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Book Reviews BRITISH JOURNAL OF PSYCHIATRY (2004), 185, 523^524 Book reviews Engstrom describes the mental hospitals of the mid-century as ‘institutions of discipline and care, expressions of both EDITED BY SIDNEY CROWN, FEMI OYEBODE and ROSALIND RAMSAY bourgeois moralism and solicitude. Their directors were patriarchs . their exacting house rules effected a certain bedlamic order’ (‘bedlamic’ is a new adjective to me). In this they resembled institutions elsewhere in Europe and in the USA, but Prevention Strategies What are the likely public health inter- in Germany the system was more efficient for Schizophrenic Disorders: ventions that might reduce the incidence of and even more rigid. Nevertheless, by the Basic Principles,Opportunities schizophrenia? First we must ask what end of the century ‘entirely different institu- and Limits causes schizophrenia. A number of chapters tions had come to represent the epitome of Edited by Allessandro Grispini. in this book give excellent reviews of professional power and knowledge’. These Rome: Giovanni Fioriti. 2003. 369 pp. »50 the literature considering this question, were the university psychiatric clinics, (pb).ISBN 88 87319 421 although many are tailored to this book which were significantly smaller, centrally only by the insertion of a beginning and situated and headed by doctors who were ending paragraph on prevention. Some of not only clinicians and administrators but the risk factors, such as being brought up in natural scientists. In Engstrom’s view, they an urban environment, seem to give little were nationally conceived to try to solve hope for prevention unless cities are done the troublesome ‘social problem’ of insanity. away with. Genetic risk factors can, at British readers will then wonder why present, be used only to counsel those with nothing like this existed in the UK until affected relatives. Obstetric difficulties may the late 1930s – an enigma that awaits an be a causal factor, but services are in any historically satisfying answer. case trying to reduce these and there would OnefactorheremaybethemoreOne factor here may be the more seem to be little scope for further action. intrusive power of the state in Wilhelmine So what is the conclusion about the Germany, which made professional prac- prevention of schizophrenia? Many limits tices inherently ‘political’. From the other and not many opportunities: further direction, psychiatrists are said to have research is needed. ‘mobilised much of the cultural machinery needed to expand the profession’s influence Glyn Lewis Professor of Psychiatric across civil society’. Anticipating the 1960s, Epidemiology,University of Bristol,Cotham House, Engstrom identifies a movement of ‘anti- Cotham Hill, Bristol BS6 6JL,6JL,UK. UK. psychiatry’ in this period, but regards fear E-mail: Glyn.lewis@@bristol.ac.uk of confinement in an asylum as indicating a A prevention for schizophrenia is still a holy grail and whether it exists at all is the Clinical Psychiatry in Imperial $64 000 question. This grail is no closer Germany: AAHistory History of Psychiatric and answers to the big question are no PracticePractice clearer after reading this multi-author By Eric J. Engstrom. Ithica & London:London: Cornell collection of essays. University Press. 2004. 295 pp. »29.95 (hb). Prevention is classically divided into ISBN 0 8014 4195 1 primary, secondary and tertiary, although the second and third are concerned with Eric Engstrom is a bilingual historian who treatment and management in the health has already published scholarly works in service. Primary prevention of new cases of both English and German, focusing on the disorder is quite different and often relies 19th century. This time, he has examined on population-based methods and changes the evolution of the psychiatric profession in policy. Thus, primary prevention of in Germany, from just before national cardiovascular disease includes limiting unification to the outbreak of the First tobacco advertising and improving food World War. In this story, he finds the labelling. Primary prevention of sudden outstanding process to be the rise of infant death syndrome has involved public university psychiatric clinics, providing a education programmes to encourage contrast with the established culture of the parents to lie their babies on their backs. asylum.asylum. 523 Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 02:43:40, subject to the Cambridge Core terms of use. BOOK REVIEWS ‘heightened sensitivity for liberal and demo- the disorder. This forms a substantial part cratic values’. There were even calls from of the book and it is not something that one some German psychiatrists for a move to could readily deduce from the title, which is community-based care, revealing an active a pity as there are few reviews of this response to the social questions of the day. subject in the PTSD literature. This is an exhaustively referenced The author covers a wide range of work, and one that makes a significant issues related to memory, including con- contribution to the psychiatric history of cepts of repression, the recovered memory the period. What would be fascinating debate and how this relates to Freudian would be an examination of how these theory. He criticises both sides of the trends influenced the German response to debate for failing to distinguish between the mass psychiatric casualties of the First observations and theoretical explanation. World War. He then presents some of his own research on memory inhibition and argues for the Hugh Freeman Honorary Visiting Fellow,Green concepts of a visual accessible memory College, Oxford OX2 6HG, UK (VAM) and a situational accessible memory (SAM), which form part of the dual representation theory for PTSD. This provides a feasible explanation for the phenomena of repression and dissociation. One chapter covers the prevention and Post-Traumatic Stress Disorder: treatment of PTSD, including the contro- Malady or Myth? versial area of psychological debriefing. PTSD and the relative aetiological import- By Chris R.Brewin. Finally, there is a summing up and a look ance of exposure to a traumatic event New Haven,CT:Yale University Press. 2003. to the future. compared with premorbid vulnerability. 272 pp. »25 (hb). Overall, this is a well-written volume This is well-travelled ground and those ISBN 0 300 09984 3 with excellent and comprehensive refer- whose special interest is PTSD will not find ences (although I would have preferred a Chris Brewin is the Professor of Psychology anything particularly new or startling in the title that was more indicative of the at University College London and is an first third of the book. However, it is a content). It would be of value both to a expert in both post-traumatic stress dis- good overview of the area and with an relative newcomer to the subject and to an order (PTSD) and memory. This volume international rather than purely North expert.expert. is from the Current Perspectives in American perspective. Less predictable, Psychology Series. and arguably more interesting, Brewin then As the title might lead one to expect, reviews the evidence and explores possible Martin Baggaley Consultant Psychiatrist, Professor Brewin initially explores the topic theories that explain the laying down of South London and Maudsley NHS Trust, in an adversarial way, presenting the traumatic memories and how this process Ladywell Mental Health Unit, Lewisham Hospital, argument for and against the concept of might shed light on the core symptoms of Lewisham High Street, London SE13 6LW,UK 524 Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 02:43:40, subject to the Cambridge Core terms of use..
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