Copeland, A.D. TEXTBOOK OF ADOLESCENT PSYCHOPATHOLOGY AND TREATMENT Springfield, III.: Charles C Thomas, Publisher, 1974, 141 pp.
Dr. Copeland presents a vast amount of practical material in an introductory text written for pediatricians, medical students, pediatric nurses, social workers, and allied professionals. The style is clipped and terse, the vocabulary unpretentious. The presentation is straightforward, with liberal use of outlines where appropriate. The format is conducive to rapid, easy assimilation.
The text is organized into categories devoted to developmental characteristics of adolescents, psychopathology and diagnosis, psychotherapy and pharmacotherapy, and adjunctive therapies. Traditional psychiatric formulations are adhered to, with no departures from current practices and orthodoxies. Thus, the focus is sharp and narrow, with no excursions into theory or speculation and no new insights. As a basis for an elementary text, this approach is highly effective.
The chapter devoted to the developmental characteristics of adolescent thinking and adaptation is particularly useful to the pediatric practitioner. Dr. Copeland makes the point that differentiation between transient, developmental manifestations and significant psychopathology is more often quantitative than qualitative, that degree of severity and persistence weigh heavily in the determination of the clinical significance of symptoms. He emphasizes a fact well known to the clinician in any field of specialization - namely, that experience is the sine qua non in clinical diagnosis. "In the final analysis, judgment about an adolescent's normality is a clinical one requiring experience." A further point in psychiatric diagnosis, which can be confusing to those whose clinical experience is with physical disease, is the occasional lack of correlation between severity of symptoms and seriousness of the disturbance or ultimate outcome. This lack of correlation can be especially reassuring to pediatricians when they encounter the excesses of adolescent behavior.
Dr. Copeland's traditionalism is particularly apparent in his treatment of psychosexual phenomena. He discerns clearcut behavioral and motor differences between the sexes, based on biologic differences, manifested from birth. He views these basic differences as being enhanced throughout childhood and adolescence by psychosocial influences. He sees adolescent boys as being more concerned with orgasmic and frankly sexual activity, girls as being preoccupied with romance and the giving and receiving of love. Homosexuality and problems of gender identity are seen as psychologic "disturbances" and a "defense against a more painful and difficultto-handle heterosexuality." Although this view is currently under attack in many lay circles and among some adult psychiatrists, it is a view wholly consistent with the observations of child and adolescent psychiatrists who observe homosexuality in statu nascendi, before the emergence of characteristic adult intellectual defenses have obscured the basic pathology.
On the subject of adolescent drug abuse, Dr. Copeland has important observations - not new, certainly, but worth restatement and emphasis. The current predilection, for example, for multiple-drug usage is something that any careful observer could have predicted seven or eight years ago. Dr. Copeland shows his appreciation of this phenomenon in a simple, categorical, unqualified statement: "The concept that 'soft drugs' (cannabis derivatives) do not lead to 'hard drugs' (opiates) is simplistic and misrepresentative." He points out that the adolescent is by nature immoderate and lacking in self-control and that these qualities extend to his drug usage; he also mentions that the younger the user, the less controlled he will be. He underscores the potential that drug usage has for unmasking emotional disorders and simultaneously rendering the therapeutic task "most difficult." Heavy cannabis users have a high incidence of psychopathology and are particularly hard to treat. Dr. Copeland reminds us that we have very little knowledge of the long-term effects of drugs on the "special physiology of the adolescent."
On the subject of pharmacotherapy, the author makes the same point - namely, that there has been very little study on the response of adolescents to psychotherapeutic drugs, and clinically their reactions are often unpredictable.
The topic of psychotherapy is generally well handled, with an excellent definition of terms and constructs, a table contrasting the essential differences between therapy of adolescents and that of children and of adults, and an outline of the indices of therapeutic progress with concrete, usable criteria. Thus, the practitioner is enabled to evaluate the psychotherapy being offered and determine how the patient is progressing. On one particular, however, many of us might take issue with Dr. Copeland. He states repeatedly that early therapeutic intervention increases the success of treatment and improves results. Many current studies suggest not only that outcome is unrelated to the mode of therapy but also that one cannot predict who will benefit and to what extent. It is important to avoid overselling psychotherapy, especially to the practitioner and other professionals, in order to avoid the disillusionment that is inevitable when psychiatry is unable to meet expectations.
This is a highly readable, unamibiguous text that should be very useful as an overview of the field. Each chapter has an excellent bibliography, and the text is generously crossreferenced. Two criticisms are offered: no mention is made of alcohol, which is by far the most abused drug in this country, and there is a distractingly large number of misspellings.