Hong Kong J Psychiatry. 2002;12(1):23-24
BOOK REVIEW
Authors: Tyrer P, Sterberg D
John Wiley & Sons Ltd, Chichester, 1998.
US$49.95; pp146, ISBN 0-471-97433-1
“Those who imprison themselves within the conf ines of one model only have the perspective of the keyhole”. This is probably the reason why Tyrer and Steinberg wrote this small book, and updated it with a third edition in 1998. Psychiatry is not yet an exact science. It accommodates a range of disciplines and it is often not easy to find out if a statement represents fact, theory, or opinion. In order to explain psychiatry, it is necessary to use models that offer the practitioner a consistent approach that justifies treatment or investigation.
Following a thought-provoking introduction, individual chapters are devoted to disease model (often wrongly termed ‘medical’ model), psychodynamic model, behavioural model, cognitive model, and social model in psychiatry. The authors use plain language to help readers understand many basic issues that could otherwise be quite profound and complicated.
In the corresponding chapters, typical clinical situations are interpreted using the models, highlighting the advan- tages and disadvantages of each model in practice. Readers readily appreciate that the same clinical problem can be conceptualised by different models, and dimensions in understanding and intervention are correspondingly widened.
The disease model is particularly appropriate for psychoses in which identif iable disease already exists. The psychodynamic model helps to understand aspects of both normal behaviour and symptomatology that otherwise appear meaningless.
The social model shows that mentally ill people, particulary those with neuroses and personality disorders, cannot be considered in isolation from their families, and social and cultural background. The behavioural model is at its best in explaining and treating some aspects of neuro- tic illness that lead to abnormal patterns of behaviour, and the cognitive model shows the importance of irrational thoughts in much of mental illness.
Although such models are probably familiar to most practising mental health professionals, the book uncovers many underlying assumptions and the implications for each model. Clinicans often use a particular model without awareness of hidden assumptions that they have made about their patients. By exploring such fundamental conceptual issues, one can reflect on many aspects of our daily habitual practice that we have taken for granted.
The book elegantly depicts the conflicts and difficulties that professionals from different conceptual perspectives encounter when they come together to discuss the formula- tion and management of a particular patient. Instead of f itting patients rigidly and uncomfortably into diagnostic pigeon holes as ‘atypical’, the book reminds us of the possibility of adopting alternative conceptual perspectives that may alleviate this clinical uneasiness and perhaps bring in useful interventional ideas.
I particularly like the f inal chapter in which the authors attempt to bring about a ‘correlative model’. Levels of func- tioning and hierachy of models are involved so that a multi- dimensional and harmonious model could be worked out. Teamwork, consultation, and models of care are discussed in the context of this integrative model. Of course, the key is still when and where to use a particular model to get the best from it.
Although the book is said to be targetted at students of social work, psychology, and medicine, I think advanced practitioners will still find it useful and refreshing.
Dr Patrick Kwong
Chief of Service and Consultant Psychiatrist
Kwai Chung Hospital
Hong Kong, China
