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Generalized Anxiety Disorder Across the Lifespan: An Integrative Approach. By Michael E. Portman Springer. 2009. £49.99 (hb). 182pp. ISBN: 9780387892429

Published online by Cambridge University Press:  02 January 2018

Peter Tyrer*
Affiliation:
Centre for Mental Health, Imperial College London, London W6 8RP, UK. Email: p.tyrer@imperial.ac.uk
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Abstract

Type
Book Reviews
Copyright
Copyright © Royal College of Psychiatrists, 2010 

After reading this book I thought more about the author than the subject. Michael Portman is a clinical social worker who both researches and treats generalised anxiety disorder (GAD). This background flavours the whole of this book. Portman almost certainly came across the subject as a genuine novice, but now is an avowed enthusiast of generalised anxiety disorder as a concept, a diagnosis and an important focus of treatment. I know the average reader does not get excited about GAD, but its unattractive acronym is appropriate in this case. ‘By GAD’, I can see Portman exclaim, ‘what a diagnosis. It is like no other – and is mine to survey in all its glory’. So, rather like the revelation that Keats experienced when first looking at Chapman's translation of Homer, he feels ‘like some watcher of the skies when a new planet swims into his ken’, and he wants us to know all about it too.

By contrast I feel that GAD is better described as a ‘god-awful diagnosis’, as it is grossly heterogeneous, overlaps with almost every other psychiatric diagnosis known to man, and is singularly unhelpful in selecting treatment. So it might be expected that I would have a jaundiced view of this book. But I don't. It is actually quite refreshing to read unadulterated enthusiasm even when in my view it is slightly misplaced. We have a straight account of the symptoms, assessment, concepts and treatment of the disorder, not just in adults, but also in children and in older people, and by and large these are accurate, comprehensive and highly informative. There are also appendices that include seven scales for recording generalised anxiety disorder.

Although we gain by straight delivery of information, we sometimes lose in a lack of reflection and criticism. There are too many references to ex cathedra statements by ‘international experts’ and ‘leading figures’, but virtually no mention of the problems of dependence with benzodiazepines and other drugs, the influence of pharmaceutical companies on both prescribing and trial reporting, and the problems of management in primary care, where computerised cognitive–behavioural therapy is likely to be an important therapy source in the future. Still, this is an honest and useful book that is worth reading closely and which is an asset to the subject.

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