BOOK REVIEWS
behavior as the result of cultural influences. Mental health
professionals who expect detailed exploration of cognitions,
feelings, and behavior from the standpoint of the mental
processes within the individual are likely to be disappointed.
The case histories are simply not extensive enough to pro-
vide that kind of information. Nevertheless, many mental
health professionals will find this a very helpful book be-
cause it provides an awareness of the kinds of people with
whom their patients or clients are dealing when they pur-
chase or sell drugs.
Another level of reading is from the orientation of the
specialist in addictive disorders. Much of what is presented
will not be new to those who work constantly with patients
who have substance use disorders . Such specialists may be
concerned that the 4-year outcomes for the drug ring mem-
bers might imply that it is easier to end an addiction to
cocaine than is in fact true . However , Dr. Williams never
indicates that the results he reports are necessarily gener-
alizable to the general population of drug dealers . He simply
reports what is happening to the members at the end of a
4-year period. It is an unfortunate omission in this work
that at the conclusion Dr. Williams does not make it clear
to what extent the "cocaine kids" are still personally using
cocaine. Most of them have stopped dealing , but the ques-
tion of whether they have stopped using cocaine is one that
badly needs to be answered.
This short book is well worth reading . It will leave many
readers wanting more: more detailed histories, study of a
larger population and, particularly, longer follow-up. It is
hoped that Dr. Williams in the future will tell us what has
become of the "cocaine kids" after 10, 15, and 20 years.
It would be fascinating to know how their children develop
and whether they repeat the same patterns.
JOHN B. GRIFFIN, JR., M.D.
Professor & Director
Child Psychiatry Outpatient
Training Program
Emory University School of Medicine
Child and Adolescent Psychopathology and Involuntary
Hospitalization. By Tony D. Crespi . Springfield, Illi-
nois: Charles C Thomas, 1989, 148 pp ., $31.75 (hard-
cover).
This slim volume purports to be a primer , introducing the
uninformed or the newcomer to the world of inpatient psy-
chiatric treatment of children and adolescents. Its prepos-
sessing concern, however, is with a variety of legal and
social policy issues associated with civil commitment, pa-
tients' rights, coercive management measures, psychotropic
medication, and the like , relative to children and adoles-
cents. For the author, however, it is also an unabashed
working through of a savage beating he received from a
psychotic adolescent . Dr. Crespi is a psychologist who is
long associated with the evaluation and treatment of psy-
chiatrically hospitalized youth. Conspicuously placed in the
preface, where only the most casual of readers could miss
160
it, is a passage describing the assault on him. The ensuing
narrative suggests that he indeed meets many of the criteria
for a post-traumatic stress disorder, and that this presenta-
tion, with its constant interplay between issues of civil rights
and the need for societal control, serves as a therapeutic
function for him in addition to its declared purpose.
His stated goal is to provide a readable reference for
nonpsychiatric physicians and other professionals who are
unfamiliar with inpatient psychiatric settings serving youth .
In pursuit of this , he provides nine succinct chapters that
cover such diverse topics as the evolution of child and ad-
olescent inpatient units, civil commitment and patients '
rights, child and adolescent psychopathology, psychotropic
medication, and behavior management issues.
The opening chapter provides an interesting historical
overview , addressing the development of inpatient adoles-
cent treatment programs and units, the earliest debates re-
garding the segregation of adolescents from both children
and adults, and the inevitable issues that arise regarding the
management of adolescent aggression . He describes the ev-
olution of these programs, in more than a few broad sweeps,
but neglects to mention the seminal contributions of such
pioneers in nonhospital residential treatment as Fritz Redl,
Nicholas Hobbs , and Bruno Bettelheim .
A second chapter proceeds to outline the course of civil
commitment in this country , with some scant mention of
the issues related to minors. As most child clinical specialists
know, minors are typically admitted to psychiatric units
using the same involuntary procedures employed with adults
as well as voluntary procedures in which the minor and/or
his parent or guardian consent to the admission . The author
fails to draw clear distinctions between these forms of ad-
mission, nor does he directly address the growing body of
due process protections, now afforded in approximately half
of the states, relative to the voluntary admission of minors .
Oddly enough, he places a disjointed coverage of voluntary
admission in the chapter on patient rights , which contributes
somewhat to the confusion that will be generated for the
reader. This is particularly noteworthy , given the burgeon-
ing national debate about psychiatric hospitalization of chil-
dren and adolescents , especially that occurring in the private
sector. Regrettably , he also makes no reference to Lois
Weithorn and seems unaware of her critical, although con-
troversial, views regarding psychiatric hospitalization of mi-
nors. With respect to this same issue, he does cite the guide-
lines for involuntary hospitalization recommended by the
American Psychiatric Association but fails to note criteria
proposed by the American Academy of Child and Adoles-
cent Psychiatry for consideration when children and ado-
lescents are hospitalized. Finally, there exists a small but
significant body of literature regarding the clinical impact
of commitment procedures on children and adolescents; these
data are routinely ignored by the legal sector , but one might
have hoped that Dr. Crespi, a clinician, would have rec-
ognized the issue in a text that is much concerned with such
matters.
In additional chapters , the author analyzes a variety of
other patients' rights matters , including a coverage of se-
clusion and restraint that is admirable for its comprehen-
l .Am.Acad . Child Adolesc .Psychiatry ,30 :1,lanuary1991

siveness and relative clarity. Chapters follow that discuss
psychotropic medication and child and adolescent psycho-
pathology. The former seems too complex for the general
reader, but too brief for other nonpsychiatric mental health
practitioners, thus missing the mark. The latter is derived
from DSM-lII-R , with additional coverage for behavior dis-
orders and would be suicides. One would like to have seen
some extended mention of other common adolescent ad-
missions, i.e., eating disorders, mood disorders , and ado-
lescent schizophrenia.
Overall, this text is uneven. At times, the author achieves
his mission of succinctly and clearly summarizing complex
matters for those unfamiliar with the inpatient enterprise; at
other times he overwhelms the reader with detail that lacks
priority and organization . For the most part, this book serves
as a useful reference . Dr. Crespi has made an impressive
and scholarly review of the extant literature on some topics,
citing relevant references and case law not always known
even to those familiar with these issues. The book is often
quite readable, although overused literary cliches, wom turns
of phrases, and an unusually large number of typographical
or other errors detract , as do imprecise and awkward gram-
matical glitches; the most bothersome of all was the repeated
reference to the landmark Supreme Court case regarding
psychiatric hospitalization of minors as the" Parnham" case
(rather than "Parham"). The text reflects a continuing os-
cillation-at times stunning the novice with detail or nar-
rative that reads like a legal brief, and at other times, ov-
ersimplifying very complex matters through brevity (which
is necessitated by a work that is confined to 149 pages). In
spite of its shortcomings as an introduction for the nonspe-
cialist, it does serve as a reference for those more attuned
to the field by providing sometimes systematic, detailed,
and well-documented coverage to these interrelated and con-
troversial issues.
MARC AMAYA, M.D.
Director, Children's Psychiatric Institute
John Umstead Hospital, Butner , NC
Chronic Illness during Childhood and Adolescence: Psy-
chological Aspects. By William T. Garrison and Susan
McQuiston. Newbury Park, California: Sage Publica-
tions, 1989, 160 pp., $19.95 (hardcover), $12.95 (paper).
This book integrates research and practical issues in ad-
dressing the approach to psychiatric intervention/support of
children and adolescents with chronic illnesses and their
families. The text is addressed to those within the mental
health field who care for such children . Unfortunately, few
traditional therapists in psychiatry , psychology , social work,
or nursing are involved in caring for these patients. Addi-
tionally, pediatricians are mainly concerned with primary
prevention and wellness, not chronic illness; yet it is the
pediatrician who sees most of these children. Therefore , the
answer is complicated when one asks, " To whom is the
book directed?" Most likely, those who read it will include
child and adolescent psychiatrists involved in pediatric con-
J.Am .Acad. Child Adolesc. Psychiatry, 30:1 ,January 1991
BOOK REVIEWS
sultation/liaison programs, psychologists, social workers,
nurses, and others working within a pediatric setting. Pe-
diatricians clearly would benefit from reading this textbook,
but they probably would not read it since they do not see
themselves as intervening psychiatrically or psychosocially
with chronically medically ill patients.
The goals of this book are: (1) to inform the reader med-
ically of the most prevalent chronic illnesses that affect
children and adolescents, with attention to specific illnesses ,
and how they impact on development and family function-
ing; (2) to review the literature on the psychosocial and
developmental aspects of chronic child/adolescent illnesses;
(3) to reach those providers involved in medical , psycho-
logical, psychiatric, social service, and family treatment!
support for chronically ill children and adolescents; and (4)
to provide a disease-specific rather than disease-global em-
phasis and to make the clinical examples relevant in regard
to the care of children and adolescents .
The book utilizes three major themes, as follows:
1. Psychological coping, including the degree of func-
tional impairment and the quality of life, is used in describ-
ing clinical entities and research findings. As the authors
note, psychopathological and personality models fail to ac-
curately characterize the process of responses and adjust-
ment to a chronic illness. Most children with chronic ill-
nesses cannot be diagnosed psychiatrically by using the
DSM-III-R; however, they have substantial amounts of psy-
chological dysfunction and require careful , sensitive, and
empathic intervention.
2. Developmental theories of cognition, self-perception,
and emotion are used to understand how a child/adolescent
comprehends chronic illness.
3. The role of the family is examined and studied in terms
of understanding, explaining, and predicting the child/ad-
olescent's adjustment to chronic illness. A family systems
approach is used in attempting to understand the dynamics
of the families involved.
The content of the book is easily readable and informa-
tive. Chapter I introduces the topic with illustrative case
vignettes. They make good points ; for example , a 9-year-
old girl with leukemia had no problem with treatment com-
pliance following her initial diagnosis , but when she failed
to enter remission the girl and family regressed substantially
and required intervention. A 12-year-old boy with cystic
fibrosis was well adjusted to his illness for the first 11 years
of his life. Subsequently, he became unhappy and anxious
about his increasingly poor respiratory function and contin-
ued limitation of physical activities. His hands, not easily
hidden from view, had become elongated, and his finger-
nails curved downward, making them appear disfigured.
This clubbing is commonly seen in this disease at the later
stages. These symptoms caused him problems with self-
perception and peer relatedness that required intervention .
Chapter II provides an overview of specific chronic ill-
nesses experienced by children and adolescents . Perspec-
tives on mortality/morbidity , epidemiology, and clinical
features are offered. Additionally, insight into psychological
161