Psychopharmacology for Everyday Practice

adjuncts to terminal care management. As with all multiauthor volumes. the chapters differ vastly in focus and quality. They are all written by psychologists and thus some physicians may find the medical perspective somewhat naive. However. most of the topics are generally well handled. in particular. the chapters on "Behavioral Thanatology." "Humanistic Perspectives on Behavior Therapy in Terminal Care." "Pain and the Terminally III Cancer Patient: A Cognitive-Social Learning Perspective"; they also maintained the best connection to the overall subject. Each of these chapters includes an integrative approach and gives particular examples for the management of terminal patients with specific reference to cancer. In addition. the chapter on "Preventing Bum-Out and Reducing Stress" would be helpful for all caregivers in terminal care. and offers interesting reading. Other topics were well done but suffered from the author's taking a general perspective on behavioral treatment while giving only a limited focus. through references and documentation. for the subjects of cancer patients or terminal illness. For example. "Behavioral Treatment of Depression in the Dying Patient" is an excellent overview. but very few examples are given with relevance to cancer. The reader is left to surmise its impact and to speculate as to future research directions. In a similar vein. rational-emotive therapy is covered very well but there is no connection for the reader to terminal illness or application of the therapy to paAPRIL 1984 • VOL 25 • NO 4

tients. A good chapter on "Grief and the Elderly" once again gives a major overview of a fascinating topic. but mainly discusses the elderly rather than the terminally ill. leaving the reader to make the connections. These chapters offer rather scanty help for the practitioner in the present challenge of managing the terminally ill but may stimulate further research. In summary. the book suffers from some lack of integration. although the relevant and interesting theme is fairly easily followed. A medical perspective would have been enhanced by inclusion of a few medical authors particularly involved with terminal illness. A number of chapters do not always live up to the overall subject, but quality throughout remains high. The book will make useful reading for all those interested in terminal care. In general. it will be an excellent introduction to behavioral concepts for both physicians and nurses. The hesitancy of medical people to get into psychological reading is not warranted here since most of the authors limit the use of psychological jargon. David L. Keegan, M.D. Saskatoon, Sask.

Psychophannacology for Everyday Practice By Thomas A. Ban and Marc H. Hollender. New York. S. Karger. 1982. 194 pp. $22.50

• Psychopharmacology for Everyday Practice consists of 194 pages of questions and answers. organized in one chapter each on lithium. neuroleptics. tricyclic antidepressants. monoamine oxidase inhibi-

tors. benzodiazepines and other anxiolytic sedatives. pregnancy and nursing. and antiparkinsonian medication. The authors mention that the questions were posed by residents. and that the book is intended to teach the practitioner what to do and what not to do. With this format the authors succeed in reviewing the relevant literature useful for everyday practice. The book is readable and covers all the major areas of clinical psychopharmacology. Unfortunately, there are a number of difficulties in using it as a reference. General statements are made throughout the book without providing further information. For example. the assertion is made that for unipolar depression there is sufficient information for the use of lithium treatment as well as for its superior prophylactic value as compared with tricyclic antidepressants. No contradicting evidence is offered. There are also some inconsistencies. On page 9 of the text we find that in offspring of lithium-treated mothers "there is a higher incidence of congenital heart disease than in the general population. although the total number of congenital anomalies is the same." In contradiction to this statement is the material on page 179 noting that "the incidence of all congenital defects in the general population is 7%; in babies born to lithium-treated mothers it is 10.8%." No references are provided in either of these sections. In another section (p 56) the authors mention that "for treating catatonic schizophrenics. neuroleptics alone are not effective. but neuroleptic-tricyclic antide345

BOOK REVIEWS pressant or neuroleptic MAOI antidepressant combinations may be effective." Do they mean that patients having catatonic excitement need combination treatment and respond less than do hebephrenics? The book does not have an index or cross-references. However, the content of each chapter is organized into a number of subsections that are easy to find, and the inclusion of references at the end ofeach question might serve as an impetus for further reading. The book can be read quickly and there are some pearls hidden in the midst of its general information. It would probably be of some use to family physicians, medical students, and libraries, but would seem insufficiently stimulating for residents and would not satisfy the needs of practicing psychiatrists who want to prescribe drugs meaningfully. Jambur Ananth, M.D. University of California Los Angeles

The Minds of the Chinese People: Mental Health in New China By Martha Livingston and Paul Lowinger. Englewood Cliffs, N.J., Prentice-Hall. 1983, 237 pp, $16.95.

• Imagine that a psychiatrist and a social psychologist from China became fascinated with the American mental health care system. Individually and unbeknownst to the other, each made multiple, although short, trips to the United States. Over the years they were able to visit quite a few psychiatric institutions (most of them well organized and internationally known), and make friends with the

few American psychiatrists who happened to speak Chinese. Through these exposures and occasional interviews with American patients by means of interpreters, they believed that they had gained some general understanding of how the American mental health system works. Their curiosity led them further to review whatever literature was available in Chinese about mental health care here, as well as books and articles discussing American history, society, culture, and people. One day by chance these two Chinese mental health professionals met. Each one was overjoyed at finding someone else with similar experiences and impressions in regard to their American trips. They shared the conviction that there was much the Chinese urgently needed to learn from the Americans, and they decided to collaborate in writing a book. Surprisingly, they entitled the book The Minds of the Americans, implying a promise to unravel to their Chinese readers the mystery of how Americans think and behave. Not surprisingly, such a book would be rich in personal reminiscences and vivid descriptions of unsystematic observations. Their recounting of the visits and people involved was fascinating and provided interesting reading. Government rhetoric and statistics were copiously and uncritically quoted. Since the authors' literature search and background readings were limited to things written in or translated into Chinese, it was remarkable that their grasp of the data and the retracing of the historical development of the Ameri-

can health and mental health systems were generally accurate. However, many of the attempts at interpreting the data appeared naive and superficial. Suppose now that an American psychiatrist proficient in reading Chinese came across such a book. What would be his or her reaction? On the one hand, that reader would likely be grateful that the authors had shown so much cultural sensitivity in attempting to see events in their special sociocultural contexts, and in refraining from passing harsh judgment on that which did not make sense to them. The reader would be especially pleased with the general tone of the book, which expounded on merits and achievements. On the other hand, however, he or she would be amazed at the extent to which the authors overidealized the advances of American psychiatry. That reader might even be irritated by some statements, apparently the results of misunderstanding or even wishful thinking. The Minds ofthe Chinese People: Mental Health in New China is roughly a mirror image of the above hypothetical book. It provides pertinent information for readers seeking basic knowledge about the Chinese medical system and its interface with society. It argues eloquently the merits of cross-cultural, cross-national learning: "There are things we can, and need to, learn from the Chinese system." However, if you expect that the book will better your understanding of Chinese "minds," you will be disappointed. Keh-Ming Lin, M.D. University of California, Los Angeles PSYCHOSOMATICS