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Book Review: Action AIDS—An Interactive Resource Pack for HIV Education and Training.

ill can be costly and emotionally draining. During the final phase, when death is imminent, there is an acceptance of the finality of death and the impending loss. At this time, the family can momentarily stop functioning, pulling in upon itself in an effort to cope. In discussing the phases of adaptation to death, Rosen introduces the notion of anticipatory : grief in which the family begins the process of grieving before the death has occurred. Although this is not an automatic response of all families, Rosen suggests that it is one which often facilitates a positive resolution of the crisis for the family. For the grieving family to resume normal functioning after a death has occurred, certain psychological experiences and behavioral changes must occur. These include acknowledgementof the reality of death, experienceof the painof loss, reorganization of the family system, and redefinition of the family goals. Accomplishment of these tasks must be shared by all family members and is often a process which extends long after the death of the individual. Anticipatory grief, by allowing the dying person to be part of the process, facilitates these tasks. It is easy to understand then, why unexpected death is particularly stressful to a family. In families in which there are also conflictual interpersonal relationships, such unexpected death can generate a shock wave which results in abnormal grief. Three types of abnormal grief are discussed: unresolved grief in which there is too little grieving over a past death; interminable grief in which grieving is an ever-present factor in the family long after the event; and unsanctioned grief in which society's failure to validate the significance of the death, e.g. perinatal death, circumvents the process of grieving. Most families cope with the death of one of its members, calling upon their interpersonal and institutional sources of support to survive the crisis. Nonetheless, there are other familieswho are in need ofpsychosocial intervention. Theseare most likelyto be those with a history of conflictual relationships and/or those who have faced unexpected or sudden death. For such families, simple yet timely interventions can often produce short-term change that facilitates the process of grieving. Rosen outlines several such measures. These include the enactment of rituals which formalize the grieving process, the useofbooks and films that address importantthemes, and coaching the patient and family to confront long-standing interpersonal conflicts. The book ends with a timely reminder that there is tremendous variation in normal responses to dying and death. Highlighting the importance of ethnic background and heritage, significant variations in family behavior are described. These include differences in attitudes toward life and death, expressions of pain and suffering, acceptance of outside authority, expectations of family responsibility in caring for the patient, and gender roles for caretaking and grieving. These differences shape how patients and families cope with loss. Health care professionals who recognize and accept these variations will be better able to provide effective care to families facing death. In this book, an important and difficult topic is dealt with in an informative yet compassionate manner. The book's strengths are numerous. These include an exceptionally clear presentation of theoretical material which is relatively free of jargon and is well amplified with concrete examples. As well, there is extensive use of case examples of families from the author's own practice which provides a vivid glimpse into the functioning of families in these circumstances. Finally, there is an absence of dogmatism that is manifested in Rosen's respect for the integrity of the family and for each family's right to cope with death and grieving in its own fashion. The book's one weakness is that the author fails to clearly articulate from the beginninghow familybased, psychosocial caring is in the best interests of the patient as well as the family. There is a danger that those health care professionals who are providing front-line services to numerous patients may view the provision of care to the whole family as more work than they can cope with. It is implicit throughout the book that the patient benefits from such holistic care. Nonetheless, the book would profit from an explicit discussion of how familyoriented care enhances the care of the patient. It would also be enriched by a discussion of how such comprehensive care can relieve some of the emotional burden that accrues to those caring for the terminally ill. These, however, are small points which should not detract from the value of the book overall. This is an excellent text which deserves to be widely read by students and practitioners in the fields of palliative care and family therapy.