Abstract
When this book was offered for review I accepted it eagerly thinking that here was a textbook which would update a neglected area of psychiatry: the delineation of the methods for comprehending mental disorders. In my view the definitive textbook until now is General Psychopathology by Karl Jaspers despite the fact its first edition was written in 1913 [1]. Today we have much more information than Jasper found crowding the shelves in Heidelberg but we still disagree about how best to order this information so as to encourage progress and understand its fundamental messages [1].
The book arrived and it appeared authoritative; large, well-bound with a subtle grey cover. However, when I opened it I received the first of several surprises. Despite the title Oxford, the book was clearly North American; Oxford Publishing New York rather than Oxford, England. Second, all the authors bar one came from North America. It struck me as unusual that only one writer was from Europe, which has a longstanding tradition of writing in the area of psychopathology. Third, I went to the index to see how frequently Jaspers was cited. There were two (yes, two) page references; Otto Kernberghas 22, even I have one. This book was clearly not what I had expected.
So I returned to the Preface; what did this book aim to be? The opening sentence gave a clue: ‘Whereas most abnormal psychology texts…’. It goes on to state (it is assumed) ‘that the reader has ready access to a copy of DSM-IV while studying this text’ and that ‘this text may be viewed as a companion to the descriptive material given in DSM-IV with several enhancements’. The book has a different purpose from what I had envisaged. It is no more (and no less) than an in-depth look at adult abnormal psychology based upon the DSM-IV classification system.
The contents reflect this; there are four sections, Foundations, Major Axis I Syndromes, Other Axis I Syndromes and Axis II Disorders. The first chapter, ‘Classification’, gives a pithy summary of the history of classification focusing on the past few decades and an excellent overview of the general history of classification in biological science (this is the chapter containing the two Jaspers references). There is then a chapteron ‘Developmental pathogenesis’ followed by ‘Research strategies for studying psychopathology’. For me, these chapters constituted the most interesting part of the book.
The rest of the book essentially accepts the DSM-IV classification system and presents historical and epidemiological facts about a disorder, its presenting characteristics, comorbidity and so on. Most chapters also include alternative conceptual models, biological features and some discussion of risk factors and aetiology. In the major axis I syndromes these features are spread over several chapters. Most are safe, competent and somewhat bland surveys of the respective disorders.
One feature is the large amount of space given to personality disorders. This probably reflects the editors' own research interests in the area. Here the book does offer some of what it aims for – depth. There is more consideration of historical concepts and alternative theoretical perspectives. Bornstein's chapter on dependent and histrionic personality disorder, for example, offers psychoanalytic, biosocial-learning and cognitive perspectives on each disorder and attempts to evaluate the evidence favouring the different models. Hare et al. discuss the two diagnostic traditions associated with psychopathy, its relationship to crime and models of aetiology.
Overall, I was disappointed with this book but that may reflect my expectations. It is a sound, competent, somewhat bloated text. It provides detailed information on psychopathology as we currently conceptualize it – or rather, as North America currently conceptualizes it (which unfortunately appears to be much the same thing). It could be useful for trainees in psychiatry and other mental health professionals but would not be my first choice. Jaspers noted that psychiatristsmust ‘develop and order knowledge guided by the methods through which it is gained – to learn the process of knowing and thereby to clarify the material’ [1]. This book not only does not achieve that, it has hardly paused to consider the problem.