Giving Up the Gun. Japan's Reversion to the Sword, 1543-1879

This is an eminently readable text. Each chapter begins with several "vignettes," short case presentations which arouse curiosity, illustrate problems and their diversity, and generally introduce the chapter. The authors thoughtfully provide annotations for "recommended readings" in addition to "references," showing sensitivity to medical students' needs for general review articles, "classics," and works of special interest rather than more narrowly focused reference articles and texts. Chapter summaries are followed by short discussions of "implications" that each chapter's concepts will or should have on patients, physicians, and the health care system. "On Becoming a Patient: Psychosocial Considerations" is the first of four sections. Here we meet the person before he or she becomes a patient; discussions include illness and help-seeking behavior, the sick role (with a brief but excellent summary of Parsons' classic work), and patients' and physicians' expectations regarding treatment. The second section, "On Becoming a Patient: Psychophysiologic Considerations," presents anxiety, psychological defense mechanisms, depression, pain, and sleep and dreaming. The chapter on pain is superb; no one should treat or deal with patients in pain without having read this first. The third section, "On Assessing a Patient: A Clinical Systems Approach," introduces and explains the "Patient Evaluation Grid," a three-by-three grid relating current, recent, and background contexts (paralleling the traditional chief complaint, present illness, and past history) to biological, personal, and environmental dimensions of illness and help-seeking behavior. The concluding section, "On Managing a Patient," discusses therapy and its limits. Two excellent chapters examine the doctorpatient relationship with its therapeutic significance and patients' personality types, with specific suggestions for understanding and managing each patient's unique and diverse needs and expectations. Three detailed case presentations of illustrative patients serve as synthesis and summary. The text has few flaws, the most notable being a tendency to encumber sound concepts with general systems jargon. Its merit, however, is unequivocal; it should become a standard text for preclinical behavioral science courses as well as a valuable resource for more advanced students, clinicians, and others who work with the people we call patients.