BOOK REVIEWSPSYCHIATRIC DRUGS: A DESK REFERENCE,Gilbert Honigfeld and Alfreda Howard. AcademicPress, New York, 1973. 227 pp.

The authors state that their book is to provide abalanced overview of the current state of the clinicalpsychopharmacological arts from the point of viewof the nonmedical mental health practitioner and stu­dent. Specifically, this book will be useful to psy­chologists, social workers, occupational therapists,psychiatric nurses, pastoral counsellors, and othersin related professions.

There is a chapter devoted to each of the followingtopics: The clinical indications, contraindications, andside effects of antidepressant, antipsychotic, antianxi­ety, and antimanic agents, the sedative and activatingdrugs, and electroconvulsive therapy. Included alsois material on side effects, maintenance and preventivemedication, drug treatment of drug abuse and alcohol­ism, new developments in drug treatment, and themanagement of drug emergencies. A concludingchapter presents the authors' views concerning theimplications of this new field of psychopharmacologyfor mental health training in general.

There are 5 appendixes as follows: Appendixes 1and 2 enable the reader to translate between drugtrade names and generic (chemical) names whenreading the professional literature or when dealingwith patients and their treatment histories. Appendix3 summarizes the physical appearance of psychoactivecapsules and tablets organized according to tradename. Appendixes 4 and 5 will help establish drugidentification through physical characteristics of thedrugs alone, including form (tablet or capsule), color,shape, and special identifying marks. Information ontablets is in Appendix 4, and capsule information isin Appendix 5.

The style of the writing is succinct and forcefuland the authors haxe placed the use of drugs into aproper perspective: correct diagnosis, adequate dosage,adequate period of trial of drug, use of supportivemeasures, understanding of psychological factors, anddrug interactions.

The nonmedical practitioner will appreciate the ab­breviated descriptions of the various psychiatric dis­orders in each of the chapters, since they are brief,thorough, and capture the essence of the psycho­pathology of the various disorders. The authors havesummarized the drugs discussed in their book bytables, and again are models of brevity and useful­ness. Chapter 13 provides an overview of the indica­tions and contraindications for somatic treatmentacross the full spectrum of psychiatric disorders. Theauthors noted that summary tables of this sort are

S:p::mber-October. 1973

limited, substituting brevity of coverage for depth.It would have been a real plus for this book if theauthors could have attempted more of a coverageand consolidated the diagnostic categories insteadof listing each and every one as they did.

The final two chapters of the book (Evaluating YourPsychiatric Colleagues, and Training Implications) areinvaluable, as they give insight into how to assess thequality of drug practice (which we medical practi­tioners could benefit from by reading) and stress theimportance of diagnosis. Like the man who asked hisreal estate agent: "What are the three most importantassets to list in trying to sell my house?" The agentreplied, "Location, location, location." The basis ofa successful treatment is built upon the same founda­tions--correct diagnosis, correct diagnosis, correctdiagnosis!

William W. K. Zung, M.D.Professor of Psychiatry, Duke UniversityMedical Center, Durham, North Carolina

PSYCHOSOMATIC CLASSICS. Edited by L. A.Gottschalk, P. H. Knapp, M. F, Reiser. J. D. Sapiraand A. P. Shapiro. Published by S. Karger, Basel,1972.

To choose fourteen papers from the wealth oforiginal contributions published in PsychosomaticMedicine over a period of thirty-odd years, is no easytask. It is even more difficult to critically review trulyepochal contributions by venerable pioneers whostarted from scratch in an area of medicine which isstill in need of further maturation.

The study of an infant (Monica) with a gastricfistula by Engel, Reichsman and Segal, which is thelead article, provided new concepts of psychophysio­logical transactions. This is followed by a study ofthe etiology of peptic ulcer by Weiner, Thaler, Reiserand Mirsky. Here hypersecretors of pepsinogen weredifferentiated from hyposecreters on the basis of psy­chological data alone. They were also able to predictwhich hypersecretors would develop a peptic ulcerduring their basic army training. Neither a high rateof gastric secretion nor a specific psychodynamic con­stellation was found to be independently responsible.Together, however, these two parameters could pre­cipitate an ulcer in a noxious situation.

"Psychosomatic Disease and the Visceral Brain"was contributed by P. D. MacLean. His studies pro­vided the long needed link between neurophysiology,neuroanatomy and the psychodynamic understandingof emotion. "Psychologic Mechanisms in MalignantHypertension" are considered by Reiser, Rosenbaumand Ferris. It was clearly proven that emotional

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events, specific for the patient, were important pre­cipitating events for malignant hypertension. Theirdata did not reveal any specific personality structureor contlict situation; they also showed that remissionsmay occur with supportive psychotherapy.

Romano and Engel's studies of Syncope attemptedto differentiate between vasodepressor and hystericalfainting. They felt that the fortner had concomitantchanges in circulatory dynamics whereas the latterwas better related to symbolic expression.

Therese Benedek and B.B. Rubenstein's "Correla­tion Between Ovarian Activity and Psychodynamics"pointed up that daily psychological material could becorrelated with endocrine findings. "Emotions andGastroduodenal Function" by Mittelman and H. G.Wolff showed that resentment, guilt, frustration andanxiety were usual1y associated with gastric hyper­motility and hypersecretion.

Franz Alexander's "Psychoanalytic Study of a Caseof Essential Hypertension" influenced psychosomaticthinking for many years; he felt that inhibited hos­tility was a major influence. Despite the fact thatcurrent thinking discredits many of these early spe­cificity theories, Alexander's contribution does havehistorical value in the troubled history of psychoso­matic thinking.

Saslow, Gressel, Shrobe, Dubois and Schroeder alsoconsider the possible etiologic relevance of person­ality factors in essential hypertension. They found agreater degree of obsessive-compulsiveness in addi­tion to abnormal assertiveness in their patients. Hereagain, specificity is seen to dominate the psychoso­matic scene.

Chambers and Reiser discuss emotional stress inthe precipitation of congestive heart failure. Theirconclusions note that this could occur in the patientwith a limited cardiac reserve- a concept in keepingwith the current belief that "equal time" be given toboth soma and psyche. Most significant is their dem­onstration that the doctor-patient relationship hastherapeutic value in and of itself. This, incidental1y,has withstood the test of time and despite the cur­rent potent oral diuretics.

Gastro-intestinal lesions in behavioral1y condition­ed monkeys by Porter, Brady, Conrad, Mason, Ga­lambos and McK. Rioch is an interesting study whereonly the "executive" monkeys developed the gastro­intestinal lesions.

Autonomic response specificity is the contributionof Lacey, Bateman and VanLehn. This study shiftedthe emphasis away from emotional specificity towardsthe role of individual differences in autonomic respon­sivity.

Hinkle, Christenson, Kane, Ostfeld, Thetford andH. G. Wolff fol1ow with an investigation of the re­lationship between life experience, personality char­acteristics and general susceptibility to stress. Theimportance of the perceived or subjective social en­vironment is emphasized, rather than the focus on

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the personality and the temporal relationship of lifeevents to exacerbations and remissions of thedisease.

Grace and Graham's contribution indicates the re­lationship of specific attitudes to certain bodily dis­eases. Different individuals might share the samesymptoms, despite individual differences.

This summary of each of the contributions can·not possibly due justice to the wealth of materialpresented. Despite the fact that many of the earliertheories have been abandoned, each of these studieshas provided growth and understanding to the cur­rent status of psychosomatic thinking.

The contents of this paper-back should be readmany times by those who still retain the self· image ofthe physician rather than that of the super-specialist.Body and mind may still be separated for academicpurposes, but not in the person who seeks our helpas true physicians.

W. D.

PRACTICAL PROBLEMS OF A PRIVATE PSY­CHOTHERAPY PRACTICE. Edited by George D.Goldman, Ph.D. and Geo'ge Stricker, Ph.D. Spring­field, l11inois, Charles C. Thomas, 1972, 285 pp.Price $11.50.

This is a practical book that discusses relevant is­sues and problems usual1y neglected in the educa­tion of psychotherapists who are p:eparing for pri­vate practice. Most of the chapters are very readableand to the point. For example, Dr. Segal's com­ments concerning fees and confidentiality regardinggroup psychotherapy are issues one commonly has todeal with in daily practice-issues that are usual1yneglected when discussing problems of group therapy.

The chapter on "Aspects of Physical Disability"made some excel1ent points; however, it would havebeen beneficial to readers to have the author's ex­pertise and comments on other common physicaldisability problems such as whiplash injuries, low­back problems, industrial accidents, and environ­mental1y induced organic brain syndromes.

The chapter on "Pharmacotherapy" p:imarily dealswith a limited classification and presentation of drugsand is rather introductory for the professional non­physician. Perhaps brief discussions about such dailyworries as common polypharmacy problems and drugaddiction issues and family reaction and attitudes tothe patient's use of drugs would have been helpfulfor those who are not familiar with drugs and theiruse on a daily basis.

I think Practical Problems of a Private Psycho­therapy Practice would be beneficial to any readerwho is responsible for patient care, though the bookseems to be prepared primarily for clinical psycholo­gists who are beginning private practice.

A. Dale Gul1edge, M.D.Mayo Clinic and Mayo FoundationRochester, Minnesota

Volume XIV