INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 10: 163 (1995)

BOOK REVIEWS Human Behaviour: An Introduction for Medical Students. Editor: ALAN STOUDEMIRE. J . B. Lippincott Company, UK. 1994 Second Edition. No. of pages 464.

This book has been published during a time of great change and upheaval in medical education throughout the world. There is a general consensus that most Curri- cula are overburdened with the didactic teaching of bio- medical facts. Many schools are now attempting to define a core content and adopt adult learning systems such as problem based small group design. This is coupled with the acceptance and promotion of newly graduated doctors being much more proficient in communication skills and having a far deeper understanding of human behaviour.

The book is multi-authored with 27 contributors all based in the United States. It is divided into five major sections covering all aspects of human behaviour, deve- lopment and major psychological theories together with clinical applications. Each chapter comes with an exten- sive reference list, for example one chapter cited 133 arti- cles, some from as recent as 1993. It also has an annotated bibliography at the end of each chapter which I think

will be more useful to a student wishing to delve more deeply into a particular aspect of human behaviour.

The study of a subject can be defined both by the breadth and also the depth. I think that this book is remarkable for the depth to which it discusses the subject matter. A student wishing only to acquire the rudimen- tary aspects of human behaviour may therefore find it quite difficult to dip into. A more interested student though, would be amply rewarded.

For my own part I found the book readable and was drawn to the chapters covering child development through my own vested interest as a parent. Throughout the book there is liberal use of case vignettes and I think that these are always useful to keep the reader ‘in the real world’.

Notwithstanding its price and origins in one particular medical education system, I would recommend the book to a student who wishes to study and understand human behaviour to a much greater depth than a core compe- tency would demand.

PAUL O’NEILL Withington Hospital, Manchester

State Mental Hospitals and the Elderly. A Task Force Report of the American Psychiatric Association. American Psychiatric Association, 1993. No. of pages: 99.

Selected Models of Practice in Geriatric Psychiatry. A Task Force Report of the An 9rican Psychiatric Associa- tion. American Psychiatric Association, 1993. No. of pages: 82.

Psychosocial Treatment Research in Psychiatry. A Task Force Report of the American Psychiatric Association. American Psychiatric Association, 1993. No. of pages: 96.

While APA Task Force reports are clearly commissioned and carried out for local reasons they often contain insights and lessons that might be of benefit to health services in other countries.

The report on the State Mental Hospitals betrays the poor conditions with which patients and staff have to cope and the unplanned way in which institutions have continued to function. Most radical of its recommenda- tions is the fusion of psychiatric and geriatric care, justi- fied by the interaction of physical and mental disorder in the elderly. Joint training schemes, (better training for all staff), the attachment of state hospitals to nearby academic centres and the creation of part-time posts to attract researchers are some of the ideas advocated. The clearer focusing of the institutions objectives, a change of emphasis towards outcome-based quality measures and better administration of care are also mooted. Speci- fic examples of the latter include; the removal of the anomaly by which medical insurance funds inpatient but

not outpatient care for certain conditions, and the devol- ution of budgets to individual psychiatrists in order to increase responsibility and involvement.

The second report contains a number of case histories exemplifying different models of care found in the United States and Canada. The main problem here appears to be the implication of variable quality and dissemination of good practice. Although the references are rather dated, the section on international perspectives includes mention of 4 UK services of note; those of South Hamp- ton, West Cornwall, Gloucestershire and Goodmayes Hospital.

The last report concerns psychotherapy and only one page is specifically devoted to the elderly. Reassuringly, the authors advocate a shift from a traditional dynamic psychoanalytic model towards a ‘biopsychosocial’ one. The lack of recognised professional training and regist- ration schemes, of centres of excellence and systematic research is lamented.

Each report contains a review of the relevant literature, a survey of current practice and recommendations for the future. This involves setting up committees or further task forces to effect implementation, encouraging indivi- duals and services to collect specific data relating to elderly patients and, in some areas, setting standards by which services should be evaluated.

I was quite surprised that, despite being official reports, they are all written in very straightforward prose. How- ever, they are definitely a set of books for a specialist library rather than the personal bookshelf.

MICHAEL PHILWT United Medical and Dentul Schools,

Guy S Hospitul, London