Solving Psychiatric Puzzles

Abstract

Psychiatric treatment is a private experience cloaked in confidentiality and, often for the outsider, mystery. Too rarely, the insiders—psychiatrist or patient—reveal the essentials of how the psychiatric treatment process works. Solving Psychiatric Puzzles by V. Sagar Sethi reveals through the stories of his patients over the last 15 years of practice the process by which he has assessed and treated them. It's a self-portrait of his psychiatric practice. Beginning with an introduction that examines Dr. Sethi's personal history, the way physicians listen, psychiatric decision-making, and a “Very Brief History of Psychiatry,” the book is organized into 3 sections: “Voices of Patients,” “Assorted Stories,” and “Appendices.” The first section presents 10 cases, first through the voice of the patient, describing the symptoms and why psychiatric care was sought, then through Dr. Sethi's summary of the history, the treatment plan, and follow-up visits—often including his thoughts on the difficulties involved in dosing medications, prescribing to children, hearing threats of suicide, involuntary commitment to hospitals, and other challenging areas of psychiatry. The second section presents 17 vignettes illustrating the range of problems faced by a general psychiatrist. The “Appendices” include information for the lay reader on psychiatric disorders, schools of psychotherapy, medication names, and the private practice of psychiatry. Dr. Sethi has written a book that will interest the general reader as well as physicians, medical students, and anyone curious about the practice of psychiatry. He writes of his frustrations with managed care and the changes in medicine that have occurred while he has practiced. Numerous editing errors are distracting, but minor specks on this revealing window into Dr. Sethi's practice.