Behavioral psychology in rehabilitation medicine: Clinical applications

Behavioral psychology in rehabilitation medicine: Clinical applications

464 BOOK D. HEWITT: The Mass Media and Social Problems. (paperback). Pergamon REVIEWS Press, Oxford (1982). viii + 204 pp. E15.00 (hardback); f...

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D. HEWITT: The Mass Media and Social Problems. (paperback).



Press, Oxford

(1982). viii + 204 pp. E15.00 (hardback);


Does television aggravate, reduce or merely reflect social problems? This book, the second in the International Series in Experimental Social Psychology, overviews the many ways in which the mass media, especially television, might influence the quality of our lives. Topics covered include racism, sexism, health, violence and crime. Examples are given of how media programmes and characters, such as Alf Garnett in Till Death Do Us Purt, might influence, in this case, racial attitudes. The diversity of lay and professional opinions about such matters is illustrated, and some relevant research studies are outlined. The theme throughout is one of critical analysis. Attention is drawn to the limitations of the various research strategies, and to some inconsistencies in the results obtained. The problems of generalizing from experimental to naturalistic situations are especially emphasized. The result is a rather negative impression that research is too complex to produce any clear answers or even guidelines for social policy decisions such as censorship. Laboratory research, in particular, tends to be dismissed as of little value because it lacks a real life context. For example, in studying influences on aggression, the experimenter usually finds that violence films do increase the likelihood of subsequent aggression. But Howitt argues that this is merely a demonstration of what in theory should happen; in real life, constraints such as a fear of counter-attack or of being arrested, will probably prevent people from expressing their aggression. Subsequently, value tends to be placed only on research carried out on “real people in the real world”. But unfortunately, such research is beset with practical and ethical difficulties and very little has been attempted. More useful would have been a consideration of how research has thrown light on the mechanisms of influence. For example, desensitization would seem to be an important mechanism by which people’s attitudes and behaviour are modified by constant exposure to the mass media. But no mention is made of this possibility. Imitation is briefly mentioned, it being argued that research merely demonstrates that people have a capacity to learn by imitation and not that they actually will imitate in a real life setting. But if socialization and learning does not occur as a result of such mechanisms, then what factors are responsible? No constructive alternative is offerred. D. K. B.

KAKIN OBHOLZER: The Wolf-Man (1982). 250 pp. E12.50.


Years Later: Conversations

with Freud’s Patient.


& Kegan


Paul, London

This book was written by an Austrian journalist, with a background in philosophy and psychology, who traced Freud’s famous patient in Vienna at the age of almost ninety, and conducted many lengthy interviews with him. These were taped, and constitute the main basis for this book. It is of interest because the Wolf-Man was one of Freud’s most famous cases, and is often considered as proof of the successful application of psychoanalysis, What this book makes clear is that the patient suffered many relapses, had to receive much more psychoanalytic treatment from several analysts, and indeed showed no lasting effects whatsoever of the Freudian treatment. No properly trained psychologist would have expected anything else; in cases of depression, obsessive thoughts and schizophrenia-like episodes, it is well known that patients have their ups and downs, and that no treatment can be called successful unless follow-ups show a cessation of symptoms. Freud of course was no scientist, and there is no provision for follow-ups or control groups in his treatment; as a consequence, he was completely misled (and has misled many of his followers) concerning the effectiveness of his treatment. This book sets the record straight. Behaviour therapists will be amused to see that the man who accused practitioners of “merely symptomatic treatment” of a useless kind of activity inevitably resulting in relapses, should have found that his own much vaunted non-symptomatic treatment resulted in precisely the kind of relapse which he expected to find (but which was not in fact found) in behaviour therapy! This is the ultimate irony in the strange and almost incredible story of how a theory which made no contact with reality at any point succeeded in subverting psychiatry from its true path for over half a century. From that point of view alone the book is well worth reading for any psychologist, psychiatrist or psychoanalyst interested in the strange vicissitudes of this remarkable doctrine. H. J.


L. P. (Ed.): Behavioral Psychology Md. (1980). xvi + 436 pp. $24.00.

in Rehabilitation


Clinical Applications.


& Wilkins,



In the foreword the series editor, Basmajian, says of this book: “It contains sparks that can and should ignite an explosive revolution in rehabilitation medicine”. However, the anticipated rewards of encountering these sparks do not quite materialize. There are a few exciting, spark-filled pages but these are accompanied by many damp, heavy going ones. The book contains 12 chapters arranged in three sections. Section I-Basic Principles and Methodology+onsists of one chapter on ‘Behavioural Engineering’ by Minke. It is an interesting enough chapter touching on many aspects of behavioural treatments but it oversimplifies. The result is that it is too superficial both for the newcomer to behavioural methods and for the experienced behaviour therapist who wishes to adapt his/her skills to physical rehabilitation. Section 2-Treatment and Training--contains eight chapters and is the most substantial section of the book. The first few pages of Friedlander’s contribution “Automated Operant Methods for Assessment and Treatment in Physical



Rehabilitation” provide one of the sparks. His ingenuity in overcoming severe physical handicap is inspiring. However, our awe is tempered by his failure to be more explicit about the teaching methods he used and by his failure to provide svstematic and reliable observations for some of the treatments he claims were not only successful but generalized to other tasks. Even so, ideas on how these automated methods can be applied to other problems and other patient groups, crowd into the reader’s mind. For example, he discusses how to teach people to refrain from responding. This could be of great benefit to head-injured patients with frontal lobe damage. The-Diller chapter on perceptual remediation for right-brain damaged people is the only one to tackle cognitive impairment. This failure to include alleviation of memory and attentional deficits or other cognitive problems is one of the weaknesses of the book. Diller says “there is no useful taxonomy of memory Not everyone would agree with him. Apart disturbance which can help guide the student concerned with remediation”. from the question of taxonomy there are certainly some memory remediation programmes being carried out within a behavioural framework in Britain if not in the U.S.A. The other chapters in this section include disorders of coordination, motor problems, biofeedback, speech disorders, chronic pain and cardiovascular rehabilitation. The one on speech disorders contains a fascinating table comparing the length of time different groups of people spend talking and what percentage of the time is spent talking too loudly. The final section-The Experimental Laboratory and Beyond-onsists of three chapters. The first of these on spinal cord learning by Ince provides a useful summary on the effects of spinal injury. The remaining chapters are mostly descriptions of animal studies. One wonders whether the devastating effects of these experiments on monkeys and cats really do more than provide a few crumbs of practical value to people with CNS damage. The ideas put forward about motivational aspects and learned non-use of hemiplegic limbs are interesting and can be tested experimentally. However, they could have been developed by observation of patients rather than animal experimentation. One of the interesting findings, for example, from rehabilitation is that right-brain damaged (left hemiplegic) patients take longer to rehabilitate/reach maximal recovery than left-brain damaged patients. Will the suggestions put forward by Taub and Yu work differentially for these two groups? Animal work will not help here. In conclusion, the book does not live up to its initial promise but should prove a useful reference book for a restricted audience. It is doubtful whether many physiotherapists, occupational therapists, nurses or speech therapists working in rehabilitation will read it. Some doctors might, and the few clinical psychologists and neuropsychologists interested in rehabilitation, but even these will probably find only a few chapters of value. BARBARA WILSON

F. REIMER (Ed.): Verhaltenstherapie in der Psychiatric. 13. Weinsberger Kolloquium. Weissenhof,


(1982). 261 pp.

This book presents a report of a symposium, with 20 contributors writing on various aspects of behaviour therapy as seen in the context of German psychiatry. The symposium was held in Weinsberg, famous in German history because when the town was invaded by Wallenstein’s troops during the Thirty Years War, the inhabitants offered to surrender provided that the women would be allowed to go free, and to carry with them their most precious possessions. Wallenstein agreed, but was surprised to see the women tottering out of the gates, carrying their husbands on their backs! It is also interesting to note that the Colloquium was held in a very large mental hospital employing 17 psychologists, some of them heads of separate departments, with psychiatrists working under them; the major occupation of psychologists was the carrying out of behaviour therapy. Conditions are not as favourable everywhere in Germany, but as the book makes clear behaviour therapy has definitely arrived in Germany, and has inspired a good deal of research. In the future there is no doubt that German psychological work will have to be reckoned with, and that German psychologists will soon succeed in overcoming the bigoted objection of the German medical profession to their carrying out any form of therapy. It would be impossible to discuss in detail the contributions, which range from behaviour therapy and anorexia nervosa to treatment of schizophrenics, and from behaviour therapy in addicts to group treatment of obsessivecompulsive neurosis. One chapter describes the philosophy underlying the work carried out at the Weinsberg Hospital itself. For anyone who can read German this would be an interesting and worthwhile book to study. H. J. EYSENCK

A. ROY (Ed.): Hysteria. Wiley, Chichester

(1982). xiv + 316 pp. E18.00

Following the near success of Eliot Slater’s attempt in the 1960s to abolish hysteria as an acceptable psychiatric diagnosis it has slowly been making a comeback. Alec Roy celebrates hysteria’s return to favour by editing this compendium. All the major authorities (and the old disputes) are here, five represented merely by reprinted articles but fifteen others with newly commissioned chapters. Perhaps the seminal article is that by Woodruff and his colleagues in which they explain their concept of hysteria, rechristened Briquet’s Syndrome, for it has been the St Louis school who have orchestrated hysteria’s revival. Also included is Slater’s vitriolic article in which he damns St Louis hysteria as “self-condemned to absurdity by being, supposedly, confined to women”, and Aubrey Lewis’s quiet rejoinder that “a tough old word like hysteria dies very hard. It tends to outlive its obiturists.” Other old favourites are updated; Abse and Whitlock, respectively, review multiple personality and the Ganser Syndrome, the latter more impressively than the former; once again Eysenck reiterates his touching belief that hysterical behaviour occurs predominantly in high E-high N individuals in spite of the objective evidence to the contrary. There are other, less