The history of the treatment of mental disorder is a fascinating topic. In most cultures it was traditionally the task of priests rather than of doctors. The move from one to the other has been gradual and complex – within living memory a doctor at the Maudsley Hospital (the epicentre of British scientific psychiatry) was controversially involved in an exorcism, on the understandable grounds that the patient wanted it and thought it would do him good. The growth of the psychotherapeutic profession, from Freud to the modern plethora of bereavement counsellors, relationship counsellors, stress therapists etc., has whittled away at the priest's traditional functions of comforting the distressed, mildly depressed, worried well, and neurotic. On the other hand recognition of the fact that there are drugs which can at least alleviate the symptoms of the psychotic disorders has greatly strengthened the medical profession's position. Priests have virtually dropped out of the running, just left with empty rituals – many people want a clergyman for marriage, christening and funeral ceremonies but would be most upset if he turned up subsequently offering relationship counselling, child guidance or bereavement therapy. The controversy now lies between psychotherapists who believe that listening to and talking to a patient can cure, and psychopharmacologists, who put their faith in drug treatments. It is, of course, obvious that both are right – there are plenty of ill people who need someone to talk to and for whom a course of mental guidance, such as the current government favourite – cognitive behaviour therapy, will effectively put them back in control of their own lives. On the other hand there are seriously ill people whose symptoms can be most effectively controlled by drugs.
Drug treatment for mental disorder has been tried from time immemorial. Virtually the only medicines in the pre‐modern pharmacopoeia that are now recognised as effective are alcohol and opium, both of which have been extensively used. The first person to try to match these to a scientific theory of mind was probably Kraepelin, who also included the newly‐discovered anaesthetics – ether and chloral hydrate, and caffeine, in his research. Morphine came into use with the invention of the hypodermic in the 1850s. The hallucinogens were first isolated around the turn of the century, as was amphetamine (though that was initially only used as an asthma treatment and only came to the attention of psychiatrists in the 1930s). The real breakthrough to the modern science of psychopharmacology only came in the 1950s however, with the serendipitous discovery of the effectiveness of chlorpromazine in alleviating psychotic symptoms. The general medical pharmacopoeia grew up gradually. The modern psycho‐pharmacopoeia has had a mushroom growth in the past half‐century or so, from those small beginnings to the position where a massive (barely portable) and expensive specialised encyclopedia like this can be a viable commercial proposition.
A major problem in the treatment of mental illnesses, as distinguished from organic disorders with a known aetiology, is that they are nearly all what are known as spectrum disorders. They exist in a complete range, from normality to life‐threatening debility, with no clear cut‐off points. Insurance companies and other funding bodies need labels, and precise cut‐offs to indicate where someone switches from being “well” to being “ill”. To satisfy these funding bodies, rather than to assist clinicians in their work, precise classification schemes have been drawn up, most notably the American Psychiatric Association's Diagnostic & Statistical Manual (DSM). This tends to say things like “At least six of the following ten symptoms must be present for ten consecutive days for classification as […] ”. A patient who only has five of the symptoms, or has a good day on Thursday can slip through the net and not get funded treatment.
A further problem is that little is known about the causes of many mental disorders: they can only be defined by their symptoms. An organic disease like, say, diphtheria has a known bacterial cause. An antibiotic will combat the cause of the disease. No‐one really knows what causes schizophrenia yet, and the DSM line between eccentricity and psychosis is fairly arbitrary. Treatments can only prevent the symptoms of the disorder rather than cure it. It is therefore much harder in psychiatry than in general medicine to decide whether drug treatment is necessary, and to judge whether treatment is actually working or is merely masking a normal process of recovery.
All this puts clinicians in a very difficult position. It is obviously in the financial interests of governments, insurance companies, and other funding bodies, to have as few “ill” people as possible. It is obviously in the interests of drug manufacturers to have as many “ill” people as possible – especially those who are going to need continual treatment to control their symptoms rather than those who will merely need a one‐off treatment to cure their disease. Even as early as the use of amphetamine mentioned above, it was Smith, Kline & French who aggressively marketed what had been an unsuccessful asthma treatment as a treatment for depression. The pressure on all physicians from drug companies is enormous. The pressure on psychiatrists has to be seen to be believed.
The massive expansion of psychopharmacology has, of course, been matched by an equivalent growth in its literature. There are an enormous number of general pharmacological reference sources on the market, some of which we have looked at in past issues of Reference Reviews. The editor here particularly notes the Encyclopedia of Molecular Pharmacology (Offermans and Rosenthal, 2008). There are a number of well‐established and regularly updated psychopharmacological texts aimed at clinical practitioners. I would note, for example, the Handbook of Psychiatric Drug Therapy (Labbate et al., 2010) which has just produced its sixth edition, the Handbook of Clinical Psychopharmacology, also now in a sixth edition (Preston et al., 2010), the new seventh edition of the APPI Manual of Clinical Psychopharmacology (Schatzberg et al., 2010) and the growing mini‐library based on Essential Psychopharmacology (Stahl, 2006). All of these are authoritative texts that should be considered for acquisition by medical libraries. There is, understandably, a wide public distrust of psychiatrists and therefore a wide public interest in the drugs they offer. There are a large number of books, websites and other information sources that purport to guide the lay enquirer through the topic. I would particularly note Psychiatric Drugs Explained (Healy, 2009) as a reasonably balanced book for the general reader.
The Encyclopedia of Psychopharmacology differs somewhat from these well‐established sources in being scientifically‐orientated rather than clinician‐orientated, and in being an encyclopedia, arranged in English alphabetical order rather than in a logical subject order. The bulk of the book consists of lengthy essays, up to four or five pages, on individual drugs and groups of drugs; descriptions of fundamental psychological and biological processes affected by psychoactive drugs; psychiatric disorders considered to be pharmacologically treatable (and a few that are not); and basic methodological or technical descriptions. These are interspersed with brief one‐paragraph definitions. The definitions are unsigned and were presumably produced by the editor and the ten “field editors”. The longer essays are signed, by about 400 expert contributors. The editor is to be congratulated on recruiting a genuinely international team of genuine experts – far too many encyclopedias, even those that call themselves “world” or “international” seem to be written by a narrow range of American associate professors. These authors all come from reputable research centres, all around the world.
Having contributors from around the world can, of course, cause problems, in that some of them will have to write in a language which is not their own, in such a way as to make themselves incomprehensible by readers who are not experts in their specialist field. We have recently had cause to criticise Springer over this – when looking at the Encyclopedia of the Aral Sea (RR 2009/296), for example, we came to the conclusion that “the kindest explanation is that the authors wrote their contributions in Russian, and these were then machine‐translated and machine‐sorted with no human intervention whatsoever”. In this case Springer is to be congratulated. The publisher and/or the editor have tried to ensure that all the entries should be clearly comprehensible to any Anglophone reader with a good scientific or medical background. This last point needs emphasising. This is not a reference tool for the general reader. For Reference Reviews purposes I would define an encyclopedia for the general public as one which defines all the terms it uses other than those of a standard English vocabulary. This book uses innumerable scientific and biomedical terms. Abbreviations tend to be explained once only. All the main entries are thoroughly referenced to specialist refereed scientific journals, rather than providing guides to further reading in generally accessible books and websites. Anyone accustomed to working with scientific literature will feel comfortable with this. Other readers will not.
A further point for consideration when purchasing books in this subject area is that it is still developing very rapidly. There are some areas of pharmacology where progress has clearly slowed – there have been no recent major developments in antibiotics for example. A glance at the publishing history of the psychopharmacological books mentioned shows how frequently they have needed revising. This book is remarkably up to date. Many of the books looked at in Reference Reviews indicate the time it has taken to put them together by the dates of their most recent bibliographic references. Apart from checking for topics where I know there have been fairly recent developments, a scan through lists of references clearly shows that the publisher, the editor, and his team have done an admirable job of producing an up to date reference tool. Nevertheless, it will need replacing eventually. Providing a reference service in this subject area is not cheap.
I do have some quibbles with the publisher. Surely it was not necessary to print fifty pages of lists of contributors etc in both volumes? If the contributor's institutional affiliations etc are published in this prefatory section was it necessary to spend two or three lines at the beginning of every entry to repeating this information? The cross‐referencing is admirable, making it very easy to navigate your way around the book, but did the cross‐references need to be quite so widely spaced? The reference “Genetically Engineered Animal see Genetically Modified Animals” (which is the next entry in the book anyway) takes the equivalent of half‐a‐dozen lines of text. I am sure that the book could have been made slightly shorter, and therefore lighter and possibly cheaper. Nevertheless, this is a well‐presented and well thought out up to date reference book on an important subject. The editor and all concerned are to be congratulated.
It remains to be considered which libraries should consider this for purchase. I have to admit that my answer is, not many. All public libraries should ensure that they have something like Healy (2009) in the latest edition. Clinical medical libraries are likely to have at least one of the more clinical books mentioned and should also try to ensure that they are up to date. Academic bioscience libraries should have something like Offermans and Rosenthal (2008) in stock. Both these latter groups would find this book to be a useful supplementary reference tool. All academic libraries catering for research in the neurosciences in general, and psychopharmacology in particular, should seriously consider this for acquisition.
