The British Journal of Psychiatry (2009) 194, 572–576 Book reviews Sims’ Symptoms in the Mind: An Introduction to Descriptive Psychopathology (4th edn) Edited by Allan Beveridge, Femi Oyebode and Rosalind Ramsay By Femi Oyebode Elsevier–Saunders 2008 £37.04 (pb) 484pp ISBN 9780702028854 The Mental Health Act 2007 A Guide (DVD) By David Jessel, Maggie Fogarty & Paul Bacon Chestnut/BFM Productions 2008 £92.00 I wish I’d seen this before Before, that is, reading so many descriptions of what to expect Before going to so many training events Before hearing lawyers, doctors, managers, social workers and academics speak on the subject Information overload, coupled in some instances with a substantial helping of conjecture, is not a healthy combination Perhaps I overdid it in my enthusiasm to know everything there is to know about the Mental Health Act 2007 I should, therefore, confess I am one of those people, one of those psychiatrists what’s more, who find mental health law interesting, fascinating even And I believe it’s important to know it, if we are not to our patients, ourselves and others a disservice So this DVD would have been of even greater value had I known of it sooner For it is what it says it is, ‘a concise, easy-to-follow guide to the Mental Health Act 2007’ It is well-structured, to mirror the changes, clear and uncluttered, which is what one would expect given the five experts whose interviews with David Jessell constitute the vast majority of the material and who include William Bingley, Nigel Eastman and Lucy Scott-Moncrieff The material is broken down into eight parts, each focusing on a particular area of the new Act It is well-edited and easy to follow and use Each section can be viewed, then paused or played again Questions posed are to the point and get at the essence of the appropriate subject The information is factual and the contributors avoid speculation as to what the possible effects of the changes might be The running time is 50 minutes The disc comes accompanied by a booklet with a verbatim transcript of the interviews and notes on the relevant sections of the 2007 Act and how these relate to and amend the 1983 legislation All in all, a good learning resource It could be argued that it is of less value now that most of the changes have come into force Equally, though, we are not going to know much more about the new law, how it works and what it changes, until it has been in use for some time and this DVD is an important reference work 572 This new edition is very welcome It is an essential tool for trainees and indeed everyone interested in understanding symptoms which we meet in others Andrew Sims has cause for pride that his book has attained iconic status, as in Gray’s Anatomy Professor Femi Oyebode has done a splendid job in preserving the style that helped to make the earlier editions so attractive Only 36 pages are added so that middle-age spread has been avoided The format has benefited from the use of colour and other additions make it more accessible to anyone looking for an answer to a problem in describing and understanding symptoms Sims said he aimed the work specifically at the trainee, but hoped others would benefit – the general welcome that successive editions have received show his success Others of us, like the older Freud (who was said to have a recurrent anxiety dream about failing in the only subject in which he had won a gold medal) may use the book to refresh one’s memory In using it we come across a number of unexpected benefits, including illuminating quotes from past writers, vivid accounts of patients and a remarkable way of putting symptoms in larger contexts; diagrams are helpful The book continues the tradition of Karl Jaspers ‘to be empathic and theoretically neutral’ and gives an alternative to popular accounts of dynamics that derive from Freud and others Unlike Jaspers who, even in translation, has a forbidding Teutonic density of style, Sims and his editor Oyebode have preserved the approachable, compulsively readable style that may show, in itself, how you can preserve the content even when the form is changed Reading this book again reminded me of how Anselm (an 11th-century Archbishop of Canterbury) wrote about his ‘delight in understanding’ This book will help many readers to enjoy such a delight instead of being alarmed and frightened by some of the more difficult concepts in psychopathology If they read it carefully, some of the empathic approach is sure to rub off I sometimes feel psychiatry is threatened by the approach that ticks boxes and seeks refuge in a team I am glad that books on compassion are now being published: such a spirit seems to me to give this iconic book an added texture I wish it as much success in psychiatry’s troubled future as it has had in the past Martin Humphreys University of Birmingham, Hillis Lodge, Hollymoor Way, Northfield, Birmingham B31 5HE, UK Email: martin.humphreys@bsmhft.nhs.uk Gaius Davies Emeritus Consultant Psychiatrist, correspondence c/o British Journal of Psychiatry, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG, UK Email: bjp@rcpsych.ac.uk doi: 10.1192/bjp.bp.108.060244 doi: 10.1192/bjp.bp.108.061689 Book reviews Sexual Deviance: Theory, Assessment, and Treatment (2nd edn) Edited by D Richard Laws & William T O’Donohue Guilford Press 2008 US$70 (hb) 642pp ISBN: 9781593856052 Sexual Offending and Mental Health Multi-disciplinary Management in the Community Edited by Julia Houston & Sarah Galloway Jessica Kingsley Publishers 2008 £25 (pb) 288pp ISBN: 9781843105503 services for sex offenders in the UK You get a clear sense of what a mental health service can and should For example, they offer assessment, treatment and case consultation for individuals within mental health and criminal justice systems where issues arise concerning mental illness, personality disorder or paraphilia There is also the important issue of men who present with troubling fantasies or behaviour, but without a conviction – clear guidelines are given on how to deal with these clinical issues For anyone who has any doubts, the book clearly sets out why mental health services have a crucial role to play in the management of sexual violence There has been a recent glut of books on sex offending The field is small, so the same experts contribute repeatedly to most edited volumes, often saying very similar things I had a couple of ‘groundhog’ moments reading these two books, but that does not take away from the quality and importance of the material For a clinician working with sexual offenders, these books are essential reading I will use them to inform my assessments and formulations, to guide the advice I give to other agencies, to better consider treatment options, to inform service development and to prompt and formulate clinical research questions The psychiatrist willing to take on board the information and messages in these books, should, when confronted with the task of assessing a complex sexual offender with personality or sexual psychopathology, be able to avoid the ‘opinion: not mentally ill’ culture and therapeutic nihilism that characterises the current response in most cases Rajan Darjee Orchard Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK Email: rajan.darjee@nhslothian.scot.nhs.uk doi: 10.1192/bjp.bp.108.056408 These books were already on my wish list when I was asked to review them So, as a psychiatrist with a special interest in the assessment and management of sex offenders, was I right to covet them? The first edition of Sexual Deviance was a key reference for those in the field This second edition, with chapters written by international experts, is probably now the essential reference work Following a thought-provoking introduction, there are new chapters on aetiology and changes in sexual deviation over the lifespan There follows the meat of the book: each ‘clinical syndrome’ has two chapters, the first on psychopathology and theory, the second on assessment and treatment New syndromes covered include internet offending, sexual deviance in females and multiple paraphilias Chapters on legal issues and neurobiology follow Grubin’s chapter sets out elegantly the role of medication in the treatment of sexual aggression, an area which has sadly been neglected by psychiatrists in the UK Laws’ final chapter cogently argues for a public health approach This is a comprehensive, scholarly and up-to-date account of the state of the art in both theory and practice Gaps and deficiencies in the research evidence, contentious issues and problems for practitioners are set out to guide clinicians and provide useful pointers to researchers This is a superb and indispensable book for those involved in the field Sexual Offending and Mental Health is essential for anyone working in or developing a clinical service for sexual offenders Largely written by clinicians from the Sex Offender Service at the Shaftesbury Clinic in London, it is a wonderfully practical clinical book The service is one of a handful of mental health Philosophical Perspectives on Technology and Psychiatry Edited by James Phillips Oxford University Press 2008 £32.95 (pb) 256pp ISBN: 9780199207428 This book comprises 17 essays on the theme of technology and psychiatry The term ‘technology’ in the title is used more broadly than many readers might anticipate In this volume, it embraces the general application of scientific, rationalist thinking to the treatment of mental ill health and the impact of technological imperatives on our mental wellbeing and patterns of living Thus defined, it includes not only pharmacological and other physical treatments but also the common forms of psychotherapy The essays cover a diverse range of topics and it would be impossible to summarise each of these in a short review A common theme is the need to balance the benefits to psychiatry of scientific rationalism, such as new pharmacological treatments 573 Book reviews and psychotherapies, with the threat that rationalism poses to our sense of identity The scientific approach was first widely used in an attempt to elucidate the nature and causes of serious mental illnesses such as Alzheimer’s disease and schizophrenia The scientific techniques are now being applied to understanding normal psychology and to areas that have historically been within the province of nonscientific disciplines such as moral philosophy There is an intuitive fear that rationalism is potentially all-consuming and that the things that give value and purpose to our lives, such as morality, emotions and free will, may be diminished or even negated by scientific scrutiny Some, including Donald Mender in this volume, hope that quantum theory may offer a scientifically respectable haven from deterministic causation and that this will allow ‘existential authenticity’ to be reconciled with science This is a highly problematical position as it is difficult to see how quantum indeterminacy offers anything other than randomness A concern frequently expressed in this book is that science and rationalism are potentially dehumanising The paradox is that rational thinking is the characteristic that distinguishes us, more than any other, from other creatures and therefore makes us distinctively human There is a fear that there is something undignified and demeaning about taking a reductionistic approach to human problems This is a real, but avoidable, risk In one of the essays in this book, Karen Iseminger and Dale Theobald describe how computer-aided monitoring of symptoms in patients with cancer can be sensitively combined with qualitative, face-to-face assessment The application of the scientific model to psychology and psychiatry is growing rapidly and will create new and challenging moral dilemmas Anyone who is interested in this area (and that should include all mental health professionals) will enjoy and learn much from this book John S Callender Royal Cornhill Hospital, 26 Cornhill Road, Aberdeen AB25 7ZH, UK Email: jscall@doctors.org.uk doi: 10.1192/bjp.bp.108.061739 Oxford Textbook of Old Age Psychiatry By Robin Jacoby, Catherine Oppenheimer, Tom Dening & Alan Thomas Oxford University Press 2008 £59.95 (pb) 640pp ISBN: 9780199298105 After working as an old age psychiatrist for 30 years, I have experienced a change in old age psychiatry from a psychiatric subspecialty, dominated by a close band of charismatic pioneers, to a faculty with close links to many other clinical and non-clinical disciplines The wide-ranging and topical nature of the subject is clear in this book which was ‘highly commended’ in the BMA 574 Medical Book Awards 2008 – an accolade that is well deserved This is the 4th edition, albeit under another name, of an indispensable textbook Psychiatry in the Elderly Earlier editions have been well-thumbed aids to my daily practice, but this new volume is completely revised with additional editors and it offers an even richer range of topics and authors, so that practitioners will definitely wish to add it to their personal bookshelves The book is divided into five sections The first concentrates on the basic sciences underpinning the practice of old age psychiatry These well-referenced and scholarly chapters contain some surprising topics, such as a fascinating account of brain development, as well as more standard themes The section on clinical practice includes wider discussion of different psychological treatments of older adults than is the case in previous editions In particular, Jane Garner provides a welcome review of psychodynamic theory and practice from Freud, Jung and Erikson onwards, challenging the orthodox utilitarian view that older people are too rigid or impaired to be suitable for psychotherapy Other chapters offer excellent introductions to cognitive, interpersonal and family therapies These chapters are complemented by a timely discussion of non-pharmacological intervention in care homes Work in this area is complex as the residents are among the most frail and vulnerable patients, staff are often undervalued in pay and training, and pharmacological treatments are of limited benefit and increase morbidity Professor Dawn Brooker in a chapter on person-centred care approaches with clarity this often misused concept, stimulating reassessment of traditional practice Psychiatric services are explored in section three, ranging from underlying principles to service developments such as memory clinics and liaison old age psychiatry; the chapter on building design has been rewritten Services are evolving fast and textbooks are a long time in gestation So, for example, the next edition might need to take into account the impact of the National Dementia Strategy on memory services Also, more evidence may have accumulated to justify a chapter dedicated to the effectiveness of assistive technology in individuals with dementia Specific disorders are well covered in the next section, with reviews of a wide range of topics, including moving personal accounts of the experience of being diagnosed with dementia or experiencing an episode of psychotic depression The subtypes of dementia are explored and there are excellent chapters on the functional disorders I found the chapter on alcohol and substance misuse in the elderly very informative The breadth of cover is illustrated by the inclusion of Tony Holland’s contribution on older people with intellectual difficulties and by the instructive chapter on sleep disorders The last section of the book deals with sexuality, ethics and medico-legal issues The writing is clear and authoritative, making this section a valuable resource for clinicians I will also use the chapters on testamentary capacity and driving as an educational aid for trainees in psychiatry It would be useful in future editions to include a chapter focusing on the impact of the Bournewood and subsequent judgements on mental health law This new edition remains an indispensable resource for practitioners On a minor point, I retain affection for the thicker paper and more manageable feel of the 2nd edition, but perhaps that reflects my own stage of life! Ann Marisa Silverman South London and Maudsley NHS Foundation Trust, Department of Mental Health of Older Adults, Greenvale Specialist Care Unit, Voss Court, 4–5 Streatham Common Southside, London SW16 3BS, UK Email: marisa.silverman@slam.nhs.uk doi: 10.1192/bjp.bp.108.062323 Book reviews Treatment of Borderline Personality Disorder: A Guide to EvidenceBased Practice By Joel Paris Guilford Press 2008 US$35.00 (hb) 254pp ISBN: 9781593858346 are treated within the National Health Service The difficulty is that this is often not clearly stated or seen as a legitimate treatment modality This is a sensible and thoughtful book with practical applications for anyone interested in, or working with, individuals with BPD My only caveat is that it underplays the role of group treatments for BPD and, true to its American origins, ignores cognitive analytic therapy altogether Ian Simpson South London and Maudsley NHS Foundation Trust, Psychotherapy Service, St Thomas’ Hospital, Lower Ground Floor, Adamson Centre, London SE1 7EH, UK Email: ian.simpson@slam.nh.uk doi: 10.1192/bjp.bp.108.060236 Paris approaches a subject he knows very well by critically reviewing the available psychosocial and pharmacological therapies for borderline personality disorder (BPD) He explores evidence-based treatments and translates the research, with numerous examples from his own lengthy clinical experience, into a set of practical guidelines with recommendations for clinicians for improving diagnosis, treatment planning and clinical management In the first chapters he concentrates on distinguishing BPD from other disorders, traces the causes of the disorder and looks at outcomes Borderline personality disorder overlaps with other mental disorders, particularly depression and bipolar disorder, and there can also be confusion with schizophrenia and post-traumatic stress disorder The danger in diagnosing BPD as a form of another disorder is that it can lead to patients getting the wrong treatment and not receiving therapies that have been specifically shown to be effective for BPD This is particularly relevant when it comes to the question of medication The evidence base for pharmacological treatment for BPD is slim Yet almost all patients today are being prescribed drugs, often with harmful consequences As Paris points out, the evidence for psychotherapy is much better than for any specific drug Medication should therefore be seen as an adjunct to psychological treatment rather than a therapeutic intervention in its own right The second part of the book is devoted to treatment and management A variety of available treatments are examined and assessed, acknowledging that the methods and length of therapy used for other groups of patients may not be effective in BPD Paris firmly believes that management requires patients to ‘get a life’, emphasising the importance of work, meaningful social networks and acquiring life skills Treatments should be wellstructured, involving a high level of activity on the part of the therapist, and focused on the ‘here and now’ Empathy, validation, mindfulness, reflection and tolerance of distress within clear boundaries are highlighted and Paris shows that there is a surprising degree of convergence between psychodynamic and cognitive approaches when considering this group of patients Paris also has some interesting things to say about the length and regularity of treatment, pointing out how individuals with BPD recover in stages, not all at once, and that most of them will improve over time This raises questions about dependency on treatment and therapists and how some longer-term therapies may become iatrogenic Intermittent treatment should be considered as it enhances the patient’s sense of healing themselves while leaving a door open to return to treatment if required My own experience shows this is in fact how many of these patients Multidisciplinary Handbook of Social Exclusion Research Edited by Dominic Abrams, Julie Christian & David Gordon Wiley–Blackwell 2007 £80.00 (hb) 270 pp ISBN: 9780470095133 I guess I was asked to review this book because, with my colleague Richard Warner, I recently published a book on social inclusion I also gave evidence to the government’s Social Exclusion Unit several years ago At the time I wondered why the government’s emphasis was on exclusion rather than inclusion, viewing them as diametrically opposed This became clear as I trawled through this edited volume of contributions from sociologists, social psychologists, other social scientists and academics, and clinicians In the first chapter, Jane Millar quotes one definition of social exclusion: ‘An individual is socially excluded if he or she does not participate in the key activities of the society in which he or she lives’ She considers that this ‘implies that the opposite of social exclusion is not social inclusion, but participation’ Other definitions are cited throughout the book, with acknowledgements that as yet there is no internationally agreed definition of social exclusion Each chapter deals with a different group of people who are subject to exclusion from society, among whom are women, homeless people, ethnic minorities and children in care I searched in vain to find a section on people with psychiatric illness Even though the author of the chapter on homelessness notes that one-third to one-half of rough sleepers have mental health problems, this issue is not referred to again There is a chapter on stigma and exclusion in healthcare settings, in which substance misuse, the most stigmatised of psychiatric conditions, is discussed However, the stigmatisation by staff in accident and emergency departments of people who self-harm is not mentioned Despite the title of this handbook, research studies take second place to discussion of policies, both national and international 575 Book reviews Time and again the issue is raised of an oscillation between promoting social action (left wing) and holding the individual responsible for their exclusion (right wing, the ‘undeserving poor’) I actually gleaned most from the final chapter in which Abrams & Christian propose a framework for analysing social inclusion and exclusion that draws extensively on research and ends with a brief section on designing interventions It contains the following gem: ‘People under the age of 25 typically viewed youth as ending at 38 and old age as starting by 55, while people over 65 typically viewed youth as not ending until after 56 and old age as not starting until after 67’ 576 I was disappointed to find very little documented research on attempts to facilitate social inclusion, and none that related to psychiatric patients In short, this is not a handbook from which the psychiatric professional will derive much of relevance, but I did find that the policy issues widened my perspective on exclusion Julian P Leff Institute of Psychiatry, South Hill Park Gardens, London NW3 2TD, UK Email: j.leff@medsch.ucl.ac.uk doi: 10.1192/bjp.bp.108.060293 Philosophical Perspectives on Technology and Psychiatry John S Callender BJP 2009, 194:573-574 Access the most recent version at DOI: 10.1192/bjp.bp.108.061739 References Reprints/ permissions You can respond to this article at Downloaded from This article cites articles, of which you can access for free at: http://bjp.rcpsych.org/content/194/6/573.2#BIBL To obtain reprints or permission to reproduce material from this paper, please write to permissions@rcpsych.ac.uk /letters/submit/bjprcpsych;194/6/573-a http://bjp.rcpsych.org/ on January 14, 2017 Published by The Royal College of Psychiatrists To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/