- Email: [email protected]
The Need to be Loved
PSYCHOSOMATICS reader can make a virtue of this necessity. The reviewer certainly enjoyed reading this beautifully produced edition. H. ANGUS BOWES, M.D.
STRECKER'S FUNDAMENTALS OF PSYCHIATRY. By Manuel M. Pearson, M.D. 6th Edition, 274 pages. Philadelphia: ]. B. Lippincott Co. 1963. This edition brings to the readcr the many advances in psychiatry since the last edition, published a decade ago. It includes the new classification of psychiatric disorders adopted by the American Psychiatric Association in 1952 and gives full consideration to the recent breakthrough in psychopharmacology. This edition maintains the principles which guided Doctor Strecker's outstanding career as a teacher of psychiatry-especially his holistic approach to the study of the "total" person. It is interesting that the chapter formerly entitled "Psychosomatic Medicine" is now labeled "Psychophysiologic Autonomic and Visceral Disorders"-a change which is indeed commendable. Doctor Strecker's preface to the first edition underscores the need to close the gap between internal medicine and psychiatry-a concept which indicates his concept of psychiatry as an inteh'Tal portion of medical practice. The author's belief that "to single out certain diseases as psychosomatic is erroncous and futile since every disease is psychosomatic" again points up the orientation and philosophy of the author. His review of the history of psychiatry traces its roots to primitive cultures and notes the contributions of Kraepelin, Eugcn B1culer, Adolf Meyer and Sigmund Freud. It is also noted that the current needs for basic research are indeed great; that competent physicians must utilize short-term psychotherapeutic techniques which are geared to their training. It is a revelation indeed to find that the patient's physical status should be induded in the psychiatric examination. Laboratory tests, roentgenograms, and cardiograms arc not exduded. Under "Psychodynamics," which is defined as "a study of the motives of human behavior," it is stated that the designation of an illness as "functional" or "psychogenic" is by no means to be regarded as final. Perhaps eventually, manic-depressive and schizophrenic disorders may be found to be associated with impairment of brain tissue function. Even when the mechanisms in the psychoses are clearly "non-structural," the body still participates. As for manic-depressive reactions, the periodicity of the illness is hardly explained by psychogenic causes. Its abrupt, spontan('ous appearance without significant precipitating situations and the factors of inheritance must be taken into consideration. Even in the psychoneuroses, the problem of organic morbidity is included in that it may playa precipitating role in the production of functional symptoms. As for "psychosomatic medicine," the symptoms are seen to represent a pathologic compromise. Etiological factors are not to be considered as being of necessity only physical or only mental. Close liaison between the psychiatrist and the medical practitioner is underscored. The chapter on "psychopharmaco-therapy" provides
264
adequate coverage of the phenothiazines as well as the milder tranquilizers. Antidepressants too are conSidered-dosage, side effects, et cetera. The value of electroshock as a specific for depressions of late middle life is indicated. As for "Psychotherapy" the goals and types are outlined. Interviewing technique is stressed. As for psychoanalysis, it is noted that many analysts are not sufficiently interested in recent advances in physiology and pharmacology, thus isolating psychoanalysis from the main stream of medicine. This book is recommended. It is a most meaningful contribution both for psychiatrists as well as nonpsychiatrists. W.O.
EGO-ORIENTED CASEWORK. Problems and PerspC(tives. (Papers from the Smith College School for Social Work) Editors: Howard]. Parad and Roger R. MiUer. New York: Family Service, 1963. $5.50.
This book is written by the Director of the Smith College School for Social Work and the Director of Research of the same College, and its audience is clearly aimed to be social workers and allied groups. In view of these facts, it is not surprising that the opinion of qualified social workers should be sought. Mr. Raymond Blackard, my co-worker, is the Chief of Social Service work at the Peoria State Hospital, and I\liss Joan Nesler his assistant, have wide experiences in the field. Their opinions are well reflected in this review. Ego-Oriented Casework comprises a series of wellselected papers written by psychiatrists and social workers. They combine theoretical concepts with a rich assortment of case examples, all of which portray the theoretical "why" and important "how." The change in perspectives of social work are emphasized which tend to lead away from the long and intense relationship in therapy. Instead the book deals with immediate problems in the social structure affecting the individual. However, an awareness and understanding of the unconscious needs and conflicts are important, since the everyday problems with which therapist and social worker deal are an expression of these. Emphasis is evident that more and more the social forces and the individual psychiatric aspects of the patient (client) are recognized not as entities unto themselves but are intertwined. This book is well written and organized, pleasant in its form and highly recommended to workers in the field for whom it is primarily aimed. WALTER }. GARRE, M.D.
THE NEED TO BE LOVED. Theodore Reik. 276 pages. New York: Noonday Press (Farrar, Straus II< Co.) 1963. $4.95. This new book by one of Freud's students is a most readable account of a problem that has been too often neglected: the distinction between loving and being loved. He takes a definitive stand in stating that "to be unloved makes one unhappy." He differentiates between the female and the male in that women want Volume V
BOOK REVIEWS to be appreciated for their beauty and charm, while men require it for their actions and achievements. Happiness is related to the seeming ful6llment of the wishes of childhood-the feeling of being loved. Masochists try to get love "at any price"-often humiliating themselves so that they can gain this end. These patients indulge in self-sabotage, unconsciously hoping for the reward (being loved) because of their sacri6ces. The ncurotic need for love is complicated by the inability to give it. Unconscious guilt feelings arc created because of intensive violent impulses which arise because of the feeling of being unloved. It seems to be a vicious cycle. The author points out that this need to be loved is often disguised and concealed, as if it were the "confession of a hidden weakness." A second part of this book, entitled "Contrasts and Compliments," compares the behavior and the emotional life of women and men, of old age and youth. The author feels that a man must have a "dedication toward the concentration upon something outside of himself." This is apparently not a necessity for the female. A woman cherishes the idea that she is the most essential part of a man's life; she does not realize that the center of a man's existence is his work. The third part, "From the Notebooks of an Old Psychoanalyst," contains observations over a period of 6fty years of psychoanalytic practice. The fourth part, "Of Life and Letters," relates depth psychology to the writings of many great authors. This book, with its wealth of psychodynamic understanding, should be of interest to readers who can appreciate the wit and wisdom of a gifted psychoanalyst. \V.D.
PSYCHOTHERAPY IN OUR SOCIETY. By Theron Alexander. 181 pages. Englewood: Prentice-Hall, 1963. $1.95 (paperback). The theme of this book is that society, largely responsible for the existence of mental disorders, has a responsibility for correcting them. In Part I the author presents the psychiatric categories in a rather didactic manner. He then discusses tlwir inappropriateness for the disorders of children amI the role of cultural diHerences in determination of what is "abnormal" behavior. Diagnostic procedures are described in such a way that a patient would know what to expect. The chapter on therapy with children is illustrated with several case summaries. Involvement of the parents is seen as particularly rewarding, since success can improve conditions not only for the children but for all with whom the family has relationships. What the author calls "a societal paradox" means society's demands for conformity which at the same time causes nonconformity. In certain subcultures, deprivations of one kind or another, together with such factors as family disorganization, lack of close emotional ties, frequent brutality, and uncertainty of food and shelter, precipitate mental disorder. Examples are cited of cases rehabilitated by intervention of educational, weHare, and judicial organizations. Part II is a description of the process of theraJuly-August, 1964
peutic change in a young woman who was successfully treated. This is a useful little book for persons seeking an introduction to the concept, process, and goals of psychotherapy. The style is clear and readable, and the content is appropriate for those with a minimum of information in this area. The absence of jargon is indeed refreshing. EUZABETIi THOMA, Ph.D.
PSYCHIATRY: DESCRIPTIVE AND DYNAMIC. Jackson A. Smith, M.D. 342 pages. Baltimore: Williams and Wilkins Co., 1960. $7.00. This book contains concise descriptions of various psychiatric syndromes. Areas where controversy exists and where various schools of thought produce more heat than light are minimized, so that the 6nal result is an excellent summation of prevailing dynamic concepts. The contents include the following chapter headings: History of Psychiatry, Schools of Psychiatry, Psychodynamics, Psychiatric Examination, Types of Psychoneuroscs, Hysteria, Psychophysiological Reactions, Psychotherapy, Hypnosis, Sociopathic Personality Disturbance, Alcoholism, Affective Reactions, Schizophrenic Reactions, Somatic and Drug Therapies, Child Psychiatry, Mental De6ciency, Epilepsy and Emotional Problems in the Geriatric Patient. The chapter on the "History of Psychiatry" is a most readable account, in which many contributions are evaluated. Thus Hippocrates, Asklepiades, Galen, Pinel, Esquirol, Tuke, Rush, Kraepelin, Bleuler, and others are given their just due without the verbosity so characteristic of other books dealing with this prohlem. In "Schools of Psychiatry," the differences expressed by Jung, Adler, Ferenczi, Harry Stack Sullivan, Karen Horney, Freud and existential analysis are handled with ohjectivity-which is in itself commendable. "Psychodynamics" provides material de6ned by Freud as well as others. The theory of instincts, life and dcath instincts, motivation of behavior, the division of the personality (id, ego, superego) , concepts of psychic activity (free association), levels of psychic activity (concept of a dynamic unconscious), psychosexual development are considered. The various mental mechanisms, such as repression, sublimation, rationalization, are outlined. The chapter on "Psychiatric Examination" provides pertinent details. Psychoneuroses are then considered in all of their rami6cations. "Psychophysiological Reactions" should be of interest to every physician interested in psychosomatic correlations. The chapter on "Psychotherapy" points up the indications as well as the limitations of this method. Factors determining the plan of treatment are examined. "Sociopathic Personality Disturbances" includes homosexuality, fetishism, transvestism, exhibitionism and antisocial reactions. The chapter on "Alcoholism" is most valuable in that it distinguishes between different types of alcoholics and provides excellent instructions for the management of various complications of alcoholism. "Affective Reactions" includes a consideration of
265
STRECKER'S FUNDAMENTALS OF PSYCHIATRY. By Manuel M. Pearson, M.D. 6th Edition, 274 pages. Philadelphia: ]. B. Lippincott Co. 1963. This edition brings to the readcr the many advances in psychiatry since the last edition, published a decade ago. It includes the new classification of psychiatric disorders adopted by the American Psychiatric Association in 1952 and gives full consideration to the recent breakthrough in psychopharmacology. This edition maintains the principles which guided Doctor Strecker's outstanding career as a teacher of psychiatry-especially his holistic approach to the study of the "total" person. It is interesting that the chapter formerly entitled "Psychosomatic Medicine" is now labeled "Psychophysiologic Autonomic and Visceral Disorders"-a change which is indeed commendable. Doctor Strecker's preface to the first edition underscores the need to close the gap between internal medicine and psychiatry-a concept which indicates his concept of psychiatry as an inteh'Tal portion of medical practice. The author's belief that "to single out certain diseases as psychosomatic is erroncous and futile since every disease is psychosomatic" again points up the orientation and philosophy of the author. His review of the history of psychiatry traces its roots to primitive cultures and notes the contributions of Kraepelin, Eugcn B1culer, Adolf Meyer and Sigmund Freud. It is also noted that the current needs for basic research are indeed great; that competent physicians must utilize short-term psychotherapeutic techniques which are geared to their training. It is a revelation indeed to find that the patient's physical status should be induded in the psychiatric examination. Laboratory tests, roentgenograms, and cardiograms arc not exduded. Under "Psychodynamics," which is defined as "a study of the motives of human behavior," it is stated that the designation of an illness as "functional" or "psychogenic" is by no means to be regarded as final. Perhaps eventually, manic-depressive and schizophrenic disorders may be found to be associated with impairment of brain tissue function. Even when the mechanisms in the psychoses are clearly "non-structural," the body still participates. As for manic-depressive reactions, the periodicity of the illness is hardly explained by psychogenic causes. Its abrupt, spontan('ous appearance without significant precipitating situations and the factors of inheritance must be taken into consideration. Even in the psychoneuroses, the problem of organic morbidity is included in that it may playa precipitating role in the production of functional symptoms. As for "psychosomatic medicine," the symptoms are seen to represent a pathologic compromise. Etiological factors are not to be considered as being of necessity only physical or only mental. Close liaison between the psychiatrist and the medical practitioner is underscored. The chapter on "psychopharmaco-therapy" provides
264
adequate coverage of the phenothiazines as well as the milder tranquilizers. Antidepressants too are conSidered-dosage, side effects, et cetera. The value of electroshock as a specific for depressions of late middle life is indicated. As for "Psychotherapy" the goals and types are outlined. Interviewing technique is stressed. As for psychoanalysis, it is noted that many analysts are not sufficiently interested in recent advances in physiology and pharmacology, thus isolating psychoanalysis from the main stream of medicine. This book is recommended. It is a most meaningful contribution both for psychiatrists as well as nonpsychiatrists. W.O.
EGO-ORIENTED CASEWORK. Problems and PerspC(tives. (Papers from the Smith College School for Social Work) Editors: Howard]. Parad and Roger R. MiUer. New York: Family Service, 1963. $5.50.
This book is written by the Director of the Smith College School for Social Work and the Director of Research of the same College, and its audience is clearly aimed to be social workers and allied groups. In view of these facts, it is not surprising that the opinion of qualified social workers should be sought. Mr. Raymond Blackard, my co-worker, is the Chief of Social Service work at the Peoria State Hospital, and I\liss Joan Nesler his assistant, have wide experiences in the field. Their opinions are well reflected in this review. Ego-Oriented Casework comprises a series of wellselected papers written by psychiatrists and social workers. They combine theoretical concepts with a rich assortment of case examples, all of which portray the theoretical "why" and important "how." The change in perspectives of social work are emphasized which tend to lead away from the long and intense relationship in therapy. Instead the book deals with immediate problems in the social structure affecting the individual. However, an awareness and understanding of the unconscious needs and conflicts are important, since the everyday problems with which therapist and social worker deal are an expression of these. Emphasis is evident that more and more the social forces and the individual psychiatric aspects of the patient (client) are recognized not as entities unto themselves but are intertwined. This book is well written and organized, pleasant in its form and highly recommended to workers in the field for whom it is primarily aimed. WALTER }. GARRE, M.D.
THE NEED TO BE LOVED. Theodore Reik. 276 pages. New York: Noonday Press (Farrar, Straus II< Co.) 1963. $4.95. This new book by one of Freud's students is a most readable account of a problem that has been too often neglected: the distinction between loving and being loved. He takes a definitive stand in stating that "to be unloved makes one unhappy." He differentiates between the female and the male in that women want Volume V
BOOK REVIEWS to be appreciated for their beauty and charm, while men require it for their actions and achievements. Happiness is related to the seeming ful6llment of the wishes of childhood-the feeling of being loved. Masochists try to get love "at any price"-often humiliating themselves so that they can gain this end. These patients indulge in self-sabotage, unconsciously hoping for the reward (being loved) because of their sacri6ces. The ncurotic need for love is complicated by the inability to give it. Unconscious guilt feelings arc created because of intensive violent impulses which arise because of the feeling of being unloved. It seems to be a vicious cycle. The author points out that this need to be loved is often disguised and concealed, as if it were the "confession of a hidden weakness." A second part of this book, entitled "Contrasts and Compliments," compares the behavior and the emotional life of women and men, of old age and youth. The author feels that a man must have a "dedication toward the concentration upon something outside of himself." This is apparently not a necessity for the female. A woman cherishes the idea that she is the most essential part of a man's life; she does not realize that the center of a man's existence is his work. The third part, "From the Notebooks of an Old Psychoanalyst," contains observations over a period of 6fty years of psychoanalytic practice. The fourth part, "Of Life and Letters," relates depth psychology to the writings of many great authors. This book, with its wealth of psychodynamic understanding, should be of interest to readers who can appreciate the wit and wisdom of a gifted psychoanalyst. \V.D.
PSYCHOTHERAPY IN OUR SOCIETY. By Theron Alexander. 181 pages. Englewood: Prentice-Hall, 1963. $1.95 (paperback). The theme of this book is that society, largely responsible for the existence of mental disorders, has a responsibility for correcting them. In Part I the author presents the psychiatric categories in a rather didactic manner. He then discusses tlwir inappropriateness for the disorders of children amI the role of cultural diHerences in determination of what is "abnormal" behavior. Diagnostic procedures are described in such a way that a patient would know what to expect. The chapter on therapy with children is illustrated with several case summaries. Involvement of the parents is seen as particularly rewarding, since success can improve conditions not only for the children but for all with whom the family has relationships. What the author calls "a societal paradox" means society's demands for conformity which at the same time causes nonconformity. In certain subcultures, deprivations of one kind or another, together with such factors as family disorganization, lack of close emotional ties, frequent brutality, and uncertainty of food and shelter, precipitate mental disorder. Examples are cited of cases rehabilitated by intervention of educational, weHare, and judicial organizations. Part II is a description of the process of theraJuly-August, 1964
peutic change in a young woman who was successfully treated. This is a useful little book for persons seeking an introduction to the concept, process, and goals of psychotherapy. The style is clear and readable, and the content is appropriate for those with a minimum of information in this area. The absence of jargon is indeed refreshing. EUZABETIi THOMA, Ph.D.
PSYCHIATRY: DESCRIPTIVE AND DYNAMIC. Jackson A. Smith, M.D. 342 pages. Baltimore: Williams and Wilkins Co., 1960. $7.00. This book contains concise descriptions of various psychiatric syndromes. Areas where controversy exists and where various schools of thought produce more heat than light are minimized, so that the 6nal result is an excellent summation of prevailing dynamic concepts. The contents include the following chapter headings: History of Psychiatry, Schools of Psychiatry, Psychodynamics, Psychiatric Examination, Types of Psychoneuroscs, Hysteria, Psychophysiological Reactions, Psychotherapy, Hypnosis, Sociopathic Personality Disturbance, Alcoholism, Affective Reactions, Schizophrenic Reactions, Somatic and Drug Therapies, Child Psychiatry, Mental De6ciency, Epilepsy and Emotional Problems in the Geriatric Patient. The chapter on the "History of Psychiatry" is a most readable account, in which many contributions are evaluated. Thus Hippocrates, Asklepiades, Galen, Pinel, Esquirol, Tuke, Rush, Kraepelin, Bleuler, and others are given their just due without the verbosity so characteristic of other books dealing with this prohlem. In "Schools of Psychiatry," the differences expressed by Jung, Adler, Ferenczi, Harry Stack Sullivan, Karen Horney, Freud and existential analysis are handled with ohjectivity-which is in itself commendable. "Psychodynamics" provides material de6ned by Freud as well as others. The theory of instincts, life and dcath instincts, motivation of behavior, the division of the personality (id, ego, superego) , concepts of psychic activity (free association), levels of psychic activity (concept of a dynamic unconscious), psychosexual development are considered. The various mental mechanisms, such as repression, sublimation, rationalization, are outlined. The chapter on "Psychiatric Examination" provides pertinent details. Psychoneuroses are then considered in all of their rami6cations. "Psychophysiological Reactions" should be of interest to every physician interested in psychosomatic correlations. The chapter on "Psychotherapy" points up the indications as well as the limitations of this method. Factors determining the plan of treatment are examined. "Sociopathic Personality Disturbances" includes homosexuality, fetishism, transvestism, exhibitionism and antisocial reactions. The chapter on "Alcoholism" is most valuable in that it distinguishes between different types of alcoholics and provides excellent instructions for the management of various complications of alcoholism. "Affective Reactions" includes a consideration of
265