PSYCHOSOMATICS

author might han' drawn more heavily on examplesinvolving specific locales.

At the theoretical level, it appears that the authoroffers two theories undC'rlying primary prevention.One theory concerns the importance of crises as agenetic aspect of mental illness. The other theoryinvolves the need for "supplies" for the preventionof mental illness; "supplies" inelude physical, psy­cho-social, and socio-cultural factors. While thesetwo theories can be readily related, the author leavesunstated which of the two theories is nesessary orsufficient as the basis for primary prevention.

Another area of emphasis in the Volume is thatof the mental health consultation technique oftlwme-interference-r('(luction in the consultee-cen­tered case consultation. In this method the con­sultant works with tIl<' manifest content of theconsultee to free him of the distortions that he isusing in relation to the cliC'nt. It appears to meto be a type of indirect psychotherapy althoughthe author repeatedly denies that he is practicingpsychotherapy on thc consultee. The author speaksof enhancing the ego of the consultee, relievinghim of perceptual distortions, etc. which would ap­pear to relate the method to the therapeutic ap­proach. At one point (p. 246) the author points outthat one may be consciously "psychotherapeutic"without practicing psychotherapy. I think the authorhas drawn too fine a line for his method. Theauthor's pursuit of elegance in this consultationmethod strikes me as a negation of one of themost important aspccts of preventive and communitypsychiatry which he has emphasized, namely, thesetting-up of priorities in mental health activities.The method cited does not appear to be one thatwarrants a very high priority in mental health pro­grams. No data is given on the effects or valueof this specific consultation method.

LEON HANKOFF, M.D.

DRUG-SET INTERACTION: THE EFFECT OFEXPECTATIONS ON DRUG RESPONSE INOUT-PATIENTS. S. Fisher, ]. A. Cole, K. Rickelslind E. H. Uhlenhuth, NeuropsychophaTTTUlcology,Vol. 3, Elsevier PulJ. Co., New York. 1964.

This study had three main purposes: (1) to de­termine whether meprobamate administered for sixweeks at a fixed dosagp is more effective than aninert placebo in th(· treatmpnt of neurotic out-patients;( :2 ) to determine whethpr patients' expectationsabolll the doctors' attitudes toward the medica­tion haw a significant pffect; and (3) to determinewhethcr a favorable setting may potentiate theclinical rcsponsp to an active drug.

The authors notl' that new forms of therapy areoften enthusiastically received on the basis of earlyuncontrolled clinical impressions; subsequently theyare laid to rpst after controlled evaluation. How­ever, in many controlled experiments the patients be­come definitely aware that they are participating ina research project, which tends to inhibit drug ac­tion. In this study, the intent is to determine whethera meprobamate-placebo c.:omparison for patientstreated by an enthusiastic physician is the same ordi/ferent if the doctor were a more skeptical physi­cian.

264

The study indicates that the drop-out rate issimilar for patients treated by placebo, irrespective ofthe attitude of the doctor. However, for those re­ceiving meprobamate, the influence of the doctor'sattitude produced substantial differences, in that thedrop-out rate was half as great where the doctorutilizl'd a therapeutic attitude.-\V.D.

THE EXCEPTIONAL CHILD IN THE FAMILY.By Allen O. Ross. 225 pages. New York: Groneand Stratton, 1964. $3.95.

This book is addressed not only to the parentsof exceptional children, but to those who are calledupon to deal professionally with the dynamic andoften difficult relationships between such childrenand their parents.

It is a practical book. From his wide experienceas counselor and teacher the author recognizes theexceptional demands placed upon the parents and theproblems arising from goal discrepancies amongfamily members. Denial, projection, over-protectionand the other defenses against anxiety produced bya defective child lead sooner or later to stress anddisruption in marital relationships. Realisticallycoping with these crises is the responsibility of theprofessional; is important to guard against the dil­emma of identifying with the parents while hidingbehind a mask of objectivity.

The aim of the counselor is neither a restructuringof basic personality nor a complete exploration ofunconscious motivations, but a freeing of the par­ent's ego to permit an undistorted perception ofreality as it affects his child. Interpretation ofdefensive behavior is rarely of value; insight isseldom achieved through verbal statements madeby the counselor, but is rather the outcome of mean­ingful experiences by the parents themselves. Groupcounseling, preferably in the setting which also ex­tends help to the children, has been found effective.

A very small portion of the book is devoted tothe problems encountered by the parents of giftedand adopted children.

ELIZABETH THOMA, Ph.D.

LONG-TERM RESULTS OF PSYCHIATRIC OUT­PATIENT TREATMENT. B. E. McLaughlin, M.D.Charles C Thomas, 1965.

This book, and the research behind it, resultedfrom an honest attempt to review some of the failuresin psychiatric care. One hundred of the least suc­cessful were selected for review and study.

The author reviewed patients treated from 1946to 1952 and those from 1952 to 1960. The firstgroup was treated by classical analytical methods;the second by a modification produced by the adventof the new psychopharma('eutical agents. This lattermethod permitted less frequent and shorter visits.

It is indicated that the new drugs have been both"disappointing as well as helpful." They have beendisappointing because they have not answered theunanswerable problem of building a strong person­ality in the psychiatrically ill; they have been help­ful in that they have enabled the therapist to provideemotional support more quickly and efficiently.

Ten typical cases of the one hundred are then

Volume VII