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How Psychiatrists Look at Aging
Book Reviews ulation-ridden, resource-poor OBRA regulations that now dominate geropsychiatry practice in the United States. Also of interest is the dominance of American authors in the clini... cally oriented chapters of this volume and their relative absence from chapters related to epidemiology and social planning. Despite the overall high quality of this volume, several niggling problems detract from it. Misspellings are rife, and even some word usage appears to be incorrect. Biographies exist for the four editors, but not for the chapter authors, whose disciplines, positions, and addresses would be of interest to readers. The editors have failed to remove considerable duplication and even triplication of pharmacological facts, epidemiological data, and psychosocial analyses. The term psychogeriatric, probably new to many American geropsychiatrists, is not defined, although it is used in decidedly different ways throughout the text. These include the following: a general area of medical practice; an overlapping service field occupied by psychiatrists, psychologists, social workers, and psychiatric nurses; and as an equivalent term for geriatric psychiatry. Perspective, experiences, and research on the elderly from around the world make this an interesting read for the geropsychiatrist, as well as for other clinicians interested in the elderly. Even those politicians and social planners concerned with the Uelder boom" occurring across the planet will find a wealth of information. Americans of any occupation should be discomforted by this book. Why are American geropsychiatrists not more central to the planning of services and training of a professional cadre for the elderly? Have we been pushed out? Or has our focus on the Utrees of clinical care kept us from appreciation of the "forest" of societal care for the elderly? And what should we do about it? Although these chapters do not provide an answer, they do help in highlighting the question. U
Dr. Westermeyer is at the Depattment of Veterans Affairs in Minneapolis, MN. 270
Ho'W Psychiatrists Look at Aging Edited by George H. Pollock, M.D., Ph.D. Madison, Cf, International Universities Press, 1992 ISBN 0-8236-5722-1, $32.50
Reviewed by Leon]. Epstein, M.D.
G
eorge Pollock, in his Introduction section, reported that he asked a group of specially chosen colleagues for their reflections on their own aging, that of significant others, what they learned about aging from their self-examination, and what they would want to teach others. There are 15 chapters by psychiatrists over 60 years of age whose contributions since World War II have placed them in the forefront of psychiatry and psychoanalysis. In addition, Edith Karlin Atkin, the widow of Samuel Atkin, eloquently describes the change from me" to "I" in widowhood and notes that ccthe silence" is what she finds hardest to bear. Several chapters cite the physical changes associated with aging and the impact of chronic illness. Samuel Atkin, the oldest contributor, commented, "1 am going to pot in my ruined, damaged body. A weak old man dies ten thousand deaths-he dies every day as his vitality ebbs away." His body image, however, remains unchanged and he continues to see himself in fantasy as a much younger man. Several others comment about the certainty of physical decline and their prior sense of invulnerability which has been challenged by serious illness. Death is not feared by the contributors, but they are concerned about physical and mental incapacitation. Martha Kirkpatrick refers to physical changes with reference to gender. Aging for her is also an attack on self-esteem and she notes that one hears of sexy, older men, but it is rare to hear of a sexy, older woman. She also notes with respect to body image that the inner view, like Dorian Gray, tries to remain unaltered and resists the wear and tear of time. U
VOLUME 1 • NUMBER 3 • SUMMER 1993
Book Reviews
Most contributors continue to practice) and the practice of psychiatry and psychoanalysis is evidently of great importance and satisfaction to the group, described by one as "a mainstay of identity) value and structure. " MelVin HUlWitz comments on the difficulty of suspending the registration of his medical license and his practice because of illness. Only one person spoke about planning for retirement and her purchase of a condominium with a sense of comfort in knowing that it is waiting for her when she does decide to retire. Prejudice directed against the elderly is occasionally cited. John Nemiah notes that modern society can show its hostility toward the aged in blunt ways) particularly when "their organization into a formally constituted group makes the aging a readily visible target." He also refers to patronizing attitudes, benign condescension, and assignments to pasture) to play shuffleboard, to go fishing, or to discuss the virtues of one's favorite oatmeal. Joe Yamamoto comments about the contrast between Asia and America in their treatment of older individuals-in Asia the aged are respected; however, in America he suffers the treatment accorded to the old and used. Helen Stoehen Wagenheim notes that many of the jokes one hears about aging reveal implicit negative assumptions. There are occasional reflections about changes in the direction that psychiatry is taking. Theodore Lidz comments that there is "pain because of the turn psychiatry has taken...Now what I have learned and taught is largely disregarded..." and he notes that he is disappointed at the current predominant emphasis on genetics, neurobiology, and chemistry. Robert Stoller commented that, at age 66, he was not ill, felt as energetic as 40 years ago, had no need to retire, or an imposed retirement date, and practiced and taught with enthusiasm. He also noted that without luck, one could hardly learn to age well, and with luck, one hardly needs to begin. Tragically, this gifted psychiatrist was THE AMERICAN JOURNAL OF GERIATRIC PSYCliIATRY
killed in an automobile accident in September 1991. His chapter was written with the wry enthusiasm that one came to expect in all of his presentations. It was also one of the few chapters that emphasize what he would want to teach others. A psychiatric colleague recently, in my absence, saw this volume on my desk, "How Psychiatrists Look at Aging. He left this note on the cover: ClWith fear and loathing, of course, just like everybody else. Such is not the case in the reflections of these 15 psychiatrists. Without question, this is a book to be read and reread with interest, affection) certainly with reflection about ourselves, and with deep appreciation of those who reflected about themselves for us. I recommend it highly and eagerly await the next volume. I agree with Robert Butler, who refers to it as u an important work of literature for anyone who plans on growing old. n tJ
U
Dr. Epstein is Professor Emeritus, Department ofPsychiatry, University ofCalifornia, San Francisco
The NeW" Aging: Politics and Change in Atnerica
Fernando M. Torres-Gil, M.D. Westport, CT, Greenwood Publishing Group, Inc.) 1991 ISBN 0-86569-035-9, $47.95 Reviewed by William]. Burke, M.D.
T
his is a book which would have been nlerely of passing interest if the Republican party had maintained its stronghold on the White House. Instead, it has a real sense of importance and immediacy in the new political climate. The author, a distinguished gerontologist, and President Clinton's appointee as the Assistant Secretary for Aging, writes persuasively of the need to come to grips with the demographic imperative bearing down on our society. Torres-Gil pro271
Dr. Westermeyer is at the Depattment of Veterans Affairs in Minneapolis, MN. 270
Ho'W Psychiatrists Look at Aging Edited by George H. Pollock, M.D., Ph.D. Madison, Cf, International Universities Press, 1992 ISBN 0-8236-5722-1, $32.50
Reviewed by Leon]. Epstein, M.D.
G
eorge Pollock, in his Introduction section, reported that he asked a group of specially chosen colleagues for their reflections on their own aging, that of significant others, what they learned about aging from their self-examination, and what they would want to teach others. There are 15 chapters by psychiatrists over 60 years of age whose contributions since World War II have placed them in the forefront of psychiatry and psychoanalysis. In addition, Edith Karlin Atkin, the widow of Samuel Atkin, eloquently describes the change from me" to "I" in widowhood and notes that ccthe silence" is what she finds hardest to bear. Several chapters cite the physical changes associated with aging and the impact of chronic illness. Samuel Atkin, the oldest contributor, commented, "1 am going to pot in my ruined, damaged body. A weak old man dies ten thousand deaths-he dies every day as his vitality ebbs away." His body image, however, remains unchanged and he continues to see himself in fantasy as a much younger man. Several others comment about the certainty of physical decline and their prior sense of invulnerability which has been challenged by serious illness. Death is not feared by the contributors, but they are concerned about physical and mental incapacitation. Martha Kirkpatrick refers to physical changes with reference to gender. Aging for her is also an attack on self-esteem and she notes that one hears of sexy, older men, but it is rare to hear of a sexy, older woman. She also notes with respect to body image that the inner view, like Dorian Gray, tries to remain unaltered and resists the wear and tear of time. U
VOLUME 1 • NUMBER 3 • SUMMER 1993
Book Reviews
Most contributors continue to practice) and the practice of psychiatry and psychoanalysis is evidently of great importance and satisfaction to the group, described by one as "a mainstay of identity) value and structure. " MelVin HUlWitz comments on the difficulty of suspending the registration of his medical license and his practice because of illness. Only one person spoke about planning for retirement and her purchase of a condominium with a sense of comfort in knowing that it is waiting for her when she does decide to retire. Prejudice directed against the elderly is occasionally cited. John Nemiah notes that modern society can show its hostility toward the aged in blunt ways) particularly when "their organization into a formally constituted group makes the aging a readily visible target." He also refers to patronizing attitudes, benign condescension, and assignments to pasture) to play shuffleboard, to go fishing, or to discuss the virtues of one's favorite oatmeal. Joe Yamamoto comments about the contrast between Asia and America in their treatment of older individuals-in Asia the aged are respected; however, in America he suffers the treatment accorded to the old and used. Helen Stoehen Wagenheim notes that many of the jokes one hears about aging reveal implicit negative assumptions. There are occasional reflections about changes in the direction that psychiatry is taking. Theodore Lidz comments that there is "pain because of the turn psychiatry has taken...Now what I have learned and taught is largely disregarded..." and he notes that he is disappointed at the current predominant emphasis on genetics, neurobiology, and chemistry. Robert Stoller commented that, at age 66, he was not ill, felt as energetic as 40 years ago, had no need to retire, or an imposed retirement date, and practiced and taught with enthusiasm. He also noted that without luck, one could hardly learn to age well, and with luck, one hardly needs to begin. Tragically, this gifted psychiatrist was THE AMERICAN JOURNAL OF GERIATRIC PSYCliIATRY
killed in an automobile accident in September 1991. His chapter was written with the wry enthusiasm that one came to expect in all of his presentations. It was also one of the few chapters that emphasize what he would want to teach others. A psychiatric colleague recently, in my absence, saw this volume on my desk, "How Psychiatrists Look at Aging. He left this note on the cover: ClWith fear and loathing, of course, just like everybody else. Such is not the case in the reflections of these 15 psychiatrists. Without question, this is a book to be read and reread with interest, affection) certainly with reflection about ourselves, and with deep appreciation of those who reflected about themselves for us. I recommend it highly and eagerly await the next volume. I agree with Robert Butler, who refers to it as u an important work of literature for anyone who plans on growing old. n tJ
U
Dr. Epstein is Professor Emeritus, Department ofPsychiatry, University ofCalifornia, San Francisco
The NeW" Aging: Politics and Change in Atnerica
Fernando M. Torres-Gil, M.D. Westport, CT, Greenwood Publishing Group, Inc.) 1991 ISBN 0-86569-035-9, $47.95 Reviewed by William]. Burke, M.D.
T
his is a book which would have been nlerely of passing interest if the Republican party had maintained its stronghold on the White House. Instead, it has a real sense of importance and immediacy in the new political climate. The author, a distinguished gerontologist, and President Clinton's appointee as the Assistant Secretary for Aging, writes persuasively of the need to come to grips with the demographic imperative bearing down on our society. Torres-Gil pro271