Book Reviews

How to Cope with Childhood Stress: A Practical Guide forTeachersP. Alsop and T. McCaffreyLongman: Harlow. (1994) pp. 270, £13.95

This book is intended for teachers and advisory staff of both primary and secondaryschool children. There are a number of contributors who have extensive experienceworking with children, including social workers, educational psychologists, clinicalpsychologists and psychiatrists. The book covers a range of personal crises that mightbe faced by children and adolescents. The 12 chapters cover a variety of areasincluding child protection issues, divorce and separation, depression, eating disorders,and alcohol and drug abuse. There are also chapters that deal with helping childrenwith mentally ill parents, with life-threatening illnesses, and helping the bereavedchild. Finally there is a chapter on group work with stressed children.

Unfortunately the chapter on eating disorders is a little disappointing. The authorargues that weight loss due to anorexia nervosa results in brain `failure' and as a resultcognitive abilities deteriorate in a very predictable sequence. The author presents adiagram of the sequence of `anorexic brain failure' in which the ability to use abstractconcepts is supposedly the ®rst to diminish, followed by a loss of ability to usemathematical concepts and culminating in a disruption in memory and disorientationin time and space. This seems to me to be a gross oversimpli®cation of the researchwith regard to the effects of anorexia nervosa. We do have evidence that there iscerebral atrophy in anorexia nervosa and that in many cases this is reversed withweight restoration. However, the precise role of the brain in terms of the developmentand maintenance of eating disorders is largely unclear and the effects of thisdeterioration are certainly not as neatly ordered or as `predictable' as the authorsuggests. Many would also argue that some of the supposed effects of braindeterioration mentioned by the author, such as `black-and-white thinking' arepredisposing factors to the development of anorexia nervosa rather than the result ofcontinued starvation. Very little attention is paid to the condition of bulimia nervosa,where it does not arise out of anorexia nervosa. In fact, the author says that thephysical and psychological consequences outlined for anorexia nervosa are largelyabsent for bulimia nervosa. This has the effect, although I am sure that this was notthe intention, of underestimating the very serious consequences of this condition.

On the whole, however, this is a very sensitive and carefully considered book. Theauthors are very aware of the dif®culties that a teacher might face in dealing with the

CCC 1072±4133/97/030214±02$17.50 European Eating Disorders Review& 1997 John Wiley & Sons, Ltd and Eating Disorders Association. 5(3), 214±215 (1997)

issues covered. The book sets out very clearly what the role of the teacher should beand gives advice on how, when and where, they should enlist the help of outsideagencies. The book has a very practical emphasis and a variety of case illustrations areprovided. Each of the chapters contain additional reference information. This usuallyincludes the addresses of relevant support organizations and further reading andteaching materials.

Jacqueline Smith

Conversations About Illness: Family PreoccupationsWith BulimiaWayne A. BeachLawrence Erlbaum Associates (1996)

Early in my career as clinical psychologist I was told by a distinguished and respectedsupervisor that if at all possible I, along with other aspiring therapists, should avoidworking with people with eating disorders. His rationale was that these psychologicalcoping strategies were by and large complex, entrenched, culturally condoned, poorlyunderstood and `dif®cult to shift'. This excellent text attempts to remedy his criticismof the de®cit of understanding.

Beach rejects the trite and simplistic cognitive formulations that plague the eatingdisorders literature. Instead he adopts a Conversation Analytic model. This model isrigorously empirical but qualitative in its orientation. Its focus is on the everydaypractices that make up the medically-de®ned category of `Bulimia'. He situates hisanalysis in the family and examines how various individuals are elected to the statusof having an eating disorder. The linguistic interplay between the family members isconsidered to be indexical of the psychological processes that are deployed as thebehaviour we call Bulimia.

The analysis that Beach deploys is ®ne-grained and rigorous. It represents a ®neexample of well executed Conversation Analysis. As a result I am sure that this textwill be a signi®cant contribution to the literature but will leave the practisingclinician perplexed. It contains no easy answers, formulations or treatment plans. Itdoes however do justice to the complexities of the social and linguistic origins of thistroubling behaviour and as a result is worth reading for this alone.

Denis Salter

Eur. Eating Dis. Rev. 5: 214±215, 1997 Book Reviews

& 1997 John Wiley & Sons, Ltd and Eating Disorders Association. 215