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Hughes' Outline of Modern Psychiatry, 4th revised ed.
Reviewed by IAN STEVENSON, M.D.
Am J Psychiatry 1998;155:703-704.
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by Jennifer Barraclough, and David Gill. New York, John Wiley & Sons, 1996, 302 pp., $29.95 (paper).

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Biological Psychiatry: British Medical Bulletin, vol. 52, number 6

edited by Eve C. Johnstone. London, Royal Society of Medicine Press, 1996, 269 pp., $73.00.

These two books survey modern psychiatry, although the first covers the entire field, whereas the second is restricted to "biological psychiatry."

Hughes' Outline of Modern Psychiatry is a revision of a work first published by the senior author, then Jennifer Hughes, in the late 1970s. For this fourth edition, she enlisted a colleague to assist her in bringing the work up-to-date while adding little to its length. The authors are English psychiatrists.

Nearly every illness or condition pertaining to psychiatry receives some attention, but the authors appropriately describe and discuss at greater length the more important disorders, such as depressions, schizophrenia, neuroses, and "the psychiatry of old age."

The descriptions of the disorders are accurate and the recommendations for treatment appropriate for contemporary psychiatry.

I fault the authors for recommending that physicians—presumably this includes medical students—"take notes during the [history-taking] interview since there is too much material to recall accurately afterward." I believe the decision to take notes during the interview should depend on the circumstances; note-taking can distract attention from the more important task of listening, and little need be lost if the history-taker writes his or her notes immediately after the interview.

The chapter on forensic psychiatry will be of limited value to American readers, for whom the laws of Great Britain, e.g., the Mental Health Act of 1983, have little relevance. Similarly, the reference to the Abortion Act of 1967 will convey nothing to American psychiatrists. For sales in the United States, the publishers should have added or substituted a section on forensic psychiatry in this country.

The cover of the book states that "although designed primarily for medical students and trainees and practicing psychiatrists, the book will also be of value to readers in other specialties who have no knowledge of the subject." I can certainly recommend it for medical students and for physicians in specialties other than psychiatry. I think it will be of little value, however, to psychiatric residents and more experienced psychiatrists. The authors have included sections of "further reading" that list some books and review articles. Unfortunately, the references are far from compulsively organized. Within the text, numerous references occur to authors who figure in no list of references. Readers with habits like mine—of wanting to read further and to check references—will share the frustration that this otherwise excellent survey of modern psychiatry provoked in me.

Biological Psychiatry, as its name suggests, has a much less ambitious program, because it addresses genetic, anatomical, biochemical, and pharmacological aspects of mental disorders and almost nothing else. Within its announced domain, its authors—there are many of them, nearly all from the United Kingdom—have succeeded admirably. The contributors write well, and they document their assertions with data and abundant references. They provide valuable information on the genetics of mental illness, imaging techniques, and psychopharmacology. I recommend the work highly as an accurate guide to the latest knowledge in "biological psychiatry" up to, say, 1995.

Some of the authors show a defensive, almost apologetic attitude toward "biological psychiatry," as if they might offend by presuming to establish a subspecialty within psychiatry. In the introductory chapter, entitled "Biological Psychiatry in Perspective," Michael Gelder admits that a valid psychiatry must take account of environmental factors in development and of stresses in a patient's current life that cannot be subsumed under biological factors.

Despite Gelder's disclaimer, this book is a signal, one might say a symptom, of a deplorable separation in psychiatry between the prescription writers and the listeners. It should not be too late to expect to find both of these skills within one mind, yet there seems to be a growing ignorance on the part of each group of the knowledge the other may have obtained. Gelder himself provides an alarming illustration of this in the introductory chapter. There he states that psychiatric epidemiology has shown "that the major mental disorders occur in a wide variety of different societies (arguing strongly against the view that schizophrenia is a product of social conditions)." From the same data one could argue, just as strongly, that beneath the superficial differences of cultures humans in different societies have similar familial conflicts and social stresses that are sometimes strong enough to generate mental illnesses.

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