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Law in the practice of psychiatry: A handbook for clinicians
BOOK REVIEWS
Phenomenology and Treatment of Anxiety. William E. Farm, Ismei Karacan, Alex D. Pokorny. and Robert L. Williams (eds). New
York and London, Spectrum 1979, 406 pages, $35.00.
Publications,
This group of editors from Baylor College of Medicine, Houston, Texas offers their third contribution in what is now a series of fine symposium style books. The two previous volumes in the “Phenomenology and Treatment of. .” sequence addressed schizophrenia and depression. With this latest addition on anxiety, they expand their spectrum to include almost every disorder that a psychiatrist or general practitioner may encounter. What is most engaging about this book is its basic, clear headed approach, which might start with a simple question like “Anxiety, what is it?.” Thirty-three authors offer concepts currently being explored to broaden our understanding of anxiety. Although this is by no means a comprehensive study of the subject. as the editors state. it does offer the clinician a methodical approach to understanding, evaluating and formulating possible treatment for various manifestations of pathological anxiety states. This volume is the result of a 1977 symposium designed, as the editors explain, “to bring together scientists and clinicians of established reputation for a mutual exchange of ideas concerning the nature and treatment of anxiety.” The format of the proceedings is reflected in the structure of the book. The opening seven papers deal with the evaluation of anxiety. Included in this part are children and the aged, suicide, and methods for developing research tools to improve our ability to clinically measure anxiety. There is also a paper specifically addressed to primary care practitioners. The second section of eight chapters reviews biological parameters of anxiety. Medical illness, disturbed sleep, vocal patterns, animal models. human EEG and anxiolytics. biochemical induction, and the norepinephrine system are reviewed in a comprehensible way. There is something here for researcher and clinician, expert and student, generalist and specialist. The next five contributors review psychodynamic perspectives. Freudian and Sullivanian concepts are both present for comparison. Comprehensive
Psychiatry,
There are also case histories which demonstrate a developmental approach to understanding a “success phobia.” General hospital anxietysituations are reviewed from a dynamic point of view which offer the nonpsychiatrist valuable insight into how the attentive physician can better deal with this ubiquitous phenomenon. Finally, there are seven papers which review treatment plans for anxiety. Included in this portion are sex therapy, psychopharmacological approaches, beta-adrenergic blocking agents. behavior modification, short-term psychotherapy, and hypnotic procedures. Each chapter is relatively short and easy to read, making this a good reference book for the busy clinician or student. The researcher may also find that the variety of ideas present between the covers of this book stimulate new questions about anxiety and how it can be studied. This book will make a very good addition to the library of any person working with patients. for there are no clinical situations where an improved understanding of anxiety would not be welcomed. Phi/lip E. Romero. M.D. New York, New York
Law in the Practice of Psychiatry: A Handbook for Clinicians. Seymour L. Halleck, M.D. Plenum, New York 1980. 294~. The author divides this book into three parts under the headings: Malpractice: The Regulation by Legislative Bodies and the Courts: and Expert Witness Roles. In each he attempts to familiarize the practitioner with the current glut of legal issues. To this end, he organizes the book in a question-and-answer format and assiduously avoids the use of legal jargon. He assumes no particular level of familiarity with these important issues and explains the most basic tenets in clear readable prose. Nor does he shy away from more complicated questions such as: “What legal issues regarding causation and damages should the psychiatrist be aware of in examining the patient for psychic injury suits?” The format allows the reader to quickly refer to areas of special interest. Yet the readability in some ways belies the fundamental message Dr. Halleck wishes to get across. For we live in a time when the law is
Vol. 23, No. 1 (January/February),
1982
99
100
undergoing rapid expansion and elaboration. Psychiatrists who think they can find “what the law says” about any one specific situation, either from this book, or from calling their lawyer, may find themselves disappointed to hear that they might just be the defendant who provides the definitive answer or, more likely, that they must remain uncertain of “the law” and must proceed through poorly charted waters. For example, what is the psychiatrist’s liability concerning Tardive Dyskinesia and how does it relate to the doctrine of Informed Consent? Faced with a person experiencing a paranoid psychosis, what amount of information about adverse reactions constitutes “informed consent” and what amount impinges on the patient’s right to receive treatment? Does “the law” seriously believe the paranoid person capable of being rationally informed about the many adverse reactions, short- and long-term, of neuroleptics? If not, are we then liable for proceedings not initiating “incompetence” against the paranoid before treating him? The author reminds those psychiatrists who have moved off into the supposedly less risky areas of office-based psychotherapy that recent legal decisions have made inroads here, too. For example. in the case of the “negative therapeutic reaction” is the psychiatrist, though his
BOOK REVIEWS
performance may have been blameless, liable for an actionable tort, analagous to the plastic surgeon who was recently sued for an accident of anesthesia? How does one navigate through the intricacies of the issue of “confidentiality” after deicisons such as the Tarasoff case in California? The author’s point, unfortunately, is that the jury is still out on many issues; that there are no clear-cut answers except as specific questions are adjudicated in courts of law. To know how the law is established and how it operates is the best defense against what the future may bring. In this respect, Dr. Halleck’s book leaves one better informed but more uncertain about any of the day-to-day practices of a psychiatrist’s professional life. An uneasiness has crept into our practice and though Dr. Halleck’s book will not dissolve this feeling, a careful reading and re-reading will help the individual psychiatrist forge a personal strategy to cope with this increasingly burdensome social responsibility. These days, the psychiatrist who neglects to inform himself about how the law works, may learn it first-hand or. worse, many find himself too uneasy to continue in the role he envisioned for himself in less complicated times. James S. Bove, M.D. New York, New York
Phenomenology and Treatment of Anxiety. William E. Farm, Ismei Karacan, Alex D. Pokorny. and Robert L. Williams (eds). New
York and London, Spectrum 1979, 406 pages, $35.00.
Publications,
This group of editors from Baylor College of Medicine, Houston, Texas offers their third contribution in what is now a series of fine symposium style books. The two previous volumes in the “Phenomenology and Treatment of. .” sequence addressed schizophrenia and depression. With this latest addition on anxiety, they expand their spectrum to include almost every disorder that a psychiatrist or general practitioner may encounter. What is most engaging about this book is its basic, clear headed approach, which might start with a simple question like “Anxiety, what is it?.” Thirty-three authors offer concepts currently being explored to broaden our understanding of anxiety. Although this is by no means a comprehensive study of the subject. as the editors state. it does offer the clinician a methodical approach to understanding, evaluating and formulating possible treatment for various manifestations of pathological anxiety states. This volume is the result of a 1977 symposium designed, as the editors explain, “to bring together scientists and clinicians of established reputation for a mutual exchange of ideas concerning the nature and treatment of anxiety.” The format of the proceedings is reflected in the structure of the book. The opening seven papers deal with the evaluation of anxiety. Included in this part are children and the aged, suicide, and methods for developing research tools to improve our ability to clinically measure anxiety. There is also a paper specifically addressed to primary care practitioners. The second section of eight chapters reviews biological parameters of anxiety. Medical illness, disturbed sleep, vocal patterns, animal models. human EEG and anxiolytics. biochemical induction, and the norepinephrine system are reviewed in a comprehensible way. There is something here for researcher and clinician, expert and student, generalist and specialist. The next five contributors review psychodynamic perspectives. Freudian and Sullivanian concepts are both present for comparison. Comprehensive
Psychiatry,
There are also case histories which demonstrate a developmental approach to understanding a “success phobia.” General hospital anxietysituations are reviewed from a dynamic point of view which offer the nonpsychiatrist valuable insight into how the attentive physician can better deal with this ubiquitous phenomenon. Finally, there are seven papers which review treatment plans for anxiety. Included in this portion are sex therapy, psychopharmacological approaches, beta-adrenergic blocking agents. behavior modification, short-term psychotherapy, and hypnotic procedures. Each chapter is relatively short and easy to read, making this a good reference book for the busy clinician or student. The researcher may also find that the variety of ideas present between the covers of this book stimulate new questions about anxiety and how it can be studied. This book will make a very good addition to the library of any person working with patients. for there are no clinical situations where an improved understanding of anxiety would not be welcomed. Phi/lip E. Romero. M.D. New York, New York
Law in the Practice of Psychiatry: A Handbook for Clinicians. Seymour L. Halleck, M.D. Plenum, New York 1980. 294~. The author divides this book into three parts under the headings: Malpractice: The Regulation by Legislative Bodies and the Courts: and Expert Witness Roles. In each he attempts to familiarize the practitioner with the current glut of legal issues. To this end, he organizes the book in a question-and-answer format and assiduously avoids the use of legal jargon. He assumes no particular level of familiarity with these important issues and explains the most basic tenets in clear readable prose. Nor does he shy away from more complicated questions such as: “What legal issues regarding causation and damages should the psychiatrist be aware of in examining the patient for psychic injury suits?” The format allows the reader to quickly refer to areas of special interest. Yet the readability in some ways belies the fundamental message Dr. Halleck wishes to get across. For we live in a time when the law is
Vol. 23, No. 1 (January/February),
1982
99
100
undergoing rapid expansion and elaboration. Psychiatrists who think they can find “what the law says” about any one specific situation, either from this book, or from calling their lawyer, may find themselves disappointed to hear that they might just be the defendant who provides the definitive answer or, more likely, that they must remain uncertain of “the law” and must proceed through poorly charted waters. For example, what is the psychiatrist’s liability concerning Tardive Dyskinesia and how does it relate to the doctrine of Informed Consent? Faced with a person experiencing a paranoid psychosis, what amount of information about adverse reactions constitutes “informed consent” and what amount impinges on the patient’s right to receive treatment? Does “the law” seriously believe the paranoid person capable of being rationally informed about the many adverse reactions, short- and long-term, of neuroleptics? If not, are we then liable for proceedings not initiating “incompetence” against the paranoid before treating him? The author reminds those psychiatrists who have moved off into the supposedly less risky areas of office-based psychotherapy that recent legal decisions have made inroads here, too. For example. in the case of the “negative therapeutic reaction” is the psychiatrist, though his
BOOK REVIEWS
performance may have been blameless, liable for an actionable tort, analagous to the plastic surgeon who was recently sued for an accident of anesthesia? How does one navigate through the intricacies of the issue of “confidentiality” after deicisons such as the Tarasoff case in California? The author’s point, unfortunately, is that the jury is still out on many issues; that there are no clear-cut answers except as specific questions are adjudicated in courts of law. To know how the law is established and how it operates is the best defense against what the future may bring. In this respect, Dr. Halleck’s book leaves one better informed but more uncertain about any of the day-to-day practices of a psychiatrist’s professional life. An uneasiness has crept into our practice and though Dr. Halleck’s book will not dissolve this feeling, a careful reading and re-reading will help the individual psychiatrist forge a personal strategy to cope with this increasingly burdensome social responsibility. These days, the psychiatrist who neglects to inform himself about how the law works, may learn it first-hand or. worse, many find himself too uneasy to continue in the role he envisioned for himself in less complicated times. James S. Bove, M.D. New York, New York