Book Forum
TEXTBOOKS As in the previous editions, each chapter presents highly
Principles of Neural Science, 4th ed., edited by Eric R.
Kandel, James H. Schwartz, and Thomas M. Jessell. New York,
McGraw-Hill Professional Publishing, 2000, 1,414 pp., $85.00.
The welcome fourth edition of Principles of Neural Science
follows the third edition by 9 years. Although this may not
seem like a long time, the task of covering the scientific ad-
vances of this period is onerous, given the tremendous
growth in neurosciences, particularly molecular biology. This
text does an admirable job of presenting these scientific ad-
vances despite their magnitude. The overall goals of this edi-
tion echo those of its predecessors and include the following
key inquiries: 1) How does the brain develop? 2) How do nerve
cells communicate? 3) How do various patterns of intercon-
nections give rise to different perceptions and motor acts?
4) How is communication between neurons modified by ex-
perience? and, lastly, 5) How is neural communication modi-
fied by disease?
Molecular neuroscience has always had a presence in pre-
vious editions; however, the current edition has an even
greater molecular emphasis, which has superseded the origi-
nal emphasis on cellular structure and function. This expan-
sion of molecular topics has been incorporated throughout
the various topics because there are now strategies to study
molecular mechanisms from neural growth and differentia-
tion, to cellular signaling, to the pathogenesis of disease. Per-
haps the most difficult task of all is to tie these seemingly
technical mechanisms and molecules into human experi-
ence, behavior, and consciousness. As the editors aptly state
in the preface, the understanding of consciousness, or the at-
tempt to “know thyself,” is the greatest challenge to the mod-
ern neuroscientist. The frontier of consciousness is an excit-
ing territory that is more accessible now than ever before with
the tools of molecular neurobiology, as clearly outlined in this
edition. It is an exciting time to be a student of neuroscience,
and this text reflects that promise and excitement.
Delineating each addition to the 63 chapters covering new
developments, techniques, and knowledge in neuroscience
would require excessive space. Generally speaking, the pro-
gression of the chapters has remained the same, with relevant
additions made to each to deal with new developments. Most
of these additions, as already noted, fall into the molecular
arena. A new chapter, “Genes and Behavior,” is presented in
part 1 and provides the foundation for genetic topics in sub-
sequent chapters. The “Genes and Behavior” overview de-
scribes very cogently the multiple avenues for exploration of
the genetic determinants of behavior, including single gene
allele determinants of normal variations in behavior, as well
as the effects of mutations, deletions, and other defects in
manifest behaviors. This introduction does an exceptional
job of setting the stage for the remainder of the text. The
broad scope of this text is exemplified in the introduction as it
overviews genetic findings in worms, Drosophila, and mice,
bridging these findings with studies of complex behavioral
and psychiatric disturbances such as bipolar affective disor-
der and schizophrenia.
662
concentrated scientific information in a very digestible and
reader-friendly way. Particularly for the reader who is not a
neuroscientist, the beauty of this text is that it makes no as-
sumptions. Each new term and symbol is clearly defined, and
each chapter thoroughly covers the pivotal historical studies
leading to present-day research in each area. The visual ap-
peal of the text is another great strength. Nearly every page
has a relevant image, diagram, table, or figure. Rendering the
information to memory is much easier with this visual tactic;
the editors were clearly using their knowledge of learning and
memory in their design.
Each chapter addresses a different aspect or functional mo-
dality of neuroscience, but there is ample attention to focus-
ing the reader back to the overarching theme of how all as-
pects work together to create a functioning nervous system.
There are frequent cross-references within the text to other
relevant aspects of the topic at hand. For example, in chapter
8, “Local Signaling,” at the point where the ionic current flow
in myelinated fibers is discussed, the reader is referred to
chapter 35 for a discussion of demyelinating diseases and
their effects on behavior.
Overall, Principles of Neural Science continues to be a
mainstay reference for the field. The enhancements in the
fourth edition include a greater molecular focus as well as
more attention to higher cortical function and consciousness.
The latter is particularly intriguing, since increasingly sophis-
ticated technologies have allowed the exploration of abstract
cognitive processes in a more quantitative way. The psychia-
trist reader will also appreciate the thorough coverage of the
major axis I disorders in terms of their proposed genetic fea-
tures and neurobiological bases as well as the neural under-
pinnings of psychopharmacological interventions. Again, for
all readers, it is an exciting time to be a student of neuro-
science. To comprehend the magnitude of the advances seen
in this decade of neural research, students are precisely what
we must continue to be, regardless of our station.
SUSAN K. SCHULTZ, M.D.
Iowa City, Iowa
The American Psychiatric Press Textbook of Psychia-
try, 3rd ed., edited by Robert E. Hales, M.D., Stuart C. Yudof-
sky, M.D., and John A. Talbott, M.D. Washington, D.C., Ameri-
can Psychiatric Press, 1999, 1,762 pp., $199.00.
The new edition of this textbook is both comprehensive
and innovative. Up-to-date, skillfully edited, and well-au-
thored, the 50 chapters present the information that consti-
tutes the subject matter of our medical specialty. In addition,
the textbook is the main part of a trio. The second part of this
trio is Essentials of Clinical Psychiatry (1), which is also re-
viewed in this issue of the Journal. The third part is Study
Guide to Essentials of Clinical Psychiatry (2), which contains
questions analogous to those on the Board examinations and
thus helps readers assess their learning. An online interactive
companion to the Textbook and the Study Guide is also being
readied for release.
The Textbook of Psychiatry includes a CD-ROM containing
the text of DSM-IV, the nine APA Practice Guidelines, the
Am J Psychiatry 158:4, April 2001

American Psychiatric Glossary (3), the Principles of Medical
Ethics With Annotations Especially Applicable to Psychiatry
(4), and the collective opinions of the APA Ethics Committee
on the Principles. The CD-ROM will enable the user to search
for the contents of the Textbook of Psychiatry by disorder,
code, or phrase for cross-references and hypertext links.
Pardes’s brilliant introduction gives the Textbook of Psychi-
atry an exciting start. He notes that a century ago the U.S. ver-
sion of the famous 1896 sixth edition of Kraepelin’s Clinical
Psychiatry (5) heralded the developments in psychiatry in the
20th century, many of which are in accord with Kraepelin’s
definition of psychiatry as “the science of mental illness and
its treatment.” Pardes states that “both books embrace a bio-
psychosocial model for understanding all people in health
and disease.” He deplores much of the current biological re-
ductionism, evident, for example, when medications are pre-
scribed and used “without attention to intrapsychic, interper-
sonal, familial, occupational, dietary, or exercise components
of causation and treatment.”
The biopsychosocial emphasis in the Textbook of Psychiatry
appears even in the excellent first section, Theoretical Foun-
dations, which includes chapters titled “The Neuroscientific
Foundations of Psychiatry,” “Genetics,” “Epidemiology,”
“Child and Adolescent Development,” and “Theories of the
Mind and Psychopathology” (this fifth chapter is superb). The
next section, Assessment, begins with an outstanding short
chapter by Steven Scheiber titled “The Psychiatric Interview,
Psychiatric History, and Mental Status Examination,” all of
which are brought to life by brief vignettes of clinical situa-
tions and supported by short tables and a glossary. The sec-
ond section also contains chapters on “Classification,” “Psy-
chological and Neuropsychological Testing,” and “The Use of
Laboratory and Other Tests.”
The large third section consists of 17 chapters, each of
which is devoted to one of the major psychiatric disorders, in-
cluding sleep and pain disorders. All are written by authorities
on the various topics. Most are 40–60-page, well-edited de-
scriptions of what is known about the condition discussed,
but, as would be expected, they vary considerably in length.
The 130-page chapter “Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence,” by Popper and West, is
actually a short, well-written child psychiatry textbook.
The fourth section, Psychiatric Treatments, consists of nine
chapters, beginning with “Pharmacologic and Other Somatic
Therapies,” short discussions of which were included in the
presentations on the specific disorders. The remaining chap-
ters in this section focus on individual psychotherapies, be-
havior therapies, and family and group therapies. The “Mari-
tal and Family Therapy” chapter seemed too brief, if not
sketchy; for example, only one-half page is given to postmod-
ern therapies. I think that in view of the extensive marital and
family instability that is becoming a hallmark of our contem-
porary era, more attention needs to be directed toward the
mental and physical health of the family and the well-being of
its members.
The last section, Special Topics, begins with chapters on
“Suicide” and on “Violence” and includes a refreshingly new
and welcome chapter on “Psychiatric Assessment of Female
Patients.” This is followed by an excellent 30-page chapter by
Ezra Griffith and colleagues titled “The Basics of Cultural Psy-
chiatry.” This interesting section also contains chapters ad-
Am J Psychiatry 158:4, April 2001
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dressing “Ethics, Managed Care, and Psychiatry,” “Practice
Guidelines in Psychiatry,” and the innovative “Psychiatric
Practice Research Network,” authored by Deborah Zarin et al.
In the concluding chapter, Melvin Sabshin praises the
many changes that have taken place during the past century,
such as the decline in stigma and developments in psycho-
pharmacology. He adds, however, that “the future of psycho-
therapeutic work by psychiatrists is under attack from several
fronts, and strong efforts will have to be made to prevent atro-
phy of psychiatrists’ psychotherapeutic skills.” He also fore-
sees a need for more forensic psychiatrists, a development
that is in accord with our society’s becoming more litigious, as
was true of Classical Greece during its decline in the second
and third centuries. Sabshin emphasizes that psychiatrists
would benefit from concentrating on the combined use of
psychotherapy and pharmacotherapy and that it is “an excit-
ing area of psychiatry that awaits additional refinement.”
Many of us would agree but think that the imperative first
change is a drastic reduction in the managed care companies’
insistence that psychiatrists limit their therapeutic efforts to
simplistic “med checks.” Sabshin concludes by expressing the
hope that economic constraints on psychiatrists and their pa-
tients will diminish.
This edition of The American Psychiatric Press Textbook of
Psychiatry more than meets its goals to be a “one-volume,
clinically oriented, comprehensive textbook of psychiatry.” It
is probably as good a one-volume textbook of psychiatry as it
is possible to write, compile, and edit. I devoted a substantial
portion of my reading time for 2 months to it and found it to
be a rarity. Not only is it accurate and comprehensive, but
many of the chapters are so interestingly written that they
were really enjoyable reading. Also, many of the chapters in-
clude a short historical background that heightens both inter-
est and understanding. The Textbook of Psychiatry compares
favorably with my cherished 1967 one-volume first edition of
Freedman and Kaplan’s Comprehensive Textbook of Psychiatry
(6) and even with some of the top British texts. I recommend
it highly, without reservation, and when added to both the
summary volume, Essentials of Clinical Psychiatry (1), and the
Study Guide (2), one has as complete a trio as could be
wished. In closing, I lift a line from young William Faulkner’s
preface to his early novel, Sanctuary (7), “Please buy this
book.”
References
1. Hales RE, Yudofsky SC (eds): Essentials of Clinical Psychiatry,
Based on The American Psychiatric Press Textbook of Psychia-
try, 3rd ed. Washington, DC, American Psychiatric Press, 1999
2. Hilty DM, Hales RE, Yudofsky SC: Study Guide to Essentials of
Clinical Psychiatry, Based on The American Psychiatric Press
Textbook of Psychiatry, 3rd ed. Washington, DC, American Psy-
chiatric Press, 1999
3. Edgerton JE, Campbell RJ (eds): American Psychiatric Glossary,
7th ed. Washington, DC, American Psychiatric Press, 1994
4. American Psychiatric Association: Principles of Medical Ethics
With Annotations Especially Applicable to Psychiatry. Washing-
ton, DC, APA, 2000
5. Defendorf AR: Clinical Psychiatry, a Text-Book for Students and
Physicians Abstracted and Adapted From the Sixth German
Edition of Kraepelin’s “Lehrbuch der Psychiatrie.” New York,
Macmillan, 1902
6. Freedman AM, Kaplan HI (eds): Comprehensive Textbook of
Psychiatry. Baltimore, Williams & Wilkins, 1967
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BOOK FORUM
7. Faulkner W: Sanctuary: The Corrected Text (1931). New York,
Vintage Books, 1993
JOHN J. SCHWAB, M.D.
Louisville, Ky.
Essentials of Clinical Psychiatry, edited by Robert E. Hales,
M.D., and Stuart C. Yudofsky, M.D. Washington, D.C., Ameri-
can Psychiatric Press, 1999, 900 pp., $75.00 (paper).
This book is an excellent abridgment of the third edition of
The American Psychiatric Press Textbook of Psychiatry (1), also
reviewed in this issue of the Journal. It is intended primarily
for use by third- and fourth-year medical students, psychiatry
residents, and those in allied fields. In addition, a companion
Study Guide to Essentials of Clinical Psychiatry (2) is designed
specifically to help readers master the material presented in
each chapter by including questions about the key concepts
and other important information.
The 25 chapters selected mainly cover the psychiatric dis-
orders. The first five are devoted to fundamental background
subjects, specifically, “Neuroscientific Foundations of Psychi-
atry,” “Normal Child and Adolescent Development,” “Theo-
ries of the Mind and Psychopathology,” “The Psychiatric In-
terview, Psychiatric History, and Mental Status Examination”
(an outstanding chapter), and “Laboratory and Other Diag-
nostic Tests in Psychiatry.” Each of the next 16 chapters deals
with a major psychiatric disorder and its closely associated
disorders. The final four chapters address “Psychopharmaco-
logic and Electroconvulsive Therapy,” “Brief Dynamic Indi-
vidual Psychotherapy,” “Psychoanalysis, Psychoanalytic Psy-
chotherapy, and Supportive Psychotherapy,” and “Treatment
of Children and Adolescents.” The two appendixes are titled
“Diagnostic Criteria From DSM-IV” and “Excerpts From the
American Psychiatric Glossary,” and both mainly include
helpful definitions.
The 50% reduction of the original chapters is a substantial
achievement. Necessary conceptual background material has
been retained or successfully summarized, and important
clinical information is presented effectively and meaning-
fully. Marmar’s outstanding chapter, “Theories of the Mind
and Psychopathology,” with its presentation of Freudian and
other views, wisely has been shortened only slightly, as has
Scheiber’s “The Psychiatric Interview, Psychiatric History, and
Mental Status Examination.” Almost all of the chapters on the
various disorders include a historical and conceptual pro-
logue that enhances understanding of subsequent develop-
ment of the concepts and scientific advances and enriches
the accumulation of the many indispensable clinical princi-
ples and facts intrinsic to the disorder discussed. In this re-
spect, Black and Andreasen’s chapter, “Schizophrenia,
Schizophreniform Disorder, and Delusional (Paranoid) Disor-
ders,” has retained its excellence.
The treatment section starts with Marangell, Silver, and
Yudofsky’s comprehensive chapter “Psychopharmacology
and Electroconvulsive Therapy,” which gives readers the prin-
ciples of drug action, including mechanisms of action, indica-
tions and contraindications for use, and recommendations
about the selection of medications for specific conditions.
The next two chapters, “Brief Dynamic Individual Psycho-
664
therapy” and “Psychoanalysis, Psychoanalytic Psychotherapy,
and Supportive Psychotherapy,” merit special comment. In
our current managed health care era, in which many for-
profit companies provide insurance coverage for only 10 psy-
chotherapy sessions, it has become necessary, if not manda-
tory, for psychiatrists to become expert in the use of brief psy-
chotherapies. This chapter presents specific guidelines,
illustrated by tables and outlines of key points, that supply
students and residents with the fundamentals of brief ther-
apy. The ensuing chapter complements the presentation of
brief dynamic psychotherapy by supplying the psychody-
namic background for it and by discussing interpersonal psy-
chotherapy briefly. Moreover, it presents the basic principles
and practice of supportive psychotherapy by explicitly defin-
ing and listing goals and techniques along with characteris-
tics of the types of patients for which it is indicated. Those two
chapters will be especially valuable for students, residents,
and even experienced practitioners, who too often consider
supportive psychotherapy to consist mainly of somewhat
nebulous “reassurance.”
The 42-page chapter on “Treatment of Children and Ado-
lescents” adequately discusses both basic and special issues
for young patients, such as pharmacokinetics, pharmacody-
namics, and ethical considerations. The chapter also includes
specific clinical guidelines for the use of stimulant medica-
tions. Although psychopharmacology is adequately covered,
family therapy and group therapy are only briefly described,
even though Cozza and Dulcan point out that “group therapy
offers unparalleled opportunities for the clinician to evaluate
youths’ behavior with peers, to model and facilitate practice
of important skills, and to provide youngsters with compan-
ionship and mutual support.”
Essentials of Clinical Psychiatry was prepared primarily for
use by medical students and psychiatry residents; however, I
predict with confidence that it will be popular with many psy-
chiatrists in practice, who will use it for ready access to clini-
cal facts and treatment recommendations. In this respect, the
115-page inclusion of diagnostic criteria from DSM-IV and
the glossary excerpts in the two appendixes will be especially
helpful. The summaries of many of the clinical chapters in
The American Psychiatric Press Textbook of Psychiatry (1) will
make Essentials of Clinical Psychiatry especially valuable to
psychiatrists and other mental health students and workers
who are studying for their specialty, graduate, or licensure ex-
aminations. Also, for them, the Study Guide to Essentials of
Clinical Psychiatry (2) will become indispensable. I urge all
psychiatrists, other mental health professionals, and physi-
cians in family medicine, internal medicine, and neurology to
obtain this valuable book. It will be both handy and useful.
References
1. Hales RE, Yudofsky SC, Talbott JA (eds): The American Psychiat-
ric Press Textbook of Psychiatry, 3rd ed, Washington, DC, Amer-
ican Psychiatric Press, 1999
2. Hilty DM, Hales RE, Yudofsky SC: Study Guide to Essentials of
Clinical Psychiatry, Based on The American Psychiatric Press
Textbook of Psychiatry, 3rd ed. Washington, DC, American Psy-
chiatric Press, 1999
JOHN J. SCHWAB, M.D.
Louisville, Ky.
Am J Psychiatry 158:4, April 2001

Substance Use Disorders: Assessment and Treatment,
by Charles E. Dodgen and W. Michael Shea. Orlando, Fla., Aca-
demic Press, 2000, 173 pp., $49.95.
The authors of this book indicate in their introduction that
“the knowledge domains assessed by the American Psycho-
logical Association certification exam served as a basis for or-
ganization and inclusion of material for this publication.”
Further, they state that “other professionals seeking certifica-
tion in their respective fields (psychiatrists…) are required to
master the same information.” To provide this information,
the authors “set out to faithfully present the current thinking,
as reflected in professional journals and books, on important
aspects of psychoactive substance use disorders.” This book
thus presents itself as useful to all professionals in substance
abuse, including psychiatrists, especially those preparing for
substance abuse certification examinations.
Problems develop for psychiatric readers, however, in the
book’s first section, which deals with clinical pharmacology of
psychoactive substances and epidemiology of substance use
disorders. The material is often too basic (“the cells in the
brain are called neurons”), the information is sometimes out-
dated (“six different types of neurotransmitters have been
identified”) and occasionally incorrect (phencyclidine is clas-
sified as a Schedule III, not a Schedule I, drug), chemical
names are misidentified (THC is identified as tetrahydracan-
nabis), medical terms are misclassified (pupillary constric-
tion and respiratory depression are listed under acute psy-
chological effects of opioid use), and incorrect physiological
statements are made (“alcohol…is sometimes thought of as a
stimulant; the increased energy that is observed is due to in-
creased blood sugar”).
Some of these errors are probably due to the fact that most
of the discussion on specific drugs is based on a single 1984
review article. Most of the book’s references are to such sec-
ondary sources. Very few references occur after 1995 (the
book was published in 2000), and most of the text seems to
have been prepared in 1995 or earlier with little apparent at-
tempt at updating after that time.
After the clinical pharmacology section, the book dis-
cusses etiology in six pages with one-page overviews of ge-
netic, psychodynamic, behavioral, and family system etio-
logical theories. Similar brief discussions on course and
prevention follow. A larger section is devoted to substance
abuse screening and assessment instruments. However,
there is no substantial or sustained discussion of why the au-
thors choose to discuss the particular instruments, what the
validity and reliability of these instruments are, and for
which substance abuse populations and settings they are
most useful. The authors include their own basic unpub-
lished assessment instrument, which would not be adequate
for a psychiatrist assessing substance abuse (it provides for
an inadequate mental status examination and an incomplete
medical history and review of systems).
A chapter on comorbidity appropriately emphasizes the
necessity to treat co-occurring psychiatric illness and sub-
stance abuse together in an integrated fashion but gives little
guidance on how to do this. The next two chapters on treat-
ment allot one sentence to several paragraphs of discussion
to specific types of psychotherapy. Pharmacotherapy is cov-
ered in four pages with two paragraphs; the section on phar-
Am J Psychiatry 158:4, April 2001
BOOK FORUM
macotherapy of alcohol dependence makes no mention of
such drugs as naltrexone or the experimental use of acampro-
sate. The following chapter covers special populations and is
equally telegraphic, with a page or less on substance abuse in
physicians, ethnic minorities, people with HIV, the elderly,
and the homeless. The final chapter covers legal issues, in-
cluding confidentiality and coercion concerns and the rela-
tion of substance abuse to the Americans with Disabilities
Act.
In summary, for whom is this book appropriate? Anyone
new to the substance abuse field with no background should
benefit from this overview. The book might benefit profes-
sionals intending to take a certifying exam in substance abuse
who are not psychiatrists or any other type of physician. This
book would not be very useful for physicians because it is not
current and does not sufficiently weigh information based on
evidence that would give practitioners direction as to the best
methods to use in assessing and treating patients with sub-
stance abuse disorders.
BARRY I. LISKOW, M.D.
Kansas City, Mo.
PSYCHOTHERAPIES
The Yalom Reader: Selections From the Work of a
Master Therapist and Storyteller, by Irvin D. Yalom, ed-
ited by Ben Yalom. New York, Basic Books, 1998, 512 pp.,
$20.00 (paper).
Born the same year as Irvin Yalom, I heard of his work and
writings throughout my professional career, but somehow I
never read any of his writings, heard him speak, or met the
man. It was with great interest, therefore, that I approached
the opportunity to read and review this anthology. Yalom tells
us he was asked by his publisher of three decades to write a
retrospective, presumably on the occasion of his retirement
from his academic position at Stanford University. With the
aid of his son Ben, who organized and edited this soft-cover
volume, he embarked upon the task.
Yalom starts with a vignette that not only launched him
into a psychiatric career but also demonstrates his writing
ability and contributes to our understanding of why many
consider him a master therapist. Yalom’s first patient as a
third-year student on a psychiatric clerkship was a young de-
pressed woman who was a lesbian in the days when homo-
sexual acts were illegal and her sexual preference would be di-
agnosed as sexual deviance. He knew nothing about lesbians
aside from one titillating passage in Proust where Swann
spied on two women making love. He wondered what he
could offer her and decided that he would allow her to be his
guide in exploring her world. Over a period of several weeks
she developed “a tender, even loving relationship” with the
first of his sex to listen attentively and respectfully to her. She
seemed to improve rapidly. At a weekly case conference on
that clerkship, Yalom presented this patient before an audi-
ence that included luminaries of the Boston Psychoanalytic
Institute. He tells us that no one took notes and that silence
enveloped the conference room. After this presentation, to
665
BOOK FORUM
his astonishment, he was praised lavishly and told that noth-
ing more needed to be said because this spoke for itself. This,
he tells us, was an epiphany, a moment of insight. It also tells
the reader that empathic listening and some understanding
enabled him to capture the essence of the patient’s life, to
communicate it to others, and to be therapeutic. This appar-
ently is the talent that makes Yalom the person he is. The book
focuses on Yalom’s three areas of interest and contribution:
group therapy, existential psychotherapy, and writing.
Jerome Frank, a master of group psychotherapy, trained
Yalom at Johns Hopkins. Being a good therapist, Yalom first
deals with resistance, that is, resistance to the concept of
group therapy, which prevails despite a formidable body of
research showing that it is at least as effective as individual
psychotherapy. There are economic and system concerns and
resistances. Because group therapy potentially can allow the
therapist to earn more money in a shorter period of time,
therapists need to question their motivation in initiating this
form of therapy and patients need to deal with their feelings
about this factor. Doing group therapy is very challenging. It
requires a lot of energy and a wide referral base, both of which
are essential to its initiation and continuation. Yalom tells us
that the uninformed and unprepared patient may find this
form of treatment threatening and seek safety in individual
therapy. There may be ingrained professional prejudice
against a form of treatment that may be viewed as counter to
the traditional one-to-one analytic model, which older thera-
pists would be loath to abandon. Yalom also points to the re-
sistance of some therapists to give up their position as a tradi-
tional authoritarian medical practitioner in favor of the more
transparent and egalitarian head of a group.
Having dealt with resistance, Yalom then goes into the work
of group therapy, largely based on his best-selling book
(600,000 copies in print) The Theory and Practice of Group
Psychotherapy (1). In discussing how group psychotherapy
works, he deals with many factors. These include instillation
of hope, the universality of impulses of problems and fanta-
sies etc., imparting information, the role of altruism in pa-
tients helping each other, the corrective recapitulation of the
primary family group, the developing of socializing tech-
niques, imitative behavior, catharsis, existential factors,
group cohesiveness, interpersonal learning, and the group as
a social microcosm.
Yalom separates here-and-now therapy, an area in which
he has made his most original contributions, from groups in
which it plays little role, such as Alcoholics Anonymous, cog-
nitive therapy, psychoeducational groups, and cancer sup-
port groups. He tells us that the here-and-now approach does
not naturally develop on its own but needs to be learned. It
consists of two parts: a nonhistoric immediate experience
part that takes precedence over the current outside life and
the distant past of group members and an essential second
part that consists of recognizing, examining, and understand-
ing the process. Yalom also discusses non-here-and-now
groups, such as hospitalized patients, those suffering from
addictive disorders, the terminally ill, and the bereaved.
I found the second part of this book, which deals with exis-
tential psychotherapy, the most interesting. It is based on Ex-
istential Psychotherapy (2), which Yalom tells us was 4 years in
the writing and twice as long in the reading. Somehow I got
through a first-rate psychiatric residency program and an ac-
666
ademic career without knowing what the term “existential”
really means. Perhaps this was because, as Yalom tells us, the
term “defies succinct definition” and because “existential”
has been used by colleagues as a false sophistication. Instead
of plain ordinary anxiety and depression, for example, the
pseudosophisticate refers to existential anxiety and existen-
tial depression, in many instances without knowing its mean-
ing themselves, thereby enhancing resistance to the concept.
Yalom comes as close as anybody can to explaining the term
and its usefulness in the practice of psychotherapy, using
meaningful clinical examples. He tells us that it is a dynamic
approach to therapy that focuses on concerns rooted in the
individual’s existence. It deals with four ultimate concerns—
death, freedom, isolation, and meaninglessness. Yalom im-
plies that the perceived amorphous nature of existentialism is
based on the fact that its approach cuts across categories and
clusters in a novel manner. He says that “the clinician will find
the language psychologically alien” and that “the existential
position cuts below the subject-object cleavage and regards
the person not as a subject who can, under the proper cir-
cumstances, perceive external reality but as a consciousness
who participates in the construction of reality.” He explores
life-death interdependence, death anxiety and the lack of at-
tention paid to it in psychotherapy theory and practice, and
fundamental defenses against death. He says that death
awareness opens only one facet of existential therapy. It helps
us understand anxiety. To arrive at a fully balanced therapeu-
tic approach, however, one must examine the other con-
cerns—freedom, isolation, and meaninglessness.
The third section of the book, On Writing, is the most per-
sonal. Essentially Yalom explores his interest in writing and
his experience in it in making him a better communicator. He
says that he often turns to a great writer for a phrase or literary
device that brings home an insight with power and clarity. He
starts with the interesting observation that, although Freud
considered himself a scientist, not a single one of his insights
came from science but from his own intuition, artistic imagi-
nation, and knowledge of literature and philosophy. Yalom
discusses his and his wife Marilyn’s exploration into what has
been called applied psychoanalysis—using psychological in-
sights in a publication to understand the author.
In the still more personal remainder of this book, we learn
of the historic underpinnings of Yalom’s interest in and use
and love of fiction and storytelling. We learn of his ninth
birthday, when he lay sick with the mumps in the back of his
father’s roach-infested grocery store in a Washington, D.C.,
ghetto. His Aunt Leah gave him a book, Treasure Island (also
my first book), which opened him up to the world of the writ-
ten word and fiction. Yalom believes that his interest in and
love of writing has contributed to his ability to communicate.
No doubt this is correct, but most observers of artists, includ-
ing writers, believe that inborn, perhaps inherited qualities
play an important role. We are told that Yalom learned that his
father “wrote wonderful poems” as a youth. Perhaps Irvin
Yalom and his readers are also indebted to the man behind
the grocery counter in Washington, D.C.
As Professor Emeritus of Psychiatry at Stanford University,
looking at his work over the past decades with the help of his
son Ben, Irvin Yalom gives us a volume that offers a wide array
of knowledge and insights. It tells me what I missed in not
reading Yalom sooner than this and offers a first-rate anthol-
Am J Psychiatry 158:4, April 2001

ogy of a first-rate communicator and psychiatrist. It is a book
that should interest all behavioral professionals as well as the
lay public.
References
1. Yalom ID: The Theory and Practice of Group Psychotherapy,
4th ed. New York, Basic Books, 1995
2. Yalom ID: Existential Psychotherapy. New York, Basic Books,
1980
NORMAN B. LEVY, M.D.
Brooklyn, N.Y.
Introduction to the Technique of Psychotherapy:
Practice Guidelines for Psychotherapists, by Samuel I.
Greenberg, M.D. Springfield, Ill., Charles C. Thomas, 1998, 122
pp., $32.95; $10.95 (paper).
Can a book barely more than 100 pages long make an im-
pact for its profundity? Samuel Greenberg’s slim volume
should be essential reading for all training directors and
chairs of psychiatric departments throughout the country. By
studying this book, the product of an obviously seasoned and
astute clinician, the teachers of the next generation of psychi-
atrists will learn that “in therapy we treat the whole person,
not one divided into Axes I–V” (p. x). As a psychoanalyst and a
psychiatrist, I have been troubled because this message has
been given too rarely, or without any emotional substance to
the utterance of the words, to medical students and psychia-
try residents.
The book, pragmatic in its approach, is divided into chap-
ters that could form the basis of an ongoing seminar over 1 or
2 years, including case presentations by both the instructor
and the students. In this volume of basic psychotherapy,
Greenberg essentially presents a way of conceptualizing and
organizing the treatment of a patient, regardless of whether
psychopharmacological interventions are used or not. He be-
gins his discussion (p. 6) with the formal definition of psycho-
therapy by Hans Strupp: “Psychotherapy is an interpersonal
process designed to bring about modification of feelings, cog-
nition, attitudes, and/or behavior which have proved trouble-
some to the person seeking help from a trained professional.”
Studying this book will make it clear that the interpersonal
process is central for all interactions between psychiatrist and
patient.
An outline of the chapters in the book will give the reader a
flavor of Greenberg’s approach: “Initial Interview,” “Life His-
tory,” “Early Phases of Treatment,” “Interpretation and In-
sight,” “Use of Dreams,” “Therapist-Patient Relationship:
Transference, Countertransference, and the Working Alli-
ance,” “Conducting Therapy,” “Anxiety and Depression,”
“Termination.” There are four additional chapters on suicidal
patients, combining medication and psychotherapy, sex with
patients, and how to become a better therapist.
For psychiatry residents, who are accustomed to the con-
cept of structured interviews, Greenberg’s notions that there
is no standard manner of conducting an initial interview (p.
10) and that one has to be aware of the hidden meanings re-
vealed in the first session (pp. 13–14) may be refreshing ideas
inspiring some of them to listen to their patients rather than
merely trying to fit them into DSM categories.
Am J Psychiatry 158:4, April 2001
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Greenberg stresses the centrality of collaboration with the
patient as the therapist gradually understands the patient’s
life history over the course of therapy. He provides very nice
demonstrations of the concepts of transference and counter-
transference and teaches novices that they cannot assume
they know what the patient means from the manifest content
of what the patient says. The therapists’ meaning of the words
may be very different from the patient’s meaning of the
words. The message, in short, is that therapists have to try to
understand their patient’s words—what they mean to the pa-
tient at that particular moment in time. A welcome message
in this age of quick stereotypic diagnostic workups.
LEON HOFFMAN, M.D.
New York, N.Y.
Humanistic and Transpersonal Psychology: A Histori-
cal and Biographical Sourcebook, edited by Donald Moss.
Westport, Conn., Greenwood Publishing Group, 1999, 457 pp.,
$95.00.
This book is exactly what the title says it is. Well written,
thorough, and enlightening, it provides extensive references
and documents the history of the humanistic psychology
movement and the people involved in its development, ongo-
ing research, and clinical application. A definition of human-
istic psychology and its goals is provided in the introduction:
Humanistic psychology began as a bold movement of
creative individuals who set out deliberately to remake
American psychology in the image of a fully alive and
aware human being.…Humanistic psychologists criti-
cize the emphasis of scientific psychology on the mea-
surement, prediction, and control of behavior and pro-
test the exclusion from psychological investigation of
such basic aspects of humanness as consciousness,
value, creativity, freedom, will, love, and spirit.
The first 14 chapters provide an overview, beginning with a
chapter on the historical and scientific background of hu-
manistic psychology. The major theorists and schools are dis-
cussed, including Carl Rogers’s person-centered therapy, Ge-
stalt therapy, body therapies, existential psychology, feminist
psychology, and mind-body medicine. These chapters
present the areas in which these approaches overlap as well as
their similarities and differences. In addition, the Christian
and transpersonal psychologies are well represented and
placed in perspective. Throughout these chapters runs a
theme of critiquing each approach and discussing research
that is ongoing or needed. These chapters provide clarifica-
tion of the theory behind the development and continuation
of each approach to humanity at its best. The last two chap-
ters present a cogent rationale for the continuation of these
approaches. There is a excellent balance between pointing
out the strengths and the limitations of each theory, support-
ing each comment with the literature.
The last 16 chapters are in a section titled Biographical and
Critical Essays on Central Figures in Humanistic Psychology
and Transpersonal Psychology. These chapters are fascinating
to read because the subjects are presented with all their warts
and bumps as well as their genius, creativity, and individual-
ity. This makes for fascinating reading that leads to reflection
667
BOOK FORUM
and considered thought. The figures are a fascinating and var-
ied group: Diana Baumrind, James F.T. Bugental, Moshe
Feldenkrais, Erich Fromm, Amedeo Giorgi, William James,
Sidney Jourard, Ronald Laing, Abraham Maslow, Rollo May,
Fritz Perls, Paul Goodman, Laura Perls, Carl Rogers, Ida P. Rolf,
Erwin Straus, and Ken Wilber. Taken as a whole, these chap-
ters provide an intimate glimpse into the lives and profes-
sional hopes of bright creative thinkers and their interactions
with and effects on each other as the field of humanistic psy-
chology developed to the present day.
I feel that this book is an excellent resource for anyone who
works with people and is given the privilege of assisting them
reach their potential, whether as therapist, counselor, priest,
or consultant.
TERRY A. TRAVIS, M.D.
Springfield, Ill.
SOMATIC THERAPIES
Ritalin: Theory and Practice, 2nd ed., edited by Laurence
L. Greenhill, M.D., and Betty B. Osman, Ph.D. Larchmont, N.Y.,
Mary Ann Liebert, 2000, 443 pp., $90.00.
I approached this book with some misgivings because its ti-
tle connotes a promotional text about a brand drug. Since Ri-
talin is one of five marketed stimulants with few clinical dis-
tinctions, why focus exclusively on one? Perhaps because
Ritalin, and its generic methylphenidate, are commonly pre-
scribed in attention deficit hyperactivity disorder (ADHD)
and have borne the greatest public outcry concerning alleged
misuse and abuse. Therefore, a summary of current knowl-
edge serves a useful purpose.
The book is scholarly and interesting. It does an excellent
job of reviewing important, timely topics. The chapter on
pharmacoepidemiology by Safer and Zito is especially infor-
mative in describing secular patterns of use. Staff from the
Drug Enforcement Administration report a fivefold increase
in methylphenidate “emergency room mentions” and con-
clude that its abuse is similar to that observed with other psy-
chostimulants, including cocaine. This thought-provoking re-
view would be more informative if it explained the meaning
of the “mentions” in emergency room records. Could these re-
flect the increased use of stimulants in accident-prone chil-
dren with ADHD rather than medical emergencies linked to
the medication? Although cocaine and methylphenidate are
mentioned with equivalent frequency in emergency room
records, these figures are not interpretable because the rate of
exposure for each compound is not given.
It is often assumed that adjusting methylphenidate dose to
body weight equates drug exposure across individuals of dif-
fering sizes. Rapport and Denney describe empirical strate-
gies that refute the idea that body weight is a guide to dose.
Such studies are important to clinicians and parents as well as
researchers who often struggle to standardize doses across in-
dividuals. This goal may well be an elusive one.
Other clinically relevant topics include the effect of anxiety
disorders on methylphenidate response in children with
ADHD. The jury is still out, but it seems possible that children
668
with ADHD and anxiety disorders may differ in pharmacolog-
ical sensitivity. The book serves clinicians well by also includ-
ing thoughtful discussions of the effects of methylphenidate
on learning and cognition, aggression, and tics as well as side
effects and long-term treatment.
There is limited attention to other treatments for ADHD,
except for parent training in a chapter by Schachar and Sugar-
man, who note a dilemma in interpreting seemingly contra-
dictory findings. Thus, parent training alone is reported to be
effective, but it offers no incremental advantage when added
to methylphenidate. This conclusion is not trivial because it
should guide practice. The reader would have been better
served by being informed that efficacy for parent training is
found on parent reports exclusively. Since parents are active
treatment participants, they are likely to report improvement.
Due to its timing, the text does not include the large National
Institute of Mental Health study of intense psychosocial treat-
ment and medication used alone and in combination (1),
which failed to reveal superiority for combination treatment
over solo medication.
The stated mission of the text is to set the record straight—
a worthwhile goal given public controversies that have
plagued patients and professionals. However, the examina-
tion of Ritalin focuses exclusively on ADHD, but meth-
ylphenidate has wider clinical applications. Since these are
omitted, a full appreciation of methylphenidate is not part of
the package. It may be time to rethink the title.
Reference
1. The Multimodal Treatment Study of Children With ADHD Coop-
erative Group: A 14-month randomized clinical trial of treat-
ment strategies for attention-deficit/hyperactivity disorder.
Arch Gen Psychiatry 1999; 56:1073–1086
RACHEL KLEIN, PH.D.
New York, N.Y.
The Antidepressant Sourcebook: A User’s Guide for
Patients and Families, by Andrew L. Morrison, M.D. New
York, Main Street Books, 1999, 275 pp., $12.95 (paper).
Education of patients and their families about recognition
and treatment options for mood disorders has become an in-
creasingly important endeavor. Data regarding low recogni-
tion rates of depression in primary care settings, low rates of
treatment of depression when it is recognized, and inade-
quate treatment make depression awareness on the part of
the public much more critical. More individuals with depres-
sion and families of depressed individuals are requesting in-
formation that will help them understand the disorder and
treatments applied. Advocacy groups (including, among oth-
ers, the National Depression and Manic Depression Associa-
tion), pharmaceutical companies, patients, and professionals
have all attempted to provide educational material for pa-
tients regarding mood disorders and treatment options.
The Antidepressant Sourcebook: A User’s Guide for Patients
and Families is written for the public regarding depression. It
is a paperback, and the cost is quite affordable. It includes an
index and references to both scientific and lay publications
and organizations that may be of assistance. There is also a
list of antidepressants with brief annotations regarding their
use and particular side effects.
Am J Psychiatry 158:4, April 2001

There are 38 chapters in this book, which means that many
of the chapters are only a few pages. Several of the chapters
are peppered with examples of patients and the problems
they experience with depression.
There are four major sections. The first, The Basics, has
eight chapters discussing antidepressants, placebos, and de-
pression. What to Say to the Doctor has nine chapters related
to signs and symptoms, chronological history, previous treat-
ment, genetic factors, and substance abuse. What to Expect
has nine chapters related to which antidepressant is best,
finding the right medicine and the right dose, blood levels,
and how to stop an antidepressant. The final section, Warn-
ings, has 12 chapters on drug interactions, side effects, preg-
nancy, relapses, and giving up. I have not mentioned all of the
titles of all the chapters, but I think the general thrust of this
book is to provide knowledge about depression that would be
important for patients and their families to have.
The book is well written, and the chapters, although short,
are to the point and, I think, quite useful. Some of the infor-
mation here may be a bit too technical for some patients. Al-
though we always feel we are writing in “person language”
rather than “professional language,” there is a tendency for all
of us who are in the mental health field to use terms that per-
haps we best understand rather than terms that may be well
understood by lay people. I don’t think this is a serious prob-
lem for this volume.
I personally think that the most useful aspects of this book
relate to the listings of other source material references and
helpful organizations. This information is often not included
in books directed toward patients.
There is much here for patients to read. I think it is an
important contribution and would recommend that it be
high on the list of books recommended to patients and their
families.
DAVID L. DUNNER, M.D.
Seattle, Wash.
Handbook of Substance Abuse: Neurobehavioral
Pharmacology, edited by Ralph E. Tarter, Robert T. Ammer-
man, and Peggy J. Ott. New York, Plenum, 1998, 602 pp.,
$110.00.
Overall, this an excellent compendium of 11 classes of
compounds that have the potential to lead to a substance
abuse disorder. The handbook corresponds to the substance
abuse disorders listed in DSM-IV in 1994. The book is divided
into 12 sections, each organized into chapters on pharmacol-
ogy, behavioral pharmacology, and the psychological and
psychiatric consequences of each particular compound or
psychotropic medication. As a small point, the multiauthored
book (there are 62 authors) lists its contributors without a
professional degree. Therefore, the reader is unaware initially
as to whether the writer is a physician, a pharmacologist, or
both. It is unclear why the various authors, many of them very
knowledgeable, are not listed with their professional degrees.
Notable are the brief historical accounts of each substance
presented at the beginning of each pharmacology chapter.
For the clinician and researcher not familiar with the topic,
the information is succinct but well presented. To those inter-
ested in the history of each substance or compound, some
not too well-known facts are presented. For example, on the
Am J Psychiatry 158:4, April 2001
BOOK FORUM
chapter on heroin, the author points out that the term “her-
oin” was coined by the Bayer Company in 1898. There are
many other interesting historical footnotes.
The handbook addresses itself to the standard substance
abuse disorders that most clinicians manage and confront in
the clinical setting. Uniquely, however, the authors also
present chapters titled “Anabolic Steroids,” “Ecstasy,” and
“Phencyclidine.”
With respect to the content and narrative style, the chap-
ters on the pharmacology and behavioral pharmacology of
each compound or substance at times become overloaded
with article references, technical animal studies, and incon-
clusive findings. For the most part, the summaries at the end
of each chapter serve to sift through the complex material
presented and provide the reader with a sense of future re-
search goals and, to a lesser degree, clinical applications. As
with most multiauthored handbooks, there are some scat-
tered repetitions of material and a lack of smooth linkage,
even within the chapters of each major section.
The book is very descriptive about drug receptors. The
pharmacological information is impressive for a text aimed at
substance abuse and is superior to most writings directed at
this topic. Illustrations and diagrams are well-done.
Overall, the Handbook of Substance Abuse may serve as a
reference book for the clinical researcher interested in addic-
tive illnesses or for busy clinicians who choose to update their
knowledge of the pharmacological basis of potentially abus-
able compounds, medications, or commonly prescribed psy-
chotropics, such as benzodiazepines.
In summary, the strengths of this handbook are in the areas
of research issues in addictive illnesses and pharmacology.
The handbook falls short, however, in the areas of diagnosis
and clinical management of complex addictive illness.
JAMES A. WILCOX, D.O., PH.D.
ARTHUR L. RAMIREZ, M.D.
El Paso, Tex.
NEUROPSYCHIATRY AND NEUROLOGY
Clinical Neuropsychology: Behavioral and Brain Sci-
ence, by John L. Bradshaw and Jason Mattingley. Orlando,
Fla., Academic Press, 1995, 458 pp., $54.95 (paper).
What could be more fascinating than the attempt to link
brain to mind? This book introduces the reader to this at-
tempt and pulls off a rare feat in that it neither baffles nor
bores. Bradshaw and Mattingley do not presume that the
reader has previous neurological knowledge; they succinctly
and methodically provide the medical information a psychol-
ogist would need for reading case notes on brain injury. They
also introduce the medical reader to core concepts in the psy-
chological literature, such as modularity and the relative mer-
its of single and group studies.
In their very readable style, the authors take us on a tour of
disorders of speech, reading and writing, object recognition,
spatial cognition, memory, and movement and thought; along
the way they mention right-hemisphere contributions to lan-
guage, the effects of callosal damage, the dementias, and
669
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“neuropsychiatric disorders.” These last include Tourette’s dis-
order and autism, which, with schizophrenia, are described
rather charmingly as the bridesmaids at the (re)unification of
neurology and psychiatry.
What is notable about the discussion of each topic is that
the reader is given a sense of the current controversies and
debates. The chapter on neglect is a good example, present-
ing five alternative theories with evidence and counter-evi-
dence. This book will be of enormous value to students at all
levels, not just for its content, but also for the model it pre-
sents of how to appraise alternative theories.
Perhaps the main focus of the book is functional localiza-
tion—finding what part of the brain does what. Readers may
ask, however, whether localization is explication; when we
have located all functions and connections, will we under-
stand the mind? The book is described as “more biological
than cognitive in emphasis,” and in this respect may leave
wanting those readers in search of a science of the mind. The
subtleties of localization are not obscured, however. Informa-
tion from subjects with brain damage and animal models is
supplemented with functional imaging results. However, the
authors also warn the reader that this body of exciting data is
built on an assumption that increased blood flow marks in-
creased neuronal activity, without any clear indication of
whether this activity is excitatory or inhibitory.
The accessible writing style, clear and useful illustrations,
helpful chapter summaries, and suggested reading all make
this book ideal for students or for experts in other areas. The
authors also use case histories very effectively to bring to life
many of the disorders discussed.
The book finishes with a look to the future and mention of
the impact of both imaging and genetics. Here it would have
been nice to see consideration of the complementary roles of
functional imaging and lesion studies (the former demon-
strating sufficient brain substrates and the latter, necessary
substrates). Similarly, some indication of how insights from
genetics will converge with findings from neuropsychology
would have been an exciting, if demanding, addition. Perhaps
these will appear in a second edition—a volume I would cer-
tainly like to read.
FRANCESCA HAPPÉ, PH.D.
London, U.K.
Cognitive Neurorehabilitation, edited by Donald T. Stuss,
Gordon Winocur, and Ian H. Robertson. New York, Cambridge
University Press, 1999, 385 pp., $110.00.
Brain dysfunction and resulting problems afflict a large
number of patients and their families. These problems may
occur following a variety of processes including normal aging,
stroke, and degenerative conditions such as Alzheimer’s dis-
ease. This book is a comprehensive review of cognitive reha-
bilitation, bridging the various issues from basic science to
clinical outcome. Theoretical concepts and methodological
issues are reviewed systematically. It also provides a view of
the future of cognitive neurorehabilitation, presenting the
concept of “smart houses” that will use technology to help pa-
tients with altered brain function live independently.
This book provides an updated review of the concept of
brain plasticity. In reading the first chapter I realized that
there was a considerable degree of new information on the
670
degree of brain plasticity. There is an excellent presentation of
injury-related structural changes, including the concept of in-
creasing connections of the surviving neurons. The book pro-
vides evidence to link dendritic growth with functional recov-
ery. These new concepts, although quite complex in nature,
are presented in an easy to understand fashion.
The chapter on intracerebral transplantation presents a
powerful strategy to study plasticity and regeneration in the
brain. Various techniques used in this area, such as animal
models, lesion models, and fetal tissue implants, are dis-
cussed with reference to the cholinergic system in the brain.
Despite the fact that these techniques are still in the experi-
mental stages, the book provides hope and insights into the
future.
Neuroimaging is a technique that has greatly improved our
understanding of brain function in the recent past and con-
tinues to provide new insights into the brain. This book pre-
sents the application of neuroimaging to cognitive neuro-
rehabilitation.
I was particularly impressed by the chapter on the psycho-
social environment and the elderly, which presents practical
strategies for reversing age-associated cognitive decline that
could be applied to the aging population. This chapter pre-
sents a rehabilitation program that includes a psychosocial
component to enhance feelings of control, cognitive training
to teach practical strategies, and activities for overall well-be-
ing. These programs, in conjunction with those described in
other chapters in the book focusing on training techniques to
improve cognitive function in neurological patients, have sig-
nificant potential for use in relatively healthy older adults.
I found the chapter on memory rehabilitation in the elderly
and brain-injured people and the chapter on rehabilitation of
executive disorders to be so fascinating that I skipped to them
first. I think they would benefit clinicians from various disci-
plines. Techniques for improving problem-solving abilities,
attention, and awareness are discussed very well. There is fo-
cus on the caregiver, an important component in the plan-
ning of care for these patients.
Traumatic brain injury accounts for the major share of
costs for rehabilitation of neurological injuries in the United
States. Chapter 18 presents the dilemma professionals face
today between cost criteria and the lack of clear clinical
guidelines and the fear that cost might prevail as the driving
force in selection of those who receive rehabilitation. The im-
portance of secondary mood disorders in patients with brain
dysfunction is also presented in this book; these disorders
need to be addressed for a comprehensive management of
these patients.
High technology has been harnessed to improve the quality
of life for patients with brain dysfunction. The use of “smart
houses” was news to me. Technology is used in such houses to
maintain independence for patients with cognitive impair-
ments. The concept of a “neuro-page,” a simple portable pag-
ing system that reminds memory-impaired individuals to
complete certain tasks, was also interesting to learn about.
The interactive task guidance system provides a set of cues to
guide subjects through everyday tasks. This book gives an ex-
cellent overview of these concepts in the section dealing with
brain-injured people.
This book is not exactly light reading, but it is easy to un-
derstand. It requires that attention be paid to the concepts
Am J Psychiatry 158:4, April 2001

presented, so they can be assimilated and used. Overall, the
information in this book is excellently organized and covers
the wide range of issues involved in cognitive neurorehabili-
tation. This book will be of immense value to professionals
and paraprofessionals working in the area of cognitive defi-
cits following brain dysfunction. It will be particularly useful
to occupational therapists and physiotherapists, neurolo-
gists, psychiatrists, psychologists, neuroscientists, and those
involved with basic science research.
SANJAY GUPTA, M.D.
Olean, N.Y.
Disorders of Brain and Mind, edited by Maria A. Ron and
Anthony S. David. New York, Cambridge University Press,
1998, 373 pp., $90.00; $44.95 (paperback published 2000).
The recent increase in appreciation of the role that the
brain plays in psychiatry, coupled with advances in neuro-
science, brain imaging, and pharmacology, has led to an ex-
plosion of information on the interplay of brain and mind in
the expression of psychiatric disorders. Pertinent research
over the past two decades has been of two types. On the one
hand is study of the psychiatric and psychological manifesta-
tions of coarse brain diseases or damage to specific brain re-
gions as well as conditions closely linked to the brain, such as
cognitive disorders and amnesia. On the other hand is careful
study of the brains of patients with major psychiatric ill-
nesses, particularly schizophrenia and the mood disorders,
using a variety of modalities.
Disorders of Brain and Mind is a compilation of much of the
research in these areas. The book contains seven sections,
each with two chapters. The first section is on frontal lobes
and neuropsychiatry. Its chapters are on the neuropsychology
of the frontal lobes and on frontal lobe structural abnormali-
ties in schizophrenia. The second section is on basal ganglia
in neuropsychiatry; the first chapter is on the neuropsychol-
ogy of basal ganglia disorders, and the second is on the be-
havioral pharmacology of brain dopamine systems with im-
plications for schizophrenia. The next section is on memory
and its disorders. Once again, there is a chapter on neuropsy-
chology of memory and amnesia. The second chapter in this
section is on clinical neuropsychological studies of patients
with amnestic disorders. Next is a section on brain disease
and mental illness, which has one chapter on the psychiatric
manifestations of demonstrable brain disease and one on
structural brain imaging and the psychoses. The section that
follows is on epilepsy; one chapter is on behavior in chronic
experimental epilepsies and the other is a conceptual paper
regarding the behavior disorders of epilepsy. A section on
schizophrenia follows with both chapters expanding on the
neurodevelopmental hypothesis of schizophrenia. The final
section, Imaging Brain and Mind: Old and New Approaches,
includes one chapter that discusses magnetic resonance
spectroscopy in neuropsychiatry and another that discusses
the hallucination as a disorder of brain and mind.
Overall, this book is quite well written, thorough, and well
founded empirically. In fact, the reference lists at the end of
each chapter are very comprehensive. The chapters are all
well balanced in their strengths, but the chapter by David and
Busatto on the hallucination is an especially well-written in-
tegration of psychiatric phenomenology and neuroscience. It
Am J Psychiatry 158:4, April 2001
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nicely illustrates the complex reasoning that will be necessary
in future explorations of the relationship between brain and
mind.
Disorders of Brain and Mind is a very important book, de-
spite its small weaknesses in conceptualization and integra-
tion of the topic and the occasional duplication or even slight
contradiction in content, typical of an edited book. Its major
strength is that it is a comprehensive “state of the field” re-
view of the interface between brain and mind. Although the
philosophical issues of the mind-brain problem are not ad-
dressed directly, the book’s empirical nature is quite satisfy-
ing. The book is also presented in a way that helps the reader
appreciate the complexities of the issues at hand as well as
some of the advances that have recently occurred. For any
psychiatrist, both clinical or academic, interested in the in-
terface of brain and mind, this is a valuable book that can be
read through quite easily as an update and can also be re-
ferred to from time to time. For students new to psychiatry,
this volume might also serve as an introductory text. Neuro-
scientists who are looking for a rather thorough review of
brain-behavior relationships in select disorders will also find
this book of interest.
CONSTANTINE G. LYKETSOS, M.D., M.H.S.
Baltimore, Md.
Adult Neurology, edited by Jody Corey-Bloom, M.D., Ph.D.,
and Ronald B. David, M.D. St. Louis, Mosby, 1998, 456 pp.,
$69.00.
This book is part of Mosby’s Neurology/Psychiatry Access
Series, the essential aims of which are to provide specialist in-
formation to primary care physicians and to provide a con-
cise but clear guide to the discipline at hand.
The book is laid out in three sections. The first concerns the
adult neurological examination, the second reviews common
problems in adult neurology, and the third is a review of some
neurological diseases or disorders. It is clear from the table of
contents that psychiatry has very little play in this text.
The individual chapters are accompanied by clear tables
that serve to aid diagnosis, and they also contain “pearls and
perils” boxes. There are halting comments in the text when a
box is introduced that says “consider consultation when….”
Reviewing this text with psychiatrists in mind, I found it
helpful to note that the layout of the tables is certainly helpful,
and they are an aid to understanding the neurological condi-
tions being described. What is singularly lacking in the text
(apart from a collection of brain scans and EEG tracings) are
good diagrams outlining the underlying relevant neuroanat-
omy to explain the development of symptoms. Familiarity
with the neuroanatomy appears to be taken for granted but is
such an essential part of understanding neurological disease
that this is an error, particularly in a text meant for an audi-
ence of psychiatrists who are not sophisticated in neurologi-
cal differential diagnosis.
As noted, there is no reference to psychiatry in this book.
Epilepsy, which is associated with a high frequency of psycho-
pathology (perhaps up to 50% of patients), is treated solely as
a neurological disorder. Even in the discussion of Parkinson’s
disease there is no reference to psychosis or its difficult man-
agement. The index does not mention schizophrenia, and the
only reference to depression is in dementia.
671
BOOK FORUM
These omissions do not necessarily reflect on this book as a
potentially friendly book for psychiatrists to learn neurology,
but they are a rather sad reflection on the way some neurolo-
gists still view their discipline. In summary, this is a helpful
text, but it lacks appropriate neuroanatomical diagrams and
sticks very strictly to its subject with little imagination.
MICHAEL R. TRIMBLE, F.R.C.P., F.R.C.PSYCH.
London, U.K.
PAIN MANAGEMENT
Pain: What Psychiatrists Need to Know, edited by Mary
Jane Massie, M.D. Washington, D.C., American Psychiatric
Press, 2000, 224 pp., $28.50 (paper).
This is a magnificent book. It is timely, readable, and au-
thoritative. Over recent decades, psychiatry has become pe-
ripheral to pain management. That is bad, because psychiatry
has an enormous amount to offer this field, at least as much
as any another single discipline. Freud opened the batting at
the turn of the twentieth century and made an important
contribution with psychodynamic theory and hysteria as an
explanation for chronic pain for which a physical basis could
not be located. Other important contributions from psychia-
try include the conceptualization of pain as a variant of de-
pression (1). Recently anesthesiology has moved onto center
stage with ever more sophisticated interventions, including
radiofrequency neurolysis, implanted medication pumps,
and spinal cord stimulators.
One of the great contributions to humanity of the twentieth
century was the liaison psychiatrist George Engel’s biopsy-
chosocial medical model (2). This model is particularly well
suited to the management of chronic pain. Other advances
include moving away from the concept of the nervous system
as a fixed stimulus-response mechanism and the coining of
the definition of pain as “an unpleasant sensory and emo-
tional experience associated with actual or potential tissue
damage, or described in such terms” (3).
Why are psychiatrists so well placed to assist in the field of
pain management? First, they know the biopsychosocial
model. Second, they understand the nervous system and
have some familiarity with the new area of plasticity. Third,
they already use many of the most important drugs in the
Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.
Correction
In the March 2001 issue of the Journal, on p. 498, the letter authors’ names in the first column should have
appeared as follows: R. Andrew Chambers, M.D., and Marc N. Potenza, M.D., Ph.D., New Haven, Conn.
672
field (antidepressants and membrane stabilizers). Fourth,
they are skilled in treating the comorbidity of depression (at
least 30% of cases) and adjustment problems. Fifth, they are
conversant with addictive behavior. Finally, they can tolerate
ambiguity and uncertainty.
Pain: What Psychiatrists Need to Know, written by 11 prom-
inent clinicians, is a wake-up call. It alerts psychiatrists to the
size of the problem and informs them that they have the skills
to make a contribution. It begins with a chapter on definitions
and assessment, which describes the biopsychosocial model
and gently introduces the necessary terminology such as no-
ciception and neuropathic pain. A major chapter concerns
pharmacological and nonpharmacological treatments.
Aimed at psychiatrists, most of this chapter is given over to
pharmacological matters. It is straightforward and practical
and of great value to the psychiatrist looking for a sensible re-
introduction. There is not a lot in this chapter that is totally
unfamiliar to the general psychiatrist.
Randy S. Roth, Ph.D., writes an excellent chapter titled
“Psychogenic Models of Chronic Pain.” He draws attention to
the wide range of opinion on the prevalence of psychogenic
pain and gently suggests that neuroplasticity and sensitiza-
tion may explain some of the pain that appears to exist inde-
pendent of tissue damage. He finds that the psychodynamic
of pain as a variant of depression models, while useful in indi-
vidual cases, is insufficient as a general model of chronic pain.
He attacks the operant model, stating that this focus on pain
behavior rather than pain experience has not served patients
well. He ends by encouraging the multivariate (biopsycho-
social) perspective.
This is an excellent book. I hope it will encourage psychia-
trists back into a field, recently abandoned, in which they
have much to offer.
References
1. Blumer D, Heilbronn M: Chronic pain as a variant of depressive
disease: the pain-prone disorder. J Nerv Ment Dis 1982; 170:
381–406
2. Engel G: The need for a new medical model: a challenge for
biomedical science. Science 1977; 196:129–136
3. Merskey H: Pain terms: a list with definitions and a note on us-
age recommended by the International Association for the
Study of Pain (IASP) Subcommittee on Taxonomy. Pain 1979; 6:
249–252
SAXBY PRIDMORE, M.D.
Hobart, Tasmania, Australia
Am J Psychiatry 158:4, April 2001