Book Review: Case Studies in Abnormal Psychology (3rd Edition)

Case Studies in Abnormal Psychology (3rd Edition) by Thomas F. Oltmanns, John M. Neale and Gerald C. Davison, John Wiley & Sons, Chichester (1991) 341 pp.

I first came across this book when I was searching for a suitable text for one of the courses on the Advanced Diploma in Existential Psychotherapy. Most texts on abnormal psychology emphasise theory over case material and when case studies are presented they are usually in such a highly truncated form that they give little sense of the individual and unique encounter that has led to the diagnostic analysis which, in a more general form, takes up most of the text This book was a pleasant surprise. In their preface, the authors make their purpose plain: (1) to provide detailed descriptions of a range of clinical problems, (2) to illustrate some of the ways in which these problems can be viewed and treated, and (3) to discuss some of the evidence that is available concerning the epidemiology and etiology of the disorders in question (p v). On the whole, the authors succeed in this task and provide the reader with twenty case studies each focused on a particular disorder as classified by the DSM-III-R.

When I read the text, I was initially struck by two thoughts. First, how dramatic and successful has been the rise and acceptance of cognitively-derived theory in therapeutic treatment. Second, that the authors of the text (and those clinicians who provided the case material) seem to inhabit a world that has either never heard of or else has remained impervious to, the differing critiques of a Thomas Szasz or an R D Laing. Both these are, I think, important lessons (and reminders) for those of us who espouse existentially-derived views and approaches to the treatment of the mentally disturbed. We have still, I'm afraid, a very long way to go before our views are not only considered, but merely heard. Naturally, throughout the whole text there is not one mention of 'an existential focus'. I think it is about time we ask ourselves 'why not?'

I say this not merely in anger, or sadness, but also because in spite of such feelings, this text also provides more than a little hope. Particularly in the examples of therapeutic dialogue that appear throughout the sections, and in many of the general discussions that follow each case summary, there is a more than a hint that quite a number of existentially-derived views and ideas, as well as some practical assistance as to how to engage the client in a manner which is both clarificatory and challenging while respectful of his or her intersubjective views would be immediately dismissed as, in the words of an authority I recently expressed my views to, 'the ravings of crackpots'. Indeed, I would go so far as to suggest that it may be no bad thing for us that cognitively-derived approaches have gained such respectability; we may well find that their language, while clearly not ours, nonetheless shares several points of contact and possible dialogue.

So, I recommend mis text not because it says much that I can agree with, but because it is a reminder (and, in this, a pretty clear and accurate account) of how the majority of individuals involved in treatment work, what they think and what the bases for their thinking may be. The cases themselves are representative of the most recurring 'disorders' that we are likely to be confronted by, are usually detailed enough so as not to appear as cyphers for a particular diagnostic measurement, and, if we are willing for them to be so, are a challenge to us to provide constructive alternative analyses.

I hope that enough of us read this text so that those challenges are taken up and reciprocated.

Ernesto Spinelli