Abstract
This modest monograph, edited by two of the leaders of German psychiatry, arose from an invited meeting which aimed to overview current perspectives in research across the whole field. It is a most ambitious aim for just eight chapters. Remarkably, the results are quite worthwhile, in at least two respects.
First, although most contributions are biological, cuttingedge issues in psychological and social domains (including primary prevention) are presented. To me, it is a fair proportional representation of psychiatric research. The reader will gain a sense of what is going on in current psychiatric studies.
Second, as the editors and authors of five of the eight chapters are German, we receive a distinctly different perspective as what would otherwise be common themes. The book is a striking contrast to the usual psychiatric research agenda which is dominated by opinion from the United States and the United Kingdom. Even the non-German contributors, two from the USAand one from the UK, are not the ‘usual suspects’.
The highlight of the book is undoubtedly the chapter by Heinz Hafner concerning a study of patients with first episode schizophrenia from the area surrounding Mannheim and Heidelberg. The strength of this study is in its detailed analysis of the prodrome (which was found to have a mean length of 5 years), the psychotic episode and the subsequent course of illness. Hafner's detailed evaluation of symptom accumulation and onset of social disabilities describes the poorly understood prepsychotic phase of schizophrenia and challenges the frequent tendency to ascribe illness onset to a much briefer prodrome of a few months' duration which Hafner identifies as the ‘psychotic prephase’. The book is worth reading for Hafner's contribution alone.
Also of enormous interest is the contribution by Kellam and Regan from Baltimore describing two skill-based intervention programs which were provided for half of the city schools in first and second grades, aimed at reducing aggressive behaviour and improving reading achievement. Follow-up was then carried out throughout subsequent school years. The results are of considerable interest for primary prevention research, which is rarely carried out but vitally needed. Descriptions of primary prevention studies are rarely seen in such a general book.
One of the longest chapters is by Robert Cloninger and concerns his psychobiological model of temperament and character. Cloninger proposes four dimensions of temperament (defined as automatic emotional responses to stimuli) and three dimensions of character (described as self-awareness). Temperament and character make up personality. The model is heuristically fascinating but as is usual in such ‘theories of everything’, the shortcomings are in detail of what contributes to temperament and character.
The other chapters in the book vary in interest and quality. Included are accounts of the psychobiology of depression, neuroimaging and molecular genetics. The Australian Colin Masters is a co-author with the German contributors in a review of Alzheimer's disease research. Additionally, there is a unique and interesting perspective on the long-term treatment of schizophrenia which attempts to integrate pharmacological, psychosocial and service dimensions of management.
Each chapter is accompanied by an excellent commentary which occasionally challenges the chapter in terms of value. No punches are pulled. Rather disappointingly, there is no commentary on the neuroimaging contribution. This is a pity because while applications of high technology to psychiatric illness are always initially exciting, it is usual that disappointments will follow and critical promise is not often achieved. A commentary along these lines is always useful to contain excessive enthusiasm.
Amazingly, this book does deliver what it promised. It does so in 182 pages, the contributions are of the highest intellectual quality and present an unusual and distinct perspective of German psychiatrists which we will otherwise rarely see.