Doctor's Bookshelf

Review of Modern Synopsis of Comprehensive Textbook of Psychiatry, by Alfred M. Freedman, Harold I. Kaplan, and Benjamin J. Sadock. Edinburgh: Churchill Livingstone, 1972, pp. 853+xvi, illus.)

World Medicine, 11 July 1973, p. 85

   Despite its many merits, one can only regret that this ambitious work was ever undertaken. In it the 1,600 pages of the American Comprehensive Textbook of Psychiatry have been compressed to 853 including over 100 pages of glossary and index. The original articles by about 150 different authors have been synopsized and brought up to date, apparently with the aim of providing a textbook of com­fortable size for medical students and graduates. There can be little doubt that it will be warmly welcomed by the pro­spective readership, as giving them every­thing they need for the passing of examinations. The process of synopsizing and modernizing has reduced the whole of psychiatry, both the hard lumps and the mush, to a homogeneous predigested goo, which may be imbibed without effort, and regurgitated in acceptable form when called for by teachers and examiners. This makes about the worst type of teaching one can imagine. Glib answers are provided for all questions; and not only is the student not faced with the necessity of doing any thinking of his own, but is actively discouraged from doing so.

   Where matters are difficult, as for instance in the important problems of the aetiology of schizophrenia, all awkward­nesses are avoided by being smothered in woolly phrases. First the reader is given, in about one third of a page, a brisk statement of seven alternative theories. Instead of proceeding from there to show what these theories involve, and what evidence there is to support or rebut them, they are all promptly forgotten and we are told: "In the last 30 years psycho­analytic observations and hypotheses have focused increasingly . . . In the absence of conclusive evidence, most psychoanalytic theories postulate ... The recent focus in psychoanalytic hypotheses has shifted ... Some analysts and analytically oriented psychiatrists have studied these disturbances . . . According to current psychoanalytic opinion... etc."

   One does not get a textbook by sum­marizing a series of articles. This reader's digest of what were no doubt excellent articles has probably exaggerated an original lack of balance in selection. We are given here a glimpse into a very curious world, the world of American Psychiatry. American Psychiatry must not be confused with psychiatry, which as a branch of medicine knows no fron­tiers. The psychiatry we read of in this Synopsis knows nothing of scientific method, of hypothesis and refutation, of the evaluation of evidence, of controlled experiment, and statistical analysis. It has, so it seems, a nodding acquaintance with physiology and medicine, but it is essentially an autonomous art and mystery. It is founded, not on medicine, but on Freudian psychoanalysis. In this wonderland Ronnie Laing rates more space than Emil Kraepelin; and Wagner­Jauregg, who won the Nobel Prize for the conquest of general paresis, rates exactly one line‑in the historical section where he can lie safely buried.