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Psychotherapie. Kompendium für studierende und ärzte
382
Book reviews
J. 0. LEIBOWITZ: The History of Coronary Heart Disease. Medicine London, 1970. pp. xvii +227. f3.00.
Wellcome Institute
of the History of
IT WAS
not until the eighteenth century that the syndrome of angina1 pain was first delineated by IIeberden and only in the early years of this present century that myocardial infarction became clinically recognisable. Although arterio-sclerosis has been found in Egyptian mummies, and references occur in the classical medical writings to ‘heart pain’, and to sudden deaths from presumed disease of the heart, this late discovery of such a dramatic condition as angina pectoris has puzzled medical historians. Is coronary heart disease a disorder associated with an increasing tempo in human life, as has been postulated for the last two hundred years ? Or is it the result of changes in dietary habit, or other unknown factors? Professor Leibowitz provides us, in this monograph, with a magnificent survey of the historical background. Despite much earlier work it was Heberden’s classical description of angina pectoris which laid the foundation stone of our knowledge. British clinicians, Edward Jenner amongst them, put forward the view that angina pectoris was associated with disease of the coronary arteries. Pathological studies such as Lobstein’s work on arteriosclerosis, and Virchow’s on thrombosis consolidated the clinical findings, and also directed attention toward the myocardium. In 1912 Herrick was able to describe a clear-cut clinical syndrome of cardiac infarction which was much consolidated with the development of electro-cardiography. In the earliest descriptions the important role of emotion was well recognised, William Harvey, for instance giving an excellent account of a man ‘overcome with anger and indignation which he yet communicated to no-one’ who developed coronary artery disease. Similar examples are to be found in the literature over the next three centuries. Professor Leibowitz has written a book which will be of value to anyone who is concerned with the problems of coronary artery disease. As with all the publications of the Wellcome Institute of the History of Medicine, the book is beautifully produced, and is very reasonably priced. DENIS LEIGH
THOMASFREEMAN:Psychopathology of the Psychoses. Tavistock Publications, London, 1970. pp. 215 s2.25. THE AIMof this book is to study the psychopathology of psychotic phenomena, with special reference to the manner in which patients experience their thoughts, feelings, bodily sensations and the world around them. It is based on detailed observations, over an extended period, of patients suffering from schizophrenia, organic psychoses and psychotic depression in a hospital setting, by doctors, nurses, occupational therapists and others involved in their daily care. The framework for the study of the psychopathology is based on psychoanalytical principles but attention is directed to the significance of the patient’s present behaviour and experience, rather than on its relation to earlier life events and family relationships. For this purpose the author has devised an examination scheme derived from psvchoanalvtic concepts, in conjunction with concepts from descriptive psychiatry, under the follow’in’g headings: nature of the relationshin with real and delusional obiects. uercention of the self. self-reeard and i&tinctual personal identity, status’ of cognitive functions, mot&y, &&so&motor organisation, drive activity, affectivity and defence organisation. The psychological understanding of psychotic phenomena obtained from these studies constitutes a real advance on the purely descriptive approach used by many clinical psychiatrists who fail to pay proper attention to object relationships and mental, including unconscious processes in their approach to the psychoses. The author then describes how such understanding of the patient’s behaviour can be used in the total treatment programme, drugs included, of psychotic “especially schizophrenic” patients, by the team responsible for their care. The book can therefore be strongly recommended to psychiatrists and others who wish to increase their understanding of psychotics and to improve their therapeutic skills. HEINZ WOLFF
DIETRICHLANGEN: Psychotherapie. Kompendium fiir Studierende und xrzte. Georg Thieme Verlag, Stuttgart, 1971. pp. 163. DM 6.80
2nd (enlarged) Edn.
THIS IS a short and well written German paperback by Professor Langen, Director of the Clinic for Psychotherapy at the University of Mainz. It starts with a discussion of the concept of causality in medicine in which Jasper’s distinction between explanation and understanding is stressed, and due
Book reviews
383
regard is paid to the multi-factorial aetiology of disease. This is followed by a brief account, in terms of psychic phenomena and conflict situations, of abnormal psychological reaction patterns, sexual and personality disorders, psychoneuroses and psychosomatic disorders. He then proceeds to a discussion of psychological methods of diagnosis, with special emphasis on unstructured interviewing techniques and psychological understanding. The remainder of the book gives a clear and factual account of a wide variety of psychological treatment procedures; these include the therapeutic aspects of single diagnostic interviews, supportive psychotherapy, hypnosis, hypnotherapy and autogenic training, insight-directed and analytical forms of psychotherapy, group psychotherapy, and behaviour therapy. The book is based on an eclectic approach in which psychological aspects are seen as playing their part alongside social and biological ones. When discussing the psychotherapeutic procedures, the author stresses the need to get away from the exclusive use of one or other form of treatment, and instead to combine different methods of psychotherapy, according to the needs of individual patients. The book does not claim to provide the reader with detailed instruction as to how to conduct the various forms of psychotherapy, but it certainly provides him with the essential basis of psychological understanding required in clinical practice, and with an objective account of existing psychotherapeutic methods. It can be recommended to anyone interested in widening his knowledge of the psychological basis of ill-health and psychotherapeutic management. HEINZ WOLFF Psychosomatic
Specificity. Volume I. Experimental Study and Results. Edited by FRANZ ALEXANDER, THOMASM. FRENCH and GEORGEH. POLLOCK. University of Chicago Press, Chicago, 1968. pp. 263. f3.40.
THIS VOLUME provides a detailed account of the work done at the Chicago Institute of Psychoanalysis
by Franz Alexander and his research team from 1951 to 1965, to test the hypothesis that there is a specific psychodynamic constellation and psychogenesis, characteristic of each of the so-called psychosomatic diseases. Patients with asthma, rheumatoid arthritis, ulcerative colitis, essential hypertension, neurodermatitis, thyrotoxicosis and duodenal ulcer were studied. For each patient a detailed protocol, based on a psychodynamic interview was prepared, and after removing all possible medical clues, these protocols were given to analysts and internists who were unaware of the patient’s medical diagnosis; they were then asked to make a diagnosis on the basis of these psychological data alone. The correlation between these and the actual diagnoses was then subjected to statistical analysis. There was, not surprisingly, a large variability in the results, not only among the diagnoses made but also among the different analysts and internists, but the authors claim that a correct diagnosis was made on the psychological data given to them more often than would have been expected by chance. Although these findings are put forward as evidence in support of psychosomatic specificity, they may fit better into the more modern view that emotional factors in illness in general are likely to act as contributory factors, some of them perhaps occurring more often in some disorders than in others. In spite of this the detailed and careful exposition of the authors’ findings will be of interest to those engaged in research in this difficult field of psychosomatic medicine. HEINZ WOLFF
KENNEM GRANVILLE-GROSSMAN: Recent Advances in Clinical Psychiatry. 1971. pp. 340. E3.75.
J. &A. Churchill, London,
THIS IS an impressive book which will be welcomed by many psychiatrists, particularly, I imagine, by candidates for the D.P.M. and the membership of the College of Psychiatrists. The author has selected ten areas in which there have recently been important theoretical or practical developments and reviewed the literature of the last decade in each. The range of topics reflects the sphere of interest of British academic psychiatry, ranging from the physical treatment of affective disorders to drug dependence, organic brain disease and the psychiatric aspects of pregnancy and the puerperium. The author’s treatment of all these subjects is well-informed, comprehensive and up to date and there is a valuable list of recent references at the end of each section of text to provide easy access to more detailed information. In some ways it is a pity that the author generally refrains from stating his own opinions and conclusions, for the facts, when left to speak for themselves, often do so with discordant voices, but this is a small criticism of most welcome publication. R. E. KENDELL
Book reviews
J. 0. LEIBOWITZ: The History of Coronary Heart Disease. Medicine London, 1970. pp. xvii +227. f3.00.
Wellcome Institute
of the History of
IT WAS
not until the eighteenth century that the syndrome of angina1 pain was first delineated by IIeberden and only in the early years of this present century that myocardial infarction became clinically recognisable. Although arterio-sclerosis has been found in Egyptian mummies, and references occur in the classical medical writings to ‘heart pain’, and to sudden deaths from presumed disease of the heart, this late discovery of such a dramatic condition as angina pectoris has puzzled medical historians. Is coronary heart disease a disorder associated with an increasing tempo in human life, as has been postulated for the last two hundred years ? Or is it the result of changes in dietary habit, or other unknown factors? Professor Leibowitz provides us, in this monograph, with a magnificent survey of the historical background. Despite much earlier work it was Heberden’s classical description of angina pectoris which laid the foundation stone of our knowledge. British clinicians, Edward Jenner amongst them, put forward the view that angina pectoris was associated with disease of the coronary arteries. Pathological studies such as Lobstein’s work on arteriosclerosis, and Virchow’s on thrombosis consolidated the clinical findings, and also directed attention toward the myocardium. In 1912 Herrick was able to describe a clear-cut clinical syndrome of cardiac infarction which was much consolidated with the development of electro-cardiography. In the earliest descriptions the important role of emotion was well recognised, William Harvey, for instance giving an excellent account of a man ‘overcome with anger and indignation which he yet communicated to no-one’ who developed coronary artery disease. Similar examples are to be found in the literature over the next three centuries. Professor Leibowitz has written a book which will be of value to anyone who is concerned with the problems of coronary artery disease. As with all the publications of the Wellcome Institute of the History of Medicine, the book is beautifully produced, and is very reasonably priced. DENIS LEIGH
THOMASFREEMAN:Psychopathology of the Psychoses. Tavistock Publications, London, 1970. pp. 215 s2.25. THE AIMof this book is to study the psychopathology of psychotic phenomena, with special reference to the manner in which patients experience their thoughts, feelings, bodily sensations and the world around them. It is based on detailed observations, over an extended period, of patients suffering from schizophrenia, organic psychoses and psychotic depression in a hospital setting, by doctors, nurses, occupational therapists and others involved in their daily care. The framework for the study of the psychopathology is based on psychoanalytical principles but attention is directed to the significance of the patient’s present behaviour and experience, rather than on its relation to earlier life events and family relationships. For this purpose the author has devised an examination scheme derived from psvchoanalvtic concepts, in conjunction with concepts from descriptive psychiatry, under the follow’in’g headings: nature of the relationshin with real and delusional obiects. uercention of the self. self-reeard and i&tinctual personal identity, status’ of cognitive functions, mot&y, &&so&motor organisation, drive activity, affectivity and defence organisation. The psychological understanding of psychotic phenomena obtained from these studies constitutes a real advance on the purely descriptive approach used by many clinical psychiatrists who fail to pay proper attention to object relationships and mental, including unconscious processes in their approach to the psychoses. The author then describes how such understanding of the patient’s behaviour can be used in the total treatment programme, drugs included, of psychotic “especially schizophrenic” patients, by the team responsible for their care. The book can therefore be strongly recommended to psychiatrists and others who wish to increase their understanding of psychotics and to improve their therapeutic skills. HEINZ WOLFF
DIETRICHLANGEN: Psychotherapie. Kompendium fiir Studierende und xrzte. Georg Thieme Verlag, Stuttgart, 1971. pp. 163. DM 6.80
2nd (enlarged) Edn.
THIS IS a short and well written German paperback by Professor Langen, Director of the Clinic for Psychotherapy at the University of Mainz. It starts with a discussion of the concept of causality in medicine in which Jasper’s distinction between explanation and understanding is stressed, and due
Book reviews
383
regard is paid to the multi-factorial aetiology of disease. This is followed by a brief account, in terms of psychic phenomena and conflict situations, of abnormal psychological reaction patterns, sexual and personality disorders, psychoneuroses and psychosomatic disorders. He then proceeds to a discussion of psychological methods of diagnosis, with special emphasis on unstructured interviewing techniques and psychological understanding. The remainder of the book gives a clear and factual account of a wide variety of psychological treatment procedures; these include the therapeutic aspects of single diagnostic interviews, supportive psychotherapy, hypnosis, hypnotherapy and autogenic training, insight-directed and analytical forms of psychotherapy, group psychotherapy, and behaviour therapy. The book is based on an eclectic approach in which psychological aspects are seen as playing their part alongside social and biological ones. When discussing the psychotherapeutic procedures, the author stresses the need to get away from the exclusive use of one or other form of treatment, and instead to combine different methods of psychotherapy, according to the needs of individual patients. The book does not claim to provide the reader with detailed instruction as to how to conduct the various forms of psychotherapy, but it certainly provides him with the essential basis of psychological understanding required in clinical practice, and with an objective account of existing psychotherapeutic methods. It can be recommended to anyone interested in widening his knowledge of the psychological basis of ill-health and psychotherapeutic management. HEINZ WOLFF Psychosomatic
Specificity. Volume I. Experimental Study and Results. Edited by FRANZ ALEXANDER, THOMASM. FRENCH and GEORGEH. POLLOCK. University of Chicago Press, Chicago, 1968. pp. 263. f3.40.
THIS VOLUME provides a detailed account of the work done at the Chicago Institute of Psychoanalysis
by Franz Alexander and his research team from 1951 to 1965, to test the hypothesis that there is a specific psychodynamic constellation and psychogenesis, characteristic of each of the so-called psychosomatic diseases. Patients with asthma, rheumatoid arthritis, ulcerative colitis, essential hypertension, neurodermatitis, thyrotoxicosis and duodenal ulcer were studied. For each patient a detailed protocol, based on a psychodynamic interview was prepared, and after removing all possible medical clues, these protocols were given to analysts and internists who were unaware of the patient’s medical diagnosis; they were then asked to make a diagnosis on the basis of these psychological data alone. The correlation between these and the actual diagnoses was then subjected to statistical analysis. There was, not surprisingly, a large variability in the results, not only among the diagnoses made but also among the different analysts and internists, but the authors claim that a correct diagnosis was made on the psychological data given to them more often than would have been expected by chance. Although these findings are put forward as evidence in support of psychosomatic specificity, they may fit better into the more modern view that emotional factors in illness in general are likely to act as contributory factors, some of them perhaps occurring more often in some disorders than in others. In spite of this the detailed and careful exposition of the authors’ findings will be of interest to those engaged in research in this difficult field of psychosomatic medicine. HEINZ WOLFF
KENNEM GRANVILLE-GROSSMAN: Recent Advances in Clinical Psychiatry. 1971. pp. 340. E3.75.
J. &A. Churchill, London,
THIS IS an impressive book which will be welcomed by many psychiatrists, particularly, I imagine, by candidates for the D.P.M. and the membership of the College of Psychiatrists. The author has selected ten areas in which there have recently been important theoretical or practical developments and reviewed the literature of the last decade in each. The range of topics reflects the sphere of interest of British academic psychiatry, ranging from the physical treatment of affective disorders to drug dependence, organic brain disease and the psychiatric aspects of pregnancy and the puerperium. The author’s treatment of all these subjects is well-informed, comprehensive and up to date and there is a valuable list of recent references at the end of each section of text to provide easy access to more detailed information. In some ways it is a pity that the author generally refrains from stating his own opinions and conclusions, for the facts, when left to speak for themselves, often do so with discordant voices, but this is a small criticism of most welcome publication. R. E. KENDELL