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The family in clinical psychiatry
Journal of Psychosornatic Research, Vol.39, No. 3, pp. 381 387, 1995
ElsevierScienceLtd Printedin Great Britain 0022-3999/95 $9.50+ .00
Pergamon 0022-3999(94)00136-7
BOOK REVIEWS The Family in Clinical Psychiatry. BLOCH et al. Oxford: Oxford University Press, 1993. Price £19.50. 296 pp. CLINICIANS readily accept that family factors play a part in the aetiology of mental disorders but there is uncertainty about the role of family therapies in adult psychiatric practice. Patient's families are often approached with reluctance and in the spirit of merely gathering information or providing advice. Even when it seems very likely that relational factors are exerting a powerful influence, therapy will be conducted with the individual patient. In part this happens because interventions at the relational level do not follow in a simple or logical manner even when a complex bio-psycho-social formulation has been developed. Reading this book will go some way to help clinicians make the necessary steps between understanding a patient and knowing what to say to them and their family. The authors have extensive clinical and research experience and they have provided a much needed bridge between standard psychiatric texts on the one side, and family therapy texts on the other. The opening chapters describe the well functioning family, models of family function and their measurement, and methods of assessment of the family. The bulk of the book is concerned with the role of family in the aetiology, presentation and management of the main categories of mental disorder seen in general adult psychiatric disorders, schizophrenia, eating disorders, alcohol and drug abuse, anxiety disorders, personality disorders and dementia. There are also chapters on the family and physical illness (with sections covering the impact of both acute and chronic physical illness), family violence, and ethics. Throughout the book the existing research literature is reviewed thoughtfully. Like good family therapists the authors are not only thorough in collecting and evaluating information but also maintain a reassuring neutrality when suggesting treatment implications. On a negative note the book has too few case and therapy vignettes of the kind that can be so potent in promoting curiosity in new ways of working. Nonetheless, clinicians cannot fail to notice the relevance of this text to their day-to-day work. This is not a therapy manual so those who wish to know how to extend their practice will need further training. The book is also a rich source of ideas for important further research. PETER ALLMAN Consultant Psychiatrist Hereford County Hospital, Stonebow Road Hereford HR1 2ER, UK
Textbook of Pain, Third Edn. Edited by PATRICK WALL and RONALD MELZACK. Edinburgh: Churchill Livingstone, 1994. Price £150.00. 1467pp. THIS is a recognizably rewritten and extended edition, with new subsections on geriatric issues, pain management in children, and in cancer, within the same three main sections, Basic Aspects, Clinical Aspects of Diseases in which Pain Predominates, and Therapeutic Aspects. Professor Wall, in a most engaging Introduction, describes how most authors found radical revision necessary in such a fastdeveloping field, and anticipates the next edition by addressing "unmentionable topics which, nonetheless, show signs of future solution." Among these are euthanasia, and "the silence of psychiatrists and the burden on psychologists" in addressing the problem of pain. Both psychologists and psychiatrists, whether silent or productive, would do well to work through the new and updated first 12 chapters in Basic Aspects, concerning peripheral and central pain mechanisms, and to evaluate the hardwired nervous system assumptions of most psychiatric models against the sophisticated and plastic models repeatedly described. Much of this understanding is also implicit in the clinically focused chapters of the second section. However, readers of this Journal are more likely to turn first to the eight chapters in the Psychotherapy subsection (under Therapeutic Aspects), and these are uneven, both in quality and in tone. There are two excellent 'how-to' chapters, on Behaviour Therapy (Keefe and Lefebvre), and A Cognitive-Behavioural Approach to Pain Management (Turk and Meichenbaum); interesting and thoughtful summaries, with 381
ElsevierScienceLtd Printedin Great Britain 0022-3999/95 $9.50+ .00
Pergamon 0022-3999(94)00136-7
BOOK REVIEWS The Family in Clinical Psychiatry. BLOCH et al. Oxford: Oxford University Press, 1993. Price £19.50. 296 pp. CLINICIANS readily accept that family factors play a part in the aetiology of mental disorders but there is uncertainty about the role of family therapies in adult psychiatric practice. Patient's families are often approached with reluctance and in the spirit of merely gathering information or providing advice. Even when it seems very likely that relational factors are exerting a powerful influence, therapy will be conducted with the individual patient. In part this happens because interventions at the relational level do not follow in a simple or logical manner even when a complex bio-psycho-social formulation has been developed. Reading this book will go some way to help clinicians make the necessary steps between understanding a patient and knowing what to say to them and their family. The authors have extensive clinical and research experience and they have provided a much needed bridge between standard psychiatric texts on the one side, and family therapy texts on the other. The opening chapters describe the well functioning family, models of family function and their measurement, and methods of assessment of the family. The bulk of the book is concerned with the role of family in the aetiology, presentation and management of the main categories of mental disorder seen in general adult psychiatric disorders, schizophrenia, eating disorders, alcohol and drug abuse, anxiety disorders, personality disorders and dementia. There are also chapters on the family and physical illness (with sections covering the impact of both acute and chronic physical illness), family violence, and ethics. Throughout the book the existing research literature is reviewed thoughtfully. Like good family therapists the authors are not only thorough in collecting and evaluating information but also maintain a reassuring neutrality when suggesting treatment implications. On a negative note the book has too few case and therapy vignettes of the kind that can be so potent in promoting curiosity in new ways of working. Nonetheless, clinicians cannot fail to notice the relevance of this text to their day-to-day work. This is not a therapy manual so those who wish to know how to extend their practice will need further training. The book is also a rich source of ideas for important further research. PETER ALLMAN Consultant Psychiatrist Hereford County Hospital, Stonebow Road Hereford HR1 2ER, UK
Textbook of Pain, Third Edn. Edited by PATRICK WALL and RONALD MELZACK. Edinburgh: Churchill Livingstone, 1994. Price £150.00. 1467pp. THIS is a recognizably rewritten and extended edition, with new subsections on geriatric issues, pain management in children, and in cancer, within the same three main sections, Basic Aspects, Clinical Aspects of Diseases in which Pain Predominates, and Therapeutic Aspects. Professor Wall, in a most engaging Introduction, describes how most authors found radical revision necessary in such a fastdeveloping field, and anticipates the next edition by addressing "unmentionable topics which, nonetheless, show signs of future solution." Among these are euthanasia, and "the silence of psychiatrists and the burden on psychologists" in addressing the problem of pain. Both psychologists and psychiatrists, whether silent or productive, would do well to work through the new and updated first 12 chapters in Basic Aspects, concerning peripheral and central pain mechanisms, and to evaluate the hardwired nervous system assumptions of most psychiatric models against the sophisticated and plastic models repeatedly described. Much of this understanding is also implicit in the clinically focused chapters of the second section. However, readers of this Journal are more likely to turn first to the eight chapters in the Psychotherapy subsection (under Therapeutic Aspects), and these are uneven, both in quality and in tone. There are two excellent 'how-to' chapters, on Behaviour Therapy (Keefe and Lefebvre), and A Cognitive-Behavioural Approach to Pain Management (Turk and Meichenbaum); interesting and thoughtful summaries, with 381