418 PSYCHOSOMATICS SEPTEMBER-OCTOBER •

personality of the "rational therapist" probablyenters the clinical interaction to such a degreethat some of the astounding results reflect proc­ess and relationship between patient and thera­pist rather than fundamental changes in behav­tor. The book is written in a kind of languagethat is likely to be better understood by personswho have already accepted a certain amount ofreflectivity and introspection as modes to im­prove their fortunes. To the very sick and tothe psychologically evasive person it may not ap­peal and may even add to their bewilderment.

Klaus W. Berblinger, M.D.

BASIC ANXIETY. Walter J. Garre, PhilosophicalLibrary, N. Y., pp. 123. $5.00.

The author's presentation of a basic theory ofanxiety is original and proves to be stimulatingas well as provocative, as might well be sus­pected. Aware of the limitations of Freud's firstas well as second theories of anxiety, an attemptis made to explore the roots still further. Dr.Garre is especially concerned, and rightfUlly so,with the origin, primacy and persistence of anx­iety. The need for illness is identified with de­pendency (a hangover from the troubled timesof infancy when fear of destruction, fear of aban­donment, and the fear that he would not be pro­tected if danger arises, are all related to themother-child relationship.)

An interesting speculation is offered for theformation of psychosomatic diseases. The ag­gressive mobilization for flight or fight, with itsarousal of the sympathetic nervous system, pre­dispose to hypertension. When the threat is ex­perienced primarily as a fear of abandonment,the parasympathetic nervous ,system is stimu­lated in order to preserve available resources,with resultant vagotonia and predisposition topeptic ulcer and ulcerative colitis. If fear oflack of protection results, external irritants mightassume an excessive significance and result inhypersensitivity (allergy to external as well asinternal irritants.)

It is noted that the difference between func­tional reactions and organic changes is basedupon present day gross or microscopic findings.More refined techniques such as electron micro­scopy have enlarged the field of observation, sothat changes which at first are perhaps only in­tracellular, molecular or humoral will eventu­ally be perceived in the more conventional labo-ratory procedures. .

Successful psychotherapy requires that thetherapist himself has achieved sufficient matur­ity so that he can understand himself, (and thushis patients). It is the author's conviction thatonly those psychiatrists whose maturity was oc­casioned because of their own emotional needs

can recognize and meet these similar needs intheir patients. (The author defends this dictumWith the fear that this will provoke his colleaguesand launches his theory as if he has opened upa new territory.) Unfortunately, he avers, evenpersonal analysis and superVisory analysis can-.not bridge this gap in maturity, only personalmotivation can do it-but here the author rUnsout of theories and finally abandons the readerto his own devices.

This book is excellent in that it is both highlyreadable and provocative. The author is to becongratulated for his fortitude in presentingthese basic concepts before his most critical col.leagues despite the anticipated feed back in chal.lenging the psychiatrist to know himself. Socra­tes should rest peacefUlly now that this is finallyout in the open.

PSYCHOSOMATIC MEDICINE - THE FIRSTHAHNEMAN SYMPOSIUM. Edited by John H.Nodine, M.D., and John H. Moyer, M.D. Leaand Febiger, Philadelphia, 1962, pp.1002.

This is a most comprehensive coverage of theproblems of psychosomatic medicine. It is basedon a week-long conference held in Philadelphia inDecember 1961 in which 135 participants, repre­senting many disciplines, served as essayists andpanelists.

The material includes: psychiatric classifica­tion and diagnosis, psychologic testing, psycho­dynamics, cerebral chemistry and physiology,psychopharmacology (methods, mechanisms, andclinical use of various drugs), psychoanalysis,psychotherapy, management of specific psycho­neuroses, personality disorders and specific psy­chosomatic disorders, as well as projections forthe future.

The individual presentations are well preparedin spite of the brevity necessitated by the factthat the program was long and the time allottedeach speaker was short. The panel discussionsare lively and spontaneous and repeatedly pointup the need for an interdisciplinary approach tomuch of psychosomatic medicine.

The editors, Drs. Nodine and Moyer, (who alsoarranged for the program and incidentally provethat medical meetings can be well organized),have done an outstanding job in bringing thismaterial together. The fact that they could pro­duce meaningful communication among the rep­resentatives of the many varied disciplines isin itself an accomplishment.

This book sl:ould be of value to physicians.Psychiatrists, psychoanalysts, generalists andspecialists in all the various fields of medicineand surgery will find practical material here thatwill help them in the management of their mostdifficult patients.

W.D.