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Health psychology: Stress, behaviour and disease
BOOK REVIEWS
125
A. BURNS and R. LEVY (E,ds): Dementia. Chapman & Hall Medical, London (1994). liii + 874 pp. £125.00 There is plenty in this major textbook for neuropsychiatrists to get their teeth into. With over 50 chapters and 85 contributors, Burns and Levy have clearly had quite a task on their hands. The division into the two sections of Alzbeimer's dementia and Non-Alzheimer dementia is not entirely satisfactory since all the chapters on services, diagnostic issues and therapeutic strategies have been subsumed within the first section. The editors' wish to provide a text in the 'mainstream' has been largely fulfilled but it is very much on organic psychiatrist's textbook and there is consequently little space devoted to the psychosocial aspects of dementia despite their importance. In the chapter on age-associated memory impairments, psychological approaches to treatment cover only a short paragraph and the authors do not appear enthusiastic about the possibilities noting that this is a 'noble tradition' which has been 'reviewed elsewhere'. Hardly the stuff to inspire new research in psychological therapies for these impairments, On the other hand, many of the chapters are of a high standard and where there is already a solid body of research on the subject the 'mainstream' approach works well. There is a useful chapter on neuropsychological investigations giving a good account of the various tests available. The use of case reports injects life into an otherwise dry topic. The chapter on management of the family emphasises the impact on the carer at the various stages of the illness but the interaction between cater and sufferer does not get the attention it deserves, and none of the three studies on expressed emotion in dementia is cited. The chapter on psychological therapies is rather brief considering the volume of work done in the area; however the authors give a clear exposition of contemporary views and rightly emphasise the importance of reality orientation therapy being used in a sensitive and humane way. Like the authors, I agree that better controlled research needs to be done in order to know the real value of the various different interventions. This is a useful reference book for specialists working with dementia. However, there is not much covering the psychological aspects and even less on the psychological therapies. Most readers will prefer to nip down to the library to refer to it rather than spend over a hundred pounds to have it on their shelves. MARTIN ORRELL
DOUGLASCARROLL: Health Psychology: Stress, Behaviour and Disease. Falmer Press, London (1992). viii + 129 pp. £32.00 Hardback; £11.95 Paperback This is a volume in the Contemporary Psychology Series, which has produced several valuable short texts on key subjects. The present publication is very welcome. Health Psychology is developing at rapid pace, and its relevance is being increasingly recognised. The author, who has done much research in health psychology for many years, has selected some central topics and themes in the area and given sensible, useful discussions of each of them. The key theme is the role of stress, and this is rightly discussed in detail. If some readers and students are disappointed at the selectivity of topics included, the book compensates for this with its lucidity and thoroughness in the discussion of the topics that are included, and in its role as a starting point for whetting the reader's appetite. All in all, a good book that will be found valuable by readers in several fields. The hardback, though, is overpriced, which is a pity. E. K. RODRIGO
W. DRYDEN & C. FELTHAM (Eds): Psychotherapy and its Discontents. Open University Press, Buckingham (1992). xvi + 272 pp. £13.99 "The field of psychotherapy cannot be defined intellectually or ideologically . . . . functionally. . . . socially or by means of a cultural analysis. The field can be defined by dispute". This book gathers together the views of some well-known "discontents", presenting the material in the form of a debate. Each author "proposes" his view in a separate chapter; a psychotherapist "responds" to this, and the author has the final word in the form of a "rebuttal". Jeffrey Masson writes of the tyranny of psychotherapy; Ernest Gellner of its mystical, untestable nature and of its social role. Hans Eysenck and Paul Kline, in separate chapters, discuss the problems with outcome research and the possibility that psychotherapy is no more effective than no treatment. Katherine Mair challenges the "myth" of therapist expertise, while Gill Edwards suggests that psychotherapy lags the sciences in lacking a soul. David Pilgrim discusses the political evasiveness of psychotherapy, and finally Stuart Sutherland makes a critique from the consumer's point of view. This format works well up to a point, as it does indeed appear that "psychotherapy" means different things to different authors. For example, Eysenck quotes much evidence for the ineffectiveness of psychoanalysis (as opposed to behaviour therapy!); to Stuart Sutherland the term applies to his whole experience as a patient, and to Gill Edwards there is a spiritual dimension to the subject. However, I am not sure that the definition of psychotherapy is made any clearer by the contributions in this book. The chapter on methodological problems is difficult unless one has considerable statistical sophistication. Stuart Sutherland's contribution is practical and I feel bears repetition. Overall, the book is a useful introduction to current debates in the field, but to anyone familiar with the contributors' views it adds little new. ANNE J. M. WARD
H. HAFNER and W. F. GATTAZ (Eds): Search for the Causes of Schizophrenia, Volume H. Springer Verlag, Berlin (1991). 450 pp. DM 158 This is the second volume in the series 'Search for the Causes of Schizophrenia', based on symposia organised by the Central Institute of Mental Health in Mannheim, and the University of Heidelberg. The proceedings of the first symposium, published in 1987, were extremely well received and its successor maintains these high standards. Three of the sections from the earlier volume, epidemiology, genetics, and vulnerability models, have their equivalents in this book. It is reassuring that some, albeit slow, progress is detectable. The study of brain anatomy in schizophrenia is quite rightly allocated a section and includes an excellent overview by Bogerts of current research in this area.
125
A. BURNS and R. LEVY (E,ds): Dementia. Chapman & Hall Medical, London (1994). liii + 874 pp. £125.00 There is plenty in this major textbook for neuropsychiatrists to get their teeth into. With over 50 chapters and 85 contributors, Burns and Levy have clearly had quite a task on their hands. The division into the two sections of Alzbeimer's dementia and Non-Alzheimer dementia is not entirely satisfactory since all the chapters on services, diagnostic issues and therapeutic strategies have been subsumed within the first section. The editors' wish to provide a text in the 'mainstream' has been largely fulfilled but it is very much on organic psychiatrist's textbook and there is consequently little space devoted to the psychosocial aspects of dementia despite their importance. In the chapter on age-associated memory impairments, psychological approaches to treatment cover only a short paragraph and the authors do not appear enthusiastic about the possibilities noting that this is a 'noble tradition' which has been 'reviewed elsewhere'. Hardly the stuff to inspire new research in psychological therapies for these impairments, On the other hand, many of the chapters are of a high standard and where there is already a solid body of research on the subject the 'mainstream' approach works well. There is a useful chapter on neuropsychological investigations giving a good account of the various tests available. The use of case reports injects life into an otherwise dry topic. The chapter on management of the family emphasises the impact on the carer at the various stages of the illness but the interaction between cater and sufferer does not get the attention it deserves, and none of the three studies on expressed emotion in dementia is cited. The chapter on psychological therapies is rather brief considering the volume of work done in the area; however the authors give a clear exposition of contemporary views and rightly emphasise the importance of reality orientation therapy being used in a sensitive and humane way. Like the authors, I agree that better controlled research needs to be done in order to know the real value of the various different interventions. This is a useful reference book for specialists working with dementia. However, there is not much covering the psychological aspects and even less on the psychological therapies. Most readers will prefer to nip down to the library to refer to it rather than spend over a hundred pounds to have it on their shelves. MARTIN ORRELL
DOUGLASCARROLL: Health Psychology: Stress, Behaviour and Disease. Falmer Press, London (1992). viii + 129 pp. £32.00 Hardback; £11.95 Paperback This is a volume in the Contemporary Psychology Series, which has produced several valuable short texts on key subjects. The present publication is very welcome. Health Psychology is developing at rapid pace, and its relevance is being increasingly recognised. The author, who has done much research in health psychology for many years, has selected some central topics and themes in the area and given sensible, useful discussions of each of them. The key theme is the role of stress, and this is rightly discussed in detail. If some readers and students are disappointed at the selectivity of topics included, the book compensates for this with its lucidity and thoroughness in the discussion of the topics that are included, and in its role as a starting point for whetting the reader's appetite. All in all, a good book that will be found valuable by readers in several fields. The hardback, though, is overpriced, which is a pity. E. K. RODRIGO
W. DRYDEN & C. FELTHAM (Eds): Psychotherapy and its Discontents. Open University Press, Buckingham (1992). xvi + 272 pp. £13.99 "The field of psychotherapy cannot be defined intellectually or ideologically . . . . functionally. . . . socially or by means of a cultural analysis. The field can be defined by dispute". This book gathers together the views of some well-known "discontents", presenting the material in the form of a debate. Each author "proposes" his view in a separate chapter; a psychotherapist "responds" to this, and the author has the final word in the form of a "rebuttal". Jeffrey Masson writes of the tyranny of psychotherapy; Ernest Gellner of its mystical, untestable nature and of its social role. Hans Eysenck and Paul Kline, in separate chapters, discuss the problems with outcome research and the possibility that psychotherapy is no more effective than no treatment. Katherine Mair challenges the "myth" of therapist expertise, while Gill Edwards suggests that psychotherapy lags the sciences in lacking a soul. David Pilgrim discusses the political evasiveness of psychotherapy, and finally Stuart Sutherland makes a critique from the consumer's point of view. This format works well up to a point, as it does indeed appear that "psychotherapy" means different things to different authors. For example, Eysenck quotes much evidence for the ineffectiveness of psychoanalysis (as opposed to behaviour therapy!); to Stuart Sutherland the term applies to his whole experience as a patient, and to Gill Edwards there is a spiritual dimension to the subject. However, I am not sure that the definition of psychotherapy is made any clearer by the contributions in this book. The chapter on methodological problems is difficult unless one has considerable statistical sophistication. Stuart Sutherland's contribution is practical and I feel bears repetition. Overall, the book is a useful introduction to current debates in the field, but to anyone familiar with the contributors' views it adds little new. ANNE J. M. WARD
H. HAFNER and W. F. GATTAZ (Eds): Search for the Causes of Schizophrenia, Volume H. Springer Verlag, Berlin (1991). 450 pp. DM 158 This is the second volume in the series 'Search for the Causes of Schizophrenia', based on symposia organised by the Central Institute of Mental Health in Mannheim, and the University of Heidelberg. The proceedings of the first symposium, published in 1987, were extremely well received and its successor maintains these high standards. Three of the sections from the earlier volume, epidemiology, genetics, and vulnerability models, have their equivalents in this book. It is reassuring that some, albeit slow, progress is detectable. The study of brain anatomy in schizophrenia is quite rightly allocated a section and includes an excellent overview by Bogerts of current research in this area.