Psychiatr Serv 49:117, January 1998
© 1998 American Psychiatric Association
The New Psychiatry: The Essential Guide to State-of-the-Art Therapy, Medication, and Emotional Health
by Jack M. Gorman, M.D. ; New York City, St. Martin's Press, 1996, 388 pages, $27.50
Richard W. Roukema, M.D.
This is a highly practical and informative book written primarily for the patient and his or her family. It is an up-to-date view of what is new in psychiatry in today's world of health maintenance organizations, which has forced fiscal and therapeutic pragmatism on all those who work with the emotionally and mentally ill.
Dr. Gorman begins with a list of eight principles. Among them is the idea that mental health treatments must be result oriented in terms of the patient's needs and not dictated by the therapist's favorite theories. Only treatments with demonstrated effectiveness should be used. If they are not useful, they should be "abandoned or changed." Also, a patient has a right to know his diagnosis, the available treatments, and the reasonable expectations for help with the various disorders. Psychiatric care should be regarded as similar to care for medical illnesses such as cancer, high blood pressure, or diabetes.
Practical considerations such as when to ask for help, where to seek it, the importance of a psychiatric diagnosis, and the involvement of family members in determining treatment plans are stressed. The author speaks with a refreshing frankness. For example, he suggests that if a psychiatrist, especially during the first session, follows the patient's straightforward query with the old saw "Now what do you mean by that question?" maybe it is time to look for another psychiatrist.
Patients are advised on how to pick a psychiatrist, on what should happen in the first meeting, and on other topics such as fees, cancellations, and self-help groups. The New Psychiatry suggests using the simpler, shorter therapies first—cognitive-behavioral and biological therapies. If success is not attained, then longer dynamically oriented psychotherapy is recommended. Psychoanalysis is considered useful only in very specific situations, such as personality disorders. Group therapy and family therapy are also considered. The pros and cons of the various therapies are clearly spelled out. Dr. Gorman includes a very detailed but clear discussion of how psychiatric medications work and how they are used effectively for each disorder.
The author provides clinical examples of the various psychiatric disorders that are helped by treatment, including the anxiety and depressive disorders, schizophrenia, substance abuse, eating disorders, and personality disorders. The treatment plans outlined for each are so specific that psychiatric residents, nurses, psychologists, social workers, family practitioners, and other mental health workers could benefit from reading and following them.
Several topics are missing in the discussion of adult psychiatric disorders, such as sexual dysfunction, paraphilia, and dementia. The author doubts that avoidant and dependent personalities are valid diagnostic entities and regards paranoid, schizotypal, and schizoid personalities as variations of schizophrenia.
Dr. Gorman has successfully written a well-rounded book that is reader friendly and extremely useful. It is time to take psychiatry out of its theoretical mumbo-jumbo and put it into plain language. Dr. Gorman has succeeded remarkably in accomplishing this long overdue task.
Footnotes
Dr. Roukema is associate clinical professor of psychiatry at the University of Medicine and Dentistry of New Jersey in Newark and clinical director of the outpatient mental health service at Ramapo Ridge Psychiatric Hospital in Wyckoff, New Jersey.
Dr. Roukema is associate clinical professor of psychiatry at the University of Medicine and Dentistry of New Jersey in Newark and clinical director of the outpatient mental health service at Ramapo Ridge Psychiatric Hospital in Wyckoff, New Jersey.
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