Shock Treatment and other Somatic Procedures i?
Psychiatry. :Author: Lomar u. is.aiinowsKy, and Paul H. Hocn, m.jl>. wiiiiam tieineniiu”Medical Books Ltd. 21s.
This book, by two American authors, is a comprehensive and generally useful source of information for those employing physical methods of treatment in psychiatryWith praiseworthy caution, a broad view of their subject is taken in the early part of the book, and the writers make it clear that they are not to be numbered amongst those who would attempt to explain or treat various forms of mental illness through the intricate elaboratio11 of a single theme. This approach is endorsed by pr’ Nolan D. C. Lewis in the foreword where he emphasize t that psychosomatic medicine is no novelty, and views the terms as chiefly as useful in providing a unifying concept of psychiatry.
Concerning the matter of terminology, it is unfortunate that while decrying the term in the text, the authors have perpetuated the term ” Shock Treatment ” on the cover. As a formulation of mode of action of the Methods described, it has less to recommend it than tnany other speculations given?in a detail they do not deserve?in the final chapter.
Discussing historical development, it is shown how the attempted application of current treatment in general Medicine to psychiatry has declined. The trend is now towards the psychological and metabolic, perhaps some would add the traumatic in a temporary sense, rather than the pharmacological method. Fever, nypoglycEemia, convulsions and surgery gain the attention of many psychiatrists. As the authors point ?ut, clinical observation rather than laboratory experimental work has been the foundation of these physical jnethods. Such is the nature of the problem that no ^e trend is ever likely to dominate the rest, and it is |r?.re probable that with methods yet to be discovered, neir interdependence will increase.
Jn the description of Insulin treatment the advice n the use of restraint is rather surprising, since with the ^ecasionai use of sodium amytal, and an adequate ah there should be little need for any mechanical fa d- 1? case selection, no preference is expressedj r any particular schizophrenic type, though most siihp therapists have generally found treatment more toe^tlVe-in Paran?id and catatonic cases as opposed ” the simple and hebephrenic patients amongst whom e often to be found the early dementing types that did “uch to popularize the now discarded term of Dementia r?cox. The authors state that if there is no improveco t? a^ter ^ comas, the treatment should be disontinued. It would be instructive to know how many patients improve after 20 to 25 comas, who have shown per eyidence of gain before attaining this number. rsonal experience suggest that the number is small, of {v*er Point concerns Insulin sensitivity, the onset dosW h as the authors stress, requires reduction of f0 ,a^e> often drastically in the earlier comas. Unis aUnately ^ey do not emphasize that failure to do so and P?tent cause of prolonged or irreversible coma, ‘s m fact a form of over-dosage of insulin.
book6- ma’n Points of an otherwise instructive bv th 1S ^at the important points are often submerged To th ?^er e’aboration of details of little significance, clear k’ne*Per’enced, ‘t would not’ be immediately denr ? n primary indication for psychotic evenC-Sr 1?n’ convulsive therapy can get patients well, as v * the illness has lasted 2-3 years, with an efficiency in th ? UnaPPr?ached by any of the other treatments six jyflr ?Wn special fields. Only in cases of less than insulin0 duration, and in the most expert hands can schiZo , Pr?duce anything like similar figures for theran ? 6n*a’ Conversely the role of convulsion indiviH ‘i1 schizophrenia is overstressed. Undoubtedly figures “th patients do well, but in large numbers of the cn ‘ater results are not impressive even with Possibl^’derable number of fits advocated, though it is iniprov6 h ^u.rther modifications in technique may Such Position. In a relatively drastic treatment numernC?nVU^V? therapy, which has been tested against its lim;tU*- Psychiatric disorders, some indication of form of10”5 wou’d be advisable, as in the dementing Phrenin schjzophrenia or in the psychopathic schizoPaticnt. The need for renewing search for reactive stress in first attack depressions who relapse after apparently adequate treatment by convulsions, is worth mention.
Treatment by prolonged sleep is still used frequently enough to warrant a more detailed description of technique, and control of complications. It is sometimes useful for abreaction in its lighter phases. Similarly, the section on pre-frontal leucotomy is inadequate, more especially from the practical aspects, such as the care of the leucotomized patient. With reference to the ? | operation, the authors say that ” unlike shock therapy, the basic disease is not touched “. Remembering our uncertain knowledge of the pathology of schizophrenia and manic-depressive states, and also that leucotomy has been often successful where all other methods have failed, one feels rather dubious about such an assertion. There is much valuable material in this book for the student of physical methods of treatment, but much could be omitted to advantage in the insulin and conr vulsive therapy chapters. With all their experience the authors could well give more lead in emphasizing important aspects of treatment. The other somatic procedures merit far more attention than has been given them in order lo achieve a proper perspective for a work of this type. D. E. S.
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