BOOK REVIEWS

Psychotherapy, Strategies of Psychotherapy, and Of- to be advised to have the infant placed directly from the new-
fice Psychotherapy. Although the book is written for the born nursery so as not to let his wife become attached to
nonpsychiatrist, I myself frankly found these chapters very it. Until about 10 years ago, most data reported about the
instructive. potentials for development of infants with Downs syndrome
Features that may be less attractive to some readers stem were based on observations made on children in institutions.
from the authors tendency to skimp on detail and depth, pre- We now know that the very process of caring for the children
sumably to enhance readability. Chapters particularly lack- in this way considerably reduced their effective functioning.
ing in this regard are Psychoactive Medications and Mar- One of the contributions of this volume is to provide docu-
ital Conflict. Other chapters, although limited in scope and mentation based on creditable research rather than on iso-
perhaps elementary in presentation. seem appropriate for lated instances showing the changed expectations for devel-
the intended audience. opmentah and social quotients obtained at various ages by
In summary, this is a good book for psychiatrists to skim if children and adolescents with Downs syndrome raised at
they wish to be familiar with potential resources for non- home. It makes clear that the physician jeopardizes his own
psychiatrists. It is highly recommended for psychiatrists credibility if he glibly tells parents that their infant will never
who want a good model of format and style for instructing walk or talk. as has so often happened in the past.
nonpsychiatric physicians. It should also be popular with Parents have always been and continue to be intensely in-
any physician who enjoys reading how an obviously skilled terested in the etiology of their childrens disabilities. This
clinician deals with everyday problems ofmedicah practice. parental interest is reflected in several of the papers included
in this book. These papers also contain an implicit lesson for
REFERENCE parents in the methods and conduct ofrcscarch. Some of the
very parents represented in this book lobbied the Senate Sub-
1. Bahint M: The Doctor, His Patient and the Illness. New York, committee on Appropriations for the U.S. Department of
International U niversities Press . 1957 Health, Education, and Welfare in 1969. They wanted to be
sure that Mary Bazelon Coleman would be funded for her
MARTIN R. Lipp, M.D. studies on the role of serotonin in Downs syndrome. At the
San Francisco, Calif. conference in 1973 they heard her give a straightforward and
detailed account of the results of treatment with 5-hydrox-
ytryptophan: the results were largely negative.
Downs Syndrome (Mongolism): Research, Prevention and Nevertheless, hidden in Dr. Colemans paper is an impor-
Management, edited by Richard Koch, M.D. , and Felix F. de tant observation:
Ia Cruz, M.D. New York, N. Y. , Brunner/Mazel, 1975, 235
pp. $10.00.
, One of the major conclusions of our study relates to
the depression and despair that pediatricians induce in
Books that result from conferences are frequently eclectic the parents of Downs Syndrome patients by informing
in their treatment of the alleged common theme; this book is them at birth of the coming disability of their child. . .

no exception. Nevertheless, it should

light- not be dismissed The whole area of informing and supporting parents rc-
ly by the practicing physician, the medical educator, or any- garding the diagnosis and prognosis of a Downs Syn-
one else who is interested in the mental health of families drome child during the early months of life is identified
who have to cope with the presence of a chronic congenital by this study as an area which needs research. (p. 1 14)
handicap in one of their members. Its eclectic aspects stem
directly from its subject matter, which is many faceted. Psychiatry has little to contribute to the prevention of
The conference from which these papers proceed was or- Downs syndrome, and it falls relatively infrequently to the
ganized by two pediatricians and the father of a youngster psychiatrist to communicate this diagnosis. However, this
with Downs syndrome. It was sponsored by the National process is fraught with risk for parents directly and for their
Association for Retarded Citizens, organizations of parents infants indirectly. Not a single psychiatrist contributed to the
ofchildren with Downs syndrome, and the Mental Retarda- body of this book; paradoxically, this constitutes the prime
tion Branch ofthe National Institute ofChihd Health and Hu- reason why psychiatrists, especially those in teaching posi-
man Development. The papers were prepared for the pur- tions, should both own and loan it.
pose of answering many of the questions that intelligent and
concerned parents ask these days about Downs syndrome ELIZABETH M. BOGGS, PH. D.
and about the prospects ofchildren born with this condition. Hampton, N.J.
Three of the papers deal with aspects of biochemical bal-
ance. Three deal with topics relevant primarily to the adult
with Downs syndrome-employment. community mobility, What is Psychotherapy? Parts I and II. Proceedings 9f the 9th
and sexuality. Four papers deal with early intervention strat- International Congress of Psychotherapy, edited by T.-E.
egics based on psychoeducational techniques, two deal with Mogstad and F. Magnussen. New York, N. Y. , S. Karger,
longitudinal studies indicating the norms of development for 1975, 617pp., $67.50.
this group of children as they grow up, and one deals very
candidly with Present Approaches to Therapy in Downs This collection of papers from the 9th International Con-
Syndrome. As a documentation of the state of the art in gress on Psychotherapy in Oslo, Norway, is both extensive
1973, this book has both current and historical significance and expensive, the one attribute presumably justifying the
for physicians and child development specialists as well as other. The more than 100 very brief articles by as many dif-
parents. ferent authors do not explore their topics in any great depth.
Twenty-five years ago it was the usual practice for physi- The theme of nearly all of the papers seems to be that Freud
cians to recommend early institutionalization of the mongol- is not enough.
oid baby. Indeed. it was not uncommon for the childs father The articles begin by labeling psychoanalytic therapy

242 AmJPsvchiatrv 133:2, February 1976

 BOOK REVIEWS

pseudoscience. note the bankruptcy in the individual dy- fered economic reverses. Black women in particular showed
namic model, and conclude that psychotherapy today has a high degree of depression. It was equally distributed
refused to be limited to conventional interviews but has among married and single people. Contrary to recent rc-
spilled over into activities beyond the individual patient. The ports. people in high-prestige occupations. such as medicine.
participants of the conference seem motivated to elaborate showed less depression than those in low-prestige occupa-
be7ond the plain and simple Freudian meaning of psycho- tions.
therapy, with the evident goals of reaching a consensus, at- The difficulties inherent in this type of investigation are
taming greater efficiency, and providing greater adaptability well known to anyone who has attempted epidemiohogical
to various social situations. research. To begin with, in spite of the authors lengthy re-
A few writers plead for training in self-restraint and for view ofthc relevant literature and theirdiscussion of method-
gaining new insights without losing sight of the values and ology. the validity of their findings can be questioned on sev-
knowledge provided by the pioneers of analysis. Chessick eral levels. For instance, the levels of significance are fre-
seems to make the most notable effort to integrate traditional quently weak: the male-female correlation achieved only a
psychotherapy and the newer therapies. 1% level, and the income correlations achieved only a 0.1%
The expense ofthe book may bejustified by the fact that it level.
demonstrates the amazing range ofvariations in psychothera- Second, it is always difficult to know what is actually being
py that exist worldwide. Two opening lectures state that psy- detected in a study of this type. The introductory discussion
chotherapy molds the individual into
a sys- his society-into ofthe nature ofdepression-what it may be as a mood, as a
tem ofsccular ethics, which, according
is coercive, to Szasz, reaction, as a clinical condition-is insufficient and simulta-
or into a way of realizing the image of man in actual sociahis- neously too extensive to set the stage for the report that fol-
tic life circumstances, which, according to a Marxist, makes lows. This problem stems from the fact that rather than re-
life useful. The following contributions cover such remotely conceptualizing the problem of depression in the light of
related issues as family therapy, systems theory, behavior some new facts, as they set out to do, the authors have
therapy, philosophy. treatment of children, and social psy- produced, essentially, an extended journal-type article with
chiatry. findings worth publishing and clues to further research but
Most of the well-known contemporary authorities (Frank, without the depth they originally promised.
Strupp, Sifneos, etc.) are included in this volume; most of It would have been much more satisfying if they had let
them restate what they have said before. It is interesting that the reader know early on what he was going to encounter,
the most quoted authors are (in order of frequency of quota- rather than preparing him for something that never hap-
tions) Freud, Malan, Frank, Wolpe, Binswangcr, and Wol- pened. Mountains will be in labor, said Horace. and an
berg. absurd mouse will be born.
The greatest reader interest will be attracted to the articles There is an important place in the psychiatric literature for
on autogenic training, Zen, and the roles of the shaman and the monograph format. Reorganized, the material presented
the folkhealer in Africa and India. in this book would have been better published as such rather
The greatest weakness in the field of psychotherapy today than in its present form.
appears to be the scarcity of articles on research in psycho-
therapy. Except for the work of a group in Boston, the FREDERIC F. FLACH, M.D.
research articles presented at the Oslo meeting appear to be New York, N.Y.
limited to narrative reports of individual clinical experi-
cnces. In spite of their great fascination in revealing unique
situations, these solitary studies simply show that psycho- The Diagnosis and Treatment of Alcoholism, by Gary G. For-
therapy today has yet to mount a program of decisive rest, Ed.D. Springfield, Ill. , Charles C Thomas, 1975, 25!
research to establish its real worth. pp. , no price listed.

C. E. SCHORER, M.D. The author, who supervises a military alcoholism rehabihi-

Detroit, Mich. tation program, addresses himself to the broad field of clini-
cal workers in alcoholism treatment programs. He provides
background information as well as how I do it chapters
Depression: Concepts, Controversies, and Some New Facts, by that should be helpful, especially to alcoholism counselors
Eugene E. Levitt and Bernard Lubin. New York, N. Y., with limited professional background and professionals com-
Springer Publishing Co. 1975,, 163 pp. , $8.50. ing into the field with limited experience with alcoholic
patients. Experienced professionals will find the book help-
The authors of this book would have done well to select a ful, especially if it supports their particular viewpoints, and
more appropriate title than simply Depression. This presen- quite useful in staff training.
tation is not really a book but a monograph; it deals with the The first section ofthe book presents background informa-
results and interpretations of a special type of study. Using a tion about the definition ofalcoholism, the stages of alcohol-
questionnaire method of investigation, the authors sampled a ism, and personality characteristics of the alcoholic patient.
population of 3,011 individuals throughout the United States One might criticize Forrests definition of alcoholism as

to determine whether significant correlates to depression distinct from problem drinking as being a bit too restric-
could be identified. tive and placing too much emphasis on physical com-
Their findings can be briefly summarized. Depression phications rather than evidence of true addiction. His use of
seemed to be more prevalent among older people and more the term chronic alcoholism for the most advanced stage
evident in women than men. The authors also found a nega- is a redundancy because alcoholism is chronic by definition.
tive correlation between depression and education level and In discussing the meaning ofthe drinking experience, empha-
a higher evidence of reported depression among people of sis is given to rehiefofpain; the pleasure provided by alcohol
lower or moderate economic status who had recently suf- is not given sufficient importance. However, Forrest says

Am J Psychiatry /33:2, February 1976 243