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Pharmacotherapy and Psychotherapy: Paradoxes, Problems and Progress
BOOK REVIEWS stricted to neurosis. Numerous clinical vignettes and interpretations are included. The author himself suffered a swollen throat, which subsided when self-analysis enabled him to recognize that he could not swallow Freud's priority in the discovery of the unconscious. Groddeck insists that physicians be aware of symbolism that reflects the drives of the "It." Authors, poets, and artists, he remarks, are "lived" by unconscious forces and through language and other activities. These forces shape the forms we see. The child views a chair also as a coach, a horse, or a dog, but the adult represses these added projections. The author contends that the unconscious is as responsible for a compulsive neurosis as it is for the invention of a telescope. The symbolism of vision receives considerable attention. Groddeck emphasizes that seeing is not governed simply by the laws of optics. Man sees without eyes in dreams, hallucinations, and visions. Too, the eyes are known to devour, murder, pierce, and menace-. The real image, Groddeck insists, comprises both the factual or real and the internal image, which blurs objectivity. If the averted gaze, the turn of the head or body, and closed eyelids are insufficient to avoid danger, illness or even blindness can develop. The author recommends that all physicians be trained to be aware of the total human being and that diagnosis include reference to the whole person, not only to the symbolic symptom. He recommends developing positive transference through attention, sympathy, support, catharsis, and massage. 442
"Proper therapy," he states "means taking the patient back to his childhood, to the age of 3." Groddeck deserves recognition for founding a systematic approach to psychosomatic medicine. His conceptualization of the "It," however, touches on the philosophical and teleological, and care must be exercised in interpreting and applying his writings. He reduces man's stature. To think of being driven, rather than holding the reins, is demeaning. Further, Groddeck's insistence that physical examinations and laboratory tests are only occasionally necessary, is extreme. Nevertheless, there is much that he offers. His enthusiasm and attentive concern for the patient are exemplary. A critique of his work is best left to Freud's comments in his correspondence with him. He would "let the respectable idiotic public have you with all your warts and originality and ask them to take you as you are." The book is well written and suggests a wider orientation and application of psychoanalysis. It should be of interest to all practitioners of mental health. A satisfying bibliography and a workable index are included. George J. Train, M.D. Brooklyn, N. Y.
Pharmacotherapy and Psychothenpy: Pandoxes, Problems and Progress formulated by the Committee on Research, Group for the Advancement of Psychiatry, 175 pp, $8.95, New York, Brunner/Mazel, 1976.
• This volume reviews scientific studies of psychotherapy and phar-
macotherapy, and it lays to rest the myth that the two therapies are incompatible. In neuroses and non-psychotic personality disorders, effectiveness of psychotherapy itself is a formidable problem. Personalities of both therapist and patient are significant, as are their expectations and goals. However, controlled studies do indicate that a minor tranquilizer when added to psychotherapy by an experienced therapist accelerates symptomatic improvement and facilitates communication between doctor and patient. As for schizophrenia, studies indicate that combined therapy is superior to psychotherapy alone. Adding individual psychotherapy to medication offers little additional benefit during the period of acute hospitalization. In depression, possible positive effects of combined treatment include facilitation of accessibility and enhanced ego functioning. The request for drug treatment by the patient may be the vehicle through which psychotherapeutic help may become possible. Studies have indicated that combined therapy is beneficial in endogenous depressions but less so for reactive states. Despite general acceptance of this state of affairs, the Committee concludes thatthere still is a need for integrative research before these clinically accepted facts can be proven to their satisfaction. It is noted that panic anxiety attacks in agoraphobic and schoolphobia patients respond to antidepressants rather than to tranquilizers; anticipatory anxiety, however, responds fairly well to minor tranquilizers and not to anPSYCHOSOMATICS
As for drugs and behavior ther apy, Wolpe feels that in some cases drugs promote changes; however, most reports of combined therapy are anecdotal. Virtually no well controlled double-blind studies with adequate rating scales and ap propriate statistical analyses have been reported. In considering an adequate re
tidepressants. These clinical obser vations, it is admitted, warrant some modification of existing dy namic theory—but the Committee is not too clear as to what these modifications should be. The chapter on drugs and psy choanalysis notes that Freud pre dicted the advances in biology and chemistry that “¿will open for our understanding and we hope also for therapy― the phenomena of the neuroses. It has been shown that the use of these drugs permits psy choanalytical treatment of a broader selection of patients. Hos pitalization can frequently be avoided, and drugs may facilitate the psychoanalytical process when it has bogged down. There is no evidence that appropriate drug use alters or impedes the process of psychoanalytical psychotherapy.
search design for studies in com bined therapy, it is important to set goals and to have relevant target symptoms and adequate personnel to monitor the study. Many studies deal only with the drug but fail to consider the differences in psycho therapy that are afforded by dif ferent therapists with diverse per sonalities, training, and experience. A final chapter deals with insti tutional constraints in attempting to do a study using combined ther
apy. Obstacles will be produced by the resentment to placebo studies, the use of random assignment of cases, the use of double-blind stud ies, and the difficulties in getting a homogeneous group of patients. Recommendations are made that new research designs and sta tistical methods be set up. Longi tudinal studies on large groups of patients are needed. Research hos pitals adequately staffed are needed where patients can later have long-term follow-up. GAP's reports over the past 30 years have never failed to bring information as well as stimulation to their readers. This volume, in exploring the problems involved in combining pharmacotherapy with psychotherapy, is no exception. Wilfred Dorfman, M.D.
Brooklyn, N. Y.
The Fourth Annual Weiss-English Psychosomatic Symposium:
Adolescent Medicine Saturday, November 4, 1978 Temple University School of Medicine Philadelphia Topics will include:
Endocrineaspectsof adolescence: Impacton psychosexualdevelopment Angelo M. DiGeorge, M.D.
Use of psychoactivedrugs in adolescence
JohnM. Dunn,M.D. Family therapy in psychosomatics
Problemsof adolescence David Rubinstein, M.D.
FourthEdwardWeissMemorialLecture:
Managementissuesof chronic disease and dying during adolescence Michael I. Cohen, M.D. Albert Einstein College of Medicine
Afternoonworkshops: Interviewing techniques Psychosomatic aspects of Chronic renal disease Chronic pulmonary disease Diabetes, Cardiac disease
Sexual problemsof the adolescent
Attendance at the Symposium is acceptable
Marc A. Forman, M.D.
towardcredit in Category1 of the Physician's RecognitionAwardof the AMA
The adolescentas a criminal LisaA.Richette, J.D.
JULY 1978'VOL
19•N07
For further information contact: Barney M. DIm, M.D.
230 West AlIens Lane Philadelphia. PA 19119
443
"Proper therapy," he states "means taking the patient back to his childhood, to the age of 3." Groddeck deserves recognition for founding a systematic approach to psychosomatic medicine. His conceptualization of the "It," however, touches on the philosophical and teleological, and care must be exercised in interpreting and applying his writings. He reduces man's stature. To think of being driven, rather than holding the reins, is demeaning. Further, Groddeck's insistence that physical examinations and laboratory tests are only occasionally necessary, is extreme. Nevertheless, there is much that he offers. His enthusiasm and attentive concern for the patient are exemplary. A critique of his work is best left to Freud's comments in his correspondence with him. He would "let the respectable idiotic public have you with all your warts and originality and ask them to take you as you are." The book is well written and suggests a wider orientation and application of psychoanalysis. It should be of interest to all practitioners of mental health. A satisfying bibliography and a workable index are included. George J. Train, M.D. Brooklyn, N. Y.
Pharmacotherapy and Psychothenpy: Pandoxes, Problems and Progress formulated by the Committee on Research, Group for the Advancement of Psychiatry, 175 pp, $8.95, New York, Brunner/Mazel, 1976.
• This volume reviews scientific studies of psychotherapy and phar-
macotherapy, and it lays to rest the myth that the two therapies are incompatible. In neuroses and non-psychotic personality disorders, effectiveness of psychotherapy itself is a formidable problem. Personalities of both therapist and patient are significant, as are their expectations and goals. However, controlled studies do indicate that a minor tranquilizer when added to psychotherapy by an experienced therapist accelerates symptomatic improvement and facilitates communication between doctor and patient. As for schizophrenia, studies indicate that combined therapy is superior to psychotherapy alone. Adding individual psychotherapy to medication offers little additional benefit during the period of acute hospitalization. In depression, possible positive effects of combined treatment include facilitation of accessibility and enhanced ego functioning. The request for drug treatment by the patient may be the vehicle through which psychotherapeutic help may become possible. Studies have indicated that combined therapy is beneficial in endogenous depressions but less so for reactive states. Despite general acceptance of this state of affairs, the Committee concludes thatthere still is a need for integrative research before these clinically accepted facts can be proven to their satisfaction. It is noted that panic anxiety attacks in agoraphobic and schoolphobia patients respond to antidepressants rather than to tranquilizers; anticipatory anxiety, however, responds fairly well to minor tranquilizers and not to anPSYCHOSOMATICS
As for drugs and behavior ther apy, Wolpe feels that in some cases drugs promote changes; however, most reports of combined therapy are anecdotal. Virtually no well controlled double-blind studies with adequate rating scales and ap propriate statistical analyses have been reported. In considering an adequate re
tidepressants. These clinical obser vations, it is admitted, warrant some modification of existing dy namic theory—but the Committee is not too clear as to what these modifications should be. The chapter on drugs and psy choanalysis notes that Freud pre dicted the advances in biology and chemistry that “¿will open for our understanding and we hope also for therapy― the phenomena of the neuroses. It has been shown that the use of these drugs permits psy choanalytical treatment of a broader selection of patients. Hos pitalization can frequently be avoided, and drugs may facilitate the psychoanalytical process when it has bogged down. There is no evidence that appropriate drug use alters or impedes the process of psychoanalytical psychotherapy.
search design for studies in com bined therapy, it is important to set goals and to have relevant target symptoms and adequate personnel to monitor the study. Many studies deal only with the drug but fail to consider the differences in psycho therapy that are afforded by dif ferent therapists with diverse per sonalities, training, and experience. A final chapter deals with insti tutional constraints in attempting to do a study using combined ther
apy. Obstacles will be produced by the resentment to placebo studies, the use of random assignment of cases, the use of double-blind stud ies, and the difficulties in getting a homogeneous group of patients. Recommendations are made that new research designs and sta tistical methods be set up. Longi tudinal studies on large groups of patients are needed. Research hos pitals adequately staffed are needed where patients can later have long-term follow-up. GAP's reports over the past 30 years have never failed to bring information as well as stimulation to their readers. This volume, in exploring the problems involved in combining pharmacotherapy with psychotherapy, is no exception. Wilfred Dorfman, M.D.
Brooklyn, N. Y.
The Fourth Annual Weiss-English Psychosomatic Symposium:
Adolescent Medicine Saturday, November 4, 1978 Temple University School of Medicine Philadelphia Topics will include:
Endocrineaspectsof adolescence: Impacton psychosexualdevelopment Angelo M. DiGeorge, M.D.
Use of psychoactivedrugs in adolescence
JohnM. Dunn,M.D. Family therapy in psychosomatics
Problemsof adolescence David Rubinstein, M.D.
FourthEdwardWeissMemorialLecture:
Managementissuesof chronic disease and dying during adolescence Michael I. Cohen, M.D. Albert Einstein College of Medicine
Afternoonworkshops: Interviewing techniques Psychosomatic aspects of Chronic renal disease Chronic pulmonary disease Diabetes, Cardiac disease
Sexual problemsof the adolescent
Attendance at the Symposium is acceptable
Marc A. Forman, M.D.
towardcredit in Category1 of the Physician's RecognitionAwardof the AMA
The adolescentas a criminal LisaA.Richette, J.D.
JULY 1978'VOL
19•N07
For further information contact: Barney M. DIm, M.D.
230 West AlIens Lane Philadelphia. PA 19119
443