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Before starting this book, it is wise to remember that the
authors are practitioners in this specialized field.
The condition outlined is certainly serious and
exceptionally distressing. Ultimately it has the potential to destroy the whole
fabric of a family's life. Because of the overwhelming feelings of shame that
sufferers may experience, the desire to seek help may be reduced. This probably
means that all estimates of the size of the population of sufferers are on the
low side. So a book that offers insight is very welcome.
However, the book rambles on for 130 pages through an
everglade of tragic case histories, with barely a mention of effective
treatment along the way. I almost experience this over dependency on case
studies as voyeuristic. The point about the impact of the behaviours on peoples'
lives is made very early in the book but it carries on parading sufferer after
sufferer before us. How many case studies are enough? This book needs to ask
itself that question, if no one else is going to. Then, very late in the text,
it swings into "The neurobiology of Impulse Control Disorders",
followed by its dense chapter 8 on medication. This is where I find the style
to be bizarrely uneven: From an afternoon chat show style relating the ups and
downs of pathological gamblers and kleptomaniacs, we are suddenly expected to
lift meaning from assertions such as "endogenous opioids appear to
mediate levels of pleasure and influence dopamine activity in various brain
reward regions." Well I don't know about you, but I need at the very
least the companionship of a medical dictionary to grasp that one fully.
Apart from the overuse of medical terminology without even
the aid of a glossary, there is also the matter of the authors' seeming
monopoly in the field. There is a lack of cross-referencing to other peoples'
work and so their assertions remain totally unchallenged in a book that now
begins to read like medical manual.
The hopes for a cure seem bleak. If you are a sufferer then
medication appears to give the chance of a miracle, but there is a distinct
underplaying of the side effects in the short or long term of dependency on
such powerful drugs. Of the talking therapies, a whistle stop tour of cognitive
therapy seems to offer the most hope. I would like the authors to have given an
equal balance to each of the talking therapies. If brain function lies at the
heart of this condition, then I can agree that medication is the primary treatment.
However, as: "Low self esteem is an almost universal consequence of
impulse control disorders." The talking therapies are surely an
essential element of effective treatment programme. A condition that by its
nature has its sufferers entrapped in worlds of secrecy and deceit must stand a
chance of being relieved by an empathic therapeutic alliance.
The lack of clarity about what is an urge and what a
compulsion I find confusing. I wanted some things made very clear right from
the outset. Terms like "Impulse", "Compulsion", "Craving"
and "Urge" pepper the text but I must admit that I still don't feel
helped to really understand the differences between them. The difference
between Obsessive Compulsive Disorder and Impulse Behaviours remains vague for
me. I wanted at least a serious extended dialogue with the words. The authors
toy with this but don't take up the responsibility whole-heartedly. Only very
late in the text do they use the terms "human novelty seeking behaviour"
and "thrill seeking behaviour". I find these concepts
under-explored. Surely a better starting point for the whole thesis would have
been a thorough look at the meaning of the whole spectrum of the behaviours
that these terms represent.
For all the above reasons I find this book very pessimistic
and wonder if it can therefore fulfil a role in the genre of "self help".
2004 Lizzie Perring
Lizzie Perring, Cert Ed., Dip Mus., MA, Dip Counselling and
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