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Neoliberalism, cognitive therapy, positive psychology and happiness (IAPT) View project
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the program as well as country-by- each of the 20 countries, contact in- outstanding presentation of “Evi-
country reports of the experience of formation for the action group in that dence-Based Treatment for Adults
implementing this program and the country, and a brief bibliography of With Co-occurring Mental and Sub-
results of the interventions. references relevant to the particular stance Use Disorders,” which in-
The book begins by describing the interventions discussed. cludes a comprehensive account of
early reflections and planning for this For any person looking to learn the integrated–dual-diagnosis treat-
campaign. The World Psychiatric As- more about the international experi- ment model, the editors have con-
sociation felt that antistigma cam- ence of fighting stigma, this book pro- spicuously omitted any discussion of
paigns would be most successful if vides a brief overview of efforts in a the well-established best practices of
they were locally based, yet they were variety of cultures. Potential readers supported employment and family in-
aware that local leaders would have should note that this book is written tegration strategies. These serious
little experience with such efforts. in the style of a report, with brief, omissions result in a shortfall of at-
They therefore drafted a guide for structured chapters and little prose tempting to present a “comprehen-
implementing an antistigma program, linking one report to the next. The sive text.”
which provides step-by-step advice authors included the “Guidelines for In the third and fourth sections, the
guiding the group through setting up Program Implementation” in the re- editors present a collection of out-
a local group, collecting information, port’s appendix. These guidelines, in standing articles covering the issue of
designing a locally relevant program combination with the many thought- mental health services to the under-
with a carefully selected target audi- provoking, successful campaigns de- served. The third section includes a
ence, as well as implementing and scribed in the book, could certainly thorough discussion of the phenome-
evaluating the program. The remain- provide the tools necessary to set the non of oppression and the experi-
der of the book gives brief summaries right group off in the direction of ences of the African-American, Chi-
of the specific interventions from starting its own campaign. ♦ nese-American, Hispanic, and les-
bian, gay, bisexual, and transgender
populations. The fourth section con-
tains three very thorough articles on
working with people with mental ill-
Community Mental Health: ness who are homeless and begins
Challenges for the 21st Century with an excellent review of stigma.
edited by Jessica Rosenberg and Samuel Rosenberg; London, The final section, “Community
Royal College of Psychiatrists, 2006, 304 pages, $90 Mental Health: Organizational and
Policy Issues,” reviews the impact of
Jill RachBeisel, M.D. managed care, organizational net-
works, and shifting funding sources
mental health practice. It also cri- scriptions, the postpsychiatry frame- Care in America. Pub no SMA-03-3832.
Rockville, Md, Department of Health and
tiques current trends in psychiatry, work may help to engage clinicians, Human Services, President’s New Free-
including the perceived control that consumers, program managers, and dom Commission on Mental Health, 2003:
pharmaceutical companies exert on policy makers in a dialogue about di- Final Report.
academic psychiatry through the rections to take in transforming the 2. Bernstein R: A seat at the table: trend or il-
marketing of medications for depres- mental health system. ♦ lusion? Health Affairs 25(3):720–729, 2006
sion and schizophrenia. The final
References 3. Thomas P, Bracken P: Critical psychiatry in
section describes the influence that practice. Advances in Psychiatric Treat-
narrative, recovery, community de- 1. Achieving the Promise: Mental Health ment 10:361–370, 2004
velopment, and consumer-centered
social policies and programs can have
on shaping postpsychiatry. This sec-
tion contains examples of innovative Community Child and Adolescent Psychiatry:
community development and con-
A Manual of Clinical Practice and Consultation
sumer empowerment programs, in-
edited by Theodore A. Petti, M.D., M.P.H., and Carlos
cluding the Soteria project devel-
Salguero, M.D., M.P.H.; Arlington, Virginia, American
oped to help individuals during acute
Psychiatric Publishing, Inc., 2006, 320 pages, $34.95
psychotic episodes without the use of
neuroleptic medication. In addition Matthew Kleban, M.D.
to the three main sections, the book
also includes six fictional vignettes
from a consumer perspective high-
lighting illustrative points.
C ommunity child and adolescent
psychiatry is rife with chal-
lenges. Not only are there innumer-
social worker is to “support the par-
ent’s caregiving role, not supplant it.”
Another author cautions psychia-
Overall, Postpsychiatry is quite able agencies and services, each hav- trists about signing documents that
relevant to readers of this journal. ing unique characteristics and cul- are prepared by members of other
Themes in this book will resonate tures, but one’s role within any given disciplines.
with those interested in comparative agency is often not clearly defined. The third section discusses the
mental health policy, consumer em- Administrative and clinical responsi- many types of agencies serving this
powerment, human rights, and ac- bilities may overlap, and professional population: community mental health
tion research. The authors also em- standards may yield to the financial centers, schools, school-based health
phasize the importance of including restrictions of the public sector. centers, foster care programs, child
humanities and cultural studies in Whether providing direct services or care settings, day treatment centers,
medical education, which could be a consultation, it is imperative for the chemical dependence programs, resi-
offered as a source of dissenting clinician to have a clear understand- dential care programs, and advocacy
opinion for training in evidence- ing of the system in which he or she groups. Some chapters describe ad-
based psychiatry. operates. With these general princi- ministrative and organizational struc-
To truly appreciate this book, it is ples in mind, Theodore Petti and tures, including configurations of
helpful if the reader has an under- Carlos Salguero have assembled a governance from director to frontline
standing of the philosophy of science. multiauthored text to enable clini- staff. Other chapters describe opera-
A drawback is that the book does not cians to navigate these complexities. tional nuts and bolts, such as develop-
specifically include a concluding The book is divided into four sec- ing services and assessing outcomes.
summary chapter. Although readers tions. After an introductory section, This section also includes historical
may argue that postpsychiatry is sim- the book moves from principles to and political background, pertinent
ply antipsychiatry, the authors assert practice, offering a series of chapters legal and ethical issues, and tips on
that “postpsychiatry is our attempt to that describe members of an inter- maintaining financial viability in the
subdue the bright light of medical disciplinary team. These appropri- current mental health care environ-
science: not because we want to get ately credentialed individuals write ment. There is some thoughtful em-
rid of or deny its benefits, but be- the corresponding chapters. After phasis on the need to avoid burnout.
cause we believe that the insights of outlining their educational back- The chapter on schools provides a
other approaches are equally impor- ground, the authors of these chap- thorough discussion on consultation
tant and valuable. We hope that our ters provide information ranging issues. It addresses how to gain ac-
critique of the central assumptions of from their theoretical perspectives cess to local schools and maintain re-
the psychiatric canon will open a to their more quotidian functions. As lations with educational staff, and it
space in which other voices will be one author advises, the role of the revisits the pervasive issue of role
heard and taken seriously. We believe confusion. As one author articulates,
that these voices will hold the key to Dr. Kleban is a staff psychiatrist in the “the goal of the consultative relation-
the future.” Although the authors do Community Day Hospital, Bronx Chil- ship should be to increase the
not include any specific policy pre- dren’s Psychiatric Center, New York City. school’s autonomy in managing men-
PSYCHIATRIC SERVICES ♦ ps.psychiatryonline.org ♦ May 2007 Vol. 58 No. 5 719
BOOK REVIEWS
tal health problems and not to in- multisystemic therapy, as well as the the chapters for residents can also be
crease the school’s dependency.” application of ongoing technological reread as an attending in a mentoring
Although the book is largely fo- improvements. role. I am impressed by the variety of
cused on organizational matters, it in- One could argue that although the chosen topics that apply to young re-
cludes some useful clinical pearls. In title implies a target audience of cli- searchers, clinician-educators, in-
the challenging milieu of day treat- nicians already identified as part of terns, residents, faculty with a clinical
ment, flexibility is stressed. In lieu of the community sector, the true bene- focus, as well as psychiatrists in ad-
traditional individual therapy, observ- ficiaries include all mental health ministrative or leadership roles. For
ing a child’s interactions and imple- professionals working with children example, the chapter on giving feed-
mentation of coping strategies in the and adolescents. Another limitation back can be used not only for resi-
various group settings may prove to is that, as with most multiauthored dents but also when managing a treat-
be more illuminating. The chapter on books, there is some inevitable re- ment team on a unit or research team
foster care highlights the clinician’s dundancy. Perhaps a few of the chap- in a lab.
need to balance the foster child’s at- ters are overly theoretical, appealing Although all of the selected topics
tachment difficulties with the foster mainly to those who, like the editors, are useful, I was specifically drawn to
parents’ countertransference-like re- have backgrounds in public health. the section on becoming an educator,
actions toward the child. Although there is one chapter broad- because it provides a basic framework
The final section delineates innova- ly discussing forensic issues, there is for teaching in various settings, giving
tive programs and future trends. For no mention of the juvenile justice feedback, and writing letters of rec-
instance, it describes how Virginia system, a notable omission given how ommendation. The information about
and Illinois have dealt with the clos- closely linked these systems often medical education is useful even if
ing of inpatient state-operated facili- are. For the most part, however, this one’s career focus is not teaching. For
ties, namely by establishing more book succeeds in providing concise, example, the chapter on teaching a
community-based treatments and eminently readable, and clinically large or small group can also apply to
shifting care to the private sector. useful information about working researchers or administrators giving
Promising advances include the pro- with children in these various com- formal talks or teaching staff mem-
liferation of wraparound services and munity settings. ♦ bers. With the requirements from the
Liaison Committee on Medical Edu-
cation and Accreditation Council for
Graduate Medical Education for resi-
The Handbook of Career Development in dents and faculty to receive training
about educating medical students,
Academic Psychiatry and Behavioral Sciences this book provides a clear starting
edited by Laura Weiss Roberts, M.D., and Donald M. Hilty, M.D., M.A.; Arlington,
point for a discussion about medical
Virginia, American Psychiatric Publishing, Inc., 2006, 360 pages, $39
education in a variety of contexts.
Gina Perez-Madrinan, M.D. Also, giving feedback and writing let-
ters of recommendation are often
praise for this handbook. Reflecting when I entered residency. It is wel- willingness to do double-blind stud-
on my experience as a resident and a coming, not intimidating, offers prac- ies of megavitamins. This therapy
new graduate applying for an aca- tical advice, and manages to motivate has also been condemned or strong-
demic position, it is a perfect guide rather than overwhelm the reader. ly criticized by numerous other
for trainees and young faculty enter- Thank you to the authors and pub- bodies and investigators.
ing an academic career. I wish some- lisher for taking the time to carefully At points like this, McManamy’s
one had given this as a gift to me plan and write such a helpful guide. ♦ claim that he is liberally alerting
people to the wealth of what’s out
there may seem to be in good faith
but may it be naïve and credulous,
or even a con at worst. The book
Living Well With Depression and Bipolar also fails to present the views of
Disorder: What Your Doctor Doesn’t those who know very much about
Tell You . . . That You Need to Know themselves from years of nonmed-
by John McManamy; New York, HarperCollins, 2006, 416 pages, $14.95 ical personal struggle and self-disci-
pline. This book is a useful supple-
Gregory Ludwig ment but by no means is it essential
or magisterial. ♦
We meet Catherine at age 17, and ment in a psychodynamic context. able to take the best from both mod-
we follow her through a brief account His thoughts, although skewed els and learn enough about the work-
of the two-year course of her illness mainly toward the psychoanalytic ings of the brain to persuade us that
until she is hospitalized. She begins model, seem very timely in an era this is important enough to warrant
treatment with Dorman at age 19 when we are beginning to question doing battle with insurance compa-
when she is hospitalized for the first the current DSM structure and way nies and to help our patients in the
time, and we then learn more details of thinking. I think we have, at best, best way we know how. Any psychia-
about her family life from Dorman’s an uneasy alliance between prescrib- trist who is willing to overlook this
interviews with her mother, stepfa- ing medication and doing therapy, book’s clear bias against medications
ther, and sister. We are told enough in the polarity of which is reflected in will enjoy the psychodynamic discus-
these initial pages to know that our current DSM and in many psy- sions, and we all should be interest-
Catherine’s early years were very chiatry residency programs across ed in the somewhat flawed but very
traumatic in a number of ways, in- the country. Perhaps our patients stimulating last chapter in this era of
cluding deaths, separations, and will be better served once we are politics and change. ♦
much emotional abuse. She became
depressed and anorexic at about the
same time and was treated only for
the anorexia. Her depression wors-
ened, and she began hearing voices Wake-up Call: The Political Education of a 9/11 Widow
five months later. by Kristen Breitweiser; New York City, Warner Books, 2006, 287 pages, $24.99
The bulk of the book details
Helen Stein, Ph.D.
Catherine’s lengthy hospitalizations
and her psychotherapy treatments,
which lasted about four years. It de-
scribes how Catherine became pro-
O n September 11, 2001, Kristen
Breitweiser’s husband, a finan-
cial analyst, died in the World Trade
to sink into isolation, buttressed by
fear, rage, and disengagement. Her
“wake-up call” is provoked by a wor-
foundly withdrawn, even catatonic at Center attack. Wake-up Call chroni- ried neighbor’s insistence that she at-
times, and extremely psychotic, with cles her evolution from homemaker tend a survivors’ meeting, where she
constant terrifying hallucinations de- and apolitical wife to a hard-hitting ac- begins to express concern. She is able
grading her and ordering her to kill tivist who lobbies successfully for an to channel cognitive strengths—such
herself and her mother. I had great independent 9/11 commission and as intelligence, love of argument, and
difficulty with this part of the book, less successfully for accountability and fine use of language—fear, rage, and
because I am not convinced that change in U.S. homeland security. legal training into effective activism.
Catherine suffered from schizophre- Although it is tempting to focus on She begins to regulate her intense
nia but perhaps from a severe depres- Breitweiser’s unflinching portrait of emotions through late-night phone
sion with psychosis. I was left won- the frustrating political process she calls with three other 9/11 widows.
dering why the antidepressants that witnesses, it is more interesting to ac- “[W]hen four women get on the
might have curtailed her profound count for Breitweiser’s resilience. Re- phone and cry together, their crying
suffering were not tried at all, be- silience researchers have described soon turns into anger, which then
cause there were some antidepres- sets of risk and protective factors that turns into humor, which then ends up
sants available at that time that would impact an individual’s ability to in distraction and major productivity.”
not have produced intolerable side bounce back after adversity at the lev- Other coping methods include affec-
effects, unlike the thorazine that el of the individual, family, communi- tionate contact with her daughter and
Catherine dreaded. This alternative ty, and ecosystem (1). Connections to her dog and time in the natural world.
diagnosis would also partly explain for caring and competent others, cogni- Despite her rejection of the idyllic
me how Catherine could completely tive and self-regulation skills, a posi- bubble that she had inhabited os-
recover without medication and suf- tive self-image, and the desire to im- trich-like with her husband, she
fer no further relapse. pact the environment in a positive keeps their connection alive by writ-
Perhaps the most interesting and manner may be especially crucial for ing letters to him after his death.
useful part of this book is the recovery from adversity (2). Breit- Breitweiser’s close family relation-
thought-provoking last chapter. Here, weiser’s account exemplifies these ships are protective, both because of
Dorman discusses his personal views qualities. the support she receives and because
of the utility of medication versus Breitweiser’s losses after 9/11 are of the values she has absorbed. De-
psychotherapy in the context of devastating, and her initial response is spite intense adolescent conflict, she
questioning our definition of illness identifies strongly with her mother,
and the DSM model. Although I dis- whose powerful sense of purpose and
Dr. Stein has a private practice and is a
agree with many points in this chap- consultant for the Center for the Study of stoicism impelled her to continue to
ter, I applaud his method of thinking Trauma and Resilience, New York State cook for her family as she was dying
about pathology and therefore treat- Psychiatric Institute, New York City. of cancer. Although Breitweiser re-
722 PSYCHIATRIC SERVICES ♦ ps.psychiatryonline.org ♦ May 2007 Vol. 58 No. 5
BOOK REVIEWS
sents the intrusions into family life oc- Our field has traditionally paid nity in the project, and they advise
casioned by her father’s long career as scant attention to those who endure readers to start their own group, or
small-town mayor, it seems likely that and flourish without our help. But we at least to join with even one other
his dedication to public service fueled have much to learn from them. For woman and daughter to support
her own. She connects powerfully this reason, and because it is a highly their efforts.
with her new friends and continues to engrossing and inspiring read, I high- This model is based on intergen-
maintain close friendships with bonds ly recommend Wake-up Call. ♦ erational reciprocity: mothers thrive
of shared pain and also with appreci- if daughters thrive, and vice versa.
ation of one another’s skills, strengths, References Over and over in the book, mothers
vulnerabilities, and values—most 1. Stein H: Mentalization: a pathway to re- are asked to do their own work, clar-
silience, in Handbook of Mentalization-
keenly the strong desire to protect Based Therapy. Edited by Allen JG, Fonagy
ifying their experiences, values, and
their children’s future. Living inside P. Somerset, NJ, Wiley, 2006 beliefs before raising an issue with
her isolated and self-sufficient bubble 2. Masten AS, Powell JL: A resilience frame- their daughters. Often this prelimi-
before September 11, her activism, in work for research, policy, and practice, in nary work involves looking at their
contrast, connects her to many com- Resilience and Vulnerability: Adaptation in relationship with their own moth-
the Context of Childhood Adversities. Edit-
munities, less perfect but far more ed by Luthar SS. Cambridge, United King- ers, so the model becomes three-
real. dom: Cambridge University Press, 2003 generational.
The approach is normative; stress-
es and difficulties between mothers
and adolescent daughters are seen
as a common, natural part of normal
The Mother-Daughter Project: How Mothers development. They need to be ad-
and Daughters Can Band Together, Beat the dressed but not as deficits or as
Odds, and Thrive Through Adolescence pathology. They are dealt with pro-
by SuEllen Hamkins, M.D., and Renee Schultz, M.A.; actively and preventively; by using
New York, Hudson Street Press, 2007, 352 pages, $23.95 an understanding of normal devel-
opment, issues are predicted and
David Moltz, M.D. addressed before they become
problems.