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Agoraphobia: Multiple perspectives on theory and treatment
BOOK REVIEWS
591
This text is notable for the sensible, practical approach it describes-an approach which is illuminated by an understanding of current research findings. Examples of assessment procedures are both described and critically evaluated. The chapter on medication is detailed and informative. The chapters on behaviour therapy are less satisfactory. On the one hand, they are too basic; on the other, the excellent detailed description of parent-training workshops while full of clinical experience remains short on objective evaluation of behavioural interventions. Hopefully, this can be remedied in a second edition by the addition of a critical review of this expanding area. WILLIAM YULE
F. BILLER and E. FRANK: Sexual Dysfunction in Neurological Disorders. Raven Press, New York (1982). xiii + 95 pp. $15.64. $15.64. The physical factors contributing to sexual dysfunctions are manifold and stem from a number of different areas of specialization. Thus impotence may be related to many neurological disorders, including multiple sclerosis, spinal lesions, diabetic neuropathy and alcoholic neuropathy. But many other factors, such as drug taking, general ill-health, specific psychiatric disorders and local pelvic conditions (in both males and females) can also contribute to dysfunctions. The present volume restricts itself largely to neurological disorders, but there are introductory chapters on anatomy and physiology and ‘approach to the patient’. As might be expected, the authors devote more attention to eliciting cremasteric reflexes and assessing bladder function than in talking about marital relationships or sexual anxieties. However, on the neurological side the book provides some very useful information, partly based on a thorough review of the literature and partly based on clinical experience. In the section on physiology the authors are more-or-less up to date, but the doubts raised by recent research about the role of acetyl choline in erection are not covered. The section on drugs is somewhat patchy and relies heavily on published material. This is a book that all neurologists should read. It will be of less use to those working with sexual dysfunction, except as an occasional source of information on patients with pre-existing neurological conditions. M. J. CROWE
D. L. CHAMBLESSand A. J. GOLDSTEIN(Eds): Agoraphobia: Multiple Perspectives on Theory and Treatment. Wiley, New York (1982). xii + 227 pp. E21.00. In this book on agoraphobia, three of the chapters are written by the editors and five by other authors. The contributors have been chosen to represent a wide range of views from the psychodynamic through the behavioural to the organic. Most of the chapters are concerned with both theoretical and therapeutic issues but their style differs considerably. Some offer good critical reviews, e.g. personality characteristics (Chambless), in-viuo exposure (Emmeikamp) and psychophysiology (Klein), while others are descriptive or frankly speculative. Some authors clarify and expand on views expressed in earlier publications, e.g. Hafner on patterns of marital interaction and Goldstein on interpersonal and intrapsychic factors typical of agoraphobic. None of the authors seriously questions the concept of agoraphobia itself although some advocate subclassification. They appear to be seeking a ‘core problem’ or ‘core pathology’ such as ‘a fear of loss of control’ (Saltzman), ‘endogenous panic’ (Klein) or ‘sensitivity to separation/aloneness’ (Goldstein). However, as Chambless shows in her chapter, the research findings on the characteristics of agoraphobics are contradictory. Agoraphobia is fairly easy to define operationally but this does not mean that samples from different parts of the world and from clinics with different screening and referral practices will be homogeneous in other respects. It seems unsafe to infer psychological processes from the characteristics of research samples given a psychiatric diagnosis. Despite this weakness, the book offers many interesting speculations which should entice the reader to become more involved with the theoretical complexities of the subject. R. S. HALLAM
P. E. GARFINKELand D. M. GARNER: Anorexia Nervosa: A Multidimensional Perspective. Brunner/Mazel, xiv + 379 pp. $30.00. The authors of this book are based in Toronto, Canada, and have made a series of notable contributions on anorexia nervosa. The quality of their research and its presentation have been of a high standard, between empirical findings and speculation on their significance carefully considered.
New York (1982).
to the literature and the balance
591
This text is notable for the sensible, practical approach it describes-an approach which is illuminated by an understanding of current research findings. Examples of assessment procedures are both described and critically evaluated. The chapter on medication is detailed and informative. The chapters on behaviour therapy are less satisfactory. On the one hand, they are too basic; on the other, the excellent detailed description of parent-training workshops while full of clinical experience remains short on objective evaluation of behavioural interventions. Hopefully, this can be remedied in a second edition by the addition of a critical review of this expanding area. WILLIAM YULE
F. BILLER and E. FRANK: Sexual Dysfunction in Neurological Disorders. Raven Press, New York (1982). xiii + 95 pp. $15.64. $15.64. The physical factors contributing to sexual dysfunctions are manifold and stem from a number of different areas of specialization. Thus impotence may be related to many neurological disorders, including multiple sclerosis, spinal lesions, diabetic neuropathy and alcoholic neuropathy. But many other factors, such as drug taking, general ill-health, specific psychiatric disorders and local pelvic conditions (in both males and females) can also contribute to dysfunctions. The present volume restricts itself largely to neurological disorders, but there are introductory chapters on anatomy and physiology and ‘approach to the patient’. As might be expected, the authors devote more attention to eliciting cremasteric reflexes and assessing bladder function than in talking about marital relationships or sexual anxieties. However, on the neurological side the book provides some very useful information, partly based on a thorough review of the literature and partly based on clinical experience. In the section on physiology the authors are more-or-less up to date, but the doubts raised by recent research about the role of acetyl choline in erection are not covered. The section on drugs is somewhat patchy and relies heavily on published material. This is a book that all neurologists should read. It will be of less use to those working with sexual dysfunction, except as an occasional source of information on patients with pre-existing neurological conditions. M. J. CROWE
D. L. CHAMBLESSand A. J. GOLDSTEIN(Eds): Agoraphobia: Multiple Perspectives on Theory and Treatment. Wiley, New York (1982). xii + 227 pp. E21.00. In this book on agoraphobia, three of the chapters are written by the editors and five by other authors. The contributors have been chosen to represent a wide range of views from the psychodynamic through the behavioural to the organic. Most of the chapters are concerned with both theoretical and therapeutic issues but their style differs considerably. Some offer good critical reviews, e.g. personality characteristics (Chambless), in-viuo exposure (Emmeikamp) and psychophysiology (Klein), while others are descriptive or frankly speculative. Some authors clarify and expand on views expressed in earlier publications, e.g. Hafner on patterns of marital interaction and Goldstein on interpersonal and intrapsychic factors typical of agoraphobic. None of the authors seriously questions the concept of agoraphobia itself although some advocate subclassification. They appear to be seeking a ‘core problem’ or ‘core pathology’ such as ‘a fear of loss of control’ (Saltzman), ‘endogenous panic’ (Klein) or ‘sensitivity to separation/aloneness’ (Goldstein). However, as Chambless shows in her chapter, the research findings on the characteristics of agoraphobics are contradictory. Agoraphobia is fairly easy to define operationally but this does not mean that samples from different parts of the world and from clinics with different screening and referral practices will be homogeneous in other respects. It seems unsafe to infer psychological processes from the characteristics of research samples given a psychiatric diagnosis. Despite this weakness, the book offers many interesting speculations which should entice the reader to become more involved with the theoretical complexities of the subject. R. S. HALLAM
P. E. GARFINKELand D. M. GARNER: Anorexia Nervosa: A Multidimensional Perspective. Brunner/Mazel, xiv + 379 pp. $30.00. The authors of this book are based in Toronto, Canada, and have made a series of notable contributions on anorexia nervosa. The quality of their research and its presentation have been of a high standard, between empirical findings and speculation on their significance carefully considered.
New York (1982).
to the literature and the balance