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Book Reviews   |    
Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character
Reviewed by Thomas A. Simpatico
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.4.587
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by Stuart Yudofsky, M.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2005, 512 pages, $33.95 softcover

Dr. Simpatico is associate professor of psychiatry and director of the division of public psychiatry at the University of Vermont College of Medicine in Burlington and medical director of the Vermont State Hospital.

Stuart Yudofsky's remarkable crossover book Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character opens with a pithy statement, a parable with dual endings, and an analogy. The statement defines fatal flaws as "brain-based dysfunctions of thinking and impulse that lead to persistent patterns of personality and behavior that betray trust and destroy relationships." The parable tells us of a couple and their California dream house, which precariously rests over a geologically active cliff. Ending 1 provides the unhappy result of the couple's attempt to live their lives oblivious to the danger; ending 2 shows how reality-based hard work can lead to stability and ultimately greater joy. Sounds easy enough but, as the analogy provides, as vast and as powerful as the San Andreas Fault is, you can be standing right on top of it and never see it.

Dr. Yudofsky is an internationally renowned leader in both the art and science of psychiatry. He is D.C. and Irene Ellwood professor and chairman of the Menninger department of psychiatry and behavioral sciences at Baylor College of Medicine, is chief of psychiatry services at the Methodist Hospital in Houston, and is responsible for oversight of academic activities in psychiatry for a network of affiliated teaching hospitals. As I learned during the time that he chaired the department of psychiatry at the University of Chicago during the last year of my residency training, Dr. Yudofsky is also one of those rare and gifted teachers who inspires by embodying wisdom while expertly guiding us to see both the science and humanity of psychiatry.

Fatal Flaws provides us with a user-friendly instrument to help us perceive personality flaws (fatal and otherwise) in ourselves and in others, and it quickly presents us with nine principles for safely interacting with people who have fatal flaws. The body of the book then follows with broadly accessible chapters on several personality disorders: hysterical (histrionic), narcissistic (in particular detail), antisocial, obsessive-compulsive, paranoid, borderline, schizotypal, and addictive. Each chapter leads with a captivating clinical vignette and then presents the available knowledge and wisdom on the subject that at once is valuable to clinicians at all levels of experience and gives practical and effective help to the lay person in understanding and changing their destructive relationships with people who have severe and persistent personality disorders.

Ultimately, Fatal Flaws provides a message of hope. In many ways, this message it is not unlike what we find in other important works ranging from religious teachings to literature to moral philosophy or in resonant works of popular culture: always treat people with empathy, respect, and kindness, but remember to do so in a way that protects us from having serious and persistent relationship problems with those who may otherwise have many attractive qualities and positive attributes.

Drawing on the likes of Shakespeare, T. S. Eliot, Peter Yarrow, and Carly Simon, among others, Dr. Yudofsky shows how all of us can learn about the relationship between psychological well-being and emotional distress. Part text book and part self-help manual, this insightful and fascinating work guides us to master our passions rather than be enslaved by them so that we can become more humane and build a happier, more caring society.

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