BOOK REVIEWS 73

but rather exists in several forms of isotopes is valuable for applications such as radioimmune assays and radiocarbon dating.

In recent surveys anxiety disorders turn out to be surprisingly common in the general population. Much epidemiological work is reviewed by Weissman, and cultural variations are well-discussed by Good and Kleinman, including fright syndromes, shinkeishitsu in Japan, and neurasthenia in China, while Carey imaginatively discusses the two chapters. The history and bases of European classifications of anxiety and related disorders are beautifully clarified by Jablensky; Spitzer gives an American view, sober doubts about which are detailed by Detre.

Some ideas and fields are dealt with less than rigorously (chapter Nos in parentheses). Hyperventilation is prematurely reified into a syndrome (16). Much of the book elevates panic into an entity without convincing data for its discontinuity from milder forms of anxiety. Childhood separation anxiety is said to relate specifically to agoraphobia despite evidence that it relates to anxiety disorders as a whole (20). Three inconveniently negative controlled studies of antidepressants in agoraphobia are omitted so the reader is left with the impression that antidepressants are the approach of choice (27). The section on measurement of anxiety in adults (35-37) omits the immense corpus on assessing fear and obsessivecompulsive phenomena.

This meandering volume would have benefited greatly from more rigorous editorial pruning (numerous chapters overlap or are verbose) and from selection of the cutting edges in research into anxiety with less tunnel vision. Many vital growing points are omitted. The fascinating body of ethological research on fear is ignored beyond a sentence paying lip-service to its importance in the introduction. Hardly any work on the genetics of anxiety appears, despite the immense amount of thought-provoking research on the subject in animals and man. Most of the excellent enquiries into the development of fear in infancy are left out. The pioneering work on defensive reflexes by Kandel and Alkon which for the first time promises to link cell biology with psychology in a meaningful way fails to feature.

Readers of this journal will find it remarkable that so little space is devoted to the behavioural revolution that has made several formerly intractable anxiety syndromes readily treatable with enduring improvement. Foa and Kozak penetratingly review exposure methods in phobic and obsessive-compulsive disorders and theortical issues affecting outcome, including the role of ‘emotional processing’; they find that existing cognitive techniques for anxiety disorders offer little support for the hypothesized cognitive deficits, and that those techniques might be mistargeted. Some issues in fear-reduction are debated by Rachman, while Borkovec mentions tantalizing results of stimulus control for worries.

Bearing in mind the serious omissions, students of anxiety will nevertheless find many scholarly chapters in this rambling book that are well-worth browsing through. The E74 price tag is prohibitive except for libraries, although I understand that individual readers ordering direct from the publishers will pay a lower price.

ISAAC MARKS

H. WALTON (Ed.): Dictionary of Psychiatry. Blackwell, Oxford (1985). 170 Pages. f 12.50.

Anyone who has ached to know who drowned Dr Gudden in 1886 (it was his patient, King Ludwig II of Bavaria) or the definition of koro (Sout-east Asian fatal penis-shrinking neurosis) will find this book indispensable. The dictionary encompasses relevant fields from philosophy to neurochemistry and many of the entries are useful and comprehensive. Certain areas, psychoanalysis for example, are very well covered; and, taken together, the notes on prominent figures in psychiatry provide a passable history of the subject. Most of the definitions are appropriate, although a few exceptions can be found: obesity is cited as a disorder of eating caused by psychological pressures (unproven); a receptor is defined as a specialized nerve ending (too narrow-many receptors, e.g. insulin receptors, are on non-neural cell membranes); and, in the definition of promiscuity, no reference is made to number of partners. The editor has. however, managed to minimize the number of these errors. The English necessarily suffers to achieve brevity, but at times (such as in the definition of non-accidental injury) is almost incomprehensible. The most disappointing feature of the book concerns errors of omission, particularly in the more recent concepts in psychiatry. Genetic disorders are mentioned frequently, but their mode of transmission is rarely mentioned. Behavioural therapies are given scant attention, and areas of increasing influence such as the biology of endorphins and other neuropeptides, the theoretical framework of family therapy (systems theory, structural and strategic therapy) and the links between family-expressed emotion and mental disorder are omitted entirely. This dictionary can, nevertheless. be recommended as a brief reference book for any professional concerned with psychiatric disorder. It would also be useful for the lay-reader who wishes to penetrate the cloud of jargon with which we obscure the field. It is hoped that in future editions of this worthwhile effort the weaker entries will be improved and modern concepts more fairly reflected.

PAUL ROBINSON

L. WHITE, B. TURSKY and G. E. SCHWARTZ (Eds): Placebo: Theory, Research, and Mechanisms. Guilford Press, New York (1985). Pages xiii + 474. f42.00.

This book will be a very welcome addition to the bookshelves of any library of psychology or medicine. The editors argue that for too long the term placebo, derived from the Latin meaning “I shall please”, has come to denote a deceptive practice and a nuisance variable. The methodological refinement of the double-blind placebo controlled drug study recognizes placebo effects as a clinical reality, but dismisses them from further consideration. Instead, the editors propose a