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John G. Howells has authored and edited many excellent books on family therapy and the history of psychiatry. However, he has not been successful in the writing of Family Diagnosis, coauthored with Winifred Brown. There is a need for works on family diagnosis and assessment, since these topics are frequently ignored. (Another recent book on this subject is by Karpel and Strauss, 1983). Unfortunately, this book is so flawed that we will have to await further publications. The authors hope to show through microanalysis of a single case, that a full understanding of the patient requires knowledge of the family, the predecessors, and the social climate in which the patient lives. Their description is highly repetitive, the same sentences are repeated several times, and add little to a better knowledge or understanding. They quickly make the point that the 12-year-old child who was referred for help because of self-induced nosebleeds, came from a very disturbed family where each member had grave disabilities and, therefore, the entire family should be considered as the patient.
In giving detailed histories of the nuclear family, and the families of origin they examplify the multigenerational transmission of patterns of dysfunction (Bowen, 1978). The authors also demonstrate that treatment demands the integration of a number of agents and agencies. Rather than the complex and perhaps clumsy concept of vector therapy designed by Howells, we may note that this is effected by the case management service utilized by many community mental health centers in the treatment program for the chronically and severely disabled psychiatric patients. Howells and Brown are oversimplistic and mechanical in their approach. Perhaps I am misreading for whom the book was intended; I wonder who has to be told that rapport is important or that relationships of all members of the family have to be examined.
The authors introduce a number of outlines and schemata for studying the data. In exploring