BOOK REVIEWS

W. J. RAI. J. M. RACZ~YSKI. T. ROI~GERS and W. H. KIMBALL: Ero/uurior~ o/ Cluticul B~oferdhoc~ Plenum Press. New York ll979). xtt + 330 pp. 825.00.

This volume provtdes a comprehensive and balanced evaluation of the current status of clintcal biofeedback. In the decade 196X 1978 reviewed b) this book. chnical research using btofeedback rose From under IO pubhshed articles. to over XtO! With such a growth rate. CritICid evaluative surveys. such as that provtded by Ray and colleagues. will be most userul to clintcians. students. lecturers and researchers.

The reason for its wide appeal lies in the manner in which the material has been presented. The review can be used in at least three separable ways. First. it provides a general discussion (Introduction and Conclusion sections) of a number of important tssues entailed in evaluating the efficacy of biofeedback. It raises problems that are relevant to serious researchers and students of biofeedback alike. Second, it provides brief but critical surveys of each of 15 applications of biofeedback (cardiovascular disorders. Raynard’s disease: migraine/tension headaches: gastroentestinal disorders: asthma; speech: hearing. and readtng disorders; anxiety: sexual dis- orders: chronic pain: dental disorders: neuromuscular disorders: epilepsy: hyperactive children; psycho- therapy). Each sectton is self-contained. entailing a brief critical review that highlights the best studies. and finishes with a summary of the relative efficacy of biofeedback for the disorder. This section provides a qutck and readable review for the clinicran wishing to assess current progress on a specific disorder. Finally. a sizeable appendix provides summaries of each of the key studies published up until 1977. again grouped by disorders. The format of the summaries is based on the evaluative criteria established in the introduction. This large section will be a useful source of material for those making a more detailed study of biofeedback.

It i. clear from this survey that much of the enthusiasm about the potency or biofeedback has been prern,tt.tre. Only in certain areas are studies available that use controlled group outcome destgns (i.e. headache. asthmat_the majority of reports being stngle-case or anecdotal reports. Biofeedback remains an expertmental technique and is far from being a well-established clinical tool. Despite this, the results are often impressive when one constders that the disorders have been unresponstve to other treatments (i.e.. spasmodic torticollis. cerebral palsy etc.) It will be essential. in the next decade. to tighten up clinical methodology to allow systematic assessments of biofeedback. The authors emphastse the importance of evaluating non-specific determinants or change as well as the relative cost-effectiveness of the treatment. In addition. tt will be important to establish the extent to which the bioelectric feedback is the active ingredient in therapeutic change. So Tar a concern for this type of component control has been virtually absent from clinical biofeedback.

CLARI- PHILIPS

C. E. SCHAEFER: Child/toot/ Encopresis trnd Enuresis: Cuu.ws and Therup~. Van Nostrand Reinhold. New York 11979). ix + 175 pp, c10.45.

Although this book describes most of the methods by which encopresis and enuresis might be tackled it fails to evaluate the methods. The author does not point out the advantages and disadvantages of many of the treatments. Nor does he always discuss failure rates. and over and over again I found myselrasking for evidence for many or his statements. Readers or this journal may find themselves irritated by some of the remarks--For example SchaefTer describes the behavioural approach to toilet trainmg as “the carrot and stick approach”. Furthermore. he uses (apparently uncritically) inexpltcit terminology such as “the child still showed anal aggressiveness”. He confuses punishments and negative reinforcers and. although there is a Glossary, 1 was unable to find anal aggressiveness or negative reinforcer included. He is very ready with advice on enemas saying at one point that “two consecutive adult-size enemas should be given each night and each morning until the bowel is empty”. As the book is aimed at several groups of people including parents. he should have offered this advice with more caution. Sometimes he is out of date saying, for example. that overcorrection is an educational technique. A recent review or overcorrection. however. suggests that although the technique might be drscrihrd as being educational it does not appear to be anything other than an aversive procedure. In the section on enerusis there are some sensible suggestions for parents about toilet training and some useful instructions on how to rehearse with the bell-and-pad equtpment before using it properly. In spite of this. the good points of the book are outnumbered by the weaknesses. All the way through I had difficulty in suppress- ing the thought that the author was “out to make a quick buck”.

BARBARA WILSO\

VIEDA SILLTALS: Euq/r,d~ ,Madmw /dra.s OH Imurlrrr /5X0-/XYf). Routledge & Kegan Paul. London (1979). 15x pp. f7.95

Vteda Skultans has a varted background m philosophy. soctal anthropology and mental health. and her prevrous book Mutl~~~ md Mow/~ adumbrated her interest m the history of psvchiatrv. The present rather short book follows the former one in presenting extensive quotations. often very interesting. illustrating views held about psychiatric problems and procedures by many of our forefathers. The book also contains 25 very