Book Review

Current Psychiatric Therapy

N Engl J Med 1993; 328:1131April 15, 1993

Article

Current Psychiatric Therapy
Edited by David L. Dunner. 578 pp. Philadelphia, W.B. Saunders, 1992. $55. ISBN: 0-7216-3973-9

Avoiding the many pitfalls in editing a textbook of psychiatry requires the balance of a tightrope walker, the flexibility of an acrobat, a solid, no-nonsense grasp of accurate information that resembles the stolid gait of an elephant, the coordination of a trapeze artist to avoid too many contradictions among multiple authors, and finally, the self-mockery of a clown, so that readers may view many of the standard opinions with skepticism after acknowledging the inadequacy of the empirical base. We should finish the textbook feeling enriched and satisfied that we have surveyed the field and that we know not only what we know but what we don't know.

I can report, happily, that David Dunner gives a fine performance here. The book's title suggests that it will confine itself to therapy. Fortunately, it doesn't. The array of qualified authors give authoritative and amazingly concise accounts of what we know about causes of disorders and mechanisms of action of drugs, while focusing on treatment.

Most of the book deals with drug treatments, an emphasis that reflects the weight of the evidence about effective treatments for mental disorders. Around this core, there are brief, fair accounts of the major nonpharmacologic treatments. As a fillip, people currently working on the forthcoming fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describe where things seem to be going.

I don't think a textbook of psychiatric treatments could be much better than this, and I recommend it highly, as long as readers recognize the problem with all textbooks. By the time you read it, important new information may change the picture, and there isn't enough room for adequate critical commentaries. We depend on the judgment of the authors to make apodictic assertions. It is up to the readers to pursue issues of interest by reading more lengthy reviews and, preferably, the original literature.

Arthur Rifkin, M.D.
Queens Hospital Center, Jamaica, NY 11432