- Email: [email protected]
Risk and protective factors in the development of psychopathology
162
Book Reviews
much so that the shortcomings in some of the earlier chapters which provide brief overviews of, for example, existing community models of management (the Community Mental Health Resource Centre movement which has been so influential in recent years goes unmentioned here) can be forgiven. The ‘integrated’ approach means in effect integration at several levels. Integration of the service within the primary care team, working alongside the General Practitioner, integration with informal carer networks, between biomedical, psychological and social management and also between early intervention, intensive crisis and social management. Most readers will be envious of the resources that have been generously allocated to this model service, in terms of personnel, training and evaluation. However, the chapters on problem-based assessment of functioning, crisis intervention and prevention of recurrent disorders contain an enormous amount of clear, practical advice on how to go about assessing and treating mental illness in the community both effectively and efficiently. Sadly no solution is provided for the central dilemma of how to be maximally assessable without spending more time assessing and treating clients who prove not to meet criteria for mental disorder but fall instead into the categories of ‘distressed and demoralised’. Access to the service is via the GP who largely is responsible for carrying out initial screening. Rapid assessment is then provided by the mental health workers who provide such a responsive service that ‘a few family practitioners employed the easy access to specialist assessment as a means of screening a large proportion of people who presented to them in a distressed state’. This scenario will be familiar to those who have worked in CMHCs. The authors question whether their efforts to provide brief stress management and counselling for the one-quarter of cases rated as within normal limits at the initial assessment may have resulted in the apparently low inception rates for mental disorder found on evaluation of the service. To date, this question cannot be answered.
Senior
Lecturer
LINDA GASK in Community Psychiatry University of Manchester
Risk and Protective Factors in the Development of Psychopathology. Edited by JON ROLF, ANN S. MAXEN, DANTE CICCHETTI, KEITH H. NUECHTERLE~N and SHELDON WEINTRAUB. Cambridge University Press: Cambridge, 1990. Price f50.00. 533 pp. THIS book honours Norman Garmezy who is internationally recognized for his pioneering work in the field of developmental psychopathology and in particular his emphasis on the need to understand competence and resilience of individuals in the face of adversity. The volume is edited by five of his distinguished former graduate students. Apart from one chapter by Michael Rutter, the contributions are all from the U.S. and this undoubtedly acknowledges the importance of longitudinal studies in this field and their need for large scale resources. The list of contributors is very distinguished and the book provides a useful entree to many of the large scale studies concerned with understanding risk and protective factors for psychopathology. The five parts to the volume of which the first is introductory and the remaining four are roughly focused on different stages of development from preschool to adult life. Some chapters essentially provide reviews of findings of particular studies, as for example that by Sameroff and Seifer on the Rochester Longitudinal Study and that by Richters and Weintraub on the Stonybrook High Risk Project. Others also focus on particular major studies but provide more detailed findings of at least some aspects of those studies. For example, Nuechterlein and others describe findings from three studies on information processing that were themselves part of the final phase of the Minnesota High-Risk Studies investigating vulnerability factors and prodromal anomalies in schizophrenic disorders. On a different theme, children’s adjustment to parental divorce is examined in a project by Watt and his collaborators. Models or mechanisms are expounded either on the basis of more general review or the specific research of a particular group so that Ebata er al. put forward a model of adolescent developmental psychopathology and Patterson and Capaldi a mediational model for boys’ depressed moods. Rutter also draws on his own research but in characteristic fashion addresses more extensive theoretical issues, putting particular weight on the need to focus on protective processes rather than protective variables. There are an increasing number of publications concerned with developmental psychopathology and insofar as research findings are reported in this book they are often available elsewhere. However the extensive range of contributors ensures that this volume does indeed provide an entree to research into risk and protective factors, with the one proviso that it was originally published in 1990. The summaries of research of particular groups are necessarily frustrating if the reader wants original data but at least they can turn to the appropriate journals. Theorizing and the development of models is probably less strong, particularly with regard to protective factors as Rutter’s chapter and Garmezy’s closing note
163
Book Reviews
bring out. It is interesting to note also that the discussion of protective factors and processes is most highly evolved for infants and young children rather than adolescents and adults. Overall the somewhat piecemeal nature of this volume can be considered a weakness for those already well versed in the work of the various research groups but a strength for readers exploring the scope of the various major studies.
Guy’s
ANTONY D. Cox Dept of Child & Adolescent Psychiatry & St Thomas’s Medical and Dental School London
Alzheimer’s Disease: Advances in Clinical and Basic Research. Edited by B. CORRAIN, K. IQBAL, M. NICOLINI, B. WINBLAD, H. WISNIEWSKI and P. ZATTA. Chichester: John Wiley, 1993. Price f 110, $176. 633 pp. THIS book contains 73 ‘invited articles’ from Alzheimer’s disease researchers whose papers were selected from more than 550 presented at the Third International Conference on Alzheimer’s Disease and related disorders held in Padova in July 1992. The emphasis is almost exclusively on biological research, five pages being devoted to summaries of workshops on the roles of formal organizations and of the family in the provision of care for dementia sufferers. Despite intensive biological research activity, the burden experienced by many carers of Alzheimer disease sufferers has been little altered and much of the management of dementia involves the construction and delivery of social support packages. This volume would be more balanced in approach if some research on social and environmental factors in the management of dementia had been included. The general standard of contributors in this volume is high and the book is logically organized with sections on: diagnosis and biomarkers, epidemiology and risk factors, structural pathology, mechanisms of cell death, transmissible dementias, cellular and animal models, therapeutics (with emphasis on cholinergic approaches) and summaries of the two workshops mentioned above. Many of the contributions are, as might be expected, of a highly specialized nature and the reader is frequently assumed to have much prior knowledge which, for me at least, made some of the chapters heavy going. This book is a good, up to date, source for those with an interest in Alzheimer’s disease and should find a place in many libraries. In the copy submitted for review, pages 209-240 were duplicated and pages 240-273 missingpotential purchasers beware!
Consultant
The Lingering Malady: Price f6.50. 116 pp.
Anorexia
and Bulimia.
JOHN COLGAN in Psychiatry of Old Age Springfield Hospital London
JOAN PURGOLD. Edinburgh: JP Publishing,
1992.
DESPITE its front cover, which leads one to expect information about the outcome of anorexia and bulimia, this book is more a collection of personal reflections and reviews by a psychiatric social worker on certain aspects of her work. The author was for many years attached to the specialist eating disorder team in Bristol and was particularly involved with outcome research there. She has also co-authored a well-known book about the eating disorders. This book has been published posthumously in her memory and was prepared for publication by her friends. It is always difficult to review books which have been published in these circumstances, for their raison d’Ptre is different from that of other works. It is difficult, for example, to establish a target readership for this book. Much of the material is anecdotal and relatively unstructured, but it does presuppose a fairly sound knowledge of the eating disorders. The author clearly has a good knowledge of and a personal interest in these disorders and those who suffer from them, together with her own views about the usefulness of treatment approaches. However, these are presented in a rather erratic way, which makes it difficult to follow and to gain a clear picture of her thinking. Information from a welldocumented outcome study is juxtaposed with personal reflections on the interpretation of the data. To those of us involved in similar work, this is obviously of interest, but for others who are seeking to use this book for information, self-help or some sort of guidance as to how to help sufferers, there is little which could be of practical use. This mix between an objective, ‘scientific’ approach to anorexia and bulimia and a personal document is also highlighted by the intermittent references to research published
Book Reviews
much so that the shortcomings in some of the earlier chapters which provide brief overviews of, for example, existing community models of management (the Community Mental Health Resource Centre movement which has been so influential in recent years goes unmentioned here) can be forgiven. The ‘integrated’ approach means in effect integration at several levels. Integration of the service within the primary care team, working alongside the General Practitioner, integration with informal carer networks, between biomedical, psychological and social management and also between early intervention, intensive crisis and social management. Most readers will be envious of the resources that have been generously allocated to this model service, in terms of personnel, training and evaluation. However, the chapters on problem-based assessment of functioning, crisis intervention and prevention of recurrent disorders contain an enormous amount of clear, practical advice on how to go about assessing and treating mental illness in the community both effectively and efficiently. Sadly no solution is provided for the central dilemma of how to be maximally assessable without spending more time assessing and treating clients who prove not to meet criteria for mental disorder but fall instead into the categories of ‘distressed and demoralised’. Access to the service is via the GP who largely is responsible for carrying out initial screening. Rapid assessment is then provided by the mental health workers who provide such a responsive service that ‘a few family practitioners employed the easy access to specialist assessment as a means of screening a large proportion of people who presented to them in a distressed state’. This scenario will be familiar to those who have worked in CMHCs. The authors question whether their efforts to provide brief stress management and counselling for the one-quarter of cases rated as within normal limits at the initial assessment may have resulted in the apparently low inception rates for mental disorder found on evaluation of the service. To date, this question cannot be answered.
Senior
Lecturer
LINDA GASK in Community Psychiatry University of Manchester
Risk and Protective Factors in the Development of Psychopathology. Edited by JON ROLF, ANN S. MAXEN, DANTE CICCHETTI, KEITH H. NUECHTERLE~N and SHELDON WEINTRAUB. Cambridge University Press: Cambridge, 1990. Price f50.00. 533 pp. THIS book honours Norman Garmezy who is internationally recognized for his pioneering work in the field of developmental psychopathology and in particular his emphasis on the need to understand competence and resilience of individuals in the face of adversity. The volume is edited by five of his distinguished former graduate students. Apart from one chapter by Michael Rutter, the contributions are all from the U.S. and this undoubtedly acknowledges the importance of longitudinal studies in this field and their need for large scale resources. The list of contributors is very distinguished and the book provides a useful entree to many of the large scale studies concerned with understanding risk and protective factors for psychopathology. The five parts to the volume of which the first is introductory and the remaining four are roughly focused on different stages of development from preschool to adult life. Some chapters essentially provide reviews of findings of particular studies, as for example that by Sameroff and Seifer on the Rochester Longitudinal Study and that by Richters and Weintraub on the Stonybrook High Risk Project. Others also focus on particular major studies but provide more detailed findings of at least some aspects of those studies. For example, Nuechterlein and others describe findings from three studies on information processing that were themselves part of the final phase of the Minnesota High-Risk Studies investigating vulnerability factors and prodromal anomalies in schizophrenic disorders. On a different theme, children’s adjustment to parental divorce is examined in a project by Watt and his collaborators. Models or mechanisms are expounded either on the basis of more general review or the specific research of a particular group so that Ebata er al. put forward a model of adolescent developmental psychopathology and Patterson and Capaldi a mediational model for boys’ depressed moods. Rutter also draws on his own research but in characteristic fashion addresses more extensive theoretical issues, putting particular weight on the need to focus on protective processes rather than protective variables. There are an increasing number of publications concerned with developmental psychopathology and insofar as research findings are reported in this book they are often available elsewhere. However the extensive range of contributors ensures that this volume does indeed provide an entree to research into risk and protective factors, with the one proviso that it was originally published in 1990. The summaries of research of particular groups are necessarily frustrating if the reader wants original data but at least they can turn to the appropriate journals. Theorizing and the development of models is probably less strong, particularly with regard to protective factors as Rutter’s chapter and Garmezy’s closing note
163
Book Reviews
bring out. It is interesting to note also that the discussion of protective factors and processes is most highly evolved for infants and young children rather than adolescents and adults. Overall the somewhat piecemeal nature of this volume can be considered a weakness for those already well versed in the work of the various research groups but a strength for readers exploring the scope of the various major studies.
Guy’s
ANTONY D. Cox Dept of Child & Adolescent Psychiatry & St Thomas’s Medical and Dental School London
Alzheimer’s Disease: Advances in Clinical and Basic Research. Edited by B. CORRAIN, K. IQBAL, M. NICOLINI, B. WINBLAD, H. WISNIEWSKI and P. ZATTA. Chichester: John Wiley, 1993. Price f 110, $176. 633 pp. THIS book contains 73 ‘invited articles’ from Alzheimer’s disease researchers whose papers were selected from more than 550 presented at the Third International Conference on Alzheimer’s Disease and related disorders held in Padova in July 1992. The emphasis is almost exclusively on biological research, five pages being devoted to summaries of workshops on the roles of formal organizations and of the family in the provision of care for dementia sufferers. Despite intensive biological research activity, the burden experienced by many carers of Alzheimer disease sufferers has been little altered and much of the management of dementia involves the construction and delivery of social support packages. This volume would be more balanced in approach if some research on social and environmental factors in the management of dementia had been included. The general standard of contributors in this volume is high and the book is logically organized with sections on: diagnosis and biomarkers, epidemiology and risk factors, structural pathology, mechanisms of cell death, transmissible dementias, cellular and animal models, therapeutics (with emphasis on cholinergic approaches) and summaries of the two workshops mentioned above. Many of the contributions are, as might be expected, of a highly specialized nature and the reader is frequently assumed to have much prior knowledge which, for me at least, made some of the chapters heavy going. This book is a good, up to date, source for those with an interest in Alzheimer’s disease and should find a place in many libraries. In the copy submitted for review, pages 209-240 were duplicated and pages 240-273 missingpotential purchasers beware!
Consultant
The Lingering Malady: Price f6.50. 116 pp.
Anorexia
and Bulimia.
JOHN COLGAN in Psychiatry of Old Age Springfield Hospital London
JOAN PURGOLD. Edinburgh: JP Publishing,
1992.
DESPITE its front cover, which leads one to expect information about the outcome of anorexia and bulimia, this book is more a collection of personal reflections and reviews by a psychiatric social worker on certain aspects of her work. The author was for many years attached to the specialist eating disorder team in Bristol and was particularly involved with outcome research there. She has also co-authored a well-known book about the eating disorders. This book has been published posthumously in her memory and was prepared for publication by her friends. It is always difficult to review books which have been published in these circumstances, for their raison d’Ptre is different from that of other works. It is difficult, for example, to establish a target readership for this book. Much of the material is anecdotal and relatively unstructured, but it does presuppose a fairly sound knowledge of the eating disorders. The author clearly has a good knowledge of and a personal interest in these disorders and those who suffer from them, together with her own views about the usefulness of treatment approaches. However, these are presented in a rather erratic way, which makes it difficult to follow and to gain a clear picture of her thinking. Information from a welldocumented outcome study is juxtaposed with personal reflections on the interpretation of the data. To those of us involved in similar work, this is obviously of interest, but for others who are seeking to use this book for information, self-help or some sort of guidance as to how to help sufferers, there is little which could be of practical use. This mix between an objective, ‘scientific’ approach to anorexia and bulimia and a personal document is also highlighted by the intermittent references to research published