This is a landmark publication. Dealing with the major philosophical dilemmas as they relate to psychiatry, it provides a lucid and accessible introduction to a subject that can often seem forbidding and abstruse.

The book provides a philosophical overview of the different approaches to mental disturbance down the ages. The authors suggest that these approaches have veered between the twin poles of the ‘medical’ and the ‘moral’: between the belief that madness is the result of brain disease and the belief that it is a psychological or spiritual problem. This conflict was apparent at least 2000 years ago, when Hippocrates espoused a humoural theory of madness, in contrast to Plato, who believed that insanity signified a disturbance of the soul. The authors chart the winding path of this dispute through to the present day and the argument between biological psychiatrists and their opponents as to the nature of mental illness. A pivotal figure in this historical reading of events, and indeed in the book itself, is Karl Jaspers, whom the authors describe as ‘psychiatry's first philosopher’. Jaspers sought to reconcile the medical endeavour to find causal explanations for psychiatric illness with the moral emphasis on its meaning for the individual sufferer. The authors concede that he did not succeed but argue that the failure lies less with Jaspers than with the extraordinary difficulty of the problems involved. Likewise, they feel that Freud has been unfairly scapegoated for his attempts to relate meaning to mechanism.

We are still wrestling with the same problems today. The authors maintain that rapid advances in the neurosciences have made such questions of pressing practical and philosophical importance. For example, have the developments in genetics and neuroimaging abolished such concepts as free will and consciousness? Are they illusory, mere epiphenomena of brain activity? Or are the neuroscientists themselves misguided, as contended by the ‘new mysterians’ – those who hold that the riddle of the mind/body relation cannot be unravelled? The authors prefer a middle course, eschewing both the triumphalism of the biological reductionists and what they call the ‘premature retreat’ of the mysterians.

As the book makes clear, psychiatry confronts many of the fundamental questions in philosophy, whether or not its practitioners acknowledge this or are even aware of it. In fact, the great strength of this volume is that it demonstrates how philosophical considerations impinge on practice. It does this by taking examples from seemingly ordinary clinical encounters and carefully unpacking the words and actions of the participants to reveal their underlying philosophical assumptions. In this the authors are guided by the work of J. L. Austen, the Oxford philosopher, who held that we should look at how words and ideas are actually employed in the everyday world rather than how they are defined in theory. Thus the authors are able to undermine the notion that making a diagnosis is a neutral procedure. They point out that, even in the supposedly unproblematic world of the ‘hard’ sciences, such as physics, it is accepted that the observer influences what is observed. In the diagnostic interview, the values and preconceptions of the doctor shape the final assessment of the patient. The book also examines such topics as autism and how we can have knowledge of the minds of others. It looks at schizophrenia in the context of philosophical notions of personal identity, and it considers depression and the role of individual responsibility.

Throughout the volume, the authors are at pains to emphasise that they are not offering a grand unifying theory or a definitive answer to the human predicament. Instead they seek to highlight the unresolved questions in modern-day psychiatry in the hope that readers decide for themselves what should be done. The book is aimed at those who have no prior knowledge of philosophy and it takes them, in a series of steps, from the foothills of apparently mundane clinical conundrums to the very pinnacles of contemporary philosophical concerns. Along the way it provides extensive references to the relevant literature and also sketches of the major philosophers and debates that have informed Western philosophy over the preceding centuries.

The book is heavily influenced by Anglo-American analytic philosophy and gives much less space to Continental thinkers in the existential tradition, such as Kierkegaard, Nietzsche and Sartre. This is disappointing, as their writings seem much livelier and passionate than the dry tomes of many analytic philosophers. Further, there is no reference to those writers, such as Dostoyevsky, Proust and Camus, who have a strong philosophical aspect to their work. But these are minor reservations. On the whole, this is a hugely ambitious and wide-ranging enterprise. The authors acknowledge that the last word on philosophy is unlikely ever to be written, because it is an evolving and dynamic discipline. However, this textbook is destined to become the standard work in its field for some time to come.