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Lecture Notes on Neurology

Lecture Notes on Neurology. Sixth Edition

Ivan T. Draper

Boston, MA, Blackwell Scientific Publications, 1985. 217 pp.

This is the sixth edition of this concise, pocket-sized review text. One of an extensive series of similar works by British authors, this book seems aimed primarily at undergraduate medical students or other non-neurologists interested in a broad overview of the field.

Dr. Draper, neurologist at the Institute of Neurological Sciences in Glasgow, has divided his work into three major parts: Structure and Function of the Nervous System, History and Examination, and Diseases of the Nervous System. The individual chapters are well organized and well written, making it possible for the reader to review the basic information concerning a neurological subject in a matter of minutes.

Omissions are almost inevitable in a book of this size; although it is not a comprehensive textbook, one would have hoped to have found discussion of such topics as magnetic resonance imaging (MRI) and fungal meningitis, which are not covered. References for futher reading are not provided, leaving the reader with no entree into the neurologic literature if elaboration of an obscure or controversial point is desired.

In spite of these faults, the book is not without its merits, including an evenness in style that makes it a pleasure to read. Some sections, such as that on the history and examination, are especially good. It is recommended as a convenient reference for the non-neurologist.

The Psychopharmacology of Lithium

The Psychopharmacology of Lithium

F. Neil Johnson

New York, Oxford University Press, 1984. 327 pp.

Lithium is, at the same time, one of the most effective and one of the most poorly understood psychiatric medications. In this text, Johnson reviews a broad range of basic research and clinical data in an attempt to derive a cohesive model which explains the behavioral effects of the drug. Johnson is an experimental psychologist, and his work underlies many of the chapters which suggest that lithium decreases the behavioral response to novel external stimuli. He then utilizes this foundation to propose a cognitive model for lithium’s anti-manic action, its inhibition of violent impulsivity, and its prophylactic effects in recurrent depression.

Previous formulations which were clinically based, such as that of Mabel Blake Cohen and her associates, stressed the primacy of depression and noted the “manic defense” as an attempt to ward off intolerable depression. In direct contrast, Johnson views mania as the primary disturbance in bipolar disorder. He considers depression in bipolar disease as an over-zealous homeostatic inhibitory response to a mania-associated cognitive overload. Consistent with this, he believes, littium exerts its anti-manic effect by decreasing cognitive processing in a manner analogous to his animal studies. Johnson also suggests that lithium exerts its prophylactic effect in recurrent depressions by treating subclinical mania. These concepts are supported by the work of Johnson’s associate, Kukopulos, to whom the book is dedicated. The bulk of the research which describes the cognitive disturbance in mania is complex, however, and uncomfortably open to multiple interpretations. Recognized as a preliminary effort, Johnson’s formulation may help to guide further research.

Although Johnson clearly traces lithium actions through a broad range of subjects, his discussion of the neurophysiological aspects of this drug is notably spotty. In particular, Johnson ignores the work of Svensson, DeMontigny, Aghajanian, and others who suggest that serotonergic systems may play an important role in the antidepressant actions of lithium. As a result, he fails to discuss one of the most important current uses of lithium: as an agent used in conjunction with antidepressant medications to increase treatment response in medication-resistant forms of depression. Lithium augmentation of antidepressant medication also challenges the formulation presented by Johnson. This formulation suggests that lithium should have no therapeutic value in patients, such as those with endogenous depression, who already “under-process” cognitive information. The omission of lithium augmentation in depression is clearly unfortunate in this text.

Overall, this volume demonstrates the benefits of a single-authored text. It it clearly organized and readable. The bibliography is also broad and useful. In this book, Johnson primarily addresses a research audience, and his model seems designed to stimulate thought rather than to improve clinical technique. In this capacity, his book will be of most interest to behavioral psychologists. Other books, focusing purely on clinical data, may be more useful to clinicians. Nevertheless, the clear organization, the large bibliography, and the thoughtful presentation may make this text a useful addition to a clinical library as well.

Treating the Elderly with Psychotherapy

Treating the Elderly with Psychotherapy: The Scope for Change in Later Life

Edited by Joel Sadavoy and Molyn Leszcz

Madison, CT, International Universities Press, Inc., 1987. 366 pp.

As emphasized early in this book, the elderly will represent nearly 20 percent of the U.S. population in the twenty-first century. This fact underscores the importance of a work for physicians, therapists, and health workers which focuses on issues specific to clients who are 65 and older. Editors Sadavoy and Leszcz have put together a series of essays by some of the pioneers in geriatric psychiatry (e.g., George Pollack, Jerome Grunes, Martin Berezin, Ralph Kahana, and others), each of whom has brought an expertise to different aspects of psychotherapeutic care. The essays are well-written, interesting, and full of eye-opening clinical vignettes, and the book as a whole has met its challenge of encouraging “hopefulness” in geriatric care. One problem, however, is that in presenting essays largely from a psychodynamic perspective, it lacks coherent underlying theories. Several essays, moreover, fail to distinguish the elderly patient from any other client. The overall collection, however, is pioneering and should encourage more specific studies.

The book is divided into three parts. Part I, entitled “General Psychodynamic Perspectives,” comprises essays by Pollack, Grunes, and Berezin, respectively. Each focuses on a general theme: Pollack emphasizes the wealth of psychodynamic material in therapy with the elderly and presents his own notion of a mourning-liberation process in bereavement. Grunes writes about the unique features of transference between an older client and a younger therapist and provides the concept of reverse empathy to account for the elder’s regard for the therapist. Berezin presents a wonderful introduction to clinical work, stressing the depth and vitality of the elderly. Taken together, these three essays break many stereotypes of the older client and provide a much deeper sense of age-specific therapeutic needs.

Part II, entitled “Manifestations of Psychopathology,” is the most theoretical section of the book and, as a result, the weakest. Its essays, which cover such topics as paranoia in the aged, the impact of massive psychic trauma, and character disorders, are well-organized and yet tangential to the stated goals of the general collection. The flaw seems to lie in the dearth of relevant psychodynamic theories; each essay provides concise theoretical introductions, yet never adequately adapts them for a geriatric population. In addition, no essay attempts to define the elderly. Are clients in their 60s similar to others in their 80-s and 90-s? One is left with little regard for the life cycle as a viable force past adulthood. Several of the cases presented raise interesting issues but, again, do not place them within a meaningful context. One exception in Part II is an essay by Lawrence Breslau on the Exaggerated Helplessness Syndrome. This syndrome, in which elderly patients become maladjusted to their disabilities, highlights their passivity and serves to maintain the support of primary caregivers. The psychodynamic issues here are ripe for intervention, and Breslau provides good clinical examples.

Part III, entitled “Specific Psychotherapeutic Modalities,” picks up many issues from Part I and ends with a real gem: an essay entitled “The Whole Grandfather: An Intergenerational Approach to Family Therapy” by Etta Ginsberg McEwan. The other essays focus on crisis management and short-term and group geriatric psychotherapy, and the information provided here is perhaps the most practical for readers, since it addresses the appropriate structure of therapeutic intervention. For example, Kahana’s chapter on crisis management presents a crucial skill for the intake of elderly clients. He provides a working definition for geriatric crisis, along with many useful clinical pieces. Ginsberg McEwan’s essay, coming second to last, is poignant and informative, presenting an entire case study within the context of family and intergenerational therapy. It speaks to the very intent of the book in tying together the therapeutic goals of the elderly with those of children and grandchildren. By juxtaposing these issues, Ginsberg McEwan illustrates points of common interest as well as age-specific ones.

Sadavoy and Leszcz’s collection of essays will, it is hoped, serve to encourage study along the lines of its distinguished contributors. Although several essays are a bit incongruous with the book’s focus on treating the elderly, one should not be discouraged. There has simply not been enough longitudinal work on the elderly, and the very concept, both before and after reading the book, remains a diffuse notion of “people 65 years and older.” What emerges from the book, then, is not a specific definition, but a well-rounded appreciation for the complex issues facing the elderly and the enormous potential for therapeutic intervention.

Psychological Testing

Psychological Testing from Early Childhood through Adolescence. A Developmental and Psychodynamic Approach

By Miriam G. Siegel

Madison, CT, International Universities Press, Inc., 1987. 529 pp.

Although psychological testing has been around for some time, Miriam Siegel has written a refreshing and insightful guide to the testing of children and adolescents. Most notable is her illumination of the context in which such young subjects present themselves, specifically in terms of its effects on both administration and interpretation. Though the work is evidently written for clinicians, its clear style and case presentations make it a good introduction for interested students and other professionals.

The book is divided into two parts. Part I focuses on the setting in which testing is done and looks at qualitative impressions which the clinician should consider in approaching the child. For instance, the affective and cognitive style of the child, in addition to parental factors (both during and outside the session) form a composite of external effects on the test results. Certain age-specific factors are also relevant, and here Siegel points to developmental milestones (such as Piaget’s stages). Often, the way in which children enter the room, approach the test, and interact with parents, clinicians, and their own bodies will indicate much about their background. Part I advises the clinician to consider the test results with respect to these features, in addition to culture, environmental idiosyncrasies, and past experiences.

A general introduction is then given to several tests: Wechsler intelligence tests, Rorschach Inkblot, Thematic Apperception Test (TAT), Children’s Apperception Test (CAT), human figure drawings, and Bender Gestalt drawing. A brief history and introduction is provided, along with examples. Siegel then spells out age-specific features of administration, along with a guide to integrating the results. It is noteworthy that the author also talks about the clinician as well as the subject, warning, “the clinician’s unconscious attitudes toward mental health and illness may sometimes distort his judgment” (p. 140). Such a careful consideration of all features of testing underlies the entire work. The final chapters in Part I, on integration and presentation of results along with diagnosis, are especially thorough and insightful. Although Siegel writes about age-specific elements, there is a general lack of detail in terms of differentiating children versus adolescents. More information on developmental milestones, especially around the time of puberty, would have been extremely helpful.

Part II consists of eight case studies, and provides all test results (including all responses and relevant human figure drawings) with interpretations. The cases range in age and type of disorder. Siegel draws upon Part I to illustrate her holistic approach, showing how a battery of psychological tests is used to analyze a child. Although the cases are well presented, interesting, and easy to follow, they presume some experience with the tests and with clinical work in general. In addition, several of the analyses seem a bit contrived, especially since the reader knows only a little about the subjects’ backgrounds. It should be noted that the author relies upon a “developmental and psychodynamic approach,” which is appropriate, given the tests’ historical and theoretical basis (especially the projective tests). Again, background knowledge of psychoanalytic and/or developmental theory (Piaget in particular) is useful.

In all, Siegel has written an eloquent, masterful introduction to psychological testing of children and adolescents. The book’s holistic perspective with clear case studies presents a well-substantiated, thorough guide for numerous clinicians and test protocols.

Handbook of Parkinson’s Disease

Handbook of Parkinson’s Disease

Edited by William C. Koller

New York, Marcel Dekker, Inc., 1987. 505 pp.

Although the tremor of Parkinson’s disease has been described intermittently throughout recorded history, the increasing life expectancy of human beings has made it a commonly treated illness today. Due to its slow progression and many coexistent symptoms, it is quite likely that most medical practitioners will encounter patients with this disease. Recognizing the need to understand and treat this debilitating illness, James Parkinson ended his 1817 description of shaking palsy with this admonishment to basic and clinical scientists:

Before concluding these pages, it may be proper to observe once more, that an important object proposed to be obtained by them is, the leading of the attention of those who humanely employ anatomical examination in detecting the cause and nature of diseases, particularly to this malady. By their benevolent labors its real nature may be ascertained, and appropriate modes of relief, or even of cure, pointed out.

Dr. Koller and his associates have answered his call by producing a handbook that provides up-to-date information on the pharmacology, physiology, pathology, and psychology of Parkinson’s disease. In this comprehensive text, topics range from genetics to stereotactic surgery and include such varied subjects as pharmacologic therapy, rehabilitation, epidemiology, and history. There are also chapters that deal with patient concerns, such as sleep disorders and psychosocial interaction. The appendix includes common staging scales, drug availability and cost, organizations that help patients to cope with their disease, and books that the patients can consult to understand it. The danger in attempting to produce a book of such magnitude is the creation of a tedious morass that a reader must wade through to find the useful facts, but the contributors to this book fall into this pitfall only occasionally.

On the whole, I found this handbook to be well written, well referenced, and interesting. Dr. Koller’s text offers the clinician current useful information about the disease and gives the researcher a comprehensive review of the progress other disciplines have made to understand and treat Parkinson’s disease.

Psychopharmacology

Psychopharmacology: The Third Generation of Progress

Edited by Herbert Y. Meltzer

New York, Raven Press, 1987. 1,824 pp.

The utility and desirability of Psychopharmacology: The Third Generation of Progress is attested to by the fact that it was the first book to be stolen from our newly established psychiatry library. This book is the third in a series, updated every decade since 1967, from the preeminent biological psychiatry organization in the United States, the American College of Neuropsychopharmacology (ACNP). This comprehensive review of clinical neuroscience was “trimmed” to 184 chapters by 350 authors and amounts to more than 1,800 pages.

For a book that is so large and cumbersome, relevant information on most topics in neuroscience is surprisingly accessible. Topics are presented as clusters of individual reviews covering specific interest areas rather than as a single comprehensive review chapter. Thus, an experienced clinician or researcher seeking an update on a specific topic, such as maintenance pharmacotherapy for schizophrenia, is likely to find a brief, focused review. In contrast, readers with limited psychiatry or neuroscience backgrounds may find that the magnitude of the text and its somewhat fragmented presentation style make information more difficult to integrate. For example, in order to learn about schizophrenia, the novice neuropsychiatrist must read two introductory chapters, at least four preclinical chapters, and 24 clinical chapters from over thirty authors. Although this mountain of information would appear to be daunting, I have found that the chapters are quite popular as review materials among second-year psychiatry residents.

Despite the excitement and interest that a book such as this generates, it suffers from some flaws that are characteristic of multi-authored texts. Some parts of the book, such as the section on neuroanatomic and neurochemical mechanisms, contain several excellent chapters but lack a central focus or clearly apparent organization. The scope of reviewed materials also varies widely between chapters. As an illustration of this problem, “animal models in psychiatry” is included in the section on “Biology of Depression,” a review of animal models is absent from the section on “Biology of Schizophrenia,” and two of the four chapters in the “Biology of Anxiety” section review animal models. Also, the quality of the chapters varies noticeably in this book. In contrast to many chapters written with depth and clarity, others appear sketchy or even poorly written.

Although generally skeptical about the utility of purchasing expensive scientific books that rapidly become outdated, I wanted to own this text in order to insure continued access to the many useful reviews that it contains. In addition, it is one of very few books that I recommend to psychiatry residents interested in clinical neuroscience. Despite its flaws, Psychopharmacology: The Third Generation of Progress is clearly an important contribution to neuroscience and psychiatry.

Psychiatric Diagnosis

Psychiatric Diagnosis. 4th Edition

Donald W. Goodwin and Samuel B. Guze

New York, Oxford University Press, 1989. 332 pp.

In their preface to the fourth edition of Psychiatric Diagnosis, authors Goodwin and Guze are clear on the limitations of their work: there is little “theory” or “speculation” nor any unproved claims in this review of a dozen psychiatric diagnoses. While this approach leaves a straightforward and complete compendium of current knowledge, it also handicaps the work. Like other texts, it provides the most current diagnostic definitions and clinical approaches. Unlike more speculative works on psychiatric diagnosis, it offers nothing interesting or exciting. What is left is a complete, but not comprehensive, up-to-date, but dull text.

Psychiatric Diagnosis presents the basic definitions, history, DSM-III-R criteria, epidemiology, clinical findings, etiological research, and treatments for the following eleven psychiatric diagnoses: affective disorders, schizophrenia, panic disorders, hysteria, obsessive-compulsive disorder, phobic disorders, alcoholism, drug dependence, sociopathy, brain syndrome, and anorexia nervosa. A final chapter presents topics addressed in a psychiatric examination, but is neither complete nor systematic; while this chapter may be of some use to a medical student who has never conducted a psychiatric interview, it would be of little use to a clinician.

The chapters themselves provide complete definitions of each diagnosis, with an emphasis on DSM-III-R criteria (which are included verbatim). The historical accounts of the developing nosologies are perhaps the most interesting parts of the chapters. The epidemiological sections provide some substantive data but reflect the often conflicting accounts of prevalence. Several chapters augment this epidemiological data with descriptions of family studies. The sections on clinical data, etiology, and treatment are well written and complete and include transcripted examples. Additional sections on differential diagnosis are included but, in general, are very brief and offer little discussion on either psychometric measures or clinical data which would be of use in distinguishing one diagnosis from another. References at the end of each chapter are extensive and complement the evidence presented throughout the chapters. In particular, the chapters on hysterical disorders and sociopathy are excellent presentations.

Although Psychiatric Diagnosis presents solid accounts of eleven disorders, it offers nothing more — in fact, much less — than many other texts. In intentionally omitting their own opinions, the authors have also left out any clinical wisdom which may be critical in making a diagnosis. The text is certainly well written and well researched, but one gets the sense throughout that too much is missing, and that there is nothing unique about it. The book attempts to tackle such relevant topics as alcoholism and anorexia nervosa while eliminating much of the speculative and theoretical research which, although not “absolute proof” for etiology, clinical course, or treatment, has sparked so much of the creative thinking on these disorders. Much of psychiatry is “theory, speculation, and explanation,” and deliberately to leave this out ignores much of the credible phenomenological, psychological, and psychodynamic evidence which has provided the impetus for current research. Ironically, the authors frequently quote Karl Jaspers, perhaps one of the most systematic and yet speculative phenomenological psychiatrists.

The authors’ desire to provide the best objective guide to diagnosis is admirable and certainly consistent with current psychiatric approaches; however, they should have provided more current research, rather than such sketchy accounts, to flesh out what is currently known about each disorder. Not even the current psychobiological theories are presented in sufficient depth.

For a student or layperson who is unfamiliar with psychiatric diagnoses, Psychiatric Diagnosis would be a useful guide. It would also be useful to a clinician seeking a quick review of a particular diagnostic category. In general, however, there are many more comprehensive textbooks on diagnosis, and many smaller works on psychopathology which include more interesting clinical vignettes and theory. A less sterile approach, either with more personal clinical wisdom and theory, or with more objective data on each diagnosis, would have added much to this volume.

Chronic Mental Illness in Children and Adolescents

Chronic Mental Illness in Children and Adolescents

Edited by John G. Looney

Washington, American Psychiatric Press, Inc., 1988. 267 pp.

For many, the notion of chronic mental illness in children is hard to accept. Children, even emotionally disturbed children, usually engender a sense of optimism and hope in the future. For those who work in the fields of child welfare and child psychiatry, however, it is well known that there exists a fraction of children and adolescents whose disturbance is both severe and enduring. This book focuses on severely disturbed youngsters, describes these children, and illuminates their needs.

The book, with fifteen contributors, is an outgrowth of a national conference held in 1985 aimed at this same population. There are four major sections in the book and a total of thirteen chapters; each of the major sections addresses a particular aspect of the larger picture of child mental health services. Although the volume evidences some repetition, it is well organized; each chapter builds on previous chapters.

The first section deals with the nature and scope of the problem and moves nicely from the case examples of Chapter 1 to Chapter 2’s discussion of these children in the aggregate. Some readers may find the methods used in Chapter 3 to estimate the prevalence of severely emotionally disturbed children and adolescents from existing data a bit facile, but, given the state of the art of child psychiatric epidemiology, the estimates offered may not be far out of line. Another chapter in this section, written by Jane Knitzer, provides a lucid review of recent policy concerning this population and offers some ideas regarding pressing policy questions. The major theme of this section is that, as a group, severely emotionally disturbed children have needs that require careful treatment and planning.

Section two considers the role of the public and private sectors in the treatment and programmatic planning for severely disturbed children and adolescents. Two of the chapters in this section point out the continuity of care problem, which is compounded by the fragmented service system and the multiple treatment needs of these youngsters. The problem is described in Chapter 5, and a model for solving the problem is outlined in the last chapter of this section. Included in this section is an essay on private inpatient care. Unfortunately, this chapter describes long-term treatment of children and adolescents in a private psychiatric hospital, in contrast to the current trend, driven to a great extent by economic pressures, which is clearly toward brief hospitalization.

In the third section, special issues such as the training needs of mental health professionals, the value of family treatment with this population, and the importance of evaluative research to assess the effectiveness of various treatment programs are considered. Although the chapters in this section are not as unified as those in other sections of the book, each of these chapters is particularly strong.

The last section considers the policy and funding issues that require resolution in order to confront the needs of these children and adolescents. The first of the two chapters reiterates the need for a high degree of cooperation between public and private agencies to build an integrated system of care. The author, Donald Gair, returns to the notion of chronicity and cautions against building a system of care for these children. He warns that the definition of chronicity may result in the exclusion of troubled children from services. Rather than being exclusionary, the service system should focus on the tasks of childhood and provide interventions that are commensurate with developmental needs. In such a child development model, public schools would form the foundation of the service system, and psychiatry would have to relinquish the medical model to some extent. The final chapter outlines a strategy for constructing an organized system of care for children; here, John Looney, also the book’s editor, carefully maps out the barriers to building such a system and provides an agenda for further discussion and planning. This chapter could stand as a summary of the entire book.

This volume was intended for mental health professionals, though others interested in child development and public policy for children will also find the book worth reading. It does not consider in any detail the effect of current economic pressures on child psychiatric services — especially on inpatient services, which is an unfortunate omission because as inpatient stays decrease, there may well be an increase in referrals of more acutely disturbed children to residential and public facilities. Hence there is an urgent need to achieve coordination between public and private service sectors. The book effectively describes the difficulties confronting severely emotionally disturbed children and their families in human terms. The magnitude of the problem is estimated, and possible solutions are described — perhaps the major contribution of the volume. It goes beyond mere complaining about the fragmented service system that currently exists and offers an agenda for further discussion of this problem and its solution.

Psychosomatic Medicine and Contemporary Psychoanalysis

Psychosomatic Medicine and Contemporary Psychoanalysis

Graeme J. Taylor

Madison, CT, International Universities Press, Inc., 1987. 391 pp.

Psychoanalysis is often criticized for not keeping up with advances in modern medicine. In an attempt to expand one area for development, Graeme Taylor has shown how contemporary thought in psychoanalysis can provide a new disease model for psychosomatic illness. Taylor’s review is meticulously researched and presented and provides a logical and relevant basis for further work. Most notable is his clear presentation of a psychobiological perspective, integrating behavioral and neurobiological research with object relations theory.

Taylor begins with a historical review of psychoanalytic approaches to psychosomatic illness, suggesting that the latter grew out of the former. Early studies tried to discern a personality type which correlated with classic psychosomatic illnesses, such as asthma and hypertension. Franz Alexander regarded conflict and dependency as correlates of illness. In the 1950-s and 60s, disillusionment with psychoanalytic approaches led to studies which looked at stress and bereavement in generating a susceptibility to illness. Work along the lines of Hans Seyle’s general adaptation syndrome largely replaced psychoanalytic research during this period. To counter this perception, Taylor refocuses discussion on the more recent notion of “alexithymia,” a clinically derived concept which he defines as “a specific disturbance in affective and symbolic functions which renders [the] communicative style sterile and colorless.” According to Taylor, this term has reintroduced discussion of the role of psychoanalytic therapy for psychosomatic illness. In his opening chapters, Taylor clearly presents the successes and failures of each of these developments along with numerous illuminating cases.

In Parts II and III, Taylor discusses current research in object relations theory and neurobiology, respectively. The mother-infant relationship, which he describes as a regulatory factor in the child’s homeostasis, is shown to be highly relevant for research purposes. Animal studies have linked separation from the mother to variations in heart rate, sleep, growth, and thermoregulation. Recent attempts to create bridges of thought between neurobiology and psychoanalysis are discussed with respect to dream theory, and here the author seems to stray. He provides an extensive review of neurobiological studies on sleep and dreaming and ties in early psychoanalytic theory, but he does not pursue the issues sufficiently. Little is said about how sleep research — which has become the most popular area of mind-brain discussion — can bridge enormous epistemological dilemmas between psychoanalysis and neurobiology. Moreover, how is this research relevant to psychosomatic illness? Taylor’s point here is elusive and leaves too much extrapolation to the reader.

Gathering together a rich history of research and theorizing on psychosomatic illness, Taylor approaches the last chapters stressing the potential contribution of object relations theory. As stated above, an understanding of the mother-infant bond, taken here as the most original interpersonal relationship, is crucial for studying predispositions to illness. A truly biopsychosocial approach to psychosomatic illness can only gain from such an understanding, and psychoanalysis is one logical tool of study. Although the author’s overall work is successful in defining a role here for psychoanalysis, he falls short — despite a gallant effort — in establishing a clearly “new” model for disease. He has merely pointed in one direction and provided numerous signposts.

The groundwork for any psychobiological or biopsychosocial model is difficult to construct, because there are endless considerations from each direction. Despite this fact, Taylor has done a masterful job in bringing together many diverse threads of research, thought, and theory. Consequently, he has defined a unique and viable role for psychoanalysis in the study of psychosomatic medicine.

Disorders of the Developing Nervous System

Disorders of the Developing Nervous System: Changing Views on Their Origins, Diagnoses, and Treatments

Edited by John W. Swann and Anne Messer

New York. Alan R. Liss, 1988. 269 pp.

Disorders of the Developing Nervous System: Changing Views on Their Origins, Diagnoses, and Treatments is a volume based on the proceedings of the Birth Defects Symposium XVIII, held in Albany, New York, in September 1987. The book contains thirteen chapters written by 32 individuals, and is edited by John Swann and Anne Messer of the Birth Defects Institute, New York Department of Health. A possible criticism of this book is that many of the experimental findings are published by these authors elsewhere (e.g., The New England Journal of Medicine, Neurology, and Annals of Neurology). This circumstance is often a characteristic of books derived from symposia, however, and the strength of this work lies not in the novelty of its experimental results, but rather in its broad and masterful coverage of numerous “hot” areas in neurobiology. Thus, the reader is introduced to neuroimaging techniques being employed for the diagnosis and study of neurological disorders (e.g., PET scan in the diagnosis of epilepsy, MRI changes specific to the cerebellum of autistic individuals), the role of NMD A receptors in mechanisms of hypoxic-ischemic brain injury, and gene mapping and cloning in Duchenne muscular dystrophy. Other disorders dealt with in this book are cerebral palsy, dyslexia, Down’s syndrome, PKU, and storage diseases.

The individual chapters are written with exceptional clarity, and are easy to follow; each contains appropriate amounts of background information to orient the reader, which is probably due to the fact that each chapter is based on a talk at the Birth Defects Symposium. Although the central themes of this volume are the developing nervous system and childhood disorders of the nervous system, several papers contain information relevant to disorders of the adult nervous system (e.g., hypoxia-ischemia, epilepsy, and Alzheimer’s disease). This feature will undoubtedly provide the book with a larger audience. In addition, its emphasis on histopathology (especially those chapters dealing with neuroanatomic changes observed in autism), will be of interest to neuropathologists. The majority of the chapters are extremely readable and provide enough interesting information to maintain the reader’s attention, without becoming overly detailed and dry. Certain chapters tend toward the obscure, however, and their subject matter is more difficult to follow. This criticism is particularly true of the chapter entitled “Timing of cell interactions in cerebellar development.” The chapter contains a veritable maelstrom of information on cerebellar mutations in several mice strains (e.g., sg/sg, Lc). In addition, the chapter entitled “Synaptic mechanisms of focal epileptogenesis in the immature nervous system” would be more readily understood if it contained a more extensive introduction to elementary neurophysiology.

On the whole, I would recommend this book. I think it will be of interest to adult and pediatric neurologists, neuropathologists, and neurobiologists. Its strength lies in its clear presentation of the research being conducted in neurobiology today.