The Denial of Stress: Edited by Shlomo Breznitz. New York: International Universities Press, Inc., 1983. 316 pp.

The inviting title of this book elicits multiple expectations. The hope that it will be primarily clinical in focus, exploring in depth the ramifications of denial in everyday practice, is not realized, as the book deals mainly with research studies of coping, stress reactions, and adaptation. It derives from a conference held in June 1979 at the University of Haifa and sponsored by the Ray D. Wolf Centre for Study of Psychological Stress. The book contains no clinical case discussions and the clinical vignettes generally relate to research projects involving groups rather than individuals.

This conference was attended by researchers interested in the role of denial in psychological reactions to stress. Some of the conclusions involve the positive role denial can play in certain stress situations, its complexity as a defense mechanism, and the difficulties encountered in creating research designs to study it.

The various chapters deal with the interests and conclusions of different investigators who approach various facets of the clinical issues from divergent points of view. There is no obvious underlying cohesiveness.

I find it somewhat difficult to organize the different papers into groupings that clearly portray what Breznitz wishes to convey. The papers by Richard S. Lazarus and Irving Janis deal with old and new conceptions of denial and describe research aimed at diminishing pathogenic denial as a reaction to stress. Lazarus presents research findings which support the concept that denial has both constructive and destructive effects in response to stressful situations. Janis examines adaptive and pathogenic denial and discusses the concept of "stress inoculation," a technique to counteract pathogenic denial. The clinical implications would seem to relate to helping patients prepare for anticipated, stressful life events.

There is an overview of the concept and mechanisms of denial by Goldberger. It provides a clinical background to considering denial a