A complete mind set

Comprehensive Clinical Psychology
May 7, 1999

This 7,000-page collection reflects the state of a profession today. Generally, the individual entries are well written and the invited contributors have been selected for their acknowledged expertise. My interest lies broadly in the statements and silences here present.

The promotional material for the set describes it as "the definitive reference work for complete coverage of all areas of clinical psychology research". I am not sure that such a claim is logically or empirically sustainable. Clinical psychology is a divided and relatively young profession compared with its ancestors, medicine and philosophy. It is still emerging and it is being disrupted by contemporary and unresolved epistemological tensions within mainstream psychology, especially in relation to the split between realists (naive and critical) and constructivists. For most entries in the set, such tensions are not visible. With or without editorial invitation, they have been bracketed off. Had their irritating intrusion been tolerated then the secure professional identity of intended readers and invited authors might have been undermined.

Such a lack of earnest reflexivity is part of an opulent package. The set is extensive, expensive and available only in hardback. It will stand imperiously in libraries and on the shelves of very few practitioners. Its imposing size and cost are a cue for professional security, not self-doubt. If you are looking for a critical analysis of the profession, look elsewhere. If you are looking for the way in which an increasingly self-regarding profession records its administrative proceedings (volumes one and two) and justifies its existence using a particular style of scientific rhetoric (all volumes) then much is on offer to the sceptical reader. The best entries, which show social scientific sensitivity, are the ones on race in volume eight, Health Psychology .

The collection is international, with contributors coming from more than 20 countries, but the bulk of the text is North American in flavour and origin. The competent chapter on professional developments in the European Union is by a British educational, not clinical, psychologist. This raises doubts about the United States-based editors' informed choice of contributors from outside their own territory. British editors would have probably included much more about learning disability. Only two chapters out of more than 200 focus on the topic, one of which is simply titled "Mental retardation" - an offensive term to British practitioners.

The North American discourse celebrated here is conservative in its presentation, especially in relation to psychiatric knowledge. This orthodoxy seems to follow largely the biomedical contours of the American Psychiatric Society and its favoured nosology (DSM IV). There are several biological entries on genetics, pharmacology and psycho-biology. Terms like "schizophrenia" are often accepted uncritically, evading problems about their conceptual and predictive validity. The notion of "diagnosis" is also presented as a core professional task for clinical psychologists.

One of the most interesting chapters by R. K. Blashfield on "Diagnostic models and systems" manages to explore theoretical controversies without tying these to the professional role of clinical psychology (to distinguish it from psychiatry). Two whole volumes (five and six) enshrine the word "treatment" in their title. This suggests that the boundary between clinical psychology and psychiatry is now substantially blurred, despite the former profession seeking increased status by escaping the grip of medical dominance.

Quite understandably, many people do not know or care about the difference between a clinical psychologist and a psychiatrist. However, if we are to bother with a proper academic distinction, then strictly psychologists have no disciplinary mandate to diagnose and treat, as these are medical tasks. What psychologists do have is the legitimate opportunity to construct formulations about personal and interpersonal functioning and to offer interventions to facilitate experiential and behavioural change. These styles of assessment and intervention have advantages for clients that exceed solutions offered within the limited confines of medical diagnosis and treatment. If, as many of the entries indicate, the latter procedures are being deliberately mimicked or appropriated by clinical psychologists, then a creative opportunity is being lost for clients when clinical psychologists hang on to the coat-tails of medicine.

Turning to the market viability and academic relevance of large encyclopaedic collections, one question that is not properly posed is whether there is any longer a role for an expensive set of books that may be quickly out of date and that seeks to justify its status as a "definitive reference work". This doubt holds particularly true for a young profession that prides itself on incrementally gained empirical knowledge in its peer-reviewed journals. However, the editors do assert confidently in their introduction that chapters were included that would "stand the test of time". Only time will tell.

David Pilgrim is visiting professor of mental health, department of sociology, University of Liverpool.

Comprehensive Clinical Psychology: (11-volume set)

Editor - Alan S. Bellack and Michel Hersen
ISBN - 0 08 0407 3
Publisher - Pergamon
Price - $3,495.00
Pages - 7,000

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