Stigma renders an individual different and somehow less desirable, and this volume attempts to understand the process of stigmatization. The first chapter poses the question, “Why do people stigmatize?” The authors propose that there are group benefits to the exclusion of specific individuals: certain people are perceived as a threat and cannot therefore be part of a group. (Clearly, for example, identifying and ejecting thieves, cheaters, and traitors is beneficial, and for certain groups, excluding the physically or mentally ill, may be necessary for survival.)

Subsequent chapters examine the links between stigma, stereotype, prejudice, and discrimination. Stigmatization and its effects differ depending upon whether the stigma is visible or invisible, controllable or not. For example, the individual with a birth deformity (visible and uncontrollable) will elicit reactions different from those elicited by a person with an addiction. Several authors note the relation of the Protestant work ethic to the process of stigma formation. In North America, the dominant ideology is that we get what we deserve. This ideology is an important factor in the evolution of stigma against obesity, sexual preference, and addiction. Derision, rather than sympathy, is provoked if we believe that obesity is merely the result of overconsumption, and AIDS the consequence of sexual choice.

Other chapters investigate the effects of stigma on self-esteem, cognitive processes, and nonverbal behaviours. The book does not limit itself to the discussion of one type of prejudice but looks at prejudice toward race, gender, physical deformity, weight, age, addiction, and, to a lesser degree, mental illness. Less effort, however, is devoted to discussing methods of disarming stigmatization.

Stigma is a complex topic linked to many other psychological dimensions, and the authors develop their theses by citing current information on group dynamics, self-esteem, chronic stress, and thought suppression, as well as research on awkward moments and self-fulfilling prophesies—excursions that are well integrated and fascinating.

As a psychiatrist working in a rural Ontario community, I have been painfully aware of stereotyping, prejudice, and discrimination. When asked to review this book, I was full of hope that somehow, with more knowledge, I would have greater power to combat stigma.  I learned more than I expected. Unfortunately, I learned that many people, including myself, live with little or no appreciation of the process and effects of stigmatization. This book is an excellent reference for mental health professionals who wish to understand it.

With regard to presentation, I must note that, although Guilford Press is known for the outstanding quality of its publications, my copy was, unfortunately, missing the type on page 407.

Review By

Marcia Benjamin, Bsc, MD
Nasreen Roberts, MD, FRCPC, MIRCPsych
Kingston, Ontario

Child and adolescent psychiatrists only began considering pervasive developmental disorders (PDDs) frequently in their differential diagnosis about 10 years ago—and Asperger syndrome (AS) even more recently. This volume represents a concerted effort by a handful of dedicated professionals, working for their entire careers, to establish a respectable knowledge base for this group of disorders. The editors, themselves well-known experts, have chosen eminent pioneers like Wing and Wolff  to add to a list of internationally acclaimed contributors. They provide us not only with current scholarly research in such areas as genetics and neuroimaging but also with clinical studies and case vignettes of AS patients from childhood on.

The comprehensive introduction, which clarifies the text format and points readers to their area of interest, is followed by 5 sections: “Behavioural Aspects”; “Family Genetic and Neurobiological Aspects”; “Related Diagnostic Constructs”;  “Assessment, Treatment, Intervention and Adulthood”; and “Perspectives on Research and Clinical Practice and Parent Essays.” Each section comprises several chapters.

Section I covers diagnostic issues, neuropsychology, and motor and social language functioning. Its chapters are understandably densely written, due to the complexity of the subjects, and require some prior knowledge of the area under discussion—they are definitely not for the novice. The first chapter in this section comprehensively reviews the evolutionary process leading up to our present diagnostic criteria and current view of AS as compared with PDD and autism. The passages on diagnostic validity and neuropsychiatric profiles are heavily weighted with statistical analyses and  are probably more suited to psychologists and psychiatrists well versed in this domain.

Section II, comprising chapters 5, 6, and 7, offers an exciting discussion of the changes brought about by such technological advances as neuroimaging, which bring psychiatry generally, and PDDs specifically, into the 21st century. These advances are especially impressive when one considers the limited time period  within which our thinking has shifted from the concept of the “refrigerator mom” to the details discussed in these chapters. These chapters reflect the shift from folklore and myth to evidence-based psychiatry, with its advances in diagnostic assessment, drug treatment, and management of various accompanying deficits—advances that provide hope of a better future to parents, to persons with the disorder, and to health professionals (and for some parents, alleviate a sense of personal culpability).