In this new edition, there are
significant changes from the third edition of The American Psychiatric
Publishing Textbook of Clinical Psychiatry.  John A. Talbott is no longer a co-editor, and the word
"clinical" has been added to the title.  The American Psychiatric Association’s publishing arm has been
changed from "Press" to "Publishing."  The editors explain in their preface that
they wanted to maintain the book as one volume, but as the knowledge base of
psychiatry has grown, so has the length of the chapters, so they had to
eliminate some chapters and return the book to its original focus on clinical
psychiatry.  The chapters in the third
edition that were removed for the fourth edition were

·       
The Neuroscientific Foundations of Psychiatry

·       
Psychiatric Classification

·       
Public Psychiatry and Prevention

·       
Administrative Psychiatry

·       
Psychiatric Education

·       
Psychiatry and Primary Care

·       
Managed Care and Psychiatry

·       
Practice Guidelines in Psychiatry and a Psychiatric
Practice Research Network

·       
Clinical Neuropsychiatry

·       
The Future of Psychiatry. 

A chapter on "Interpersonal Psychotherapy" was
added, and in many chapters, the list of authors has expanded to include new
junior authors to keep the details completely up to date.  Other authors have been dropped. 

The book is organized into four parts: Theoretical
Foundations and Assessment (6 chapters), Psychiatric Disorders (17 chapters),
Psychiatric Treatments (10 chapters) and Special Clinical Topics (7
chapters).  The book also comes with a
CD-ROM containing a searchable text of DSM-IV-TR, the APA Practice Guidelines,
the complete American Psychiatric Glossary, Seventh Edition, the Principles
of Medical Ethics With Annotations Especially Applicable to Psychiatry, and
Opinions of the Ethics Committee on the Principles of Medical Ethics With
Annotations Especially Applicable to Psychiatry.

The Textbook of Clinical Psychiatry is a
massive resource, that even with the elimination of chapters is 1734 pages
long.  Much of it is written in
technical language that will be somewhat inaccessible to lay readers.  But those with some background in psychology
or medicine who are persistent will probably be able to understand much of the
content. 

The Textbook is a large format heavy book
that is only really suitable for use spread out on a large table.  The print is large enough to read
comfortably, and it is sturdily manufactured. 
It has an 85-page index, which should be comprehensive enough for most
purposes.  The CD-ROM, the Electronic
DSM-IV-TR Plus Version 1.0 is basically a slightly expanded version of the
Electronic DSM-IV Plus Version 3.0 that came with the third edition.  It is slightly easier to navigate between
the different parts — DSM-IV-TR, the Diagnostic Criteria, the Practice
Guidelines, the Glossary, the Principles of Medical Ethics, and the Opinions of
the Ethics Committee.  It can be useful
to have the information on one’s computer, and it is possible to copy the text
for pasting in other documents, although one loses formatting.  It is possible to export whole sections in
plain text or rich text format, which preserves formatting.  When one part of a document refers to
another part, there are links so one can move directly to that other part.  It is possible to create bookmarks and even
annotations for different pages, which is a nice feature.  It may be very useful for some readers to
have searchable versions of these texts. 
These features make the CD-ROM more useful, but on the whole it is still
far more convenient to have the printed book of DSM-IV-TR in which one can
leave post-it notes, make marginal annotations, and browse more easily.  Maybe the most obvious problem for the
CD-ROM version is that it really requires a large screen to be able to view the
text and the tables of contents at the same time. 

As a philosopher with no specific training in
psychiatry, I’m not in a strong position to judge the comprehensiveness or
objectivity of the content of most of the chapters.  It’s worth noting that even many psychiatrists and psychologists
would also be hard pressed to have expertise on all the areas covered in this
book.  Most of the chapters set out the
current state of scientific knowledge and practice in modern psychiatry.  They are very well documented, thorough, and
well organized. 

In Stephen Marmer’s chapter on "Theories of the
Mind and Psychopathology," it is surprising how much he focuses on
Freudian theories, since much of psychiatry has come to reject Freud.  In 41 pages of text, all but two are devoted
to psychoanalytic approaches.  Marmer
asserts that "Freud and psychoanalysis constitute a kind of ‘basic
science’ from which the schools [of psychotherapy] make their modifications and
their ‘applied science’" (p. 147). 
His chapter is really mistitled, and should be retitled "Theories
of Mind in Psychotherapy" or something similar.  It is good that psychiatry is not trying to completely wipe out
its origins, but it is striking that there is no equivalent chapter on
"Theories of Mind in Psychopharmacology" maybe because
psychopharmacologists tend to avoid any grand theorizing about the nature of
self.  However, given that Freudian
approaches to the self are becoming increasingly irrelevant to modern practice,
it behooves psychiatry to start thinking more about what models of the mind
underlie the modern understanding of psychopathology. 

In Part II, there are a few short chapters
(Factitious Disorders and Malingering, Adjustment Disorders, Sexual and Gender
Identity Disorders) and other chapters are substantial (Mood Disorders has 114
pages), but by far the largest is that on Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence, at 142 pages — it was also the largest
chapter in the third edition.  It’s also
noteworthy that often the chapters on specific kinds of mental disorder also
have sections devoted to children and adolescents.  In contrast, the chapters on Women’s Mental Health and Geriatric
Psychiatry are in the Part IV on Special Clinical Topics and are both less than
25 pages.  These simple statistics
suggest that child and adolescent psychiatry is firmly part of the psychiatric
mainstream now, and constitutes one of the major sub-specialties of the
field.  The authors, Charles W. Popper,
G. Davis Gammon, Scott A. West and Charles Bailey, devote 28 pages to
Attention-Deficit/Hyperactivity Disorder alone.  At the end of their long survey of child and adolescent
psychiatry, they make a particularly interesting comment: "If we are
imbedded in a medical model of the psychiatric disorders first diagnosed in
youth, young patients will see that we do not perceive an important side of
their beings and the promise of their realistic hopes. … If, instead, we view
these individuals as having medical conditions that are part of ‘the human
condition’ that they can struggle against and use their abilities to overcome,
we will be able to understand these children — and the adults they become — in
a more accurate, balanced, and complete way."  It is the presence of remarks such as these in a book that
represents the mainstream of psychiatric thinking that gives one hope that
psychiatry still has an open mind and has not become completely reductionist in
its approach.

In Part III the length of chapters also varies
dramatically.  Some chapters are short,
at about 20 pages, (Behavior Therapies, Interpersonal Psychotherapy), while
other chapters are long, at over 100 pages, such as that on Psychopharmacology
and Electroconvulsive Therapy, by Lauren Marangell et al.  This chapter contains detailed discussion of
most psychotropic medications and will serve as a useful resource for both
doctors and others wanting reasonably objective information.  As one would expect, the authors take
seriously the many possible side effects of medication but on the whole
recommend the use of such drugs when carefully monitored.  More controversially (at least for the
general public) they endorse the use of ECT as a "safe, specific, and
effective treatment regimen" (p. 1126). 
The information they give in this chapter is similar to that in most
psychiatric books on physical treatments in psychiatry and so it is not aimed
to settle the long-standing debates over psychotropic drugs and ECT, but it
does provide a long list of references in support of its claims. 

There are chapters on Brief Dynamic Individual
Psychotherapy, on Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive
Psychotherapy, on Interpersonal Psychotherapy (associated with Gerald Klerman
and Myrna Weissman), on Behavior Therapies, Cognitive Therapy, and even on
Hypnosis.  There are also chapters on
Group Therapy and on Couple and Family Therapy, which provide useful
information, and focus more on practical issues rather than theoretical issues
concerning the conceptualization of the problems facing systems of more then
one person.  One of the central
theoretical questions concerns whether the emotional problems of groups can be
best understood as additive combinations of the problems of individuals, or
whether it is possible to have a disordered group when none of the individuals
has a mental disorder.  However, despite
their focus on the clinical, these two chapters say little about one of the
central practical problems for clinicians treating families and couples, which
is how to get managed care administrators to authorize reimbursement for such
treatment.  The final chapter in this
part is on the Treatment of Children and Adolescents.  Since this covers a wide range of treatments including
medication, various forms of psychotherapy and other kinds of intervention, it
is inevitable that the discussion of each is somewhat abbreviated.  Nevertheless, the chapter does an impressive
job of summarizing a large amount of information.

The final part of the book, on Special Clinical
Topics, contains some of the most fascinating content all too briefly discussed
— no chapter here is more than 44 pages and most are about 20 pages.  The chapters on Suicide, Violence, Women’s
Mental Health and Geriatric Psychiatry contain information that is probably
familiar to most experts in mental health, but they do a great job of succinct
summarizing and synthesis.  The final
three chapters, on Cultural Psychiatry, the Law and Psychiatry, and Ethics and
Psychiatry will be of special interest to researchers in the humanities and
social sciences. 

In all, The American Psychiatric Publishing
Textbook of Clinical Psychiatry is an excellent resource for those seeking
up-to-date and thorough information about clinical psychiatry.  It is especially notable for its clarity of
prose, at least compared to some other psychiatric textbooks.  Those without a background in medicine or
biology may have difficulty understanding some of the scientific explanations
in the book but even for such readers it contains a wealth of information
explained in straightforward ways.  It
makes few apologies for adopting a medical stance, and so will come under
criticism from those who believe a medical model for mental illness is
inappropriate.  However, it does present
a rich and sympathetic picture of the medical model with an even-handedness
between biological and psychological theories of mental illness and its treatment.  Therefore, it is a particularly good
starting point for both those who believe modern psychiatry is following the
right path, those who are highly critical of the profession, and those who
simply want to know more about it.

 

 

Link: Review of The American
Psychiatric Press Textbook of Psychiatry

 

 

© 2003 Christian Perring. All
rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department
at Dowling College, Long Island, and editor of Metapsychology
Online Review.  His main research is on philosophical issues in
medicine, psychiatry and psychology.

Categories: Psychology, General