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We report the spectrum of cardiovascular pathology found on autopsy examination in 106 consecutive patients with end-stage renal disease. Cardiovascular pathology was present in nearly all patients, and was the most frequent cause of death (36%), with acute myocardial infarction accounting for 15%. Particularly frequent pathologic findings were left ventricular hypertrophy, coronary and aortic atherosclerosis, pericarditis with effusion, myocardial fibrosis, and valvular dilatation. Cardiovascular death rate was higher during the first year than after the fifth year of dialysis. Nearly all patients had a history of hypertension. The nature of the underlying cause of renal failure and pre-existing cardiovascular disease, specifically diabetes mellitus and hypertension, were the principal predictors of cardiovascular mortality rather than maintenance hemodialysis therapy per se.

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For many clinical psychologists' and students entering the profession, few subjects could seem further removed from their intellectual interests than philosophy. Psychologists and other mental health professionals are looking for practical solutions to the pressing problems of human suffering that they are confronted by daily in clinical settings. Complex and abstract articles arguing the nature of being, knowledge, or virtue seem at best to be an academic luxury, or at worst, obsessive intellectualization that avoids the painful problems of daily living faced by the clinician. Nor has it been just the practitioners who have an aversion to philosophy. Clinical researchers reject philosophical discussion as a pernicious form of armchair psychology, an atavistic influence dragging clinical psychology back to its 19th-century prescientific status. As the 20th century comes to a close, practitioners, researchers, and scientist-practitioners find themselves increasingly divided as to the future course of American psychology. Yet, on one topic there has been virtual agreement: Twentieth-century philosophy has little to offer clinical psychology.The disavowal of philosophical issues and discourse as a proper concern of clinical psychology comes in a variety of forms, some direct and others subtle. Few writers or theorists in Throughout this book my primary focus is on the discipline and profession of clinical psychology. However, the conflicting models of personality and psychotherapy that I discuss are found to some extent in all of the mental health professions (psychiatry, counseling psychology, school psychology, clinical social work, psychiatric nursing, mental health counseling, etc.). In fact, several of the articles reprinted in this book were written by individuals identified as leaders in these other mental health professions. I believe that the major thesis of this book-that contemporary philosophy has been neglected and needs to be reintegrated with theories of personality, psychopathology, and psychotherapy-holds true for work being done in all of the mental health professions. However, for purposes of economy of expression, and because I am more familiar with the nuances of the clinical psychology literature, I generally refer throughout the text to clinical psychology rather than to the mental health professions as a whole. This is in no shape or manner intended to imply a judgment on the relative importance of the various mental health professions or on their respective literature.

Students and others who become interested in the study of psychology typically do so because of personal concerns or problems in their life. They are confused or troubled by some aspect of their own inner experience or behavior or that of someone close to them. They arrive at the doorstep of psychology brimming with questions about the meaning of their dreams, the influence of the mind on illness, why someone would kill him-or herself, how to be less depressed, how to stop a loved one from abusing drugs or alcohol, or how to recover from having been the victim of child physical or sexual abuse, and so forth. These are the same sort of concerns that, with an added sense of urgency, bring clients to clinical psychologists and other men tal health providers. In either case, psychology is viewed by almost everyone outside of academia as a therapeutic, pragmatic, problem-solving profession and discipline. Today's aspiring psychologists share this pragmatic bent with the first person to be appointed professor of psychology in the United States, William James (1892/1983a), who wrote the following:We live surrounded by an enormous body of persons who are most defi nitely interested in the control of states of mind, and incessantly craving for a sort of psychological science which will teach them to act. What