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The Journal of ForensicPsychiatryPublication details, including instructionsfor authors and subscription information:http://www.tandfonline.com/loi/rjfp19

Delusional Disorder:Paranoia and RelatedIllnessesJohn Cutting aa Consultant Psychiatrist, 7 DevonshirePlace, London , W1N 2PAPublished online: 09 Dec 2010.

To cite this article: John Cutting (2000) Delusional Disorder: Paranoia andRelated Illnesses, The Journal of Forensic Psychiatry, 11:2, 472-473, DOI:10.1080/09585180050142688

To link to this article: http://dx.doi.org/10.1080/09585180050142688

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schizophrenia in many cases is a lifelong illness, is this discontinuity a ‘goodthing’?

This book is a useful description of an innovative service. As the authorspoint out, however, what seems to work in urban Melbourne may not beappropriate elsewhere, especially in rural areas, such as Nithsdale where Ipractise. In Nithsdale, for example, the median age of onset of schizophreniais 36 years. The EPPIC model focusing on young patients would miss halfour patients.

R. G. McCreadie, DSc, MD, FRCPsych, director of clinical research and consultant psychiatrist,Crichton Royal Hospital, Dumfries DG1 4TG, Scotland, UK

Alistair Munro, Delusional Disorder: Paranoia and Related Illnesses,Cambridge: Cambridge University Press, 1999, £45 (h/b), 261 pp.

Cambridge University Press was advised by an elderly American psychiatristto publish this book by a retired Canadian psychiatrist. The result is on old-fashioned textbook on nosology. Why Cambridge University Press cannotwork out who is worth publishing among the young in Great Britain I cannotunderstand. My dealings with them suggest that they are only interested in‘textbooks that sell well’. Where is their British adviser?

Nosology is the study of categories of disease. In the psychiatric realm, thismeans the differentiation of ‘disease’ entities. As Professor Munro says, thenosological classi�cation codi� ed now in American manuals was set out byKraepelin a hundred years ago, but with the proviso that delusional disorder,paranoia, or atypical psychosis has been left in an anomalous position eversince. This is what the book is about. Are there sorts of madness which arecategorically different from the � ve sorts generally recognized as indepen-dent categorically – schizophrenia, mania, depressive psychosis, delirium,dementia?

This argument has been going on ever since I started psychiatry 25 yearsago, and will no doubt continue for a good few years yet. It is an importantargument, and I credit Professor Munro with having kept it alive for severaldecades. He himself is emotionally committed to nosological independence,probably overly so:

The book has two main purposes . . . [� rst] to gather together what weknow about delusional disorder . . . the second is to hammer home [myitalics] the point that this is a very real illness which causes a great dealof suffering.

But these days, and it was apparent to Kraepelin and Bleuler as well, noso-logical categories must be underpinned by some measure independent of the

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say-so of a psychiatrist, however eminent. Kraepelin and Bleuler tried to vali-date their schemes with both neurological and psychological theories. In thisenterprise they were entirely correct, although neither the neurological northe psychological theories at their disposal were up to the task. That was nottheir fault. On the contrary, they homed in on the most contemporarytheories that they knew about. What is peculiar about recent attempts atnosology, including this book, is that virtually no acknowledgement is givento either neurological or psychological theories advanced since the start ofthe twentieth century.

Nosological entities, or rather ‘proposed’ nosological entities, must belinked with either philosophical, psychological, or neuropsychological facts,or, preferably, all three. Otherwise, as in Munro’s formulation, they are either‘valid’ because an eminent psychiatrist, however eminent, says that they arevalid; or because they have a response to treatment that is allegedly differentfrom that of the ‘typical’ psychoses, an argument that Munro makes much ofhere; or because they have a different outcome from their ‘typical brethren’.All these issues were dealt with admirably years ago in Kendell’s (1975) bookon diagnosis. What needs to be currently addressed is the completely revol-utionary way in which the nosology within psychiatry is being tackled. Thethree ways, overall, comprise the philosophical, the psychological and theneuro-psychological. There are numerous books on the matter, none ofwhich is covered here.

Cambridge University Press, having eschewed any British contribution totheir library here, have been left with an outdated, nineteenth-century book.When will British publishers learn to respect their compatriots and appreci-ate what the twentieth century was all about?

Dr John Cutting, MD, FRCPsych, consultant psychiatrist, 7 Devonshire Place,London W1N 2PA

REFERENCE

Kendell, R. E. (1975) The Role of Diagnosis in Psychiatry. Oxford: Blackwell.

HM Prison Service and NHS Executive, The Future Organisation ofPrison Health Care, London: Department of Health, 1999, free(p/b), 101 pp.

National television news on the evening of 3 October 1999 showed the HomeOf�ce minister for prisons and the director of prison health care in the gate

REVIEW S 473

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