Ivan Leudar, Philip Thomas

Brunner-Routledge, £15.99, pp 240 

ISBN 0 415 14787 5

Rating:

When I began training in psychiatry in 1982 I was taught that the form of patients' unusual experiences was usually more important than the content when making a psychiatric diagnosis. Despite this, one patient sticks in my mind.

This man had shot himself in the roof of the mouth in an attempt to rid himself of chastising voices which he thought came from the head of his late wife's doctor attached to his shoulder. It seemed to me that the content of these experiences might have been important in determining his behaviour.

Leudar and Thomas would have sympathised with my patient. Their book is an eloquent plea for us to take the experiences of voice hearers seriously and not to devalue them by categorising the content of their experience as meaningless, as the influential phenomenologist Jaspers suggested we should.

Organised into nine chapters and a brief conclusion, the book examines accounts of hearing voices from antiquity to the present day and critically analyses the views of 19th century and contemporary psychiatrists on the experience of hearing voices. The experiences of Socrates, Schreber, and Janet's patient Marcelle are considered in detail, as are contemporary patients with whom the authors have worked. Jaynes's extraordinary theories about the Homeric gods and the nature of consciousness among the heroes of the Iliad receive a detailed exposition and trenchant criticism. Jaynes is in good company. Slater and Roth get a thorough ticking off for failing to refer, in their 1969 textbook Clinical Psychiatry, to the work of members of the object relations school when dismissing psychoanalytic theory as a tool for illuminating psychotic states. A whole chapter is given over to the distorted image of voice hearers portrayed in British broadsheet newspapers in the late 1990s, while the malevolent effect of such portrayals on government attitudes and subsequent legislation is clearly expounded.

This is a radical book. Thomas is described in it as having a "highly critical position in relation to his chosen profession, because of the extent to which it is dominated by the medical model and clinical neuroscience." However, despite occasional use of the term "privilege" as a verb and repeated use of the word "narrative," it is, unlike many radical texts that take a postmodernist viewpoint, clearly written, cogently argued, and eminently readable.

I would be critical of the authors' reliance on translation when interpreting Greek primary sources, their use of the experiences of a rather unusual voice hearer from which to generalise some conclusions in Chapter 7, and their implicit assumption that modern psychiatrists tend to believe that any patient who has a first rank symptom described by Schneider is suffering from schizophrenia (many of us accept that some of these symptoms can occur in mania and other non-schizophrenic states). However, I will be advising my psychiatric trainees to purchase and read this book.

Where I come from, psychiatrists in general and trainee psychiatrists in particular tend to know too little of the philosophical basis on which much of their professional activity is founded and not enough of the history of their own profession. Reading this book would help them redress those deficiencies. If the experience gets them to listen to their patients better that would be a bonus, and if one or two of them read the Iliad in consequence it would be even better.

David Ames, associate professor of psychiatry of old age. 

Royal Melbourne Hospital, Australia