I well remember the climate of 1970s psychiatry — a clash of the old and the sort-of-new. The old was represented by the ‘buried treasure’ theory, which ruled supreme — care more, try harder and insights will be revealed. With revelation, cure. Schizophrenia, however, was stubborn. Either I was slovenly and callous, for my caring was not catching, or this view was manifest rubbish.
The sort-of-new had logic and vitality. Biological psychiatry was nothing more than a new attempt at old challenges but technology did offer the prospect of putting Bleuler, the great analyst, to the test. Was schizophrenia a brain disease, as he believed?
For inquisitive humans there is nothing so convincing as that which can be seen. Better still if it can be measured. The arrival of what was then called the EMI scan — now known as the CAT scan — offered just that prospect. Not that psychiatry was ready for what it showed. It took 3 years for Johnstone et al's first report of ventricular enlargement to be replicated. This was ground-breaking stuff. How we ooh'd and ah'd in awe at the grainy images, with the definition of impressionist paintings, and marvelled at our abilities to get statistical significance from measurements that involved everything from tracing paper to a semi-automatic counter rejected by haematology as obsolete!
The application of imaging in schizophrenia is no longer for curious amateurs: it is now peppered with physicists, experimental psychologists and artificial intelligence whiz-kids. This useful little book aims to orient those not familiar with this field, yet whose clinical material forms its core, to both the technology and the findings. It outlines with brevity and clarity the basics of each of the principal imaging methods, structural and functional, and provides an overview of conclusions so far. Its style is highly readable, although its infectious enthusiasm must be tempered by the knowledge that conclusions remain provisional and circumscribed. One of the requirements of a monograph, the provision of an up-to-date reference list, is richly fulfilled. Most readers will be familiar with structural images, examples of which add little, while most will be unfamiliar with functional and spectroscopic material and what is illustrated here is unlikely to enlighten. None the less, reproductive quality is superb.
The price of a night out and a couple of hours of time are all this book asks, and neither is too great. Trainees will find it useful as a primer for exam purposes and old timers a valuable account of where things are — even if they aren't!
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