1
1961 PSYCHOSOMATICS 401 raise the question, though, whether a larger book is not needea to do such a large job. Many of the problems cited are treated in too little detail to be fully perceived; many of the controversies mentioned leave the reader wondering what the pros and cons are. At times, the reader who is unfamiliar with psychiatry and the mental health movement, and who is therefore ignorant of the sources of the author's allusions, will feel that she has sacri- ficed clarity to conciseness. Nevertheless, such a reader will find much that he does understand, and he will also find a new awareness of the im- pact of the mental health movement. He will find that the book puts his understanding of this movement, and the problems with which he is daily wrestling, into proportion and perspective. One wonders whether the legislators (who Miss Ridenour says in her preface "hopefully" will find it useful) will bring to it su1llcient back- ground understanding to comprehend it clearly, but her avowed principal audience - mental health association people, students and profes- sional workers in medical, social, and behavioral sciences-will surely find it so. Because this book is written in a smoothly tlowing style by an experienced and capable writer it is most readable and one can painlessly learn a great deal. One still wishes, however, that the work had been documented more explicitly to enable him more easily to find the source refer- ences. More plentiful and extensive footnoting, and a more formal and extensive bibliography would greatly increase its usability. This little book, deservedly hailed even in manuscript, by many of psychiatry's contempo- rary greats, will surely create a hunger for the still unwritten big book whose need is here shown so clearly. This little book would serve as an excellent outline for that big book we need. No one more than our present author combines the interest, the intimate personal ex- perience, the broad knowledge, and the outstand- ing literary skill needed to write that big book for us. William F. Sheeley, M.D. PROBLEMS OF ESTIMATING CHANGES IN FREQUENCY OF MENTAL DISORDERS. By the Committee on Preventive Psychiatry, Group for the Advancement of Psychiatry. Report No. 50, Aug. 1961,64 pages. 75 cents. This most recent pUblication of G.A.P. indi- cates that mental disorders may change with re- spect to prevalence, Incidence, severity, duration and eventual fate. Social attitudes toward ill- ness change and this may a1fect the total num- ber of patients who seek help. The methodologi- cal problems Involved in seeking out these changes are further complicated by the fact that psychiatric diagnoses often vary with the ob- server; in addition, diagnostic fashions change from time to time as do the tolerance of families and the population in which the patient lives. The report proves that epidemiological research teams can avoid some of these pitfalls. Illustra- tive disorders were chosen. Conversion hysteria has decreased in frequency, especially where the population has shown a high degree of cultural sophistication. In the past a conversion symptom was treated with indulgence and was a source of secondary gain; today an unsympathetic environment cuts short Its course. In syphilitic psychoses, there has been a dra- matic decline. This has been mainly due to the discovery of effective treatment of the disease in its early stages. In psychoses of the aged, in- cluding arteriosclerotic psychoses, the Commit- tee felt there had been a definite increase due to the increasing number of people above 65 (3 mil- lion in U.S. in 1900; 17 million in 1960). The in- creased admission rates to mental hospitals may also indicate a decreased tolerance for mainte- nance of these patients at home. In psychoses associated with pellagra, the decrease has been related to the discovery of the nutritional origin of the disease. In deliria with pneumonia, the decrease has been attributed to the better man- agement of the disease with sulfa drugs a.'1d antibiotics As for alcoholic psychoses, no clear- cut conclusions were possible. It is suspected that cretinism has decreased because of the use of iodized salt. Post-encepha- litic encephalopathy is now rare compared to forty years ago, as a result of the epidemic of encephalitic lethargica of 1917. As for bromide psychosis, decrease is questionable. The easy availability of bromide drugs without prescrip- tion counteracts the fact that prescriptions for bromides have decreased with the advent of the barbital drugs and the ataractics. Neurocircula- tory asthenia is decreasing, due to the lessened frequency with which it is diagnosed. The symp- toms still appear, but the diagnosis is now neu- rosis. As for psychoneuroses with diffuse anx- iety as the primary manifestation, this category ranks second only to psychoses of the aged in the degree of increased frequency. The Committee suggests that improved meth- ods of data collection and analysis will provide more definitive conclusions and eventually enable psychiatrists to obtain leads as to etiology, pre- vention and management. This report, just as the others contributed by G.A.P., presents valuable information for all those Interested in emotional illness. W.D.

Problems of Estimating Changes in Frequency of Mental Disorder

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1961 PSYCHOSOMATICS 401

raise the question, though, whether a larger bookis not needea to do such a large job. Many ofthe problems cited are treated in too little detailto be fully perceived; many of the controversiesmentioned leave the reader wondering what thepros and cons are.

At times, the reader who is unfamiliar withpsychiatry and the mental health movement, andwho is therefore ignorant of the sources of theauthor's allusions, will feel that she has sacri­ficed clarity to conciseness. Nevertheless, such areader will find much that he does understand,and he will also find a new awareness of the im­pact of the mental health movement. He willfind that the book puts his understanding of thismovement, and the problems with which he isdaily wrestling, into proportion and perspective.One wonders whether the legislators (who MissRidenour says in her preface "hopefully" willfind it useful) will bring to it su1llcient back­ground understanding to comprehend it clearly,but her avowed principal audience - mentalhealth association people, students and profes­sional workers in medical, social, and behavioralsciences-will surely find it so.

Because this book is written in a smoothlytlowing style by an experienced and capable writerit is most readable and one can painlessly learna great deal. One still wishes, however, that thework had been documented more explicitly toenable him more easily to find the source refer­ences. More plentiful and extensive footnoting,and a more formal and extensive bibliographywould greatly increase its usability.

This little book, deservedly hailed even inmanuscript, by many of psychiatry's contempo­rary greats, will surely create a hunger for thestill unwritten big book whose need is hereshown so clearly. This little book would serveas an excellent outline for that big book weneed. No one more than our present authorcombines the interest, the intimate personal ex­perience, the broad knowledge, and the outstand­ing literary skill needed to write that big bookfor us.

William F. Sheeley, M.D.

PROBLEMS OF ESTIMATING CHANGES INFREQUENCY OF MENTAL DISORDERS. Bythe Committee on Preventive Psychiatry, Groupfor the Advancement of Psychiatry. Report No.50, Aug. 1961,64 pages. 75 cents.

This most recent pUblication of G.A.P. indi­cates that mental disorders may change with re­spect to prevalence, Incidence, severity, durationand eventual fate. Social attitudes toward ill­ness change and this may a1fect the total num-

ber of patients who seek help. The methodologi­cal problems Involved in seeking out thesechanges are further complicated by the fact thatpsychiatric diagnoses often vary with the ob­server; in addition, diagnostic fashions changefrom time to time as do the tolerance of familiesand the population in which the patient lives.The report proves that epidemiological researchteams can avoid some of these pitfalls. Illustra­tive disorders were chosen.

Conversion hysteria has decreased in frequency,especially where the population has shown a highdegree of cultural sophistication. In the past aconversion symptom was treated with indulgenceand was a source of secondary gain; today anunsympathetic environment cuts short Its course.In syphilitic psychoses, there has been a dra­matic decline. This has been mainly due to thediscovery of effective treatment of the disease inits early stages. In psychoses of the aged, in­cluding arteriosclerotic psychoses, the Commit­tee felt there had been a definite increase due tothe increasing number of people above 65 (3 mil­lion in U.S. in 1900; 17 million in 1960). The in­creased admission rates to mental hospitals mayalso indicate a decreased tolerance for mainte­nance of these patients at home. In psychosesassociated with pellagra, the decrease has beenrelated to the discovery of the nutritional originof the disease. In deliria with pneumonia, thedecrease has been attributed to the better man­agement of the disease with sulfa drugs a.'1dantibiotics As for alcoholic psychoses, no clear­cut conclusions were possible.

It is suspected that cretinism has decreasedbecause of the use of iodized salt. Post-encepha­litic encephalopathy is now rare compared toforty years ago, as a result of the epidemic ofencephalitic lethargica of 1917. As for bromidepsychosis, decrease is questionable. The easyavailability of bromide drugs without prescrip­tion counteracts the fact that prescriptions forbromides have decreased with the advent of thebarbital drugs and the ataractics. Neurocircula­tory asthenia is decreasing, due to the lessenedfrequency with which it is diagnosed. The symp­toms still appear, but the diagnosis is now neu­rosis. As for psychoneuroses with diffuse anx­iety as the primary manifestation, this categoryranks second only to psychoses of the aged inthe degree of increased frequency.

The Committee suggests that improved meth­ods of data collection and analysis will providemore definitive conclusions and eventually enablepsychiatrists to obtain leads as to etiology, pre­vention and management.

This report, just as the others contributed byG.A.P., presents valuable information for allthose Interested in emotional illness.

W.D.