Book Review of “Psychopathology of Rare and Unusual Syndromes” by Femi Oyebode

Prof. Femi Oyebode is the Emeritus Professor of Psychiatry at the University of Birmingham. He is a leading psychiatrist, academic, author and a poet. As an authority on descriptive psychopathology, in addition to Psychopathology of Rare and Unusual Syndromes he has also more recently authored the seventh edition of Sims’ Symptoms in the Mind: Textbook of Descriptive Psychopathology (Oyebode, 2022). For many psychiatrists, the subject of rare and unusual psychiatric syndromes conjures distant memories of medical school and specialty examinations. Although these syndromes were undoubtedly fascinating when first encountered in this context, for many students and trainees they were typically presented in a decontextualised manner which rendered such accounts superficial. There was generally little elaboration given to their phenomenological characteristics, or, indeed, their societal context, never mind any discussion on theories as to their potential neural substrates. As such, there was often the distinct impression they were to be treated more like exotic medical curios than relevant clinical entities worthy of further study. This book represents an ambitious attempt at integrating aspects of the history of psychiatry and psychopathology, so-called ‘culture-bound syndromes’, phenomenology, epidemiology and neuroanatomy. In that way, it should pique the interest of many psychiatrists.

The book is structured to address the most prominent categories of rare and unusual syndromes of this nature, namely, abnormalities in the domains of belief and judgement, experiences of love, perception, the self, experiences of the body, memory function and behaviour. Examples of some of the 19 different entities covered within each domain include Othello syndrome and Couvade syndrome (abnormalities of belief and judgement); Charles Bonnet syndrome and Ekbom syndrome (abnormalities of perception), and confabulation and Ganser state (abnormalities of memory function). Obvious strengths of this book lie in its clarity of structure and in the rigour and depth applied to each topic: a thorough and wide-ranging review is afforded to each entity with a healthy balance struck between integration of evidence of various fields and the provision of clinically useful information. The range is both relevant to modern psychiatric practice and intriguing, and there is an absence of exceedingly esoteric topics highly unlikely to be encountered over a clinician’s career.

For each condition presented to the reader, thought is given to how these abnormal subjective experiences and their classical descriptions and paradigms reflect more than merely a particular cultural setting. But, rather, how they are more likely to represent the complex interplay of neuroscientific correlates, social anthropology, evolutionary biology and the humanities. By considering historical descriptions, the relevant societal contexts, various case studies, pertinent explanatory hypotheses and key clinical aspects, Oyebode explores a broad range of rare and unusual psychiatric syndromes to provide for each a multifaceted and integrative account of their current understanding within our specialty. Oyebode does not limit coverage strictly to pathological states explicitly relevant to clinical practice, however. Notable inclusions in this regard are synaesthesia, and vulvodynia and penoscrotodynia. Depending on an individual reader’s willingness to digress in that way – that is, beyond merely the clinical – this could potentially be framed as a weakness of the book, however, I appreciated their inclusion and felt they strengthened the book.

With Psychopathology of Rare and Unusual Syndromes, Oyebode has achieved his task of integrating understanding from several disparate fields on these fascinating clinical entities and, in doing so, has produced a highly engaging and accessible book on a long misunderstood and overlooked area within clinical psychiatry. It may prove to be of particular interest to psychiatric trainees and those working at the interface of psychiatry and neurology.