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General psychopathology—An introduction
9001; REVIEWS
465
CHRISTIANSCHARFETTER:Generul Psychoputho/ogy-An Introduction. Cambridge Univ. Press, Cambridge (19801. 329 PD. f20. DANIELFR&+IAN. ARNOLDFRIEDHOFF.LAWRENCEKOLB. REGINALDLOWRIE,JOHN NEIMIAH,JOHN ROMANO (Eds.): IYXO Yeor Book of Ps>&iurrr and Applied Mentul He&h. Year Book Medical Publishers. Chicago (1980). 378 pp. f30. These two books represent quite opposite poles of contemporary academic psychiatry. In Generul Psyhopurhology Scharfetter presents the distilled life-time experience of one clinician in the German-speaking region of Switzerland, while in the 19X0 Year Book Freedman and his colleagues summarize and comment upon several hundred papers published in mainly American psychiatric journals. Professor Scharfetter’s book is very much in the phenomenological tradition originated by Karl Jaspers which seeks to define, distinguish and classify abnormal mental experiences. It is by no means easy to read. partly because of the condensed rather telegraphic style and partly because of the intrinsically difficult nature of many of the concepts discussed. Nevertheless, it is certainly worth making the effort since Scharfetter’s philosophically-based approach provides a useful antidote to the empirical and operational approach so prevalent in Britain and tt ’ U.S.A. today. Scharfetter himself hopes that his book may provide the substance for a series of seminars but in spite of the extremely comprehensive bibliography, I believe that its real value is in the clinical situation. Each aspect of psychopathology discussed is illustrated by one or more apt. and often fascinating. excerpts from actual patient histories. Those chapters concerned with thought disorder, delusions and abnormalities of perception are particularly illuminating. Thus, this is the book to consult when one is puzzling over some unusual clinical presentation or when a dispute breaks out in the ward round over whether a patient shows, for example, delusional perception or not. The 1980 Yew Book o/Psychiatry and Applied Mental Health sets out to review the world literature on subjects relevant to psychiatry for the year ending in July 1979, but inevitably the papers reviewed reflect the interests and biases of the six American editors. The sections on the biological sciences. with the noticeable exception of genetics, are good and those on general clinical topics competent if not inspired. Orthodox psychoanalysis is discussed ad nuusewn and there are also articles on encounter groups, primal scream therapy and even evangelical religion. But readers of this journal will be astonished by the total neglect of behaviour therapy which is mentioned in relation to adults only through a paper which claims that four out of eightythree behaviourally-treated patients developed radically new symptoms; this is naturally hailed as evidence in support of symptom substitution. This book is not worth buying but it may be worth flicking through a library copy if one is looking for recent articles on some unfamiliar topic-there is even an article on “Santa Claus, Easter Bunny and the Tooth Fairy”! ROBINMURRAY
L. C. SOBELL,M. B. SOBELLand E. WARD (Eds.): Ecaluating Alcohol and Drug Abuse Trearment Ef/rcrireness: Recenr Adaanres. Pergamon Press, New York (1980). xvi + 188 pp. 820.00. Up until 20 years ago workers in the addiction field had to face a paradox which must have dampened their enthusiasm for meticulous assessment and research. The evaluation of alcoholism and drug treatment programmes typically relied upon one dependent measure. namely the number of clients who said that they had been abstinent during the follow-up period. At the same time, it was generally accepted that, to quote Sir William Osler in 1892. addicts are “inveterate liars, and no reliance whatever can be placed on their statements”. Alcoholics and drug addicts were not to be trusted and yet there was a total reliance on self-reports. In spite of this paradox, hundreds of evaluative studies have been carried out. but even within the last decade. most of them were so inadequate from the methodological point of view. that they can be cheerfully ignored. Crawford and Chalupsky (1977) reviewed 40 reports published between 1968 and 1971. They found that the most common flaws were: a lack of control groups, inadequate sampling procedures, nonreliability of measuring instruments. inadequate follow-up techniques, poor reporting of follow-up, a lack of pretreatment baseline datas. an absence of specific descriptions of treatment. an absence of any description of populations, a failure to relate sample variations to outcome variations. a collapse of data in coding and a rudimentary level of statistical analyses of the data collected. They concluded that: “the concomitant presence of a set of such inadequacies calls to question whether perhaps half or more of these studies should have been undertaken. let alone reported”. Recently, a great &al of research on reliability and validity. the use of multiple outcome measures and controlled drinking as an acceptable outcome has paved the way for a more sophisticated approach. Evaluating the effectiveness of treatment in the field of alcohol and drug dependence is now a much more daunting but rewarding task. The first two chapters in this scholarly book describe the numerous methodological problems that have to be overcome, and also provide a well documented review of the types of outcome measures that have been used during the last 20 years. The rest of the book focusses upon innovative measures and procedures, as well as a number of ‘exemplary studies’. There is no doubt that most people involved in the addiction field could profit from the ideas and information gathered by the Sobells and their colleagues. Nevertheless. the book is not the gem that we had hoped for. but rather a hodge-podge of conference proceedings. The “recent advances” that are promised tend to be embedded in a mass of dull and redundant information. Most of the contributors take great pleasure in getting their teeth into. and mauling yet again. the rotting carcass of the simple disease model. As a critique of old approaches, the book serves a very useful function. but we must still wait for a clear. uncluttered AJ$C of treatment evaluation which simply describes the pitfalls and the various ways of avoiding them. along with the most important supportive evidence. Mark and Linda Sobell
465
CHRISTIANSCHARFETTER:Generul Psychoputho/ogy-An Introduction. Cambridge Univ. Press, Cambridge (19801. 329 PD. f20. DANIELFR&+IAN. ARNOLDFRIEDHOFF.LAWRENCEKOLB. REGINALDLOWRIE,JOHN NEIMIAH,JOHN ROMANO (Eds.): IYXO Yeor Book of Ps>&iurrr and Applied Mentul He&h. Year Book Medical Publishers. Chicago (1980). 378 pp. f30. These two books represent quite opposite poles of contemporary academic psychiatry. In Generul Psyhopurhology Scharfetter presents the distilled life-time experience of one clinician in the German-speaking region of Switzerland, while in the 19X0 Year Book Freedman and his colleagues summarize and comment upon several hundred papers published in mainly American psychiatric journals. Professor Scharfetter’s book is very much in the phenomenological tradition originated by Karl Jaspers which seeks to define, distinguish and classify abnormal mental experiences. It is by no means easy to read. partly because of the condensed rather telegraphic style and partly because of the intrinsically difficult nature of many of the concepts discussed. Nevertheless, it is certainly worth making the effort since Scharfetter’s philosophically-based approach provides a useful antidote to the empirical and operational approach so prevalent in Britain and tt ’ U.S.A. today. Scharfetter himself hopes that his book may provide the substance for a series of seminars but in spite of the extremely comprehensive bibliography, I believe that its real value is in the clinical situation. Each aspect of psychopathology discussed is illustrated by one or more apt. and often fascinating. excerpts from actual patient histories. Those chapters concerned with thought disorder, delusions and abnormalities of perception are particularly illuminating. Thus, this is the book to consult when one is puzzling over some unusual clinical presentation or when a dispute breaks out in the ward round over whether a patient shows, for example, delusional perception or not. The 1980 Yew Book o/Psychiatry and Applied Mental Health sets out to review the world literature on subjects relevant to psychiatry for the year ending in July 1979, but inevitably the papers reviewed reflect the interests and biases of the six American editors. The sections on the biological sciences. with the noticeable exception of genetics, are good and those on general clinical topics competent if not inspired. Orthodox psychoanalysis is discussed ad nuusewn and there are also articles on encounter groups, primal scream therapy and even evangelical religion. But readers of this journal will be astonished by the total neglect of behaviour therapy which is mentioned in relation to adults only through a paper which claims that four out of eightythree behaviourally-treated patients developed radically new symptoms; this is naturally hailed as evidence in support of symptom substitution. This book is not worth buying but it may be worth flicking through a library copy if one is looking for recent articles on some unfamiliar topic-there is even an article on “Santa Claus, Easter Bunny and the Tooth Fairy”! ROBINMURRAY
L. C. SOBELL,M. B. SOBELLand E. WARD (Eds.): Ecaluating Alcohol and Drug Abuse Trearment Ef/rcrireness: Recenr Adaanres. Pergamon Press, New York (1980). xvi + 188 pp. 820.00. Up until 20 years ago workers in the addiction field had to face a paradox which must have dampened their enthusiasm for meticulous assessment and research. The evaluation of alcoholism and drug treatment programmes typically relied upon one dependent measure. namely the number of clients who said that they had been abstinent during the follow-up period. At the same time, it was generally accepted that, to quote Sir William Osler in 1892. addicts are “inveterate liars, and no reliance whatever can be placed on their statements”. Alcoholics and drug addicts were not to be trusted and yet there was a total reliance on self-reports. In spite of this paradox, hundreds of evaluative studies have been carried out. but even within the last decade. most of them were so inadequate from the methodological point of view. that they can be cheerfully ignored. Crawford and Chalupsky (1977) reviewed 40 reports published between 1968 and 1971. They found that the most common flaws were: a lack of control groups, inadequate sampling procedures, nonreliability of measuring instruments. inadequate follow-up techniques, poor reporting of follow-up, a lack of pretreatment baseline datas. an absence of specific descriptions of treatment. an absence of any description of populations, a failure to relate sample variations to outcome variations. a collapse of data in coding and a rudimentary level of statistical analyses of the data collected. They concluded that: “the concomitant presence of a set of such inadequacies calls to question whether perhaps half or more of these studies should have been undertaken. let alone reported”. Recently, a great &al of research on reliability and validity. the use of multiple outcome measures and controlled drinking as an acceptable outcome has paved the way for a more sophisticated approach. Evaluating the effectiveness of treatment in the field of alcohol and drug dependence is now a much more daunting but rewarding task. The first two chapters in this scholarly book describe the numerous methodological problems that have to be overcome, and also provide a well documented review of the types of outcome measures that have been used during the last 20 years. The rest of the book focusses upon innovative measures and procedures, as well as a number of ‘exemplary studies’. There is no doubt that most people involved in the addiction field could profit from the ideas and information gathered by the Sobells and their colleagues. Nevertheless. the book is not the gem that we had hoped for. but rather a hodge-podge of conference proceedings. The “recent advances” that are promised tend to be embedded in a mass of dull and redundant information. Most of the contributors take great pleasure in getting their teeth into. and mauling yet again. the rotting carcass of the simple disease model. As a critique of old approaches, the book serves a very useful function. but we must still wait for a clear. uncluttered AJ$C of treatment evaluation which simply describes the pitfalls and the various ways of avoiding them. along with the most important supportive evidence. Mark and Linda Sobell