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Progress in Clinical Psychology
BOOK REVIEWS
IMPOTENCE AND FRIGIDITY. By Donald W. Ha.stings, M.D. Boston: Little, Brown and Company, $5.50. From Doctor Hastings' unhappiness over his lack of fonnal medical school training in sexual areas comes this excellent monograph on impotence and frigidity. Some 25 years ago, there was no fonnal education in these most vital fields of human behavior within our culture. Even now, Doctor Hastings finds that only four medical schools treat this material in any sort of fashion. Doctor Hastings has added materially to our knowledge. Ill' mentions thc valuc of the Kinsey volumes on sexual behavior. He includes, as well, the classic work by ~Iasters and Johnson. Beyond this, the paucity of medical literature is overwhelming. This monograph adds materially to our knowledge in these areas. Hastings has gathered in one place, in a brief and readable fonn, the known medical infonnation about two common conditions, impotence and frigidity. In order to create a guideline by which to measure the pathological, a description of the nonnal or usual aspects of coitus is included as well. He has divided his book into sections on a general introduction, sexual intercourse, impotence, premature ejaculation, frigidity, treatment of the various problems, and finally, homosexuality. A most useful bibliography is included. This is all in English and includes only those contributions which Hastings felt would elaborate upon his own presentation. The reader who wishes to delve more deeply is given excellent guidelines. In thc 127 pages of this volume lies a physician's lifelong accumulation of knowledge which has been achieved as a clinician, as a psyehiatrist and as a teacher not only of students but of patients as well. This is an extremcly eompassionate book and one which the reviewer recommends to any person ministering to humanity. ROBERT N. RUTHERFORD, M.D.
RESEARCH IN PHCHOPATHOLOGY. Edited by Herbert C. Quay. 216 pages. New York: Van NostratuI, 1963. $1.95 (softbound). This is one in the series of Van Nostrand's Insight Books, which the publisher states "are devoted to filling a vital need in the efficient study of human behavior. By makinJ.( available, in paperback, essential materials that are inaccessible or neglected the Insight St'ries renders a valuable service to stud~nts, tt'aehers and interested laymen." The publishers are to be praised for presentinl!: these books to the public for $U.l5. The rich flow of scientific reports presents an increasinl!: problem of staggering dimensions to students, physicians, and researchers in scientific fields. At this time in the development of our scientific literature, then' is an urgent need for monol!:raphs which deal with a sinl!:le subject, and for selectivt' abstracts and reviews of significant current papers from various journals which othenvise might be lost in "the Literature;" in short, there is a need for cn'ative and skillful editing. This book is not a monoJ.(raph; instead, it is a compilation of thirteen separate research studies deal~Iarch-April,
1965
ing with methodological problems and research in psychopathology. The various papers are reprints which were originally publi~hed in the Journal of Clinical Psychology, the Journal of Abnonnal and Social Psychology, the Journal of Consulting Psychology, and the Journal of Personality, during the years 1951-1959. The editor has grouped the various publications, but has devoted only a few pages to their significan('('. Since none of the material in the book is new, it would have been enriched by more skillful editing which provided a discussion of the relationships within and between these discrete areas of research in psychopathology. The stated aims of the publishers are to provide valuable resource material for graduate students' seminars and to St'rVt' as research paradil!:ms. In view of these aims, a critique of the various ml'lhodolol!:ical approaches would have served a valuable function. The content of the book is divided, classically, to include problems with psychiatric diagnosis, the neuroses, the psychoses, and the charactt'r disorders. Among thc specific subjects arc the accuracy and validity of the nosologic catt'w)ries used by psychiatrists, neuroticism scales, the role of the family in the etiolol!:Y of schizophrenia, and the "processreaction" distinction in schizophrenic illness. Two excdlent studies of the psychopathology of character disorders are found in thc final section. It should be noted that although the book will probably not be of general interest to the practicing professional, the student audience will find it a valuable educative adjunct. I hope that the series will continue. JOHN J. SCHWAB, ~I.D.
PROGRESS IN CLINICAL PSYCHOLOGY. Volume V. Edited by Lawrence E. Abt and Bernard F. Reiss. 226 pages, New York: Grone and Stratton, 1963. $7.50.
This volume is the most recent in a series covering significant progress in the field. It opens with a pres('ntation of the important medical rehabilitative work with cerebral palsied children being done in the Soviet Union. The author, a pediatrician, describes the careful physiological and psychological examinations which are perfonned to detennine in each case the locus of dysfunction. Diagnosis is followed by a mmbination of conditioned reflex treatment and motor manipulation, together with milieu therapy. Emphasis is on improving remaining function rather than on pathology. Sincc the timely use of speech is of great importance in the child's intellectual development, parents are taught the value of early verbal inter<.'Ourse; it has been found that the mentally retarded are hdped when the routine processes of bathing, dressing, and feeding are aceompanied by speech. Thus, such methods, closely related to mrrective educational work, should be begun early by properly instmcted parents. Medication frequently acmmpanies kinesitherapy as practiccd in the Soviet special schools. New findings concernin~ psychological concomitants of physical disability are discussed by Robert and Selma Morrow. Among the cerebral palsied population, especially in the spastic group, there is a 123
PSYCHOSOMATICS tendency toward concrete types of responses, stereotopy, and distractibility. Because of the association of cerebral palsy with the birth process, many parents feel guilt or shame, and either overprotect the child or reject him altogther. In multiple sclerosis, the most striking loss is similarly ability to deal with abstract problems; there is also progressive loss of learning ability, coordination, and speech. Permorbid personality does not seem to provide a basis for psychosomatic explanations in these patients. Many badly disabled persons are apparently well adjusted, according to valid criteria, and many slightly disabled ones are poorly adjusted. In his discussion of progress in therapy with children, Archie Silver notes two fresh and important trends: one is an emerging emphasis on primary preventive aspects and the other is a more critical appraisal of what happens in therapy and what makes it happen. For the former, the role of prenatal and paranatal organic factors and prevention at the school level are emphasized. For the latter, specific techniques in management of severely disturbed and symbiotic children and those suffering from psychosomatic syndromes are presented. Especially with young patients referred for ulcerative and mucous colitis, asthma, and certain skin disorders, treatment was found to be relatively ineffective without involvment of the mother, whose unconscious resistance prevented the child from dissolving the symbiotic relationship. Although to the clinical psychologist some of the material may not be entirely new, this book is useful to readers in related professions who are interested in keeping up with the literature. EUZAIlETH THOMA, PH.D.
PRINCIPLES OF PREVENTIVE PSYCHIATRY. By Gerald Caplan; Foreword by Robert H. Felix, xvi chapters plus 304 pages. New York, London; Basic Books, Inc., 1964. This is one of the important books which presents the milestones of progress in American psychiatry. The reader will receive an enlightening image of the important new trends; on occasions he may disagree with some ideas of the author, who himself is often most willing to accept the challenge of other authorities and clearly state his divergent views on many issues. Two main points should illustrate the new psychiatric trends so clearly presented in this volume: (1) With the present psychiatric practice limited to a face-to-face contact with an individual patient, and the mental hospital practice, we will never have enough psychiatrists in America to take care of the most pressing needs of the m{'ntally and emotionally sick population. (2) The second principle claims that practically no major scourge of mankind has ever been eradicated by treatment alone-the greatest progress in medicine was nearly always dependent on developing proper preventive measures. To solve the first problem, psychiatrists have to abandon their ivory towers and multiply their skills and efforts through consultation and supervision of the para-psychiatric healing groups which include
124
general practitioners, psychologists, social workers, public health nurses, clergymen, school counselors, teachers, etc. To this end two chapters of the book are dedicated where the author discusses methodology and techniques of the "mental health consultation." To outline the preventive role of psychiatry, the author discusses the needs, the nature, and the methods of this new and rapidly developing field of mental health. It is difficult to give justice to this exceptionally well-written volume containing very rich material on this new subject. Of special interest, however, may be the relation of the new developments to the present-day practice of psychiatry. The author stresses the necessity for a new subspecialty of "community psychiatrists;" they would be in charge of community mental health centers and would probably spend most of their time in preventive work and provide a smooth functioning of all the mental health resources inclusive of consultation work with the parapsychiatric professions. However, the author does not draw a sharp line between this new type of a psychiatrist and the presently known patterns of private practice including psychoanalysis, large psychiatric hospitals, psychiatric units of different type [night, day, and children servicesJ and psychiatric wards in general hospitals. To the contrary, he believes that every psychiatrist should devote some of his time to professional participation in all the community mental health activities as a part-time consultant at different social agencies, services, schools, hospitals, etc. He emphasizes that there is certainly no threat to private psychiatric practice due to the development of the mental health centers or clinics. In fact, a rapidly increasing awareness of mental health problems will make individuals, organizations, business and industry much more aware of the value of early diagnosis and treatment; this would undoubtedly increase the need for private services of all psychiatrists, whether in their private offices or as part-time members of the clinical staH of various mental health institutions. "It is safe to predict that a substantial increase in the number of planned community programs and of the budgetary resources to energize them will mean not only that a new group of community psychiatrists will be added to the ranks of the profession, but also that a considerable portion of the time and energy of those psychiatrists who are currently treating patients along traditional lines in private offices and in clinics will in the future be diverted to community practice." [p.4J Dr. Caplan is both modest and courageous in handling his subject. In spite of an unusual wealth of personal experience and research evidence, he advances his ideas, anticipating further development and verification of his principles. On the other hand, he presents the overall picture of this new field of psychiatry by introducing a number of hypotheses which, in spite of their logical structure, would need considerable test of time. This, in particular, applies to the organization of the mental health programs and future development of a methodological approach. All who have worked in this field know that it is not easy to bring together Volume VI
IMPOTENCE AND FRIGIDITY. By Donald W. Ha.stings, M.D. Boston: Little, Brown and Company, $5.50. From Doctor Hastings' unhappiness over his lack of fonnal medical school training in sexual areas comes this excellent monograph on impotence and frigidity. Some 25 years ago, there was no fonnal education in these most vital fields of human behavior within our culture. Even now, Doctor Hastings finds that only four medical schools treat this material in any sort of fashion. Doctor Hastings has added materially to our knowledge. Ill' mentions thc valuc of the Kinsey volumes on sexual behavior. He includes, as well, the classic work by ~Iasters and Johnson. Beyond this, the paucity of medical literature is overwhelming. This monograph adds materially to our knowledge in these areas. Hastings has gathered in one place, in a brief and readable fonn, the known medical infonnation about two common conditions, impotence and frigidity. In order to create a guideline by which to measure the pathological, a description of the nonnal or usual aspects of coitus is included as well. He has divided his book into sections on a general introduction, sexual intercourse, impotence, premature ejaculation, frigidity, treatment of the various problems, and finally, homosexuality. A most useful bibliography is included. This is all in English and includes only those contributions which Hastings felt would elaborate upon his own presentation. The reader who wishes to delve more deeply is given excellent guidelines. In thc 127 pages of this volume lies a physician's lifelong accumulation of knowledge which has been achieved as a clinician, as a psyehiatrist and as a teacher not only of students but of patients as well. This is an extremcly eompassionate book and one which the reviewer recommends to any person ministering to humanity. ROBERT N. RUTHERFORD, M.D.
RESEARCH IN PHCHOPATHOLOGY. Edited by Herbert C. Quay. 216 pages. New York: Van NostratuI, 1963. $1.95 (softbound). This is one in the series of Van Nostrand's Insight Books, which the publisher states "are devoted to filling a vital need in the efficient study of human behavior. By makinJ.( available, in paperback, essential materials that are inaccessible or neglected the Insight St'ries renders a valuable service to stud~nts, tt'aehers and interested laymen." The publishers are to be praised for presentinl!: these books to the public for $U.l5. The rich flow of scientific reports presents an increasinl!: problem of staggering dimensions to students, physicians, and researchers in scientific fields. At this time in the development of our scientific literature, then' is an urgent need for monol!:raphs which deal with a sinl!:le subject, and for selectivt' abstracts and reviews of significant current papers from various journals which othenvise might be lost in "the Literature;" in short, there is a need for cn'ative and skillful editing. This book is not a monoJ.(raph; instead, it is a compilation of thirteen separate research studies deal~Iarch-April,
1965
ing with methodological problems and research in psychopathology. The various papers are reprints which were originally publi~hed in the Journal of Clinical Psychology, the Journal of Abnonnal and Social Psychology, the Journal of Consulting Psychology, and the Journal of Personality, during the years 1951-1959. The editor has grouped the various publications, but has devoted only a few pages to their significan('('. Since none of the material in the book is new, it would have been enriched by more skillful editing which provided a discussion of the relationships within and between these discrete areas of research in psychopathology. The stated aims of the publishers are to provide valuable resource material for graduate students' seminars and to St'rVt' as research paradil!:ms. In view of these aims, a critique of the various ml'lhodolol!:ical approaches would have served a valuable function. The content of the book is divided, classically, to include problems with psychiatric diagnosis, the neuroses, the psychoses, and the charactt'r disorders. Among thc specific subjects arc the accuracy and validity of the nosologic catt'w)ries used by psychiatrists, neuroticism scales, the role of the family in the etiolol!:Y of schizophrenia, and the "processreaction" distinction in schizophrenic illness. Two excdlent studies of the psychopathology of character disorders are found in thc final section. It should be noted that although the book will probably not be of general interest to the practicing professional, the student audience will find it a valuable educative adjunct. I hope that the series will continue. JOHN J. SCHWAB, ~I.D.
PROGRESS IN CLINICAL PSYCHOLOGY. Volume V. Edited by Lawrence E. Abt and Bernard F. Reiss. 226 pages, New York: Grone and Stratton, 1963. $7.50.
This volume is the most recent in a series covering significant progress in the field. It opens with a pres('ntation of the important medical rehabilitative work with cerebral palsied children being done in the Soviet Union. The author, a pediatrician, describes the careful physiological and psychological examinations which are perfonned to detennine in each case the locus of dysfunction. Diagnosis is followed by a mmbination of conditioned reflex treatment and motor manipulation, together with milieu therapy. Emphasis is on improving remaining function rather than on pathology. Sincc the timely use of speech is of great importance in the child's intellectual development, parents are taught the value of early verbal inter<.'Ourse; it has been found that the mentally retarded are hdped when the routine processes of bathing, dressing, and feeding are aceompanied by speech. Thus, such methods, closely related to mrrective educational work, should be begun early by properly instmcted parents. Medication frequently acmmpanies kinesitherapy as practiccd in the Soviet special schools. New findings concernin~ psychological concomitants of physical disability are discussed by Robert and Selma Morrow. Among the cerebral palsied population, especially in the spastic group, there is a 123
PSYCHOSOMATICS tendency toward concrete types of responses, stereotopy, and distractibility. Because of the association of cerebral palsy with the birth process, many parents feel guilt or shame, and either overprotect the child or reject him altogther. In multiple sclerosis, the most striking loss is similarly ability to deal with abstract problems; there is also progressive loss of learning ability, coordination, and speech. Permorbid personality does not seem to provide a basis for psychosomatic explanations in these patients. Many badly disabled persons are apparently well adjusted, according to valid criteria, and many slightly disabled ones are poorly adjusted. In his discussion of progress in therapy with children, Archie Silver notes two fresh and important trends: one is an emerging emphasis on primary preventive aspects and the other is a more critical appraisal of what happens in therapy and what makes it happen. For the former, the role of prenatal and paranatal organic factors and prevention at the school level are emphasized. For the latter, specific techniques in management of severely disturbed and symbiotic children and those suffering from psychosomatic syndromes are presented. Especially with young patients referred for ulcerative and mucous colitis, asthma, and certain skin disorders, treatment was found to be relatively ineffective without involvment of the mother, whose unconscious resistance prevented the child from dissolving the symbiotic relationship. Although to the clinical psychologist some of the material may not be entirely new, this book is useful to readers in related professions who are interested in keeping up with the literature. EUZAIlETH THOMA, PH.D.
PRINCIPLES OF PREVENTIVE PSYCHIATRY. By Gerald Caplan; Foreword by Robert H. Felix, xvi chapters plus 304 pages. New York, London; Basic Books, Inc., 1964. This is one of the important books which presents the milestones of progress in American psychiatry. The reader will receive an enlightening image of the important new trends; on occasions he may disagree with some ideas of the author, who himself is often most willing to accept the challenge of other authorities and clearly state his divergent views on many issues. Two main points should illustrate the new psychiatric trends so clearly presented in this volume: (1) With the present psychiatric practice limited to a face-to-face contact with an individual patient, and the mental hospital practice, we will never have enough psychiatrists in America to take care of the most pressing needs of the m{'ntally and emotionally sick population. (2) The second principle claims that practically no major scourge of mankind has ever been eradicated by treatment alone-the greatest progress in medicine was nearly always dependent on developing proper preventive measures. To solve the first problem, psychiatrists have to abandon their ivory towers and multiply their skills and efforts through consultation and supervision of the para-psychiatric healing groups which include
124
general practitioners, psychologists, social workers, public health nurses, clergymen, school counselors, teachers, etc. To this end two chapters of the book are dedicated where the author discusses methodology and techniques of the "mental health consultation." To outline the preventive role of psychiatry, the author discusses the needs, the nature, and the methods of this new and rapidly developing field of mental health. It is difficult to give justice to this exceptionally well-written volume containing very rich material on this new subject. Of special interest, however, may be the relation of the new developments to the present-day practice of psychiatry. The author stresses the necessity for a new subspecialty of "community psychiatrists;" they would be in charge of community mental health centers and would probably spend most of their time in preventive work and provide a smooth functioning of all the mental health resources inclusive of consultation work with the parapsychiatric professions. However, the author does not draw a sharp line between this new type of a psychiatrist and the presently known patterns of private practice including psychoanalysis, large psychiatric hospitals, psychiatric units of different type [night, day, and children servicesJ and psychiatric wards in general hospitals. To the contrary, he believes that every psychiatrist should devote some of his time to professional participation in all the community mental health activities as a part-time consultant at different social agencies, services, schools, hospitals, etc. He emphasizes that there is certainly no threat to private psychiatric practice due to the development of the mental health centers or clinics. In fact, a rapidly increasing awareness of mental health problems will make individuals, organizations, business and industry much more aware of the value of early diagnosis and treatment; this would undoubtedly increase the need for private services of all psychiatrists, whether in their private offices or as part-time members of the clinical staH of various mental health institutions. "It is safe to predict that a substantial increase in the number of planned community programs and of the budgetary resources to energize them will mean not only that a new group of community psychiatrists will be added to the ranks of the profession, but also that a considerable portion of the time and energy of those psychiatrists who are currently treating patients along traditional lines in private offices and in clinics will in the future be diverted to community practice." [p.4J Dr. Caplan is both modest and courageous in handling his subject. In spite of an unusual wealth of personal experience and research evidence, he advances his ideas, anticipating further development and verification of his principles. On the other hand, he presents the overall picture of this new field of psychiatry by introducing a number of hypotheses which, in spite of their logical structure, would need considerable test of time. This, in particular, applies to the organization of the mental health programs and future development of a methodological approach. All who have worked in this field know that it is not easy to bring together Volume VI