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Handbook of borderline disorders
Book Reviews
mane to the work of both general and medical psychiatrists. It deserves a place in the psychiatrist’s library alongside the Massachusetts General Hospital Handbook of General Hospital Psychiatry. I eagerly await subsequent volumes. JAMES CIARCIA, M.D.
New Haven, Connecticut
Reference 1. Rosebush PI, Stewart TD, Mazurek MF: Treatment of
neuroleptic malignant syndrome: Are dantrolene and bromocriptine useful adjuncts to supportive care? Br J Psychiatry 159:709-712, 1991
Handbook of Borderline Disorders. Edited by Daniel Silver and Michael Rosenbluth. Madison, CT, International Universities Press, Inc., 1992 ($75.00), 744 pp. In assembling this volume, the editors hoped to move beyond the relatively homogeneous perspectives of first generation (largely psychoanalytic) workers and present a contemporary overview enriched by current empirical research in the areas of infant observation, classification and nosology, follow-up studies, and psychobiologic and pharmacologic investigations. The editors contend, and their collection of essays by and large successfully demonstrates, that attention to multiple perspectives is required for the optimal care of the borderline patient. With 32 contributors and over 700 pages (including 50 pages of references), Silver and Rosenbluth’s Handbook of Borderline Disorders might better be titled of Borderline Disorders.” “The Encyclopedia Twenty-five individual chapters are organized into four sections; Diagnosis, Classification and Outcome; Concepts and Controversies; Therapeutic Issues and Treatment Modalities; and Particular Borderline Populations. Within each section individual chapters are often authored by leading scholars who address their particular areas of expertise. Among other excellent contributions, Michael Stone addresses differential diagnosis; Tom McGlashan, long-term follow-up; Robert Michels, the implications of theory for treatment; Gerald Adler, the therapeutic alliance; John Gunderson, psychotherapy; John Maltsberger, suicide; Thomas Gutheil medicolegal issues; Edward Shapiro, projective identification and family dynamics; Rex Cowdry, psy-
chobiology and psychopharmacology; Joel Sadovy, the aging borderline; and Edgar Nacy, alcoholism in borderline disorders. An epilogue consisting of an open discussion among Drs. Cowdry, Gunderson, Michels, and Stone provides an unusual glimpse into how these distinguished clinicians actually manage their patients and think about their clinical practices. The heterogeneity of borderline disorders in terms of clinical presentation, functional impairments, and probable underlying constitutional and/or environmental determinants emerges as a major theme of this collection of essays. Though a variety of treatment approaches (including individual, group, family, rehabilitative, behavioral, and psychopharmacologic therapy) are espoused with compelling theoretical rationales and supporting clinical vignettes, the absence of credible empirical support for any one or combination of treatments is striking. The problem of matching individual patients at particular phases in their disorders with the optimal constellation of treatment modalities adds yet another level of complexity for which virtually no data are available to inform clinical practice. Most authors in this volume explicitly acknowledge these significant gaps in our knowledge base, yet, recognizing the urgency with which patients seek and require intervention, they lend expert clinical advice based on opinion and experience. Creativity, flexibility, commitment, self-reflection, and a willingness to stick with it emerge as therapist characteristics encouraged by clinicians across a variety of theoretical orientations. The rigid application of one theoretical model or one treatment approach across the board to all patients emerges as the therapeutic strategy least likely to be of value. Most chapters in this book presuppose the reader’s basic knowledge of psychopathology, developmental theory, psychotherapy, clinical psychiatry, and/or psychopharmacology. As such, this is not a text for beginners. Although few will wish to read this weighty volume cover to cover, to do so will provide a relatively comprehensive and contemporary overview of theory and research pertinent to the treatment of patients with borderline disorders. For most, this book will be of value as a reference, with relevant chapters serving as a starting point for those wishing to explore specific areas within the broad and emerging scientific literature on borderline conditions in greater depth. S. FENTON, M.D. Rockville, Ma yland
WAYNE
195
mane to the work of both general and medical psychiatrists. It deserves a place in the psychiatrist’s library alongside the Massachusetts General Hospital Handbook of General Hospital Psychiatry. I eagerly await subsequent volumes. JAMES CIARCIA, M.D.
New Haven, Connecticut
Reference 1. Rosebush PI, Stewart TD, Mazurek MF: Treatment of
neuroleptic malignant syndrome: Are dantrolene and bromocriptine useful adjuncts to supportive care? Br J Psychiatry 159:709-712, 1991
Handbook of Borderline Disorders. Edited by Daniel Silver and Michael Rosenbluth. Madison, CT, International Universities Press, Inc., 1992 ($75.00), 744 pp. In assembling this volume, the editors hoped to move beyond the relatively homogeneous perspectives of first generation (largely psychoanalytic) workers and present a contemporary overview enriched by current empirical research in the areas of infant observation, classification and nosology, follow-up studies, and psychobiologic and pharmacologic investigations. The editors contend, and their collection of essays by and large successfully demonstrates, that attention to multiple perspectives is required for the optimal care of the borderline patient. With 32 contributors and over 700 pages (including 50 pages of references), Silver and Rosenbluth’s Handbook of Borderline Disorders might better be titled of Borderline Disorders.” “The Encyclopedia Twenty-five individual chapters are organized into four sections; Diagnosis, Classification and Outcome; Concepts and Controversies; Therapeutic Issues and Treatment Modalities; and Particular Borderline Populations. Within each section individual chapters are often authored by leading scholars who address their particular areas of expertise. Among other excellent contributions, Michael Stone addresses differential diagnosis; Tom McGlashan, long-term follow-up; Robert Michels, the implications of theory for treatment; Gerald Adler, the therapeutic alliance; John Gunderson, psychotherapy; John Maltsberger, suicide; Thomas Gutheil medicolegal issues; Edward Shapiro, projective identification and family dynamics; Rex Cowdry, psy-
chobiology and psychopharmacology; Joel Sadovy, the aging borderline; and Edgar Nacy, alcoholism in borderline disorders. An epilogue consisting of an open discussion among Drs. Cowdry, Gunderson, Michels, and Stone provides an unusual glimpse into how these distinguished clinicians actually manage their patients and think about their clinical practices. The heterogeneity of borderline disorders in terms of clinical presentation, functional impairments, and probable underlying constitutional and/or environmental determinants emerges as a major theme of this collection of essays. Though a variety of treatment approaches (including individual, group, family, rehabilitative, behavioral, and psychopharmacologic therapy) are espoused with compelling theoretical rationales and supporting clinical vignettes, the absence of credible empirical support for any one or combination of treatments is striking. The problem of matching individual patients at particular phases in their disorders with the optimal constellation of treatment modalities adds yet another level of complexity for which virtually no data are available to inform clinical practice. Most authors in this volume explicitly acknowledge these significant gaps in our knowledge base, yet, recognizing the urgency with which patients seek and require intervention, they lend expert clinical advice based on opinion and experience. Creativity, flexibility, commitment, self-reflection, and a willingness to stick with it emerge as therapist characteristics encouraged by clinicians across a variety of theoretical orientations. The rigid application of one theoretical model or one treatment approach across the board to all patients emerges as the therapeutic strategy least likely to be of value. Most chapters in this book presuppose the reader’s basic knowledge of psychopathology, developmental theory, psychotherapy, clinical psychiatry, and/or psychopharmacology. As such, this is not a text for beginners. Although few will wish to read this weighty volume cover to cover, to do so will provide a relatively comprehensive and contemporary overview of theory and research pertinent to the treatment of patients with borderline disorders. For most, this book will be of value as a reference, with relevant chapters serving as a starting point for those wishing to explore specific areas within the broad and emerging scientific literature on borderline conditions in greater depth. S. FENTON, M.D. Rockville, Ma yland
WAYNE
195