New Oxford Textbook of Psychiatry, vols. 1, 2

Our current era of globalization demands international partnering (1). Accordingly, we can now welcome one of the first substantial multinational efforts to develop a global textbook of psychiatry. Three eminent editors, from England, Spain, and the United States, have created a scholarly, erudite, and readable work that will enter the pantheon of outstanding, major textbooks. How international and major is it? Contributing authors, organized into 11 sections and 261 chapters, represent 24 different countries: England (152 authors), the United States (85 authors), Germany (13 authors), Australia (11 authors), Canada (10 authors), Scotland (nine authors), Spain (eight authors), the Netherlands (seven authors), France (six authors), Israel (five authors), Finland, Italy, and Sweden (four authors each), Belgium and Switzerland (three authors each), Denmark and New Zealand (two authors each), and Argentina, Austria, Chile, Ireland, Hong Kong, Norway, and Yugoslavia (one author each). Readers of psychiatry will notice that the editors clearly have assembled an all-star cast, selected from many of the world’s best universities and research institutes. The relative lack of representation from Asia, Africa, and other parts of the non-English-speaking world suggests plenty of room for additional globalization in future editions.

Since all of the section editors, almost half of the authors, and the publisher are from the United Kingdom, the text inevitably speaks in a British voice. Where British and American usages differ, terms preferred by the World Health Organization are used. Spellings, even in chapters written by Americans, are British (e.g., aetiology, behaviour, programme). Medications are referred to only by generic names.

Given the size and scope of this text, I can point to only a small number of the gems contained inside. The first section, which examines large conceptual issues in psychiatry, contains several chapters that should be widely read. They concern patienthood in psychiatry, stigma, and psychiatric problems as worldwide public health problems. The chapter on descriptive phenomenology includes clinically rich material from German perspectives often skimped on in most American texts. The chapter titled “From Science to Practice” starts with an honest description of the “difficulties in keeping up to date” to introduce an excellent discussion of evidence-based medicine and its role in clinical decision making.

The section on the scientific basis of psychiatric etiology is especially extensive, with lucid, up-to-date chapters on all aspects of neuroimaging, molecular genetics, and population genetics. A chapter titled “The Brain and the Mind” spans from genes to networks and briefly alludes to the recent, seminal work of Edelman and Tononi on consciousness. Similarly, sections on psychological and social sciences are outstanding. The section on psychodynamic contributions to psychiatry contains two excellent contributions by authors well-known to Americans that cover familiar territory but also includes an interesting chapter on existential and phenomenological approaches featuring the contributions of Jasper, Binswanger, Zutt, Tellenburg, Blankenburg, and others who are less familiar.

The major large section on clinical syndromes of adult psychiatry covers all the bases. Discussions of neuropsychiatric disorders are comprehensive and include an exceptionally long chapter on prion diseases, not surprising from a country preoccupied with mad cows. The chapter on acute and transient psychotic disorders has a distinctly European flavor, focusing on ICD-10 categories such as the acute polymorphic psychotic disorders, with and without schizophrenic symptoms, and cycloid psychoses. The discussion of delusional disorders exceeds what is found in most American texts. A section on psychiatry and medicine covers the usual topics pertinent to general hospital psychiatry. The section on treatment contains excellent introductions to how medications are tested and approved as well as a thorough review of contemporary psychopharmacology; many medications not yet approved in the United States (and which may never be approved) are described. The section on psychological treatments begins with a thoughtful and honest chapter on “counselling,” a topic from which most American texts shy away; all trainees should read this chapter. Chapters on cognitive behavior therapy for a number of individual disorders are more extensive than usually found in American texts.

The section on social psychiatry and service provision is particularly outstanding, touching on all aspects of mental health services, including community planning, evaluating psychiatric services, and economic analyses of psychiatric services. A special problems section returns to globalization, discussing psychiatric problems of refugees and ethnic minorities. The sections on geriatric psychiatry, child psychiatry, mental retardation (learning disability), and forensic psychiatry are all virtual textbooks within a textbook.

Although many of the authors have tried to integrate British, American, and other national perspectives and have succeeded, some important chapters are distinctly British and will not serve American psychiatrists well as a sole source. For example, chapters on “Mental Health Law” and “Law Relating to People With Mental Disorders” discuss how the law works primarily in England; “The Psychiatrist as Manager” describes how psychiatrists function in the National Health Service. Although these concepts may be helpful for American psychiatrists struggling with managed care, the orientation is useful largely for those working in the United Kingdom. “Psychiatric Nursing Techniques” discusses the excellent way in which British community psychiatric nursing practices, also adopted by Australia and New Zealand, have evolved. “Organisation and Provision of Services for the Elderly” describes how psychiatric care is an integral aspect of geriatric services. “Residential Care for Social Reasons” and several psychosocial interventions for children and families characterized in the section on child psychiatry are yet to be adequately developed in the United States. Americans may well be envious.

How does the New Oxford Textbook of Psychiatry compare with the Comprehensive Textbook of Psychiatry(2)? My impression is that the New Oxford contains fewer illustrations and fewer patient vignettes. The editors sometimes bunch batches of illustrative plates from several chapters together rather than reproduce them with their individual chapters, a practice I find to be suboptimal. Only 13 authors have written for both this text and the Comprehensive Textbook of Psychiatry. On the whole, chapters in the New Oxford tend to be shorter and more concise; the authors and editors have done an excellent job of keeping the chapters brief and to the point. The text is written in a highly instructive manner. You often feel as if you’re listening to good lectures, not boring talks. In good Socratic fashion, topic headings are occasionally introduced by questions, a practice I wish more authors used, e.g., “What Makes a Stressor Traumatic?” “Is GAD a valid disorder?” “ Has the incidence of anorexia nervosa increased since 1950?” and “Where, when and why do we see placebo effects?” Chapters often contain clearly laid out suggestions for practice presented in a straightforward manner, with little hedging. Several contain decision trees. For this reason, this text will be a useful source not only for clinicians and trainees but also for educators who are preparing for lectures or rounds.

Thankfully, we have not yet achieved an entirely globalized, McDonald’s style of uniformity in understanding or practicing psychiatry. For me, one of the pleasures of reading through this text stems from the fact that it’s not entirely an American or even a British book. Because the text has so many international contributors, the sources cited include large numbers of references that American authors might not ordinarily encounter. You will be introduced to increasingly popular assessment scales being used elsewhere that are still relatively unfamiliar to most American clinicians. The discussion of diagnoses and classification comparing ICD-10 with DSM-IV reaches to the heart of what sorts of evidence should be required for defining psychiatric disorders. How refreshing it is to read a chapter on the major historical influences on the development of ideas about psychiatric etiologies that focuses on Bayle, Griesinger, Morel, Meynert, Wernicke, and von Monakow.

If, like me, you prefer to study psychiatric topics from more than one textbook—to contrast and compare the sifted opinions of different authorities—this text would make an excellent companion to the best standard American texts. Although much will be similar, this text may also open your eyes and opinions to perspectives that you might not otherwise encounter. Plus, it will definitely help with your difficulties in keeping up to date.