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Book Review   |    
Margery Gans
Psychiatric Services 2006; doi:
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by William J. Koch, Ph.D., Kevin S. Douglas, Ph.D., Tonia L. Nicholls, Ph.D., and Melanie L. O'Neill; New York, Oxford University Press, 2006, 336 pages, $39.95

Dr. Gans is a licensed psychologist at Forensic Services, Arlington, Massachusetts.

The Canadian authors of this volume—a psychiatrist, psychologist, and two researchers—seek to illuminate issues related to the forensic assessment of psychological injuries. They review the history of injury law in Britain and America and the evolution of claims from those made solely for physical injury to those made for psychological damage, which is less easy to determine and measure. The book is well written and should be accessible to lawyers, psychologists, and other professionals with a basic knowledge of clinical and forensic practice.

The increase in claims for psychological damage has depended heavily on the diagnosis of posttraumatic stress disorder (PTSD). The authors explore this diagnosis, a post-World War II concept that has become increasingly sophisticated and complex. They review screening methods designed to diagnose and assess PTSD, their strengths and limitations, and their applicability to different populations. They address malingering and review research on the course, prevalence, treatment, and prevention of PTSD, and then present cases that link clinical and forensic concerns.

Two of the book's strengths are the focus on the experience of minorities and the emphasis on clinical issues. The authors stress that research outcomes for groups need to be applied carefully to individual clients or unstudied communities. Research may not ask the questions that are salient to particular subgroups. For example, the higher incidence of PTSD among women may be related to oversimple definitions of trauma in specific measures. Also, women may experience assault differently from men because of the implicit sexual threat that may accompany physical assault, the greater likelihood of physical injury, and their greater vulnerability to adult and childhood sexual assault. Their experience has not necessarily been captured in research.

Regarding minorities, the authors point out that dichotomizing the population into white and nonwhite provides almost no information about the complex subcultures in the United States today. Each of these cultures may have its own individual understanding and experience of what is traumatic and how posttraumatic stress is expressed. Being a minority and facing racism may in itself be a potentially traumatic experience, and the adversarial court system may exacerbate posttraumatic symptoms, especially for anyone not in the mainstream.

The authors also address evaluator bias and assumptions—heuristics—that can skew an evaluation and the general lack of familiarity most clinicians have with recent research on PTSD. Practice lags behind empirical findings, and clinicians are urged to use a structured assessment with empirically tested tools. Finally, the book anticipates future trends in injury assessment and how psychology and the law may interact and identifies areas for research.

In sum, this book is thoughtful and thorough. The authors review the field, balancing their faith in empirically grounded research with healthy skepticism. They remind us that our biases, heuristics, and the client's subjective experiences must always remain in awareness as we become educated in the most up-to-date techniques.




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