Four years in the making, this entirely revised edition of a classic text provides a lucid and erudite review of the state of psychiatry today. Since the publication of the last edition in 1988, remarkable advances have been made in laboratory and clinical psychiatric research; the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has been published; managed care has radically altered the provision of all medical care; and the profession of psychiatry has come to a sophisticated new understanding of the interplay between psychiatric knowledge and issues in the larger society.

All these changes are reflected in the new text. Of particular interest are the masterful and lucid reviews of current knowledge in the neurobiology of mental disorders, in the section on brain and behavior. The section on psychopathology clarifies newly emerging diagnostic categories and offers new insight into addictions, anxiety disorders, and disorders of cognition.

Like its predecessors, The Harvard Guide To Psychiatry focuses throughout on the relationship between the physician and the patient. Its unspoken motto is that the art of psychiatry is as important as the science. For this recognition of what is relevant clinically as well as technically, this book will be an essential reference and support for both the new and the experienced psychiatrist.

This new edition includes up-to-date discussions of:DSM-IVManaged careImprovements in neuroimagingThe increased use of psychoactive drugsRecent advances in molecular biologyResearch on the biology of schizophrenia, depression, anxiety, and addictive disorders

Where madness meets the law, history leaves no easy verdict.

Homicidal insanity has remained a vexation to both the psychiatric and legal professions despite the panorama of scientific and social change during the past 200 years. The predominant opinion today among psychiatrists is that no correlation exists between dangerousness and specific mental disorders. But for generation after generation, psychiatrists have reported cases of insane homicide that were clinically similar. Although psychiatric theory changed and psychiatric nosology was inconsistent, the mental phenomena psychiatrists identified in such cases remained the same. The central thesis of Homicidal Insanity is that as psychiatric theory changed, psychiatrists regarded these phenomena variously as symptoms of mental disease or the disease in itself. It is possible to trace these phenomena throughout the history of Anglo-American psychiatric theory and practice. A secondary thesis of the book is that psychiatrists have used these phenomena as predictors and markers in the practical matters of preventing insane homicide and of testifying in the courts to defend the irresponsible and expose the culpable.

For 200 years, scientific and philosophical disagreement raised controversy and brought the issues to public attention. Still, to this day no rational method exists to discriminate the dangerous from the harmless in matters of involuntary commitment, nor insanity from crime in the courts.

Most psychologists claim that we begin to develop a “theory of mind”—some basic ideas about other people’s minds—at age two or three, by inference, deduction, and logical reasoning.

But does this mean that small babies are unaware of minds? That they see other people simply as another (rather dynamic and noisy) kind of object? This is a common view in developmental psychology. Yet, as this book explains, there is compelling evidence that babies in the first year of life can tease, pretend, feel self-conscious, and joke with people. Using observations from infants’ everyday interactions with their families, Vasudevi Reddy argues that such early emotional engagements show infants’ growing awareness of other people’s attention, expectations, and intentions.

Reddy deals with the persistent problem of “other minds” by proposing a “second-person” solution: we know other minds if we can respond to them. And we respond most richly in engagement with them. She challenges psychology’s traditional “detached” stance toward understanding people, arguing that the most fundamental way of knowing minds—both for babies and for adults—is through engagement with them. According to this argument the starting point for understanding other minds is not isolation and ignorance but emotional relation.