Book Reviews DoNNA
B. GREENBERG, M.D.
BOOK REVIEW EDITOR
Oxford Textbook of Palliative Medicine Edited by Derek Doyle, Geoffrey W. C. Hanks, Neil MacDonald New York, Oxford University Press, 1993 845 pages, ISBN 0-19-262028-2, $125.00
Reviewed by Donna B. Greenberg, M.D.
his book was at first intimidating, a tome written in very small print. It was via questions about symptom management-pain, unremitting nausea, sialorrhea, malignant intestinal obstruction-that I found my way into the book to a succinct, practical reference textbook. Tables are common, style clear, principles outlined. Cancer and AIDS are the primary challenges. It is the major statement of palliative care, placing the hospice movement in historical context from origin to the 19908. Cicely Saunders wrote the preface. A total of 103 contributors complete the assignment. Their concise sections understate the depth of their authority in each field. The editors of Edinburgh, London, and Edmonton found Schipper, Portenoy, Foley, Bruera, Inturrisi, Twycross, Vachon, Parkes, Breitbart, and an array of others to collaborate in this statement of the state of the art. The section on symptom management clarifies palliative use of chemotherapy, radiation, general surgery, and orthopedics. The discussion of pain extends a comprehensive 140 pages. Lymphedema, mouth care, skin care, infection, blood, breathing, cachexia, hepatic encephalopathy and gastrointestinal comfort are considered. The psychological aspects include bereavement, psychopharmacology, behavioral treatment, family, and spiritual and ethical management. They cover depression, anxiety, delirium, suicide, sedation, and insomnia. Children are the subject of a distinct 5~ pages. The positive side of hospice-bound palliative care is underVOLUME 36. NUMBER 5. SEPTEMBER - OCTOBER 1995
scored by sections on rehabilitative therapy. Beside unremitting symptoms, the field is marked by the challenges of the oncology interface, the interdisciplinary team, place of death in society, service development, communication, and the definition of quality of life. Research, education, and training in palliative care, and the global perspective are considered. This is not the place to find the natural history of specific diseases but the physiology of symptoms and the science of treatments to alleviate them. The emphasis is maximum comfort, quality of life given progressive illness, and the process of safe passage. We know a lot that can help. It is logged here with wisdom and dedication. Dr. Greenberg is psychiatrist at Massachusetts General Hospital, and assistant professor of psychiatry. Harvard Medical School. Boston, MA.
The Suicidal Patient: Principles of Assessment, Treatment, and Case Management By John A. Chiles and Kirk D. Strosahl Washington, DC, American Psychiatric Press, Inc., 1995 282 pages, ISBN 0-88048-554-X, $42.50
Reviewed by Peggy E. Chatham Showalter, MD.
uicidal patients are an enduring feature of psychiatric practice. This book brings a fresh and pertinent perspective to the view of these patients. The author team of a medical-model psychiatrist and a hard-core behaviorist have produced an engaging and well-written book that challenges convention and wisdom on managing suicidal patients. The book is divided into three sections: "Understanding Suicidality," followed 505