Vertigo and Dizziness.

Yardley L, New York, NY 10001-2299. Routledge, 1994, paperback, 169 pp, $15.95.

For those practitioners who are experienced in working with patients who are dissy, many of the comments in this book will he familiar and undoubtedly will bring to mind particular patients and experiences. We know that there are some people with balance problems from a vestibular disorder who return to their normal lives. Those are the easy cases. In contrast, there are patients with seemingly identical deficits whose lives are devastated by their experience with vertigo and disequilibrium. This book provides helpful insight into the basis for the reaction of these individuals and will improve our understanding, compassion, and, hopefully, our ability to help these people. The book is part of a series on the experience of illness and is written by a medical psychologist.

The difficulties associated with the problems of vertigo, disequilibrium, and disorientation are common to practitioners everywhere. As the author indicates, it is often difficult to achieve a diagnosis, leaving the patient in a continuous quandary as to the reality of the problem and the likelihood of recovery. Additionally, there is little research on the impact of dizziness on peoples' lives. The sensations that assault the patient are often vague and difficult to describe and the symptoms of organic problems can be confounded by psychological problems such as panic attacks. The author has limited the scope of the book to organic disorders resulting in balance dysfunction and, therefore, is able to address those psychological reactions which might otherwise be dismissed as being due to underlying anxiety or a psychiatric problem.

The focus of the book is on the experience of disorientation rather than on particular vestibular disorders. The author attempts to increase the reader's awareness of the complex psychological impact of disorientation. She states that one purpose of the book is to present an alternative to the tendency of ascribing the symptoms of dizziness to an emotional basis. She does this by improving the reader's awareness of the response of psychologically normal and stable individuals to the effects of recurrent episodes of vertigo and dizziness. The second emphasis of this book is to illustrate ways in which the environment, the person's activities, and their premorbid personality all interact to affect the impact of vertigo on the individual's life. The author has done an admirable job of integrating patient comments with research throughout the entire book. It makes for interesting, stimulating, and sometimes embarrassing reading.

The book begins with a brief but accurate section on the normal function of the vestibular system and the pathophysiology of different vestibular disorders. There is a review of the central vestibular disorders and of non-vestibular disorders that may produce similar symptoms. The author simply lays out the background necessary for understanding the physiological basis for vertigo, dizziness, and disorientation. The author then follows patients from the development of symptoms through the decision to seek medical help and the tests and follow-up care that is offered.

The next sections deal with the perceptual-motor basis for disorientation and imbalance, and the physical consequences of these problems. The differences between physical incapacity and physical inactivity, disability, and handicap are addressed, along with the mechanisms of adaptation for these conditions. The author critically explores the research on the association between emotions and vertigo. The author does not attempt to describe assessment and treatment of particular vestibular problems, although in the last section of the book, which addresses coping, she does critique the current research on medical and physical therapy treatment. The last sections of the book deal with coping with the problems associated with vertigo, disequilibrium and disorientation. The author describes strategies that do and do not work, and, perhaps most importantly, this section explores the reasons people choose different strategies.

Susan J Herdman, Phd, PT Univ of Miami Ear Institute Miami, Fla

Dr Herdman is an associate professor in the department of otolaryngology, and has authored several articles on vestibular disorders. She is the editor of Vestibular Rehabilitation.