Creating a textbook of general psychiatry at the beginning of the 21st
century requires many tough choices. First, identifying the intended audience—medical
students, residents, members of the profession, or others. Second, is the
book to be written by one person or a small group with a single voice and
"philosophy," or by many different experts, sacrificing coherence and a consistent
perspective for subspecialty excellence? Third, what are the appropriate boundaries
of contemporary psychiatry? There may be agreement at the core, but should
a psychiatry text include molecular genetics, neuroimaging, basic statistics,
health economics, hospital administration? Related to this, many areas of
psychiatry are defined and described in accordance with conventions that vary
from country to country and region to region. Should the text use DSM-IV, ICD-10, both, or neither? Is the discussion
of treatment by a shaman to be classified as a standard therapy or a cultural
variant? What about psychoanalysis, or electroconvulsive therapy, or behavior
therapy for homosexuality? Fourth, how should the book be organized? Is the
management of the suicidally depressed child best discussed under the topics
of child psychiatry, mood disorder, treatment, suicide, emergency psychiatry,
or all of the above? How does one guide the reader, and, for that matter,
the authors, through such a maze? Finally, what is to distinguish this text
from others; what is its special flavor or unique contribution?