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Forensic pharmacology: Medicines, mayem & malpractice
152 Journal of Clinical Forensic Medicine
A Practical Guide to Forensic Psychotherapy E.V. Welldon, C. Van Velson (eds), 1997. Jessica Kingsley: London. 304 pp. £18.95 I S B N 1 85302 389 2
Challenges in Forensic Psychotherapy H. van Marle (ed.), 1997. Jessica Kingsley: L o n d o n . 146 pp. £18.95. I S B N 1 85302 419 8 Trainee psychiatrists are taught 'YAVIS' as the mnemonic for the ideal psychotherapy patient Young, Attractive, Verbal, Intelligent, Successful. A Practical Guide to Forensic Psychotherapy is a book about psychotherapy with patients as old as 54 (although no upper age limit is implied), who are not only unattractive but even within psychiatry downright unpopular, some who are barely able to speak, some who are of abnormally low intelligence and many who are life's tragic failures. It is a book which describes psychotherapy which is mainly quite different to that practised in conventional National Health Service (NHS) psychotherapy services. It has to be. Forensic psychotherapists deliver services to people with serious alcohol and drug problems, the learning disabled, people who act out their psychopathology, sometimes in acts of extreme violence or in disturbingly deviant sexual behaviour, and people who may be very irregular in attending appointments. Forensic psychotherapy services also cater for many patients who lack motivation, at least initially, for psychotherapy or are even unwilling participants in psychotherapeutic activities by virtue of being detained patients. I hoped that this book would enable me to provide psychotherapy for my arsonists, rapists, burglars, fraudsters, exhibitionists and alcoholic offenders. These are just some of the categories of forensic psychotherapy patient each given a chapter. Some chapters do contain excellent and illuminating accounts of forensic psychotherapy but some are disappointingly limited to describing the psychopathology rather than psychotherapy. Nevertheless, I learnt a lot about issues which arise in forensic psychotherapy and make it different in application to psychotherapy for non-offenders. However, at the end of the book I was left with a feeling of envy. The advancement of forensic psychotherapy does require ordinary forensic psychiatrists to acquire or perfect the sort of techniques described in this book and ordinary NHS psychotherapists need to be encouraged to work with some of these patients who would conventionally be regarded as unsuitable for psychotherapy. But my lasting feeling is one of envy for my colleagues who have working in their teams dedicated, enthusiastic and often pioneering therapists whose chapters form the central part of this book.
Challenges in Forensic Psychotherapy, with its descriptions of psychotherapy in the Dutch penal system, where prisoners have had to choose between 'punishment or coercive measure' and where those choosing the latter 'will in the first place surely not be motivated ... to participate in a certain treatment' provides even more stark contrasts to psychotherapy as it is conventionally practised in the NHS. This book is based on a conference of forensic psychotherapists held in The Hague in 1994. Although proposed new legislation for England and Wales, which will enable prison and hospital to be combined for mentally-disordered offenders ('hybrid order'), may seem to have a superficial resemblance to the Dutch model, it is important to realize that the 'hybrid order' will make the two components consecutive and not integrate them as the Dutch system does. Inevitably this is a patchy book. Eastman's chapter on 'Psychopathic Disorder and Therapeutic Jurisprudence' is well reasoned and certainly worth reading. West's chapter on 'Treating Psychopaths in England' is disappointing from one of the founding fathers of academic forensic psychiatry although probably the oral paper served its purpose at the conference. Cordess, on the responsibilities of forensic psychotherapists is very brief but perhaps his oral presentation was short. This is a book for forensic psychiatry libraries and probably not for individual purchase. KEITH RIX Visiting Consultant Psychiatrist H M Prison, Leeds, U K
Forensic Pharmacology: Medicines, Mayem & Malpractice R.E. Ferner. 1996. Oxford University Press: Oxford. ISBN 019 854826 5. This is a real 'Curate's egg' of a book. The good parts are wonderfully illuminating whilst other areas are immensely tedious. Robin Ferner has attempted to organize the text of his book into three sections. The first provides a general overview of drugs, their pharmacodynamics and pharmacokinetics. Whilst possibly aimed at the clinical pharmacologists and biochemists these chapters do serve as a useful (if perhaps over technical) refresher for the clinical physician. The excellent chapter on the Law by Elizabeth Norman, Barrister at Law, is clear and concise, but perhaps should have benefited by being juxtaposed with the chapter on negligence and medicines which appears somewhat out of place later in the book.
Book reviews The second section describes the effects of drugs on the behaviour of the perpetrators and victims of crime and it provides some interesting background material to contemplate. The final section on drugs of forensic importance, was for me the most disappointing, perhaps because I was expecting so much from it. It appears to contain very little new material and makes only fleeting reference, if any, to the street drugs that we commonly encounter in every day clinical forensic medical practice. In general, the text flowed reasonably and I personally found the insertion of referenced cases and practical examples helpful, although I appreciate that they can irritate other readers. In essence, l do not feel that this is a book that is going to help the candidate preparing for the DMJ. Dr Ferner states that one of his aims was to make forensic pharmacology sufficiently technical so that an expert would find it useful without being so obscure as to be inaccessible to others. Unfortunately, in doing so I feel he has tried to make his book 'all things to all men' and any book that feels it has to describe in detail the phlebotomy procedure, but later goes on to provide an explanation and description of the Watson formula and Widemark calculation has probably set its sights too widely. P E T E R J. H E W I T T The Surgery, Weymouth, U K
Forensic Analysis of the Skull
153
used, many of which, as will become obvious to the reader, are very much in the developmental stage as well as other methods, which are more established. Areas covered include facial morphology and photographic comparison, cranial analysis, skull-photo superimposition and facial reconstruction. From a professional user's point of view, it is an excellent and indeed, essential work of reference. However, some areas could have been improved upon. Some of the chapters contain unnecessary repetition and this could have been addressed with more stringent editing. In addition, there are some important sections which should have been covered in more depth and the editors, I am sure, will have this in mind for the next edition. For example there is a chapter on the use of CT scanning for skull identification which does not go far enough to show how the face can be reconstituted on the skull using computer technology. The section on photo-comparison suffers from the fact that it is a fast developing area, and although the author has made a valiant attempt to cover all the main aspects, the information contained is by now, a little dated. I would also have liked to have seen an indepth discussion on the evidential value of the different types of identification. All these minor criticisms aside, the book makes thoroughly interesting reading and is a good source of reference. It is invaluable for anyone involved in cranio-facial identification. PETER VANEZIS University of Glasgow, Glasgow, UK
M e h m e t Yasar Iscan and Richard R Helmer (eds), 1993. Wiley-Liss: New York. 258 pp Establishing the identity of an individual is an essential part of any forensic investigation involving a living or dead person. It may be the principal goal of the investigation, as for example in the identification of individuals in a mass disaster, in disputed paternity cases or in identifying whether a particular person committed a crime. On the other hand, identification may be an essential part of the process of the overall investigation, for example in establishing the identity of a murder victim. When skeletal remains are discovered, assessment of the skull is a crucial part of the identification process. 'Forensic analysis of the skull', edited by Iscan and Helmer, both of whom are internationally renown for their work in this field, presents the reader with all the various aspects of how this can be achieved. It is a fascinating and challenging book in many respects, and takes us through the latest techniques
Psychological Trauma: A Developmental Approach. D. Black, M. Newman, J. Harris-Hendriks and G. Mezey (eds), 1997. Gaskell: L o n d o n . 412 pp. £30. ISBN 0 902241 98 2 The purpose of this edited book was to provide a comprehensive overview of trauma for practitioners. The book focused on mass trauma (e.g., shipping disasters, local accidents affecting large numbers of people, torture etc.) more than domestic violence and child abuse. The contributing authors represent diverse backgrounds including psychiatry, psychology, social work, law and police services. The book was divided into four parts, with part one dealing with normal and abnormal responses to stress. Issues discussed included a historical review of trauma, child development issues such as the reaction to threat and separation, classification of posttraumatic stress disorder (PTSD), grief reactions,
A Practical Guide to Forensic Psychotherapy E.V. Welldon, C. Van Velson (eds), 1997. Jessica Kingsley: London. 304 pp. £18.95 I S B N 1 85302 389 2
Challenges in Forensic Psychotherapy H. van Marle (ed.), 1997. Jessica Kingsley: L o n d o n . 146 pp. £18.95. I S B N 1 85302 419 8 Trainee psychiatrists are taught 'YAVIS' as the mnemonic for the ideal psychotherapy patient Young, Attractive, Verbal, Intelligent, Successful. A Practical Guide to Forensic Psychotherapy is a book about psychotherapy with patients as old as 54 (although no upper age limit is implied), who are not only unattractive but even within psychiatry downright unpopular, some who are barely able to speak, some who are of abnormally low intelligence and many who are life's tragic failures. It is a book which describes psychotherapy which is mainly quite different to that practised in conventional National Health Service (NHS) psychotherapy services. It has to be. Forensic psychotherapists deliver services to people with serious alcohol and drug problems, the learning disabled, people who act out their psychopathology, sometimes in acts of extreme violence or in disturbingly deviant sexual behaviour, and people who may be very irregular in attending appointments. Forensic psychotherapy services also cater for many patients who lack motivation, at least initially, for psychotherapy or are even unwilling participants in psychotherapeutic activities by virtue of being detained patients. I hoped that this book would enable me to provide psychotherapy for my arsonists, rapists, burglars, fraudsters, exhibitionists and alcoholic offenders. These are just some of the categories of forensic psychotherapy patient each given a chapter. Some chapters do contain excellent and illuminating accounts of forensic psychotherapy but some are disappointingly limited to describing the psychopathology rather than psychotherapy. Nevertheless, I learnt a lot about issues which arise in forensic psychotherapy and make it different in application to psychotherapy for non-offenders. However, at the end of the book I was left with a feeling of envy. The advancement of forensic psychotherapy does require ordinary forensic psychiatrists to acquire or perfect the sort of techniques described in this book and ordinary NHS psychotherapists need to be encouraged to work with some of these patients who would conventionally be regarded as unsuitable for psychotherapy. But my lasting feeling is one of envy for my colleagues who have working in their teams dedicated, enthusiastic and often pioneering therapists whose chapters form the central part of this book.
Challenges in Forensic Psychotherapy, with its descriptions of psychotherapy in the Dutch penal system, where prisoners have had to choose between 'punishment or coercive measure' and where those choosing the latter 'will in the first place surely not be motivated ... to participate in a certain treatment' provides even more stark contrasts to psychotherapy as it is conventionally practised in the NHS. This book is based on a conference of forensic psychotherapists held in The Hague in 1994. Although proposed new legislation for England and Wales, which will enable prison and hospital to be combined for mentally-disordered offenders ('hybrid order'), may seem to have a superficial resemblance to the Dutch model, it is important to realize that the 'hybrid order' will make the two components consecutive and not integrate them as the Dutch system does. Inevitably this is a patchy book. Eastman's chapter on 'Psychopathic Disorder and Therapeutic Jurisprudence' is well reasoned and certainly worth reading. West's chapter on 'Treating Psychopaths in England' is disappointing from one of the founding fathers of academic forensic psychiatry although probably the oral paper served its purpose at the conference. Cordess, on the responsibilities of forensic psychotherapists is very brief but perhaps his oral presentation was short. This is a book for forensic psychiatry libraries and probably not for individual purchase. KEITH RIX Visiting Consultant Psychiatrist H M Prison, Leeds, U K
Forensic Pharmacology: Medicines, Mayem & Malpractice R.E. Ferner. 1996. Oxford University Press: Oxford. ISBN 019 854826 5. This is a real 'Curate's egg' of a book. The good parts are wonderfully illuminating whilst other areas are immensely tedious. Robin Ferner has attempted to organize the text of his book into three sections. The first provides a general overview of drugs, their pharmacodynamics and pharmacokinetics. Whilst possibly aimed at the clinical pharmacologists and biochemists these chapters do serve as a useful (if perhaps over technical) refresher for the clinical physician. The excellent chapter on the Law by Elizabeth Norman, Barrister at Law, is clear and concise, but perhaps should have benefited by being juxtaposed with the chapter on negligence and medicines which appears somewhat out of place later in the book.
Book reviews The second section describes the effects of drugs on the behaviour of the perpetrators and victims of crime and it provides some interesting background material to contemplate. The final section on drugs of forensic importance, was for me the most disappointing, perhaps because I was expecting so much from it. It appears to contain very little new material and makes only fleeting reference, if any, to the street drugs that we commonly encounter in every day clinical forensic medical practice. In general, the text flowed reasonably and I personally found the insertion of referenced cases and practical examples helpful, although I appreciate that they can irritate other readers. In essence, l do not feel that this is a book that is going to help the candidate preparing for the DMJ. Dr Ferner states that one of his aims was to make forensic pharmacology sufficiently technical so that an expert would find it useful without being so obscure as to be inaccessible to others. Unfortunately, in doing so I feel he has tried to make his book 'all things to all men' and any book that feels it has to describe in detail the phlebotomy procedure, but later goes on to provide an explanation and description of the Watson formula and Widemark calculation has probably set its sights too widely. P E T E R J. H E W I T T The Surgery, Weymouth, U K
Forensic Analysis of the Skull
153
used, many of which, as will become obvious to the reader, are very much in the developmental stage as well as other methods, which are more established. Areas covered include facial morphology and photographic comparison, cranial analysis, skull-photo superimposition and facial reconstruction. From a professional user's point of view, it is an excellent and indeed, essential work of reference. However, some areas could have been improved upon. Some of the chapters contain unnecessary repetition and this could have been addressed with more stringent editing. In addition, there are some important sections which should have been covered in more depth and the editors, I am sure, will have this in mind for the next edition. For example there is a chapter on the use of CT scanning for skull identification which does not go far enough to show how the face can be reconstituted on the skull using computer technology. The section on photo-comparison suffers from the fact that it is a fast developing area, and although the author has made a valiant attempt to cover all the main aspects, the information contained is by now, a little dated. I would also have liked to have seen an indepth discussion on the evidential value of the different types of identification. All these minor criticisms aside, the book makes thoroughly interesting reading and is a good source of reference. It is invaluable for anyone involved in cranio-facial identification. PETER VANEZIS University of Glasgow, Glasgow, UK
M e h m e t Yasar Iscan and Richard R Helmer (eds), 1993. Wiley-Liss: New York. 258 pp Establishing the identity of an individual is an essential part of any forensic investigation involving a living or dead person. It may be the principal goal of the investigation, as for example in the identification of individuals in a mass disaster, in disputed paternity cases or in identifying whether a particular person committed a crime. On the other hand, identification may be an essential part of the process of the overall investigation, for example in establishing the identity of a murder victim. When skeletal remains are discovered, assessment of the skull is a crucial part of the identification process. 'Forensic analysis of the skull', edited by Iscan and Helmer, both of whom are internationally renown for their work in this field, presents the reader with all the various aspects of how this can be achieved. It is a fascinating and challenging book in many respects, and takes us through the latest techniques
Psychological Trauma: A Developmental Approach. D. Black, M. Newman, J. Harris-Hendriks and G. Mezey (eds), 1997. Gaskell: L o n d o n . 412 pp. £30. ISBN 0 902241 98 2 The purpose of this edited book was to provide a comprehensive overview of trauma for practitioners. The book focused on mass trauma (e.g., shipping disasters, local accidents affecting large numbers of people, torture etc.) more than domestic violence and child abuse. The contributing authors represent diverse backgrounds including psychiatry, psychology, social work, law and police services. The book was divided into four parts, with part one dealing with normal and abnormal responses to stress. Issues discussed included a historical review of trauma, child development issues such as the reaction to threat and separation, classification of posttraumatic stress disorder (PTSD), grief reactions,