메인 Journal of Behavior Therapy and Experimental Psychiatry Seductive mirage: An exploration of the work of sigmund freud: By Allen Esterson Open Court...
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79 Book Reviews nor hyperventilation can be assessed adequately solely by o b s e r v a t i o n of v o l u n t a r y o v e r b r e a t b i n g or by a s i n g l e observation of PCO2; she adds that previous estimates of breathing rate are flawed by hospital-sample bias. Yet nowhere in this book are there specific ins~tructions for abdominal breathing, with or without physiological monitoring of chest and abdominal excursion. Nor is capnometry taught here, i.e., what i n s t r u m e n t is r e c o m m e n d e d , h o w is it u s e d and interpreted? She questions the peculiar assertion by Garssen et al., that breathing training a "rational placebo," then asserts that only assiduous long-term follow-up will determine if somatic, behavioral, cognitive, or psychotherapeutic approaches will put some clients at risk of symptom substitution. But the cognitive approach, well represented in the literature, omitted altogether from this book, and there is no e m p i r i c a l e v i d e n c e for "symptom substitution." Finally, it would also be more prudent not to discount the warning by m a n y respected medical specialists, including some contributors to this book, that VHV is a potentially d a n g e r o u s procedure. She cites data of clinicians who induce hypocapnia in their patients - - some reportedly at PCO2 levels below 20 m m Hg, for up to 8 minutes! Hypocapnia is a powerful peripheral and cerebral vasoconstrictor, jeopardizing the heart and brain blood supply. I would be inclined to proceed with extreme caution. Summing up, a number of the chapters in this book stand out as excellent. They are well written, informative and thought provoking, but overall, the book is a disappointing patchwork of " c o n t r i b u t i o n s , " b i a s e d in content, and u n e v e n in scholarship, and prose: Some chapters overlap, there are numerous gratuitous assumptions, and misleading conclusions, and the cognitive-behavioral "approach" is omitted altogether. as are also major ph; ysiological topics. This book is about selected aspects of breathing disorders, but you will not learn how to do breathing training, capnometry, other physiological assessment, etc. It is a pity that it presents such a distorted view of clinical respiratory psychophysiology. ROBERT FRIED* Respirato~ Psychophysiology Laboratoo' Hunter College, CUNY Director of the Stress and Biofeedback Clinic Institute.~r Rational Emotive and Behavior Therapy NY 10021. U.S,A. *Robert Fried authored The Psychology and physiology of breathing in behavioral medicine, clinical psychology and psychiatry. P l e n u m Press, 1993; The breath connection Plenum Press, 1990; and The hyperventilation syndrome - Research and clinical treatment. Johns Hopkins University Press, 1987. S e d u c t i v e M i r a g e : A n E x p l o r a t i o n o f the W o r k o f S i g m u n d F r e u d by ALLEN ESTERSON Open Court Publishing Company, Peru, Illinois, 1993, 270 pp. This book is a remarkable review and critique of all of the publications of Sigmund Freud. It starts with a careful and s y s t e m a t i c description of F r e u d ' s early d e v e l o p m e n t of psychoanalytic theories and their "basis" in Freud's patients. Then, virtually all of Freud's publications are reviewed, and Esterson points out and cites inconsistencies and contradictions from article to article. Esterson presents many illustrations of "repressed memory", a very current area of investigation. He demonstrates from Freud's writings how the therapist pushes upon the patient the therapist's theories and then attributes this material to the patient. In effect the therapist puts words in the patient's mouth which then seem to confirm the therapist's theories. Esterson analyzes most of Freud's classic case histories (e.g., Dora, Little Hans) and points up a whole variety of "'frauds". In one instance Esterson notes that "one is tempted to suggest that it is the physician who is subject to fantasies (though in his case they are conscious) and not the patient." tp. 477 It is of interest to note that Freud was in continual rivalry with his fellow psychoanalysts such as Jung, Adler, and particularly Josef Breuer who had been his early mentor and collaborator. Clearly Freud is portrayed as a dangerous and hostile individual particularly to anyone he considered to be a rival. Among the other less than positive attributes of Freud, Esterson notes (citing Peter Swales) that Freud was a cocaine addict. Esterson is critical of Freud's veracity, while noting that "few people would be prepared to entertain the notion that a m a n of such stature m i g h t be the source of widespread deception." (p. 248). But Esterson demonstrates excellent scholarship and cites other investigators who have been critical of Freud and his theories. There is virtually no Freudian publication about which Esterson does not raise some doubts. " F r e u d ' s w h o l e s y s t e m is in fact p e r v a d e d by circular arguments". (p. 245) "It is clear that there are good grounds for d o u b t i n g the t r u s t w o r t h i n e s s o f F r e u d ' s a c c o u n t of the treatment; it appears that on occasion he is not above inventing the material he needs for his analysis". (p. 72) 80 Book Reviews It should be noted that there is one comment by Esterson that is favorable to Freud. In pointing out the vast influence of F r e u d ' s work which "has had an i m m e n s e impact in the Western world" and has been an "inspiration" to a "vast amount of literature pertaining to the psychological springs of human behaviour", Esterson observes, in a brief footnote: "Perhaps the most enduring aspect of Freud's work is that among this wide-ranging literature are to be found writings of considerable perspicacity and insight.'" (p. 249) Esterson's view of Freud and psychoanalysis is succinctly summarized in the last sentence of the book. "It may well be that the rise of psychoanalysis to a position of prominence in the twentieth century will come to be regarded as one of the most extraordinary aberrations in the history of Western thought." (p. 254) We could cite many more critical observations by Esterson, based on a careful, scholarly, and systematic analysis of Freud's publications. To this reviewer (who had a headstart in n o n e n t h u s i a s m for Freudian theories and publications), Esterson's book is a classic review of Freud as a theorist, as a therapist, and as a h u m a n being. The title of this book "Seductive Mirage" is an analogy that expresses Esterson's labeling of Freud as an "optical illusion" which has led, and continues to lead many individuals astray. LEONARD KRASNER Behavioral Medicine Program Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford, CA 94305 U.S.A. A Practical Guide to H e a d Injury Rehabilitation." A F o c u s on Postacute Residential Treatment by WESOLOWSKI and ZENCIOUS Plenum Press, New York, 1994 Head injury has been described as the "silent epidemic" affecting 2 million people each year (Ruff, Wylie, & Tennant, 1993). O f t h e s e c a s e s , 5 0 0 , 0 0 0 to 7 0 0 , 0 0 0 r e q u i r e hospitalization (Novak, Roth, & Boll, 1988). This book is a well written, worthwhile addition to the Critical Issues in Neuropsychology series published by Plenum Press. It provides focused behavioral programs that address the many problems associated with head injury rehabilitation, offering clinicians step-by-step instructions to execute postacute head injury rehabilitation programs. It takes into account all members of the m u l t i d i s c i p l i n a r y team; and it p r o v i d e s g u i d e l i n e s , instructional material, and data s u m m a r y charts for use throughout the rehabilitation process. The authors begin with reviews of the NYU Cognitive Retraining Model, the Hawaii State Hospital Model, and the Behavioral Neuropsychological Approach, the three major models most widely used to rehabilitate head injured patients. Then there is a chapter devoted to applied behavioral analysis which concisely reviews basic behavioral techniques and data recording. T h e d e v e l o p m e n t o f the r e h a b i l i t a t i o n plan is then addressed, providing a detailed description of the function of each member of the team during the observation, evaluation, and assessment. This section would have benefited from a consideration of the possible pitfalls of treatment planning and how to avoid them. The book thoroughly addresses the salient aspects of head injury including: deficits in interpersonal social skills, problems with aggression, sexual misconduct, and treatment noncompliance. Behavioral retraining guidelines are provided for mitigating such problems. In addition, cognitive retraining strategies are comprehensively reported with specific solutions to various cognitive problems offered. The book closes with an important chapter on the role of the family in the process of head injury rehabilitation. This chapter covers expected family reactions to head injury including the stages of adjustment throughout the course of inpatient rehabilitation. Family assessment and education is encouraged. It would have been useful to have included an outline of a structured interview to give the family. Nevertheless the book is what it claims to be - - a practical, easily understandable guide to head injury rehabilitation. BENTE K. FISCHER Pepperdine University Graduate School of Education and Psychology 400 Corporate Pointe Culver City, CA 90230 U.S.A. References Novak, T. A., Roth, D. L., & Boll, T. J. (1988). Treatment a l t e r n a t i v e s f o l l o w i n g mild head injury. Cognitive Rehabilitation, 8, 6-7. Ruff, R. M., Wylie, T., & Tennant, W. (1983). Malingering and malingering-like aspects of mild closed head injury. Journal of Head Trauma Rehabilitation, 8, 60-73.