1961 PSYCHOSOMATICS 481

thought; Part n is a survey and discussion ofbasic concepts.

As to the fundamental concepts: In the struc­ture of a neurosis, there Is an inner con1lict be­tween an Impulse and the rest of the personality,known as the ego. The impulse represents anidea unacceptable to consciousness and becomesrepressed. Part of the repressed idea finds it­self back into consciousness In disguised form.

With its emphasis on inner confiict, Freudia:lanalysis stands in opposition to other schools ofthought. Waelder regards unorthodox disci­plines as incomplete studies in psychopathology.

As to the dissident schools, Jung, Adler andRank continue as a part of the psychoanalyticmodel of human behavior. Jung deals with acollective rather than an individual unconsciouswhich makes for an important di1ference in in­terpretations. In Adlerian theory, people are sickbecause they want to be sick. It is a particularform of adjustment to reality wherein secondarygains remain the Important way of life. Rankcompletely discarded the very essence of psycho­analytic therapy substituting for it a school ofrelationship therapy. In this respect, the Ad­lerian and Rankian treatment procedure are of­ten combined.

Under the caption of "Destructiveness and Ha­tred," Waelder brings to our attention that theseare purely destructive drives.

A destructive attitUde, action or impulse maybe the reaction to: a) purpose usually attributedto the ego; I.e., a threat to self-preservation; b)the frustration of a libidinal drive; c) controlover one's body and mind; d) the mastery of theoutside world; e) essential destructiveness as adrive occurring In psychotics when not reactingto provocation. To explain all destructive behav­ior in terms of the aforementioned causes isopen for debate. Essential destructiveness maybe due to an inborn instinctual drive which Freudnamed the death Instinct. The self-destructiveinstinct is mitigated by Eros and Is the reasonWhy destructive infiuences are not felt dUringthe greater part of our lives.

In the chapter "Analytic Ego Psychology," Wael­der discusses the concept of the ego, the use ofteleological concepts, the appearance of Adler'sIndividual Psychology, ego psychology In psycho­analysis, the defense mechanisms, post-FreUdiantrends and the superego. Much emphasis isplaced on defense mechanisms. The ego idea(superego) is our conscience. Part of the su­perego Is Intimately tied up with repressed de­sires. The strongest demands of the superegoare those outlawing incest and homicide. In con­science man treats himself critically as a de­manding and punishing parent; however, manmay treat himself benevolently like an appro\'-

ing and comforting parent.Psychoanalytic treatment Is the causal treat­

ment of the neuroses. It tries to undo the re­pressions and restore the conftict to conscious­ness. The Indications for analytical therapy canbe applied to the related transference-neuroses,phobias, hysterics, and obsessional neuroses. Lesssuitable to therapy are narcissistic and psychoticconditions. All confilcts do not permit a toler­able solution but may continue to succumb Infavor of the Instinctual drives.

Tolerance for anxiety and frustration, oftencompared to the strength of the ego, are theconditions of the cure. Conditions favorable toa psychoanalytic cure are a ftexlbllity of thelibido, extent of a person's talents, the range ofhis interests and the ability to SUblimate. Pa­tients for whom psychoanalytic treatment is notIndicated are often treated with educational psy­chotherapy or psychoanalytically oriented psy­chotherapy. This form of treatment is the ther­apy of choice In disorders of non-neurotic char­acter.

This reviewed considers Basic Theory 0/ Psy­choanalysis excellent in Its scope and it certainlyshould be added to the library of all psychia­trists.

Harry Perlowitz, M.D.

EVALUATION OF DRUG THERAPY. Edited byFrancis M. Forster, M.D. University of Wiscon­sin Press, Madison, Wisconsin, 1961. Pp. 167. $4.

This book is an account of the proceedings ofthe Symposium on the Evaluation of Drug Ther­apy in Neurologic and Sensory Diseases, held atthe University of Wisconsin In May, 1960. Themain purpose of the meeting was to Improve thequality of clinical research In the area of drugtherapy. A secondary goal was to establish bet­ter communication between clinicians, pharma­cologists and statisticians.

The first portion of the book deals with theproblems encountered in drug research by thepharmacologist, the drug industry and the sta­tisticians. The difficulties in predicting biolop­cal actions from a study of the molecular struc­ture as well as the problems involved in animalscreening and extrapolation of results to humansare reviewed. A most Interesting chapter isprovided In the discussion of the role of the Foodand Drug Administration in their evaluation ofthe safety of a drug. Safety is defined as a rela­tive term, since no drug is entirely safe. Poten­tial benefits must be weighed against the haz­ard of administration.

In planning a clinical trial the importance ofcomparison is noted. Evaluations are too fre­quently subjective, despite the fact that the ob­server may have no conscious prejudice.

482 PSYCHOSOMATICS NOVEMBER-DECEMBER

The more clinical section of the text providespanel reports on various neurological conditions.These include epIlepsy, vertigo, neuralgias, andneuropathies, headache, glaucoma, multiple scle­rosis, diseases of muscles and Parkinsonism. Ineach instance an attempt is made to define andclassify, to indicate drug therapy, and to indi­cate precise methods of evaluating the effects ofdrug therapy.

This book is valuable not only to neurologists,but to all physicians interested in the complexi­ties of drug research.

w.n.

SUBNORMAL PERSONALITIES. By C. J. C. Earl.Baltimore: Williams and Wilkins Co., 1961. 338pages, $7.00.

This volume consists of the structured clinicalreflections of a man who in his work as a busymedical superintendent of a British hospitalfor retarded boys did not forego the elements ofboth warmth for his charges and scientific acuity.Dr. Earl eschews such time worn terminology as"mental defective" and "feeble-mindedness" infavor of a concept of SUbnormality that makesa valiant effort to distinguish not between meas­ured degrees of intellectual function but be­tween the varying and distinct personalities ofthe subnormal. Borrowing some concepts from"various psychiatric schools of thought" the au­thor attempts to study and classify subnormalpersonalities in terms of weakness, simplicity,immaturity, instability, neurosis, psychopathyand psychosis. He qUite rightly feels that sub­normality is a neglected field of study when com­pared to the elaborate methodologies, researchand treatment programs promoted for the men­tally ill. Over Dr. Earl's objection the subnor­mal personality is ruled out, by dint of diagnosis,from many of the weaknesses that normal fleshis heir to. How often have we heard referenceto the neuroticism of a retarded child?

Much emphasis is placed on an analysis of themotor patterns of the subnormal. The authorgo~s so far as to state "it is certain that in ananalysis of motricity, inclUding electromyogra­phy, may lie the royal road to the core of de­fective personalities in the same sense as Freudfound the royal road to the unconscious in theanalysis of dreams.

Dr. Earl has very little regard for the psycho­metric approach to the subnormal. He feels thatin evaluation adequacy of structural and func­tional development, "it is safer to rely on a flve­minute examination of the hands and their move·ment than on the evidence of any revision of theBinet." However, Dr. Earl himself has ratherhaphazardly placed together some psychometrictests of respectably ancient vintage (specifically

the Kohs Blocks, Dearborn Formboards and Bi·net-like vocabulary and absurdity verbal items)and devised what he unhappily calls the MoronBattery as a measure of likelihood of social sur­vival. Dr. H. C. Gunzburg, who supplied addi­tional material for the book, after the death ofDr. Earl, frankly states "that the battery is wideopen to attack from scientific investigation." Hedoes, however, defend its clinical usefulness. Infact, the Moron Battery deflects from what isessentially an extremely readable volume withvigorous, pithy clinical opinions offered by aman who had much to contribute to every pro­fessional worker's understanding of the problemsof the subnormal personality.

Dante A. Santora, M.D.Plattsburgh, New York

THE NEUROLOGICAL EXAMINATION. Russe"N. Dejong, M.D. Hoeber·Harper. 1078 pages.299 illustrations. $20.

The scope of this book far exceeds its modesttitle, since it is an all-inclusive treatise in whichneuroanatomy and physiology are correlated withclinical neurology. Various diagnostic proce­dures are described; their significance is ex­plained and similarly correlated with the clinicalpicture.

The book is divided into ten parts, viz.: theneurologic examination; the sensory system; thecranial nerves; the motor system; the reflexes;the autonomic nervous system; the diagnosis andlocalization of disease of the peripheral nerves;the nerve roots and the spinal cord; the diag­nosis and localization of intracranial disease;special methods of examination (states of dis­ordered consciousness and examination in casesof suspected hysteria and malingering); spinalpuncture and examination of the cerebrospinalftuid.

Some of the highlights include excellent dis­cussions of the reticular formation, the anatomicbasis for psychomotor or temporal epilepsy,methods of differentiating hysteria and malinger­ing, the pharmacology of the autonomic nervoussystem, the diagnosis and localization of intra­cranial disease, vascular syndromes of the brain,the chapter on aphasia, agnosia and apraxia,and the differential diagnosis of intracranial dis­ease.

No attempt is made to classify and describe thecommon neurologic diagnoses or to give detailedaccounts of their etiology, symptomatolgy, diag­nosis or treatment. These disease states are men­tioned only as they are related to abnormalitiesof structure or function.

Since neurology is one area of medicine wherea close correlation indeed exists between physiol-