Book Review

A History of Clinical Psychiatry: The origin and history of psychiatric disorders

N Engl J Med 1996; 334:1141-1142April 25, 1996

Article

A History of Clinical Psychiatry: The origin and history of psychiatric disorders
Edited by German E. Berrios and Roy Porter. 684 pp. New York, New York University Press, 1995. $65. ISBN: 0-8147-1259-2

This book is formidable. Expecting to review a brief narrative providing an overview of the history of psychiatry, I found myself immersed in a work of great complexity. The immersion was worthwhile; this wonderful book will be read with pleasure by historians of medicine, with profit by clinicians, and with gratitude by students of specific syndromes.

Despite its title, this book is really a historical resource on neuropsychiatry, and many chapters deal with primarily neurologic topics. Freudians are given short shrift in many of the chapters, and psychoanalysts should not search through this book for accounts of their history. A meticulous reader can infer a broad history of psychiatry, but the book really devotes itself to histories of syndromes and syndrome types. It begins with the development of our understanding of such neurologic syndromes as delirium, dementia, stroke, Parkinson's disease, Huntington's chorea, seizure disorders, multiple sclerosis, pain, and mental retardation. The second part of the book considers the functional psychoses in great detail. The final part takes up personality disorders, fatigue syndromes, post-traumatic stress disorder, conversion and somatoform disorders, eating disorders, obsessive–compulsive disorder, substance-use disorders, and suicide.

Among the many positive features of this book is its unique organization, in which a syndrome or group of syndromes is considered with regard first to its clinical history and then to its social history — the reaction of society to the syndrome, the patients who had it, and the people who were treating it. For the most part, the clinical and social sections complement each other superbly. Some of the social sections are extremely thought provoking; the one on neurasthenia should be read by every psychiatrist.

There are wonderful discussions of extinct syndromes such as chlorosis, and good presentations of old symptoms such as ice-eating. The reader learns a great deal about the efforts of physicians whose fame rests in different areas. J. Breuer's contributions on pain, for example, are of great interest. One learns some fascinating trivia, as well — from the origin of the term “anxiety” to the surprisingly long history of the term “dysmorphophobia.”

Over 40 pages are devoted to Emil Kraepelin. After reading them, I appreciated for the first time his central role in modern psychiatry. The centrality of Kraepelin does not detract at all from others; the contributions of Carl Schneider and H.C. Rümke to our appreciation of schizophrenia, for example, are richly explored. Ancient healers also receive their due, with more than a courteous mention. Galen's many contributions, for example, are fully acknowledged.

There are wonderful quotes — from Mark Vonnegut's “Schizophrenics are mystics who do not have the luxury of vacations” to Tom Lutz's “Neurasthenia is extinct in the West because its cultural work is done.” The index is accurate and helpful.

There are some disappointing aspects to the book. For example, there is nothing about child and adolescent psychiatry. There is insufficient information on important transformations that have occurred in psychiatry in the past 40 years, especially in its nosology and metapsychological models. Some very important current conditions, such as borderline personality disorder, are slighted, as are some transitional concepts, such as pseudoneurotic schizophrenia. Several chapters give rather cursory attention to the tremendous contributions of French psychiatry in the 18th and 19th centuries. Given the magnitude and comprehensiveness of most aspects of this book, however, these flaws are understandable and, at most, surface blemishes.

This book is not light reading but a serious and scholarly work. It makes demands on the reader, who will be well rewarded. I recommend this book without reservation to serious students of psychiatric history and to neophytes who want to read true history and not an overview.

Lloyd A. Wells, Ph.D., M.D.
Mayo Clinic and Mayo Medical School, Rochester, MN 55905