Abstract
This two-volume textbook complements the expanding array of general psychiatry references. Originating from the US, it is written after the style of Kaplan and Sadock's comprehensive textbook of psychiatry [1], and appears to be pitched as a rival to this text.
The preface to the second edition states that the aim of the work was ‘to produce the highest quality textbook of general psychiatry; one that would provide a valuable resource to mental health clinicians, trainees and students…’ (p.xix). Accordingly, the text (almost 2500 pages) is divided into six sections and follows a familiar structure: (i) approaches to the patient; (ii) scientific foundations of psychiatry; (iii) manifestations and assessments of psychiatric illness; (iv) disorders; (v) therapeutics; and (vi) special clinical settings and challenges.
This approach is probably as good as any given the absence of a unifying theme in contemporary psychiatry. In awork of thismagnitude, however, it can be difficult for the reader to remain orientated, irrespective of the manner in which the material is organized. In this respect, the contents pages are of little navigational assistance as they cover 117 chapters and extend to 22 pages. Fortunately, the chapter title is printed as a header on every page, and the volumes are well indexed.
One of the great challenges for a generalist text must be to provide enough detail to allowthe reader to gain a sense of the uncertainties and contradictions within the literature, while allowing a clear editorial opinion to emerge. Herein lies the strength of Psychiatry, particularly when addressing questions relevant to the practicing clinician. Dilemmas such as, ‘how long should neuroleptic treatment be continued after a first episode of psychosis?’ are discussed, and sufficiently referenced such that readers could examine some of the evidence first-hand should they choose. In this, then, Psychiatry is true to its aim of being a clinically useful reference. There are no glaring omissions in the material covered, but as might be expected in a generalist text, subspecialty information should be sourced from elsewhere. The therapeutics chapters are comprehensive, although there is scant attention given to social psychiatry.
Although more readable than the Comprehensive textbook, Psychiatry is equally as American-centred and DSM-focused. This is undoubtedly the major drawback of the text, and provides a point of differentiation from alternative, more international, general reference such as the New Oxford textbook of psychiatry [2]. Contributors to Psychiatry are overwhelmingly from the US – of more than 250 contributors, merely 20 are located outside of the US – and case vignettes and policy considerations are almost all set in the US context. This is perhaps understandable, although may be alienating to readers outside the US.
The predominantly American authorship is presumably also the source of the rather tiresome reification of the DSM system. This is disappointing in a text that arguably should provide a foundation for further studies in general psychiatry. The reliance on the authority of ‘empirical’ classification systems (DSM in particular) means that the discussions on diagnosis tend to overlook the troublesome conceptual and philosophical underpinnings of the current classification systems, and fail to tackle the issues of syndromal overlap, cultural bias, and the proliferation of diagnostic categories. As a result, the chapters on the disorders tend to be simplistic and ‘cookbookish’, and discussions on the development of their current conceptualization fall prey to a simplistic reiteration of the various DSM revisions. Dissociative identity disorder, ‘recoveredmemories’ and adult attention deficit hyperactivity disorder, for example, are accepted as real entities without discussion of the controversy surrounding these diagnoses.
Perhaps invisible to American readers, the text's hegemonic qualities may nevertheless grate upon those from other countries. Principally for this reason, this reviewer would still opt for the New Oxford textbook of psychiatry as the most authoritative, balanced, international and readable general reference for trainees and mental health clinicians.