© 2002 The Royal College of Psychiatrists
© 2002 The Royal College of Psychiatrists
reviews |
Points of View: Stories of Psychopathology
By James E. Mitchell
Department of Academic Clinical Psychology, Guy's, King's and St Thomas' School of Medicine, King's College London
Philadelphia: Brunner-Routledge. 2001. 222 pp. £17.95 (pb). ISBN: 1-58391-005-0
This is an unusual book, primarily written for students but with some
appeal for others who would make use of a guide to DSM—IV diagnoses. Its
particular claim for attention is that it functions as an aid to learning
about diagnosis by the use of well-written and carefully constructed case
studies. Unlike most cases studies, these are written in a narrative style,
with the people depicted being brought to life by additional touches of
detail. For each case study describing the person with the diagnosis, there is
a companion story describing the experience or thoughts of another person in
the patient's life, whether a family member, a friend or a mental health
professional. We are shown how the individuals think and feel and also how
they affect the people around them. There is an emphasis on the difficulties
people with the diagnoses are currently experiencing as well as the
difficulties this causes in their immediate social
environment.
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All the major and common psychiatric diagnoses are considered in brief chapters of about 6 or 7 pages (24 chapters in all). Within each chapter the common pattern is: an introduction to the diagnosis; suggestions about key issues to note in the stories; the diagnostic criteria according to DSM—IV; ‘stories’ from the view point of the patient and another person (although, interestingly, sometimes the story from the perspective of the other person comes first and is considerably longer than that of the patient); a discussion of such issues as the exclusion of other diagnoses or further information on the diagnosis; questions and references.
The result is a well-structured and lively textbook which is most suited to medical students and students of psychiatry. It will doubtless also appeal to students of psychiatric nursing and the other mental health disciplines.
However, there are some limitations to the book — from the perspective of a psychologist who is not satisfied with a view of mental illness constructed entirely within a framework of DSM—IV diagnostic categories. There is no critique of this and relatively little reflection on the difficulties of assigning patients to clear-cut categories. For the most part, the case studies are extremely neat and unquestionably fulfil the diagnostic criteria. This book will not, therefore, help junior mental health professionals think about the inadequacies of diagnostic constructs or the dimensionality of many of the phenomena described here. The book is also uncompromisingly North American in its perspective; it describes people mostly living small-town American lives, often in the mid-west, operating within a US health care system with its clear and strong emphasis on biological understandings of mental illness and diagnostic tests. Most of the people seem to be white, heterosexual and middle class. Some of the complexities of providing mental health care within a UK multicultural inner-city context seem a million miles away.
Despite theses concerns, for a textbook on DSM—IV diagnoses, this is a readable and humane book and, as such, I recommend it.
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