The Perspectives of Psychiatry, McHugh, Paul R., M.D., and Slavney, Phillip R., M.D., 2nd ed. Baltimore: The Johns Hopkins University Press, 1998. (Paperback, 299 pages)

In The Perspectives of Psychiatry, Drs. McHugh and Slavney present a "conceptual structure" for the developing science of psychiatry. The first edition of the book (1986) won wide acclaim; the New England Journal of Medicine called it "the best single volume on psychiatry that anyone could read." This newly published second edition updates and expands on the authors' four conceptual perspectives ("disease," "dimensions," "behavior," and "life experience") in the context of psychiatry today.

Although the primary audiences for The Perspectives of Psychiatry are psychiatrists and other mental-health professionals, a persevering layman, working through or around hard-to-understand parts, can learn much from this book. It provides helpful examples and a summary at the end of each chapter.

Part I, a completely rewritten introductory section, provides an extensive discussion of key psychiatric issues. One chapter reviews past conceptual developments in psychiatry and the resulting factionalism between the "biological" and the "psychodynamic" (conflict-driven) orientations, which continues today. The authors' view is that neither orientation provides a complete understanding of psychiatric disorders. Part I also includes a new chapter on the classification system of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The authors commend the system as an advance that increases the "reliability" of diagnoses across the field of psychiatry, but they also point to the weaknesses of its symptom-based classification system, which does not address the sources of the disorders. They suggest that the sources can be approached through the conceptual framework of the four perspectives they propose. The remainder of the book is devoted to explanations of those four perspectives.

In the disease perspective (Part II), the authors outline the criteria used in medicine to determine which psychiatric disorders are "diseases" and which are not. They describe how manic depression (bipolar disorder) and schizophrenia meet the disease criteria, and devote a separate chapter to each. They discuss the symptoms relating to changes in mood, self-attitude, and energy that are present in manic depression and the growing body of research findings that provide clues to the etiology (causes) of the disease.

Under the dimensions perspective (Part III), the authors discuss findings showing that inborn traits of personality and general emotional stability, as well as cognitive abilities, are distributed in the standard bell-shaped curve. Such inborn traits result in varying emotional responses to life circumstances, causing more emotional distress in some individuals than in others. The authors discuss the need to differentiate between cases in which feelings such as anxiety or depression are related to an individual's inborn traits and cases in which similar symptoms may indicate the existence of a disease.

The authors' treatment of the behavior perspective (Part IV) is the longest and most detailed, reflecting Dr. McHugh's interest and research in these areas. It focuses on the varying contributions of the factors of drive and learning to behavioral disorders such as alcoholism and bulimia. There is also extensive discussion of the treatment of behavioral disorders.

The life experience perspective (Part V) is based on the everyday concept of looking at what has happened in an individual's life and what the effect has been. It encompasses a consideration of the other perspectives, such as whether a psychiatric disease is impacting the individual's life. In stressing the importance of the life experience in the diagnosis and treatment of an individual, the authors caution that psychiatrists must be careful how they interpret an individual's life history, and not superimpose a theory or interpretation that is not applicable.

Throughout, the authors discuss the interaction between perspectives. For example, the behavior of alcoholism may be influenced by the disease of manic depression. Advantages of the perspectives concept are summarized in the concluding section of the book.

The Perspectives of Psychiatry will interest those who want to learn more about psychiatry in general and, in particular, about the thinking of Dr. McHugh, chairman of the Department of Psychiatry at Johns Hopkins University Medical School and a nationally recognized leader in psychiatry.

by Delphine Peck
DRADA Book Committee.
Smooth Sailing: Winter 1999

The Perspectives of Psychiatry is available from DRADA: $17.00 for Maryland residents ($16.19 for nonresidents), plus $4 for shipping and handling. Call Paula at 410-987-7447 to order by credit card or for more information.

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