Biobehavioral Bases of Coronary Heart Disease . Karger Biobehavioral Medicine Series, Volume 2. Edited by T. M. Dembroski, T. H. Schmidt and G. Blümchen. (Pp. 482; illustrated; SFr. 159.00.) S. Karger: Basle. 1983.

the hypothesis would be confirmed. If, however, as seems to be the case in the present account, the assumption is that the ambivalent motivation is permanent, then all we have is a totally ad hoc hypothesis, not a scientific theory. Similarly, the Tinbergens claim that the existence of islets of ability shows that autistic children are not 'really' mentally retarded. Characteristically, they suggest that all the islets relate to skills that can be learned without social interaction, forgetting that this would also apply to many skills not found as islets. Overor under-reaction to sensory stimuli is also explained by post hoc classifications of stimuli into those that are frightening and those that are not. These examples may demonstrate that the claim of showing coherent overall plausibility is somewhatexaggerated. However, the Tinbergens' main evidence is the presumed success of therapies that derive from their theory, which supposedly also gives them licence to present their amazing speculations on ' autismogenic factors'. These include 'habitual overlong weekend car drives for the sake of the drive itself, 'living in flats in high rise tower buildings', 'inexperienced young mothers', 'both parents having demanding and intellectually interesting jobs', and many more, in a list that could undoubtedly be enlarged to suit the facts of any new case not yet accounted for. The difference between this sort of speculation and science is that there is no awareness of the role of refutation; all the factors mentioned can be observed frequently not to result in autistic behaviour, let alone childhood autism. Nevertheless, it may be asked, why should one care about the fastidiousness of science if there is a cure for autism? It seems to this reviewer that if there were such a cure it would not be important whether experts had predicted it or not; it would and should change their views on causation. It may well be that the therapies advocated by the Tinbergens constitute an important advance in the treatment of children with withdrawn autistic behaviour. We have, after all, the authoritative Tinbergen say-so, backed up by testimonials from satisfied clients ( ' . . . after only x weeks of sessions, he became a normal socially responsive child.'). How can we be sure that the therapies aimed at re-bonding mother and child are different from quackery? Normally, one would turn to controlled studies, agreement on diagnosis, objective assessments of behaviour before or after treatment, subjective ratings by blind observers, etc. The Tinbergens dispense with the need for such studies which are, of course, time-consuming and difficult to set up, because they do not want to withhold any longer the good news of'hope for a cure'. Their moral stance leaves no doubt that this is the right thing to do: ' it is our clear duty to help parents face the possibility, indeed the likelihood, that the early experiences of their child. can have made him autistic. and to give them both more hope and practical advice'. It might be proper to remind the Tinbergens that holding out false hope is equally irresponsible. However, while they know what is right, they admonish their 'colleagues in child psychiatry to become a little more open-minded, a little more humble'. With this book the Tinbergens are launching no less than a campaign that they clearly intend to have much wider implications than the understanding and curing of autism. Autism is but one of many modern stress diseases. ' The problem of autism is with us because of the life style we have chosen. ' This commitment, on the part of valiant people who see that 'we are damaging the human breeding stock of tomorrow', is certainly in a different class from that normally found in scientific discussions. In this reviewer's opinion, it is clear that such discussions will not be advanced by the present volume.