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don between circulation and hydration of bone and its reactivity appears evident from the material presented. The basis for cellular activity by which hormones and vitamins appear to influence the skeleton awaits clarification. The local factor or factors causing precipitation ofcalcium phosphate to occur as die matrix proliferates remain unidentified. Even a very excellent characterization ofbone in physical and chemical terms leaves much ofbone metabolism in health and disease unexplained. The basis for the driving force by which cellular mechanisms bring about bone formation and destruction is still an enigma. The biochemical basis for die action of paradiyroid hormone and vitamin D on bone has not been defined in concrete terms. Experiments that tend to relate these agents to energy production and to the formation or destruction of members ofdie tricarboxylic acid cycle are suggestive ofreactions at the cellular level that may help explain effects on bone formation and destruction. A study of calcium metabolism or the effects of disease upon bone emphasizes die importance ofphysiological factors in the maintenance ofbone. One may observe extensive destruction or loss of minerals from the skeleton in the presence ofbody fluids whose composition appears to vary little or not at all compared to that ofthe normal organism. The spine may collapse and die extremities appear osteoporotic. Proliferating cells may replace bone in a variety ofdisease states in which erythroid, myeloid, or endothelial cells undergo hyperplasia. Metastatic growdi from a malignancy ofsoft tissue elsewhere in die body can at times dissolve bone with astounding rapidity. How do these rapidly growing cells bring about the reabsorption ofadjacent bone? A more adequate basis must be sought for relating the metabolism ofbone minerals to that ofdie bone matrix and to explain how cellular mechanisms are capable ofproducing or destroying bone. For those whose research relates to bone or die minerals ofbone, this monograph will be most helpful as a presentation of the current status of information on certain aspects ofthe subject. The text is clearly stated, adequately documented, and indexed thoroughly enough to help one readily find the comments and references on any phase ofthe subject. This book raises more questions than it answers and should fulfil the audiors' objective of provoking the interest ofthe inquisitive mind. Smith Freeman Northwestern University Psychotherapy by Reciprocal Inhibition. ByJoseph Wolpe. Stanford, CaUf.: Stanford University Press, 1958. Pp. xiv+239. $5.00. Modern psychiatry views psychoneurotic symptoms as expressions or attempted resolutions ofemotional stresses engendered by chronic, maladaptive behavior patterns. Psychodierapy , therefore, consists in efforts to help patients unlearn faulty responses and learn more appropriate ones. A wide variety ofdirect and indirect influencing mediods have been used to achieve this end. Indirect procedures, such as psychoanalysis and clientcentered therapy, strive to create a situation which, it is believed, will encourage the patient's spontaneity, foster his emotional maturation, and help him to gain insight into 123 the sources and meanings of his symptoms, on the assumption that these processes will lead to improved behavior. Direct approaches strive to alleviate the patient's symptoms and modify his behavior by exhortation, persuasion, hypnosis, retraining, and similar measures. Although the direct methods have always been widely used, they have not enjoyed the professional respectability ofdie indirect approaches. Since the indirect have never been shown to yield better results dian die direct methods, the reasons for their higher prestige must lie in other realms. Among the reasons that may be mentioned are diat they are grounded in an impressive theoretical system which has strong group support and that our culture attaches a higher value to behavior which is apparently selfdirected than to behavior which is clearly a response to outside influence. This book offers what may prove to be the first successful challenge in the American literature to the favored position enjoyed by "non-directive" methods. Though most of the techniques it describes are not new and many are in widespread use, it gives them a new scientific respectability by imbedding them in a dieoretical framework that has some experimental support and by presenting a statistical analysis ofresults which suggests that they work. Being a Soudi African,, Dr. Wolpe may be less reluctant than many ofhis American confreres to attempt to influence his patients directly...


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pp. 123-125
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