- Email: [email protected]
Altering behavior—The ethics of controlled experience
362
BOOK REVIEWS
of mind that go to make up so much of the content of this book. At all events, those who have not lost their curiosity about such questions should find in Hearnshaw a sympathetic and dependable guide. Recognizing the futility of trying to detach psychology from its philosophical nexus, he devotes much space to parallel developments in the philosophy of mind. Thanks to a lack of partisanship coupled with a robust critical intelligence, he is able to do this without overwhelming the reader. As a result, what might easily have degenerated into a confusing catalogue of competing doctrines becomes, in his hands, a truly educative experience. JOHN BELOFF
C. EISER: The Psychology of Childhood Illness. Springer-Verlag,
New York
(1985). xii + 212 pages.
DM 94.00.
This book adopts a developmental cognitive approach to analyse the impact of chronic childhood illness on the patient and the family. The conceptual framework is expounded in the first part of the book in chapters on children’s knowledge about their body and illness, children’s understanding of hospitalization and medical procedures, and the effects of illness on the parents and on the siblings. Specific illnesses, including phenylketonuria, diabetes, asthma and leukaemia are used as illustrative examples in the second part and a consistent framework has been employed throughout. The book gives informative and enjoyable reading and its major strength is to have given the cognitive approach a systematic review and an honest appraisal as it is applied to the psychology of childhood illness. For completeness of inclusion, one would have liked to see a discussion on children who have suffered from burns and orthopaedic problems. The implications for management and the evaluation of management programmes based on the cognitive approach have only been briefly mentioned. More research is needed to strengthen our knowledge in these areas. Meanwhile, this book has contributed its fair share. MONA Tso~
W. STEWART AGRAS: Eating Disorders-~Managemenr (1987). f8.50 Paperback; f IS.50 Hardback.
of Obesity, Bulimia and Anorexia IVervosa. Pergamon
Press. Oxford
This is one of the Psychology Practitioner Guidebooks series which is intended to give advice on the planning and implementation of psychological treatment. Stewart Agras is an established figure in the treatment of eating disorders and essentially he describes the treatment programmes used at the Stanford Eating Disorders Clinic. The emphasis is upon practical advice and the text is liberally sprinkled with useful tables, questionnaires, diary forms, etc. There are no extensive theoretical discussions and references are kept to a minimum. This book is not to be recommended to a beginner, who might suppose that it contained the answers to important questions in the area. However, it would be useful to someone who knew the literature well but was unfamiliar with putting theory into practice. As is usual in work on eating disorders, the juxtaposition of obesity and anorexia and bulimia feels uncomfortable. There is surprisingly little common ground. Typically the section on obesity is the longest, despite the relatively poor showing of psychological treatments in effecting significant and long-term weight loss. The obesity treatment programme is directed solely towards weight reduction with little or no discussion of value of weight loss as a goal. The section on bulmia begins with a succinct summary of the treatment research and then describers a straight-forward programme to reduce binge eating and vomiting. Similarly the anorexia section is directed largely towards weight gain. None of the sections gives much advice on handling the dissatisfaction with body shape which is probably fundamental to all three disorders. The book is brief, cheap and easy to read and offers some sensible advice on managing difficult problems. However, as the author says in the epilogue, it is no substitute for a thorough knowledge of the literature and, if all goes well, it should rapidly become out of date. JANE WARDLE
H. B. CLARK: Altering Beharior-The 235 pages. f25.00.
Ethics of Controlled Experience.
Sage Publications,
Newbury
Park, California
(1987).
In this enthusiastic and compelling book, Henry Clark has set out how “experience and behavior control” (referred to as EBC) can “be used by ordinary people to make their lives better.” His thesis is that EBC is “feasible, desirable and will prove to be a significant blessing for humankind”. He refers primarily to three types of techniques to improve human experience and performance: chemical and electrical stimulation of the brain and behaviour therapy. The book contains a brief exposition of the current state and future potential of such methods, but the bulk of the work relates to the ethical questions posed by their implementation.
363
BOOKREVIEWS
Clark locates these developments in terms of a fourth revolution in our conceptions of what it means to be human, after the contributions of Copernicus, Darwin and Freud. He stresses throughout this readable account that he is concerned with the practicalities of human behaviour and the ethics of actions and their consequences-indeed he sharply attacks both the devotees of ‘besotted hedonism’ and those ‘self-indulgently’ critical of behavioural methods. He advocates that these approaches be usd as means of improving the ‘common good’. EBC can and should generate ‘good behavior’-that is, ‘behavior that is less harmful or more helpful in its consequences for those affected by it.’ Clearly a partial account, in attempting to communicate the potential of these methods of performance enhancement, and their relevance to the well rather than to the ill or disabled, the book succeeds admirably. But in arguing for the desirability of the widespread implementation of these means, Clark’s views are less convincing. The recurrent impression left by his assertions is that he consistently underestimates the potential for abuse by individuals and the perversion of these techniques for social control. At the individual level he advocates a cost-benefit analysis as each innovation becomes available, and makes it clear that he attaches ‘supreme importance to the principle of individual self-determination.’ Any constraint upon this liberty he dismisses as ‘legal paternalism’. The ideal type proposed is the self-sufficient, industrious, highly motivated individual, judiciously using chemical, behavioural and electrical means to maximise pleasure, happiness and effectiveness. In this Clark draws a view of the future that is an extension of our current realm, where we alternate between stimulation with caffeine and tobacco, and relaxation with alcohol. meditation, personal stereos and biofeedback. In this fascinating book, we are asked to subscribe to further systematic manipulation of the limits of our capacities GRAHAM
PATRICIAGILLAS: Sex T/~rupy Manual. Blackwell Scientific Publications, Paperback; f27.50 Hardback.
THORNICROFT
Oxford (1987). xviii + 344 pages. f 14.95
It is nearly twenty years since Masters and Johnson first published their work, and there are now so many new texts on sex therapy that many titles are indistinguishable. This book is a substantial work that has opted for a very detailed, almost narrative account of current therapies which enables the reader to get a proper feel for the style and presentation of these therapies. Such a down-to-earth and enormously detailed_ account makes fascinating reading, even for the most seasoned therapist. The author makes no apologies for the lack of theoretical background, but instead uses the chapters to examine both easy and difficult cases, low sexual interest problems, individual therapy, women’s sex therapy groups, men’s sex therapy groups, sex therapy in mixed groups and, particularly usefully, work with sexual offenders. Dr Gillan has travelled wideley, and her style and emphasis on cultural differences and similarities make refreshing reading in a sex manual. Nor does she avoid the implications of AIDS on sexual mores and the way this influences clinical presentations of problems. A most useful part of the book are the numerous and detailed appendices, rather like the recipes at the end of a cookery demonstration. They ‘filled out’ in full detail a range of good practice from the author; giving therapist’s and clients’ instructions, homework, stimulation therapy, a format for a contract, and an excellent reading list. I thought that this section could almost have been published separately, but the author generously acknowledges the contributions made by her colleagues who devised and prepared the homework sheets. Behavioural psychologists will be appreciative of the detailed exposition of method, but will surely miss the scientific basis upon which these methods are based. This book would serve as an adjunct to one of the more established resources, where students, especially, would like direction on what to say and do in therapy. Highly recommended for starters and those needing refreshment! PATRICU D’ARDENNE
D. GOLDBERG, S. BENJAMIN and F. CREED:Psychiarry pages.
in Medical
Practice.
Tavistock Publications, London (1987) xii + 322
The philosophy of this compact description of psychiatric assessment and treatment is that medical students are fdled with trepidation at the prospect of their first encounter with a mentally ill patient. For those, perhaps the majority of students, for whom this is the case, this book is an excellent treatment manual for overcoming the fear and mistrust of both psychiatric patients and psychiatry which has been endemic in our society since hallucinating schizophrenics were burnt at the stake. The book is logically arranged in four sections. After a helpful introduction, there is a long section on the principles of clinical assessment, investigation and treatment including the psychiatric formulation, a ritual which is peculiar to psychiatry but which could usefully be applied to other medical specialities. A mention of systems theory and its clinical counterpart in family therapy would make this generally useful section a little more up to date. In the second part each major psychiatric syndrome is briefly described beginning with the psychiatric aspects of physical disorder, then covering organic brain syndromes, “functional” psychiatric illness and a group of “maladaptive behaviours”-a term of questionable validity-including addictions, eating disorders and obsessional states. Use of this and other poorly defined terms such as the now outdated American term “bulimia” for bulimia nervosa, detract from the book’s overall quality while on the other hand depressive disorders are sensibly classified into depressive illness and depressive psychosis. Unfortunately this recently published book shows its true age by the absence of a discussion of psychiatric aspects of the Acquired Immune Deficiency Syndrome. The third section encompasses mental retardation (disposed of in five pages, but even in a brief text deserving at least double in view of the likely effect of community care on the exposure of GPs to the problem of the mentally
BOOK REVIEWS
of mind that go to make up so much of the content of this book. At all events, those who have not lost their curiosity about such questions should find in Hearnshaw a sympathetic and dependable guide. Recognizing the futility of trying to detach psychology from its philosophical nexus, he devotes much space to parallel developments in the philosophy of mind. Thanks to a lack of partisanship coupled with a robust critical intelligence, he is able to do this without overwhelming the reader. As a result, what might easily have degenerated into a confusing catalogue of competing doctrines becomes, in his hands, a truly educative experience. JOHN BELOFF
C. EISER: The Psychology of Childhood Illness. Springer-Verlag,
New York
(1985). xii + 212 pages.
DM 94.00.
This book adopts a developmental cognitive approach to analyse the impact of chronic childhood illness on the patient and the family. The conceptual framework is expounded in the first part of the book in chapters on children’s knowledge about their body and illness, children’s understanding of hospitalization and medical procedures, and the effects of illness on the parents and on the siblings. Specific illnesses, including phenylketonuria, diabetes, asthma and leukaemia are used as illustrative examples in the second part and a consistent framework has been employed throughout. The book gives informative and enjoyable reading and its major strength is to have given the cognitive approach a systematic review and an honest appraisal as it is applied to the psychology of childhood illness. For completeness of inclusion, one would have liked to see a discussion on children who have suffered from burns and orthopaedic problems. The implications for management and the evaluation of management programmes based on the cognitive approach have only been briefly mentioned. More research is needed to strengthen our knowledge in these areas. Meanwhile, this book has contributed its fair share. MONA Tso~
W. STEWART AGRAS: Eating Disorders-~Managemenr (1987). f8.50 Paperback; f IS.50 Hardback.
of Obesity, Bulimia and Anorexia IVervosa. Pergamon
Press. Oxford
This is one of the Psychology Practitioner Guidebooks series which is intended to give advice on the planning and implementation of psychological treatment. Stewart Agras is an established figure in the treatment of eating disorders and essentially he describes the treatment programmes used at the Stanford Eating Disorders Clinic. The emphasis is upon practical advice and the text is liberally sprinkled with useful tables, questionnaires, diary forms, etc. There are no extensive theoretical discussions and references are kept to a minimum. This book is not to be recommended to a beginner, who might suppose that it contained the answers to important questions in the area. However, it would be useful to someone who knew the literature well but was unfamiliar with putting theory into practice. As is usual in work on eating disorders, the juxtaposition of obesity and anorexia and bulimia feels uncomfortable. There is surprisingly little common ground. Typically the section on obesity is the longest, despite the relatively poor showing of psychological treatments in effecting significant and long-term weight loss. The obesity treatment programme is directed solely towards weight reduction with little or no discussion of value of weight loss as a goal. The section on bulmia begins with a succinct summary of the treatment research and then describers a straight-forward programme to reduce binge eating and vomiting. Similarly the anorexia section is directed largely towards weight gain. None of the sections gives much advice on handling the dissatisfaction with body shape which is probably fundamental to all three disorders. The book is brief, cheap and easy to read and offers some sensible advice on managing difficult problems. However, as the author says in the epilogue, it is no substitute for a thorough knowledge of the literature and, if all goes well, it should rapidly become out of date. JANE WARDLE
H. B. CLARK: Altering Beharior-The 235 pages. f25.00.
Ethics of Controlled Experience.
Sage Publications,
Newbury
Park, California
(1987).
In this enthusiastic and compelling book, Henry Clark has set out how “experience and behavior control” (referred to as EBC) can “be used by ordinary people to make their lives better.” His thesis is that EBC is “feasible, desirable and will prove to be a significant blessing for humankind”. He refers primarily to three types of techniques to improve human experience and performance: chemical and electrical stimulation of the brain and behaviour therapy. The book contains a brief exposition of the current state and future potential of such methods, but the bulk of the work relates to the ethical questions posed by their implementation.
363
BOOKREVIEWS
Clark locates these developments in terms of a fourth revolution in our conceptions of what it means to be human, after the contributions of Copernicus, Darwin and Freud. He stresses throughout this readable account that he is concerned with the practicalities of human behaviour and the ethics of actions and their consequences-indeed he sharply attacks both the devotees of ‘besotted hedonism’ and those ‘self-indulgently’ critical of behavioural methods. He advocates that these approaches be usd as means of improving the ‘common good’. EBC can and should generate ‘good behavior’-that is, ‘behavior that is less harmful or more helpful in its consequences for those affected by it.’ Clearly a partial account, in attempting to communicate the potential of these methods of performance enhancement, and their relevance to the well rather than to the ill or disabled, the book succeeds admirably. But in arguing for the desirability of the widespread implementation of these means, Clark’s views are less convincing. The recurrent impression left by his assertions is that he consistently underestimates the potential for abuse by individuals and the perversion of these techniques for social control. At the individual level he advocates a cost-benefit analysis as each innovation becomes available, and makes it clear that he attaches ‘supreme importance to the principle of individual self-determination.’ Any constraint upon this liberty he dismisses as ‘legal paternalism’. The ideal type proposed is the self-sufficient, industrious, highly motivated individual, judiciously using chemical, behavioural and electrical means to maximise pleasure, happiness and effectiveness. In this Clark draws a view of the future that is an extension of our current realm, where we alternate between stimulation with caffeine and tobacco, and relaxation with alcohol. meditation, personal stereos and biofeedback. In this fascinating book, we are asked to subscribe to further systematic manipulation of the limits of our capacities GRAHAM
PATRICIAGILLAS: Sex T/~rupy Manual. Blackwell Scientific Publications, Paperback; f27.50 Hardback.
THORNICROFT
Oxford (1987). xviii + 344 pages. f 14.95
It is nearly twenty years since Masters and Johnson first published their work, and there are now so many new texts on sex therapy that many titles are indistinguishable. This book is a substantial work that has opted for a very detailed, almost narrative account of current therapies which enables the reader to get a proper feel for the style and presentation of these therapies. Such a down-to-earth and enormously detailed_ account makes fascinating reading, even for the most seasoned therapist. The author makes no apologies for the lack of theoretical background, but instead uses the chapters to examine both easy and difficult cases, low sexual interest problems, individual therapy, women’s sex therapy groups, men’s sex therapy groups, sex therapy in mixed groups and, particularly usefully, work with sexual offenders. Dr Gillan has travelled wideley, and her style and emphasis on cultural differences and similarities make refreshing reading in a sex manual. Nor does she avoid the implications of AIDS on sexual mores and the way this influences clinical presentations of problems. A most useful part of the book are the numerous and detailed appendices, rather like the recipes at the end of a cookery demonstration. They ‘filled out’ in full detail a range of good practice from the author; giving therapist’s and clients’ instructions, homework, stimulation therapy, a format for a contract, and an excellent reading list. I thought that this section could almost have been published separately, but the author generously acknowledges the contributions made by her colleagues who devised and prepared the homework sheets. Behavioural psychologists will be appreciative of the detailed exposition of method, but will surely miss the scientific basis upon which these methods are based. This book would serve as an adjunct to one of the more established resources, where students, especially, would like direction on what to say and do in therapy. Highly recommended for starters and those needing refreshment! PATRICU D’ARDENNE
D. GOLDBERG, S. BENJAMIN and F. CREED:Psychiarry pages.
in Medical
Practice.
Tavistock Publications, London (1987) xii + 322
The philosophy of this compact description of psychiatric assessment and treatment is that medical students are fdled with trepidation at the prospect of their first encounter with a mentally ill patient. For those, perhaps the majority of students, for whom this is the case, this book is an excellent treatment manual for overcoming the fear and mistrust of both psychiatric patients and psychiatry which has been endemic in our society since hallucinating schizophrenics were burnt at the stake. The book is logically arranged in four sections. After a helpful introduction, there is a long section on the principles of clinical assessment, investigation and treatment including the psychiatric formulation, a ritual which is peculiar to psychiatry but which could usefully be applied to other medical specialities. A mention of systems theory and its clinical counterpart in family therapy would make this generally useful section a little more up to date. In the second part each major psychiatric syndrome is briefly described beginning with the psychiatric aspects of physical disorder, then covering organic brain syndromes, “functional” psychiatric illness and a group of “maladaptive behaviours”-a term of questionable validity-including addictions, eating disorders and obsessional states. Use of this and other poorly defined terms such as the now outdated American term “bulimia” for bulimia nervosa, detract from the book’s overall quality while on the other hand depressive disorders are sensibly classified into depressive illness and depressive psychosis. Unfortunately this recently published book shows its true age by the absence of a discussion of psychiatric aspects of the Acquired Immune Deficiency Syndrome. The third section encompasses mental retardation (disposed of in five pages, but even in a brief text deserving at least double in view of the likely effect of community care on the exposure of GPs to the problem of the mentally