154 Book Reviews

opinions of other family members considered as an integral part of the study. Various projects
highlighted the role of social factors in mental health disability, and one project in particular
focused on psychosocial interventions. The evidence would suggest that much more work
needs to be done in understanding the complex relationship between mental illness, the
mentally ill person, and the society in which they attempt to function. The development of
appropriate services and interventions to resolve these relationship difficulties appear
challenging and important.
It would appear that various forms of CPN specialisation are becoming increasingly
required to provide professional delivery of innovative schemes in community mental health
care and treatment. Whether or not this trend is healthy for that profession, or spreads into
other professional groups, is a question of significance. The reader, as well as reflecting on the
individual projects, may do well to ponder the wider picture being revealed through the pages
of this book.
Throughout there appeared to be a tendency for the acute and neurotic client to be
identified, by default, as less ‘severely’ ill than those people described as suffering long-term
serious mental illness, and a greater balance of contents may well have been achieved by the
inclusion of projects in response to the needs of this other very important group of clients.
Alternatively, perhaps a definition of the severity of mental illness should reflect the social
dysfunctioning of a person rather than personal dysfunctioning?
The authors come from a variety of professional backgrounds and details of individual
contributors have been thoughtfully provided. The volume is generally well presented and full
credit must be attributed to the editors who have managed to mould this collection of research
projects into such compulsive reading and for leaving the reader with such stimulating
questions.
I have not sought to present a critical analysis of individual projects in this review-that is
for the individual reader-but to attempt to inform those working with mentally ill people in
the community that this volume contains material with potential to affect their everyday
practice and to challenge its ideological basis, either directly or indirectly, and to miss this
would be a mistake.
ROD HAWKER
Clinical Nurse Specialist (Alcohol),
South Devon Healthcare Trust.

Gilbert, D. G . (1995). Smoking: Individual Differences, Psychopathology, and Emotion. Taylor

and Francis. Pp. xvii + 307 f39.95 ISBN 1-56032-171-7.
As a health promotion specialist, I approached Smoking: Individual Differences,
Psychopathology and Emotion with great interest.
The subject is obviously of key relevance to improved public health, as research continues to
suggest that smoking is more risky, and in more ways, than was previously thought. And
tobacco use is increasingly associated with poorer social groups, who already bear the greatest
burden of ill health.
Yet success rates for smoking cessation methods remain depressingly low. Even the most
complex multi-intervention approaches rarely achieve more than 35% sustained cessation at
one year, and are of low cost-effectiveness (Buck and Godfrey 1994). A book which aims to
synthesise the mass of research on smoking behaviour, in pursuit of better treatment options,
must therefore be very welcome.
“Smoking” indeed presents a wealth of information. And this is both its strength, and
perhaps failing. As an overview of relevant research, and source of new hypotheses, it should
be of great interest to the researcher or theoretician. But smoking cessation practitioners or
policy makers, in search of answers to improving the health of individuals and populations,
may be daunted by the sheer mass of data presented, and the demands of American academic
writing.
The book opens with a review of current models of smoking behaviour, rebutting simplistic
ideas of ‘addiction’ or ‘dependence’. The following chapters look at the nature of affect, and
its relation to personality and psychopathology.
 Book Reviews 155

Gilbert next reviews the effects of nicotine and tobacco abstinence on mood and
performance. This section should be of value to smoking cessation practitioners, enabling
them to reassure smokers that such changes are not unusual following cessation, however
strange and unpleasant it may feel. Yet Gilbert also emphasises the great variability of
cessation experience, as it is modulated by personality and the environment.
The complex links between gender, personality factors, mental illness, and smoking
behaviour are then discussed. But, despite the stated importance of situational aspects of
response to nicotine, research on social deprivation and smoking is given scant attention.
There is also a less than critical appeal to notions of psychopathology, rather than an attempt
to understand behaviour within a social context. For example, the well-established link
between “negative affect reduction” and smoking among women is linked to “higher
neuroticism”, ignoring the effects of lower social and economic status.
The final chapters seek to integrate the proceeding material into a complete theory of
smoking behaviour, the STAR model (Situation X Trait Adaptive Response) and to suggest
related treatment options. Although generating some interesting hypotheses, I am not sure
that the final theory added much to my overall understanding. But perhaps that is because
listening to smokers, and those who work with them, continually emphasises the complexity of
tobacco use behaviour.
In relation to new treatments, Gilbert advocates an individual approach based on the
development of smoker typologies, and matched treatments. There is also an emphasis on
supporting smokers in practising coping skills, rather than simply describing such skills to
them. This is obviously the ideal.
Yet currently most of those charged with supporting smokers have neither the time, nor
perhaps the skills, to apply a battery of psychological and physical tests to assess best
treatment options. Such tests will need considerable refinement before they are of great
practical use. Nor will practitioners usually be able to offer intensive training in coping skills.
At present, progress towards public health targets must depend on reaching large numbers
of people with relatively undifferentiated messages, for example through the mass media, or
brief advice from the general practitioner (Reid et al. 1992).
The highly individualised approach advocated by Gilbert must then be an inviting option
for future development, rather than a blueprint for current practice.
KATEWOODHOUSE
Bristol Area Specialist Health Promofion Service

REFERENCES

Buck, D. and Godfrey, C. (1994). Helping Smokers Give Up: Guidance for Purchasers on Cost
Effectiveness. Health Education Authority.
Reid, D. J., Killoran, A. J., McNeill, A. D. and Chambers, J. S. (1992). Choosing the most
effective health promotion options for reducing a nation’s smoking prevalence. Tobacco
Control, 1; 185-197