J. Behm. Thu. & Exp. Psychial. Printed in Great Britain.
Vol. 14, No. 2, pp. 175-177, 1983
BOOK REVIEWS Clinical Psychology and Medicine: A Behavioral Perspective Edited by Chris J. Main; Associate Editor, William R. Lindsay Plenum Publishing Company, New York, N.Y., $39.50 This text is another in the ever increasing number of books on the application of behavioral psychology to medical problems. The title and approximately 70% of the content would lead the reader to categorize this text within the general area of behavioral medicine; however, approximately 30% is devoted to psychiatric patients. As noted in the preface, the book is an outgrowth of the Fourth Conference of the Scottish Association for Behavior Modification held in 1980. The editors note that the general emphasis of this conference was on the assessment and treatment of chronic illness and the major intent of the book is to “draw attention to recent advances in clinical psychology in multi-disciplinary settings”. The text is divided into four sections. Section 1 is entitled “Theoretical Viewpoints” and contains three chapters. These chapters cover the areas of chronic pain and illness behavior, the utility of applying probability theory in making clinical decisions, and a position statement on the disadvantages of a cognitive-behavioral approach to treatment contrasted with the advantages of a “radical behaviorism” orientation. Section 2 is entitled “Clinical Psychology in the Community” and consists of six chapters dealing with the application of behavioral psychology in primary care systems, methodological and clinical considerations in examining stressful life events and their potential impact on the female climacterium and consulting physicians for medical care, as well as a chapter critiquing the area of behavioral bibliotherapy. Section 3 of the text addresses the area of specific clinical application to physical illness and consists of four chapters. Areas covered include cardiac rehabilitation, dysmenorrhea, and psychophysiological conceptual and treatment issues for headaches. The fourth section of the book deals with the area of specific clincial applications in chronic psychiatric illness and is made up of six chapters. These chapters focus on the chronic hospitalized psychiatric patient suffering from schizophrenia. Chapter content includes the report of individual studies on using situational and environmental manipulations to change schizophrenics’ self-help skills, mealtimes behavior, speech and social behavior. The text has several strengths. Perhaps the most important is the emphasis on methodological quality and research issues found across a number of the individual chapters. This is especially true of Chapters 7, 12 and 13, as well as for the systematic research represented in Chapters 14-19. The reader is also provided with an abundance of research ideas on the application of clinical psychology to psychiatric and nonpsychiatric chronic illnesses. Of special note are Chapters 12
and 13 and Chapters 14-19. These chapters exemplify innovative and quality research on the mechanisms associated with chronic headaches and variables affecting chronically hospitalized psychiatric patients, respectively. In general, the writing style of the text is quite good. While strengths are present, there are a variety of problems apparent in the book. Given its stated intent, there are a number of significant omissions in content. It is not at all clear, other than for the possible constraints of the subject matter presented at the original conference leading to this text, why the editors did not address a number of other prevalent and important chronic illnesses. I am referring here to such things as cancer, diabetes, chronic renal failure, chronic obstructive pulmonary disease, etc. In the area of psychiatric disturbance it would also have been much more complete to have included a section on depression. The text also lacks a sense of continuity across its chapters. Again, it would appear that this is a result of limitations from the subject matter presented at the conference which served as an impetus for the book. Nevertheless, the lack of such continuity greatly compromises the general utility of the book. Certainly, more introductory and synthesis chapters at the beginning and/or end of sections would have greatly enhanced integration of the material for the reader. Even with such integration, the implicit scope of the book from the intent stated in the preface almost precludes the feasibility of adequate coverage of content material. Given that clinical psychology has such a range of application in psychiatric and non-psychiatric chronic disorders, it would be quite difficult to address adequately all these applications in one text. In short, the scope of the text is too broad. The editors would have been much more successful if they had limited the content to clinical psychology in one or two categories of chronic illness within psychiatric or nonpsychiatric arenas. In summary, while the text contains some interesting and innovative research methods and ideas, its restricted scope and the lack of continuity in content are serious deficiencies. I would recommend the book for readers whose particular needs it happens to fulfil. STEVE
Chief, Division of Behavioral Medicine University of Utah Medical Center Salt Lake City, Utah, U.S.A.