Oxford Textbook of Women and Mental Health

The British Journal of Psychiatry (2011) 198, 160–164 Book reviews Edited by Allan Beveridge, Femi Oyebode and Rosalind Ramsay Contemporary Directions in Psychopathology: Scientific Foundations of the DSM–V and ICD–11 Edited by Theodore Millon, Robert F. Krueger & Erik Simonsen. Guilford Press. 2010. US$85.00 (hb). 636pp. ISBN: 9781606235324 and empiricists, who reject these assumptions, and seek to make connections between observable phenomena. For them, validity refers not to whether a disease is really there, but to what kinds of inferences one can make about a patient on the basis of a particular diagnosis. The differences between these fundamentally different approaches to classification echo throughout the volume. Many of the papers by psychologists clearly take the latter approach, for example those by Krueger’s group on the metastructure of the diagnoses produced by the DSM–IV system. Yet unless the metastructure can be radically simplified the comorbidity problem is insoluble, and rival working groups will jealously hold on to their symptoms. The editors do not attempt to draw any general conclusions at the end, and indeed it would be impossible to do so. David Goldberg Health Service and Population Research, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. Email: david.goldberg@iop.kcl.ac.uk doi: 10.1192/bjp.bp.110.082602 The present volume contains 30 chapters by a variety of experts, dealing with conceptual issues that need to be considered in preparation for the next revision of our classifications. The great change in psychiatric classification came with DSM–III, which consisted of 265 mental disorders and replaced clinical descriptions – where the task of the clinician was to recruit the patient to the nearest description – with the Chinese menu, now familiar to us all. Lee Robins pointed out that the rule laid down was that any given symptom could only appear in one disorder. She concluded: ‘I thought then, and I still do, that the rule was not a good one, because it deviates from the practice in the rest of medicine, where many diseases share symptoms’ (p. 268). Thus, although previously anxious symptom had been seen as an integral part of what was then ‘neurotic depression’, anxiety now had to be reassigned to anxiety disorders. Sadly, the arbitrary diagnostic rules built into our classification systems impose tunnel vision on many clinicians, who tend to reify the disorders described and no longer appear to notice symptoms which are there before them. Since then, successive versions of the DSM have added 89 new disorders, and abandoned diagnostic hierarchies, so giving birth to ‘comorbidity’. Recently work has been divided into topic groups, but ‘each working group was reluctant to give up their rights to a particular domain, even when it might have been better categorised elsewhere’ (p. 61). When the American Psychiatric Association began to consider changes in preparation for DSM–V the problems seemed to be that many patients were found to have multiple comorbidity, that many more were diagnosed as ‘not elsewhere classified’, and that the categorical dichotomies of the DSM system might be supplemented by a dimensional system to allow various degrees of severity of a disorder to be recognised. Ortigo and others argue for a prototype diagnostic system, where each diagnosis would be rated on a 5-point scale, ranging from a poor to a perfect match to a prototype (p. 377). Maj (p. 263) considers two questions, whether mental disorders are really as common as community surveys suggest that they are, and whether comorbidity can really be so common. He argues that there can be no firm answer to the first problem, and makes cogent objections to the latter. Zachar & Kendler (p. 127) distinguish between ‘disease realists’, who consider that there are qualitative differences between true diseases and normality, between which Nature has beneficently provided joints, 160 Psychotherapy Is Worth It: A Comprehensive Review of the Cost-Effectiveness Edited by Susan G. Lazar. American Psychiatric Publishing. 2010. US$60.00 (pb). 359pp. ISBN: 9780873182157 Like a well-known cosmetic advert, this book makes psychotherapy beautiful: a book that proves we are worth it! As in all slogans there is some truth mixed with spin. The book is divided by diagnosis and most chapters follow a logical format. Why is the condition important? For example, Rosenblatt states that anxiety disorders are ‘one of the most expensive disorders’, accounting for 31% of mental health costs at US$46.6 billion in one year. This makes a compelling argument that mental health desperately needs cost-effectiveness studies. But there is too little on the quality criteria for health economics papers to allow readers to critique the studies effectively. The methodology is basically a simple search strategy plus literature reviews. Here is where the promise is more than the reality: the authors simply use ‘cost’ as a principal search term and produce lots of studies about the overall costs of disorders with estimates of cost reduction. There are very few studies using established methodologies to assess cost-effectiveness. The best studies are summarised with tables to allow comparisons. The sting is often in the tail, for example in the conclusions to the anxiety chapter: Although there are increasing data that specifically measure the cost-effectiveness of psychotherapy for the anxiety disorders, a strong case can be made . . . simply by considering the available data documenting the high costs of these illnesses and data indicating the cost of effective treatment. (p. 116) Book reviews Given the book’s subtitle, such an inexhaustive approach is disappointing but perhaps inevitable as we know already there are not enough health economics studies to fill a whole book. Nevertheless, this is a good compendium of research and is generally up to date. The discussions have a strong US bias, but unlike many books of this type there is a reasonable coverage of non-American studies. The emphasis on diagnosis, however, limits the book too much, although a good chapter on medical conditions mitigates this. For anyone trying to convince service commissioners that non-drug treatments are effective this book is invaluable. It argues cogently that psychotherapy can be cost-effective, but that is a big step from saying that it always will be, as cost-effectiveness depends crucially on how a service is delivered. Frank Margison Consultant Psychiatrist in Psychotherapy, Manchester Mental Health and Social Care Trust, Gaskell Psychotherapy Centre, Swinton Grove, Manchester M13 0EU, UK. Email: frank.margison@mhsc.nhs.uk doi: 10.1192/bjp.bp.110.084442 Despite these few shortcomings, this book will provide a solid reference source which can confidently take its place next to its more established rivals. Floriana Coccia Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry Centre, 25 Vincent Drive, Birmingham B15 2FG, UK. Email: floriana.coccia@yahoo.co.uk doi: 10.1192/bjp.bp.110.080200 Chronotherapeutics for Affective Disorders: A Clinician’s Manual for Light and Wake Therapy By Anna Wirz-Justice, Francesco Benedetti & Michael Terman. Karger. 2009. US$48.00 (pb). 116 pp. ISBN: 9783805591201 Psychiatry: An Evidence-Based Text Edited by Basant K. Puri & Ian Treasaden. Hodder Education. 2009. £125.00 (hb). 1323pp. ISBN: 9780340950050 This is the newest addition to the standard texts for trainees preparing for the MRCPsych examination in the UK and Ireland. The breadth of topics covered is impressive and includes a history of psychiatry, basic psychology, statistics, neurosciences (including neuroimaging and anatomy), mental disorders, and medical and psychological management. The book touches on clinical specialties, management of mental health services and legal and ethical aspects of psychiatry, as well as subjects infrequently covered in other texts: emergency psychiatry, chronic pain and palliative care. Some of the chapters are supplemented with a reading list. The book makes abundant use of tables, images and summary boxes. The sections on basic psychology and psychological therapies are likely to be sufficient for those preparing for the MRCPsych exam. This may sweeten the pill of the hefty price tag and obviate the need for additional textbooks. In the chapters covering mental illness, common pathologies are covered alongside the less common ones: psychosexual disorders and paraphilia. The sections on functional disorders are extensive and, rather perturbingly, the chapter on multiple chemical sensitivities is considerably longer than the one on schizophrenia. The ICD–10 and DSM–IV criteria are provided for some disorders but omitted in others. This may prove frustrating to those preparing for exams who wish to have all the relevant information to hand. This book has three stated aims. The authors present the theory behind chronobiological treatments for affective disorder, document evidence of their efficacy and provide a step-by-step guide to clinicians as to how these therapies might be implemented. My main criticism of the book is that the balance between these three areas may not be optimal. Manuals should probably instruct readers in how to do something rather than explain in depth why they should do it. However, whereas the guide to the implementation of chronotherapeutic techniques is detailed, the theory underlying these techniques merits expansion and I felt that evidence for their effectiveness was significantly lacking. For example, the efficacy of bright light treatment for non-seasonal depression is affirmed in fewer than 100 words, with only two references. In some European countries, chronotherapeutics are quite widely used and in Milan it is apparently routine for in-patients on medication for non-seasonal depression to receive light therapy and a single session of late-night wake therapy at the start of treatment. By contrast, in the UK, the authors would be preaching chronotherapeutics to the unconverted; most psychiatric professionals will need to know why they are using a treatment, not least because they might be asked by the patient. Despite these criticisms, I found the book to be useful and engaging. It is well written and elegantly illustrated and it links to an informative website (www.cet.org) for the Center for Environmental Therapeutics, a non-profit agency dedicated to education and research in environmental therapies. The difficulties inherent in researching and promoting such therapies, in contrast to the international resources of the pharmaceutical industry, are noteworthy. Most psychiatrists will have patients with unipolar or bipolar depression who are resistant to other treatments and this book may help to see them, literally, in a different light. There is a very useful level of detail about light therapy, including ways of estimating the best time of day at which it can be prescribed, since this varies between individuals. Helpful illustrative schedules are 161 Book reviews given for using light therapy alone, wake therapy plus light therapy and wake therapy plus light therapy plus sleep phase advance. There are informative sections on the use of melatonin and the practicalities of light therapy, including recognition that motivated and knowledgeable night nurses are required to competently implement some of the chronotherapeutic techniques with in-patients. Overall, I feel that clinicians who work with patients with affective disorders should gain new and significant insights from reading this book. John M. Eagles Consultant Psychiatrist, Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH, UK. Email: john.eagles@nhs.net doi: 10.1192/bjp.bp.110.080176 disorders and women with intellectual disabilities. I was surprised not to find a section on the mental health difficulties and challenges faced by older women. I support the arguments of this book; it highlights, from a multidisciplinary perspective, some of the essential issues facing women in the context of their daily lives and how these issues relate to their mental health. I welcome an approach that considers women’s different roles as carers, parents, workers and partners. Overall the chapters were succinct, well written and comprehensive. I accept that no book can cover all areas of such a broad topic, but in parts the coverage was lacking. If you expect a ‘practical’ text focused on service delivery, then you will be disappointed but if you accept that this is not a practical guide, then this book is a noteworthy addition to the literature. Fiona L. Mason Consultant Forensic Psychiatrist and Deputy Medical Director, St Andrew’s Healthcare, Billing Road, Northampton NN1 5DG, UK. Email: fmason@standrew.co.uk Oxford Textbook of Women and Mental Health Edited by Dora Kohen. Oxford University Press. 2010. £75.00 (pb). 352pp. ISBN: 9780199214365 doi: 10.1192/bjp.bp.110.082628 Schizophrenia: Who Cares? By Tim Salmon. Artaxerxes Press. 2010. £12.00 (pb). 178pp. ISBN: 9780956507006 I wanted to like this book; I knew and respected Professor Kohen although I did not always agree with her. Healthy debate has, however, always formed an important part of the Royal College of Psychiatrists’ Women in Psychiatry Special Interest Group, to which Professor Kohen brought her extensive intellect and unique perspective. The book is advertised by the publisher as including chapters by leading experts in their respective fields providing ‘the most authoritative information available’. There are contributions from academics in Canada, England, India, Ireland, Switzerland and Turkey. Some are indeed leading experts; however, others are not and despite their best efforts in some chapters this shows. Although I enjoyed reading many of the chapters, I found the overall structure of the book rather confused. Part 1 focuses on ‘Fundamental aspects: women and mental health’. This was an enjoyable section covering issues such as stigma, violence and ethnicity. I was pleased to see a chapter on lesbianism and mental health, an area much neglected in contemporary research despite the health inequalities experienced by lesbians. I particularly enjoyed the useful introduction to biological sex differences relating to mental health, but was disappointed that this was not followed up with specific coverage of gender differences in prescribing (although this was actively considered in the section on intellectual disability later in the book). I found Part 2, ‘Clinical aspects: women and mental health’, less coherent. Under the heading of mental illness a number of disorders such as anxiety, depression, borderline personality disorder and schizophrenia are considered, yet post-traumatic stress disorder is not; this was addressed as a ‘special clinical topic’ in Part 3. There is a specific section on perinatal psychiatric disorders and, importantly, parental psychiatric disorders are also considered. Specific focus is also given to substance misuse, eating 162 I found this book to be a bit of a long gripe at times, but nonetheless a salutary one. Before embarking on it I kept in mind three questions: Will it provide comfort/advice/guidance to other carers? Will it make mental health professionals more aware of the plight of the carer? Will it offer insights on what carers actually need in terms of support? The answer to all three questions is yes, in parts. The book relates a 20-year history of a father not only struggling to come to terms with his son’s schizophrenia, prompting guilty, soul-searching questions, but also having to cope with the idiosyncrasies of the caring system, which apparently often failed both him and his son. Father deserves admiration for the courage, resilience and sheer utter resolve not to abandon a son in distress, even when he behaved in an appalling, bewildering and risky manner, living between the extremes of ‘constant worry, increasing anxiety and heart-inmouth horror’. Salmon describes the incomprehensible institutional routines, the Kafkaesque bureaucratic system, constant changes in policy and personnel, and the ‘impersonal system of care’, which fails to take into account the inability of a person with a mental illness to navigate its forms and procedures, constantly fails to deliver despite good intentions and high-sounding but empty rhetorical words (consultation, empowerment, normalisation, accessibility, flexible pathways, Book reviews well-being agenda, therapeutic optimism, preventing revolving doors, early intervention, social inclusion) and, in the words of the author, all that ‘brouhaha’. More often than not he was left having to do all the provision himself. In terms of ideas helpful to services Salmon does offer some insights. He stresses the need to involve carers more effectively when drawing care plans that are feasible and implementable, an awareness that people with schizophrenia are particularly sensitive to defensiveness, insincerity or discomfort in staff and more likely to react in a violent or bizarre manner when faced with uncaring professionals, and the need for straight and frank communication when establishing a prognosis and therapeutic hopes. Although at times I was uncomfortable at his comments expressing a hint of resentment against other ‘creeds and races’ (both patients and staff) who often populate admission wards and poor estates, and the deference he showed the medical profession as opposed to other mental health workers, I do agree with the overriding message that we have a long way to go to work alongside carers in a mutually sharing system of care. I would recommend this book for care coordinators and those interested in more responsive and engaged services. pleasurable, utilise escape or avoidance behaviours which service to keep them stuck in a rut, such as shutting themselves away in their room and not answering the phone; pull away from their world and potential sources of antidepressant reinforcement, and as a consequence feel more down. Behavioural activation really works, as the authors have demonstrated in their research, and there is evidence that it is as effective as ‘full’ cognitive–behavioural therapy. It is now in the National Institute for Health and Clinical Excellence guidance for depression. It is being increasingly used, as I know first-hand, as a front-line therapy by workers in primary care mental health. As a client of the authors once very succinctly put it: ‘So are you saying that cognitive therapists believe that the head teaches the hands, whereas the BA (behavioural activation) approach assumes that the hands teach the head?’ That is a great way of describing something which is essentially a very practical way of learning how to feel better. Linda Gask Professor of Primary Care Psychiatry, National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL. Email: Linda.Gask@manchester.ac.uk doi: 10.1192/bjp.bp.110.080192 Leonard Fagin Honorary Senior Lecturer, University College London, and Consultant Psychiatrist, South Forest Centre, Leytonstone, London E11 4HU, UK. Email: lfagin@blueyonder.co.uk doi: 10.1192/bjp.bp.110.085902 Supportive Care for the Person with Dementia Behavioural Activation for Depression: A Clinician’s Guide Edited by Julian Hughes, Mari Lloyd-Williams & Greg Sachs. Oxford University Press. 2009. £59.95 (hb). 330pp. ISBN: 9780199554133 By Christopher R. Martell, Sona Dimidjian & Ruth Herman-Dunn. Guilford Press. 2010. US$35.00 (hb). 224pp. ISBN: 9781606235157 As the authors comment in this very accessible book, they are sometimes confronted by the objection that behavioural activation ‘sounds too simplistic’. It is indeed a very clear and straightforward model for helping people who experience depression. Nevertheless, coaching a client into accepting that what they need to do in order to feel better in their mood is to begin to identify and indulge in more ‘antidepressant behaviours’ can be a challenging task; but it is a rewarding one. In fact, for me the great advantage of the model is that it is remarkably easy to follow. For some, of course, this may be its downfall. After all, is a psychological therapy not supposed to be complicated to learn, couched in mystifying language and (these days anyway) contain the word ‘cognitive’ in its title? Behavioural activation starts from the premise that in order to feel better it is necessary to ‘act’ better; that mood and activity are inextricably related to each other; that as a person becomes more depressed they stop engaging in activities that were once This is a book covering the care for people with dementia, from diagnosis to death. The ‘supportive care’ of the title refers to a model developed to guide the comprehensive support of people with a variety of long-term, life-shortening conditions. The approach owes a lot to the philosophy of palliative care in its attention to biological, psychological, social and spiritual needs but these considerations are extended, within supportive care, to encompass diagnosis, curative and life-prolonging treatments as well as palliation and dying. The book itself is one of a series of volumes focused on different diseases and is the first to apply this framework to dementia. One of the delights of the book is the range of writings, with no fewer than 32 chapters packed into its 300 or so pages, including many contributions from well-known names as well as some newer voices. There are chapters from psychiatrists and old age physicians, general practitioners and palliative care specialists, psychologists, philosophers and many more besides. The mix is greatly enriched by contributions from individuals with dementia and family members of people with dementia, as well as chapters on often neglected topics such as Huntington’s dementia and dementia in low-income countries. Overall the content 163 Book reviews provides an excellent and broad-based distillation of up-to-date knowledge. I imagine that for every open-minded reader it will provide fresh insights and new titbits of knowledge. I blew hot and cold about the supportive care framework. The first chapter provides a seductive start for those of us who tire of the self-righteous positioning of biomedical and person-centred approaches. It holds out a promise of an all-singing, all-dancing way of ensuring that people with dementia get the services they deserve: ‘a complete mixture of biomedical dementia care, with good quality, person-centred, psychosocial, and spiritual care under the umbrella of holistic palliative care throughout the course of the person’s experience’ (p. 7). But a recipe for something so ambitious is impossible to deliver. The final chapter 164 eloquently summarises the strata of understanding that make up the model, but the third layer, the so-called logistical steps through which the model is put into practice, is sidestepped on the basis that application is context dependent. Frustrating! However, grand aspirations can be infectious and I find myself looking forward to a future volume reporting the improvements in care that have been introduced as a result of applying this approach. Jan R. Oyebode Senior Lecturer, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Email: j.r.oyebode@bham.ac.uk doi: 10.1192/bjp.bp.110.080135 Oxford Textbook of Women and Mental Health Fiona L. Mason BJP 2011, 198:162. Access the most recent version at DOI: 10.1192/bjp.bp.110.082628 References Reprints/ permissions You can respond to this article at Downloaded from This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/198/2/162.1#BIBL To obtain reprints or permission to reproduce material from this paper, please write to permissions@rcpsych.ac.uk /letters/submit/bjprcpsych;198/2/162 http://bjp.rcpsych.org/ on January 28, 2016 Published by The Royal College of Psychiatrists To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/