Book Review: Introduction to Psychopathology

Introduction to Psychopathology Alessandra Lemma Sage, London. 1996 226 pp pb

For those individuals interested in existential solutions to human anguish, the question of classification and psychopathology is by no means irrelevant. After all, directing oneself towards the single individual in Kierkegaard's sense of the term negates any easy systematising of that individual according to discrete categories. Engagement with such questions is not the main focus of Lemma's book, although she approvingly quotes Beneditti that the 'truth' of models of psychopathology 'lies in what we can do with them.' She also notes that the concept of resilience is one that has been overlooked in favour of psychopathology, a sentiment with which existentialists and more recently Solution-Focussed Brief therapists such as de Shazer would undoubtedly concur.

Introduction to Psychopathology examines a number of clinical areas: depression; anxiety; eating problems; psychosis; personality disorders; suicide and self-harm and situates them within the clinical context in which they may present. Thus there are two chapters on assessment and the management of referrals. The chapter on assessment is particularly useful in highlighting the therapeutic potential of the initial assessment as well as providing an extremely clear model for arriving at a formulation. The chapter on management of referrals provides a schematic overview of issues such as report writing, engagement with other professionals and issues of confidentiality. Lemma also provides an overview of 'psychopathology' and its developmental course which provides a theoretical overview and serves as a useful reminder as to the limitations of any categories of classification.

In terms of the chapters focusing on clinical areas Lemma successfully incorporates theoretical approaches to the work along with material on assessment, management and treatment or intervention. Each of these clinical chapters is structured around a brief case study, which forms the basis for discussions of clinical features, theories and interventions. There is also an attempt to discuss ethical issues where relevant and ground the whole of the debate in terms of current research and evidence.

Although the book is primarily written for 'counsellors and psychotherapists' it is probably useful for anyone beginning direct one-to-one therapeutic client work. Lemma is clearly aware of this by calling her book an 'introduction' and the marketing of the book suggests it as an 'invaluable resource for students of counselling / counselling psychology, psychotherapy and clinical psychology.' Pitched at this level, the book would be clearly of use and would also serve as a resource book for individuals whose work may only peripherally touch on mental health issues, such as personnel managers and teaching staff.

For those individuals with a background in existential therapy and a proclivity towards engagement without presupposition, this book will present something of a dilemma. Taking for instance the concerns identified by Yalom in his book Existential Psychotherapy of death, freedom, isolation and meaningfulness, the reality of mental ill-health and serious illness generally probably intensify some if not all of these concerns. Yet at the same we know and clearly Lemma is aware of the very real way in which discourses and categories of psychopathology can limit us, as she states ' those who by virtue of particular theoretical commitments to the presumed 'disorder' never really see the client as a person with his or her own stories and theories are neither good therapists nor good scientists.'

It is interesting given such awareness that Lemma has chosen to use the language of 'pathology' in her book, which in a sense returns us to a grand narrative of disease, medicine and normalcy. For writers such as Foucault, Scheff and Becker, psychopathology does not exist as the nucleus of a legitimate and neutral medical enterprise. Rather psychopathology is akin to a distant outpost in which bodies that are a bit unusual and behaviours that are difficult to casually explain become sites of special scientific interest. Lemma is having none of such a dispassionate non-social model of medical intervention, confirmed by her personal reflections on psychopathology at the end of the book.

On the other hand her emphasis on the importance of observation and experimental research fits into the schemata of psychopathological theorising rather neatly. Thus one is left with a position that can best be described as both sceptical and realist, for as Lemma states:

To categorise does allow us to organise our clinical experience and plan our interventions. The danger lies in forgetting how subjective this endeavour can be and so be lulled into a false sense of security. Then we may fall into the trap of believing we know what the client is feeling without really listening to their story.

Robert Hill