JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 90 June 1997

She has a kind word for CS Lewis, whose account of hisgrief became the beautifully acted film Shadowlands. Butwhen it turns out that he (like me) found that grief gave hima feeling akin to fear that was not fear, she will not allow it.He must have been afraid, she says. And adds that her owngrief made her feel terrified.

Stages that the bereaved are told they will probably gothrough annoy her (me, too, to some extent) but perhapsall of us who criticize classifications of this kind are guilty ofignoring the fact that their authors usually stress variability.

Finally, it must be said that Virginia Ironside herselfseems to recognize that her problem may be far more thanjust that of bereavement. 'Grief, she says at one point, 'was

only a small part of the whole ghastly process'. Still verymixed up and unhappy three years after her elderly fatherdied, she is now 'impatient to discover whether I have to live inthis land of grief and rage and confusion for ever'. Let's hopenot. Truly, let's hope not. She has suffered enough.

Thurstan Brewin18 Braybank, Bray, Berks SL6 2BQ, England

REFERENCE

1 'You'll Get Over It' the Rage of Bereavement. Virginia Ironside. London:Penguin, 1997. [Pp 190. ISBN 0-14-023608-2. 16.99]

An Unquiet Mind: a Memoir ofMoods and MadnessKay Redfield JamisonISBN 0-330-34650-4.London: Picador, 1995

Anthony Storr dedicated his most recentbook, Feet of Clay: a Study of Gurus, to 'myfriend and colleague Kay Redfield Jamison'.Storr's study led him to conclude that 'thedividing lines between sanity and mentalillness have been drawn in the wrong place.The sane are madder than we think, the madsaner.' Jamison, who is a Professor ofPsychiatry at Johns Hopkins Medical School,must be delighted by this dedication. Herbook is an account of her own illness anautopathobiography. Her illness is manicdepressive disorder.

Now, you and I might reserve a place formanic depressive illness in our top ten list ofchronic-but-not-usually-fatal dread diseases.Jamison takes a contrary view. Her illnesshas allowed her to '[feell more things, moredeeply; [have] more experiences, moreintensely.' It also seriously damaged her life.Her positive attitude is greatly to her credit.We can only imagine what such an illnesswould be like. Jamison knows first hand and,as she tells it, one cannot escape thesuspicion that she has coped better thanyou or I would have done. She gives afascinating account of the natural history ofher mental illness. Doctors who care forpatients with manic depressive disorder willrelish the details that are peripheral toclinical care. What really goes on in the life

and mind of the patient? How does thepatient travel from the onset of illness toeffective treatment? In Jamison's case, withgreat difficulty, resistance and delay. Whobales out the overspent hypomanic? Rela-tives. Who does the manic depressivebefriend? Others of like mind. Whatinstitution can accommodate the career of amanic depressive person? That's an easyquestion a university.

From Jamison' s account we also learnthat personality and drive, and not thedisease, determine life's direction. And thatwithout the support of friends and family shesimply could not have survived. She hasinteresting comments to offer about lithiumtherapy, psychotherapy and the problem ofhow to tell people that one has psychiatricillness. And she offers an unapologeticaccount of the social problem of being awoman who is sometimes mad, angry andbad to know.

Another reviewer called this book a'landmark in the history of writing aboutmanic depressive illness.' Maybe so, butdespite one's admiration for Jamison'sachievements and survival the book itself isa frustrating read. She uses a simple linearnarrative, but fails to provide the chron-ological details that secure the reader's placein a story. We usually know where Jamisonwas, but less often when or for how long.And the style of the book, written for a USreadership, may be troublesome to UKreaders. For example, Jamison describesher typist (a Mr Collins) as 'invariablyaccurate, reliable, pleasant, and intelligent.'Her literary agent is 'warm, lively, engaged,

perceptive, supportive.' There is clearly ahierarchy to the adjectival excess Jamisonemploys throughout the book; her typist getsfour adjectives, her literary agent five.Meanwhile, her nephews and niece are'reflective, independent, thoughtful, droll,smart, and imaginative people.' That's six,but then they're family. Jamison's life has itstragic side, and her book needed a comictouch. She inserts a little humour of herown, but her adjectival sketches of thepeople 'in her life are unintentionally thefunniest aspect of the book. She likes men,tall men. All the men she admires aredescribed as 'tall'. Her psychiatrist, whom atone stage she sees several times a week,stands at six foot four inches. The loftiness ofthose she loves is a charming running joke forthe reader. When Jamison finally meets andmarries her second husband the attentivereader will be shocked to note that althoughhe is 'attractive' no mention is made of hisheight. Some mistake surely.

Jamison was (I think) born in 1946. Shehas lived through Kennedy and Cuba, theVietnam era, Nixon and Watergate, not tomention the Apollo programme, number 13included. In 224 pages she mentions almostnothing outside of her personal life, certainlynone of the above. But surely these eventstouched her, troubled her, intrigued her. Orworse still passed her by because she was ill.She doesn't tell us. Above all she must havebeen personally affected by the plight ofSenator Eagleton, Vice Presidential runningmate to George McGovern, whose candi-dature collapsed after revelations that he hadhad ECT for depressive illness. (I'm backinghim 110%, said McGovern initially. What 353

IJOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 90 June 1997

happens, one commentator asked, whenMcGovern's backing falls to 100%? We soonfound out.) At many times in her life itwould have been easy for Jamison's career tocollapse. Her book is a convincing account ofher dletermination to survive. It is not greatliterature, but it is sincere, unflinching andoriginal, and deserves its readership.

Michael LoudonMiddleton Lodge,Church Circle,New Ollerton,Newark NG 22 9SZ.England

Hyperactivity Disorders ofChildhoodEd Seija Sandberg 517 pp Price 65.00 ISBN0-521-43250-2 Cambridge: CambridgeUniversity Press, 1996

Attention deficit and hyperactivity disorders(ADHD) are here to stay, and Seija Sandbergmakes an ambitious attempt to bringtogether and summarize knowledge.

That attention and hyperactivity are butthe manifestation of more fundamentaldysfunctions is now generally accepted.Despite the diversity of presentations,common and enduring features are found.The efficacy of medication and othertreatments, at least in terms of moderatingsymptoms, is firmly established.

The book focuses more on theoreticalthan on practice issues. The chapter on therole of attention, with its account of theconcept of state, and non-optimal arousalstate or state regulation deficit, by JJ Van derMeere, is particularly interesting and clear.He postulates that hyperactive children aredelayed in cognitive processes just precedingovert motor action-deficits in responsedecision and response organization processes.He is the only contributor to clarify his ideasfor readers with diagrams. The chapter onother disorders of conduct (although to alarge extent disorders of activity are includedin this) is also particularly stimulating for aclinician, offering hypotheses for the me-chanisms underlying associations and inter-relationships. Thorley proposes that it isattention and poor motor control problems,not the particular constellation of symptoms,that determine outcome, in whatever condi-tions they are found; this argument is wellsupported. All the 'big' questions in relationto hyperactivity disorders are directly ad-

dressed: Are ADHD or the hyperkineticsyndrome valid entities? What is caseness?Why are there such large sex differences?What theoretical mechanisms could explainthe manifestations? What theoretical biolo-gical processes could underlie the problems?How important are psychosocial variables? IsADHD a precursor of conduct disorder?What affects outcome? Are medicationeffects dose-related and how does medicationaffect different aspects of outcome? Thereare, of course, only partial answers but thedletailed consideration of each is fascinating.

I would criticize the book on twocounts the overall integration of thematerial; and the emphasis on theoreticalissues at the expense of assessment andmanagement. The lack of integration is partlydue to the failure of professionals in general,and here contributors, to agree on a unitaryconcept of hyperactivity. So each chapter hasto define its terms of reference, and authorstend to slip from talking of one type ofdisorder to another. The editor is ahyperkinetic disorder aficionado whereasmost contributors are addressing ADHD.Some chapters are clearly coloured by theparticular slant of the author- that by CGillberg and L Hallgren on outcome bringsin their ideas on motor-perceptual pro-blems. Related to this is the repetitiveness ofmany chapters. In addition to defining terms,chapters often give an overview and try to beso comprehensive that areas already andseparately addressed are reconsidered. Forexample, outcome is extensively covered inthe chapters on treatment and developmentalperspectives as well as that on 'outcome'.There is even the phenomenon of authorsmaking comments on the content of otherchapters. I would have liked to see moreattention given to the practice decisionsfacing many of us. ADHD without hyper-activity is not addressed, assessment pro-blems are skated over and the treatmentchapter is insufficiently comprehensive to beused for guidance.

For individual purchase this is anexpensive book, but it would be a goodone to keep in a department, as a source ofinformation for practice and teaching. Tryingto understand the underlying mechanisms, asin autism, is engrossing and Sandberg's bookcontributes to our attempts to unravelfundamental aspects of human behaviour.

C SturgeChildren's Services Directorate, Northwick ParkHospital, Harrow HA1 3VJ, England

On the Shoulders of Giants:Eponyms and Names inObstetrics and GynaecologyThomas F Baskett270pp Price 40 ISBN 0-902331-94-9London: RCOG Press, 1996

The first part of the book title comes from aletter written by Sir Isaac Newton to RobertHooke. In this letter the following sentenceappears: 'If those of us who follow seefurther than our predecessors, it is becausewe stand on the shoulders of giants.' As wewill see later, there are many giants in thisbook including Soranus (98-138), who hasthe oldest published work on obstetrics andgynaecology attributed to him. His mainwork, Gynaecology, brought together theknowledge of obstetrics, gynaecology andpaediatrics of that era. Among his writingswere detailed instructions for the perfor-mance of internal version in cases ofabnormal fetal lie.

The word 'eponym' was absent from DrSamuel Johnson's Dictionary of the EnglishLanguage (1755) and did not appear untilaround 1846. Eponyms can be described asthe people who give their names to wordsand medical eponyms the bridesmaids at themarriage of medicine and history. However,these elegant bridesmaids must never be-come stagnant old maids and must beconstantly updated so that they retain theirinterest. The purists will argue that it isbetter to use a descriptive term that tells ussomething about the condition. However,even the critics will concede that mostpeople, including medical students, have abetter memory and recall for eponyms thanfor medical jargon. In his preface the authorstates the following:

Despite misguided attempts to discourage them,eponvms continue to enrich the language andliterature of medicine. Few specialties have a longerand richer eponymous background than obstetricsand gynaecology. Eponyms add a human side to anincreasingly technical profession in which both theproviders and recipients of medical care continue tocrave the human touch and are diminished by itsabsence.

This carefully researched book containsbiographical data on 310 individuals (all but15 are deceased) plus an outline of theeponym or work for which they are known.More than 500 original and related refer-ences are provided along with a linkedbibliography of 530 additional references for354