Abstract
This is a refreshingly different book on mental disorders. It is an evidence-based developmental view of how psychopathology may arise. The book is frank about the paucity of data and in some cases even useful hypotheses about the courses of mental disorders. The authors note fundamental problems in how we have come to categorize mental illness. They point out that ‘categorical models use arbitrary cut-offs to define allegedly homogeneous disorders, ride roughshod over subtle differences between cultural expressions of distress and impose cut points on what are essentially disorders of different degrees of severity’ (p. 15). They comment that searching for genes for schizophrenia, depression, anxiety and so on is fruitless because ‘genes do not control man-made abstractions like psychiatric illnesses, but the biological processes that underlie them’.
The book is divided into four sections: (i) the nature and distribution of common mental disorders; (ii) the biological basis of common disorders; (iii) the human life cycle relevant to common disorders; and (iv) the authors’ proposed model. Each section sceptically examines what is known but in a way that conveys the intellectual excitement of the research. The evidence examined includes epidemiology, social science, genetics and physiology, as well as psychology and psychiatry.
The authors’ model attempts to distinguish between vulnerability and resilience (factors that precede episodes of mental disorder and serve either to increase or reduce the individual's likelihood of becoming ill); destabilization (the process by which an episode is released at a particular time); and restitution (the factors related to recovery from episodes of emotional ill health). The model is clinically relevant throughout; the reference point is always patient management.
As Lion Eisenberg points out in the foreword, the mode of analysis is population based. The reader is alerted to the way ‘caseness’ is defined and the problems in studying causality in clinical populations. Use of population studies leads to a complex dimensional model of psychological distress encompassing features of anxiety, depression and other symptoms that may for a variety of reasons present for treatment.
The concept of spontaneous resolution is given serious weight, leading the authors to conclude that ‘recovery from common mental disorders seems largely dependent upon events taking place outside the doctor's or therapist's office’. This is a concession rarely made in textbooks dealing with mental disorders but certainly something to think about.
In summary, this book provides a reasoned and concise account of what knowledge is reasonably established, what may be true and what is speculative about the genesis of mental disorders. It is a welcome change from books that appear to assume that DSM ‘man-made abstractions’ are real illnesses and proceed from that point. Goldberg and Goodyear have written a book that will broaden horizons for most psychiatrists and trainees and is highly recommended.
Roger Mulder
Christchurch, New Zealand
© 2007 Roger Mulder