PSYCHOSOMATICS

of patients and open inquiry into patients' problemsarc two of the physician's chief tasks. Using a motherbringin~ a 4-year old daughter to a physician's officeas an example, they furnish the reader with a usefulapproach, dividing it into the following areas: 1)observation, 2) finding a pattern, 3) getting informa­tion, and 4) techniques of pSYl·hotherapy.

In thp final chapter, "Evolution of a CommunityMental Health Center," Bandler states that the timehas now come for the gpneral hospital to assume itsresponsibility for the health of a geographical com­munity. He says frankly that the traditional medical­diagnostic modt'l is not out-mooed, but that it anddiffNing models, thp developmental-educational, theorganizational, and the t'l'Ological, can be seen as suc­cessively widening cirdes: "They would not be inopposition to each other but rather as perspectives ofincrcasing scopp and generality." Bandler emphasizesthat thpir joh of planning is with the community, notfor thl' community. Hc noticeahly remarks that theynl'l'd data saying, "\V{, simply do not have adequateknowledge of incidl'ncl' and prevalence of disturb­ann's of psychosocial fundioning." His description ofthe wid('spread social pathology which they en­counlt'r reinforces what WI' have read about and seenin tl1l' city riots during the summer of 1967. In thelight of this sodal turmoil, which threatens both themind aud the body of American soeit'tv, thp pntirenll'dic II profession must l'ontribu!t, its e'fforts towardthe seh.tion of such staggpring problems.

JOliN J. SCHWAll, 1\1.0.

TEXTBOOK OF PSYCHIATRY FOR MEDICALPRACTICE. Clwrlcs K. Hoying, M.D. Philadelphiaand Montreal: ]. B. Lippincott Co., 1963. 558pages.

In Brooklyn, New York, under the auspices of theKings County l\lt-llical Socidy and the Brooklyn Psy­chiatric Association, a Il'cture sprit,s in Psychiatry isbeing conduded for the non-psychiatric physician.As one of thl' ledurers, this revil'wer has sought apsychiatric text which would meet the needs of thesevery busy physicians. They have no desire to becomepsychiatrists, hut they do wish to understand psy­chiatry-its foundation, its structure, its applicationon a level suitahle to their nepds. They wish a textthat is interesting and dear, l'Ontaining a minimumof tIlt' controversial, allll rt'plpll' with useful informa­tion. UnanimouslY, tho;e studl'nts familiar with thishook find it most profitable, as do I.

Dr. HoRing and his collahorators, Drs. Clement,Gottschalk, Kaplan, MacLeod, and Titchener, all ofthe Psychiatric Departml'nt of the University of Cin­cinnati College of Medicine, haVl' done an impressivejob. In his preface, HoRing notes "the major con­tribution which psychiatry has to make to non­psychiatrists is the light it can shed upon problemswith which physicians will frequently have to deal."l\loreover, "mort' psychiatry is 'taught' in books thanis learned from tlll'm."

\Vith this orientation, the authors discuss variedpsychiatric concepts, syndromes and therapy com-

124

monly appearing in standard texts. Psychologicalproblems in medicine", "psychiatric problems seen ingeneral practice," and "psychiatry in surgery," areemphasized.

My only l'Omplaint is the absence of the termssuicide, and gerontology, or geriatrics in the index,which is otherwise ample. In a future edition, I hopeDr. HoHing will dignify the former with a chapterdiscussion and give the latter greater attention.

This book is strongly recommended for studentsand practitioners of medicine of all disciplines.

GEORGE TRAIN, M.D.

ALLERGY AND HUMAN EMOTIONS. John P.McGovern, M.D. and James A. Knight, M.D.,Springfield: Charles C. Thomas, 1967. 1966 pages$7.55.

For many years there has been a need for a skillfulreview of the literature delineating broadly the roleof the emotional factors in the allergic diseases.Especially is this of importance in conditions likeintractable asthma where unrecognized psychic con­Hicts superimposed on immunophysiological illnessmay lead to death. l\1<:Govern and Knight take aholistic view of disease which is true not only forthe allergic diseases, but also for all dis!'ase proc('sses.They emphasize: "No one factor is thl' cause of dis­ease, but that the whole patient with all of his prob­lems, must be considered." Into the relatively newdiscipline of allergy, publications in the past thirtyyears have led to the need to incorporate within thefield of aller/-,'Y another "mysterious" elem!'nt: psychicconRicts. The first action by a national allergy soddyto this need to combine immunologie illness withemotional conflicts in therapy was mad!' under theauspices of the American Collegt' of Allergists in 1947and published as a book in 1948 entitled "Psycho­dynamics and tht, Allergic Patient." II. A. Abram­son, the Editor stated: "I hope that this first step inthe coordination of organizational allergy and psycho­dynamics will lead to the ultimatl' rel'Ognition of theimportance of emotional factors in the routine therapyof the allergic patient by both the allergist and thegeneral practitioner."

I am very happy that thl' talents of l\lcGoVl'rn andKnight have provided us with the second propheticstep. No physician can read their introduction with­out ft'eling the richm'ss of the authors' understandingof the intl'raction of mind and body in their field ofinterest. The difficult suhjt,ct of how emotional fac­tors intl'nsify the symptoms of the allergic state hasbeen skillfully handled by their discussion of stressfactors. Ct'rtain diseases l'Ould not be ('Overed indetail, but the general treatment of the psyche can bereadily applied to any allergic l'Ondilion. Followingthe introduction are three chapters covt>ring emotionalfactors triggering episodes of aller/-,'Y, the manifesta­tions accompanying allergy and the organic changessecondary to aller/-,'Y that may affect the psyche.Chapter IV deals with diagnosis in all phases of theemotional content in aller/-,'Y. Chapter V is the onechapter that every reader whether allergist or psy­chiatrist will find significant because of its excellent

Volume IX

PSYCHOSOMATICS

of patients and open inquiry into patients' problemsarc two of the physician's chief tasks. Using a motherbringin~ a 4-year old daughter to a physician's officeas an example, they furnish the reader with a usefulapproach, dividing it into the following areas: 1)observation, 2) finding a pattern, 3) getting informa­tion, and 4) techniques of pSYl·hotherapy.

In thp final chapter, "Evolution of a CommunityMental Health Center," Bandler states that the timehas now come for the gpneral hospital to assume itsresponsibility for the health of a geographical com­munity. He says frankly that the traditional medical­diagnostic modt'l is not out-mooed, but that it anddiffNing models, thp developmental-educational, theorganizational, and the t'l'Ological, can be seen as suc­cessively widening cirdes: "They would not be inopposition to each other but rather as perspectives ofincrcasing scopp and generality." Bandler emphasizesthat thpir joh of planning is with the community, notfor thl' community. Hc noticeahly remarks that theynl'l'd data saying, "\V{, simply do not have adequateknowledge of incidl'ncl' and prevalence of disturb­ann's of psychosocial fundioning." His description ofthe wid('spread social pathology which they en­counlt'r reinforces what WI' have read about and seenin tl1l' city riots during the summer of 1967. In thelight of this sodal turmoil, which threatens both themind aud the body of American soeit'tv, thp pntirenll'dic II profession must l'ontribu!t, its e'fforts towardthe seh.tion of such staggpring problems.

JOliN J. SCHWAll, 1\1.0.

TEXTBOOK OF PSYCHIATRY FOR MEDICALPRACTICE. Clwrlcs K. Hoying, M.D. Philadelphiaand Montreal: ]. B. Lippincott Co., 1963. 558pages.

In Brooklyn, New York, under the auspices of theKings County l\lt-llical Socidy and the Brooklyn Psy­chiatric Association, a Il'cture sprit,s in Psychiatry isbeing conduded for the non-psychiatric physician.As one of thl' ledurers, this revil'wer has sought apsychiatric text which would meet the needs of thesevery busy physicians. They have no desire to becomepsychiatrists, hut they do wish to understand psy­chiatry-its foundation, its structure, its applicationon a level suitahle to their nepds. They wish a textthat is interesting and dear, l'Ontaining a minimumof tIlt' controversial, allll rt'plpll' with useful informa­tion. UnanimouslY, tho;e studl'nts familiar with thishook find it most profitable, as do I.

Dr. HoRing and his collahorators, Drs. Clement,Gottschalk, Kaplan, MacLeod, and Titchener, all ofthe Psychiatric Departml'nt of the University of Cin­cinnati College of Medicine, haVl' done an impressivejob. In his preface, HoRing notes "the major con­tribution which psychiatry has to make to non­psychiatrists is the light it can shed upon problemswith which physicians will frequently have to deal."l\loreover, "mort' psychiatry is 'taught' in books thanis learned from tlll'm."

\Vith this orientation, the authors discuss variedpsychiatric concepts, syndromes and therapy com-

124

monly appearing in standard texts. Psychologicalproblems in medicine", "psychiatric problems seen ingeneral practice," and "psychiatry in surgery," areemphasized.

My only l'Omplaint is the absence of the termssuicide, and gerontology, or geriatrics in the index,which is otherwise ample. In a future edition, I hopeDr. HoHing will dignify the former with a chapterdiscussion and give the latter greater attention.

This book is strongly recommended for studentsand practitioners of medicine of all disciplines.

GEORGE TRAIN, M.D.

ALLERGY AND HUMAN EMOTIONS. John P.McGovern, M.D. and James A. Knight, M.D.,Springfield: Charles C. Thomas, 1967. 1966 pages$7.55.

For many years there has been a need for a skillfulreview of the literature delineating broadly the roleof the emotional factors in the allergic diseases.Especially is this of importance in conditions likeintractable asthma where unrecognized psychic con­Hicts superimposed on immunophysiological illnessmay lead to death. l\1<:Govern and Knight take aholistic view of disease which is true not only forthe allergic diseases, but also for all dis!'ase proc('sses.They emphasize: "No one factor is thl' cause of dis­ease, but that the whole patient with all of his prob­lems, must be considered." Into the relatively newdiscipline of allergy, publications in the past thirtyyears have led to the need to incorporate within thefield of aller/-,'Y another "mysterious" elem!'nt: psychicconRicts. The first action by a national allergy soddyto this need to combine immunologie illness withemotional conflicts in therapy was mad!' under theauspices of the American Collegt' of Allergists in 1947and published as a book in 1948 entitled "Psycho­dynamics and tht, Allergic Patient." II. A. Abram­son, the Editor stated: "I hope that this first step inthe coordination of organizational allergy and psycho­dynamics will lead to the ultimatl' rel'Ognition of theimportance of emotional factors in the routine therapyof the allergic patient by both the allergist and thegeneral practitioner."

I am very happy that thl' talents of l\lcGoVl'rn andKnight have provided us with the second propheticstep. No physician can read their introduction with­out ft'eling the richm'ss of the authors' understandingof the intl'raction of mind and body in their field ofinterest. The difficult suhjt,ct of how emotional fac­tors intl'nsify the symptoms of the allergic state hasbeen skillfully handled by their discussion of stressfactors. Ct'rtain diseases l'Ould not be ('Overed indetail, but the general treatment of the psyche can bereadily applied to any allergic l'Ondilion. Followingthe introduction are three chapters covt>ring emotionalfactors triggering episodes of aller/-,'Y, the manifesta­tions accompanying allergy and the organic changessecondary to aller/-,'Y that may affect the psyche.Chapter IV deals with diagnosis in all phases of theemotional content in aller/-,'Y. Chapter V is the onechapter that every reader whether allergist or psy­chiatrist will find significant because of its excellent

Volume IX

BOOK REVIEWS

discussion of all phases of therapy related to the man­ag('ment of the allergic patient.

The reader who wishes to be a "Compleat" physi­cian will study and restudy their final chapter. Psy­chodynamics as presently viewed and as anticipatedarc outlined. The special responsibility of the ther­apist for each patient is emphasized and clearly de­scribed.

The references are comprehensive. The reviewer(who has reached the point where he might some­what narcissistically accept his position as a pioneerin the field) has taken the Iiherty of analyzing thesereferences numlX'ring more than two hundred. I amhappy to note that 71 references were contributed hy24 allt·rgists. However. 50 percent of the 71 refer­ences were contributed hy only four allergists, theremaining half of the references by 20 allergists.Perhaps these first four pioneers in psychosomaticallergy led the way for some of their colleagues toenter the field. These four allergists were all en­couraged hy the American College of Allergists whichhad the first formal section of Psychosomatic Allergy.Similiarly \1cCovern and Knight's volume will notonly IX' a source of reference, but will also provide asource of knowledge, encouragement and stimulationfor the allergists to expand our knowledge. ~o al­It'fgist with a conscience for the well-being of hispatient can afford to neglect to read and study thisvolume.

\1. \h.'RHAY PESHKIN, \I.D.

PSYCHOANALYSIS OF HEART ATTACK. Daniel E.Schneider, M.D. New York: Dial Press, 1967.

This is a bold and certainly new approach to an ill­ness which kills over 500,000 Americans each year.It is to the author's credit that he insists that nothingin this hook should he considered as an attempt toinvalidate cardiological concepts and facts.

A new pichlfe of the human mind, inclusive of the"paraconscious" system is furnished; heart, brain andmind are seen to he inscparahly interwoven. A partof thc mind allegedly functions as a monitor of theheart; when stress overwhelms this monitoring capac­ity, the "heart person" may then suffer a heart attack.

Both psychoanalysts and non-psychiatric physicianswill find much in this book to be provocative. Someof the author's concepts of the "paraconscious" areindeed vague and distant. For instance, his proposalthat one of his patients might have suffered a coronaryspasm at the age of 12 is not supported by clinical orEKC evidence. It is glibly related to his falling tothe ground, with pain over the heart region aftercarrying a heavy burden uphill with an antecedenthistory of masturbation and guilt. His belief that thispatient, who suffered a coronary attack at the age of52 (without EKG changes) was prevented from fur­ther attacks because of psychotherapy is indeed spec­ulative. (This patient had been on anticoagulants foreight years; there is, in addition, no <:onsideration ofthe well-established clinical fact that the prognosis ofcoronary disease often depends upon the fortuitiouslocation of arteriosclerotic plaques.)

Nevertheless, in spite of these points of contention,there is a need to consider the possible role of psy-

March-April, 1968

chotherapy (as an additional modality) in the man­agement of emotionally disturbed patients with a his­tory of coronary disease. In this light, the author'scontribution is indeed significant.

W.D.

CASE STUDIES IN BEHAVIOR MODIFICATION.Edited bV L. P. Ullmann and L. Krasner. NewYork: Holt, Rinehart and Winston, Inc., 1965. 401pages.

This volume contains 50 articles, and many moreauthors, on behavior rehahilitation through the em­ployment of operant conditioning techniques and in­strumental learning. This school of investigators op­erates on the principle that the symptom is the neu­rosis and freedom from symptoms implies freedomfrom neurosis. The etiology of symptoms are inex­tricably related to experiences that were rewardedor punished. Symptoms are eliminated through per­tinent principles of learning such as reinforcement,systematic desensitization, reciprocal inhibition, ex­tinction, aversive conditinning and others.

The behavior modification school received its im­petus from two main sources: through techniquesutilized in the laboratory with rodents and suh-humanprimates and, secondly, as a reaction to traditionalpsychotherapy. The fathers of behavior modification,Wolpe and Eysenck, exert a <:onsiderable influenceon the followers of this school. The authors of thistext, however, limit most of their experimentation tochildren and schizophrenics.

This hook is divided into fin' sections: 1. severelydisturbed behaviors, 2. classic neurotic behaviors, 3.other deviant adult behaviors (sexual, tics and stutter­ing), 4. deviant behaviors in children, 5. mentaldeficiency.

The first section illustrates the reinstatement ofverbal behavior in chronically mute schizophrenicsand autistic children. Behavior modification is di­rected towards normal talking and eating. Perman­ent behavioral changes are inconsist(>nt with environ­mental viscissitudes; Ofltanic factors may inhibit suc­cess. However, patients do improve in verbalization,motivation to progress, interest in the diversional ac­tivities, reduced enuresis and advancement to lessdeteriorated wards. The underlying thesis of thisschool is that all learned behavior that is destructiveto adequate personality functioning can be unlearned.

Section two demonstrates applications to anorexia,hysterical blindness and the use of systematic desen­sitization for severe cases of phobia. The anthorsdeny that the resultant chan~es art' due to "a desireto please the experimenter," and offer as evidencethe differences they find between experimental andcontrol subjects. The authors warn experimenters toexercise great caution with the anorexias. Desensiti­zation dictates working with less threateninl( situa­tions first and gradually, following success, with moreanxiety-provoking levels.

Section three substantiates the successful treatmentof a fetish with aversive conditioning, exhibitionismwith reciprocal inhibition and the control of stutter­ing and multiple techniques with aversion stimuli.

125

BOOK REVIEWS

discussion of all phases of therapy related to the man­ag('ment of the allergic patient.

The reader who wishes to be a "Compleat" physi­cian will study and restudy their final chapter. Psy­chodynamics as presently viewed and as anticipatedarc outlined. The special responsibility of the ther­apist for each patient is emphasized and clearly de­scribed.

The references are comprehensive. The reviewer(who has reached the point where he might some­what narcissistically accept his position as a pioneerin the field) has taken the Iiherty of analyzing thesereferences numlX'ring more than two hundred. I amhappy to note that 71 references were contributed hy24 allt·rgists. However. 50 percent of the 71 refer­ences were contributed hy only four allergists, theremaining half of the references by 20 allergists.Perhaps these first four pioneers in psychosomaticallergy led the way for some of their colleagues toenter the field. These four allergists were all en­couraged hy the American College of Allergists whichhad the first formal section of Psychosomatic Allergy.Similiarly \1cCovern and Knight's volume will notonly IX' a source of reference, but will also provide asource of knowledge, encouragement and stimulationfor the allergists to expand our knowledge. ~o al­It'fgist with a conscience for the well-being of hispatient can afford to neglect to read and study thisvolume.

\1. \h.'RHAY PESHKIN, \I.D.

PSYCHOANALYSIS OF HEART ATTACK. Daniel E.Schneider, M.D. New York: Dial Press, 1967.

This is a bold and certainly new approach to an ill­ness which kills over 500,000 Americans each year.It is to the author's credit that he insists that nothingin this hook should he considered as an attempt toinvalidate cardiological concepts and facts.

A new pichlfe of the human mind, inclusive of the"paraconscious" system is furnished; heart, brain andmind are seen to he inscparahly interwoven. A partof thc mind allegedly functions as a monitor of theheart; when stress overwhelms this monitoring capac­ity, the "heart person" may then suffer a heart attack.

Both psychoanalysts and non-psychiatric physicianswill find much in this book to be provocative. Someof the author's concepts of the "paraconscious" areindeed vague and distant. For instance, his proposalthat one of his patients might have suffered a coronaryspasm at the age of 12 is not supported by clinical orEKC evidence. It is glibly related to his falling tothe ground, with pain over the heart region aftercarrying a heavy burden uphill with an antecedenthistory of masturbation and guilt. His belief that thispatient, who suffered a coronary attack at the age of52 (without EKG changes) was prevented from fur­ther attacks because of psychotherapy is indeed spec­ulative. (This patient had been on anticoagulants foreight years; there is, in addition, no <:onsideration ofthe well-established clinical fact that the prognosis ofcoronary disease often depends upon the fortuitiouslocation of arteriosclerotic plaques.)

Nevertheless, in spite of these points of contention,there is a need to consider the possible role of psy-

March-April, 1968

chotherapy (as an additional modality) in the man­agement of emotionally disturbed patients with a his­tory of coronary disease. In this light, the author'scontribution is indeed significant.

W.D.

CASE STUDIES IN BEHAVIOR MODIFICATION.Edited bV L. P. Ullmann and L. Krasner. NewYork: Holt, Rinehart and Winston, Inc., 1965. 401pages.

This volume contains 50 articles, and many moreauthors, on behavior rehahilitation through the em­ployment of operant conditioning techniques and in­strumental learning. This school of investigators op­erates on the principle that the symptom is the neu­rosis and freedom from symptoms implies freedomfrom neurosis. The etiology of symptoms are inex­tricably related to experiences that were rewardedor punished. Symptoms are eliminated through per­tinent principles of learning such as reinforcement,systematic desensitization, reciprocal inhibition, ex­tinction, aversive conditinning and others.

The behavior modification school received its im­petus from two main sources: through techniquesutilized in the laboratory with rodents and suh-humanprimates and, secondly, as a reaction to traditionalpsychotherapy. The fathers of behavior modification,Wolpe and Eysenck, exert a <:onsiderable influenceon the followers of this school. The authors of thistext, however, limit most of their experimentation tochildren and schizophrenics.

This hook is divided into fin' sections: 1. severelydisturbed behaviors, 2. classic neurotic behaviors, 3.other deviant adult behaviors (sexual, tics and stutter­ing), 4. deviant behaviors in children, 5. mentaldeficiency.

The first section illustrates the reinstatement ofverbal behavior in chronically mute schizophrenicsand autistic children. Behavior modification is di­rected towards normal talking and eating. Perman­ent behavioral changes are inconsist(>nt with environ­mental viscissitudes; Ofltanic factors may inhibit suc­cess. However, patients do improve in verbalization,motivation to progress, interest in the diversional ac­tivities, reduced enuresis and advancement to lessdeteriorated wards. The underlying thesis of thisschool is that all learned behavior that is destructiveto adequate personality functioning can be unlearned.

Section two demonstrates applications to anorexia,hysterical blindness and the use of systematic desen­sitization for severe cases of phobia. The anthorsdeny that the resultant chan~es art' due to "a desireto please the experimenter," and offer as evidencethe differences they find between experimental andcontrol subjects. The authors warn experimenters toexercise great caution with the anorexias. Desensiti­zation dictates working with less threateninl( situa­tions first and gradually, following success, with moreanxiety-provoking levels.

Section three substantiates the successful treatmentof a fetish with aversive conditioning, exhibitionismwith reciprocal inhibition and the control of stutter­ing and multiple techniques with aversion stimuli.

125