BOOK REVIEWS

overlap with both schizophrenia and dip into a library copy, as might mean in the past and what meaning we unipolar disorder and also a significant established consultants and students. place on them now. To Socrates, it meant comorbidity with addictions and personal- that he was hearing a wise and divine ityitydisorders.disorders. Most major classes of psycho- AllanYoung Professor of Psychiatry,Department daemon. To the contemporary British tropictropic drugs have been used for the of Psychiatry,Leazes Wing, Royal Victoria Infirmary, press, it typically means madness and treatment of this disorder and it has been Newcastle uponTyne NE1NE14LP,UK 4LP,UK unreasoning violence. To psychiatrists it is argued that the psychopharmacological often a symptom of psychosis to be revolution was initiated by the discovery suppressed withmedication. To voice by John Cade in 1949 of lithium as a hearers nowadays it is usually as mundane treatment for mania. Lithium, of course, as most inner speech, similarly influencing remains the gold standard against which all Voices of Reason,Voices of their behaviour by directing and judging. other treatments of this disorder must be Insanity: Studies of Verbal The authors aim to describe experiences measured.measured. Hallucinations and explicitly step back from explanations. It is with the subject of bipolar medica- They conclude that voices do not necessarily tions and their mechanisms of action that By Ivan Leudar & PhilipThomas.London: indicate insanity any more than thinking, this volume edited by Manji, Bowden & Routledge. 2000. 214 pp. »15.99 hb). imagining or seeing do: they are an unusual Belmaker, three leading US researchers, is ISBN 0 415 14797 5 kind of private speech. So they have mean- concerned. In it they seek to understand ing to the hearer which can be understood lithium and other `bipolar' medications if one listens. such as the anticonvulsants and atypical This book is part of the growing body antipsychotics.If we understood how these of opinion that believes hallucinations to be treatments work we would have a better not random events but metaphors related toto grasp of the neural basis of this devastating the hearer's personality and the stresses that disorder. Despite 50 years of research we precipitate his or her condition. This has still do notnotstilldo really understand the action of therapeutic implications, recognised by lithiumlithiumoror of any of the other putative cognitive techniques that draw out the mood stabilisers. However, this volume structure and meaning of the voices. But investigates most of the major leads and Leudar & Thomas depart from some reviews results from clinical studies of cognitive therapists' approach on one point: lithium withdrawal and evidence of the they have no wish to challenge the voice efficacy of new treatments. hearer's explanation of the voices, preferring This is predominantly a North American instead to elucidate how the phenomenon textbook, with a few contributions from is rooted in the patient's past experiences Israel and the occasional chapter from the and life history. UK, Denmark, Canada and Japan. Contri- The book offers a wide and detailed butors are mostly academic psychiatrists, perspective. It struggles at times to bring basic scientists interested in this area and material from diverse sources into focus and representatives from the pharmaceutical to maintain a coherent argument. But the industry who are primarily concerned with content is fascinating and leads to a clear the development of new treatments. What does it mean if you experience verbal and important message. Leuder & Thomas Overall, this is a very good book for hallucinations? Are you mad or divinely sum up nicely the clinical perspective from the aficionado. It is frustrating that many inspired? And what does the content of which we have come: ``The question `Who of the chapters take a rather blinkered view your hallucinations signify? Is it meaning- is speaking?' is answered by `Nobody, it's of the various medications' mechanisms of ful? Or is it un-understandable nonsense, an just hallucinations'. And `What do the action, often seeking to explain them entirely epiphenomenon of biological processes that voices mean?' is answered by `They mean within a single frame of reference. There is no points only to a neuropsychological address your illness, nothing else' ''. Through their attempt to integrate the plethora of different and a diagnosis? book they remind us that, by listening findings and the book would be considerably Leudar & Thomas explore how people to the patient, we will discover where enhanced by an authoritative concluding explain verbal hallucinations. They consider to go. chapter by the editors. Notwithstanding this the voice hearers, the psychiatrist, the press caveat, the book is a mine of information and the public. They provide accounts from Frances Klemperer Consultant in General that should be purchased by departmental voice hearers with a psychiatric diagnosis Adult Psychiatry,South Kensington and Chelsea libraries. And although I would not recom- and from those without. They document Mental Health Centre, 11Nightingale Nightingale Place, London mend that trainees buy it, they should what these experiences have been held to SW10 9NG,UK

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