Clinical Manual of Sexual Disorders

Richard Balon & Robert Taylor Segraves (eds) American Psychiatric Publishing, 2009, £39.00 pb, 473 pp. ISBN 9781585623389

Sex, Sexuality and Therapeutic Practice: A Manual for Therapists and Trainers

Catherine Butler, Amanda O'Donovan & Elizabeth Shaw (eds) Routledge, 2009, £22.99 pb, 208 pp. ISBN 9780415448093

The problem, or beauty, of a psychosexual presentation is that the physiology, psychology and societal judgements are all in the room vying for attention. For instance, should hypodesire be managed as a deficiency that is hormonal or as a meaningful stance against a demanding partner, and if the latter, what can you do about it? Insurance companies in the USA have no interest in psychiatric involvement in this question. So it is against a backdrop of dwindling expertise in the field and a defensive retreat to biological management that the publication of Clinical Manual of Sexual Disorders is so welcome.

This multi-authored tome is an authoritative advance in the literature. It is split into three sections: assessment, management and age-related issues, with four, eight and two chapters respectively. Each chapter is referenced and has lists of key points, tables and diagrams. There are case histories that enliven the text for clinicians. The book is user-friendly, informative and handles the biological aspects of drugs and disease comprehensively counterbalanced with the psychological perspective. Where the evidence is weak it says so.

Sex, Sexuality and Therapeutic Practice: A Manual for Therapists and Trainers discusses sex emphasising the individual's life story, its meaning and the influence of culture. In six chapters it covers identity, communicating, disability and minority groups, age and culture. It deliberately avoids the comfort that categories bring. It challenges stereotypes and grapples with the validity of presenting problems. At times, as a psychiatrist, it makes uncomfortable reading. Our history of defining homosexuality as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (in 1952, removed in 1973) is a testament to the power of law and prejudice. I particularly enjoyed the chapter ‘Talking about sex’. It is practical and reflected the reality of the subject, which is fraught with pitfalls for the therapist who can inadequately let their own beliefs bias the assessment.

Most trainees in psychiatry now have no experience of treating sexual problems. They have never experienced the bewildering feeling of being an unwilling performer in a Pinter play that can be engendered by managing a couple at war. For them the Clinical Manual of Sexual Disorders will provide the reassurance that classification and evidence-based treatments bring when they set out to help patients in relationships professing sexual problems. Sex, Sexuality and Therapeutic Practice will illuminate the complexity of the endeavour from a cultural, ethnic and social perspective. Both books are needed by clinicians with an interest as well as teachers in this area. Trainees who believe ‘evidence is all’ should read Sex, Sexuality and Therapeutic Practice before Clinical Manual of Sexual Disorders, and those who feel changing society is the answer should try the other way around.