The American Psychiatric Press Textbook of Psychiatry

The American Psychiatric Press Textbook of Psychiatry, 3rd ed

Robert E. Hales, Stuart C. Yudofsky, John A. Talbott, editors

Washington (DC): American Psychiatric Press; 1999. 1762 pp. with index

ISBN 0-88048-819-0 (cloth)

As would be expected of both the American Psychiatric Press and the American Psychiatric Association as an organization, the latest edition of the Textbook of Psychiatry, edited by Hales, Yudofsky and Talbott, is an impressive book. Members of the editorial board, the international advisory board and the individual chapter authors, make up a Who’s Who of modern psychiatry, although with a strong American bias. As examples, the chapter entitled “Psychiatric education” is written by Jonathan Borus, “Clinical neuropsychiatry” by Jeffrey Cummings, contributions on hypnosis and dissociation are provided by David Spiegel, and “Group therapy” is by Irvin Yalom. Thus, in most cases, the chapters have been prepared by leading experts in a particular field.

But there is a problem. In many ways, it is one that is illustrated, in parallel fashion, by the inclusion of DSM-IV on CD-ROM in a kind of “book within a book.” The CD-ROM is fun — easy to load on the computer and browse through but, in the end, not particularly useful. It comes on a CD-ROM, so cannot be downloaded, which means I have to choose whether to leave it at home or at work. More important, apart from providing another way to look up something (and I still think picking up my well worn mini DSM, which opens automatically to the Global Assessment of Functioning Scale is quicker), it really doesn’t do much. You can search key words on it, and find out how many diagnoses include anhedonia in the description of symptoms, and you could cut and paste sections from the DSM into other documents, but apart from that relatively restricted use, it just doesn’t seem to have a role.

Similarly, the question arises: What is the purpose of a large textbook like this now? Is it to provide a quick reference source for the field of psychiatry, a state of the art presentation of the field or a study tool for residents preparing for their fellowship examinations? Should it provide sufficient depth of discussion of topics to allow clinicians to expand their practical skills and knowledge substantially, making the book a large one indeed, or is it designed to provide overviews of complex fields?

Clearly, a textbook, no matter how well produced, is not going to be a state of the art presentation for long, although this one does an admirable job. As a reference tool, the textbook varies in its ability to deliver. The depth of discussion is limited by size constraints so, for example, important advances such as Linehan’s work on dialectical behaviour therapy for personality disorder, are presented and described, but not in sufficient depth to do more than stimulate interest. Autistic disorders are discussed fairly thoroughly, but little useful discussion of autism in adults is provided, even though the section is clear and well written. Finally, the chapter on group therapy restricts most of its content to a focus on the interpersonal orientation of Yalom, without providing a broad overview of writing on psychodynamic groups, cognitive behavioural groups or psychoeducation groups and the roles of these in various illnesses.

This limits to some degree the value of the book as either a quick reference or a study tool for residents, and yet this limitation, with some minor exceptions, stems more from the restrictions of the art of the textbook in current medicine than from the limitations of the authors. The expansion of knowledge in any field may have pushed the limits beyond that which is practically encompassed in a comprehensive textbook. Despite my earlier comments, overall, this is a good textbook. Chapters are generally very well written and ideas presented clearly. In most cases, key, up-to-date references are included. Clearly, the editors have run a tight ship to ensure publication of a textbook as up-to-date as possible.

Organization is fairly standard, with chapters on the theoretical foundations of psychiatry, a section on assessment, a section focussing on the disorders of psychiatry (following the DSM system of classification) and one on treatments. The editors avoided the pitfall of excessive reliance on DSM by setting chapters in the final section on topics such as violence, an area not well classified in DSM.

There are some excellent sections. Despite the loss of prominence of psychoanalytic theory politically, there is an excellent chapter by Robert Ursano and Edward Silberman on psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy. It reviews important writings and research and includes an extremely useful section looking at a comparison of psychodynamic, interpersonal and cognitive therapies, and pointing out the similarities and common roots that are often forgotten or ignored in debates between proponents on the relative merits of each.

The one main drawback for an international audience, is that this text is ultimately an American one. The chapters on psychiatric education, and law and psychiatry are about medicolegal psychiatry and education in the United States. “Public psychiatry,” “Managed care and psychiatry” and “Psychiatry and primary care” are written about US models and experiences of these fields; therefore, for example, the work by Kates and others on a shared care model for psychiatry and primary care is not included. This is unfortunate because the discussion on any of these areas could, with relatively little expansion of content, be greatly enriched by the inclusion of the experience in other countries. Including differing perspectives on the legal handling of dangerousness in the psychiatrically ill, or different models of postgraduate education in psychiatry, would not only benefit readers from other countries but could expand the dialogue on these issues through contrast and comparison. After all, many of these systems evolve in a particular way for historical reasons that may not always reflect the only or the best solution. Given the inclusion of an expert international advisory panel, it is unfortunate that the textbook falls short in this way.

Textbook of Psychiatry from the American Psychiatric Press is ultimately a pretty good textbook. It is comprehensive, well written and up-to-date. It is limited by its very nature, but if one feels that one does need such a book, then this book is competitive with any other in the field. It is unfortunate that it is limited by being essentially an American textbook. Relatively minor changes could have made it a truly international one, of use to both an American and an international audience.