The American Psychiatric Press Textbook of Psychiatry, 3rd ed.

The new edition of this textbook is both comprehensive and innovative. Up-to-date, skillfully edited, and well-authored, the 50 chapters present the information that constitutes the subject matter of our medical specialty. In addition, the textbook is the main part of a trio. The second part of this trio is Essentials of Clinical Psychiatry (1), which is also reviewed in this issue of the Journal. The third part is Study Guide to Essentials of Clinical Psychiatry (2), which contains questions analogous to those on the Board examinations and thus helps readers assess their learning. An online interactive companion to the Textbook and the Study Guide is also being readied for release.

The Textbook of Psychiatry includes a CD-ROM containing the text of DSM-IV, the nine APA Practice Guidelines, the American Psychiatric Glossary (3), the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry (4), and the collective opinions of the APA Ethics Committee on the Principles. The CD-ROM will enable the user to search for the contents of the Textbook of Psychiatry by disorder, code, or phrase for cross-references and hypertext links.

Pardes’s brilliant introduction gives the Textbook of Psychiatry an exciting start. He notes that a century ago the U.S. version of the famous 1896 sixth edition of Kraepelin’s Clinical Psychiatry (5) heralded the developments in psychiatry in the 20th century, many of which are in accord with Kraepelin’s definition of psychiatry as “the science of mental illness and its treatment.” Pardes states that “both books embrace a biopsychosocial model for understanding all people in health and disease.” He deplores much of the current biological reductionism, evident, for example, when medications are prescribed and used “without attention to intrapsychic, interpersonal, familial, occupational, dietary, or exercise components of causation and treatment.”

The biopsychosocial emphasis in the Textbook of Psychiatry appears even in the excellent first section, Theoretical Foundations, which includes chapters titled “The Neuroscientific Foundations of Psychiatry,” “Genetics,” “Epidemiology,” “Child and Adolescent Development,” and “Theories of the Mind and Psychopathology” (this fifth chapter is superb). The next section, Assessment, begins with an outstanding short chapter by Steven Scheiber titled “The Psychiatric Interview, Psychiatric History, and Mental Status Examination,” all of which are brought to life by brief vignettes of clinical situations and supported by short tables and a glossary. The second section also contains chapters on “Classification,” “Psychological and Neuropsychological Testing,” and “The Use of Laboratory and Other Tests.”

The large third section consists of 17 chapters, each of which is devoted to one of the major psychiatric disorders, including sleep and pain disorders. All are written by authorities on the various topics. Most are 40–60-page, well-edited descriptions of what is known about the condition discussed, but, as would be expected, they vary considerably in length. The 130-page chapter “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence,” by Popper and West, is actually a short, well-written child psychiatry textbook.

The fourth section, Psychiatric Treatments, consists of nine chapters, beginning with “Pharmacologic and Other Somatic Therapies,” short discussions of which were included in the presentations on the specific disorders. The remaining chapters in this section focus on individual psychotherapies, behavior therapies, and family and group therapies. The “Marital and Family Therapy” chapter seemed too brief, if not sketchy; for example, only one-half page is given to postmodern therapies. I think that in view of the extensive marital and family instability that is becoming a hallmark of our contemporary era, more attention needs to be directed toward the mental and physical health of the family and the well-being of its members.

The last section, Special Topics, begins with chapters on “Suicide” and on “Violence” and includes a refreshingly new and welcome chapter on “Psychiatric Assessment of Female Patients.” This is followed by an excellent 30-page chapter by Ezra Griffith and colleagues titled “The Basics of Cultural Psychiatry.” This interesting section also contains chapters addressing “Ethics, Managed Care, and Psychiatry,” “Practice Guidelines in Psychiatry,” and the innovative “Psychiatric Practice Research Network,” authored by Deborah Zarin et al.

In the concluding chapter, Melvin Sabshin praises the many changes that have taken place during the past century, such as the decline in stigma and developments in psychopharmacology. He adds, however, that “the future of psychotherapeutic work by psychiatrists is under attack from several fronts, and strong efforts will have to be made to prevent atrophy of psychiatrists’ psychotherapeutic skills.” He also foresees a need for more forensic psychiatrists, a development that is in accord with our society’s becoming more litigious, as was true of Classical Greece during its decline in the second and third centuries. Sabshin emphasizes that psychiatrists would benefit from concentrating on the combined use of psychotherapy and pharmacotherapy and that it is “an exciting area of psychiatry that awaits additional refinement.” Many of us would agree but think that the imperative first change is a drastic reduction in the managed care companies’ insistence that psychiatrists limit their therapeutic efforts to simplistic “med checks.” Sabshin concludes by expressing the hope that economic constraints on psychiatrists and their patients will diminish.

This edition of The American Psychiatric Press Textbook of Psychiatry more than meets its goals to be a “one-volume, clinically oriented, comprehensive textbook of psychiatry.” It is probably as good a one-volume textbook of psychiatry as it is possible to write, compile, and edit. I devoted a substantial portion of my reading time for 2 months to it and found it to be a rarity. Not only is it accurate and comprehensive, but many of the chapters are so interestingly written that they were really enjoyable reading. Also, many of the chapters include a short historical background that heightens both interest and understanding. The Textbook of Psychiatry compares favorably with my cherished 1967 one-volume first edition of Freedman and Kaplan’s Comprehensive Textbook of Psychiatry (6) and even with some of the top British texts. I recommend it highly, without reservation, and when added to both the summary volume, Essentials of Clinical Psychiatry (1), and the Study Guide (2), one has as complete a trio as could be wished. In closing, I lift a line from young William Faulkner’s preface to his early novel, Sanctuary (7), “Please buy this book.”