The Early Treatment of Nervous and Mental Disorders
- Author:
Lindesay Neustatter,
M.B., B.S., M.R.C.P. J. & A. Churchill, Ltd. 15s.
” This book the preface states, ” is intended to be useful for the general practitioner and in addition be sufficiently detailed to be of use to psychiatrists as well.” The author tells us that although he set out to deal with ” early ” treat- ment he has found it ” impossible to differentiate early from any other kind of treatment There are also sections on aetiology and early diagnosis. The first section deals with aetiology, a chapter being devoted to Psychopathology, Organic Considerations and Environmental Factors. While much of interest is given about electro- encephalography this occupies a disproportion- ately large amount of space, while focal sepsis is disposed of very summarily, the author apparently considering that its importance has been overestimated.
From a diagnostic viewpoint it is stated that an attempt must be made to determine firstly whether the condition is one of psychosis, psycho- neurosis or mental defect and the differential diagnosis of the first two is discussed. The early diagnosis of schizophrenia is discussed at some length and very adequately.
The milder symptoms of General Paralysis are aptly summarized as “a pressure of activity with a dearth of judgment General management and approach opens the section on Therapeutic Techniques, in which occupational therapy is allotted rather less than a page. Passing on to a more detailed considera- tion of treatment the author puts this under two headings, Psychological and Pharmacological. The psychotherapeutic approach is dealt with at some length and the novice will find much valuable advice here.
Chapter nine deals with psychoanalysis and the description of the procedure given is an excellent introduction. The importance of the transference situation and methods of handling it are made clear and the dangers likely to occur during the course of treatment are touched on and we wish more could have been said as to the possibility of recognizing patients too unstable to be handled.
A reference to bygone methods is worth inclusion if only from its condemnation of the “pull yourself together” attitude and the recognition of the fact that ” understanding the cause ” is not a necessary condition for cure by psychoanalysis.
A single page suffices for an introduction to the theories of Jung, Adler and Meyer which can only be regarded as inadequate. Stekels’ methods are given fuller consideration.
A very useful outline is given of the shorter psychotherapeutic methods. “Abbreviated” analysis preferable certainly to ” truncated ” analysis, a term which is also used, is surely something more dangerous than ” an unsuitable method for use by those without training’Many pitfalls are, however, indicated and in general this chapter abounds with helpful advice, thus, ” a patient wants support and not a demonstra- tion of the physician’s analytical perspicacity while a reminder is given that ” every oblong object is not a phallic symbol Insulin therapy, cardiazol, prolonged narcosis and other pharmacological and physical methods are very briefly described.
The treatment of specific disorders follows and the chapters on Anxiety States and Obsessive Conditions are very useful.
Though impressed with the good results shown by cardiazol in cases of depression a necessary warning is given against its indiscriminate use. ” The treatment of sexual disorders is complex, lengthy and difficult we are told, in a most useful chapter written for the ” family practitioner ” as the ” first line of defence In the section dealing with the treatment of children’s disorders a useful discussion on play therapy appears. The important role the psychiatric social worker of the child guidance clinic has in modifying the environment, particu- larly the attitude of parents and others in the home, finds no place and this perhaps accounts for the too ready way in which ” get the child away from home ” procedure is advised.
The applicability of psychotherapy in general medical disorders is followed by some compari- sons of the results of different forms of treatment. Chapter thirty deals with methods of disposal and certification, a subject on which accuracy is an essential, so it is unfortunate that terms like ” pauper ” and ” lunatic ” still appear although the Mental Treatment Act, 1930, provides for the discontinuance of the use of these terms, while a ” Temporary Treatment Act ” is referred to although no such act has yet reached the Statute Book.
Many points of great interest and value are discussed in this book, though the omissions which have been indicated lessen its value as a guide for the general practitioner. W.J.T.K.
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