Abstract
Understanding psychopathology is the core of the interaction between psychiatrist/psychologist and patient. Descriptive psychopathology allows clinicians to reach a diagnosis and manage the patient. From time to time, debates emerge about whether diagnosis is needed, what its purpose is and what it contributes to therapeutic interventions and the therapeutic adherence and alliance. The struggle within psychiatry is also between biology and psychology and sociology. Often this debate takes the shape of a very narrow reductionist view where protagonists argue that all psychiatric conditions are brain based and caused by organic changes, whereas antagonists emphasize that cultural, social and psychological factors are more important in the genesis and perpetuation of psychiatric disorders. The truth, however, as ever, is somewhere between the two. Some psychiatric conditions – such as dementia – have a clear underlying organic basis. Others – such as anxiety – may not. We have ample evidence that schizophrenia may have a neurodevelopmental or organic basis, but high expressed emotion may lead to relapse and poor outcomes. An open debate is crucial in this context, especially as we are getting closer to the launch of DSM-IV, and ICD-11 is coming along shortly after. To this debate comes this volume, authored by well-known international experts. In their preface, the editors remind us that the present volume is similar to a volume published nearly a quarter of century ago, and one chapter of that volume is carried forward in this book. Setting the scene is a truly helpful and enjoyable précis of psychopathological history. The challenge inherent in any study of psychopathology is whether it is a subjective description of the experiences or whether the clinician and the patient are relying on more objective assessments. Using both ancient history and cross-cultural descriptions, the authors gradually take us to the modern era and the focus remains on psychopathology rather than the history of psychiatry or psychiatric services. The first section covers cultural perspectives as well. The second section deals with philosophical issues and why we need classification, construct validity and co-morbidity. These are also challenged by Wakefield in a thought-provoking chapter. Both DSM-IV and ICD-11 are moving towards dimensions rather than categories, and the resulting issues form the basis of the third part. In the last section, innovative theoretical and empirical proposals are covered. There is plenty to digest, debate and learn in this volume. Trainees will certainly benefit from dipping in and out of this thought-provoking book as the new ways of classifications are going to affect them more over a prolonged period.