Psychiatry as a Neuroscience • Psychiatric Diagnosis and Classification • Psychiatry in Society

All practicing physicians ought to be compelled, as a condition to renewal of annual relicensure, to review books like these three in their respective areas of practice and have that review published worldwide. Not only would that exercise keep them informed; it would keep them grounded and inspired.

Ralph Waldo Emerson once said that the act of reading a book involves a two-way street of serious responsibility: one that belongs to the author and the other to the reader, who needs to be smart enough and diligent enough to understand or attempt to understand the author’s message and its context. In the six decades that I have been an interactive human voyager, I have been amazed at how the res does not necessarily ipsa loquitor, that “shared” beliefs and traditions are not necessarily shared.

It is appropriate that a forum such as the 11th World Congress of Psychiatry (Hamburg, Germany, Aug. 6–11, 1999) was the basis for these books. One of the founding fathers of the World Congress was José López-Ibor of Madrid, and Dr. López-Ibor, Jr., one of the editors of these books, just ended his term as President in Yokohama, Japan. Dr. López-Ibor, Sr., died in 1991, and Pedro Ruiz, M.D., wrote about him in the American Journal of Psychiatry(1).

Psychiatry as a Neuroscience, the first of the three books, must be read first because it provides insight into the very reason for being a physician-psychiatrist. The editors brought together 17 authors—eight from the United States, one from Italy, one from Switzerland, one from France, and the rest from the United Kingdom. The nine chapters cover such topics as genetic research in psychiatry, molecular and cellular biology research, brain imaging research, neurophysiological research, neuropsychological research, neurobiology in schizophrenia, biological research in anxiety disorders, and biological research in dementias. These chapters are not for speed-reading, but the rewards are great. I have personally used them as teaching tools.

Peter McGuffin’s simplified tour of the mysteries of human genetics is both brilliant and evocative. On page 13, he skillfully maps the scary progress of gene mapping from the 1970s, when “classical” markers (6% coverage of genome) were discovered, to 2001, when 1.42 million single nucleotide polymorphism consortiums were set up. McGuffin reminds us of what Sheldon Kopp warned us of in his 1970 book (2): “Do not mistake new knowledge with advancement or progress because, for all we know, what all this could really mean is regress or deterioration.”

Sedvall and Pauli’s contribution on brain imaging research in psychiatry is must reading for every general practitioner and psychiatrist, not only to know how to order what test but why. I was riveted by their historical accounts of the origins of magnetic resonance imagers and X-ray machines. Their photographs make the arcane very accessible. The rest of the volume, for sheer thoroughness and scholarship, is rewarding.

The second volume, Psychiatric Diagnosis and Classification, is cumbersome and challenging. It includes 23 authors in 10 chapters. Eight authors are from the United States, five from Australia, three from India, one from the United Kingdom, three from Denmark, three from Luxembourg, and none from the Philippines, Russia, China, or elsewhere.

When I entered private practice in 1973, had you told me I would be treating a patient from Toronto, then one from New York, then another from Hong Kong, then another from the Philippines in the same day or in the same hour, I would say you were probably delusional. If you had asked me to tell you the differential diagnoses of ma huang psychosis from gamma-hydroxybutyrate withdrawal psychosis, I would think you were on some space odyssey. But not anymore! This is the reality of today’s practice; we see patients with different cultural, religious, herbal, medicinal, hygienic, and food practices that affect our physical, spiritual, and emotional paradigms. It is almost impossible for a Western-bred psychiatrist or psychotherapist to understand the true violence of the traditional Japanese concept of “losing face”—to understand why a young Japanese patient would commit suicide for “losing face.”

I had major problems with this volume. First was the language; second was the diversity of cultures and traditions represented. In their chapter, “Psychiatric Diagnosis and Classification in Developing Countries,” R. Srinivasa Murthy and Narendra N. Wig of India say,

Chapter 4 of this volume, however, is a gem. C. Robert Cloninger shows us how consensus can be gained regarding what on the surface appears like an insuperable quandary.

As to the third volume, Psychiatry in Society, it was the most painful for me to read. I am a Filipino. I was born in World War II and lived through the horror of it. I was trained to fight the Hukbalahaps and the Muslims. I treat three survivors of September 11, numerous homeless patients, and patients with posttraumatic stress disorder from Korea, Vietnam, the Gulf War, Afghanistan, and now Iraq. There are three Filipino psychiatrists for every 10 million population in the Philippines, yet Filipino psychiatrists who attempt to return to the Philippines come back to the United States in defeat. The moral and psychological quandary we face is dealt with head-on by this volume, without fear or second-guessing.

Leon Eisenberg sets the tone with chapter 1, “The Impact of Sociocultural and Economic Changes on Psychiatry.” To stir our conscience and make us aware of the importance of never ignoring the imperative of social remedies to a lot of medical maladies, he quotes Bertolt Brecht’s Life of Galileo:

In the second chapter, German psychiatrist Heinz Häfner doesn’t even allow us to catch our breath; he immediately asks us how fair we are to the mentally ill who are poor. Häfner deftly takes us on an intellectual and emotional historical tour of the evolution of thought in governmental attitudes toward health care of social classes throughout time.

Glyn Lewis and Ricardo Araya from the United Kingdom then take up the topic of globalization and mental health, and the succeeding chapter by José M. Bertolote et al. discusses “The Impact of Legislation on Mental Health Policy.”

This volume is a fitting wrap-up of what surely is a proud valedictory for a robust, enviable group of renaissance psychiatric role models. No legislative policy maker, no physician, no mental health worker can afford not to study this volume assiduously. As the anthropologist Margaret Mead said in a lecture at the University of Iowa, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”