112 Book reviews

does include useful forms that can be photocopied for use with the children and young
people.

Joan Pritchard
Retired headteacher of a day school for SEBD
and lecturer in higher education
Email: j.h.pritchard@btinternet.com
© 2011, Joan Pritchard
DOI: 10.1080/13632752.2011.545659

The extremes of the bell curve: excellent and poor school performance and risk for
severe mental disorders, by James H. MacCabe, Hove, UK, Psychology Press on behalf
of The Maudsley, 2010, 186 pp., £25.95 (hardback), ISBN 978-1-84872-045-9

There have long been assumptions about the reasons why there is an increase in prevalence
of schizophrenia and bipolar disorder in particular groups of individuals. This research
attempts to confirm some of these assumptions using a range of methods. There have been
numerous studies in the past but in this study the author has attempted to find the corre-
lation between educational attainment and the onset of the above mental health disorders.
By the author’s admission, it can be very difficult to use sound data and he has opted to
use data from Sweden as their collection sets have been available across the population for
many years. It was also felt that these assessment data are more closely informed as there is
strict collection guidance, which limits teachers’ personal moderations. This is the largest
study to date to investigate the association between school performance in childhood and
risk of psychosis in adulthood therefore there is confidence in the ultimate results.
The first two chapters provide the reader with information around schizophrenia and
bipolar disorder, and to the non-specialist the author uses language which is very clear and
accessible and enables the reader to understand the mental disorder and the methodological
difficulties that exist when carrying out a study of this kind.
The remaining chapters deal mainly with the research, the understanding of past studies
and their strengths and weaknesses. They also outline why the author chose to carry out
this particular study and the reasoning behind using Sweden and their data sets to complete
this research. These chapters are definitely of interest to the specialist: to the non-specialist
the access and understanding could be more difficult.
In conclusion, this book helps the reader to recognise that the development of mental
disorders can be linked to both high and low educational achievement and that external
influences can have some but limited impact. It was interesting to note that the research
confirmed that schizophrenia is linked to low educational attainment and that there is more
evidence to show that it is linked to neuro-developmental impairment, and that excellent
school performance, especially within the creative arts, is a risk factor for bipolar disorder.
Equally interesting is the suggestion that bipolar is more often diagnosed in young people
whose parents who are high achievers and that their high expectations can be unwittingly
transferred to their children. This leads to a further enquiry as to the impact of ‘demanding’
parents on a child’s emotional and academic development. The use of the bell curve in
research serves to reinforce some persistent bias but also reinforces those extremes and
that the incidence of mental ill health sits at those extremes.
 Emotional and Behavioural Difficulties 113

James H. MacCabe is a senior lecturer in psychiatric epidemiology at the Institute of

Psychiatry, Kings College London.
Janice Cahill
Headteacher, Stockport, UK
Email: headteacher@pendlebury.stockport.sch.uk
© 2011, Janice Cahill
DOI: 10.1080/13632752.2011.545661
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