Essentials of postgraduate psychiatry

Brhw.

Rc,\. & rkurap~.

Vol. t9. pp. 97 to 100

Pcrgamon PrcsrLtd 1981.Prinled in GreatBriwn

BOOK

REVIEWS

WILLIAMG. FANN. ISMETKARACAN, ALEX D. POKORNYand RUBERTL. WILLIAMS(Editors): Fh~~~ome~o~o~yund Trearmenr of Anxiery. Spectrum, New York (1979). ix + 406 pp. f21.00. If a camel is a horse designed by a committee it is to be expected that the publication of the scientific symposium is a similar truncated travesty of literature. Many volumes that represent the papers given at such symposia are simply not worth publishing. Occasionally there are exceptions, and one is when the subject of the symposium is a wide-ranging one which develops hybrid vigour from the meeting of multidisciplinary minds. The contributors to this book on anxiety had the opportunity to make such a success of their writings but do not quite achieve it. To extend the mammalian metaphor they produce something like the original drawings of the camleopard but it is not quite a giraffe. There are good chapters on the concepts and assessment of anxiety by Mefferd and Zung, on animaf models by McKinney and Moran. on analytical approaches by Gilliland and Bruch, and on pharmacological and physiolo~~l aspects by Fink. Redmond, Rickels, Greenbatt and Shader. but behavioural approaches to anxiety receive scant attention, only a single chapter on the subject written by Professor Woipe. What is lacking is any semblance of a common thread or even a common language for describing anxiety. The editors comment with some pride that each author “has found it necessary to rearticulate a definition of anxiety in the context of the work presented”. illustrating “the remarkable breadth and inexhaustible interest of the subject”. But when anxiety is variously described as “a paralysing state of emotional anguish”, “a normal state”. “a defence mechanism “, “a reaction of the ego to danger”, and “an unpleasurable affect” it is difficult lo reconcile the views expressed by different authors. The book is a fair reflection of the general muddled state 01 research into anxiety and is worth reading. but it should be regarded as a documentary rather than a guide. PETERTYRER

HAMILTON and D. M. WARBURTON (Editors): Humor? Stress und Coyrtitiorr: An In/brmurio~~ Procewirtg Approach. John Wiley. Chichester (1979). 502 pp. f19.50.

V.

This is an interesting and possibly im~rtant book. written by a number of authors all of whom are experts in their respective fields. it has four major parts. dealing with basic mechanisms and processes. coping processes and life event changes. cognition and stress in the working environment, and stress vulnerability in psychopathology. The bringing together of information processing approaches and research on stress is a relatively novel undertaking. and the book will certainly be or value to anyone seriously interested tn these areas. While the individual chapters are usually excellent summaries of work done in the respective areas. the overall integration is perhaps less successful; there seem to be large numbers of interesting ideas floating about, but without being formally integrated in any convincing manner. Perhaps it is too early to attempt anything of the kind. Sometimes contributors are a little uncritical in their acceptance of data and theories which are at best of doubtful value. but nevertheless on the whole the book will be of interest to students and behaviour therapists who have leaning towards the integration of cognitive processes with their treatment methods. H. J.

P. HILL. R. MURRAY and A. THORLEY(Editors): Essentials ofPostgraduate and Grune & Stratton. New York (1979). xviii + 802 pp. f21.50.

EYSENC-K

Psychiatry. Academic Press. London.

The authors of this interesting new book were, at the time of writing, ali members of the staff of the Institute of Psychiatry or the Bethlem Royal and Maudsiey Hospitals. As such it is-rather surprisingly-the firs&textbook of general psychiatry to have originated in that institution. It is also a little unexpected that it is written. not by the establishment. but by members of the staff who were all near the beginning of their academic careers when they, began the venture. And venture it was. for the reader is bound to have high expectations of a work which ortgmates in such a distinguished academic centre. It is good to see. therefore, that for the most part. the book lives up to these expectations. Of course, with 22 contributors it is inevitable that there should be some unevenness of quality. but there are enough good things to make the enterprise well worthwhile. The book is addressed primarily to the postgraduate psychiatrist who is assumed to be familiar with the basic facts of psychiatry and to know how to examine a patient. The subject matter is divided into four parts: general principles such as phenomenology and the concept of disease; clinical disorders from child psychiatry to dementia: psychiatry in special settings. for example, general practice and prisons; and principles of treatment. The best sections are generally those which deal with subjects for which the Maudsley has an established reputation: phenomenology. the pyschoses. child psychiatry. subnormality and physical treatment. On the other hand. readers of this journal might perhaps be expected to turn first to chapters such as those on 91

98

BOOK REVIEWS

neurosis. sexual disorders. behaviour therapy and psychotherapy. If they do, they are likely to be rather less impressed for these topics are handled with somewhat less authority and originality. Despite this. there is plenty here to interest any practising psychiatrist or clinical psychologist and the book can be recommended both for libraries and for a personal bookshelf. M,G.GELDER

H. S. KAPLAN: Techniques

The New it1 Sex Therapy.

Srx

Thrapy. Vol. II:

Brunner/Mazel.

Disorders

oJ Sexual

Desire

and

Other

:Vrw

Comxpts

and

New York (IY79). xx + 237 pp. 8 17.50.

Not so many years ago a woman who manifested sexual inclinations much like those of the average man would be deemed pathological by psychiatrists and diagnosed as a ‘nymphomaniac’. Today, a woman who manifests sexual inclinations much like those of the average woman runs the distinct risk of being diagnosed by sex therapists as suffering from ‘inhibited sexual desire’ (ED). Society. it seems, is never entirely comfortable with the range of libidos displayed by women. In Victorian days they were all expected to behave like ladies: today they are all expected to behave like men. Of course, if there is a major discrepancy between partners in level of sexual desire then a problem undoubtedly exists, but the application of labels that smack of individual-centred medical diagnosis seems to me value-laden and potentially counterproductive. The main theme of this new book by Helen Kaplan concerns the need to distinguish three phases of the sexual cycle for purposes of diagnosis and treatment of sexual disorders. These are: (I) desire, (2) excitement. and (3) orgasm. Since her previous book, The New Sex Therapy. dealt mainly with the latter two phases, the current volume focusses on the desire phase. which she argues is the most complex in etioiogy and the most difficult to treat. There is no doubt this is true for whereas sexual performance itself can be improved by correction of faulty habits, the equalization or increasing of desire usually involves either changing the basic nature of one or both individuals or dealing with a relationship that has begun to break down. Kaplan is by no means unaware of the magnitude of this task, though I could not help feeling that she was working within a slightly unrealistic framework imposed by certain unwarrantable assumptions. One is the strange concept that men and women are virtually identical animals: another is the fairy-tale idea that they are constructed as ideal complementaries who, in the absence of psychological pathology on either side, may be expected to live together in eternal monogamous bliss. Unfortunately. neither position can be sustained in the light of the hard, cold facts of nature (see Symons’ book, The Enoluriort of Hurnari Sexuality). Males and females have evolved partly incompatible instincts as a result of historical conflicts and it is futile to ignore this fact. It is interesting that Kaplan (a woman) regards security and intimacy as vital to good sex (p. 183) while Stoller (a man) is equally certain that risk and anger are essential to sexual incitement. Sometimes the writing is lucid: at other times it seems to have been produced if not by the apocryphal monkey randomly hitting typewriter keys. at least by a computer programmed to emit psychoanalytic jargon. For example. what is one to make of this sentence? (p. 89). “Desire and love problems at length and analytic formulations regarding the etiology of fails to internalize and integrate appropriate introjects.” The mysterious words ‘sig’ and ‘patint’ occur every so often; the former is apparently a neologism meaning treatment tasks. while the latter seems to be a patent spelling of patient. There is also a grandiose and omniscient air about the book that is bound to irritate academic psychologists. There is no empirical documentation of any kind. and closely related work such as that of Britain’s own Dr. Patricia Gillan is totally Ignored. Despite these reservations. this is a book that practicing sex therapists will feel obliged to read. though it is to be hoped they will do so critically. The case studies and detailed descriptions of treatment programmes will be a useful source of therapeutic ideas. and the appendix outlining the effects of various drugs and illnesses on the three phases of sexual performance will certainly prove useful. GLENX WILSON

,-I ~r~ram~or Families of New York (1979). xiii + 445 pp. f14.00.

M. A. KOZLOFF:

Children

with Learning

and

3eha~i~ur

frobie~s.

Wiley-rnters~ence.

This is an impressive book. comprehensive. sensible and well written. It offers a wealth of ideas and suggestions for professionals working with families of children with learning and behaviour problems. It is not, as the title might suggest, aimed primarily at the families themselves and parents reading it on their own might become daunted by the apparent immensity of the task in hand. The author describes how to organise and run a programme from the earliest stages through to follow up and maintenance: from how to make initial contact with parents and decide if they are ready to engage in a programme through to how to cope with the many problems that might arise. Although intended for those working with groups of parents the book will also be useful for those working with individuai families. It is written as a companion volume to Kozloffs 1974 book Educuring C~~~~~r~~i w~r~z~ear~~j/i~attd ~e~ra~iua~ frob~e~~ which would be useful extra reading butnot absolutely essential for those experienced in the field of mental handicap and child development. Kozloffs descriptions of the complaints. doubts and pesstmisms made by parents about behavioural approaches are perceptive and even amusing. He provides useful suggestions on how to answer these parents and what to do when things are going wrong. His portrayal of the everyday problems faced by professionals