Practical Lessons in Psychiatry. By Joseph L. Fetterman, M. D. (Springfield, Ill.: Charles C. Thomas, 1949.)
This book written “for general practitioners, psychologists, social workers, nurses and personnel advisers who share the responsibility of guiding those who are mentally ill,” is an exceedingly interesting volume in that it represents a trend in psychiatry away from the esoteric to the practical. The material evolved from a series of lectures delivered to student officers of the School of Military Psychiatry, and throughout it emphasizes a direct approach uncomplicated by archaic nomenclature.
The author begins with a chapter on the patient and his personality and in a simplified fashion sums up the importance of body constitution, quantity of energy or stamina, intelligence, and the effect of early environmental experiences. There is a very interesting section on mental attitude toward illness and injury as well. He next attacks the problem of the psychoneuroses discussing inheritance, childhood experiences, and training, emphasizing that “The Freudian concept, correct as it may be, does not sufficiently take into account inherited factors nor the impact of reality and actual life situations of the moment.” Several case histories are presented, after which he lists at some length the symptoms of the psychoneuroses with case examples. In this chapter is also an interesting section on fear and psychosomatic disorder.
Treatment of the psychoneuroses follows and the author emphasizes primarily the value of the briefer techniques, following to some degree Herzberg’s system. He also throws in some medicinal measures and here his pharmacological dosages, while standard, may frequently be found to be inadequate in severe cases. The author also includes a discussion of suggestion, group therapy, and psychoanalysis. Most of the material in this section is taken from the author’s experience or other writers’ and presents nothing really new.
The author next undertakes in a pair of lengthy chapters to handle the psychoses, devoting a large and well-written section to the problem of depression. He lists for the benefit of the compulsive diagnostician a differentiation between psychoneurosis and endogenous depression but adds sagely that “The borderline case is a difficult challenge.” Apparently he still feels the need to stay within nomenclature divisions although obviously in his practice as shown by occasional remarks he has successfully escaped these ties from the past. The chapter on schizophrenia is one of the most superficial, simply repeating material available most everywhere else. He does add, however, a section on insulin coma therapy and in the subsequent chapter presents a full-fledged summary of electric convulsive therapy, which he has renamed electrocoma therapy for semantic purposes.
These two sections are so detailed as to make the reader feel that they represent potential training manuals. Instructions for patients and families are presented together with complete survey of all accessory medications. This is all very fine in texts written for psychiatrists. One can only wonder at this presentation in a book written for everybody else who deals with mental disease. Certainly the general practitioner and the nurse and the psychologist should have a general working knowledge of these shock methods, but such detailed discussion in a book specifically written for them is very apt to make them feel that these techniques can well be adapted by them for use with their patients. This assumption will probably not be made by the lay workers, of course, but there seems no doubt that the average general practitioner reading the book will assume that it indicates his potential ability to handle shock therapy. It is pretty universally agreed by psychiatrists that only experts carefully trained should employ such techniques and it is this reviewer’s opinion that, while these chapters are excellent in themselves, they are definitely out of place in the present volume.
Psychopathic personalities are next taken up with several typical histories and the classifications used are mainly military and for the most part of working value. One would question the therapeutic value of discipline, which the author states “will temporarily deter some psychopaths from repeating the misconduct or the crime,” in the face of the widely accepted theory that the psychopath ordinarily is unable to profit from punishment. As usual, the term is utilized here to cover a wide variety of cases and the chapter is too short for adequate discussion of all of them. The author also includes in this chapter malingering and alcoholism.
Toxic organic psychoses and a chapter on neurosyphilis and epilepsy follow and the book is concluded by a discussion of the sequelae of head trauma. In discussing these organic reaction types the author has not deviated from the standard thinking in the field and the summaries are reasonably complete. There is also a fair index.
In general, the volume adheres to the statement of the jacket blurb that “It will not confuse the reader by any sudden breaking from tradition.” This is a useful aim in a book written for general practitioners and the book can be definitely said to achieve this purpose. Since the author has not attempted to write a volume for psychiatrists he can hardly be criticized for the numerous omissions of detail in the various chapters. He has selected his material with a specific end in view and has reasonably well reached his goal.
Douglas M. Kelley, M. D.,
University of California, Berkeley.
Editor, American Journal of Psychiatry:
Sir: Dr. Douglas M. Kelley wrote a comprehensive review of my book, “Practical Lessons in Psychiatry,” which appeared in the June, 1950, issue of the Journal. His critique shows that he read and digested the material thoroughly. However, I must point out a serious misconstruction of the contents of the chapter on electrocoma therapy.
Dr. Kelley says, “While these chapters are excellent in themselves, they are definitely out of place in the present volume.” The reason for this opinion, as given by Dr. Kelley, is, “There seems no doubt that the average general practitioner reading the book will assume that it indicates his potential ability to handle shock therapy.”
Such a statement has no basis expressed or implied in the book. On the contrary, the detailed description of the procedure, from the selection of the psychotic patient to the technical phase of the treatment, is assigned as a major task of psychiatry. In contrast to Dr. Kelley’s deduction, this is what the text actually states (page 165): “Merely possessing an electroshock machine does not assure results. There is needed an experienced psychiatrist who knows his patient, the dosage and course of the illness—and how best to employ electrocoma therapy along with psychotherapy.”
On pages 172 and 173, clearly expressed in italics, is the following: “I would advise any psychiatrist who wants to use this method successfully to train with one who is thoroughly familiar with the apparatus, the pretreatment medication, the dosage, the timing. Merely procuring the apparatus and an instruction sheet is inadequate preparation in the use of a method whose potential for good is so great. Properly administered, electrocoma therapy can contribute tremendously towards recovery. Electrocoma therapy used in a haphazard fashion, minor reactions, incomplete series of treatments, neglect of after care will lead to a higher percentage of failures than need be.”
The aim of this chapter was to provide a clear understanding for nurses, psychologists, and practitioners in a field where there has been considerable misunderstanding. How closely this aim was reached may be inferred from the following sentence from the review of my book in the Southern Medical Journal (May, 1950): “The section on electroshock therapy, with an introduction by Dr. Foster Kennedy, is the best yet seen by the reviewer.”
Joseph L. Fetterman, M. D.
Cleveland, Ohio.
Editor, American Journal of Psychiatry:
Sir: Dr. Fetterman has unfortunately misinterpreted the wording of my review insofar as my opinion naturally is my own and hardly would be expected to be expressed or implied in his book. The chapters on electroshock therapy, as the Southern Medical Journal’s reviewer states and with which I have already agreed in the review, are excellent. As a matter of fact, it is this very excellence which made me feel them to be out of place in a volume specifically written for non-psychiatrists. Warnings for psychiatrists are, of course, superfluous, unless Dr. Fetterman hoped some experts would read the book for other purposes than merely review. Since the book was not written for psychiatrists, however, Dr. Fetterman’s unusually detailed discussion, going beyond merely clear understanding of method, must be purposeful in nature. Oddly enough it was the interpretation of a half-dozen of my colleagues who are general practitioners that he had intended this excellent and well- ordered chapter to provide information that they might perhaps use the method. Unfortunately, to these physicians the excellence of the information provided outweighed the warnings.
Douglas M. Kelley, M. D.,
Berkeley, Calif.