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on 20 June 2008
Following an invitation to hold a series of seminars on the phenomenology of mental illness in the Department of Psychiatry of the University of Manitoba, Frank Fish brought together the classic descriptions of psychiatric symptoms which, at that time, were not easily found in the English literature. The seminars were published in 1967 and 'Fish's Clinical Psychopathology' rapidly became an essential text for medical students, psychiatric trainees and practising clinicians. After his death the text was revised and updated by the late Max Hamilton in 1974 and 1985.

'Fish's Clinical Psychopathology' was out of print for several years but has now been re-issued by the Royal College of Psychiatrists in a third edition. The authors, Patricia Casey and Brendan Kelly, have updated the references and expanded the chapter on abnormal personalities added to the last edition by Hamilton. They have also included two appendices covering unusual psychiatric syndromes, defence mechanisms and cognitive distortions.

In their preface - those by Fish and Hamilton have been omitted - Casey and Kelly express the hope that despite the additions and revisions of the language, `so as to take account of changes in linguistic conventions', the text `remains true to the spirit' of Fish's original work. Alas, a comparison of this volume with the previous editions reveals it to be something of the proverbial curate's egg.

In his revision of the original text Hamilton provided a detailed but succinct overview of the historical and philosophical underpinnings of phenomenology and psychopathology in an attempt to counter the lack of philosophical training of many English speaking psychiatrists. This material has been omitted from the new edition and, instead, the unwary reader is repeatedly invited to genuflect before the twin altars of the ICD-10 and DSM-IV. As a result, much of the clinical wisdom - and wit! - of the original authors is lost, potentially to the detriment of good clinical practice. In view of the recent repressed memory and multiple personality debacle in North America, it is regrettable that Casey and Kelly have chosen to omit the original, well founded, scepticism about the various dogmas of the psychodynamic schools of psychiatry. Instead, Appendix II blandly lists the `most commonly seen' defence mechanisms, ostensibly `used by the psyche to protect itself', without even hinting to the naïve reader that these `techniques' cannot be observed, measured or even refuted and that despite their enduring popularity, these concepts are not facts.

Appendix I perpetuates the questionable tradition of referring to several colourful and unusual phenomena as syndromes when, in reality, most are symptoms which occur in a variety of clinical, neuropsychiatric, settings. Their listing is also made redundant by earlier - and sometimes better - descriptions elsewhere in the text. The scholarship in this section is further marred by a number of unfortunate errors. The delusion of subjective doubles is not characterised by the belief that the patient has a double or Doppelgänger (a term misspelled throughout the text but omitted from the index). The so-called Windigo delusion is mentioned as one of the culture-bound disorders, much beloved by Anglophone psychiatrists, without giving any indication that there are serious doubts that this phenomenon has ever been observed in a clinical setting. While controversy has, undoubtedly, surrounded the concept of Munchausen syndrome by proxy, it is, pace the tabloid papers, not the case that `convictions based on this diagnosis have also been overturned in the courts in Britain'.

Finally, given the widely acknowledged limitations of the categorical approach to personality disorders, it is a pity that not more space is given to the alternative dimensional conceptualisation which has demonstrated better reliability with respect to interdiagnostic agreement, temporal stability and clinical validity.

The return of 'Fish's Clinical Psychopathology' after such a long absence is indeed welcome but this reviewer regrets that a golden opportunity has been missed to revise and update the text fully in the spirit of the original so as to provide the `firm basis for clinical work and research' which Fish had endeavoured to provide.

Karel de Pauw
Consultant and Senior Clinical Lecturer in Psychiatry
United Kingdom
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on 24 August 2008
I'll have to agree with Karel de Pauw' review. It's a thin book, and gives a clear, if brief, description of all the key psychiatric symptoms, so might be useful for the membership examination. But, it doesn't have the ring of an authoritative text, and is light on anything conceptual or theoretical. I bought it because of Fish's name in the title, and my high expectations were disappointed.
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on 15 August 2009
This book is a gross deviation from its predecessor, edited by Hamilton. As a trainee, Fish psychopathology was the first book we were asked to read - in India - where the old Hamilton's edition was in circulation, long after it was dominated by the Andrew Sims book.

The Old "Fish" - now considered a "classic" was outdated and most of us (relatively new trainees) felt like a fish out of water when reading it. (And the new edition has rectified it to an extent.)

I was looking forward to this update (which came out some 1 year back).

Unfortunately, this book ends up being here nor there. It is neither a continuation of the classic by "Fish", neither is it an authoritative textbook on "Descriptive phenomenology" - the most important part of psychiatry.

A new edition, if not a "tribute" to the original authors work (as done by Hamilton), should have been up to date and exhaustive. This book is neither. This book is not exhaustive and a number of omission cropped up as I skimmed through.

2 examples - the book does not contain the words - (As far as I read through) - "loosening of association" and "tangentiality" in the thought disorder chapter. The book does not contain the definitions of the term "palinopsia" in the chapter on disorders of perception.

This book does not do justice to the MRCPsych exam as well, as proper definitions of most psychopathological phenomena are missing. There are other books which give better descriptions of phenomenology.

Nevertheless, this book I dont think is not as bad as one might think.
This book is not as circumstantial as the Andrew Sims book, which is good, but hyperviscous and repetitive. In most of the chapters, the authors come straight to the point, which is very refreshing - compared to the Sims book.

The definitions of psychopahology in "Synopsis of Psychiatry" - by Sadock is a must read for those taking the MRCPsych exam.

This is a book brought out by the RCpsych, and I wouldn't be surprised if a number of questions at the MRCPsych exams are based on topics from this book.
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on 21 April 2012
This book is especially ment for psychiatrists or people directly involved in the mental health services. I must admit that I found it difficult to read at the begining, it think that if it could be better organised it would be easier to understand. Maybe on the next review. But it is a milestone from the semiology point of view, it gives you a very good starting point in clustering signs and symptoms.
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on 28 May 2012
I had heard my registrar speak of this book in equal terms with Sim's; consequently I bought both but read Sim's first; I'm afraid I was a disappointed. When I hear about Fish now, I realise most people are talking about the legendary / mythical 2nd edition. This edition is a good quick summary but better for those who need to learn psychopathology in a hurry e.g. medical student / HMO / psych nurse. No problems there, but what it is competing against is not Sim's but the on-line guides / random photocopies of some book chapter found scattered around the average inpatient or community unit.
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on 12 April 2010
Concise and well explained information.Psycopathology concepts are the base of psyciatry. Good material specialy for psychiatry residents.
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on 17 April 2015
Great and consise overview. Perfect to keep nearby at work for reference.
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on 1 January 2015
excellent concise and extremely
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on 16 May 2011
I don't know what all the fuss about this book not being like the original is about. Overall i found it quite useful, its certainly easier to read then Sim's, concise and to the point, which is great for exams for me. I do still have a copy of Sims however but since getting Fish's i haven't used Sims as of yet again. Got my vote! (4 stars as packaging was poor and arrived with some corners bent but that's just nit picking)
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on 1 September 2015
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