Professor Gillett is having an extraordinary life. One version emphasises simultaneous practice as a neurosurgeon, medical ethicist and philosopher – all at the highest level – resulting in election to Fellowship of the Royal Society of New Zealand, his home. Another version, sketched in the autobiographical postscript to this book, tells of an author inspired and liberated by writing, at length, about the philosophy of psychiatry.

The early chapters are the most difficult for those psychiatrists who have not studied philosophy to degree level or beyond. Gillett draws on (later) Wittgenstein to focus on rules and meanings as the essence of mental content, and intersubjectivity as a distinctive feature of human forms of life. He supports a neo-Aristotelian conception of the psyche as a mode of functioning in which meaning becomes incarnate in lived human life. Finally, Heidegger and Lacan are flagged as the philosophers who can offer a nuanced account of the development of mental life, and its disorders, as a response to lived experience. This takes Gillett to formulations such as ‘Being-in-the-world-with-others’ or ‘the imago enunciated under the name of the father’. Although strongly endorsing these choices from the philosophical canon, I had some concern about how little exposition of the writings of Heidegger and Lacan is actually offered.

Two chapters summarising and building upon the antipsychiatry literature are followed by a chapter on the unconscious, in which psychoanalytic theories of trauma are sketched. The nine chapters that follow discuss the philosophical questions raised by various psychiatric disorders: ‘Anorexia poses the question “What is desire?” just as mania poses the question of well-being, schizophrenia the question of rationality, psychopathy the question of moral action and multiple personality disorder the question of identity’. This proves a novel and rewarding approach. However, for the psychiatrist reader there is too much exposition of the familiar here, including an incomplete literature review on the aetiology of anorexia nervosa, and an overlong chapter on multiple personality disorder (I have still never seen a case!). The chapter on psychopathy was impressive and should be required reading for trainees in forensic psychiatry.

Overall, a great achievement and a substantial contribution to the (ethically) right theorisation of psychiatry. More Heidegger and less textbook psychiatry exposition for the third edition please.