Book Review

Psychiatry

N Engl J Med 1997; 337:645August 28, 1997

Article

Psychiatry
Edited by Allan Tasman, Jerald Kay, and Jeffrey A. Lieberman. 1900 pp. in two volumes, illustrated. Philadelphia, W.B. Saunders, 1997. $225. ISBN: 0-7216-5255-7

First editions of new textbooks often reflect prodigious effort, but rarely are they great books. In almost all medical fields, the length of the preparation process leaves some of the material a bit outdated by the time of publication, and the participation of many authors presents problems of style and readability. Rarely are first editions able to present a balanced view of the field. These problems are made worse in psychiatry, which is developing in many directions. Psychiatry encompasses scholars and clinicians with extremely diverse views on nosology, etiology, and treatment. Given all these potential problems, Tasman, Kay, and Lieberman have produced a truly outstanding textbook — in my view, the best current textbook of psychiatry.

Psychiatry is an expensive, 1900-page, two-volume work with nearly 100 chapters and a great many authors. The book has six major sections, covering approaches to the patient, normal development, scientific foundations of psychiatry, manifestations of psychiatric illness, syndromes, and treatments. The section on approaches to the patient considers such topics as listening to the patient, the psychiatric interview, physician–patient relationships, and ethics. The section on scientific foundations includes chapters on epidemiology, genetics, neurobiology, pathophysiology, cognition, social psychology, and theories of personality and behavior. The section on manifestations of psychiatric illness, which may be misnamed, considers developmental psychopathology, treatment planning, neuropsychological testing, consciousness, memory, speech disorders, emotions, physical signs and symptoms, culture, and nosology. The contents of the other sections are what one would expect. The authors are experts in their fields, as are the section editors. The book is profusely and very well illustrated with simple, easy-to-read, and illuminating tables, graphs, and drawings, as well as some clinical vignettes.

Positive aspects of this book cannot all be listed in such a short space. The organization is excellent. Recognition of listening as “the key skill in psychiatry” provides an important initial theme, as do the chapters on relationships and boundaries. The chapters on child and adolescent development are outstanding. Nemeroff's brief introduction to the section on scientific foundations is thoughtful and useful. The chapter on epidemiology makes a diffuse and difficult area comprehensible. The several chapters on neuropsychology bring an area that is much neglected by practicing psychiatrists and residents to the forefront, where it belongs. The chapters about psychodynamic theories provide an introduction of broad scope, including good considerations of intersubjectivity, social constructivism, and Lacanian analysis, which are rarely dealt with substantively in general textbooks. The effort by Skodol and coauthors to present psychopathology in a developmental, life-cycle perspective succeeds very well.

The book pays considerable attention to the managed-care environment, with an excellent description of treatment planning and specific aspects of managed care. The chapter on physical signs and symptoms is an important discussion of a rarely considered topic. As a child and adolescent psychiatrist, I was delighted by the nearly 200 pages on syndromes in the field; these chapters are particularly well done. Among many others, the chapters on traumatic stress disorders, dissociative disorders, sleep disorders, impulse-control disorders, relationship problems, and psychosurgery, as well as those on mood disorders and schizophrenia, are exceptional. Psychopharmacologic treatments are presented in great detail, in a very useful fashion, including a chapter on experimental therapeutics. The appendix on research methodology and statistics is very good; moreover, it is readable.

The textbook is up to date across the board. There is a comprehensive index. Each chapter is well referenced. There are several unique topics that are important but rarely included in textbooks. Any work of this magnitude will have some negative features. There is some oversimplification, but this is far less a problem than in most textbooks. Occasionally, there is a lack of balance, with a relatively obscure topic receiving more attention than more important topics. I thought the chapter on listening to the patient was important but a bit simplistic. The one on adult development was superb — one of the best in the book — but too short. I did not think that “caffeine use disorder” deserved 15 pages, and the otherwise good chapter on personality disorders reified abstractions more than was necessary. The chapter on couples therapy seemed long, as did the one on hypnosis. The appendix on the history of psychiatry is superb — but why not include it as a chapter? Finally, in a book of such beauty, why not have the four-color plates scattered through the book rather than bunched up on one page at the beginning?

Given the hazards of the first edition of any textbook, these few criticisms are picayune. This is a wonderful book. I urge all practicing psychiatrists, and especially all residents, to purchase this book and read it.

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