Journal of Cornniunitji & Applied Social Psychology, Vol. 4, 215-218 (1994)

Book Reviews Hodgkinson, P. & Stewart, M. (1991). Coping with Cutustrophe, London, Routledge. Pp x + 230. f12.99 paperback. ISBN 0-415-04098-1.

This book is subtitled ‘A Handbook of Disaster Management’ and, unlike inany ‘how to’ books, it fully deserves its handbook status-it is comprehensive, up to date, well researched (with 11 pages of references) and, more importantly, interesting to read.

The authors have drawn extensively from the literature on bereavement, crisis intervention, post-traumatic stress, and organizational culture to provide an integrated view of how human beings respond to trauma, of effective ways in which they can be helped, and also of the structures required to ensure the delivery of help.

It is the first British text on the subject of disasters-Beverley Raphael’s excellent When Dikasters Strike was published in 1986. Since then the UK has had its fair share of catas- trophes-Zeebrugge, Clapham, Lockerbie, Piper Alpha, Bradford, King’s Cross, and Enniskil- lin are names that have made the British public painfully aware of disasters and their effects. Community Mental Health Teams often have to help survivors of small- and large-scale disas- ters (and their families) as part of their normal work load, and need to know what to do and how to d o it. A book that aims (and manages) ‘to provide the reader with information and skills to respond efkctively and confidently to the needs of disaster survivors’ has to be required reading for all mental health workers.

The book is divided into seven chapters. Chapter 1 deals in detail with the experiences, feelings, thoughts and behaviour of survivors, and a cognitive model of post-traumatic stress reaction is proposed. Many different types of trauma have a common pathway in terms of the shape of the resulting distress, and the common element is often the loss of faith in the world and an associated rupture with the past: an individual’s world post-trauma is a very different and frightening place. The authors emphasize the fact that intense emotional responses to trauma are normal reactions to abnormal events, and that, with the inclusion of post-traumatic stress disorder as a definable psychiatric disorder into DSMIII, there is a risk of overmedicalizing this condition.

Interesting comparisons are drawn between reactions to natural and man-made disasters, with the evidence suggesting that technological disasters have more intense, widespread, and longer lasting effects. These d o not simply go away with time, and the provision of adequate help is vital.

The chapter on ‘Organizing for Disasters’ should be made a compulsory part of senior management training in all organizations that are called upon to act when disasters strike. The authors point out the total lack of preparedness displayed by Health, Social Services, and Voluntary Agencies when faced with the recent spate of disasters, and set out the essential questions which helping agencies have to address in preparing for potential community disaster. A well documented log of the response to Zeebrugge and the King’s Cross fire makes fascinating reading and underlines the importance of an agency taking the lead for the co-ordination of psychological support.

As the convenor of a Trauma Debriefing Service, I found the chapter on consulting and debriefing particularly useful. Organizations often wish, in the heat of crisis, to bring an expert in to work with particular individuals who may be most affected. This causes stigmatiza- tion and ignores natural processes of support that already exist. it is the leader’s task to organize a formal psychological debriefing to help group recovery, to provide accurate infor- mation and to enable rituals. How and when to conduct an effective debriefing session is

0 1994 by John Wiley & Sons, Ltd.

216 Book Review

described and the point made that this is not ‘counselling’ but a form of crisis intervention providing a framework for the individuals to express their emotions in a safe environment with their colleagues, to understand their reactions to the event, and to identify future actions. This is aimed at decreasing the likelihood of longer term psychological disturbances.

One chapter focuses on therapeutic intervention with individuals who are suffering from post-traumatic stress disorder. A variety of techniques are described and the use of medication discussed. The last chapter is a careful evaluation of the effect of helping on the helper and makes the point that support for staff should be included in the planning and setting up of disaster services.

This book is a valuable reference text based on well researched and well organized material, but it is also a book about ordinary people who suffer as a result of being in the wrong place at the wrong time. The verbatim passages provide an unforgettable account of their experiences.

ELSA SCHMIDT Psycho log,), Depur tnzen t ,

Bath Mentul Health Cure N H S Trust

McCrady, B. S. & Miller, W. R. (Eds) (1993). Research on Alcoholics Anonymous: Opportunities und Alternutives, New Brunswick, NJ, Rutgers Center of Alcohol Studies. Pp x + 430. $29.95 paperback. ISBN 91 1290-24-9.

As a mutual help organization that was started by two alcoholics in 1935 and now has 1.7 million members in 170 countries, Alcoholics Anonymous (AA) has justly commanded con- siderable attention from social scientists. Building on a conference that they organized on AA, Barbara McCrady and William Miller have assembled recent efforts to conduct research on AA in a volume that should be viewed as essential reading for self-help group researchers. Among the topics covered are how to measure and understand AA spirituality, the sociological context of AA research, women and racial and ethnic minorities in AA, and the question of whether professionals can or should match clients to AA. Although none of the 21 chapters is without interest, for the sake of brevity 1 comment only on the highlights of this volume.

The book opens with a fascinating chapter by Ernest Kurtz on the history of AA research. Kurtz traces an alarming tendency for some AA researchers to fail to show respect for AA by either not taking the time to understand the organization before commenting on it, or citing AA research inaccurately to put the organization in a bad light. As alcoholism researchers have been more vigilant in monitoring researchers’ biases in favour of AA, Kurtz’s careful documentation of biases against it is an important contribution.

Given the recent turn of AA research towards quantitative methods, Chad Emrick and colleagues’ meta-analysis of the predictors and consequences of AA affiliation is likely to garner much attention. The results suggest modest benefits of AA in psychological functioning and drinking related outcomes. Emrick and his co-authors deserve praise for their statistical acumen and for assembling a treasure-trove of AA references, but one wishes they had spent more time considering whether AA studies done 20 years ago could be compared with studies of the much-changed AA of today, or whether studies of AA in professional treatment agencies are really studies of AA proper. (The latter criticism could be leveled at many of the chapters in the volume.)

Greater sensitivity to the variation across and within AA groups is shown in the chapters of Joseph Nowinski, Robin Room, and Klaus Makela. Nowinski correctly points out that contrary to the view that AA is authoritarian and dogmatic, the organization actually gives enormous latitude for individual members and groups to define their roles and activities. In a chapter whose perceptiveness and subtlety defy brief summation, Room goes further by pointing out that AA is noteworthy for its ability to confound the iron rule of oligarchy despite tremendous expansion. Makela provides fascinating cross-cultural data on AA, show- ing that virtually every generalization one hears about the organitation (e.g. its members are largely male, middle-class, middle-aged, etc.) can be contradicted simply by looking beyond American borders. He also describes variations in how meetings are conducted and in how strongly AA is influenced by Christianity in various cultural contexts. Taken together, these