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Book Reviews   |    
Handbook of Self and Identity
Reviewed by Stephen M. Thielke, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.9.1071
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edited by Mark R. Leary and June Price Tangney; New York, Guilford Press, 2002, 703 pages, $75

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Handbook of Self and Identity is dynamite. It compiles and synthesizes research about the self, broadly defined as the reflective capacity of humans to be, in William James' original typology, both "I" and "me," subject and object, knower and known. The contributors are mainly research psychologists (none is a physician) presenting findings from the past 30 years. The discipline of self research challenges the hegemony that behaviorism has held for the past century. I believe it has deeper roots (in humanism and philosophy), stouter branches (of validated research), and choicer fruit (in clinical and personal relevance) than behaviorism. It stops short of blowing behaviorism away, but it certainly shakes its foundation.

As a psychiatry resident, I am exposed to many psychodynamic, cognitive, and behavioral theories, but I have never encountered anything like this material. It took me a while to adapt to a different vocabulary and conceptual framework in reading this book, but I soon found these theories to be well-researched, consistent, and profoundly relevant. Roughly, they address how we see ourselves and others, what motivates us, and how our behaviors and thoughts affect and are affected by our reflective capacities. These are heady and philosophical issues, but psychological research has elucidated them brilliantly, often with counterintuitive findings. Unlike much of the other theory I am learning as a resident, this material has sprung from and withstood the test of empirical research.

Although several chapters address personality disorders, the book has virtually no clinical content, much less discussion of how to carry out therapy. Yet almost every finding relates uncannily to the issues my patients bring to sessions. I found the chapters on self-evaluation, self-knowledge, self-systems, and emotions particularly meaningful in helping me understand what my patients are saying. These models have a testable predictive utility that is not often found in post hoc psychodynamic analyses. Transference is treated very lucidly and directly in the context of self-evaluation and capacity to change.

More personally, the relevance of this book to my beliefs and habits made me uneasy. After reading several chapters at a cerebral distance, I realized, "Wait, all this stuff applies to me too, and not flatteringly." In particular, thinking about what it means to stake worth on accomplishments instead of attributes, and to value performance instead of mastery, called into question the hypercompetitive scramble guiding me into and through our profession. Much of the research, when applied to myself, was downright scary, and led me to wonder deeply who I am, how I construe myself and the world, and what I hope for and suggest to my kids. Had I read this book at other times, especially during medical school, it might have trashed my sense of self. I expected it to be a pure thinking cap, but it was a blasting cap too. I doubt I am alone in this; let the reader beware.

The editors' care and scrutiny are evident throughout this attractive volume. The book is well-organized, well-indexed, and easy to read. It would be of interest to anyone who works in mental health as well as to a broader audience.

Dr. Thielke is a third-year resident in psychiatry at the University of Washington School of Medicine in Seattle.

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