Psychological Medicine, 2000, 30, 231239.

Printed in the United Kingdom

# 2000 Cambridge University Press
Book reviews
The Autistic Spectrum: A Guide for Parents and
Professionals. By L. Wing. (Pp. 239; 16.95.)
Constable: London. 1999.
Aspergers Syndrome: A Guide for Parents and
Professionals. By T. Attwood. (Pp. 224;
12.95.) Jessica Kingsley: London. 1999.
Autism and Autistic-like Conditions in Mental
Retardation. By D. Kraijer (translated by
E. Saane-Hijner). (Pp. 451; $49.00.) Swets &
Zeitlinger: Lisse, Netherlands. 1999.
Adults with Autism: A Guide to Theory and
Practice. Edited by H. Morgan. (Pp. 312;
60.00 hb, 21.95 pb.) Cambridge University
Press: Cambridge. 1996.
I have heard it said, in autism circles, that any
new idea that researchers come up with can
actually be found somewhere in Professor Lorna
Wings writings over the past 30 years. Her
insightful thinking on all aspects of autism
certainly pregures many of the recent advances
in understanding this puzzling disorder. One
such insight is reected in the title of her recently
published volume, The Autistic Spectrum. This is
a fully rewritten version of her seminal 1970
book, Autistic Children: A Guide for Parents.
The change of title is signicant, and marks one
of the major changes in thinking in this area
over the last 10 years although one suspects
Lorna Wing had no need to change her thinking,
and has always understood autism as a disorder
with a wide spectrum of manifestations.
Recent years have seen a growing awareness
of the range of manifestations of the core
impairments that characterize autism. Autism is
a disorder of social interaction, but the form of
the impairment ranges from the totally aloof
child to the over-friendly adult. Autism is a
disorder of communication, but people with
autism range from utterly mute to verbose and
pedantic. Autism is a disorder characterized by
repetitive and restricted interests and activities,
but those interests range from spinning coins
and twiddling string, to learning bus time-tables,
to an obsession with astrophysics. This vast
range of qualitatively related diculties is
comprehensively covered by Wing, who never
lets the reader forget that the individual with
autismis an individual, while giving information
that will be useful across the whole spectrum. As
Wing mentions in her Preface, she is in the
somewhat unusual position of being both a
parent and a professional, and as such she has a
very special voice, a very special insight.
Wings book is divided into two parts, the rst
describing the nature of autism. Chapters in this
part cover the history of autism, diagnostic
issues (including her subgroups; the aloof,
passive, active-but-odd), as well as detailed
descriptions of the behavioural impairments in
social interaction, communication, and imagin-
ation and exibility. The second part, entitled
Ways of helping, gives practical advice on the
problems that attend autism throughout the
lifespan, and the services and professionals that
should be available to parents. It is this section,
in particular, that carries Lorna Wings auth-
oritative, compassionate and commonsensical
voice. This book is an honest, sensitive and
thorough introduction to understanding and
living with autism, and is to be highly recom-
mended.
One of the most fascinating aspects of the
notion of a spectrum of autistic disorders, is the
question often asked as to where autism
might merge into normality. This is a complex
question, and the answer depends upon whether
one is interested in the biological, psychological
or behaviour level of analysis. However, one
answer might be that the borderland between
autism and normality is the territory of
Aspergers syndrome. This diagnosis, intro-
duced into the ocial manuals in the early 1990s,
lies at the high-ability end of the spectrum.
Often referred to as mild autism, this adjective
is in fact misleading, since the degree of insight
and social interest that such individuals have
may render this disorder more distressing, in
some ways, than more severe autism. Aspergers
syndrome is currently diagnosed on the basis of
social impairments and repetitive and restricted
interests (as for autism), but without general
cognitive or language delay. This is highly
231
232 Book reviews
controversial, and the distinction so dened has
yet to receive systematic test. In particular, the
development of some children from a classic
Kanner-type autism (silent, aloof ) to an Asper-
ger-like adolescence (verbose, socially active but
odd) is not uncommon. Many individuals are
coming for diagnosis only in young adulthood
or later, and it seems likely that still more
individuals with this syndrome never reach
clinical attention; some may nd a successful
niche in academia, or specialized elds, others
may suer severe bullying, social isolation and
depression.
Tony Attwoods excellent volume Aspergers
Syndrome: AGuide for Parents and Professionals
provides a very readable and constructive in-
troduction to the disorder. Not only does it
cover the main features of Aspergers syndrome,
it is full of practical suggestions for how to
manage problems andcoachskills; fromlearning
to recognize and label own feelings (e.g. using
visual scales as concrete gauges), to nding ways
to limit or channel obsessive special interests
(e.g. compromises based on props such as
kitchen-timers). It has extremely useful chapters
on diagnosis, social behaviour, language, special
interests and routines, clumsiness, cognitive
factors and sensory sensitivities. The book
nishes with Frequently asked questions such
as Can the person with Aspergers syndrome
develop normal relationships? and What are
the long-term outcomes?. The characteristic
feature of Tony Attwoods writing is its humour
and warmth anyone who has heard him speak
will have felt the energy and positive attitude
with which he has encouraged and aided so
many parents and individuals with Aspergers
syndrome in his clinical practice in Australia.
There are valuable tips here for parents and
teachers, as well as clinicians. Indeed, the
practical advice, as much as the factual in-
formation, will give any interested reader a real
sense of the puzzling nature of Aspergers
syndrome and an insight into why this con-
dition is anything but mild for those struggling
to t into our socially-orientated world.
At the other end of the autismspectrum, those
individuals with autism and severe general
intellectual impairment are much neglected in
research. A volume on this topic is, therefore,
greatly to be welcomed. Autism and Autistic-like
Conditions in Mental Retardation, by Dirk
Kraijer (translated by van Saane-Hijner, E.) is
divided into three sections. The rst covers
dierential diagnosis of autism and mental
retardation (MR) and the relationship between
the two. The author suggests that at least 80%
of those diagnosed with autism also have an IQ
below 70 although this must depend on how
wide a spectrum of disorders receives the autism
label (versus Aspergers syndrome, for example).
Autism is also increasingly common as one
examines groups with increasingly lower IQ.
Part II reports the authors own research with a
population (393 children aged 014 years) in an
MR clinic in the Netherlands, describing the
children and comparing those with (35%) and
without an autistic disorder, and detailing
aspects of management and outcome. Part III
deals with diagnosis and prevalence and intro-
duces the reader to the authors diagnostic
instrument (PDD-MRS) which is included with
the volume (along with appendices on adminis-
tration). The volume also contains chapters on
rarely-discussed topics such as temperament and
autistic disorders in Downs syndrome. In a bold
concluding chapter, Kraijer argues against what
he considers to be ve fallacies; that inte-
gration\normalization is intrinsically good; that
institutions are necessarily worse than group or
home settings; that small institutions are always
better than large; that de-institutionalization is
invariably positive in eect ; and that institu-
tional care is necessarily more expensive than
community-based services. Some of these views
are likely to be unpopular with many readers
but, based as they are on the authors clinical
experience, they are views of which readers in
this area need to be aware.
The other area of autism that remains rela-
tively neglected, is the nature and needs of
autism in adulthood. Autism is a life-long
disorder, and though development of skills and
compensation certainly continues through life,
so do the needs. Autism was rst named in 1943
by Leo Kanner, and so the rst generation to be
diagnosed are only now reaching their 50s; we
still have a lot to learn. Hugh Morgans book,
Adults with Autism: A Guide to Theory and
Practice, tackles this area with invited con-
tributions from experts involved with services
for adults with autism in this country. The rst
three chapters describe services for adults in the
UK and worldwide. Subsequent chapters deal
Book reviews 233
with encouraging exibility (invited contribution
by Jordan & Powell), coping with transition and
bereavement, a study of visual cue processing
(Eve Matthews), support in a further edu-
cation college (Morgan, Edwards & Mason),
employment training and support in the
Gloucestershire Group Homes (Matthews),
health care (Wainscott & Corbett), psychiatric
and behavioural problems and pharmacological
treatment (Clarke), the role of perceptual and
learning style in challenging behaviour, and
practitioner training for residential settings.
Many of the chapters use vignettes very
eectively to illustrate and bring to life problems,
and some possible solutions. What emerges
clearly is a reminder that, not only do people
with autism have diculty reading our minds,
we also have diculty reading the signals they
give to know whether something is liked or
disliked, to interpret the function and signi-
cance of aggressive or self-injurious behaviour,
to see the signs of depression or bereavement.
Although the volume is rather light on the
theory mentioned in the title, it will certainly
be of value to all those working with adults
with autism, from managers to careworkers to
clinicians.
Adulthood introduces some new questions
and dilemmas for those working or living with
people with autism; is normalization always
appropriate for individuals whose preferences,
tastes and meanings may be so very dierent
fromwhat the rest of society (we neurotypicals)
consider normal ? How do we ensure that
individual freedomand choice is respected, when
dealing with an adult who may have great
diculty holding in mind several hypothetical
options? In childhood there is an assumption
that adults are allowed, by virtue of greater
experience and judgement, to make certain
decisions for the child (whether normally de-
veloping or not), and to insist on certain patterns
of socially-accepted behaviour. To impose such
decisions on another adult is much more
problematical, emotionally and morally. One of
the quandaries for parents, carers and clinicians
living with autism is to know how to strike a
balance between the rights of the person with
autism to have his or her own idiosyncratic
interests and preferences, and the need for that
individual to t into our world. Gary Mesibov,
founder of the inuential TEACCH programme
in America, sums this issue up nicely. He says
that, when visiting young people with autism he
is often told by teachers or parents, If John asks
you a question about his special interest ( What
bus did you come on? Whens your birthday?),
dont answer wait until he asks you something
appropriate before you respond. Professor
Mesibov says he sometimes likes to imagine the
individuals with autism saying to one another,
Next time your teacher asks you one of those
stupid repetitive questions, like How are you
feeling today? dont answer wait til they ask
you something sensible, about train timetables,
or dates. These four books show us, in their
very dierent ways, how autism challenges us to
understand a very dierent view of the world,
and to question our own socially-agreed per-
ceptions.
rr:Ncrsc: n:iir!
Phantoms in the Brain. By V. S. Ramachandran
and S. Blakeslee. (Pp. 328; $27.00.) Morrow:
New York. 1998.
This sparkling book deals mainly with the
phenomenology of a variety of neurological
conditions such as phantom limbs, anosognosia,
denial, visual neglect, the Capgras and Charles
Bonnet syndromes, the types of religious think-
ing associated with left temporal lobe disorders
and others. Ramachandran has made notable
contributions to our knowledge of the clinical
neurology of these and other syndromes, in-
cluding the cortical plasticity revealed by his
studies of phantom limbs and the phenomenon
of lling-in of scotomata. This work has
already provided practical benets in the form
of an eective new way to treat (and prevent)
phantom limb pain.
What makes this book unique is that, unlike
most previous researchers in this eld, he is not
content with clinical descriptions, excellent as
these are in the tradition of Weir Mitchell and
MacdonaldCritchley, or withhumanized clinical
accounts in the style of Oliver Sacks, but he also
turns a penetrating intellect onto the question of
the possible causes of these unusual experiences.
In the past these phenomena were usually
dismissed as delusions. However, they also
present a method of enquiry into the basic brain
mechanisms involved, which Ramachandran
skillfully exploits by developing a series of
234 Book reviews
specic hypotheses. These hypotheses are in part
derived from Freudian theory, but not in the
way the psychoanalysts did. For example, his
explanations of such phenomena as unilateral
neglect and anosognosia involve the same
mechanisms denial, reaction formation,
repression, projection and confabulation
that Freud developed from his study of hys-
teria. The theoretical framework that Freud
developed was a purely psychological one. In
Ramachandrans hands they became neurologi-
cal concepts to describe basic brain mechanisms,
involving particularly the dierential function of
the two cerebral hemispheres.
In a similar fashion Ramachandran takes the
subject of the varieties of religious experience
manifested in cases of left temporal lobe dys-
function a step further from where William
James left it a century ago. Description is not
enough, we need to understand as well. In
searching for the brain mechanisms that may
contribute to these phenomena he adds a ne
poetic sensitivity to his clinical and scientic
acumen.
This book lies directly in the area of clinical
neurology but it is also very relevant to
psychiatry. Although there is a strong emphasis
on temporal lobe epilepsy and only a passing
reference to schizophrenia, nevertheless the type
of explanations he develops for the former also
spill over into considerations of rational
explanations of the latter. For example, schizo-
phrenics commonly complain that some external
agency is controlling their thoughts. In our
culture this external agency is usually identied
with such bodies as the CIA using some
mysterious rays. In other cultures magical
inuences are blamed. In reality there may be an
external agency but it is may be a disorder in
some brain mechanism, such as the corpus
striatum, that does indeed interfere with the
normal orderly conscious processes of thought.
Ramachandran includes a segment on multiple
personality disorder along these lines.
The book concludes with a look at some basic
philosophical issues including a discussion on
the nature of the self, or rather selves, as he
distinguishes many aspects of the self the body
image, the passionate self, the mnemonic self, a
conceptual or social self on Heideggerian lines
and a unied self. In the tradition of classical
Western philosophy there are two dierent views
of the self. David Hume denied that there is any
such entity as the self on the grounds that,
whenever he searched around in his conscious-
ness for a Self he could never nd one, only his
own sensations, images and thoughts. Kant
replied to this with the comment that Humes
self was that which was doing this searching. In
contrast, Berkeley said Howoften must I repeat,
that I know or am conscious of my own being;
and that I myself amnot my ideas, but somewhat
else, a thinking active principle that perceives,
knows, will and operates about ideas. I know
that I am therefore one individual principle,
distinct from colour and sound; and, for the
same reason, free from all other sensible things
and inert ideas.
However, against a global background, this
same debate took place many centuries earlier in
India. Buddha denied the existence of a personal
self, whereas the anonymous writers of the
Upanishads the most penetrating psychologi-
cal texts in the religious tradition ever written
asserted not only that a person has a personal
self, the atman, but also that the atman is part of
a greater transcendental reality called Brahman.
In our century Russell Brain, who was not only
a great neurologist but a skilled philosopher as
well, gave his opinion as follows: there must
be a self, which is in some way independent of
particular thoughts, feelings and memories, and
that being conscious of these involves experi-
encing themin relation to this fundamental self .
In conclusion, in this reviewers opinion, this
is the best book on this topic since Paul Schilders
two great classics written half a century ago. It
is very well-written and succeeds in one of the
most dicult of all literary tasks how to write
a book on a technical subject that will prove
equally readable to the intelligent general public,
to poets, artists and philosophers and to pro-
fessionals in the eld itself. To this easy ow the
co-author Sandra Blakeslee of the New York
Times makes a notable contribution.
. r. sx.1ni rs
Organic Psychiatry, 3rd edn. By W. A. Lishman.
Blackwell Science: Oxford. 1998.
The production of a new version of this best-
selling single-author book in each of the last
three decades is a remarkable achievement by
Book reviews 235
Professor Alwyn Lishman. In the forward to the
1978 edition of Organic Psychiatry, Denis Hill
wrote The appearance of this work at the
present time comes to ll a much required need.
There is no comparable book in the English
speaking world. Twenty years on this statement
is still true. Psychiatrists with specialist interests
in neuropsychiatry or the psychiatry of old-age
value this book because of the in-depth coverage
of the ever expanding forms of dementia and the
more rare forms of neurodegenerative disease.
However, many general psychiatrists also pos-
sess this book. Because it is the most com-
prehensive account of how medical illness in the
form of vascular disease, endocrinopathy, meta-
bolic disorder or vitamin deciency presents
with psychiatric symptoms, it gives a sense of
security in the knowledge that if a patient
presents with an unusual mental state or with
deranged blood results, one can check with
Lishman lest a medical diagnosis is missed.
Perhaps more important, however, is that it is
written in a style that accurately reects the man
in practice. No facet of any disorder, biological
or psychological, is ignored and each is brought
to bear when dierential diagnoses and prog-
noses are considered. Thus, having this textbook
on your shelf is not a bad substitute for a
personal consultation. Many a time have I seen
a patient on a medical ward, written an
authoritative opinion and then returned to my
oce to pore through Lishman.
The third edition keeps to the format of the
second. The rst four chapters are dedicated to
clinical assessment and dierential diagnosis.
The remaining 11 chapters cover individual
disorders, grouped into common themes. Each
section has been expanded to incorporate ad-
vances over the last decade. For those who are
already in possession of the second edition, it
would be worth investing in the third because
these additions are substantial. For example,
useful summaries of relevant ndings from the
recent explosion in neuroimaging and molecular
biology research are integrated with global
considerations of the various disorders, some-
thing that is generally not available in journal
articles. Furthermore, there are new areas of
study covered in this edition including: chronic
fatigue syndrome, eects of ecstasy abuse, HIV,
Lewy-body dementia, frontal lobe dementia and
prion diseases.
The inclusion of chronic fatigue syndrome,
however, seems odd. This is because there is, as
yet, no universally accepted biological abnor-
mality underlying the disorder, a consideration
that has presumably led to the exclusion of other
putative organic disorders such as schizophrenia.
This, of course, touches on the question of
whether the distinction between organic and
non-organic has any value in modern psychiatry.
In his preface to the 1978 and 1987 editions,
Professor Lishman strongly defends his stance.
Whereas the biological approach can be used to
study most psychiatric disorders, he suggests
that the provenance of organic psychiatry should
be restricted to disorders of cerebral function
which are indubitable and well established. In
his preface to the current edition, he concedes
that the distinction between organic and non-
organic is becoming more blurred and may
become obsolete with further advances in neuro-
science research. However, he argues that the
distinct concept of organic psychiatry is still
valid if it applies to those disorders in which
examination and investigation will uncover some
cerebral or systemic pathology responsible for,
or contributing signicantly to, the mental
condition. Of course it could be argued, for
example, that cerebral pathology in the form
ventricular enlargement can be revealed by
investigation in schizophrenia. But this nding
is not clinically useful. Intrue organic conditions,
pathological ndings inuence management
considerably. To incorporate accounts of any
psychiatric disorder in which there is evidence of
neurobiological dysfunction would diminish the
great strength of this book, which lies not only
in the comprehensive account of organic con-
ditions but also in its direct relevance to everyday
clinical practice.
ri irrN o.cr
Disorders of Brain and Mind. Edited by M.
Ron and A. S. David. (Pp. 386; 55.00.)
Cambridge University Press: Cambridge.
1998.
What is neuropsychiatry? Professor Alwyn
Lishman, to whom this book is dedicated, has
more than anyone, dened the subspeciality, in
specic terms (reference), also in his authori-
236 Book reviews
tative book Organic Psychiatry (now in its third
edition) and in the legacy of his clinical practice.
There may be those who will ask whether
anything further needs to be said, until the
fourth edition, that is. This book, Disorders of
Brain and Mind, at a slightly hefty 55, not only
marks Professor Lishmans retirement, but also
attempts to illustrate clinically relevant points of
convergence between brain and mind. It explores
cutting-edge science and the experiences of
seasoned clinicians in a way that will facilitate
the cross-pollination of brainless psychiatry and
mindless neurosciences, hopefully without pro-
ducing mindless and brainless neuropsychiatry.
Inevitably, with such a superhuman task,
there are successes and failures here although
mostly there are worthy attempts to summarize
the current, often limited, state of the art. Thus,
there are lists of neuropsychological decits and
brain circuits. There are also reams of references
in some chapters indeed, one has to question a
chapter of 27 pages with 12 packed pages of
references concluding that dopaminergic neuro-
transmission has a signicant role in cognitive
function. Perhaps it is better to travel hopefully
than to arrive but is this much eort really
worth the destination? Thankfully, not all
chapters are so overloaded with minutiae (the
chapters on memory and its disorders are
particularly successful here) but this book tends
to give an impression of a subspeciality, which
doth protest too much that it is scientic and
technologically sparkling. In truth, it is a subject
which, primarily, is clinically fascinating to
everybody who is interested in the proper study
of man, yet very little of this book stimulates the
reader with that sense of enthusiasm. There are
worthy chapters on the frontal lobes, the basal
ganglia, brain diseases and imaging usefully
brought together as summary reviews for those
who will read the book, but few chapters really
capture the clinical or scientic imagination.
Some do, the developmental perspective on
schizophrenia is a helpful, wide-ranging and
thought-provoking chapter, epilepsy, biology
and behaviour are interestingly explored and the
two chapters on memory and its disorders are
just what the book sets out to achieve, they are
clinically relevant, cutting-edge and illustrative
of mind\brain interaction.
Thus, it ends up, perhaps inevitably, being a
bit of a curates egg; indisputably excellent in
parts yet drawing attention again towards the
beautifully prepared and completely fresh piece
of academic work that Professor Lishmans
Organic Psychiatry remains.
. x. ni rb
REFERENCES
Lishman, W. A. (1992). What is neuropsychiatry? Journal of
Neurology, Neurosurgery and Psychiatry 55, 983985.
Lishman, W. A. (1998). Organic Psychiatry, 3rd edn. Blackwells:
Oxford.
Comprehensive Clinical Psychology. Edited by
A. S. Bellack and M. Hersen. (11 Volumes; pp.
6243; 2445.65\$3495.) Pergamon Elsevier:
Amsterdam. 1998.
I must begin this review by describing my
reaction to this set of eleven edited volumes. I
had been asked to reviewthemon condition that
they could be donated to the Institute of
Psychiatry library, and I instantly regretted my
decision. The books are beautifully produced
and have a lovely feel to them. Holding them,
you feel that you have acquired an invaluable
reference. Alexander and Roberts, in their
discussion of information sources in psychology,
note, quoting Boswell Knowledge is of two
kinds. We know a subject ourselves, or we know
where we can nd information upon it.. That is
clearly where this series will have its main use, as
a guide to researchers and clinicians to nding
up-to-date information on a variety of subjects.
The layout of the volumes is clear and easy to
use, and each chapter is divided into numbered
sections, with a table of contents for each.
Furthermore, the last volume is a comprehensive
index to the set as a whole. Thus, anyone who
needs an instant introduction to a particular
question can easily nd it in one of the volumes,
and can then use both volume index and over-all
index to seek additional references throughout
the set.
The editors of the individual volumes, and the
authors of particular chapters, read like a role
call of major names in psychology. It is also
pleasing to see that the emphasis is international
rather than particularly American. Similarly,
the authors attempt to approach all aspects of
psychology, considering biological, neurologi-
Book reviews 237
cal, psychological and sociological factors when-
ever possible. The volume on adult clinical work
seemed to be a natural one for me to look at,
and the coverage in the dierent articles was
excellent : for example, I am involved in a
project looking at CBT with bipolar patients,
and sure enough, some information on this
relatively obscure topic appeared in the chapter
on aective disorders, along with discussions of
biological, psychological and social factors.
Granted, this same information could probably
be found in a book or review article, but the
other volumes also cover topics that might be
harder to research, such as the historical
background to dierent topics or professional
practice in dierent countries. I was especially
pleased to see two volumes devoted to special
populations, touching on such issues as gender,
race, sexual orientation, disability and other
social factors. In sum, this seems to be an
excellent general reference set, invaluable for
any library. For the individual practitioner it
could certainly also be useful, especially if he or
she does not have access to a good library, but
I would have thought that these volumes are
best suited to institutional use, especially given
their rather hefty price tag.
ir1rr n:.v:rb
Historical Dimensions of Psychological Dis-
course. Edited by C. F. Graumann and K. J.
Gergen. (Pp. 284). Cambridge University
Press: Cambridge. 1996.
The aim of this collection of essays is both
laudable and of signicant interest. As the
editors introduction makes clear, they seek to
use historical analysis as a way of expanding our
understanding of what are often taken to be
psychological realities. The mind is commonly
treated as if it were an entity, while thoughts,
emotions, beliefs and desires become actual
phenomena. Yet we cannot be sure that this is
the case. The mind and its so-called contents
may simply be constructs, ways that our culture
has sought to analyse everyday psychological
experiences. This volume of essays attempts to
place psychology in its wider context by using
post-empiricist history to consider ideological
investments, distributions of power and privi-
lege tomake a contributionto cultural meaning
systems. The editors ambitiously attempt to
free the disciplinefrom the grasp of everyday
scientic or cultural objectivity, and to use
history not as a repository of moribund
artefacts but as the major context for
reexivity and emancipation. Contributors
have spread their net wide from emotions to
cognition, child development, psychotherapy,
gender dierences and knowledge, together with
two rst-hand accounts of historical change in
psychological movements: one on the theme of
emancipation and the other on transcendental
power.
Individual papers explore the evolution of
psychological tests and other investigative
methods, the discovery and importance attached
to new research tools (notably statistics), the
selection and descriptions applied to emotions,
the use of psychological terms in relation to the
psyche, and the ways in which beliefs about
gender have dened and evaluated emotions. An
analysis of psychology textbooks sheds light on
howboth authors and readers viewed themselves
in relation to the guardianship of knowledge.
The ways in which mental disorders have been
conceptualized and the treatments oered are
related to social constructs, while the link
between motherhood and child development is
discussed from the medieval period to the
present.
Multi-disciplinary approaches have often been
responsible for generating new ideas. It is
curious, however, that a collection designed to
employ historical methods, does not contain a
single paper written by an historian. Indeed, the
use of technical terms makes parts of the text
dicult to follow by the uninitiated reader, and
there is much of interest to historians in these
essays that they may struggle to comprehend. A
thoughtful paper by Nikolas Rose asks how
should we do the history of psychology? though
his bibliography contains virtually no references
to the considerable literature on historical
methodology. Hence, the collection is largely a
psychological, anthropological and sociological
discourse that tackles important questions but
ventures into the past with varying degrees of
success, perhaps because the complexities and
values of historical research have not been fully
absorbed.
rbc:r oNrs
238 Book reviews
Outcome and Innovation in Psychological Treat-
ment of Schizophrenia. Edited by T. Wykes,
N. Tarrier and S. Lewis. (Pp. 291; 17.99.)
John Wiley: Chichester. 1999.
The preface tells us that the idea for this book
arose from a conference in Cambridge in
September 1995 and this origin rather shows in
the varied contents of its 14 chapters and the
lack of a cohesive theme. It must have been
rather dicult to choose a title for the book and,
indeed, the title is not altogether an accurate
reection of the contents. There are chapters on
behaviour therapy, cognitive behaviour therapy
and cognitive remediation, but there are also
chapters on neuropsychology, depression and
suicide, delusional beliefs, and compliance with
medication, which are more concerned with
basic research and which discuss treatment only
in cursory ways, if at all.
What does one look for in a book of edited
chapters? If you specialize in the eld addressed
by the book, either as a researcher or as a
clinician, then you probably do not expect to
learn a great deal that is new, though it is usually
a pleasure when you nd that one or more of the
authors have taken the opportunity to develop
ideas or to present data that have not already
been published. However, you probably expect
to nd useful, up-to-date summaries of bodies of
research, which you can use for teaching and for
your own reference. This book largely fulls the
second of these expectations though even here
there are disappointments. For example, the
chapter on biobehavioural therapy, by Robert
Liberman and his colleagues, is almost wholly a
summary of two articles that were published in
the American Journal of Psychiatry before 1995.
The chapter by Brenner and Pfammatter pro-
vides a largely narrative summary of research on
the ecacy and cost-eectiveness of psycho-
logical treatments for schizophrenia but the
value of such a summary pales in comparison
with recent meta-analyses on the same topic.
The rst hope, that authors will take the
opportunity to present novel material, is largely
unfullled, though one notable exception is the
chapter by Richard Bentall and Peter Kinder-
man, on psychological processes and delusional
beliefs, which presents a concise and coherent
account of a large body of research on perceptual
abnormalities, decits in probabilistic reasoning,
biases in information processing, attributional
abnormalities, and self-representations, and
then proceeds to develop novel speculations,
which combine research on externalizing attri-
butional biases with research on impaired
information-processing capacity, especially
theory of mind decits, in a single aetiological
model.
If, on the other hand, you are new to the eld
and wish to get to grips with it then this book is
highly recommended. Its various chapters pro-
vide reasonably up-to-date summaries of most
of the published research that is most relevant to
psychological treatments for schizophrenia, in-
cluding research on basic psychological pro-
cesses, instruments to assess outcome, training
in psychosocial interventions and economic
evaluation, as well as research on the eective-
ness of the treatments.
xi ir s1:r1ii
Seminars in Psychosexual Disorders. Series
Editors: H. Freemand, I. Pullen, G. Stein and
G. Wilkinson. (Pp. 216; 15.00.) Gaskill\
Royal College of Psychiatrists: London. 1998.
Treatments for erectile dysfunction are con-
stantly in the news with the advent of oral
phosphodiesterase inhibitors such as sildenal
(Viagra). This book is, therefore, very timely. Its
aim is to educate junior doctors during their
training years and to make a contribution to the
continuing professional development of estab-
lished clinicians. It reects the current pre-
occupation of the age by beginning with a
description of the neuroendocrine basis of
sexuality and sexual dysfunction. It continues
with chapters on gender development, child sex
abuse, paraphilias and transgenderism. There
are also chapters on individual and couple
therapy and a fascinating discussion of the
management of sexual behaviour in mental
health facilities. An account of the history of
sexology focuses on male sexual behaviour since
the middle of the nineteenth century.
Covering such a large eld inevitably leads to
many omissions. There are no specic contri-
butions on the psychosexual side-eects of
prescribed or illicit drugs, sexual function in the
elderly, puberty and sexual expression in ado-
lescence, sexual function in the disabled or
Book reviews 239
physically ill, responses to sexual assault of
adults, sexual problems in lesbians and gay men
or issues for people from ethnic minorities.
Surprisingly, there is no mention of the de-
velopment of sildenal, which must have been
underway when the manuscripts were written. It
shows up the inevitable weakness of textbooks
containing chapters written some time before
publication. Even in a fairly slow-moving eld
such as this one, books can be suddenly outdone
by a new and important development. Never-
theless, this is a useful, brief introduction to the
eld of psychosexual disorders that goes well
beyond the types of patients referred to general
sexual therapy clinics. There is much of interest
here for trainees. It is relevant not only to the
examinations they face but also to an under-
standing of the background to sexual treatments
in psychiatry.
xi cn:ri ii Nc
The Rise of Psychopharmacology and the Story
of the CINP. Edited by T. A. Ban, D. Healy
and E. Shorter. (Pp. 448.) Animula Publishing
House\Collegium Internationale Neuro-
Psychopharmacologicum: Budapest. 1998.
This book, which is published by the Collegium
Internationale Neuro-Psychopharmacologicum
with nancial help from the pharmaceutical
industry, consists of a collection of brief
reminiscences written by people who were
involved in the development of psychotropic
drugs between the 1950s and 1970. For those
who have read The Psychopharmacologists, the
transcripts of interviews with the same sort of
characters, this volume may be something of a
disappointment. The wealth of interesting and
pertinent historical detail, which was gleaned
during the exploration possible in a well-
conducted interview, is not available in these
brief written accounts. There are some
interesting morsels, however. As in the inter-
views, most of the contributors allude to the
great enthusiasm and excitement of the era.
Their faith in the progress achieved is unabated
by subsequent more equivocal research ndings.
Some however express reservations, both about
the progress that has been made in drug
treatment and the direction of methodology in
research. Concerning the mechanism of action
of antidepressants, for example, Marcel Bickel
recalls telling his students a dierent story or
hypothesis almost every year. The book is
worth a look for those interested in the history
of this area, but unfortunately it is not greatly
enlightening.
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