal threats must be taken
502
BOOK REVLEWS
seriously. Whether the result be homicide or suicide, the 3 per cent incidence of homicide in his five-year follow-up may be contrasted with the .5 per cent homicide rate of criminal homicide parolees from a penitentiary study. What we would have liked to have seen emerge from this monograph unfortunately becomes obscure. When must the psychiatrist take the homicide threat seriously and hospitalize the patient? Dr. Macdonald concludes with an overall clinical statement probably close to what every experienced clinician would have thought anyway. Poor object relationships, latent homosexuality, abnormal EEG’s, paranoid delusions, and membership in a subculture of violence are all dangerous signs. Dr. Macdonald closes by recommending homicide prevention centers parallel to the now popular but questionable suicide prevention centers. This is based on the finding that homicidal behavior resembles suicidal behavior in several crucial aspects: it occurs in crisis situations, it is characterized by high ambivalence, and there is still a continued need to relate to others. This book contains much useful information and serves as a warning. Despite a certain lack of clarity, it repays reading by both the psychiatrist and layman who are concerned with the resort to violence being labelled by many, sadly or accusingly, as part of the American way of life.-Roy M. Whitman, M.D., Cincinnati, Ohio MODERN PROBLEMS OF PHARMACOPSYCHIATRY.Edited New York, Karger, 1969, 116 pages, $5.00.
by H. E. Lehmann
and T. A. Ban.
The proceedings of the Quebec Psychopharmacological Research Association Symposium on the Thioxanthenes have been published as the second volume in the series Modem Pro&m.s of Pharmacopsychiatry. The symposium held in June 1967 provided an opportunity for a gathering of researchers interested in the basic pharmacology and preliminary clinical evaluation of these drugs. About one third of the papers are related exclusively to preclinical pharmacological testing and the remainder to early pilot studies. Grouped together, these papers demonstrate that, as a class, the thioxanthenes are clinically effective in treatment of schizophrenic psychoses, and possible control of manic excitement, These drugs include thiothixene (Navane), chlorprothixene (Taractan), and clopenthixol (Sordinol). In 1962, the results of the VA collaborative study demonstrated that chlorprothixene when compared with several of the phenothiazines in a large series of acute schizophrenic patients was not significantly different from the phenothiazines. Since most of the present studies were designed only for preliminary evaluation, this reviewer has to agree with M. S. Merlis’ summary of the conference in concluding that from the report there is no evidence to specifically indicate clinically prescribing these drugs, although they provide a different chemical compound from the phenothiazines. It is this alteration in chemical structure which may provide a rationale for prescribing these drugs for otherwise resistant patients. Because of the brevity of the reports, and the preliminary nature of these studies, the book is primarily useful to workers active in psychopharmacology research as a resource for some of the initial work on these compounds.-Walter N. Stone, M.D., Cincinnati, Ohio DIMENSIONS OF READING DIFFICULTIES. By A. T. Rauenette, Press, 1968, 102 pages, $7.00.
Ph.D.
London,
Pergamon
A critical review of this book has given the reader pleasure and helped him combine and integrate his thoughts relating to reading and reading performance. It continues to confirm his admitted stereotypes regarding British literacy which seems almost invariably capable of brief, incisive, cogent exposition. Dr. Ravenette presents an overview of reading function and purpose. He is quite aware that the lay public and various professional workers are concerned with problems which can be defined in relation to certain dimensions. These dimensions are examined in orderly fashion and are best illustrated by the book chapter titles: “The Function and Nature of by Head Teachers,” the Printed Word,” “ The Causes of Reading Failure as Described “Dimensions Within the Child-Cognitive Factors; Sociological and Family Dimensions,”
BOOK REVIEWS
The two studies on social acquiescence as a personality variable predictive of drug response still leave untranslated tbe clinical meaning of this scale, and the difficulty of relating scores on various scales to clinically observable phenomenon. Interestingly enough, the reports on nonspecific factors in the treatment of depression and schizophrenia have thus far not provided any clues that for these serious illnesses nondrug variables influence treatment results (attention again is directed to Beecher’s comment). These findings, especially with the schizophrenic patients, raise a number of important questions, for certainly there is a considerable body of data in the psychiatric literature which indicates that the physician’s personality is influential in outcome; for example, the classical studies of Whitehorn and Betz. Perhaps attitudes toward the treatment of these patients have changed with the advent of effective antipsychotic medication, so that the physician’s personality factors become obscured or are no longer relevant to treatment outcome. Equally possible is a premise that non-drug treated or patients with bizzare or aberrant behavior are poorly tolerated by hospital personnel unless they are being treated with “effective” medication so that the staff attitudes might minimize the ability of the physician to interact with the patient. In historical perspective, the effect of humanizing psychiatric treatment clearly had profound effects on helping patients improve, and this data should not be forgotten. This book does not provide answers or guidelines for choosing the proper drug for any particular patient, but instead provides a resource to the present state of knowledge, and the multiplicity of factors which might influence effective drug response in any patient. This alone seems to provide a valuable contribution to the knowledge about psychiatric drugs. This book is recommended for those who wish to obtain a fuller understanding of the complexity of psychopharmacology and in addition to obtain a background to evaluate subsequent drug literature.-Walter N. Stone, M.D., Cincinnati, Ohio HOMICIDAL THREATS. By John 1968, 12.3 pages, $6.50.
M. Macdondd,
M.D.
Springfield,
Ill.,
Charles
C Thomas,
Dr. Macdonald has presented a useful monograph on a very important subject, homicide. He gives an excellent overall coverage of this problem. Homicide rates in various countries and groups are summarized. However, the core of the book, a study of 100 patients admitted to a psychiatric hospital in Colorado, specifically because they had made homicidal threats, leaves something to be desired. A major criticism of the study is that 95 of the 100 patients were Caucasians. This is clearly not representative of the people who commit homicide in the United States since Negro men and women are the largest group of such offenders. The Southern states lead in the number of homicides, and a comparative study of offenders in that area would do much to contribute to an understanding of homicide in the United States. The United States is especially concerned with homicide because of the killing of President Kennedy, Senator Kennedy and Martin Luther King. Especially the presidential assassination has done much to focus public attention on the potential homicide offender. Peculiarly, Dr. Macdonald chooses to emphasize the multiple killing by a university student in Austin, Texas, as the source of this public interest. By so doing he fails to capitalize on some of the fascinating material reported in the psychiatric examination of Lee Harvey Oswald as a young adolescent in New York. Margaret Mead has a chapter which, in her inimitable style, emphasizes the clinical importance of a past history of killing or torturing living things in childhood. This would seem to be an important prognostic sign giving us information about the ability of the child to control his sadistic impulses. Though he included this chapter, Dr. Macdonald’s 100 patients did not support this hypothesis. Cruelty to animals and the additional findings of parental sexual seduction, childhood fire-setting, enuresis and parental brutality were not significantly higher in persons who committed criminal homicide than in those who made homicidal threats. But other important findings did emerge. Absence of suicide attempts indicates a higher risk of homicide. We therefore have a clinical pearl in this book: those who have attempted suicide are more likely to kill themselves than to kill others. Dr. Macdonald emphasizes that homicidal threats must be taken
502
BOOK REVLEWS
seriously. Whether the result be homicide or suicide, the 3 per cent incidence of homicide in his five-year follow-up may be contrasted with the .5 per cent homicide rate of criminal homicide parolees from a penitentiary study. What we would have liked to have seen emerge from this monograph unfortunately becomes obscure. When must the psychiatrist take the homicide threat seriously and hospitalize the patient? Dr. Macdonald concludes with an overall clinical statement probably close to what every experienced clinician would have thought anyway. Poor object relationships, latent homosexuality, abnormal EEG’s, paranoid delusions, and membership in a subculture of violence are all dangerous signs. Dr. Macdonald closes by recommending homicide prevention centers parallel to the now popular but questionable suicide prevention centers. This is based on the finding that homicidal behavior resembles suicidal behavior in several crucial aspects: it occurs in crisis situations, it is characterized by high ambivalence, and there is still a continued need to relate to others. This book contains much useful information and serves as a warning. Despite a certain lack of clarity, it repays reading by both the psychiatrist and layman who are concerned with the resort to violence being labelled by many, sadly or accusingly, as part of the American way of life.-Roy M. Whitman, M.D., Cincinnati, Ohio MODERN PROBLEMS OF PHARMACOPSYCHIATRY.Edited New York, Karger, 1969, 116 pages, $5.00.
by H. E. Lehmann
and T. A. Ban.
The proceedings of the Quebec Psychopharmacological Research Association Symposium on the Thioxanthenes have been published as the second volume in the series Modem Pro&m.s of Pharmacopsychiatry. The symposium held in June 1967 provided an opportunity for a gathering of researchers interested in the basic pharmacology and preliminary clinical evaluation of these drugs. About one third of the papers are related exclusively to preclinical pharmacological testing and the remainder to early pilot studies. Grouped together, these papers demonstrate that, as a class, the thioxanthenes are clinically effective in treatment of schizophrenic psychoses, and possible control of manic excitement, These drugs include thiothixene (Navane), chlorprothixene (Taractan), and clopenthixol (Sordinol). In 1962, the results of the VA collaborative study demonstrated that chlorprothixene when compared with several of the phenothiazines in a large series of acute schizophrenic patients was not significantly different from the phenothiazines. Since most of the present studies were designed only for preliminary evaluation, this reviewer has to agree with M. S. Merlis’ summary of the conference in concluding that from the report there is no evidence to specifically indicate clinically prescribing these drugs, although they provide a different chemical compound from the phenothiazines. It is this alteration in chemical structure which may provide a rationale for prescribing these drugs for otherwise resistant patients. Because of the brevity of the reports, and the preliminary nature of these studies, the book is primarily useful to workers active in psychopharmacology research as a resource for some of the initial work on these compounds.-Walter N. Stone, M.D., Cincinnati, Ohio DIMENSIONS OF READING DIFFICULTIES. By A. T. Rauenette, Press, 1968, 102 pages, $7.00.
Ph.D.
London,
Pergamon
A critical review of this book has given the reader pleasure and helped him combine and integrate his thoughts relating to reading and reading performance. It continues to confirm his admitted stereotypes regarding British literacy which seems almost invariably capable of brief, incisive, cogent exposition. Dr. Ravenette presents an overview of reading function and purpose. He is quite aware that the lay public and various professional workers are concerned with problems which can be defined in relation to certain dimensions. These dimensions are examined in orderly fashion and are best illustrated by the book chapter titles: “The Function and Nature of by Head Teachers,” the Printed Word,” “ The Causes of Reading Failure as Described “Dimensions Within the Child-Cognitive Factors; Sociological and Family Dimensions,”