Review of Psychiatry

Review of Psychiatry. Volume 14

JM Oldham and MB Riba, editors

Washington DC: American Psychiatric Press Inc; 1995. 846 p

This book is the latest in what is becoming an extended series of reviews of psychiatry published by the American Psychiatric Association. I imagine most readers are aware of this series. It continues in the tradition of producing comprehensive yet fairly succinct summaries in 5 areas of special importance. These are: “Substance Abuse,” “Psychiatric Disorders in Women and Women’s Health Care,” “Psychiatric Genetics,” “Cross-Cultural Psychiatry,” and “Sexual Disorders.”

The topics chosen reflect the burgeoning interests of the day. For instance, substance abuse has had a major impact on the mental health of psychiatric patients, to the extent that the “typical” psychiatric patient of the 1990s is a rather different person from his or her counterpart of the 1950s. There are many reasons for this, but the abuse of substances is a major one. Substance use affects the course of major disorders, and the appearance of major disorders predicts the use of many substances.

Yet until recently, relatively little was known about substance abuse, and that which was known was not widely disseminated. There is probably still a series of connected prejudices on the issue, comprising such myths as “substance abusers are all low-class, unbeatable individuals” and “nothing can be done in any case.” In fact, a great deal of useful information is known, and patients can be successfully treated, using combinations of pharmacotherapy and psychosocial therapies.

To be sure, the “war on drugs” is still being won by the drugs. And the issue of substance abuse raises large and important questions that go well beyond the treatment of the individual patient—how should the nation’s wealth be apportioned to individual treatment, prevention, research, or criminal investigation, for example.

But the 6 chapters on substance abuse in this volume will be of immeasurable practical help to clinicians. And practical help is readily available in most of the other chapters in this book. I point particularly to the chapters on “Trans-Cultural Psychiatry.” This is a field on which one often finds superficial writings and meaningless conceptual articles that seem to forget that the individual doctor-patient interaction is still central to the game. The 3 leading articles in this section on assessment, psychotherapy, and drug therapy in the transcultural context are replete with (I thought they had disappeared forever!) case examples of what the author is talking about. This is a welcome regression.

The section on psychiatric genetics is the only one that contains information which this reviewer finds increasingly difficult to follow—the details of chromosome structure and gene chemistry. However, once you wade through a few pages of technobabble, you come to some excellent pragmatic articles on schizophrenia, agoraphobia, and bipolar illness, and a most sensitive and instructive article on genetic counselling.

The section on sexual disorders comprises 2 areas that those of us with overly linear minds probably separate too often: the areas of normal sexuality and the paraphilias. If I had to choose one must-read article from this section, it would be Seagraves’ essay on how drugs affect sexual behavior. I select this one, because its contents will bear on almost half of the patients seen by any psychiatrist in practice.

Finally, the section on women’s mental health issues is broad, useful, and relatively nonpolitical. The article on psychotropic medication is again one of the most useful for just about anyone, while the article on new reproductive technologies will appeal to the needs of those specializing in this area.

To be sure, there are a couple of articles in this American collection that are relatively less relevant for Canadian readers, such as the description of the US federal government’s response to women’s issues, and what seems to me to be the excessive overconcern about an infinitesimal number of transracial adoptions in the United States. But the bulk of this book contains information that will be needed by most psychiatrists.

One must be warned that this is not a book one simply sits down and reads from cover to cover; only the reviewer has that chore. Rather, the way to use this book is as an encyclopedia, turning to the areas of interest and need when necessary.

I have been reading this series for many years, and have become accustomed to the high quality of the content and style of presentation by all its authors. What I particularly admire is that the editors have succeeded in almost eliminating duplication from this multiauthored collection, a feat that I would have guessed to be impossible.

This book, and its 13 predecessors, should be readily accessible to every psychiatrist in practice. Its material is minimally dated—some reference is made to articles published as late as 1993, and I have found from experience that this book tends to remain relevant even when it gets a bit out of date. To cite only one specific example, if you look back at Robert Post’s summary of the treatment of refractory mood disorders in 1990, you will still have an excellent approach to the subject, although several new drugs have been introduced since then.

To some extent, books are going out of style in North America. The Review of Psychiatry remains a stubborn example of a medium that refuses to die. It should be on the shelf of every psychiatrist, but shouldn’t stay on that shelf for too long at a time.