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The British Journal of Psychiatry (2012)

200, 167172

Book reviews
uncontentious landscape. But it is not uncontentious; by his
writing Ronson trivialises, and in the end stigmatises, not just
Edited by Allan Beveridge, Femi Oyebode personality disorder and psychopathy, but the whole of mental
and Rosalind Ramsay illness, in the search for cheap laughs and better sales. I urge him
to change tack and use his talents to write a proper non-fiction
novel on a subject where his humour can be put to better purpose.

The Psychopath Test Peter Tyrer Centre for Mental Health, Department of Psychological Medicine,
Imperial College (Charing Cross Campus), St Dunstans Road, London W6 8RP, UK.
By Jon Ronson. Email: p.tyrer@imperial.ac.uk
Picador. 2011. 16.99 (hb). 304pp.
ISBN: 9780330492263 doi: 10.1192/bjp.bp.111.099580

Maladapting Minds:
Philosophy, Psychiatry,
and Evolutionary Theory
International Perspectives
in Philosophy and Psychiatry.
Edited by Pieter R. Adriaens
& Andreas De Block.
Oxford University Press. 2011.
34.95 (pb). 344pp.
ISBN: 9780199558667
Jon Ronson is a journalist, quite a good journalist, with a nose for
a story and a ready wit. The story he describes in this book, a
journey through the madness industry, as it is described on the
cover, is quite a convoluted one. It begins with the investigation
of a strange package sent to neurologists at University College
Hospital, which reads like the beginnings of a John le Carre novel.
During this investigation he becomes drawn into the strange
world of DSM, scientology and psychopathy. A scientologist friend
introduces him to a man who faked madness at Broadmoor The title of this multi-author text places it as a successor to two
Hospital. But of course the man is not mad; he is a psychopath. now classic texts, one on evolutionary psychology (The Adapted
So our intrepid writer, a latter-day Candide, decides to unravel Mind, 1992) and the other on evolutionary psychiatry (The
psychopathy by seeing all the experts in the condition and asking Maladapted Mind, 1997). Although each of these three volumes
them innocent questions like why does wearing a sharp suit is by different editors, they have some authors in common, for
indicate that someones a psychopath? and why do psychopaths example Randolf Nesse and John Price.
dream in black and white?. Eventually he gets the answer Compared with evolutionary psychology, which has numerous
Bob Hares psychopath test, and we get all 20 items of the test periodicals and a large following, evolutionary psychiatry is very
listed and explained. Armed with this new insight he goes to the much the poor relation. There still is not a single peer-reviewed
guru himself and ends up drinking with Bob in a hotel bar in journal worldwide dedicated to evolutionary psychiatry, nor is
rural Pembrokeshire, where he learns how to administer this test there, to my knowledge, a single university course that teaches
as part of a training course. He then spices up his account with a the subject. Hence this publication is to be welcomed.
series of interviews with a mass murderer, a corporate chief The book comprises a foreword by Geoffrey Miller, an
executive whose main joy was firing people, and an MI5 spy, introductory chapter by the editors and 11 further chapters. Both
before returning to Broadmoor to release the man who faked the foreword and the introduction provide an excellent overview
madness, and then returning to the John le Carre mystery, of evolutionary psychiatry as a subject and a useful and informed
unsolved. resume of the rest of the book. The editors raise the pertinent and
The book is an easy read and seems quite harmless. But it is thorny question of whether evolutionary psychiatry is good
sloppy and disconnected, and even the author recognises this in science. Given that one of the books aims is to explore the
a criticism from a colleague, you take a little bit of craziness from philosophical aspects of psychiatry and evolutionary theory, and
up there and a little bit of craziness from over there and then you given the scepticism that psychiatrists have shown towards this
stitch it all together. The trouble is that the craziness includes not new discipline, it is helpful to frame the question in this manner.
just psychopathy, but schizophrenia, depression, bipolar disorder, The books contributors views differ, at times diametrically so.
drug misuse, LSD treatment-induced conditions, obsessive Unusually for a book on evolutionary psychiatry, there are two
compulsive disorder, autism, and attention-deficit hyperactivity chapters that present arguments critical of the Darwinian
disorder, so the uninitiated reader is quickly lost. More approach. The authors of one of these chapters are critical of
botheringly, the book pretends to be factual but uses all the the whole adaptational paradigm that attempts to identify
devices of the non-fiction or faction novel, with detailed function and dysfunction from an evolutionary standpoint,
quotations from the people he interviews that are frequently preferring instead the mechanistic breakdown model prevalent
inaccurate (I know, as I have checked) and have been refashioned in the rest of medicine where function is considered to be designed
to make a more rumbustious read. Ronson makes fun of almost to keep a given system in homeostasis. Although I applaud the
everybody he writes about but most of the time he gets away with authors for giving space to critics of some of the prevailing
it as he is equally deprecating about himself. All this would not theories in evolutionary psychiatry (specifically Marks and Nesses
matter if the book were just a pleasant romp through an theory on anxiety and phobia), in the light of disconfirming

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Book reviews

evidence I would question the appropriateness of publishing the along with more innovative fair. Like in any multi-authored
anti-Darwinian analysis in this kind of book when it could have publication there are variations in quality of contributions. A
found a place elsewhere, in any number of publications critical couple of chapters are clinically naive and a rather poorly put
of the evolutionary approach to psychiatry. together rehash of previously published reviews. However, there
The heart of the book is in the chapters that deal with the are also well-written chapters by prominent authors in the field.
major conceptual questions. These include the role of ethology I found several gems, such as an excellent overview of the biology
in understanding mental disorder and in identifying human, of dysfunctional circadian rhythms and mood disorders by
species-specific psychological traits. There is a chapter evaluating Norman and an exciting chapter on chromatin-based treatments
an evolutionary framework for determining the nature of for affective disorders by Covington & Berton. Martin et al write
mental disorder through the application of Wakefields harmful really well on the role of the oft-forgotten 5-HT2C receptor in
dysfunction analysis and one proposing evolutionary foundations antidepressant action and provide a fairly comprehensive review
for psychiatric diagnosis and a new basis for psychiatric of the current evidence base. Cannons chapter on neuroimaging,
classification. Finally, there is a chapter exploring the limitations albeit rather textually dense, is superb if you are short of ideas for
of evolutionary theory in identifying the line of demarcation grant applications for research in this area.
between normality and disorder. These chapters would be of Would I recommend this book? There is little for the clinician
interest to any reader who wishes to reflect on the meaning of interested in new insights to assist their work in the clinic, with
mental disorder and on the shortcomings and limitations of just two relatively lightweight chapters relating to current clinical
current psychiatric diagnosis, whether or not they have an interest practice. Otherwise, the science described may influence treatment
in Darwinian theory. These chapters are very well written and are in the future, most likely in at least a decades time. For scientists
accessible to the non-specialist. working in the area, much of the views and data described can be
A further chapter presents an interesting hypothesis to explain found by searching the published literature. However, the book is
the gender differences in empathy that lie at the root of the higher a useful quick and easy source of information, especially for the
prevalence of autism-spectrum disorders among males. This real anoraks interested in the pathophysiology and treatment of
proposes that in the ancestral environment males remained with depression.
their kin group (philopatry) forming kin-based male coalitions,
whereas females migrated on sexual maturity to a different group R. Hamish McAllister-Williams Institute of Neuroscience, Newcastle University,
and thus needed to bond with non-kin. Additionally, males Academic Psychiatry, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 6BE,
UK. Email: r.h.mcallister-williams@ncl.ac.uk
regularly engaged in intergroup violence whereby empathy had
to be switched off . It is therefore argued that the pay-offs of doi: 10.1192/bjp.bp.111.092403
empathy were drastically different for males and females and
they were, therefore, subject to distinct selection pressures.
Evolutionary formulations on depression, schizophrenia and
sexual imprinting in humans are also discussed.
The Paradoxical Brain
This is not an introductory text for anyone new to the subject
of evolutionary psychiatry, nor is it a book that one would Edited by Narinder Kapur.
Cambridge University Press. 2011.
necessarily read from cover to cover in a single sitting. Each 65.00 (hb). 488 pp.
chapter is self-contained and can be read separately without ISBN: 9780521115575
reference to the rest of the book. Would I recommend it? Yes, I
certainly would. So long as the reader remembers that not all
chapters are of equal worth or quality.

Riadh Abed Consultant Psychiatrist, Rotherham District General Hospital, Moorgate


Road, Rotherham, South Yorkshire, S60 2UD, UK. Email: abedrt@btinternet.com

doi: 10.1192/bjp.bp.111.097360

Depression:
From Psychopathology
to Pharmacotherapy
Edited by J. F. Cryan The ancient Greek term paradoxon is composed of the prefix
& B. E. Leonard. para (against) and the word doxa (opinion) and literally means
Karger. 2010. beside belief or contrary to expectation. Explaining what we
US$148.00 (hb). 274pp. currently know about brain function by means of paradoxes
ISBN: 9783805596053
brain findings that are counterintuitive and go against the grain
of established neuroscientific thinking can appear a paradoxical
exercise itself. However, this original, entertaining and informative
approach has been successfully undertaken by Narinder Kapur
and a panel of leading researchers in the fields of clinical and
cognitive neuroscience.
Featuring a foreword by Oliver Sacks, this multi-authored
volume covers a wide range of brain paradoxes across different
The book is well structured and reasonably comprehensive in its disciplines. Clinical neuropharmacology informs clinical
coverage. It comprises chapters on the hypothalamicpituitary epileptologists about the paradoxical worsening of seizures by some
adrenal (HPA) axis, brain-derived neurotrophic factor (BDNF) anti-epileptic drugs (e.g. carbamazepine in absence seizures). One

168
Book reviews

of the most controversial issues in neuroepidemiology is the situation and what this means for this particular individuals life.
paradoxical, yet consistent observation that an increased Now, it could be argued that what the project of narrative
proportion of tobacco smokers in a population correlates with a medicine is striving for is only relevant to internal medicine and
lower risk of developing Parkinsons disease. An intriguing chapter the surgical specialties. For, psychiatry by definition is as much
on comparative cognition presents paradoxical experimental about objective facts as about the meaning that both patients and
findings showing that chimpanzees can identify more digits than their psychiatrists attribute to the facts of psychiatric disorders.
a human could ever do in a single glance, and remember their Bradley Lewiss thesis is that there is intrinsic poverty in the
location (photographic memory). Throughout the book there offerings of biopsychiatry, despite its ascendancy as an intellectual
are elegant examples illustrating how brain damage or sensory loss driving force in psychiatry and its triumph over psychoanalysis in
can result in better-than-normal performance. Specifically, the the USA. For Lewis, narrative psychiatry seeks a deep and
chapters on creativity and accomplishments in both neurological empathic understanding of the patient as a person (p. 74), and
(e.g. epilepsies, neurodegenerative dementias) and psychiatric appreciates that the process of recovery often involves reauthoring
conditions (e.g. psychoses, affective disorders, autism) invite the and retelling the stories of our lives (p. 74). He argues that
reader to focus on the uniqueness of the individual patient and narrative psychiatry is aware of the use of medication and the
their positive potentials, rather than thinking solely in terms of distinction between disease and illness. But, more significantly,
the disorder. that narrative psychiatrists are . . . self-reflexively adept at a
Paradoxes about the brain are intellectually stimulating narrative understanding of the many stories psychiatrists tell as
and have both negative and positive implications. A negative they are at understanding the stories of psychic life that their
implication is that these findings inevitably remind us that our clients tell (p. 74).
current understanding of brain function is limited and overall It is a truism that storytelling is at the heart of human life.
primitive, especially in comparison with what we know about Lewis makes the point that some understanding of narrative theory
other, less paradoxical organs. The positive aspect is that these the pervasive place of metaphor in language and its impact on com-
paradoxes are enlightening examples of exceptions to, or munication, and the role of plot and character in the management of
anomalies in, our current theories on brain functioning in both time and action in narration is important for clinicians. He
healthy people and neurological patients, thus suggesting future distinguishes between thin and thick stories; the former being
avenues for neuroscientists to develop better theories. These the account summarised by clinicians and the latter the rich, com-
theories will likely result from what Thomas Kuhn called paradigm plex and involved account consisting of the particularities of a life.
shift and will therefore be characterised by higher explanatory Lewis succeeds in making a case for a narrative approach in
powers to improve our understanding of brain function in health clinical psychiatry. However, I am not persuaded that one need
and disease. Will our endless attempt to uncover the secrets of accept or appeal to Foucault to see the benefits of narrative theory
brain function and to develop theories that carve nature at its joints to clinical practice, nor that the arguments of post-psychiatry or
leave us with fewer brain paradoxes? Maybe so, paradoxically. the recovery movement are germane to his thesis. Storytelling is
an integral part of human life. We all do it effortlessly, more or
Andrea E. Cavanna Department of Neuropsychiatry, University of Birmingham and
less, in exactly the same way that we all use language. But like
Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, and language, we may need to be reminded of the unobtrusive
Institute of Neurology, University College London, UK. Email: A.Cavanna@ion.ucl.ac.uk infrastructure on which stories are built. For this reason alone,
doi: 10.1192/bjp.bp.111.103432 Lewiss book is very much welcome.

Femi Oyebode The National Centre for Mental Health, Birmingham, 25 Vincent
Drive, Edgbaston, Birmingham B15 2FG, UK. Email: femi_oyebode@msn.com

doi: 10.1192/bjp.bp.111.097394
Narrative Psychiatry:
How Stories Can Shape
Clinical Practice
By Bradley Lewis. A Mind Less Ordinary:
The Johns Hopkins University
My Experience of Living
Press. 2011.
US$50.00 (hb). 240pp. with Anorexia and
ISBN: 9780801899027 Schizoaffective Disorder
By Tanya J. Sheldon.
Chipmunkapublishing. 2011.
12.00 (pb). 132pp.
ISBN: 9781849915274

The project of narrative medicine is to emphasise subjectivity and


the particular in the consideration of a patients condition. This
approach is in contrast to the usual objectifying and universalising
lens of modern medicine. In other words, the doctors interest and
concern ought to be as much about the objective facts about Patients often search for the reasons behind their illness. They try
cancer of the colon, for example, as about how the unique to pinpoint and record the changes in their mental state as they
individual in front of him or her subjectively experiences their occurred and to work out what improved their circumstances

169
Book reviews

and what made them worse. Patient memoirs, including Sheldons, tables!), include recent developments in the field and limit the
are no different. What sets her account apart, however, is that her references to a minimum (at best 25 references). The result is a
medical background makes her more aware of the process of collection of chapters with themes ranging from family and systemic
mental illness as she passes through it. influences through literacy disorders to paediatric psychopharm-
Although Sheldon has never practised, her medical degree acology. This is a remarkable feat given that this is a slim volume
informs her understanding of her mental health now and during (290 pages of text including references). Most of the contributors
the many trials she has faced along the way. In a lucid, confessional are well-known names in child and adolescent psychology and
style she produces a record of her experiences while considering the psychiatry, mainly, but not exclusively, from the UK and Ireland.
psychopathology, diagnosis and treatment of her anorexia and schizo- The book is divided into seven sections: developing
affective disorder. Her intention is to give the reader insight into competencies; promoting well-being; attachment and separation;
mental illness as medics would themselves experience and analyse it. the impact of trauma and maltreatment; atypical development;
For the clinician, most interesting are Sheldons criticisms of assessment; and approaches to intervention. It is targeted at both
her care. She is critical of her treatment by ex-colleagues, of child and adolescent psychiatrists and clinical child psychologists
misapplied diagnoses and treatment regimes, such as at the and their respective trainees. The editors have succeeded in
specialist eating disorder centre she attended, which seemed to making the topics relevant to both groups and, in fact, the mix
her cruel in the level of discipline it demanded. Her criticism is of chapters is one of the strengths of the book. The quality and
not intended to shame those that have treated her. Instead her usefulness of the chapters, however, vary widely from those that
intention is that through accurate recollection of events as they are outstanding to others that are prosaic and ordinary. The
occurred she will be able to inform her reader, whether patient chapters on anxiety disorders in children and adolescents,
or clinician. Many will feel that as unique and moving as Sheldons childhood behaviour problems, eating disorders and family
struggle has been, these are sadly stories that they hear every day. therapy assessment are rather basic. The chapter on psycho-
Certainly, Sheldon provides a history of depression, anorexia and dynamic approaches does not do justice to the subject. It would
psychotic illness that would be familiar to most people working in have been more useful if some chapters had addressed specific
mental health. If anything, her account suffers from her effort to aspects of the topic rather than the whole subject.
make it as concise and clear as she can. It often seems as if she However, Muter & Snowling provide a first-rate account of
holds back from describing important aspects of her life, such literacy disorders that includes both dyslexia and reading
as her family situation, to push on in her story. comprehension disorder. Conti-Ramsden & Durkins chapter on
Sheldons account does not have the weight of accounts like specific language impairment is an elegant summary of the topic.
William Styrons Darkness Visible, on his experience of depression, Early-onset bipolar disorder by James is an admirable account of
nor is it the only book available by a mental health professional on the current state of knowledge on the subject, and Tayors chapter
their experiences of mental illness (Undercurrents by Martha on diagnostic classification describes the issues facing child and
Manning, a clinical psychologist, is a good example). However, adolescent psychiatry masterfully and is opportune at a moment
it does describe a unique and brave battle by a patient with a when DSM and ICD are going through revisions. For these
complicated list of psychiatric problems much closer to home. chapters alone, the book is worth buying. A strength of the book
Despite Sheldons lack of experience, her background provides a is that the 46 short chapters provide something for everyone
route to refresh the empathy of a tired clinician by allowing them practising child psychology and psychiatry.
a glimpse of what it might have been like for them to go through
what their patients have experienced. Muthusamy S. Thambirajah Consultant Child and Adolescent Psychiatrist, Dudley
and Walsall CAMHS, Evergreen Place, 18 Lichfield Street, Walsall WS1 1TJ, UK. Email:
muthusamy.thambirajah@dwmh.nhs.uk
Samuel Ponnuthurai Foundation Trainee Year 1, Barts and The London NHS Trust,
correspondence c/o British Journal of Psychiatry, 17 Belgrave Square, London SW1X doi: 10.1192/bjp.bp.111.103374
8PG, UK. Email: samuel.ponnuthurai@gmail.com

doi: 10.1192/bjp.bp.111.099523

Ageing and Older Adult


Mental Health: Issues and
Child Psychology Implications for Practice
and Psychiatry: Edited by Patrick Ryan
Frameworks for Practice & Barry J. Coughlan.
Routledge. 2011.
(2nd edn) 21.99 (pb). 296pp.
Edited by David Skuse, ISBN: 9780415582902
Helen Bruce, Linda Dowdney
& David Mrazek.
Wiley-Blackwell. 2011.
39.99 (pb). 304 pp.
ISBN: 9780470973820

This is a most unusual and curious book. It took me quite a while


to work out its frame of reference, relax and start to appreciate
The editors of this book seem to have set an arduous task for the what it has to offer. Ultimately, I concluded that it challenges
contributors: provide an account of the chosen topic in a the lenses we commonly use to consider mental health in older
condensed form limited to an average of five pages (including people, making it quite a thought-provoking read.

170
Book reviews

The editors, both senior lecturers in clinical psychology at the of self-harm (the head, limbs and genitals each warrant their
University of Limerick in Ireland, aim to present the reader with own chapter), and examining different beliefs, practices and
discussions of mental health issues in old age within the context customs across the world, Favazza brought into a very public
of normal as well as problematic development across the lifespan. discourse a previously unmentionable topic.
They are upfront about their intention to provide a collection of The third edition, although 40 pages shorter, retains most of
chapters that pay attention to understanding the positive and the aforementioned trove of information, while also summarising
salutogenic aspects of ageing. These aims are achieved in part as the subsequent decades of academic and clinical endeavour into
we read about the potential of theories, such as Eriksons lifespan the prevention and treatment of self-harm. Notable additions
developmental theory, attachment theory and the dual process include an in-depth discussion of the social forces behind the
model of assimilative and accommodative coping, to shed light exponential increase in tattoos and body modification observed
on thinking about matters such as adjusting to bereavement or in modern popular culture, as well as the pivotal role the internet
to life in care. In this respect, the book succeeds in drawing these now plays in providing information about self-harm, including
ways of thinking to the fore. treatment for people who self-harm and their families. Thousands
In other respects, when I was not finding the book fascinating, of websites, chat rooms and forums dedicated to self-harm have
I found it frustrating. There are many spelling errors, a paucity of been created since the second edition was published in 1996.
tables or figures (four in the entire volume) and considerable The latest edition includes Favazzas personal reflections on his
repetition between chapters, with population demographics and career-long exploration of self-harm and body modification, in
the basics of Eriksons theories being the main victims. It promises which he reaffirms that there is hope for those whose lives have been
to appeal to students, educators, practitioners and policy-makers, overtaken by such potentially destructive behaviours. The book ends
yet its coverage of fundamental research evidence is often sketchy with a fascinating epilogue by Fakir Musafar, a pioneer of the modern
and sometimes superficial the chapter on treatment of mental primitive body modification movement, who discusses the
health issues, for example, tries to cover treatment of major attractions, dangers and possibilities represented by such behaviours.
conditions within sections of just 13 paragraphs each; that on My only criticism of the book is that Favazza confusingly uses
carers fails to acknowledge the role of spouses; whereas that on a number of interchangeable terms for self-harm, the preferred
assessment mistakenly cites the Mini-Mental State Examination UK term. Indeed, the proliferation of terms describing the same
as an assessment of mood. Students should not rely on this book phenomenon has arguably held back research in this field. Overall,
for basic education in this field, nor should professionals rely on it however, the book is very well written and extremely informative,
for an update on the latest research or practice. and Favazza has produced a refreshingly honest and objective
This book lacks polish but it is a bit of a rough diamond. I feel account of self-harming behaviour. It is, as stated by Favazza,
it needs to be read as a collection of interesting essays rather than more than a catalogue of horrors; 25 years on, it is still an
as a conventional text. important publication in this challenging area of psychiatry and
a particular strength of the third edition is its comprehensive
Jan R. Oyebode Director, Clinical Psychology Doctorate, School of Psychology, (26-page) reference list, which spans more than 130 years of
University of Birmingham, Edgbaston, Birmingham B13 8DL, UK. Email:
j.r.oyebode@bham.ac.uk
literature about self-harm. There is much to be learned from this
book and, for clinicians or academics working with people who
doi: 10.1192/bjp.bp.111.095166
self-harm, it is an invaluable resource. Highly recommended.

Rohan Borschmann Postdoctoral Research Worker, Health Services and


Population Research Department, Institute of Psychiatry, Kings College London,
Bodies under Siege: De Crespigny Park, London SE5 8AF, UK. Email: rohan.borschmann@kcl.ac.uk

Self-mutilation, doi: 10.1192/bjp.bp.111.103440


Nonsuicidal Self-injury,
and Body Modification
in Culture and Society
(3rd edn)
A Life Too Short: The
By Armando Favazza.
Tragedy of Robert Enke
Johns Hopkins University Press.
2011. $35 (pb). 352 pp. By Ronald Reng.
ISBN: 9780801899669 Yellow Jersey. 2011.
16.99 (hb). 400 pp.
ISBN: 9780224091657

Self-harming behaviour is a global public health problem. It is


one of the main risk factors for suicide and it results in extensive
mortality and morbidity. Every year in the UK, self-harm results
in more than 200 000 attendances to casualty departments, placing
considerable strain on the National Health Service.
Favazzas original Bodies Under Siege, published in 1987,
rapidly became the seminal textbook on self-harm. It contained In late 2009, Robert Enke was at the peak of his footballing
an unparalleled cultural exploration of an array of self-harming powers, acknowledged as one of the German Bundesligas best
behaviours. By dedicating separate chapters to specific variants goalkeepers and expected to represent his country in the 2010

171
Book reviews

World Cup. He had seemingly overcome personal tragedy, in his own abilities, illustrated by excerpts from his diary and from
depressive episodes and a series of ill-fated foreign transfers, interviews with Reng.
regaining the form that had previously linked him with some of As one would expect, the book is less accessible to those who
the biggest clubs in the world. On 10 November 2009, Robert are not fans of the sport, not least because Enkes attention to
Enke ended his life, aged only 32. Over 40 000 people attended detail and enthusiasm for the minutiae of goalkeeping is reflected
his memorial service. in Rengs writing. Although many of the characters described
A Life Too Short was originally intended to be a collaboration outside of the sport are colourfully depicted by the author, it is
between Enke and his friend, author Ronald Reng; not an the portrayal of many of Enkes contemporaries and their impact
autobiography, but a chronicling of how Enke had managed and on his game that is most interesting to the football supporter.
overcome his depression. The book is an intimate portrait of a Some personalities in the game are reflected very badly in their
man who appears to be the antithesis of our description of the lack of understanding of both Enkes mental illness and the
modern international football player; a reserved, thoughtful and difficulties some young players have in adjusting to new teams,
dignified individual, who married his childhood sweetheart and countries and languages.
for whom manners and respect were more important than money Critics will draw attention to the frequent use of the word
or trophies. Indeed at times, the reader could be forgiven for depressives to describe those with depression, but by and large
wondering whether Enkes untimely death and the writers close the book addresses mental health issues in general with both
relationship to his subject has led to a somewhat rose-tinted sensitivity and rationalism. Although Enkes recovery from
portrayal of him. depressive episodes is inspiring, the spectre of his suicide looms
Rengs previous bestselling book, The Keeper of Dreams, large over much of the book, and the less-informed reader could
explored the unique physical and psychological characteristics be forgiven for coming to the conclusion that his eventual suicide
of a professional goalkeeper compared with his outfield was inevitable.
counterparts, and A Life Too Short often reads like a case in point. At the very least, A Life Too Short shines a spotlight on what
The trained reader can identify a number of cognitive biases that must be a more prevalent issue than is currently recognised that
dogged Enke, such as the selective abstraction that he often of mental illness in professional footballers. It begs the question
applied to individual performances. why few cases are reported in British football leagues and whether
The players private struggle with such thoughts runs parallel or not it will take a tragedy like the death of Robert Enke for the
with the matches, tournaments and transfers that many readers sport in this country to recognise its presence.
will be familiar with, lending an insight into aspects of football,
particularly the art of goalkeeping, that some would not have Joseph Kane Lagan Valley Hospital, 39 Hillsborough Road, Lisburn BT28 1JP, UK.
previously considered. The subtle development of Enkes skills, Email: jpmkane@gmail.com
observed beautifully by the author, and his growth in stature doi: 10.1192/bjp.bp.111.105155
among his peers are in stark contrast to the players confidence

172
A Mind Less Ordinary: My Experience of Living with Anorexia
and Schizoaffective Disorder
Samuel Ponnuthurai
BJP 2012, 200:169-170.
Access the most recent version at DOI: 10.1192/bjp.bp.111.099523

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