Failures in Psychiatric Treatment: Edited by, Paul Hoch, M.D. (New York: Grune and Stratton, 1948. Pp. 241.)

This book aims to present a general review of therapeutic failures with different psychiatric methods of treatment, and the scope ranges from failures in social casework to disappointments in psychosurgery. The collection is somewhat unique in that it attempts to rectify the disinclination to report unsuccessful cases. The evaluation and comparison of failures is difficult because of the wide divergence in the therapeutic aims of the various psychiatric disciplines, and the views expressed are essentially personal impressions and opinions.

C. P. Oberndorf, discussing failures with psycho-analytic therapy, calls attention to the meagre recording of unsatisfactory results and to the tendency in the past to focus on the question of technique when investigating unsatisfactory results. He emphasizes that 'there are many cases treated by psycho-analysts recognized as thoroughly trained and competent where, after prolonged orthodox treatment, five times a week for a year or more, the results are admittedly unsatisfactory to the analyst, the patient, the referring physician and those most intimately concerned with the patient's welfare'. He is especially concerned about failures in 'cases where the symptoms and the patient's personality justify the application of classical psycho-analysis'. It is regrettable that the author avoided discussing more fully the failures due to errors or difficulties in technique. Dr. Oberndorf also submits two suggestions for increasing efficiency in treatment: (1) Review of cases under psycho-analysis for more than 300 hours, by a panel of three analysts. (2) Greater elasticity in the application of the method.

Sandor Rado, in discussing Oberndorf's paper, supplemented another suggestion: 'a painstaking re-examination and re-systematization of Freud's psychodynamics will increase the effective value of his creative work.'

Wendel Muncie, discussing the failures in treatment