B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 2 ) , 1 8 1 , 4 5 0 ^ 4 5 4
Book reviews
EDITED BY SIDNEY CROWN and ALAN LEE
Contemporary Approaches
to the Study of Hysteria: Clinical
and Theoretical Perspectives
Edited by Peter W. Halligan,Christopher Bass
& John C. Marshall.Oxford: Oxford
University Press. 20 01. 368 pp. 75.0 0 (hb).
ISBN 0 19 263254 X
Hysteria has been a diagnosis under siege
for longer than most of us can remember.
Eliot Slater, foremost among the hatchet
men, believed that hysteria was a fertile
source of clinical error and advocated that
the term be dropped. Aubrey Lewis, in a
more sober judgement, thought that psy-
chiatrists would be hard-pressed if they
were unable to use the term and predicted
that hysteria would outlive its obituarists.
Despite Slaters attempts to abolish the
concept, hysteria has survived although it
is now thinly disguised in modern classifi-
cations as conversion disorder or dissocia-
tive disorder. Neurologists, even more than
psychiatrists, find the term helpful both
diagnostically and therapeutically.
This book is a welcome addition to the
literature on hysteria and provides a bal-
anced and generally critical review of
450
other psychiatric diagnoses such as neur-
asthenia or schizophrenia. The psychiatrists
skill involves elucidating the underlying
causal factors and coordinating an appro-
priate treatment plan.
This book can be recommended to all
those interested in the bewildering yet
fascinating hinterland between neurology
and psychiatry. It will be particularly useful
contemporary theories on classification, to neurologists, neuropsychologists and
epidemiology, aetiology and management. liaison psychiatrists. Hysteria has indeed
The boundaries between hysteria and con- survived, even if it is living under an alias.
ditions such as factitious disorders, mal-
ingering and somatisation disorder are Geoffrey Lloyd Consultant Liaison Psychiatrist,
acknowledged and discussed at length. In Royal Free Hospital, Pond Street, London
this context, there is a particularly useful NW3 2QG,UK
chapter by Christopher Bass, who discusses
the diagnostic pitfalls involved in trying to
distinguish between unconscious and
conscious motivation. There is also an
intriguing but speculative account of a
possible neuropsychological substrate ex-
Research and Innovation on the
trapolated from observed changes on a
Road to Modern Child Psychiatry.
positron emission tomography (PET) scan.
Volume 1. Festschrift for Professor
Therapeutic interventions are also
Sir Michael Rutter
well reviewed. The clinician looking for Edited by Jonathan Green & WilliamYule.
evidence-based studies will struggle to find London: Gaskell. 20 01. 166 pp. 25.0 0 (pb).
them, but several chapters discuss the role ISBN1 901242 62 5
of psychodynamic psychotherapy, abreac-
tion, hypnosis, cognitivebehavioural ther- Michael Rutter published his first paper
apy and rehabilitation. These will be very more than 40 years ago, and the most
helpful to the psychiatrist to whom is striking feature of this excellent Festschrift
referred a patient with hysterical symptoms for him is just how far research in child
but who has not much experience of psychiatry has come over that time.
managing them, a common scenario in Research into autism provides a good
contemporary psychiatry where most clin- example. In the 1960s it was widely
ical experience is acquired well away from believed that autism was an early-onset
the wards of a general hospital. form of schizophrenia. The aetiology was
Recent follow-up studies have shown poorly understood, but the finding that
that the diagnosis of hysteria is much more
reliable than Slater led us to believe. Much
of this results from increased neurological
acumen and particularly from the avail-
ability of non-invasive imaging investiga-
tions. There is also now greater awareness,
acknowledged by several of the contribu-
tors to this volume, that dual diagnosis is
common and that the presence of coexisting
neurological or psychiatric disease does not
exclude a diagnosis of hysteria. Maria Ron,
one of Slaters successors at the National
Hospital for Neurology and Neurosurgery,
Queen Square, concludes that the diagnosis
of hysteria can be made safely and accu-
rately. Although its aetiology is uncertain,
clinicians continue to find it a useful concept
without believing that there is a single
aetiology or therapeutic approach. Hysteria
is thus best considered to reflect a clinical
syndrome, very much in keeping with all

some parents of children with autism had
social and communication problems (so-
called refrigerator parents) was widely
taken to mean that poor parenting led to the
syndrome. The result was that many parents
felt blamed for causing their childs problems.
Treatment often included psychotherapeutic
and regressive approaches that focused on
repairing faulty relationships.
The situation nowadays could scarcely
be more different. Autism is viewed as a
developmental disorder unrelated to schizo-
phrenia. The mainstay of treatment is
therefore a developmentally oriented edu-
cational and behavioural programme. The
association between autism and social or
communicative deficits among relatives is
now thought to be the result of a shared
genetic liability. Recent molecular genetic
studies have identified several promising
loci for these genes.
This book contains many other exam-
ples of how research has influenced modern
child psychiatry. Barbara Maughan, for
instance, draws out some of the lessons
from longitudinal studies. The chapters on
classification, neuropsychiatry and conduct
disorder also illustrate the huge research
advances of the past 40 years and Rutters
important contributions in each of these
areas. But my favourite parts of the book
are those that describe Rutters clinical
skills and his clinical approach. His re-
search contributions have been so great that
it is easy to forget what a skilled clinician
he is. These skills are well illustrated in his
own chapters on autism, and also in Ann Le
Couteurs moving tribute to him. All in all,
this is a book that will be of use not only to
researchers but also to clinicians of all
disciplines.
Richard Harrington Professor of Child and
Adolescent Psychiatry, Royal Manchester Childrens
Hospital, Hospital Road, Pendlebury, Manchester
M27 4HA,UK
Research and Innovation on the
Road to Modern Child Psychiatry.
Volume 2 . Classic papers by
Professor Sir Michael Rutter
Edited by EricTaylor & Jonathan Green.
London: Gaskell. 20 01. 34 0 pp. 25.0 0 (pb).
ISBN 0 901242 63 3
As Eric Taylor points out in his introduc-
tion to this book, no one has contributed
more to child psychiatry than Michael
Rutter. The sheer volume of his work is
impressive more than 30 books and 300
scientific papers. But what makes his work
so important and influential is not its
volume but two other features. The first is
quality. He has produced an extraordinary
number of classic original studies and
reviews, many of which are still widely
cited. The second is its breadth. Rutters
work has covered much of child psychiatry,
ranging from landmark studies of the
importance of psychosocial factors to some
of the best research on genetics.
In this second volume of papers pub-
lished to celebrate Michael Rutters
achievements, Taylor & Green had the
unenviable task of choosing from among
his many classic papers a selection that
would demonstrate his huge contribution
to child psychiatry. They have done a good
job. The papers included here not only
represent some of the best of his work but
also its pervasiveness. Thus, the reader will
find classic accounts of psychiatric inter-
viewing techniques, large-scale epidemiolo-
gical studies, state-of-the-art molecular
genetic designs, longitudinal research and,
of course, psychosocial risks. However, this
book is not in any way a history of child
psychiatry. Much of the material is of real
relevance to current academic and clinical
work and it deserves to be widely read.
Richard Harrington Professor of Child and
Adolescent Psychiatry, Royal Manchester Childrens
Hospital, Hospital Road, Pendlebury, Manchester
M27 4HA,UK
B OOK R E V I E W S
Psychotherapy with Children
and Adolescents
Edited by Helmut Remschmit, Peter Matthias
Wehmeier & Helen Crimlisk.Cambridge:
Cambridge University Press. 20 01. 576 pp.
4 4.95 (pb). ISBN 0 521 777558
7558 2
The title of this book is misleading, as it is
more a general textbook than a specific
volume on psychotherapy. It is divided into
four main sections: principles, methods,
specific disorders and different settings.
Only evidence-based methods are described,
although several of the chapters mention
that there are few satisfactory studies. All
diagnostic categories are dealt with sep-
arately, which leads to the repetition that is
often a problem in multi-authored books.
The basic principles underlying the way
the material is presented would be agreed by
most practitioners: (a) specificity of inter-
vention to the problem; (b) the importance
of keeping a developmental perspective; (c)
variability of the method depending on
setting; and (d) evaluation of effectiveness.
The point is made repeatedly that a
range of therapies may be used in any one
case and that a flexible treatment model is
necessary. Most generalists in the field
would recognise this as the way they work.
There is discussion of medication, parent-
training and the range of behavioural
interventions as well as the different types
of psychotherapy.
The chapter on current activity in
Germany reveals that little medication is
used, parents are seen as well as children
and that a flexible, multi-modal treatment
4 51
B OOK R E V I E W S
tends to be used to fit each case. This seems
at odds with the rigid framework of the
book.
I liked the chapter on quality assurance
and the need to allow for innovation and
imagination and to not be imprisoned by
treatment protocols.
This is a very inclusive book and not
easy to read. It could be useful as an
overview of treatments in child psychiatry
or as a reference for reading up on possible
actions in certain situations. Although there
is an extensive bibliography, it is almost all
in German. My preference would be for a
more straightforward textbook and a range
of specialist texts for the detail.
Rachel Leheup Independent Child Psychiatrist,
c/oThe Royal College of Psychiatrists,
17 Belgrave Square, London SW1X 8PG,UK
Early-Onset Dementia:
A Multidisciplinary Approach
Edited by John R. Hodges.
Hodges.Oxford:
Oxford: Oxford
University Press. 20 01. 478 pp. 75.0 0 (hb).
ISBN 0 19 263034 2
Early-onset dementia is an important area
for clinical practice and research and tests
the mettle and resources of both old age
and general adult psychiatrists. The impact
of early-onset dementia on sufferers and
their families can be devastating. All the
more reason to be practised and know-
ledgeable in approaching its diagnosis and
treatment.
4 52
John Hodgess book consists of 20
multi-authored chapters on different as-
pects of early-onset dementia, from epide-
miology through assessment and diagnosis
to management. Each chapter ends with a
number of key points. A comprehensive
synthesis of clinical and basic aspects of
early-onset dementia is presented. The
reference list is comprehensive in relation
to early-onset dementia as contrasted with
Alzheimers disease or dementia in general.
The text is amply augmented by tables,
images and illustrations. The chapter on
clinical assessment and bedside tests is
particularly useful. Other outstanding chap-
ters are on neuropsychological assessment
and neuroimaging.
The book does have some gaps. An area
that I would like to have seen covered is the
clinic model and how it works in a truly
multi-disciplinary fashion. In this regard,
Hodges refers us to another textbook but a
critical appraisal of the Cambridge model
and alternatives could have pointed provi-
ders setting up early-onset dementia clinics
in the right direction. Also, a chapter on
service provision beyond the memory clinic
model and how we should be moving
forward in this direction would have been
helpful in informing opinion in this much
neglected area. Carer burden can be ex-
treme in early-onset dementia and some
consideration of this topic and advice on
management from a multi-disciplinary per-
spective would also have added to the value
of the book.
However, this is a book that I expect to
use regularly and profitably. I would recom-
mend it to anyone with an interest in
dementia and to those of us who work in
memory clinics and continue to be chal-
lenged by our early-onset dementia cases.
Brian A. Lawlor Consultant Old Age
Psychiatrist and Professor of Old Age Psychiatry,
Jonathan Swift Clinic, St Jamess Hospital, Dublin 8,
Ireland
Eating Disorders and Cultures
inTransition
Edited by Mervat Nasser, Melanie A.Katzman
& Richard A.Gordon. Hove: Brunner
Routledge. 20 01. 201 pp. 30.0 0 (hb).
ISBN 0 415 22859 X
The three editors of this interesting book
are authorities on eating disorders and each
has wide experience of sociocultural issues.
They bring together authors and perspec-
tives from around the world to provide the
cutting edge of opinion.
The book is organised into nine main
chapters, each answering a different ques-
tion. Each chapter is followed by two
commentaries, one written by a clinician
and the other by an expert from fields such
as sociology, economics and anthropology.
The purpose is to create debate about each
of the questions posed. As none of the
chapter authors had seen the responses
before the book went to press, the views
expressed in the chapters have not been
influenced or altered by the commentaries.
The use of commentators from widely dif-
fering disciplines is very thought-provoking
and fosters involvement in the debate.
The questions posed are diverse. Topics
include the notion of eating disorders as
culture-bound syndromes, the recent emer-
gence of eating disorders in Black South
African women, the meaning of self-
starvation in China, as well as the pos-
sible political and economic meanings of
the pursuit of thinness in Argentina. The
identity struggle of women in changing
societies is a recurring theme and is
proposed as a possible factor in the increase
in the incidence of eating disorders. How-
ever, there is little robust evidence with
which to compare current levels of eating
disorders, as most epidemiological studies
on eating disorders are relatively recent.
Although many of the clinical accounts
focus on local issues, they are surprisingly

easy to read, and this is indicative of the
similarities in clinical thinking around the
globe. The commentaries by the non-
clinicians raise many more questions. For
example, Penny Van Esterik introduces the
different perspective taken by anthropolo-
gists. She states that anthropologists look at
eating disorders from a holistic comparative
perspective, placing them in the context of
food systems, gender systems and kinship
systems. She also proposes that anthropol-
ogists become involved with psychologists
to examine eating disorders further.
The arguments in this relatively small
volume are weighty and the debate is
scholarly. They illustrate the fascination of
sociocultural models of eating disorders
and provide an excellent source of refer-
ences for further study and research.
Although it does not make light reading
material, I would recommend this volume
to anyone interested in sociocultural
aspects of mental disorders.
Helen Baxter Consultant, Nottingham Eating
Disorders Service,Queens Medical Centre,
Nottingham NG7 2UH,UK
Console and Classify: The French
Psychiatric Profession in the
Nineteenth Century
By Jan Goldstein.Chicago, IL: University of
Chicago Press. 20 01. 432 pp.US$50.0 0 (hb),
US$20.0 0 (pb). ISBN 0 226 3016 0 5 (hb),
ISBN 0 226 30161 3 (pb)
This book is a reprint of a classic work of
historical scholarship, which examines key
figures and events in the history of French
psychiatry. Although the names of Pinel,
Esquirol and Charcot are well known, this
volume provides a detailed picture of their
intellectual, political and cultural back-
ground. It begins with the birth pangs of
French psychiatry in the early days of the
Revolution, when Pinel was writing his
ground-breaking Traite Me Medico-Philoso-
dico-Philoso-
phique,
phique, and goes on to consider the rise
and fall of the concept of monomania. It
describes the Law of 1838, which ushered
in a nation-wide asylum system, and con-
cludes with the glory days of Charcot and
his clinical demonstrations of hysteria at the
Salpe
Salpetriere.
trie`re. This was an era when French
psychiatry was pre-eminent and students
came from all over Europe and America to
study in Paris. The title, Console and
Classify,
Classify, reflects the twin origins of French
psychiatry in religion and medical diagnos-
tics. From Catholic pastoral care, clinicians
adopted the concept of offering consolation
and reassurance to the patient. In parallel,
they also strived to develop a satisfactory
classification of insanity.
The figure of Philippe Pinel is sym-
pathetically discussed and the passages
dealing with his treatment of patients are
probably the most interesting in the book.
Pinels Traite of 1801 introduced a funda-
mental psychiatric innovation; moral treat-
ment. In contrast to the prevailing reliance
on physical measures, he emphasised meth-
ods that engaged the intellect and emotions.
Pinel did not claim to be original the
English physician Francis Willis had used
such methods in his treatment of King
George III but he did claim that he was
the first to explain in detail the practical-
ities of moral treatment. Pinels Traite was
composed of little stories or clinical anec-
dotes, which provided shared examples of
successful treatment.
Although historians have warned
against anachronistic readings of the past,
many of Pinels techniques will strike the
modern clinician as very familiar. For
example, he held that the lunatic was
not absolutely deprived of reason and was
amenable to psychological interventions.
He advocated the use of diversion and
distraction in the combating of delirious
ideas. Elsewhere, he used more theatrical
methods, which he dubbed medicine of the
imagination. He described the case of a
guilt-ridden tailor who believed that he was
B OOK R E V I E W S
condemned to death. Pinel staged a mock
trial and acquitted the patient, who
improved, but, alas, only briefly.
Pinels pupil, Esquirol, championed the
concept of monomania, and its spectacular
adoption and subsequent rejection by the
psychiatric community illustrate the role of
social and political factors in diagnostic
fashions. Some of the stormiest debates
about its validity took place in the court-
room, where it was being advanced as an
insanity defence, a line particularly pushed
by one of Esquirols followers, Georget.
Critics responded sceptically that it merely
provided a pseudo-scientific excuse for
criminal behaviour. The latter part of
the 19th century saw another change in
nosological fashion with the re-emergence
of hysteria, a diagnosis which was in-
creasingly applied to women admitted to
the Salpe
Salpetriere
trie`re during the 1880s.
The book shows how psychiatric ideas
seeped into general culture, for example, in
the writings of Balzac, Zola and Flaubert,
whose Madame Bovary was popularly
perceived as the portrait of a hysteric.
Partly in response to what he saw as the
secular and positivist claims of psychiatry,
Huysmans wrote his occult novel, La `-Bas..
La-Bas
Although written in the rather dry
academic style favoured by many profes-
sional historians, Console and Classify
deals with a crucial period in the develop-
ment of psychiatry and is of great interest,
both in its depiction of iconic figures from
psychiatrys past and in its demonstration
that many of our current ideas about
mental illness were being discussed 200
years ago.
Allan Beveridge Consultant Psychiatrist,Queen
Margaret Hospital,Whitefield Road, Dunfermline
KY12 0SU,UK
Handbook of Cultural Psychiatry
By Wen-ShingTseng.
San Diego,CA: Academic Press. 20 01. 855 pp.
US$149.95 (hb). ISBN 0 12 701632 5
Culture can be conceived of as a complex
construct of socially transmitted ideas,
feelings and attitudes that shape behaviour,
organise perceptions and label experiences.
Culture affects various aspects of mental
health the conception of personal identity,
communication styles, gender and family
roles and beliefs and rituals. It also influences
4 53
B OOK R E V I E W S
mental illness in many ways assessment
and diagnosis, illness behaviour and help-
seeking, the expectations of patients and
health professionals and the acceptance of
appropriate therapies. Concepts of illness
vary between cultures and people from
different cultures express their symptoms
differently. What may be abnormal and
psychopathological in one culture may be
454
culturally acceptable in another. Thus, an
understanding of the patients culture is
important in assessing the clinical signifi-
cance of specific symptoms and behaviours
and in the treatment of mental disorders.
Cultural psychiatry is a field within
psychiatry which examines issues related to
culture, mental health and illness. The past
few decades have seen an increased empha-
sis on the role of culture and ethnicity and
this has resulted in an explosion of journal
articles and books on the subject. This
handbook provides a concise yet com-
prehensive overview of the many issues
involved. It contains chapters that include
the role of culture in human behaviour,
mental health, psychopathology and psy-
chological therapies. It also covers clinical
practice and therapy with specific popu-
lation groups. It reviews cross-cultural
theory, research and training, examining
issues related to many diverse cultures.
Each chapter has many subsections and
subheadings, which make assimilation easy.
For example, the chapter on stress and
coping patterns discusses the dynamic
nature of stress, its measurement, its effect
on mental disorders, cultural contributions
to stress and problems, culturally inherent
vulnerability and the role of culture in coping
patterns. Similarly, the section on culture
and psychopathology has separate chapters
on the many categories of mental disorder
and presentation. There is an appropriate
degree of overlap between chapters, but
cross-referencing is done by chapter and
section rather than page number, which is a
bit frustrating. The appendix has a useful list
of books on the subject.
The author has tried to appeal to a wide
audience, including psychiatrists, psy-
chologists, sociologists and anthropolo-
gists. The wide potential readership does
make the content uneven, with some parts
being considered detailed or brief depending
on ones background. A weakness is the
limited references to British and European
work on the subject, with increased emphasis
on North American and Micronesian
perspectives.
Overall, the book presents a compre-
hensive review of the subject. It is highly
recommended to anyone seeking to broad-
en their knowledge of culture, mental
health and illness.
K. S. Jacob Professor of Psychiatry,Christian
Psychiatry, Christian
Medical College,Vellore 632002, India
Contemporary Approaches to the Study of Hysteria: Clinical and
Theoretical Perspectives
Geoffrey Lloyd
BJP 2002, 181:450.
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