Əsas səhifə The British Journal of Psychiatry A Piece of My Mind: A Psychiatrist on the Couch. By Gordon Parker. Pan Macmillan Australia....
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Book reviews Govanhill, Glasgow, on what would have been his 84th birthday. His memory has also been reinvigorated by this new intellectual biography of the early Laing by Allan Beveridge, another Glasgow-born psychiatrist with a broad interest in the arts and humanities. This volume is an important addition to the Laing literature, a body of work where one might have imagined all had already been said, because it synthesises primary research undertaken in the Laing archive at Glasgow University Library Special Collections with an in-depth understanding of both Laing’s published work and the secondary literature on Laing from both academic sources and popular accounts. One of the joys of the book is its use of extensive quotes from Laing’s unpublished notebooks, including some entitled ‘Elements for an Autobiography’. Laing did publish a first instalment of his autobiography in Wisdom, Madness and Folly. The Making of a Psychiatrist, 1927–1957, which also included a section on his views of mainstream psychiatry at the point of publication in 1985, 4 years before his death. The near match between the years covered by Beveridge’s biography and the autobiography allows for an exploration of where notes made by Laing at the time, diverge from his retrospective account many years later. The tendency by Laing to overplay the uniqueness of his insights and to play down the contribution of those around him is a theme of recent Laing scholarship that is brought out, once again, in this work by Beveridge. The complexity of this issue is well handled, and to read this book is to be left in no doubt that Laing was a serious and committed thinker from an early date and some of the theories that were to come to fruition in The Divided Self were already being rehearsed at medical school in prize-winning essays. Evidence is presented in an analysis of what Laing both read and retained in his library, of a precocious and driven scholar who, unusually for a medical student, was more interested in literature, theology and Eu; ropean philosophy than in science. Laing read and wrote daily, denying himself sleep in his pursuit of the frontier of philosophy which he hoped to extend. The Glasgow of his formative years was fertile soil to cultivate these interests, with the young Laing joining a mixed group of older men – including some such as Abenheimer and Schorstein with direct connections to thinkers admired by Laing such as Jaspers and Heidegger – to discuss philosophy. The final ingredient for the mixture that was to produce Laing’s seminal 1960 publication was clinical practice and research and, as in the autobiography, the experiences of the neurosurgical unit, the army psychiatric unit, the mental hospital, the department of psychological medicine and the move to the Tavistock Clinic are all covered in detail. The 1950s was a pivotal decade for modern psychiatry, adding to the interest of this book. Again, a fascinating aspect of this book is the comparison of notes made on patients contemporaneously, to be found in the Laing archive, with the later incorporation of the shortened, anonymised and reinterpreted case histories in Laing’s published work. An impression is formed of a dedicated clinician trying to do the best for each individual in his care. The approach continues with Laing’s move to London despite Laing having doubts as to his initial practice there, removed from his primary interest in the psychotic state. Of particular interest for myself is the account of Laing’s 18 months at Gartnavel Royal Hospital and his relationship with the Physician-Superintendent, Angus McNiven, there. We are at the tipping point of institutional psychiatry and Laing’s contribution, along with others, to the movement towards closing the asylums is one of his main legacies, along with the strong advocacy that the severely mentally ill have a legitimate voice. The book leaves us with Laing – a psychiatric Icarus (see end of Chapter 1) – fully winged and about to take flight with the publication of The Divided Self in 1960. We are left with an insightful and fresh account of the making of this particular psychiatrist, with the biases of our knowledge of Laing’s subsequent divisive reception kept to a minimum. A finer memorial birthday present would be hard to imagine. Iain Smith Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. Email: email@example.com doi: 10.1192/bjp.bp.111.103473 A Piece of My Mind: A Psychiatrist on the Couch By Gordon Parker. Pan Macmillan Australia. 2012. AUD $13.63 (pb). 347pp. ISBN: 9781743345320 What makes a good psychiatrist? Is it a bonus to like your colleagues? What does depression mean? What is it like to be a professor of psychiatry? Disparate questions find disparately satisfying answers in this lively but disjointed book, part memoir, part polemic, by a grizzly Australian academic who early on defines his role with consummate clarity as one of ‘a prickly bastard who keeps asking questions and won’t shut up’. The biographic opening speeds through early decades, carried by a fluent, informal style. Parker’s emotive recall of events is interesting; his use of ‘closure’, for example, seems to overlap with justice and satisfaction. En route from medical school to professorial chair, via a detour into comedy writing, he paints a fondly detailed picture not only of Australian psychiatry but of Australian culture at an interesting time. Readers familiar with the world of psychiatry – not necessarily Parker’s target audience – may take perverse comfort from the fact that stigma, petty managerialism and vested interest have long bedevilled the efforts of psychiatrists all over the planet. Parker delights in bringing them to book, although his method is curiously unfunny for a comedy writer. His definition of a good psychiatrist is unashamedly Hippocratic. Like any other branch of medicine, he contends, the art and science of the craft lies in pattern detection; the recognition of shifts and signs in the suffering that enable a physician to do something useful. Where the suffering is mainly mental, the patterns may be much harder to recognise. He expands on this idea as he approaches his main theme, the diagnosis and treatment of depressive disorders. Here the relaxed, thoughtful tone gives way to a didactic voice which is clumsy at first. A résumé of the research paradigms that led to his grand oeuvre reads like a cut-and-paste from 20 years’ worth of grant applications, but over the next 60 pages the scholarly style finds its stride in a cogent analysis of depression as an illness. Those who worry about the medicalisation of distress in the DSM era 417 Book reviews will find much to support the growing concern that the diagnostic shift from validity to reliability may be more costly than we realise. Parker responds by sketching out a return to an evidence-based diagnostic formulation, based on pattern recognition. A portrait rather than a sketch would have been welcome here. Finally, he describes how his disillusion with the psychiatric establishment prompted him to approach businessmen and politicians directly, setting up an institution dedicated to mood disorder treatment and research that practised as Parker preached. His Black Dog Institute has evidently gone from strength to strength. The same cannot be said for his fluency in the last section of the book. He serves the reader with a salad of opinions, vignettes and excerpts from earlier publications, sprinkled over an essay on the style and substance of psychiatric practice that feels 418 incomplete, but consistent with a life spent giving people a piece of his mind. The true hero of this biography is Australia itself. Parker paints a picture of a rich, creative Western culture that for all its success retains a willingness to care for its mentally ill and do something about it, all the way from clinic to parliament. The understanding of mood disorders and their management has a long and troubled history. Anyone with an interest in its future will gain from this idiosyncratic book. Mark Salter Consultant Psychiatrist, East London NHS Foundation Trust, London, UK. Email: firstname.lastname@example.org doi: 10.1192/bjp.bp.112.110551