Fifty people contribute to this 600-page book, ranging from academics with international reputations to doctoral students. Although it is possible to make multi-authored books work, it requires strict editorial control to do so, both in terms of defining chapter coverage and content and of being relatively savage in quality control of the eventual product.
The book's structure tends to mirror, for a large part, what one might expect to find in a general psychiatry textbook, and readers are obliged to pick through the various chapters for information about assessment and management of violence in particular disorders, treatment settings or special patient subgroups. It is certainly not a manual for the assessment and management of violence. In fact, only 5 of the 28 chapters deal directly with principles of assessment and management. These include introductory chapters on structured risk assessment and on psychological testing, all of which are informative, but US-focused (e.g. US courts' pre-occupation with risk ‘scores’, consideration of the Rorschach test). The final chapter on clinically based risk management of potentially violent individuals disappoints in that it concentrates largely on Tarasoff warnings and on patients with guns.
The editors state in the preface that ‘much latitude was given to the different authors’ writing styles and perspectives'. The result is a hodgepodge of chapters, some of which appear to be written for the professional and some for the novice. We are told, for instance, that ‘from Biblical times to the present, we have known that alcohol is often associated with out-of-control behaviour and violence,’ and that ‘schizophrenics may be delusional and develop ideas of persecution’. This contrasts with the style in other chapters where, for instance, details are set out of controlled trails of mean QTc increase following administration of intramuscular ziprasidone.
The editors state that the chapters are ‘tutorials’ and it is quite clear that they are not reviews of the area. The authors seem to have been asked to produce 20-page articles with case examples and a list of ‘key points’ at the end. The case examples work very well, but the key points are let down by a tendency towards banality. For example, a ‘key point’ in the chapter on the elderly is that ‘Violence resulting from dementia and delirium with resultant confusion is more common in the elderly’. Furthermore, the differences in approach between authors are illustrated by the length of their reference lists, the chapter on mood disorders giving more than 140 references and the one on schizophrenia and delusional disorder listing 24.
The question arises as to who exactly this book is written for. Clearly, it is a US product and a number of chapters are of no direct relevance to those working outside the USA. Individual chapters may appeal to others, but this is not a textbook for the specialist: it is an introductory tome which will be of interest to the intern, to non-medical members of psychiatric teams and to the lone clinician working in private practice in the USA. Perhaps its strength is that it is a book written for general psychiatrists in an area where specialist forensic treatises tend to dominate. But those clinicians in the UK wishing a direct and practical approach to an issue which besets them in everyday practice might better be advised to turn to Maden's Treating Violence: A Guide to Risk Management in Mental Health (Oxford University Press, 2007).
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