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Ben Sessa BJP 2011, 199:258-259. Access the most recent version at doi: 10.1192/bjp.bp.110.

087437

The Pharmacology of LSD: A Critical Review

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The British Journal of Psychiatry (2011) 199, 255260

Book reviews
Edited by Allan Beveridge, Femi Oyebode and Rosalind Ramsay
psychosocial management in paediatric conditions and identify areas where evidence is lacking. This book will help us do both.

Katy Auckland Consultant child and adolescent psychiatrist working in paediatric liaison, Royal Hospital for Sick Children, Edinburgh EH9 1LL, UK. Email: katy.auckland@nhslothian.scot.nhs.uk doi: 10.1192/bjp.bp.110.084459

Textbook of Pediatric Psychosomatic Medicine


Edited by Richard J. Shaw & David R. DeMaso. American Psychiatric Publishing. 2010. US$135.00 (hb). 551pp. ISBN: 9781585623501

The Talking Cure Wittgensteins Therapeutic Method for Psychotherapy


By John M. Heaton. Palgrave Macmillan. 2010. 57.00 (hb). 240pp. ISBN: 9780230237612

Paediatric psychosomatic medicine, or paediatric liaison psychiatry, is at a crossroads in the UK and elsewhere. Is it to be an easy target for cuts or can we convince those in power of its potential to actually save money, not to mention suffering, both now and in the future? In this context a comprehensive textbook whose aim is to articulate the evidence base for the mental health aspects of paediatrics is very welcome. Although the majority of contributors are from the USA, the cultural differences, though present, are not intrusive. I liked the format of the book, with the scene set by a description of the biopsychosocial model and a rationale for its use. This thread runs through the book resulting in a cohesive approach to a breadth of clinical areas. The focus on referral questions was the most useful area for me, working in paediatric liaison psychiatry; it fills in the gaps in my reading and reassures me that my clinical work is not out of step with the available evidence from national and international colleagues. The chapter on treatment adherence and the subsequent section on specialties and subspecialties should be mandatory reading for paediatricians in training. It helps to understand the psychosocial adjustment and other psychosocial difficulties across a range of conditions, also discussing evidence-based treatments for each. Perhaps it is because treatment issues are so well handled in the individual subsections that I was so disappointed with the more general concluding section on treatment. Being at a crossroads, paediatric liaison psychiatry needs to sell itself and what it has to offer harder. I would also have liked to see attention given to our input into medical systems, particularly our role in containing anxiety in these systems. In truth, although this is often the most valuable and difficult part of our job, it is probably also the hardest to measure. I suspect this lack of evidence is the reason for this absence. The other omission is looking in more detail at chronic fatigue syndrome. Rightly or wrongly, it is a significant part of my clinical work, an area of immense suffering and impairment where mental health professionals, working as part of a multidisciplinary team, can have a significant impact. In spite of these reservations, I can wholeheartedly recommend this book to any health professional working with children. We need to use what evidence there is regarding

John Heaton is, among other things, a practising psychiatrist and psychotherapist, a regular lecturer on the Advanced Diploma in Existential Psychotherapy programme at Regents College, London, and a long- and sometime editor of the Existential Analysis journal. This is Heatons third book with Wittgenstein in its title. In it, he applies Wittgensteins insights to the psychotherapeutic process in all its forms. Heatons principal thesis is that many of our deepest and most intractable problems find their roots in linguistic confusions and limitations, and are resolved not by the search for causes inherent in the various pseudoscientific doctrines and theories of the mind (such as those of Sigmund Freud and Melanie Klein), but by careful attention to the use of language. This is particularly true in neurosis and psychosis, in which language is used not so much to clarify and communicate as to deceive and obfuscate. Like all the best things, the talking cure has its roots in the ancient Greece of Socrates and Diogenes the Cynic. Upon being asked to name the most beautiful of all things, Diogenes replied parrhesia (free speech, full expression), and his intransigently courageous and sometimes delightfully shocking behaviour consistently accorded with this his truth. The self-understanding that underlies parrhesia is revealed not in reductionist propositions based on questionable pictures of the mind, but in the singular use of language both by the expression and by its truthfulness. In short, it is revealed not in causes, but in reasons, with all their multiplicities and particularities. For Wittgenstein as for Heaton, the talking cure is, like philosophy itself, a battle against the bewitchment of intelligence by means of language, for it is not knowledge but understanding that is needed to live an integrated, productive, and, dare I say it, happy life. To date, this important, indeed, devastating, critique has had little or no effect on psychotherapeutic practices, and Heatons revolutionary book requires, needs, and deserves to be read not only by psychotherapists and psychiatrists but by every

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mental health professional. Although the book is not difficult to leaf through, the reader with little more than a scientific background may find it difficult to understand, accept, or come to terms with certain concepts. As the German satirist Georg Lichtenberg tells us, A book is like a mirror: if an ape looks into it an apostle is hardly likely to look out . . . he who understands the wise is wise already.
Neel Burton Visiting academic, Green Templeton College, University of Oxford, Oxford, UK. Email: neel.burton@gtc.ox.ac.uk doi: 10.1192/bjp.bp.110.082522

Responsibility and Psychopathy: Interfacing Law, Psychiatry and Philosophy


Edited by Luca Malatesti & John McMillan. Oxford University Press, International Perspectives in Philosophy and Psychiatry series. 2010. 34.95 (pb). 340pp. ISBN: 9780199551637

Practical Management of Bipolar Disorder


Edited by Allan H. Young, I. Nicol Ferrier & Erin E. Michalak Cambridge University Press. 2010. 35.00 (pb). 226pp. ISBN: 9780521734899

The book provides a broad guide to the current practical management of bipolar disorder, doing what it says on the tin. It clearly lays out available management for the different subgroups of the illness including bipolar I and bipolar II depression. It also highlights the reality of the lack of available evidence for certain aspects, such as bipolar II disorder. There is plenty of meat looking at psychotropic and psychosocial treatments and a useful and interesting strategy of personal medicine, to enhance medication adherence and quality of life. There are treatment algorithms for both bipolar mania and bipolar depression developed from the Canadian Network for Mood and Anxiety Treatments (CANMAT), which provides an alternative to the current UK National Institute for Health and Clinical Excellence guidelines. The two documents have differing second- and third-line strategies but appear to be similar in principle. Some more detail on switching medication may be a useful addition, as multiple psychotropics are common in bipolar illness. Generally, the sections are well laid out and there are full chapters on particular groups including older adults, adolescents and women of reproductive age; however, clearer information on medication in pregnancy and breastfeeding can be found in the Maudsley prescribing guidelines. Individual aspects that are covered in depth include physical health, anxiety, substance misuse and sleep. There are specific strategies for the management of sleep as it is both a marker of relapse and has been implicated in the aetiology and course of bipolar disorder. Overall, this is a useful complementary text for an illness which is complex to both diagnose and manage.
Peter Curtis ST6 psychiatry, South London and Maudsley Mood and Anxiety Disorder Clinical Academic Group, North Lambeth Community Mental Health Team, 190 Kennington Lane, London SE11 5DL, UK. Email: jackpeteuk@yahoo.com doi: 10.1192/bjp.bp.110.084392

If psychopaths did not exist, philosophers would have invented them. This book explores the moral questions raised by the existence of individuals whose moral emotions seem to be reduced or absent. The authors start from the premise that, long before the work of Robert Cleckley and Hervey Hare, philosophers interested in moral judgement have experimented with the idea of a person with no feelings and no empathy for others. What sort of moral judgements would they make? Would they be moral at all? And if a person did exist who was persistently and incorrigibly cruel, how should we (the society affected by these people) respond to them morally? Both philosophers and psychopathy researchers have attempted to answer these questions; and this rich book is a compilation of their answers. The book combines together essays from lawyers, psychologists and philosophers; Luca Malatesti and John McMillan have an established track record in making these collaborations fruitful, and the contributions in this book are clear and lucid. I particularly recommend the chapters by Robert Hare and colleagues, and one by Antony Duff who offers a welcome follow-up to a previously influential paper published in 1977. I recommend this book for anyone who has an interest in the effect of mental disorders, especially personality disorders, on moral reasoning. It offers an interesting consensus view about the moral responsibility of psychopaths; namely, that because (Hare) psychopaths have emotional reasoning deficits, they should not be held responsible for their actions, and should therefore not be punished. I have no quarrel with this conclusion particularly; but I thought the argument would have been stronger if there had been more human material from those people called psychopaths. There is an irony here that if we treat them as pure objects of study, and not as people with voices (albeit disturbing ones), then we become, as it were, psychopathic. It was the depth and thickness of Cleckleys clinical descriptions that stimulated the research into psychopathy that is the basis for this book; and I missed such descriptions in this work. There is another point that needed more emphasis. Neither the word evil nor violence appears in the index of Cleckleys original work on psychopathy. It is Robert Hare and his group who have identified a subgroup of violent offenders who are persistently cruel and violent, and who better fit the stereotype of psychopathy beloved of philosophy and movie-goers alike. The people we think of as Hare psychopaths are a minority of violent offenders, let alone criminals: not all violent criminals are psychopaths, and hardly any non-violent criminals. None of the men at the Wannsee conference in 1941 who planned the Final Solution would score highly on Hares Psychopathy Checklist. We

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should therefore be cautious about inferring too much about the nature and scope of normal human moral reasoning based solely on a small group of highly selected individuals with antisocial behaviours. In my experience, the most common and significant failures of moral reasoning happen every day in the minds of ordinary men and women.

Gwen Adshead Consultant psychiatrist, Dadd Centre, Broadmoor Hospital, Crowthorne RG45 7EG, UK. Email: gwen.adshead@wlmht.nhs.uk doi: 10.1192/bjp.bp.110.089862

reviews the merit of cognitive therapy approaches in the treatment of schizophrenia and concludes, rewording text from Tarrier & Wykes 2004 influential paper, that cognitivebehavioural therapy use in schizophrenia should be considered a cautionary tale, rejecting the authors alternative of cautious optimism. In conclusion, this volume of edited papers is an up-to-date exposition of clinically relevant themes in the contemporary management of schizophrenia, with the chapter lengths being easy to manage and the reference lists recent and thorough. This book should appeal to higher trainees anticipating working within adult psychiatry teams or destined for early intervention specialist services. Consultant psychiatrists wishing a quick up-to-date refresher of the management of schizophrenia will also find it useful.

Therapeutic Strategies in Schizophrenia


Edited by Ann Mortimer & Peter McKenna. Clinical Publishing. 2010. 49.99 (hb). 256pp. ISBN: 9781846920356

Robert McCabe Tier IV CAMHS (IPU & EPSS), Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. Email: robert.mccabe@nhslothian.scot.nhs.uk doi: 10.1192/bjp.bp.110.089763

Clinical Addiction Psychiatry


Edited by David Brizer & Ricardo Castaneda. Cambridge University Press. 2010. 75.00 (hb). 268pp. ISBN: 9780521899581

Given my work in a child and adolescent mental health servicesbased early intervention team working with adolescents and young adults with first-episode psychosis, I was interested in reviewing this book. Its collection of well-written, handily sized chapters should appeal to many working with individuals with schizophrenia. Several authors are academics but their reference to their own clinical experience suggests practice familiar within the National Health Service (NHS); a particularly pragmatic and valuable example of this is Ann Mortimers chapter on the role and effectiveness of additional drugs in schizophrenia. There are 14 chapters in this volume. The authors are a mix of British academics and NHS clinicians and several overseas academics. Ann Mortimer is the Head of Psychiatry at Hull University, UK and her co-editor Peter McKenna is a research psychiatrist based in Barcelona, Spain. There are several chapters on the aetiological understanding of schizophrenia, one on neurochemical theories of schizophrenia (McKenna) and two succinctly covering structural and functional brain imaging; the former, by Salgado-Pineda, Pomarol-Clotet and McKenna, addresses implications for pathophysiology, whereas the latter, from Howes and Kapur, focuses on therapeutic inferences. There is a clear emphasis on the pharmacological management of schizophrenia with individual chapters addressing medical sideeffects of antipsychotic agents (Frighi), the current status of clozapine (Kelly & Buchanan) and disturbed behaviour and its management (Dye). A helpful brief overview of treatment strategies in early psychosis is included (Drake & Lewis), although clinicians familiar with early intervention teams and their approaches will not find much new content here. The title wording of the chapter by Cheng and Jones I found particularly apt Second generation atypical versus first-generation conventional antipsychotic drug treatment in schizophrenia: another triumph of hope over experience? McKenna critically

This is a multi-author book edited by two New York-based psychiatrists. All of the 30 or so contributors are from the USA. It is brief for such a textbook at around 260 pages but the list price is 75. The back cover tells us that the book is aimed at addiction counsellors, with a hope that it will be of interest to patients, families and physicians. Unexpectedly for a multi-author book, most of the chapters have a consistent tone and style, best described as clinical lore leavened with the occasional reference to supportive peerreviewed evidence. Only the chapters on pharmacotherapy and dialectic behaviour therapy attempt a systematic review of published evidence. There is much accumulated clinical experience described across other chapters, and the value which readers draw from this will vary depending on their own experience and whether their interests and inclinations match those of the authors. I found the chapter on cosmetic psychopharmacology, which covered caffeine, methylphenidate and steroids, interesting and novel. The section on ibogaine, a drug derived from a west African plant which has been reported to help with withdrawal and relapse prevention in opiate and cocaine dependence, was well researched and informative. Too many of the other chapters, though, were subjective and selective for this to be recommended as a comprehensive textbook for any readership. To a UK reader, the absence of any reference to brief interventions in a chapter on substance misuse in primary care seems inexplicable. There is little on harm reduction.

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Motivational interviewing only gets a couple of passing references. The chapter on methadone gives interesting insight into the US healthcare system but, like other contributions, is more a polemic than a review. Only the dialectic behaviour therapy chapter deals in any depth with aspects of co-occurring addiction and psychiatric disorder. For many practitioners in substance misuse and addiction psychiatry, the interface with local cultural influences is part of the fascination of the discipline. Successful international publications in addiction utilise international differences to enhance learning. This book, however, is too parochial and I could not recommend it.
Peter Rice Tayside Alcohol Problems Service, Sunnyside Royal Hospital, Montrose DD10 9JP, UK. Email: peter.rice@nhs.net doi: 10.1192/bjp.bp.110.089789

with, say, William Hogarths Gin Lane or George Cruikshanks The Worship of Bacchus, there appears to be a lack of awareness of the social causes of the problems that are depicted. This book is very much influenced by the prevailing disease-model ideology of addictions in the USA, based on an emphasis on neurobiology at the expense of psychological and social understandings of addiction. I found myself doubting the claim put forward by the editors that science and art are reconciled here, with the art giving us the wide variety of personal experience that lies beneath the seemingly uniform surface of addictive disorders. Ultimately, this is a worthwhile book, not only for the many striking images it presents, but also for showing how an involvement with art might for some prove therapeutic. The book does not stand alone and the project from which it is taken (www.addictionandart.org) appears to continue to thrive.
1 Jay, M. High Society: Mind-Altering Drugs in History and Culture. Thames and Hudson, 2010.

Iain Smith Gartnavel Royal Hospital, Kershaw Unit, 1055 Great Western Road, Glasgow G12 0XH, UK. Email: iain.smith@ggc.scot.nhs.uk

Addiction and Art


Edited by Patricia B. Santora, Margaret L. Dowell & Jack E. Henningfield. Johns Hopkins University Press. 2010. US$29.95 (hb). 184pp. ISBN: 9780801894817

doi: 10.1192/bjp.bp.111.093245

The Pharmacology of LSD: A Critical Review


By Annelie Hintzen and Torsten Passie Oxford University Press/ Beckley Foundation Press. 2010. 29.95 (pb). 240pp. ISBN: 9780199589821

As the High Society exhibition at the Wellcome Collection in London has shown, there is widespread interest in the influence of alcohol and drugs on our culture. If one examines Mike Jays lavishly illustrated book of the exhibition,1 it can be seen that drug use has a multifaceted relationship with the worlds of art and literature. Much of the artwork is celebratory and indicative of the initial lure of mind-altering substances. If Jays book presents us with the intoxication of a Saturday night, then Addiction and Art gives us the hangover of a Sunday morning, multiplied many times over by the enslavement of addiction. The 61 stark images included in this book were selected by an expert panel from a much larger pool of work, to give insight into the desperation wrought by addictive disorders and to increase public understanding of these disorders. A further purpose was to give hope for recovery, as many of the artists are themselves recovering from addiction. Some of these images appear to be a warning to the sober self as to where a return to drug use might lead. The hopeful images contrast poignantly with those commemorating people who have died through illness, overdose or suicide. I found the painting entitled The Addiction Savior, by a Baltimore funeral director, particularly striking as a response to the epidemic of premature death wrought by tobacco, alcohol and other drugs. Each image is complemented by explanatory text from the artist on an opposing page. These pieces then are deeply personal and give insight into a variety of individual hells. In comparison

Many psychiatrists today are not aware of the role lysergic acid diethylamide (LSD) played in the profession in the mid 1950s. Heralded as the next big thing in psychiatry, this fascinating drug looked set to transform the management of neurotic patients. But in the wake of the subsequent drug revolution LSD was banned and largely consigned to museums shelves for the past 40 years. Until now. Psychedelic research is enjoying a worldwide renaissance with a major UK conference in April 2011 and this book provides an impressive trawl through the database of over a 1000 pharmacological studies conducted on LSD in the past 60 years since the drugs discovery by Albert Hofmann. The books approach to evidence for the experienced academic researcher is exhaustive, while also remaining accessible to psychiatrists and the lay enthusiast. LSD is remarkable not least for stimulating the imagination of so many varied people. What other subject, ask the authors, spans the academic fields of biology, medicine, cultural anthropology, theology, botany, psychology and chemistry? Not to mention the drugs influence in religion, music and art. The authors illustrate the immense potency of LSD, its pharmacodynamics and what is known of its beguiling

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pharmacokinetic properties. An extensive chemistry section outlines the many lysergic acid derivatives and the drug is described accurately as a non-addictive, tasteless, colourless, immensely potent substance with a virtually absent toxicity. After 60 years of sustained use by hundreds of millions of people there has never been a recorded human death from physiological overdose. As a pharmacology book it only touches on the subject of therapeutic uses. There are many psychiatric studies missing from the text and a disheartening lack of credit is given to the important role LSD played in psychiatry in the past. Likewise, the sections on the drugs psychological effects and particularly the phenomenon of spiritual experience a hallmark of the LSD experience are very brief indeed. For a more detailed review of these effects one is directed towards Masters and Houstons The Varieties of Psychedelic Experience (Henry Holt & Co, 1966) or many other texts of that period. Nevertheless, overall this is an essential addition to the library of any self-respecting psychedelic enthusiastic. Especially for those keen to swot up and join the resurgence of interest in what is undoubtedly the worlds most famous molecule after DNA.

proceed. Medical students might also find it a useful adjunct to their textbooks. The depth of the information and the more straightforward nature of many of the cases are probably not sufficient for psychiatric trainees preparing for examinations. However, the book would probably provide a valuable quick reference for new psychiatric SHOs facing their first on-calls. Finally, it may be a useful reminder for all psychiatrists of areas they do not usually cover but which they may sometimes encounter on call.

Rui Zheng Barberry Centre, Birmingham and Solihull Mental Health Foundation Trust, 25 Vincent Drive, Edgbaston, Birmingham B15 2SG, UK. Email: rui.zheng@bsmhft.nhs.uk doi: 10.1192/bjp.bp.110.089805

Handbook of AIDS Psychiatry


By M. A. Cohen, H. Goforth, J. Lux, S. Batista, S. Khalife, K. Cozza & J. Soffer. Oxford University Press USA. 2010. 35.00 (hb). 398pp. ISBN: 9780195372571

Ben Sessa Child and Adolescent Psychiatrist, Foundation House, Wellsprings Hospital Site, Wellsprings Road, Taunton, Somerset, TA2 7PQ, UK. Email: Ben.Sessa@sompar.nhs.uk doi: 10.1192/bjp.bp.110.087437

100 Cases in Psychiatry


By Barry Wright, Subodh Dave & Nisha Dogra. Hodder Arnold. 2010. 20.99 (pb). 278pp. ISBN: 9780340986011

Senior house officers (SHOs) in liaison psychiatry and doctors working in any specialty are likely to meet on a regular basis patients whose presentation will tax their psychiatric knowledge. 100 Cases in Psychiatry is aimed at doctors across all disciplines. As the title implies, the book consists of 100 examples of common clinical scenarios that practitioners may come across in various settings. Each scenario is set out on a single page, along with two or three questions to guide the readers thinking. The examples cover a broad range of psychiatry, focusing especially on more commonly encountered situations but including those presentations it would be risky to miss. The stories are general enough to allow for pattern recognition but they are also idiosyncratic enough to feel real and interesting. The answers are to be found on the following page and manage to convey a lot of useful information in a concise format. So who should buy this book? Clearly, SHOs in accident and emergency, and indeed any doctor who fears they may run into a psychiatric situation in which they may feel at a loss as to how to

This handbook presents itself as a practical guide for AIDS psychiatrists and other mental health professionals. The preface notes that persons with severe mental illness and substance misuse tend to have a higher prevalence of HIV infection than the general population. The authors go on to say that they aim to provide insight into the interface between the psychiatric, medical and social dimensions of HIV and AIDS, because there is an ample body of evidence that psychiatric care can decrease transmission, improve adherence, and decrease mobility and mortality. I am not sure I would be quite as upbeat as this. Attitudes to AIDS have evolved in the Western world. One young man recently diagnosed told me that he was not shocked because it is a treatable disease now, isnt it? Female HIV physicians have told me that they would rather have AIDS than breast cancer or insulin-dependent diabetes. We do not know ` whether the normalisation of HIV vis-a-vis other life-threatening or chronic diseases has contributed to the still relentless rise in infection rates in the UK. The core clinical issue relates to the direct neuropsychiatric consequences of HIV infection, but this would make for a very short book which this is not! In addition to the clinical chapters, there are sections on HIV through the life cycle, strategies for primary and secondary prevention of transmission, psychiatric aspects of stigma, palliative and spiritual aspects of care, ethical and legal issues, and resources for caregivers. Detailed and informative as it is, this book is oriented to the USA, and its biomedical focus means that it misses some of the major practice issues we encounter in an HIV mental health service in London. (At the time of writing, we are at risk of being

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closed.) For example, the words work and employment do not even feature in the index, yet it is striking in the UK how few HIV-positive people who are physically well on combination medication are in regular work by comparison with those of similar age carrying other life-threatening diseases. The authors write that depressive illness is a major cause of distress in a patient with HIV and AIDS. How are we to be clear that when we diagnose depression we are not simply medicalising situational distress, whether in UK patients or those from abroad? Half of our patients are African women: although many are referred as depressed, this is a biomedical category that does not exist in the cultures from which they come. Do we know

better? I find that I spend a lot of time trying to unstick the label psychotic depression from some of these women: in nine cases out of ten, auditory hallucinations are not evidence of active psychosis, but are merely non-specific markers of stress and distress. It is an omission for a clinical textbook aiming to be comprehensive to say nothing about psychiatry and culture.

Derek Summerfield Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, Cascaid, 5 Windsor Walk, London SE5 8BB, UK. Email: derek.summerfield@slam.nhs.uk doi: 10.1192/bjp.bp.111.092395

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