Kaplan and Sadocks Comprehensive Textbook of Psychiatry, 11e



In the eighth edition, John Nemiah (1918–2009), at the time Pro fessor of Psychiatry at Harvard Medical School and long-standing editor of the American Journal of Psychiatry commented on an issue that is still present: the conflict between a psychoanalytic and psy chodynamic approach versus a biologic approach to understanding human behavior. He was prescient when he wrote the following. Psychiatry has been reassessing its position. It is fortunate that the cur rent self-reflection coincides with recent major advances in knowledge of the biological side of psychiatric illness and human behavior. The understanding of brain function is beginning to approximate the sophistication of psycho logical observations and theories, inspiring the hope that psychiatrists are coming closer to substantial correlations between those two complementary approaches. Already, the contributions of psychopharmacology have made it possible for psychiatrists to alleviate the symptoms of major psychoses that were generally beyond the reach of their skills. Biological knowledge, in other words, is beginning to restore balance that has too long tipped steeply toward psychology. There is danger in this too - a danger that the balance dip too far in the other direction and that psychiatrists forget the important gains that have been made in the psychological and social understanding of human behavior. For the ninth edition of the textbook, Robert Michels, M.D., then University Professor of Medicine and Psychiatry at Weill Cornell Medical College, wrote the foreword. He entitled his contribution The Future of Psychiatry . He was concerned about the social and economic structure of the health care system, as are we. He covered broad areas: medicine in general; science and research; education and many others. A brief excerpt of his many interests follows. The social and economic structure of the healthcare system has lagged behind the development of knowledge and is currently the limiting factor in the quality of care available to most patients. The future promises a con tinuing growth of our knowledge and, particularly, an increased rate of its translation to clinically relevant tools. However, developments in the health care system are more difficult to predict and more problematic. Psychiatry is increasingly recognized as a full participant in medicine and health care and is unlikely to return to its former marginal status, as represented in the past by the asylum, the stigma associated with mental illness, and the woeful underfunding of psychiatric services. However, we continue to grapple for a more rational and effective healthcare system in the United States, and although the urgency is increased, the outcome is uncertain. The magnitude of the problem suggests that larger social and political forces will determine the course, and the psychiatric profession will have to struggle merely to participate in the dialogue. Psychiatry for the future will evolve in the context of the future use of these–of medicine, of the other mental health professions, of the scientific basis of psychiatric practice, of the healthcare system, of education, and of the organization of the profession. Each will change, and as it is so often said, the future is, therefore, hard to predict. For the last edition the foreword was written by Herbert Pardes, M.D. At the time he was the Professor of Psychiatry and Dean of the

Columbia College of Physicians and Surgeons. His interests were in the recent history of psychiatry, especially legislation that made mental health “more visible, accessible and patient oriented.” He mentioned the benefits that accrued to the mentally ill from the Com munity Mental Health Act of 1963 that led to deinstitutionalization and community health centers. His foreword emphasized emerging research into the cause and treatment of mental illness, and he regret ted the trend to defund research and treatment programs. He focused on problems that exist to this day where psychiatry has a vital role to play. A multitude of factors, that is, veterans’ problems, increased suicide, increased cost of comorbid psychiatric and nonpsychiatric conditions, mass violence along with recognition of the overwhelming numbers of individuals who both need care yet are winding up in prisons and jails, has given mental health unprecedented visibility. The many editions of CTP reviewed here are a living history of psychiatry in the last half-century. There have been so many changes during this period, in the delivery of care, in our understanding of what causes mental illness, in treatment methods and in methods of investigation. Neuroscience, which occupied no more than 200 pages in the first edition is now covered in almost 1,000 pages. The first edition was about 1,600 pages in length, the last edition had close to 5,000 pages. Such was and is, the expansion of knowledge. Despite this, psychiatry is a frontier science with large gaps still to be filled. The connectome which has as its goal the mapping of more than 86 billion neurons of the brain is in its infancy. It may hold the clue that finally explains psychiatric disorders. New editions of this text book will record these events. One of the insights we had in reviewing the editions was an awareness of how much we missed Harold. Thinking about him 25 years after his death brought back many memories. It was more than a work relationship—it was a friendship of long standing. We went on vacations with our families while working at the same time. This has been a labor of love, but after more than 50 years of working on this textbook it was time to release ourselves from bond age. The search for new editors to carry on our work resulted in the choice of Robert Boland, M.D. and Marcia Verduin, M.D., distin guished academicians. We had the opportunity to give them some advice, but they produced the current edition on their own. We are pleased to see that they organized the book based upon the solid foundation of the previous edition. We said goodbye to “our child” with, as in all partings, feelings of sadness. But we take comfort that the book is in very excellent hands. They have done a superb job and we wish them both many more edi tions of this classic textbook.

Benjamin Sadock, M.D. and Virginia Sadock, M.D. New York University Grossman School of Medicine

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