72 BOOK REVIEWS

J. B. BAKALAR and L. GRINSPOON: Drug Control in a Free Society. Cambridge Univ. Press. Cambridge (1985). Pages x + 174. f 17.50.

Familiar confusions in the literature on excessive drug use-concerning for instance the concepts of ‘addiction’ and ‘dependence’, and the dilemma of medical vs moral designation-are formulated and explored within a wider discussion of the political dimension. For example, the potential of psychoactive drugs for constraining individual autonomy is considered against the backdrop of a philosophical debate about the nature of personal liberty. Likewise, consideration of the political problem of reconciling private freedom with the needs of social systems highlights the symbolic as well as practical functions of formalizing rules for drug use.

Structurally, the book is divided into five chapters, each of which represents a change in emphasis. However, they are closely interconnected, and there are no subheadings within chapters, so that as a whole the text reads as a continuous essay.

It is a book which raises more questions than it answers, and intentionally so: the authors explicitly set out to provide a framework for policy development, based on description and analysis of historical and societal patterns, rather than to advocate any specific approach. From this educative point of view it is clearly relevant to anyone with an interest, professional or otherwise, in the area.

The complexity of the analysis is such that at times reading becomes laborious. However, in general the prose is lucid, and abstract arguments are complemented liberally with concrete illustrations such that the challenge is both stimulating and absorbing.

JANE POWELL

M. HERSEN (Ed.): Practice of Inpatient Behavior Therapy: a Clinical Guide. Grune & Stratton, Orlando, Fla (1985). Pages xii + 291. $34.50.

This multiple-author book gives a series of accounts of the application of cognitive-behavioural methods in the inpatient management of a variety of disorders. It is divided into three sections: General Issues, including a discussion of staff training from the perspective of sociotechnical systems theory; Treatment of Adults, dealing with obsessive-compulsive disorder, affective disorders, psychotic disorders, alcohol abuse and personality disorders; and Treatment of Children and Adolescents, covering acting-out disorders, pervasive developmental disorders, eating disorders and paediatric medical problems. The chapters are generally clearly written and follow a set pattern, with a brief description of the condition based on the defining criteria set out in DSM-III, methods of behavioural assessment, description of treatment approaches with case examples, the role of medication in combination with behaviour therapy and a discussion of problems commonly encountered during treatment.

True to its title the book is aimed primarily at the behavioural clinician rather than the researcher. The treatments described are to a large extent based on the authors’ clinical experience; literature reviews are not comprehensive and evidence tended as to the effectiveness of these therapies is often anecdotal or based on single-case experiments. Adequate controlled studies comparing behavioural treatments with other therapies, and research into which components of behavioural programmes are necessary for good response are still largely lacking, particularly in personality disorders, eating disorders and alcohol abuse. The book does however contain interesting and in some cases stimulating descriptions of ‘state-of-the art’ applications of cognitive and behavioural treatments in American psychiatric practice, and a convincing argument is made that behaviour therapists have a role in the inpatient management of a wide variety of disorders.

PAUL LELLIOTT

A. H. TUMA and J. MASER (Eds.): Anxiety and the Anxiety Disorders. Lawrence Erlbaum, Hillsdale, N.J. (1985). Pages xxxv + 1020. f74.00.

Anxiety/panic is the flavour of the 198Os, and a torrent of publications overwhelms the student trying to keep abreast of the subject-more than a 1000 annually. In a valiant attempt to review the field, Tuma and Maser have edited a huge 1055-page tome with 43 chapters and over 2000 references which span biological, psychological and clinical issues, the work originating in a conference in Sterling Forest, New York, in 1982.

Many of the chapters are a fine introduction to the state of play in their particular sector. Several are valuable reviews of biological concerns-Gray on septo-hippocampal structures in the neuropsychology of anxiety, Costa on benzodiazepine/GABA interactions, Stokes on neuroendocrinological facets, and Redmond on neurochemical features. Psychophysiological aspects are discussed by Weiner. Lang sees a particular emotional experience as a network of expressive-motor reactions, ideas and memories, the activation of any one component evoking other parts of the network and argues for more work on the factors which govern the spread of activation of such networks.

The pros and cons of animal experimental models of anxiety are splendidly etched by Mineka, other limitations are revealed by Kanfer, and creative ideas from such work continue to be put forward by Neal Miller after 45 years in the field. An analogy of his is worth bearing in mind concerning the puzzling relationship of anxiety with depression-the notion of carbon as a single element helps us deal with many chemical phenomena, but the idea that carbon is not a single entity