The patient: Biological, psychological, and social dimensions of medical practice

Book Reviews The Clinical Prediction of Violent Behavior. John Monahan, Ph.D. U.S. Department of Health and Human Services, National Institute of Mental Health, Rockville, Md., 1981, 134 p. Can mental health professionals accurately predict violent behavior? Many in the field believe it is not possible; yet mental health professionals are nevertheless called upon from time to time to make such predictions. John Monahan’s The Clinical Prediction of Violent Behavior is certain to prove invaluable to clinicians in increasing the appropriateness and accuracy of their assessments of violent behavior. This monograph, sponsored by the Center for Studies of Crime and Delinquency, National Institute of Mental Health, is one of a series on current issues in the area of crime and delinquency. The author is professor of law at the University of Virginia, Charlottesville, Virginia, and is by training a psychologist. Dr. Monahan has written extensively on the topic of violence prediction, served on professional committees concerned with this topic, testified before legislative bodies, and his work has been cited in several judicial opinions. Monahan worked on this monograph at Harvard Law School where he was a Fellow in Law and Psychology; at the Law School of the University of California, Los Angeles; and completed it at Stanford Law School where he was a visiting scholar. The first five chapters of the monograph include discussions of the moral and political issues raised by prediction; the basic concepts of prediction; the interaction between personality and situational factors influencing violence potential; the use of statistical concepts in prediction (including such parameters as age, sex, race, drug and alcohol abuse, and presence of mental illness); and the interaction between persons and their environment. Additionally, the third chapter provides an excellent and thorough review and discussion of the existing literature on the prediction of violent behavior. And the sixth chapter offers a series of questions-a synthesis of the material in chapters one through five-that the clinician may use to make the difficult task of violence prediction less overwhelming. 194

Comprehensive

Violence is a matter of increasing concern in our world; and, therefore, violence prediction is of growing interest to mental health professionals. Monahan makes an important contribution to the topic with this clear, concise, and highly readable monograph. It is the most comprehensive work of its nature to date, making it essential reading for mental health professionals engaged in the prediction of violent behavior. Robert M. Carvalho, M.D. New York, New York

The Patient: Biological, Psychological, and Social Dimensions of Medical Practice. Hoyle Leigh and Morton Reiser. New York, Plenum, 1980, 351 pages, $19.50. Drs. Leigh and Reiser have given us a remarkably engaging, clinically relevant book which successfully brings behavioral science data into the medical setting. Basic information derived from the behavioral sciences is presented clearly and concisely, in a fashion which facilitates its intergration with biological clinical medicine. The book is organized in four parts. The first considers psychological aspects of being a patient: help seeking and illness behavior, the sick role, and the role of the physician. The discussion of patients’ and physicians’ expectations of each other is a highly effective introduction to transference and countertransference phenomena for the nonpsychiatric clinician. The second section is an overview of the biology and psychology of anxiety, depression, pain, and sleep; a review of defense mechanisms is also presented. The third section discusses a general systems approach to patient assessment. Three dimensions are included: biological, personal, and environmental. Each is in turn assessed in three contexts: current, recent past, and background. Part four, concerned with management, discusses the doctor-patient relationship, personality types and the sick role, the hospital environment and social system, as well as biological, psychological. and social approaches to therapy. Each topic is introduced and discussed with relevant case material. The style of writing is Psychiatry,

Vol. 23, No. 2 (March/April),

1982

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BOOK REVIEWS

clear and lively; topics are covered quite comprehensively within the constraints of a brief text. One can only hope this book will reach its intended audience: medical students, housestaff, and practicing clinicians in nonpsychiatric specialities. It should be seriously considered for inclusion in behavioral science courses for

medical students (although its sophistication makes clinical clerks and housestaff a more appropriate audience). It will also be valuable to psychiatrists working in the field of consultation-liaison. Judith Bukherg.

M.D.

New York. N.Y.