Abstract
Something is going horribly wrong with medical education. Psychiatry training is getting much better and doctors, in general, are becoming much more sophisticated in their handling of psychiatric problems. They end up treating all the straightforward patients themselves. The ones they refer on to psychiatrists are nearly all difficult, if not near impossible. This book then is very timely. The problems described will be familiar to all general psychiatrists who have ‘we take all comers’ practices. It joins a number of other books with ‘impossible’ or ‘difficult’ in their titles on my bookshelves.
It is comprehensive in its scope; it has things to say about almost all my favourite problems with the exception of borderline and other personality disorders. There are chapters on psychoses, mood and anxiety disorders, substance abuse, eating disorders, violence and disorders of children and old age.
The authors are from diverse backgrounds. It was a pleasure for me, cocooned from the rest of the world by the English language, to read contributions from a number of European countries, as well as the UK, USA and a certain ubiquitous Australian. Almost all the chapters had something useful to teach me. They contained a rich mix of biopsychosocial approaches to the understanding and treatment of the disorders mentioned. All the authors betrayed themselves as people who had laboured in the real world of psychiatric illness rather than with the rarified and atypical populations of academia. As a result, there were no extravagant and unrealistic claims for any particular treatment approach, but rather a recognition that a range of treatments, often in combination, were required to make a dent in the problems of severely ill patients.
I recommend this book to all psychiatrists who each day fight the good fight to help people with the full range of psychiatric problems. I would be surprised if they didn't find it a comfort to turn to it when the battle seems in danger of being lost.