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The Psychotherapy of the of a lawyer who is balking at the prospect

of retiring, Dr. Muslin points out that a
Elderly Self patient may become depressed at the
By Hyman L. Muslin, M.D. thought of a life filled with cruises and trips
New York, Brunner/Mazel, 1992 to Florida if retirement 111eanS the loss of
220 pages, ISBN 0-87630-657-1 identity that such a patient derives from his
$27.50 or her professional identity. Dr. Muslin
demonstrates with clarity and empathy how
Reuieuied by Ruth EVel11S Netscher; M.D. to manage this kind of loss. For him, the
emergent management of such a patient is

T his is a delightful book. I can recorn-

mend it wholeheartedly for anyone who
has an interest in either aging or psychother-
in providing a bond that will calm him or
her by leading with firm direction. Dr. Mus-
lin also points out that such a patient will
apy. For those whose interest is in aging, the eventually need to understand why he/she
book offers a concise review of the psychol- experiences the pending loss of mirrors for
ogy of normal aging. Well-written and con- professional identity as enfeebling. Here, a
cise, The Psychotherapy qf the Elderly Self genetic interpretation emerges as the pa-
flows easily, fulfilling with ease its stated tient recognizes the lifelong need to aCC0111-
purpose. Written to encourage therapists to modate to the needs of others. Whenever
accept aging patients, this book achieves his/her own needs become prominent,
more: Dr. Muslin's case reviews are quite he/she is overwhelmed by anxiety.
unique in that his emphasis is on how, not Classical psychoanalysis has always at-
just why, to help an older patient. tempted to help patients accept that which
The language is accessible to nonpro- cannot be changed, and Dr. Muslin's pur-
fessionals, so that even relatively unsophis- pose in writing 771e Psychotherapy of the
ticated audiences, like medical students and Elderly Se{(is to "lower the age barrier" for
caregivers in retirement facilities, 111 a y ben- the psychotherapy patient. So, how does he
efit. The review of self-psychology con- see the role of classical therapy, or analysis?
forms to all the conventions, but Blakes the Certainly, Dr. Muslin feels that some pa-
complex philosophies of Kohut available to tients require psychoanalysis, and the case
a lay reader in a 1110st refreshing manner, he presents is the kind COll11TIOnly seen in
The review of how psychological mat- outpatient practice, although the patient is
uration occurs after middle-life is in accord older. Dr. Muslin's requirements for such
with mainstream teaching, but it is made analysands are the usual ones: they should
particularly poignant by such thought-pro- be motivated (of course); they should be
voking examples as how it feels when a capable of self-observation; and they
cinema cashier automatically gives a senior- should be able to form a therapeutic alli-
citizen's discount without asking for identi- ance. However, for an older patient, ques-
fication. Even a seemingly trivial event like tions also include whether the patient is
this can result in narcissistic losses severe physically able to make several visits each
enough to fragment the self if they are not week. The need for a transformed self must
assimilated in a supportive environment, be weighed against the patient's projected
How does a therapist help an elderly patient life span to justify the cost.
accept that he or she is aging and adapt to Expanding the modlfications in tech-
that process? nique, Dr. Muslin recognizes how elderly
S0111e of the losses of aging are narcis- patients become frustrated with traditional
sistic losses, like those brought on by the nondirective therapy. His solution is to offer
loss of identity when an aging person re- the positive transference as a bond, using
tires. Using as an example the case history his influence to direct the patient to do what


Book Reuieus

the patient clearly needs and wants to do. atively and incisively, looking, in some
In summary, this book is useful for depth, at the complex of social, environ-
self-psychologists extending their own mental, genetic, and technological factors
range, but is equally useful for those who that interact with mortality variables. The
deal with the aging or those who are inter- discussions proceed conservatively, render-
ested in a guide to psychological prepara- ing the interpretations compelling,
tion for their own aging. (As a member of Chapters Two through Six comprehen-
the "sandwich generation" I found it of sively review mortality differentials, 1110rt'1l-
value in dealing with my in-laws.) Patients ity trends, and life expectancy. Chapter Two
in therapy of any kind will do better with a specifically examines mortality differentials
therapist who has had the benefit of study- by age, gender, race, ethnicity, marital sta-
ing cases handled with the capability that tus, socioeconomic status, and geography,
Dr. Muslin demonstrates, including a discussion of international COIU-
parisons. Chapter Three explores variations
Ruth Evans Netscher, lvl.D., is a Clinical As- in infant 111011ality, which is first examined
slstant Professor in the Department of PS)'- from an international perspective, featuring
chiatry at the University of Texas Health comparisons of patterns in developed vs.
Sciences Center at Houston. developing countries. Patterns within the
United States are then compared with re-
spect to age, gender, race, ethnicity, and
Mortality Patterns and geography. The chapter concludes with a
discussion of temporal trends.
Trends in the United States Chapter Four focuses on causes of
By Paul E. Zopf death, identifying the ten leading causes of
Westport, CT, Greenwood Press, 1992 death in the United States and examining
281 pages, ISBN 0..313-26769-3, $59.95 HIV/ AIDS, drugs, alcohol, and Alzheimer's
disease as factors in mortality patterns. Vari-
Reuieuied by Steven Seuush, M'D. ations in cause by age, gender, race, and
ethnicity are examined, The chapter con-

T his VOlUt11e is a single-author work that

addresses the subject of mortality pat-
terns on multiple levels. The author goes
cludes with an inspection of the geographic
distribution of deaths from heart disease
and cancer. Chapter Five concentrates on
beyond simple reporting of raw data, offer- trends in cause of death, with particular
ing interpretation and teaching in each focus on infectious diseases, cardiovascular
chapter. I-Ie describes his book as being diseases, stroke, cancer, diabetes, accidents,
"about an American revolution comprising suicide, and homicide. The effects of gender
lower general death rates, dramatically re- ancl race on trends in mortality ratios are
duced infant mortality rates, increased life also examined.
expectancy, changes in the relative i111POl1- Chapter Six analyzes life expectancy. It
ance of various causes of death, shifting develops the concept of life expectancy ancl
mortality differentials, and even the pros- examines differentials by age, gender, race,
pect of increases in the ,~ 'fixed lifespan.' " geographic location, and marital status, It
The book is organized into seven chap- examines the relationship between life ex-
ters. The first examines the general issues of pectancy and cause of death and addresses
life expectancy and mortallty and provides national health goals from the perspective
a useful discussion of methods of measure- of life expectancy. The final chapter pro-
ment, the concept of death rate, and the use vides a summary analysis of the book's
of life tables. In a manner typical of ensuing principal conclusions about mortality pat-
chapters, the author treats his subject ere- terns and trends in the United States.