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The lumbosacral spine: Emphasizing conservative management
Book Reviews
813
dynamically based techniques, or the yield is so minor in terms of improvement as to be universally discouraging. And yet there are some disappointments in this book, particularly in its attacks on psychoanalysis. Continuing the precedent set by Eysenck and Wolpe, and drawing strongly on Szasz as a deviant analyst, the authors are not content to let their own material speak for itself, but have to include repeated jabs at the psychoanalytic schools. Unfortunately, the authors repeatedly identify the psychoanalytic model as a medical model. Nevertheless, the medical model, as understood in clinical medicine, is really closer to the behavioral therapy school. Psychoanalysis has long been at odds with this medical model, because of its emphasis on single factor causation of disease and of a clinical attitude in the doctor-patient relationship, where the doctor is in complete charge, and does or gives something to the patient. Psychoanalytic therapy has insisted on a collaborative relationship with the patient in which, during the course of the treatment, patterns of malfunctioning and multifactorial antecedents of neurosis have been demonstrated. Symptomatic cure has been usually considered secondary to personality change. What does this book and its various writers offer to medical and psychotherapeutic science? They emphasize that one of the important factors in successful psychotherapy may be the application of a system of rewards and punishments given in the form of differential attention and approval by the therapist. They put Franz Alexander’s idea of the corrective emotional experience into conditioning terms. This correctly continues the work of Dollard and Miller in their book of the 1950’s, Persodity andPsychotherapy. To this reviewer they have also brought forcibly to his attention the idea of forced fantasies and the desirability of utilizing them in psychotherapy. None of this is incompatible with the psychoanalytic theoretical framework. As physicians and therapists, our orientation must be, if one thing doesn’t work, use another. This book provides something else that seems to work. ROY M. WHITMAN
MEETING THE SOCIAL NEEDS OF LONG-TERM PATIENTS: REPORT OF A WORKSHOP. American Hospital Association, 1965. 54 pp. $1.50. THIS brief monograph is a report of a workshop in which representatives of the health and social science fields considered the social needs of the long-term patients. The first formal presentation by Albert F. Wesson, Ph.D. “Long-Term Care-The Forces That Have Shaped It ” is an excellent statement of the demographic and health factors related to the increasing need for qualitative longterm care. The lack of prestige attached to long-term care by the health professions is highlighted with the resultant effect that relatively untrained personnel provide the major part of care for these patients. Less than 10 per cent of the nation’s general hospitals are involved in long-term care. In addition Dr. Wesson’s well written thoughtful statement suggests some of the most important problems and needs of the long-term patients. A second formal presentation by Dr. Prescott W. Thompson “The Long-Term Patient and Those Who Serve Him,” deals primarily with the need for staff awareness “of what it means to a man to have a social identity beyond that of patient.” This brief paper is an important contribution for those involved in long-term care. These papers are followed by the summary and recommendations arrived at during the discussions. The monograph is brief, well organized and contains meaningful information and ideas regarding this area of medical care, which has for too long been relatively neglected. As Federal legislation forces many involved in patient care to reassess their methods and attitudes, these articles offer some useful guidelines. ELEANORCLARK
THE LUMBOSACRAL SPINE: EMPHASIZING CONSERVATIVE MANAGEMENT. WILLIAMS. McGraw-Hill, New York, 1965. 210 pp. $11.00 (88s. Od.).
PAUL
C.
FEW people will get through a lifetime without a backache, and few doctors, whatever their field of interest, get through a professional career without dealing with cervical or low-back pain in one way or another. Even the ophthalmologic surgeon, after telling the patient that he must rest absolutely quietly in bed, will be told from time to time that this is impossible because “my back is killing me”. Dr. Paul C. Williams has long been known for his interest in and contributions to the subject of lumbar backache, and this book is of particular interest to the entire profession because it emphasizes the non-operative treatment of low-back conditions. Any doctor who is familiar with the contents of this book will be more inclined to make an exact diagnosis of the tissue involved and level of its involvement than to simply tell the patient after a cursory examination, “You’ve got a disc,” or “You’ve got a sacroiliac.” The author stresses the fact that the majority of patients suffering from
Book Reviews
814
low-back pain with leg radiation have degenerative skeletal changes secondary to intervertebral disc lesions, but he also stresses that surgical treatment of one kind or another is by no means a panacea for these ailments. This work is particularly important for those doctors in genera1 practice, and for those in the practice of internal medicine and general surgery. With the expected decreasing ratio of doctors per 100,000 population, there will be a corresponding decrease in the ratio of orthopedic surgeons to the population. If all doctors were cognizant of the contents of this useful book, there would be much less need for referral. JAMESK. STACK
MATHEMATICS
AND COMPUTER
SCIENCE IN BIOLOGY AND MEDICINE. Office, London, 1965. 317 pp. $8.25 (f3).
biEDICAL
RFSEARCH COUNCIL. H.M. Stationery
Trns soft covered volume consists of the proceedings of a conference held by the British Medical Research Council in association with health departments in July, 1964. The purpose of the conference was to bring together mathematicians and computologists with medical men and biologists in order to discuss the potentials and limitations of the uses of modem data processing techniques and mathematics for the solution of problems in the biological sciences. The volume is divided into six sections: (1) uses of data processing for the storage and retrieval of records; (2) methods and potentials of record linkage; (3) numerical methods in the classification and diagnosis of diseases and other biological variables; (4) uses of computers in the analysis of biomedical data such as electrocardiograms, electroencephalograms and for measuring and counting chromosomes; (5) mathematical models to depict epidemiological studies and clinical trials; (6) mathematical methods of studying biological structure and function. The book is an excellent survey of current research in this area. For individuals not familiar with the many current uses of computers in biology and medicine, this volume will be worth reading. On the other hand, because of the breadth of the subject matter, readers will find some of the papers difficult to interpret. Of particular interest to individuals interested in chronic disease epidemiology and medical care is the first section on data processing, and a later section on the uses of computers on the interpretation of data. LEWISKIJLLER CONTRIBUTIONS TO THE PSYCHOBIOLOGY OF AGING. Edited by ROBERTKASTENBNM, Ph.D. Springer Publishing Co. Inc., New York, 1965. 115 pp. Indexed. $3.00. Tms small book contains four essays on ‘psychological perspectives’ in the field of aging, and five essays on ‘biological perspectives.’ While both parts of the book purport to deal with theories of aging, it seems to this reviewer that the psychologists are primarily describing what they see rather than trying to explain it. The biological papers, in contrast, are much more provocative in that they propose truly explanatory constructs for verification or rejection. LOUIS LASAGNA
813
dynamically based techniques, or the yield is so minor in terms of improvement as to be universally discouraging. And yet there are some disappointments in this book, particularly in its attacks on psychoanalysis. Continuing the precedent set by Eysenck and Wolpe, and drawing strongly on Szasz as a deviant analyst, the authors are not content to let their own material speak for itself, but have to include repeated jabs at the psychoanalytic schools. Unfortunately, the authors repeatedly identify the psychoanalytic model as a medical model. Nevertheless, the medical model, as understood in clinical medicine, is really closer to the behavioral therapy school. Psychoanalysis has long been at odds with this medical model, because of its emphasis on single factor causation of disease and of a clinical attitude in the doctor-patient relationship, where the doctor is in complete charge, and does or gives something to the patient. Psychoanalytic therapy has insisted on a collaborative relationship with the patient in which, during the course of the treatment, patterns of malfunctioning and multifactorial antecedents of neurosis have been demonstrated. Symptomatic cure has been usually considered secondary to personality change. What does this book and its various writers offer to medical and psychotherapeutic science? They emphasize that one of the important factors in successful psychotherapy may be the application of a system of rewards and punishments given in the form of differential attention and approval by the therapist. They put Franz Alexander’s idea of the corrective emotional experience into conditioning terms. This correctly continues the work of Dollard and Miller in their book of the 1950’s, Persodity andPsychotherapy. To this reviewer they have also brought forcibly to his attention the idea of forced fantasies and the desirability of utilizing them in psychotherapy. None of this is incompatible with the psychoanalytic theoretical framework. As physicians and therapists, our orientation must be, if one thing doesn’t work, use another. This book provides something else that seems to work. ROY M. WHITMAN
MEETING THE SOCIAL NEEDS OF LONG-TERM PATIENTS: REPORT OF A WORKSHOP. American Hospital Association, 1965. 54 pp. $1.50. THIS brief monograph is a report of a workshop in which representatives of the health and social science fields considered the social needs of the long-term patients. The first formal presentation by Albert F. Wesson, Ph.D. “Long-Term Care-The Forces That Have Shaped It ” is an excellent statement of the demographic and health factors related to the increasing need for qualitative longterm care. The lack of prestige attached to long-term care by the health professions is highlighted with the resultant effect that relatively untrained personnel provide the major part of care for these patients. Less than 10 per cent of the nation’s general hospitals are involved in long-term care. In addition Dr. Wesson’s well written thoughtful statement suggests some of the most important problems and needs of the long-term patients. A second formal presentation by Dr. Prescott W. Thompson “The Long-Term Patient and Those Who Serve Him,” deals primarily with the need for staff awareness “of what it means to a man to have a social identity beyond that of patient.” This brief paper is an important contribution for those involved in long-term care. These papers are followed by the summary and recommendations arrived at during the discussions. The monograph is brief, well organized and contains meaningful information and ideas regarding this area of medical care, which has for too long been relatively neglected. As Federal legislation forces many involved in patient care to reassess their methods and attitudes, these articles offer some useful guidelines. ELEANORCLARK
THE LUMBOSACRAL SPINE: EMPHASIZING CONSERVATIVE MANAGEMENT. WILLIAMS. McGraw-Hill, New York, 1965. 210 pp. $11.00 (88s. Od.).
PAUL
C.
FEW people will get through a lifetime without a backache, and few doctors, whatever their field of interest, get through a professional career without dealing with cervical or low-back pain in one way or another. Even the ophthalmologic surgeon, after telling the patient that he must rest absolutely quietly in bed, will be told from time to time that this is impossible because “my back is killing me”. Dr. Paul C. Williams has long been known for his interest in and contributions to the subject of lumbar backache, and this book is of particular interest to the entire profession because it emphasizes the non-operative treatment of low-back conditions. Any doctor who is familiar with the contents of this book will be more inclined to make an exact diagnosis of the tissue involved and level of its involvement than to simply tell the patient after a cursory examination, “You’ve got a disc,” or “You’ve got a sacroiliac.” The author stresses the fact that the majority of patients suffering from
Book Reviews
814
low-back pain with leg radiation have degenerative skeletal changes secondary to intervertebral disc lesions, but he also stresses that surgical treatment of one kind or another is by no means a panacea for these ailments. This work is particularly important for those doctors in genera1 practice, and for those in the practice of internal medicine and general surgery. With the expected decreasing ratio of doctors per 100,000 population, there will be a corresponding decrease in the ratio of orthopedic surgeons to the population. If all doctors were cognizant of the contents of this useful book, there would be much less need for referral. JAMESK. STACK
MATHEMATICS
AND COMPUTER
SCIENCE IN BIOLOGY AND MEDICINE. Office, London, 1965. 317 pp. $8.25 (f3).
biEDICAL
RFSEARCH COUNCIL. H.M. Stationery
Trns soft covered volume consists of the proceedings of a conference held by the British Medical Research Council in association with health departments in July, 1964. The purpose of the conference was to bring together mathematicians and computologists with medical men and biologists in order to discuss the potentials and limitations of the uses of modem data processing techniques and mathematics for the solution of problems in the biological sciences. The volume is divided into six sections: (1) uses of data processing for the storage and retrieval of records; (2) methods and potentials of record linkage; (3) numerical methods in the classification and diagnosis of diseases and other biological variables; (4) uses of computers in the analysis of biomedical data such as electrocardiograms, electroencephalograms and for measuring and counting chromosomes; (5) mathematical models to depict epidemiological studies and clinical trials; (6) mathematical methods of studying biological structure and function. The book is an excellent survey of current research in this area. For individuals not familiar with the many current uses of computers in biology and medicine, this volume will be worth reading. On the other hand, because of the breadth of the subject matter, readers will find some of the papers difficult to interpret. Of particular interest to individuals interested in chronic disease epidemiology and medical care is the first section on data processing, and a later section on the uses of computers on the interpretation of data. LEWISKIJLLER CONTRIBUTIONS TO THE PSYCHOBIOLOGY OF AGING. Edited by ROBERTKASTENBNM, Ph.D. Springer Publishing Co. Inc., New York, 1965. 115 pp. Indexed. $3.00. Tms small book contains four essays on ‘psychological perspectives’ in the field of aging, and five essays on ‘biological perspectives.’ While both parts of the book purport to deal with theories of aging, it seems to this reviewer that the psychologists are primarily describing what they see rather than trying to explain it. The biological papers, in contrast, are much more provocative in that they propose truly explanatory constructs for verification or rejection. LOUIS LASAGNA