Psychodynamic Psychiatry in Clinical Practice, 3rd ed

From our regular book review column.

This third edition of Glen O. Gabbard’s seminal textbook comes 10 years after the first (1990) and 6 years after the second (1994). Taken as a group, the 3 editions chronicle the evolution of psychodynamic psychiatry from the introduction of the "atheoretical" DSM-III in 1980 to the current era of evidence-based medicine and psychotherapy competency determinations. As Gabbard (Introduction) and Robert Wallerstein, M.D., (Foreword) note in the first edition, the era of DSM-III/DSM-III-R (1987) was fueled by the rise of biological, genetic, and epidemiologic psychiatry and modern psychopharmacology. Many gains accrued to psychiatry and to the mentally ill through this "remedicalization" of psychiatry. The era was, however, also characterized by the polarization of biological and psychodynamic approaches in psychiatry and by the increasing marginalization of training in psychotherapy and psychodynamic thought in psychiatric training programs. Perhaps, as Wallerstein suggested, the notion that biological understanding and remediation were sufficient for effective treatment was a common illusion. In any case, the editors at American Psychiatric Publishing, Inc., and Dr. Gabbard recognized that our patients’ treatments would suffer if psychodynamic thinking was lost in the sea of remedicalization change. Subsequently, this 3-book sequence was launched.