Psychological Concepts and Biological Psychiatry: A Philosophical Analysis. By P. Zachar. (Pp. 340; $39.95.) John Benjamins: Amsterdam. 2000.

Some years ago I attended a lecture given by the then outgoing President of the Royal College of Psychiatrists. The topic was the future role of the consultant in ‘general adult psychiatry’. The take homemessages were that consultants would become increasingly acquainted with neuroscience but see fewer patients ; wouldmanage teams but see only ‘difficult cases ’ ; that psychotherapy would be ceded to psychologists (and would comprise only cognitive behavioural therapies). Nowadays, I meet trainees who are disenchanted with the state of psychiatry. Journal clubs spent picking apart company-sponsored drug trials lack the sustenance of a good paper by Freud; out-patient clinics are sometimes perceived as prescription services. Has the biological paradigm been ‘too successful ’? The risk is that the perceived reductionism of the current paradigm may precipitate a reactionary flight into a narrow, psychodynamic obscurantism. The book under review may go some way towards encapsulating the disquiet felt by some of these psychiatrists in training. Peter Zachar’s text is part of a series entitled Advances in Consciousness Research and, throughout, he argues for a space for psychological description, theory and practice in contemporary psychiatry. His theoretical opponents reside among the ‘biomedical materialists ’ (of psychiatry) and ‘eliminative materialists ’ (of philosophy). These authors appear to argue for a radical reduction of the first person, subjective world of experience (and ‘folk belief ’) to a third person, objective world of scientific measurement and data (‘broken brains ’). Proponents of the latter view purvey a form of ‘scientism’ (below), which is narrow in its purview and heavily dependent upon analogies with the more neurological end of psychiatric practice. Hence, if it can be argued that all mental disorders are really brain disorders akin to general paresis of the insane (GPI) or traumatic brain injury (TBI), then what is really required for their treatment is invariably a biomedical solution. There is no point ‘wasting time’ on psychological understandings when physical treatments are required. Zachar pulls at the seams of each of these assertions, eventually demonstrating that theymay be unravelled. However, the biomedical materialists may also go on to espouse moral justifications for their project : biomedical perspectives on psychiatric conditions will reduce blame and stigma, harsh treatments will be curtailed ; while psychological theories and treatments unfairly burden sufferers. This is a Utopian quest that sufficient knowledge of genetics and neurophysiology will serve to instantiate. How much of this is true? Is it all just ‘scientism’? ‘Scientism is the (implicit) presumption that, in addition to the superiority of scientific methodology, the more rigorously and exclusively we use the scientific approach in any endeavor, the more superior the product’ (Zachar, p. 115, emphasis added). Zachar’s response is a measured, careful and (perhaps) overly long consideration of the evidence. He is explicit in stating his bias : he is for a ‘broadly considered co-evolutionary perspective, which accepts multiple levels of analysis, explanatory pluralism, the ecology of neuroscience, andmolar explanation (in the evolutionary sense of the term)’ (p. 269). He shows that the most rigorous diagnostic systems rely for their application upon the elicitation of subjective information, describing the mood or perceptions, that empathy and understanding are central topractice, and thatpsychiatric diagnoses do not resemble ‘natural kinds’. Instead, Zachar posits that our diagnostic categories comprise ‘practical kinds ’ : prototypical descriptions, of clinical utility but not equivalent to ‘ultimate reality ’. Hence, investigators must be careful to avoid the reification of concepts they may misapply. Zachar argues that a diagnosis has multiple uses : providing a common language Psychological Medicine, 2003, 33, 369–374. f 2003 Cambridge University Press Printed in the United Kingdom