about breadth of the topic in a broad framework from one relatively easy-to-readbook.

Anna C. BaldryDepartment of Clinical Psychology

Free University of Amsterdam, The NetherlandsHonorary Lecturer, Kings College London

Institute of Forensic Psychiatry, UK

Shame, Guilt and Alcoholism: Treatment Issues in Clinical Practice

By Ronald Porter-Efron. Haworth Press, Binghampton, New York, 2002.Hardback US$49.95, ISBN 0-7890-1516-1. Paperback US$24.95, ISBN 0-7890-1517-X

Shame and guilt are self-conscious emotions that are often ignored in ourtheories of psychopathology. For example, there is no classification of them inany diagnostic system and they are very rarely mentioned in those systems.However, as Ronald Porter-Efron points out, they are often the key to manydisorders and their treatment can make the difference between success andfailure. This book has two main areas of focus: an exploration of theories/modelsof shame and guilt and the impact of shame and guilt on vulnerability toalcoholism, help seeking and the therapeutic journey (including the therapeuticrelationship).

The analysis of shame and guilt is social/cognitive, based on the idea thatthese are important social and self-regulating emotions that begin to emergewith self-conscious awareness. There is an increasing view, however, that this isonly one route, another being the dynamic interactions between child andcaregiver from the first days of life. This is called intersubjectivity and may offeran emotional infrastructure for later vulnerability to shame (Trevarthen andAitken, 2001). Also, shame should be distinguished in its external (concernwith what others think) and internal (related to self-evaluation) manifestations.

Another concern I have is that this approach is highly reliant on a cognitivesystem, distinguishing guilt as behavioural and shame as related to evaluationsof the self. In my view, guilt is routed as totally emotional in its relationshipsystem to shame. Guilt evolves from caregiving and concern systems. To have acapacity for guilt, one has to have a capacity for empathy and sympathy and tobe sensitive to distress in the other. This is not necessary for shame. One can beshame aware (e.g. that others look down on you), and you may even feel badlyabout yourself, but have very little empathy or insight into the harm you doothers. These issues have enormous implications for therapy, which are notexplored here.

Having said that, this book is an important and major attempt to structure

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interventions around the key problems with shame and guilt in people with analcohol problem. The book is rich and highly informative of ways to assess theseself-conscious emotions and help people work through their shame and guilt. Ilearnt a lot from this book and picked up many ideas I would like to workthrough in therapy. This updated edition from the 1989 edition will be aninvaluable aid to all of those working with people with these kinds of diffi-culties. It is recommended and readable text.

References

Trevarthen C, Aitken K (2001) Infant intersubjectivity: research, theory and clinical applica-tions. Journal of Child Psychology and Psychiatry 42: 3–48.

Paul GilbertMental Health Research Unit

Kingsway Hospital, Derby , UK

Infanticide: Psychological and Legal Perspectives on Mothers who Kill

Edited by Margaret G. Spinelli. American Psychiatric Publishing, Washington,DC. 2003, 272 pp. Hardback US$49.95, ISBN 1-58562-097-1

Professor Spinelli has compiled a truly important book for the better under-standing of homicidal mothers. This is a book that should be read by everyoneworking with depressed mothers in the legal, medical and social fields. Thechapters are clearly divided into the different aspects of the subject. Theusefulness of this book is global but especially vital to the US because of thatcountry’s lack of legal consistency in these matters.

The first two chapters show that infanticide, the killing of a child in its firstyear of life, is neither merely a contemporary phenomenon nor an isolated one.Its history and epidemiology are described. The second part of the book illus-trates some biopsychosocial and cultural aspects. The psychological andphysiological events of motherhood are described. The postpartum state is ahigh-risk period for psychiatric morbidity, for which professionals as well asfamilies need improved awareness. Denial of pregnancy is associated withneonaticide, the killing of a newborn; thorough description attempts to shedlight on this perplexing phenomenon. Guidelines for assessment andmanagement do not exist and studies are scarce, but this book tries to improvethe situation. The final chapter of Part II reminds the reader of context. It asks:‘what effects do deprivation, loss, and abandonment have on the ability to love,nurture, trust, and have and keep faith in the broadest terms?’. ‘Ambiguities ofMother Love’ cannot be discussed without reference to its cultural context.

Part III discusses contemporary legislation in the US and Britain, which is of

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