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Book Reviews   |    
Understanding and Treating Schizophrenia: Contemporary Research, Theory, and Practice
Reviewed by Benjamin Crocker, M.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.6.762-a
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by Glenn D. Shean, Ph.D.; Binghamton, New York, Haworth Press, 2004, 336 pages, $44.95

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I found reading this book to be worthwhile and interesting, an experience that significantly expanded my understanding of the varieties of points of view about schizophrenia.

In his preface, author Glenn D. Shean, Ph.D., explains that this book is intended as an overview, not as an exhaustive review of the literature. I found most of the chapters very readable, and I appreciate the author's pattern of summarizing the important points at the end of each chapter; he does this clearly but in a manner that keeps the reader's interest. I especially found the chapters on the neurophysiology of schizophrenia easy to follow, given that I an not fluent in CNS anatomy.

Understanding and Treating Schizophrenia: Contemporary Research, Theory, and Practice looks at schizophrenia from a variety of theoretical and historical perspectives, beginning with the history of the concept in Europe and the evolution of the DSM diagnosis. I found these chapters helpful, especially in the presentation of the evolution of Kraepelin's point of view over time, having spent a couple of years as an amateur professor telling medical students a cartoon version of his differentiation of the schizophrenias from the affective disorders. I was surprised to find that, in the chapter on epidemiology, the author does not mention the effect of paternal age on the incidence of this disorder, but otherwise I found his review thorough and balanced, as was his handling of course and outcome. The chapter on medication was clear and up to date.

Reading this book reminded me how limited my education about schizophrenia has been compared with the mood and anxiety disorders. The author spends several chapters reviewing psychodynamic and family systems theories about schizophrenia and its treatment and is pretty clear about some of the weaknesses in the research that led to these now largely discounted ideas. Shean's respectful but objective treatment of these theories seems to follow from an open-mindedness about schizophrenia that seems apt given our continued difficulties in coming to consensus about what the term means. He spends several pages on Kingsley Hall and Soteria in the same chapter in which he discusses the more accepted program for assertive community treatment (PACT) and Fountain House models but does not touch on current controversies about fidelity and efficacy of PACT. In the book's final chapter, "Schizophrenia and Life in the Community," the author touches only briefly on the importance of employment in rehabilitation, and overall it is difficult to find reference to concepts of recovery, which is a significant omission. The only direct quotes in the book from patients are from people who are actively psychotic; the longitudinal first-person voice is lacking.

As the blurbs on the back cover suggest, this is a book more for students and academics than for frontline clinicians and the average lay audience. That having been said, I appreciated reading the book, because its clarity and accessibility persuaded me that I have a residual student or academic persona that comes out every once in a while between the e-mails, the drug-company dinners, and the immediacy of clinical work.

Dr. Crocker is the medical director of the behavioral health program of the Maine Medical Center Physician Hospital Organization in Portland.




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