Psychopathology
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Editorial Psychopathology JOHN GUNN As psychiatry concerns itself increasingly with brain structure and physiology it is good to be able to welcome a steady trickle of books on the somewhat neglected topic of psychopathology. ‘Diagnosis’ has come to be dominant in psychiatry before an adequate understanding of pathology is available. The reification of diagnosis is a problem in any branch of medicine but it can have serious unfortunate consequences in psychiatry and it requires an urgent study. In the meantime the good practical psychiatrist should fall back to psy- chopathology. Research teams investigating brain structure and physiology are increasingly using psychopathology as their markers; more accuracy and meaning can be obtained if structure and function are related to psy- chopathology such as particular types of delusion and hallucinations. Unfortunately the brain scientists won’t find a lot of meat within the cur- rent crop of books reviewed here but it is encouraging to note how behaviour in its broadest sense is coming back into the psychiatric frame. Politicians are annoyed when areas of pathology that are fairly obvious to them are ignored by psychiatrists and, in Britain at least, they’ve taken to inventing their own syndromes such as ‘dangerous severe personality disorder’ in a clumsy attempt to indicate that all pathology should be the concern of the medical world, not just pathology which fits conveniently into a current syndromic classification or theory. To regard behaviour which might lead to arrest as psychopathology has been for some years unfashionable and indeed frowned upon. After all we don’t want to be considered as inhabiting Erewhon, Butler ....) and behavioural abnormalities are, after all, very difficult to manage. As a result some very important medicosocial issues have been neglected. In this set of reviews Paul Mullen picks up on one of those neglected matters in two ways. He reviews a new book by J. Reid Malloy, The Psychology of Stalking, a book he calls ‘the first scholarly book on stalking’, while his own outstanding book, Stalkers and their Victims, is reviewed by Edward Petch. S42 Criminal Behaviour and Mental Health, 11, S42–S43 2001 © Whurr Publishers Ltd
Transcript of Psychopathology
EditorialPsychopathology
JOHN GUNN
As psychiatry concerns itself increasingly with brain structure and physiologyit is good to be able to welcome a steady trickle of books on the somewhatneglected topic of psychopathology. ‘Diagnosis’ has come to be dominant inpsychiatry before an adequate understanding of pathology is available. Thereification of diagnosis is a problem in any branch of medicine but it can haveserious unfortunate consequences in psychiatry and it requires an urgent study.In the meantime the good practical psychiatrist should fall back to psy-chopathology. Research teams investigating brain structure and physiology areincreasingly using psychopathology as their markers; more accuracy andmeaning can be obtained if structure and function are related to psy-chopathology such as particular types of delusion and hallucinations.
Unfortunately the brain scientists won’t find a lot of meat within the cur-rent crop of books reviewed here but it is encouraging to note how behaviourin its broadest sense is coming back into the psychiatric frame. Politicians areannoyed when areas of pathology that are fairly obvious to them are ignoredby psychiatrists and, in Britain at least, they’ve taken to inventing their ownsyndromes such as ‘dangerous severe personality disorder’ in a clumsy attemptto indicate that all pathology should be the concern of the medical world, notjust pathology which fits conveniently into a current syndromic classificationor theory.
To regard behaviour which might lead to arrest as psychopathology hasbeen for some years unfashionable and indeed frowned upon. After all wedon’t want to be considered as inhabiting Erewhon, Butler....) and behaviouralabnormalities are, after all, very difficult to manage. As a result some veryimportant medicosocial issues have been neglected. In this set of reviews PaulMullen picks up on one of those neglected matters in two ways. He reviews anew book by J. Reid Malloy, The Psychology of Stalking, a book he calls ‘thefirst scholarly book on stalking’, while his own outstanding book, Stalkers andtheir Victims, is reviewed by Edward Petch.
S42 Criminal Behaviour and Mental Health, 11, S42–S43 2001 © Whurr Publishers Ltd
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Stalking is a key issue for forensic psychiatry at the present time. It’s one ofthose matters that have annoyed politicians. Anybody can tell that the grosserforms of stalking are ‘mad’ or to be somewhat less colloquial represent mentalpathology. Yet there has been no place for considering this important socialand medical issue within the structures which have developed for psychiatryand we have found difficulty in classifying the behaviour. The fact that we arenow beginning to be able to classify antisocial behaviours more clearly, toassist some of the sufferers from certain types of antisocial behaviour, and torecognise that such annoying and victimising behaviour as stalking does also create suffering for the stalker, is a sign that we are beginning to movebeyond a very narrow view of psychiatry towards something which will appealmore directly to patients, to our paymasters and to the public. The bookPsychopathology and Violent Crime, edited by Andrew Skodal, should pick thisup but it seems to be something of a missed opportunity.
Sometimes we forget the centrality of the psychopathology of paranoia tomuch of psychiatry, all too frequently equating it simply with persecutorydelusions. Paranoia is a much wider topic than that and is at the basis of agreat deal of other secondary psychopathology. Paranoia in its broadest senseis a common feature of the mental states of individuals who undertake stalk-ing, for example. A new book on paranoia is therefore very timely and wehave a review of a psychoanalytically oriented book Even Paranoids HaveEnemies (a strange title given its content) by Berke and colleagues, reviewedby Tina Roberts. I’m still waiting for a book on the way in which paranoidmechanisms affect social and political life in general. That would be a fasci-nating contribution to the literature.
Paranoia undoubtedly plays its part in the psychopathology of violentcrime and it may also play a role in the so-called ‘Munchausen by ProxySyndrome’ although it does not seem to be prominently discussed in the bookof this title edited by Parnell and Day. Perhaps this is a further indication thatpsychopathology should regain its centrality in clinical psychiatry.Psychopathology includes careful observation, thorough description, and mostimportantly a closer understanding of meanings and mental mechanisms. Inthe longer term, psychopathology will, I venture to predict, become muchmore closely related to neuropathology. If it does this it will be the way inwhich neuropathology takes on meaning and it will be the route for the deliv-ery of psychological means of treatment.
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