by James Whitney Hicks, M.D. New Haven, Conn., Yale University Press, 2005, 416 pp., $27.50.
Most self-help books about psychiatric conditions include a presumptive diagnosis in the title and require that the patient has been diagnosed or will self-diagnose. This book starts with signs and symptoms and explains what they add up to and how they may be treated. The symptom is described in second-person address, allowing the reader to try it on. For example, under “euphoria (meaning hypomania or intoxication),” one reads, “So what if you’re crossing in the middle of the block; pedestrians have the right of way, don’t they? You wonder why the driver is so grumpy. It’s a great day!” (p. 114).
The tone is friendly, interested, and inviting, and the scholarship behind it is seamless:
The “50 signs” are as follows: Anger, Antisocial Behavior, Anxiety, Appetite Disturbances, Avoidance, Body Image Problems, Compulsions, Confusion, Deceitfulness, Delusions, Denial, Depression, Dissociation, Euphoria, Fatigue, Fears, Flashbacks, Grandiosity, Grief, Hallucinations, Histrionics, Hyperactivity, Identity Confusion, Impulsiveness, Intoxication, Jealousy, Learning Difficulties, Mania, Memory Loss, Mood Swings, Movement Problems, Nonsense, Obsessions, Oddness, Panic, Paranoia, Physical Complaints and Pain, Psychosis, Religious Preoccupations, Self-Esteem Problems, Self-Mutilation, Sexual Performance Problems, Sexual Preoccupations, Sleep Problems, Sloppiness, Speech Difficulties, Stress, Suicidal Thoughts, and Trauma. These rubrics cover the waterfront, and it is hard to think of a major area not covered. Shame disorders and gambling come to mind. While movement disorders from typical neuroleptics are patiently explained, diabetes with the atypicals is briefly mentioned; patients could use more help in warding off the metabolic syndrome (1). The book helpfully distinguishes what not to worry about, for example, the section, “Some Unusual Beliefs Are Not Delusions” (pp. 79-80) and a good index is provided. If “you” only have one of these problems, will you want the whole book? Perhaps few patients have only one, and there are always one’s acquaintances to evaluate. I am reminded of the kooky girl in the film American Splendor who knew the DSM by heart and gratuitously diagnosed all the other characters. But for the cartoonist R. Crumb, she chose the old symptom term, polymorphously perverse.
The author’s treatment recommendations are generally sound, and more important, presented comprehensibly with a positive spin. For example, discussing selective serotonin reuptake inhibitor as a treatment for depression, he writes, “sexual side effects can usually be treated with sildenafil (Viagra). Though viewed as harmless by most doctors, these medications can interfere with the metabolism of some other medications” (p.104). While he gives credence to St. John’s Wort, he gently urges readers to consult a psychiatrist.
The book should have a wide lay appeal, but as one who trains residents and medical students, I believe it would also be useful for apprentice general clinicians and therapists. Compared with training student professionals to listen, it is more difficult to teach them how to talk to patients in a helpful way. The strength of this book is not in its outdoing a textbook or presenting novel material, but in its parsing subjects and phrasing acceptable ways to speak about them. It wouldn’t hurt doctors a bit to read Hicks’ book and commit some of his patient-friendly language to memory.