Theoretical principles of psychosomatic medicine

Theoretical principles of psychosomatic medicine

Journal o[' the NeurologicalSciences, 1977, 33 : 461-463 ~: Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands 461 Book ...

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Journal o[' the NeurologicalSciences, 1977, 33 : 461-463 ~: Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands

461

Book Reviews

Blood-Brain Barrier in Physiology and Medicine, b y S. 1. R a p o p o r t , xii + 316 p a g e s , 99 i l l u s t r a t i o n s , 39 t a b l e s , R a v e n Press, N e w Y o r k , N . Y . , 1976, U S $ 28.00. The blood brain barrier is an important concept to clinicians and research workers in the neurosciences, not only because of the alterations which occur in disease but also because of the increasing awareness of the importance of the blood brain barrier in therapeutics. This monograph provides an excellent summary of the present state of knowledge of the blood brain barrier and all its important functions are considered. It starts with an account of the anatomical basis of the barrier and the four principal methods of transport across the barrier: passive and facilitated diffusion, active and vesicular transport. Then follow details of the sites at which the barrier operates and both the general and special functions at each site. An account of the permeability and osmotic properties of the barrier complete the part of the book relating to normal mechanisms. The remaining chapters deal with pathological alterations in the barrier, regulation of drug entry and the transport of sugars, amino acids and other meta bolites. The final chapter covers the blood aqueous and blood-vitreous barriers in the eye with an account of normal mechanisms and drug entry. Inevitably a review monograph of this size cannot cover the background of every aspect of the blood-brain barrier in great detail, since this would involve extensive discussion of cerebrovascular physiology, membrane physics, neurochemistry and neuropharmacology. Specialists in any of these fields might find the discussion rather superficial, but this is compensated by the broad coverage of subjects in other areas and the author has maintained a satisfactory balance. Further information is readily available from more than a thousand references; these seem to indicate that the book was largely completed in 1975. The producers of this book are to be congratulated on an exemplary index and reference system which makes the wealth of information easily accessible. Each chapter is preceded by a detailed precis and followed by an appendix of the mathamatical content where appropriate. All the authors' names are given in the text instead of the tiresome numerical suffixes now so widely used. All the references are listed in alphabetical order in one section and this is followed by a full author index, giving both the page where the reference is quoted and the page of the full reference. There is a comprehensive index and an index of abbreviations. The text is well illustrated with numerous tables, figures and graphs. This is an essential book for any medical library and will be consulted by a broad spectrum of clinicians and those engaged in research which in any way involves the blood-brain barrier. M. D. O'Brien

Theoretical Principles of Psychosomatic Medicine, b y I. T. K u r t s i n , t r a n s l a t e d f r o m R u s s i a n b y N. K a n e r , xi -F 257 p a g e s , 44 i l l u s t r a t i o n s , 12 t a b l e s , K e t e r P u b l i s h i n g H o u s e , J e r u s a l e m , d i s t r i b u t e d in t h e W e s t e r n H e m i s p h e r e b y H a l s t e d Press, a d i v i s i o n o f J o h n W i l e y a n d S o n s , N e w Y o r k , 1976, £ 15.95, U S $ 31.90. This book is a review of the enormous Russian and Eastern European work on experimental neurosis and for every 9 pages of script there is 1 of references. It is the logical continuation of Parlor's conditioned reflex work with ideas of cerebral excitation and inhibition and is about central mechanisms of corticovisceral disturbances. The authority of the great Russian physiologist is everywhere and it is hard to escape from the idea that so far, if the Russians had to choose between shedding light on psychosomatic mechanisms other than by the " h a r d " scientific way that Parlor laid down, they'd

462 just as soon leave it as it is. However, this would be unfair because each chapter and each subject di:,cussed states clearly that they have not yet yielded the promised results, although the prospects a(c good and lie around the next corner. They leave one to wonder if it has not been a cul de sac situation. The work is highly specialised and methodology sound, so far as it is observable. Emotional and psychosomatic problems are clearly to be found in physiological and neuro-physiological research with animals on the basis of conditioned reflexes and only there. About halfway through the book one gets the feeling that they must really have struck oil and have something to say to those of us who have come along what begins to seem like, another evolutionary pathway from the trees. Yet each chapter and subject examined indicates "not yet" with an honesty which is straightforward. Much of our own study of psychology is claimed by some of those who do it to be about rats and not about people and so in Russian psychosomatic research it is about animals (dogs) mainly and not about people. Psychological factors in neurosis and emotional stress are given little preference. They know a great deal about the experimental neuroses in animals but one wonders about neuroses in people. Freud gets mentioned and is dismissed in 9 lines as being obviously mistaken. Then at the end of the book one begins to see that in the Expert Committee of the World Health Organisation (1960) there was some very important work done whichallows the Eastern corticovisceral medicine and the Western psychosomatic medicine approaches to come together. Some idea that the West are concerned about aetiology and want to look at people while the Russians are concerned about pathology and physiology and look at animals, emerges. It is possible to say "these approaches are by no means mutually exclusive but are different approaches to the same problem, therefore, scientifically compatible". One wonders if this book is not an indication of a change and from it some relaxation and thinking which does not have to start and end with a text from the great Pavlov. It is sad to see no references to the enormously rich behavioural studies of the West, e.g. Seligman in Philadelphia in his delightful book on "Helplessness" which has followed Pavlov in work to which few can object. Nor to Wolpe and the workers in Britain, such Marks and his colleagues at the Maudsley. Freud is lambasted with enthusiasm and relish at the end. He has no business to have had more influence than Pavlov and this amounts to a political indiscretion. Yet one is left with the thought that Freud has been disagreed with vigorously and vehemently (quite properly in some things) and Pavlov has unfortunately never been accorded this courtesy by his countrymen. Despite this being heavy reading it is a good statement of the Russian approach to medicine and research and honestly indicates their " h a r d " scientific rigour. It also indicates that there have been limitations that have bound them to holy writ. It would be delightful if we could look at some of our own sacred assumptions and consider that there may be more things in heaven and earth (and psychosomatic medicine in particular) than are dreamed of in our and the Russians' philosophies. W. Brough

Advances in the Drug Therapy o f Mental Illness, 170 p a g e s , W o r l d H e a l t h O r g a n i z a t i o n , G e n e v a , 1976, Sfr 6 0 . - . This volume reports the proceedings of a symposium on advances in the drug therapy of mental illness sponsored jointly by WHO and the International Task Force on World Health Manpower held in Geneva in November, 1973. With a list of contributors which reads like an International Who's Who of psychiatry and pharmacology the symposium ought to have been a stimulating occasion. Unfortunately, in print the presentations appear rather uninspiring and a certain overall incoherence of style bespeaks a lack of editorial control. Furthermore the 3-year delay in publication renders the advances something less than recent. Nevertheless the contributions do cover the main aspects of the current use and theoretical modes of action of psychotropic drugs. Included are conventional reviews of the pharmacotherapy of affective disorders (Angst and Woggon), schizophrenia (Ban) and other psychiatric disorders (Johnson). Grattini attempts to elucidate the reasons for the wide individual variation in the response to psychotropic drugs and Lehmann discusses the integration of medication with electroplexy, psychosocial and behaviour therapy. Kielholz dispenses clinical wisdom from his extensive experience in a characteristically thorough review of advances in the nosology, phenomenology and pharmacotherapy of depression and theoretical and practical aspects of lithium therapy are well-presented by Rafaelson and Schou respectively.