Downing Street Blues: A History of Depression and Other Mental Afflictions in British Prime Ministers

Abstract

Downing Street Blues: A History of Depression and Other Mental Afflictions in British Prime Ministers By Jonathan Davidson. McFarland. 2011. US$45.00 (pb). 228pp. ISBN: 9780786448463

Starting with Walpole in 1721, Downing Street Blues finishes with Blair in 2007. It is directed at specialist and

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Starting with Walpole in 1721, Downing Street Blues finishes with
Blair in 2007. It is directed at specialist and general readers and
its plain language, remarkably free of jargon, means it should
have wide appeal. It is also appropriate that its author, Jonathan
Davidson, trained as a psychiatrist in the UK before moving to
the USA. Also that he, with two colleagues at Duke University,
was the author of a widely respected study of psychiatric disorders
and their effects on all US presidents up to Richard Nixon. Among
British prime ministers, 72% had psychiatric problems at some
time in their lives.
Davidson asserts he had access to more extensive biographical
detail on which he based his assessment in the UK. The most
fascinating of the prime ministers written about is Gladstone
and, understandably for the Grand Old Man of British politics,
it is also the longest entry. Gladstone experienced 15 depressive
episodes and while there was mania, the author writes, ‘it is
unlikely that he succumbed to the greater extremes of bipolar
disorder, but milder manic (i.e. hypomanic) forms of illness are
distinctly possible, and his temperament is quite in keeping with
this notion’. Self-flagellation and his religious zeal to ‘save’ women
led to numerous encounters with prostitutes. In 1851, he set up 12
meetings with one particular woman in a 3-week period and spent
two ‘strange, questionable hours with her after which he flogged
himself’. In 1852–1853 he had 120 encounters. When a man tried
to blackmail him, he ‘brazenly marched the man to a police
station’. His extraordinary relationship with the ‘courtesan’ Mrs
Thystlethwaite which lasted from 1864 till 1870 meant he ‘pushed
the concept of platonic love to the extreme’ and they explored
spiritualism together.
There are many other captivating pictures of politicians working
through their mental illness and in some cases being strengthened in
their role as prime minister. This book is important in convincing
the general public that mental illness is not something to be
ashamed of or hushed up. Rather, it is common and affects people
in all walks of life, and can be managed and even controlled.
David Owen The House of Lords, Westminster, London SW1A 0PW, UK.
Email: lordowen@nildram.co.uk
doi: 10.1192/bjp.bp.111.094920
Woods is very clear at the outset of this book what her aims are: ‘a
study of schizophrenia in theoretical texts . . . of how the concept
of ‘‘schizophrenia’’ is represented in specific disciplines, and of
how, at the meta-discursive level, these representations reveal
some of the complex relations between the disciplines’ (p.2).
For this purpose, the term ‘sublime’ refers to ‘something that
exceeds or exists beyond our capacity for comprehension and
representation’ (p. 8), and ‘because it threatens to overwhelm
our sense of self, the sublime initially inspires in its subjects
feelings of awe and terror, but these . . . are then superseded by
the sense of delight that comes from mastering the perceived
threat’ (p. 8).
The first section of this book deals with clinical theories
deriving from Kraepelin and Freud. Woods correctly sums up
the position with regard to our understanding of the patho-
physiology and treatment of schizophrenia, namely that there is
much yet to learn and that no cure exists at present. But, she
understates the progress in knowledge since Kraepelin’s day. For
one, treatments are by any definition better, even if there are
troubling side-effects and incomplete benefit. The main issue is
that while correctly summing up, although correct in her
summing up, Woods tends towards exaggeration. For instance,
she says that within psychiatry schizophrenia is ‘framed as an
opaque and bizarre disorder of unknown or unknowable
aetiology, it exceeds and thus marks disciplinary limits as a form
of unreason which can be neither adequately represented nor
analytically mastered’ (p. 63).
Central to her examination of the psychoanalytic understanding
of schizophrenia are Freud and Lacan’s analyses of Daniel Schreber’s
Memoirs of My Nervous Illness. Woods’ point is that these analyses
are dependent on text, indeed a particular and singular text, and
that, like all literary texts, Schreber’s Memoirs supports manifold
interpretations and is seemingly symbolically inexhaustible. She
deems it a sublime text within psychoanalysis.
The second section deals with cultural theory starting off with
the antipsychiatry movement, focusing on Szasz, Laing, and the
duo of Deleuze and Guattari. These writers serve only as a prelude
to Woods’ exploration of the works of Louis Sass and Baudrillard.
She expends considerable time on Bret Easton Ellis’ novel
Glamorama. There is a growing body of work that equates
modernity and/or postmodernity with schizophrenia. It is never
clear whether these cultural analyses are using schizophrenia as
a metaphor, that is, are taking aspects of the experience of patients
who experience schizophrenia and carrying these over to describe
features of modern or postmodern society. Sometimes, the
arguments veer in the direction of merging the tenor with the
vehicle, a form of concretisation of a poetic image. At other times,
413
Edited by Allan Beveridge, Femi Oyebode
and Rosalind Ramsay
The British Journal of Psychiatry (2012)
201, 413–418
Book reviews
Downing Street Blues:
A History of Depression
and Other Mental
Afflictions in British
Prime Ministers
By Jonathan Davidson.
McFarland. 2011.
US$45.00 (pb). 228pp.
ISBN: 9780786448463
The Sublime Object
of Psychiatry:
Schizophrenia in Clinical
and Cultural Theory
By Angela Woods.
Oxford University Press. 2011.
£34.99 (pb). 272pp.
ISBN: 9780199583959

the arguments assert that modern or postmodern society causes
schizophrenia because of the similarities that have been identified.
In all this, what is lost is the distinction to be drawn between
objects being similar and being identical. Or, the distinction
between a lion in the Serengeti and an image of a lion emblazoned
on a football jersey. Discussions about the one and the other may
have points of intersection but are distinguishable.
This is a compelling book. It draws widely and is full of novel
ideas and interpretations. It definitely shows how varied and
disparate are the uses and understandings of the term
‘schizophrenia’. It ought to be read, if only to appreciate the
cultural history of the term ‘schizophrenia’.
Femi Oyebode Professor of Psychiatry, University of Birmingham, National
Centre for Mental Health, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG, UK.
Email: Femi.Oyebode@bsmhft.nhs.uk
doi: 10.1192/bjp.bp.111.107243
This fascinating book is a collection of papers by the American
psychiatrist and psychoanalyst Otto F. Kernberg. He has a long
track record in psychotherapy research and has written extensively
on psychoanalytic theory (linking it to neurobiology) and
contemporary issues facing psychoanalysis and psychoanalytic
trainings. All of these areas are covered within this book, which
is divided broadly into five sections.
Parts 1 and 2 describe aspects of the work involved in the
diagnosis and treatment of the most severe personality disorders,
particularly severe narcissistic psychopathology. This is not a
description of the research work, which is well-referenced, but
more a focus on clinical experience and the development of new
psychotherapeutic techniques that have arisen from his research.
One of the chapters in this section describes the way in which
manualised transference-focused psychotherapy (TFP) principles
have been applied to psychoanalytic group psychotherapy in both
day hospital and in-patient settings. These initial chapters give
very detailed theoretical aspects and clinical examples of this work
and, usefully, contrast TFP with mentalisation-based therapy
(MBT), the brief evidence-based treatment perhaps more
commonly used in the UK for this group of patients.
The first part includes very useful chapters on the assessment
and treatment of narcissistic personality disorder, which emphasises
the pervasive nature of envy and the impact of this on the patient,
treatment and therapist. Kernberg points out that when working
with very severe personality disorder, the safety of the therapist is
paramount and takes precedence. As he says, the work cannot be
done if the therapist is not safe, and techniques need to be adjusted
in line with this. He makes the point that although this might seem
‘obvious or trivial’, it is often the case that therapists finds themselves
seduced into a treatment situation with these patients in which their
safety is actually at risk. He goes on to describe how one might
decide between different psychotherapeutic approaches ranging
from supportive treatments and cognitive–behavioural therapy,
to individual psychodynamic psychotherapy and psychoanalysis,
depending on the psychopathology of the patient. Chapters on
countertransference and the use of supervision bring together issues
for the therapist and the supervisor in treating this patient group.
I was interested to see that the use of videotapes of psychotherapy
sessions is, as with MBT, seen to be the gold standard in terms of
supervision of psychoanalytic psychotherapy with this patient
group. Although limiting his comments to this particular patient
group, he says that on the basis of 30 years’ clinical and research
experience, his findings are that patients readily accept video
recording, as long as they have been appropriately informed and
reassured about confidentiality.
Parts 3–5 of this book range across a broader field. Part 3 is
concerned with the psychology of sexual love, Part 4 with
contemporary challenges for psychoanalysis and Part 5 with the
psychology of religious experience. In these chapters he moves
between describing sexual pathology in patients with borderline
personality disorder to a powerful description of the factors involved
in the capacity for mature sexual love. The chapters on the sexual
couple and the limitations to the capacity to love are fascinating.
This attention to aspects of more ‘ordinary’ relationships is
to my mind beautifully crystallised in the chapter titled ‘Some
observations on the process of mourning’. This is a moving
description of mourning the loss of a long, loving relationship.
Kernberg acknowledges that this was initiated by his own painful
experience of mourning his late wife. This led him to question
what he felt were some generally assumed characteristics of grief
and mourning in the psychoanalytic literature. He describes many
questions stemming from this which he addressed both by
reviewing his past clinical experiences and by interviewing a
number of people who had experienced the loss of a spouse after
a long, happy relationship. He describes an awareness of the
relative paucity of work focusing on normal mourning in the
analytic literature, particularly on the losses of spouses. Using
many examples he crafts a beautifully direct, emotionally powerful
description of this loss and the gradual incorporation of the lost
object into the experiences and behaviours of the individual
who has lost. He concludes by describing normal mourning as a:
‘permanent, not a transitional, process that leads to structural psychic changes
manifest in typical conscious experiences and behaviours. This conclusion runs
counter to the present psychoanalytic view of normal mourning and considers
mourning as an ongoing psychological process that fosters emotional growth and
increases the capacity for commitment to new love relationships’.
The questioning of psychoanalytic theory as described in this
chapter is clearly present throughout this volume. It illustrates
Kernberg’s ongoing curiosity and determination to research and
question all levels of his craft. These include the minutiae of
individual clinical interactions and range through the
relationships of psychoanalysis with universities and the ways in
which psychoanalytic organisations function and struggle. He
moves fluidly between internal object relationships, patient–
therapist relationships and organisational dynamics. The book
ends with two chapters about religion and spirituality in relation
to psychoanalysis. Again, these describe and critically review the
psychoanalytic literature and end with a conclusion that there is
a need for integrating and understanding of these areas into our
understanding of normality and pathology rather than using
414
Book reviews
The Inseparable Nature
of Love and Aggression:
Clinical and Theoretical
Perspectives
By Otto F. Kernberg.
American Psychiatric Publishing.
2012. £39.00 (pb). 380 pp.
ISBN: 9781585624287

science and reason as a way of replacing religion and spirituality.
These are challenging notions but powerfully argued.
Overall this is a broadly ranging book. At times it is academically
dense and at times emotionally moving. I was left with a picture of
a man who was curious, intellectually challenging of established
theory and practice, and unafraid to question deeply held views.
His arguments are intellectually rigorous, extensively researched
and intellectually erudite. Although not a book for reading from
cover to cover, it does offer ample opportunities for visiting a wide
variety of areas concerning love and aggression. The book is not
always an easy read, but it does repay the effort involved.
Siobhan Murphey Southern General Hospital, Department of Psychiatry,
1345 Govan Road, Glasgow G51 4TF, UK. Email: siobhan.murphy@ggc.scot.nhs.uk
doi: 10.1192/bjp.bp.112.110015
Near-death experiences are a fascinating phenomenon, often
shrouded in mystery and spirituality. The aims of this book are
to give examples of this experience across different cultures and
age ranges and to explore how this presents and can be managed
in everyday clinical practice. Furthermore, and most interestingly,
the book explores some of the possible scientific explanations
behind this occurrence. The book as a whole was easy to read,
and the structure made it very easy to dip in and out of. However,
there was considerable repetition that was probably unavoidable
given that this is a multi-author text.
A few chapters are dedicated to explaining the origins of
near-death experiences. At times, these biological explanations
are very basic for the medically trained professional. However,
some explanations that attempt to enlighten how the mind may
exist independently of the body derive from quantum physics.
This possibility has profound implications for our concepts of
consciousness and, potentially, even life and death themselves.
So how does this book help us as psychiatrists? The intense
effect a near-death experience has on a person after such an
event is often what we may have to deal with in what is a
surprisingly common experience. Also, we need to understand
such presentations to ensure we do not misdiagnose someone as
having a mental illness on this basis. However, the true strength
of the book does not lie with its application to clinical practice,
but in the introduction to the biological and physical possible
origins of such events. This turns this phenomenon from
something you would only hear about in science fiction to
scientific possibility. However, as the book acknowledges, there is
still a lot of work to be done, but what fundamental repercussions
this further work may have for us as psychiatrists and human
beings cannot be underestimated – this book makes you believe
that there just may be something more to this, and historic times
may lie ahead. This is a truly thought-provoking read.
Rebecca Russell Birmingham and Solihull Mental Health NHS Foundation Trust,
Birmingham, UK. Email: rebecca.russell@bsmhft.nhs.uk
doi: 10.1192/bjp.bp.112.110155
This book is the latest volume of the series ‘Very Short
Introductions’, which covers a diverse range of topics from biblical
archaeology to witchcraft. It is written by two brothers, Daniel and
Jason Freeman, the former a consultant clinical psychologist and
the latter an editor and author specialising in popular psychology
and self-help.
Over the course of 11 chapters, the Freeman brothers cover the
psychoanalytic, behavioural, cognitive and neurobiological
theories of anxiety, before dedicating a further chapter to each
of the major anxiety disorders, such as generalised anxiety
disorder, panic disorder and obsessive–compulsive disorder. The
final chapter describes the treatment options available, before
presenting the reader with a number of self-assessment
questionnaires, references and suggestions for further reading.
One of the appealing features of this book is the way in which
it colours hard fact and theory with interesting historical asides,
while peppering references to anxiety in literature, television and
film alongside references to anxiety disorders in peer-reviewed
journals.
The inclusion of case studies, as well as first-person narratives
from household names such as Michael Palin, compliments some
of the more heavy concepts and facts presented and helps put
them into context. It also provides the reader with an identifiable
figure with whom to relate and empathise with.
As a core trainee between part I and part II of the MRCPsych
examinations, I found this book a refreshing read, putting into
perspective information I had read from other sources with a
more solid but dry academic grounding. My only criticism is that
I am unsure of who the ideal reader for this book would be. In a
sense the book suffers from a Goldilocks-type dilemma. It is not
rigorous or comprehensive enough for medical students or
trainees working towards their MRCPsych, yet I wonder whether
it would be a little too academic for the average member of the
public.
415
Book reviews
Making Sense
of Near-death
Experiences:
A Handbook for Clinicians
Edited by Mahendra Perera,
Karuppiah Jagadheesan
& Anthony Peake.
Jessica Kingsley Publishers. 2011.
£18.99 (pb). 176 pp.
ISBN: 9781849051491
Anxiety:
A Very Short Introduction
By Daniel Freeman
& Jason Freeman.
Oxford University Press. 2012.
£7.99 (pb). 155 pp.
ISBN: 9780199567157

However, it was an enjoyable read as an adjunct to core texts. I
would also recommend this book to patients with a relatively high
level of education and an interest in learning more about anxiety.
David McLaughlan Bloomsfield Centre, Guys Hospital, South London
and Maudsley Trust, London SE1 9RT, UK. Email: david.mclaughlan@slam.nhs.uk
doi: 10.1192/bjp.bp.112.117127
The International Psychoanalytical Association (IPA) was founded
in 1910. At that stage there were fewer than 100 members, most of
whom were friends or colleagues. Despite its modest size there was
no shortage of prestige – it was founded by Sigmund Freud, on an
idea proposed by Sa
´ndor Ferenczi. The first president was Carl
Jung and its first secretary was Otto Rank. Other founding
members included Max Eitingon and Karl Abraham. Today, it is
an association that counts 12 000 psychoanalysts as members
and works with 70 constituent organisations. It is recognised as
the world’s primary accrediting and regulatory body for
psychoanalysis and takes an active role in the development of
psychoanalytic thought and practice throughout the world.
2010 was the centenary year of the IPA and is marked by the
publication of this book, a collection of essays from 41 of the
member nations, each describing their own history and develop-
ment within their particular geographical area. The psychoanalytic
world is broadly split into four within the book: Europe, North
America, Latin America and Asia and Oceania together.
The book begins with an essay from the Viennese branch of
the IPA and the subsequent chapters trace the story of the
growth and development of not just the IPA, but psychoanalytic
thought and practice, outwards from Vienna and across the globe.
It thus provides not just a history of the constituent member
organisations, but an interesting account of the interplay between
the social, cultural and political factors that both shaped, and were
shaped by, the spread of an understanding of the unconscious.
For those with an interest in psychoanalysis or psychotherapy,
the rich historical detail and the linking of advances to the context
of the time provides both a fascinating read and much to consider
in terms of how and why psychoanalysis in the reader’s own patch
may have reached where it has. For those working within the
National Health Service (NHS) in the UK today, the book serves
as a timely reminder of how the history of psychoanalysis is one
of periods of enthusiasm and uptake followed by waning interest
or attack, often to the point that it seems as though survival is
threatened. Splits and divisions are commonplace. Throughout,
however, is a clear message that in some form or another
psychoanalytic thought and practice not only survives, but spreads
and grows.
The collected histories of the member organisations provide
many examples of how survival often requires history to be
processed to allow the required change. Also highlighted is the
need for innovation and to remain responsive to the environment
of the time, including a flexible approach as to how treatments
and training are not only funded, but structured. Edith Kurzweil
is quoted in the history of German psychoanalysis, making the
point that a country gives rise to the form of psychoanalysis it
needs. The example of the growth of psychoanalysis in China since
the end of the Cultural Revolution (where there is now a rigorous
3-year analytic training for psychiatrists and psychologists)
illustrates not just this sentiment, but the importance of creating
a training programme capable of providing the treatments that a
country can use at that particular point in time.
For the reader without a particular interest in psychoanalysis
or psychotherapy there is still much of interest and relevance
within the book, especially in the current climate of enforced
change and upheaval within the NHS. Reading the book leaves
one in no doubt as to the importance of the emotional life of
an organisation and how this can affect its functioning. The value
of holding onto the history, in particular the importance of the
‘primal scene’ of an organisation to its subsequent growth and
development, is illustrated time and again. The histories of those
groups who had their primal scenes or conceptions in the product
of a forced marriage or a brutal takeover – and how those traumas
affected not just their emotional life, but their smooth running
until the trauma was processed – seems particularly relevant when
similar events seem to be happening within different parts of the
NHS today. It is in this area that the book, and the IPA, provides
an eloquent and convincing argument for the importance of
continually developing a rigorous and structured approach to
understanding the present through an honest appraisal of past
and current emotions, conscious or otherwise.
Paul MacAllister Specialist Registrar, Wells Road Centre for Community Forensic
Psychiatry, Wells Road, Nottingham NG3 3AA, UK. Email: paul.macallister@nottshc.
nhs.uk
doi: 10.1192/bjp.bp.111.107169
The memory of R. D. Laing, the most famous British psychiatrist
to date, refuses to fade almost 25 years after his death. In 2011, a
plaque was unveiled in his honour at his childhood home in
416
Book reviews
100 Years of the IPA.
The Centenary History
of the International
Psychoanalytical
Association, 1910–2010:
Evolution and Change
Edited by Peter Loewenberg
& Nellie L. Thompson.
Karnac Books. 2011.
£45.00 (pb). 570pp.
ISBN: 9781905888160
Portrait of the
Psychiatrist
as a Young Man
The Early Writing
and Work
of R. D. Laing, 1927–1960
By Allan Beveridge.
Oxford University Press. 2011.
£39.99 (pb). 384 pp.
ISBN: 9780199583577

Govanhill, Glasgow, on what would have been his 84th birthday.
His memory has also been reinvigorated by this new intellectual
biography of the early Laing by Allan Beveridge, another
Glasgow-born psychiatrist with a broad interest in the arts and
humanities. This volume is an important addition to the Laing
literature, a body of work where one might have imagined all
had already been said, because it synthesises primary research
undertaken in the Laing archive at Glasgow University Library
Special Collections with an in-depth understanding of both
Laing’s published work and the secondary literature on Laing from
both academic sources and popular accounts.
One of the joys of the book is its use of extensive quotes from
Laing’s unpublished notebooks, including some entitled ‘Elements
for an Autobiography’. Laing did publish a first instalment of his
autobiography in Wisdom, Madness and Folly. The Making of a
Psychiatrist, 1927–1957, which also included a section on his
views of mainstream psychiatry at the point of publication in
1985, 4 years before his death. The near match between the years
covered by Beveridge’s biography and the autobiography allows
for an exploration of where notes made by Laing at the time,
diverge from his retrospective account many years later. The
tendency by Laing to overplay the uniqueness of his insights
and to play down the contribution of those around him is a theme
of recent Laing scholarship that is brought out, once again, in this
work by Beveridge. The complexity of this issue is well handled,
and to read this book is to be left in no doubt that Laing was a
serious and committed thinker from an early date and some of
the theories that were to come to fruition in The Divided Self were
already being rehearsed at medical school in prize-winning essays.
Evidence is presented in an analysis of what Laing both read and
retained in his library, of a precocious and driven scholar who,
unusually for a medical student, was more interested in
literature, theology and European philosophy than in science.
Laing read and wrote daily, denying himself sleep in his pursuit
of the frontier of philosophy which he hoped to extend. The
Glasgow of his formative years was fertile soil to cultivate these
interests, with the young Laing joining a mixed group of older
men – including some such as Abenheimer and Schorstein with
direct connections to thinkers admired by Laing such as Jaspers
and Heidegger – to discuss philosophy.
The final ingredient for the mixture that was to produce
Laing’s seminal 1960 publication was clinical practice and research
and, as in the autobiography, the experiences of the neurosurgical
unit, the army psychiatric unit, the mental hospital, the
department of psychological medicine and the move to the
Tavistock Clinic are all covered in detail. The 1950s was a pivotal
decade for modern psychiatry, adding to the interest of this book.
Again, a fascinating aspect of this book is the comparison of notes
made on patients contemporaneously, to be found in the Laing
archive, with the later incorporation of the shortened, anonymised
and reinterpreted case histories in Laing’s published work. An
impression is formed of a dedicated clinician trying to do the best
for each individual in his care. The approach continues with
Laing’s move to London despite Laing having doubts as to his
initial practice there, removed from his primary interest in the
psychotic state.
Of particular interest for myself is the account of Laing’s 18
months at Gartnavel Royal Hospital and his relationship with
the Physician-Superintendent, Angus McNiven, there. We are
at the tipping point of institutional psychiatry and Laing’s
contribution, along with others, to the movement towards closing
the asylums is one of his main legacies, along with the strong
advocacy that the severely mentally ill have a legitimate voice.
The book leaves us with Laing – a psychiatric Icarus (see end
of Chapter 1) – fully winged and about to take flight with the
publication of The Divided Self in 1960. We are left with an
insightful and fresh account of the making of this particular
psychiatrist, with the biases of our knowledge of Laing’s
subsequent divisive reception kept to a minimum.
A finer memorial birthday present would be hard to imagine.
Iain Smith Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH,
UK. Email: iain.smith@ggc.scot.nhs.uk
doi: 10.1192/bjp.bp.111.103473
What makes a good psychiatrist? Is it a bonus to like your
colleagues? What does depression mean? What is it like to be a
professor of psychiatry? Disparate questions find disparately
satisfying answers in this lively but disjointed book, part memoir,
part polemic, by a grizzly Australian academic who early on
defines his role with consummate clarity as one of ‘a prickly
bastard who keeps asking questions and won’t shut up’.
The biographic opening speeds through early decades, carried
by a fluent, informal style. Parker’s emotive recall of events is
interesting; his use of ‘closure’, for example, seems to overlap with
justice and satisfaction. En route from medical school to
professorial chair, via a detour into comedy writing, he paints a
fondly detailed picture not only of Australian psychiatry but of
Australian culture at an interesting time. Readers familiar with
the world of psychiatry – not necessarily Parker’s target audience
– may take perverse comfort from the fact that stigma, petty
managerialism and vested interest have long bedevilled the efforts
of psychiatrists all over the planet. Parker delights in bringing
them to book, although his method is curiously unfunny for a
comedy writer.
His definition of a good psychiatrist is unashamedly
Hippocratic. Like any other branch of medicine, he contends,
the art and science of the craft lies in pattern detection; the
recognition of shifts and signs in the suffering that enable a
physician to do something useful. Where the suffering is mainly
mental, the patterns may be much harder to recognise. He
expands on this idea as he approaches his main theme, the
diagnosis and treatment of depressive disorders. Here the relaxed,
thoughtful tone gives way to a didactic voice which is clumsy at
first. A re
´sume
´of the research paradigms that led to his grand
oeuvre reads like a cut-and-paste from 20 years’ worth of grant
applications, but over the next 60 pages the scholarly style finds
its stride in a cogent analysis of depression as an illness. Those
who worry about the medicalisation of distress in the DSM era
417
Book reviews
A Piece of My Mind:
A Psychiatrist
on the Couch
By Gordon Parker.
Pan Macmillan Australia. 2012.
AUD $13.63 (pb). 347pp.
ISBN: 9781743345320

will find much to support the growing concern that the diagnostic
shift from validity to reliability may be more costly than we realise.
Parker responds by sketching out a return to an evidence-based
diagnostic formulation, based on pattern recognition. A portrait
rather than a sketch would have been welcome here.
Finally, he describes how his disillusion with the psychiatric
establishment prompted him to approach businessmen and
politicians directly, setting up an institution dedicated to mood
disorder treatment and research that practised as Parker preached.
His Black Dog Institute has evidently gone from strength to
strength. The same cannot be said for his fluency in the last
section of the book. He serves the reader with a salad of opinions,
vignettes and excerpts from earlier publications, sprinkled over an
essay on the style and substance of psychiatric practice that feels
incomplete, but consistent with a life spent giving people a piece
of his mind.
The true hero of this biography is Australia itself. Parker paints
a picture of a rich, creative Western culture that for all its success
retains a willingness to care for its mentally ill and do something
about it, all the way from clinic to parliament. The understanding
of mood disorders and their management has a long and troubled
history. Anyone with an interest in its future will gain from this
idiosyncratic book.
Mark Salter Consultant Psychiatrist, East London NHS Foundation Trust, London,
UK. Email: mark.salter@eastlondon.nhs.uk
doi: 10.1192/bjp.bp.112.110551
418
Book reviews

10.1192/bjp.bp.111.094920Access the most recent version at DOI:
2012, 201:413.BJP
David Owen
Afflictions in British Prime Ministers
Downing Street Blues: A History of Depression and Other Mental
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