Hypertension is one of the cardiovascular diseases which is most common throughout the world. It is generally defined as an elevation of systolic and/or diastolic arterial blood pressure, which is 120/80 mm Hg in normal situation. A value of 140/90 mm is generally accepted as the upper limit of normotension. Hypertension with certain risk factors such as hypercholes terolemia, diabetes, smoking and a family history of vascular disease pre disposes to arteriosclerosis and consequent cardiovascular morbidity and mortality. The treatment of hypertension leads to reduced risk of hyperten sive renal failure, haemorrhagic stroke, myocardial infarction and cardiac failure. In most cases, the cause of the hypertension can not be clearly defined. Such hypertension is termed as essential hypertension. In a few cases (5- 15%), the hypertension is secondary to definable causes, such as renal artery stenosis, a pheochromocytoma, or an endocrine disorder. This type of hyper tension is known as secondary hypertenSion. Although the exact etiology of essential hypertension is still not well known, the following factors are sup posed to play causative roles."

As psychoanalysis approaches its second century it seems no closer to being a science than when Freud first invented the discipline. All the clinical experience of the past hundred years, Donald Spence tells us in this trenchant book, has not overcome a tendency to decouple theory from evidence. Deprived of its observational base, theory operates more like shared fantasy. In support of this provocative claim, Spence mounts a powerful critique of the way psychoanalysis functions - as a clinical method and as a scholarly discipline or "science". In the process, he prescribes an antidote for the uncontrolled rhetoric that currently governs psychoanalytic practice. This reliance on rhetoric is the problem Spence identifies, and he attributes the troubling lack of progress in psychoanalysis to its outmoded method of data collection and its preference for fanciful argument over hard fact. Writing to Jung in 1911, Freud admitted that he "was not at all cut out to be an inductive researcher - I was entirely meant for intuition". His intuitive approach led him to retreat from the traditional Baconian principles of inductive investigation and to move toward a more Aristotelian approach that emphasized choice specimens and favorite examples, played down replication, and depended on arguments based on authority. Detailing this development, with particular attention to the role of self-analysis in the Freudian myth and the evidential drawbacks of the case study genre, Spence shows how psychoanalysis was set on its present course and how rhetorical maneuvers have taken the place of evidence. With this diagnosis, Spence offers a remedy - an example of the sort of empirical research that can transformclinical wisdom into useful knowledge. His book holds out the hope that, by challenging the traditions and diminishing the power of rhetoric, psychoanalysis can remain a creative enterprise, but one based on a solid scientific foundation.

This profound new volume by Donald Spence extends and amplifies his earlier, important, provocative discussion in Narrative Truth and Historical Truth of method and meaning in psychoanalysis. Focusing on metaphor, he provides a powerful examination of the way meaning is created between analyst and patient and between analysts in scholarly discourse. Spence s presentation of a judicial analogy, in which he recommends to psychoanalysts an approach comparable to the legal system s development of benchmark cases with successive commentaries, brings this elegantly written, stimulating book to a most felicitous conclusion. Anton O. Kris, M.D., Boston Psychoanalytic Institute"

Meaning and Interpretation in Psychoanalysis. Donald Spence's book is so disturbing and so revolutionary, in the sense of essaying so radical and fundamental a critique of our most central clinical and theoretical operating assumptions.