166 PSYCHOSOMATICS MARCH-ApRIL

symptoms and syndromes, statistical approach topsychiatry, basic principles of psychiatric exami­nation, extensive discussion of modern treatmentand a chapter on the legal aspects. There is avery detailed presentation of various etiologicalfactors covering four chapters, a solid chapteron preventive psychiatry and a very stimulatinganalysis of psychiatric research. The reader israther surprised to find a presentation of treat­ment placed not only ahead of a section describ­ing special psychiatric conditions but also pre­ceding presentation of the etiological factors.

Another feature of this book is the completeelimination of case histories. This is debatable,although it may fit a very concise, informative,and brief outline of psychiatry.

Considering this book to be of special assist­ance to general practitioners and non-psychiatricspecialists, more detailed treatment of psychiatriccomplications in various medical and surgicalconditions would probably be qUite welcome. Amuch more extensive discussion on psychodynam­ics of the doctor-patient relationship still waitsfor its proper place in the modern textbook.

A new text should introduce the reader to theup-tO-date approaches in the discussed field; ref­erences should be made primarily to the mono­graphs or papers opening further vistas beforethe interested reader, e.g., in case of organicbrain disorders the excellent book of Dewan andSpaulding is appropriately quoted. On the otherhand, numerous general references to variouschapters of the established textbooks seem qUitesuperfluous. Still worse, a number of originalcontributions quoted in the text could not befound at all in the list of references, preventingthe interested reader from tracing the subjectfurther.

In reviewing separate chapters, the first onedevoted to introduction of the basic conceptsseems particularly appropriate in teaching med­ical students. We should certainly agree withthe author in his very sober discussion on chang­ing concepts in psychiatric diagnosis and fre­quent disagreements among the diagnosticiansbelonging to di1ferent psychiatric orientations.This should not justify many vague and poorlysubstantiated diagnostic labels, distributed occa­sionally in psychiatric practice. The chapter onpsychiatric statistics is valuable and informative.Speaking of psychiatric evaluation the authorrightly remarks that "initial interviews have adual purpose of evaluation and establishing therelationship on which further therapeutic interac­tion will be based . . . the etIects of the inter­viewer's questions and behavior upon the patientand upon any subsequent treatment undertaken

should be constantly born in mind during theinitial process of evaluation."

The pleasant surprise of this book was the in­clusion of the existential approach among psy­chotherapeutic techniques. As for other thera­peutic methods, sociotherapy with juvenile delin­quents and rehabilitation of psychiatric patientsin rural communities, by placement in farmingfoster homes, could be included. The chapterson preventive psychiatry and research shouldstimulate the interest of every medical practi­tioner. They conVincingly show considerable in­adequacies in our mental health movement andbring out constructive suggestions.

In the discussion of sexual deviation andchronic alcoholism, a more detailed psychody­namic interpretation of such conditions wouldprobably be expected. The same applies to thediscussion of marital problems. Child Psychi­atry has been rather neglected by the authorand this chapter provides limited factual ma­terial. From a psychodynamic point of view,truancy should be carefully distinguished fromschool phobia.

It may be said in general that Gregory's newtextbook of psychiatry prOVides interesting read­ing and should be welcomed into the psychiatricliterature.

Victor Szyrynski, M.D., Ph.D.

CLINICAL MEDICINE AND THE PSYCHOTICPATIENT. O. F. Ehrentheil, M.D., and W. E.Marchand, M.D. Chas. C. Thomas, Springfield,III. Pp. 383.

Case finding and diagnosis may be difficult inpsychotic patients due to lack of complaints. Inaddition, the difficulties in the management ofmedical illnesses in the psychotic warrant theauthors' etIorts in bringing together the informa­tion gathered through extensive experience.

The book includes considerations of the disor­ders that are peculiar to psychotics (e.g. exhaus­tion syndrome in catatonia, megacolon, irrever­sible insulin coma). It is noted that the mostfrequently overlooked disease in psychotics isacute myocardial infarction. Other chapters con­sider organic diseases of the central nervous sys­tem and the problems encountered in surgicalpractice. A most interesting chapter deals withthe low incidence of asthma, hay fever and rheu­matoid arthritis in psychotics, in contrast to therelative frequency of duodenal ulcer.

Physicians interested in psychophysiologicalrelationships will find much of interest in this lu­cid presentation of a difficult area of medicalpractice.

W.D.