Until a few years ago most writing on personality disorder made for dismal reading. The reference list consisted of all the usual suspects and, however great one's respect for the man, it had to be accepted that a topic was dead when the last word on it came from Aubrey Lewis. Happily, things look different now, with a flurry of legislative activity and a growing body of research. It would be comforting to believe that this change represented the coming of age of psychiatry. Has the profession realised at last that difficult patients do not go away just because one ignores them? Well, no. Like many comforting beliefs, this one would be untrue. Most credit should go to the government, for forcing us to confront a problem that had been ignored for too long.
This development may have unfortunate consequences, as the Government must be tempted to ignore psychiatry completely. While the impulse is understandable, this would be a serious mistake, for two reasons. First, psychiatrists had good reason to be wary of the compulsory treatment of someone's personality, and a workable solution will have to deal with many of these concerns. Second, if the ‘big idea’ amounts to locking up all the bad people before they commit their offences, the government needs all the advice it can get. After all, if the solution was so simple, other (democratic) countries would have adopted it already. This book shows that the solution is far from simple. It shows that progress is likely to be made over the long-term, through properly funded research and treatment programmes. There is little encouragement here for anyone who is looking for a quick and dramatic answer.
In less than 100 pages the book summarises the state of our knowledge about offending and personality disorder. The matter of fact tone tells a depressing tale of children who are the victims of poor or cruel parenting, made worse by exclusion from schools. They graduate to offending of varying degrees, before forming and breaking dysfunctional relationships that serve to complete the cycle.
Despite its origins as the work of a College committee, it is concise and readable throughout. The authors have synthesised a wide range of views to produce a consensus that is nicely balanced between, on the one hand, acknowledging our limitations and, on the other, pointing the way forward. They spell out the difficulties facing researchers and clinicians in this area, without ever being tempted to throw up their hands in horror and abandon the challenge. This book should be in your library. If you are thinking of a research project, you should have read it already. If you are involved in providing a psychiatric service, you should read it soon. If you are thinking of making laws in this area, you should read it twice.
Open access
eLetters
No eLetters have been published for this article.