The Perspectives of Psychiatry [Paperback]

The field of psychiatry may at first appear bewildering. People are complicated. The variety of ways in which thoughts, feelings, and behaviors can go awry are plentiful. The history of psychiatry has seen a number of attempts at reductionism in the face of this complexity, most notably that of the psychoanalytic school, the behaviorists, and the biological psychiatrists. These monolithic viewpoints have each distorted psychiatry, emphasizing some important features of mental life and its abnormalities while giving short shrift to others. Further the acrimony between adherents of these schools have left psychiatric trainees as well as the general public uncertain of what to believe about the nature of mental illness. In this book Drs. McHugh and Slavney have done a masterful job of making clear what we know in psychiatry and how we know it. Paul McHugh has been chairman of psychiatry at Johns Hopkins from 1977-2000; Phillip Slavney was director of residency training in the Hopkins psychiatry department for most of that time, and now directs consultation psychiatry there. Their book describes four perspectives of psychiatry, or ways of seeing disturbance of mental life, and shows how each is especially illuminating for particular types of psychiatric issues. The disease perspective is most useful for explaining major mental illnesses such as dementia, schizophrenia,and bipolar disorder. It is the most clearly biological, and invokes medications for treatment and laboratory methods for research. The life story perspective is most useful for a person who has suffered a setback and is demoralized. It emphasizes the uniqueness of each individual and the meaning that people's experiences have for them. The behavioral perspective concerns things people do that get them into trouble. Drug and alcohol abuse are the most common of these, but eating disorders and sexual disorders are included as well. Treatment in this perspective prioritizes stopping bad behaviors over understanding them. The dimensional perspective looks at the vulnerabilities that people have as a result of their lifelong traits. These vulnerabilities may arise out cognitive limitations or out of features of personality such as being impulsive or being a worrier. McHugh and Slavney draw on both their vast knowledge of the literature of psychiatry, psychology, and neuroscience, and their long experience of evaluating and treating patients in order to make the case for their perspectival approach to the field. They succeed impressively, I think, for two reasons. One reason is that the approach is such an intelligent and sensible one. The other reason is that they have had the benefit of 15 years between the first edition of their book and this second edition. Major changes and additions were made between the two and the result is greater clarity, especially in the opening chapters, as well as a fuller discussion of themes that were only touched on in the original edition. For example, new chapters were written in the behavioral perspective section on suicide and on hysteria. This book is essential reading for anyone seeking to understand where psychiatry stands today. But more than that, it is essential because it makes clear on what psychiatry stands, i.e. what sets of reasoning have gotten us where we are. With this clarity the path towards new insights and new discoveries becomes navigable. In short, this book is a gem.

This book is unlike any other. It represents the accumulated wisdom and understanding of two sensitive and intelligent psychiatrists who were in the position of teaching often skeptical Johns Hopkins medical students. These students are among the smartest and able individuals in the country - most of them were not going into psychiatry and had a variable amount of interest and respect for it. The authors were therefore in the position of presenting their chosen field to a challenging audience.
This book represents their masterful response. Four separate perspectives are presented, Disease, Dimension, Behavior and Narrative.
The combination of creativity and intellectual integrity make it a delightful and worthwhile experience for anyone in psychiatry. The persuasive power of it's ideas make it an essential book for anyone who teaches intelligent medical students or even residents and psychologists in training.

Paul Mc Hugh continues his practice of writing prose that delights and informs .The Perspectives of Psychiatry should be read by every trainee psychiatrist and anyone else with an interest in what are called the Behavioral Sciences .I found it hard to put down .I particularly liked the respect accorded to the phenomonology of psychiatric disorder - something of which 99% of contemporary pscyhiatrists know little and no doubt care less : being preoccupied with risk assessment never helps. The chapter on Schizophrenia is exemplary.The work gets my vote .

James H Willis FRCP