This is an opportunity, but also a challenge, to write about books, especially at a time when the pre-eminence of books as the source and repository of knowledge is no longer indisputable. It is, of course, an impossible task to select merely ten books with the implication that these ten have been the most influential in my professional career, which is the same thing as saying that they have been the most influential books in my life. I have selected ten books from literature, philosophy and psychiatry, and these books, drawn from all my main interests, serve as the springboard for discussing other books. There is no principle underlying the order in which the books are discussed. In many respects, the order has been dictated by the internal logic of this essay.

Labyrinths

Labyrinths (Reference Borges, Yates and IrbyBorges, 1964), which was the collection of stories that brought Jorge Luis Borges to the attention of the English-speaking world, is a good starting-point for any essay on books. The essential themes of Borges' writing include the problematic nature of knowledge, time, the self and scholarship. Borges, a librarian and scholar, in the story ‘The library of Babel’ explores and undermines a number of our presuppositions about books. For example the idea that books are valuable repositories of knowledge, and that scholars and scholarship are admirable. Borges, with his usual restrained wit, reminds us that not many books contain much of value and that the search for the perfect book is vain. Also, like the universe, a library full of books is open to our inquiry for knowledge but does not guarantee the discovery of knowledge. It is ironic that a librarian and scholar should write in this vein but perhaps only a librarian and scholar could express a healthy disrespect for books. This short story is thus a warning to me not to overvalue books.

There are other short stories in this collection of interest to psychiatrists. In ‘Funes the memorious’ Borges tells the story of a man with a prodigious memory such that ‘it bothered him that the dog at 3.14 (seen from the side) should have the same name as the dog at 3.15 (seen from the front)’. Furthermore, ‘we at one glance, can perceive three glasses on a table; Funes, all the leaves and tendrils and fruit that make up a grapevine. He knew by heart the forms of the southern clouds at dawn on 30th April 1882’. Borges concludes that ‘to think is to forget differences, generalise, make abstractions. In the teeming world of Funes, there were only details, almost immediate in their presence’. It is clear from this that a prodigious memory without the capacity for generalising and abstraction is tragic. In Borges' world classifying is an example of higher-order reasoning and, of course, the process of reaching a diagnosis is based on this principle. Also, in psychiatry we are more used to regarding memory impairment as a sign of pathology, in other words we value memory. What Borges' story does is at least get us to question whether a prodigious memory is a good of itself. In ‘Everything and nothing’ Borges explores the inner world of Shakespeare. For Borges, ‘there was no one in him; beside his face... and his words, which were copious, fantastic and stormy, there was only a bit of coldness, a dream dreamt by no one... In London he found the profession to which he was predestined, that of the actor, who on a stage plays at being another before a gathering of people who play at taking him for that other person’. He goes on: ‘No one has ever been so many men as this man who like the Egyptian Proteus could exhaust all the guises of reality’. Borges has Shakespeare say after his death in the presence of God, ‘I who have been so many men in vain want to be one and myself’. This brief essay is as good an introduction to the psychology of self-identity as any academic text. There are other more personal essays ‘Borges and I’ and ‘The other’ (published in the Book of Sand, Reference Borges and di GiovanniBorges, 1979) which delve into the nature of the self, its identity and its relationship to the world.

One Hundred Years of Solitude

It is a great regret to me that I speak only two languages, Yoruba and English. This has meant that I know the great literature in Russian, French, German, Portuguese and Spanish only in translation. The 20th-century Spanish American novels, including writings by Vargas Llosa and Carlos Fuentes, and the works of the Portuguese Americans Jorge Amado, Machado de Assis and Marcio Souza that have influenced modern literature are enjoyed at one remove. The poetry of Pablo Neruda, Octavio Paz and others have had to be studied in translation and translated poetry is always problematic. Gabriel Garcia Marquez's (Reference Marquez and Rabassa1967) novel, One Hundred Years of Solitude, is an extraordinary work that employs a family saga as its basic form. The narrative is set within the span of 100 years and in the one place, Macondo. Marquez achieves what all writers dream of — a simple story that has emotional depth and gives the author enough room to deploy his narrative skills, and in Marquez's case, to expand the limits of the language, such that ordinary things, objects and events assume mythic significance. One is perpetually surprised by the turns and twists of imagination. Nothing stands still, yet everything is the same. The characters change names but the essential characters of the place remain steadfast. The story of a given place, of its residents, becomes our own story. We live through the most astounding events, experience the love, pain, grief and sheer exuberance of life.

It is the book on which the genre now called magical realism is founded. It is a book built to survive rereading because there is always an inflection of language, a metaphor, a mood that was missed the last time round or that now has special significance because of one's own situation. The language is baroque in style: sumptuous, luxurious, indulgent but never opulent to the extreme. It is a style fit for the Caribbean mainland, adequate to encompass the languor of a siesta hour, of indolent and drowsy afternoons, of a fecundity peculiar to the tropics, a fecundity symbolised in the colour, size and plurality of the flora and fauna of the Caribbean. Marquez's own imagination is only another instance of this fecundity.

But why should a psychiatrist be interested in this place of literature? Marquez's depiction of the futility of war, of the emotional desolation of warring is exceptional. Where other novels concentrate on the gruesome or material devastation of war, Marquez's accomplishment is his accurate description of the effect of war on the individual's spirit. Colonel Aureliano Buendia, one of the principal characters, is a liberal rebel who leads several insurgencies. Marquez writes of him:

Marquez acknowledged the contribution of African—Colombian oral tradition to his literary style. Magical realism has its African counterpart and is exemplified in Fagunwa's Ogboju Ode Ninu Igbo Irunmale (Reference FagunwaFagunwa, 1950) (translated by Wole Soyinka as The Forest of a Thousand Daemons, Reference Fagunwa and SoyinkaFagunwa, 1982), the novels of Amos Tutuola, including The Palm-Wine Drinkard (Reference TutuolaTutuola, 1952), and more recently Ben Okri's novels. I believe that quite aside from the stylistic triumph of this genre, for a psychiatrist it is an exposition of the extreme reaches of human imagination even though still guided by authorial structure and control.

The Myth of Sisyphus

The Myth of Sisyphus (Reference Camus and O'BrienCamus, 1955) and its accompanying short novel, The Outsider (Reference Camus and LaredoCamus, 1982), are Albert Camus' attempt to address the issue of suicide and the nature of experience, that is, of the phenomena that constitute experience. At the outset of this extended lyrical essay, Camus states clearly that ‘there is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy’ (p. 11). He then proceeds to answer this question. For Camus, there is no God, no afterlife and no possible justification for life as we experience it. Thus, the question is how to live in the certain knowledge of death without the illusion of an afterlife. What justification can there be for continuing to live, for deciding against voluntary death? The myth of Sisyphus is not about melancholia, but rather about despair that results from reason's unfaltering conclusion drawn from the reality of human life. Camus' solution is to appeal to the limited freedom we have in living our life freely within the span of our years. He says, ‘A world remains of which man is the sole master’ (p. 106).

The accompanying novel, The Outsider, opens at a death, the halfway mark occurs following a death and the book ends with a death. Of course, The Outsider can be read without recourse to the Myth of Sisyphus, but the novel's meaning is enriched by an understanding of what Camus is aiming for. The novel is particularly interesting from a psychiatrist's perspective because it attempts to describe the main character's experience of the world in a phenomenological fashion. So the character's experience of a hot day, his mother's funeral, his own trial are described as if they are experienced devoid of any theory about the world. This is, of course, an impossible task. Camus solves this literary problem by showing, for example, how during the trial disparate incidents are linked into a meaningful narrative that automatically condemns the main character. What is notable is that these incidents had no primary coherence for the principal character. Again, this is a lesson well learnt by clinicians: our habit of interpreting and making coherent the incidents in a life is suspect. There are several other readings of Camus' novel. In the 20th century it could also be read as a warning against a civilisation that produces an underclass who have no hope, no stake in society, and who are indifferent to their own fate.

Crowds and Power

Crowds and Power (Reference Canetti and StewartCanetti, 1962) is Elias Canetti's magnum opus. He wrote in his Notes (Reference Canetti and HargravesCanetti, 1998), ‘How do I feel about my finished book? It reads well, better and better, perhaps. I am not unhappy with it. What alarms and depresses me is the time I spent on it. If it had been one book among five or six, how proud I could be of it! For half a lifetime it is too little’ (Reference Canetti and HargravesCanetti, 1998: p. 27). This book is difficult to classify. It is principally about the sociology and psychology of crowds and is usually described as a book on social theory. But Canetti is also interested in the nature of power — and who would not be, if they had lived through the war years? It is important to be aware that Canetti was European in every sense. He was from a Spanish—Jewish family and spoke Spanish, German, French and English fluently. He was born in Bulgaria, brought up in Vienna, Manchester and Zurich and finally settled in England. Also, he lived through a period of immense artistic flowering in Vienna. He knew Robert Musil, Karl Kraus, Alma Mahler and Oskar Kokoschka personally. His autobiography is a rich source of information about the Vienna of the early part of the 20th century.

Crowds and Power is Canetti's attempt to bring order to our understanding of the nature of crowds. He classifies and describes crowds, but his most original insights are about the relationship of the living to the crowd of the dead. It is only in the past 5 years or so that there have been more people alive than the sum total of all our ancestral dead. Therefore there has been a recent shift in balance. At the time of Canetti's writing the balance was still very much in favour of the ancestral dead. Canetti writes: ‘everyone who dies and is buried adds to their number. All who have ever lived belong there and there are so many of them that they cannot be counted’ (p. 43). For Canetti, the ancestral dead have a force and presence in the life of the living. Thus, being alive and surviving war, for example, is experienced as ‘satisfaction that it is someone else who is dead. The dead man lies on the ground while the survivor stands’ (p. 265). He concludes, ‘the feeling of strength, of standing alone against the dead, is in the end stronger than any grief. It is a feeling of being chosen from amongst the many who manifestly shared the same fate. Simply because he is still there, the survivor feels that he is better than they are’ (p. 266).

Canetti's interest is in exploring the structure of crowds, the composition and mode of dispersal of varying crowds. His attention focuses on the orchestra, the army, the hunting pack, the baiting crowd and the flight crowd. Always he is interested to seek how power is enacted within these varieties of crowd. Although eschewing Freudian or psychoanalytic understanding of group phenomena, his territory is coextensive with that of psychoanalysis. Indeed, he attempts an exploration of Schreber's (Reference Schreber, Macalpine and Hunter1955) Memoirs. There is little doubt that Canetti's insights are often false, but it is the liveliness of his ideas, the sheer originality of his approach that makes him immensely readable. He is also a source of intriguing tales and myths from other cultures.

Sociobiology: The New Synthesis

Sociobiology is defined as the systematic study of the biological basis of all social behaviour (Reference WilsonWilson, 1975). Edward O. Wilson was a student of termites and his project was to focus on animal societies, their population structure, castes and communication, together with all the physiology underlying the social adaptations. Wilson's programme was ambitious and he wrote without any hint of irony: ‘It may not be too much to say that sociology and the other social sciences, as the other humanities, are the last branches of biology waiting to be included in the modern synthesis’ [my italics] (1975: p. 4). It is thus easy to see why Wilson's writings drew considerable criticism from other evolutionary biologists and, of course, from sociologists. His aim was to re-form the foundations of the social sciences on biology.

Wilson quickly dispels any doubts we may have about the apparent differences between termites and monkeys, for example. He reminds us that both are formed into cooperative groups that occupy defined territories. The group members communicate hunger, alarm, hostility, caste status and reproductive status using non-syntactical signals. Individuals within the groups are aware of the distinction between group-mates and non-members. Kinship plays an important role in group structure. Furthermore, there is a distinct division of labour.

Wilson's concept of sociobiology, whatever the criticisms, has profound implications for psychology and psychiatry. Many of his ideas are now popularised in the writings of Richard Dawkins and others. For example, his ideas about dominance hierarchy, sexual selection, social spacing, roles and castes should be of great interest to psychiatrists. These ideas impinge on our understanding of the nature of leadership within groups, the manifestations of authority, mate selection and sexual behaviour in people, territoriality and the relationship of this to aggression in our patients and, finally, role definition in human society.

Wilson's ideas have been attacked as being unduly deterministic and politically dangerous because they can be seen as supportive of the oppression of women and minority groups. Richard Lewontin, Stephen Jay Gould and others argued in a letter published in the New York Review of Books in 1975 (Reference Leeds, Beckwith and MadanskyLeeds et al, 1975) that genetic hypotheses attempting to establish a biological basis for social behaviour tend to justify the continuing oppression of particular groups and linked Wilson's ideas with the eugenics movement. However the conceptual and empirical problems are solved in the future, Wilson's contribution to our understanding of the biological basis of social behaviour is not likely to be minor.

Cerebral Lateralisation and Cerebral Basis of Psychopathology

My MD thesis was on schizophrenia-like psychosis in epilepsy. My interest was in exploring the influence of laterality and handedness on the development of psychoses in epilepsy. Geschwind & Galaburda's book Cerebral Lateralisation (Reference Geschwind and GalaburdaGeschwind & Galaburda, 1987) and Flor-Henry's book Cerebral Basis of Psychopathology (Reference Flor-HenryFlor-Henry, 1983) read together were ready sources on the subject of hemispheric lateralisation and its relationship to neurological, immunological and psychiatric disorders. Geschwind & Galaburda's thesis is that there is a pervasive asymmetry of the brain and that this is reflected in foetal brain development and influenced by sex hormones and genetics. This asymmetry is also found in other species and accounts for some developmental disorders predominantly found in males. Their book is a rich source of information about gross anatomical asymmetries, asymmetry of pathways, cytoarchitectonic asymmetry, chemical and pharmacological asymmetry, developmental asymmetry and the evolution of human asymmetry. There is also useful information on asymmetry in other animals, including structural, chemical and functional asymmetry. As an example of bold hypothesising, Geschwind & Galaburda set out to argue a case, and their method is admirable for the range and depth of their sources. This is also the advantage of Flor-Henry's book. His thesis is simple, namely that disturbances of lateral cerebral organisation and of reciprocal interhemispheric balances are fundamental to the genesis of psychopathology. His aim was explicitly to have a cerebral cartography of psychopathology. It is the extent to which Flor-Henry amassed data to support his ideas that is most impressive.

The cerebral basis of psychopathology is indisputable, for there is no other possible basis for any psychological experience. Geschwind, Galaburda and Flor-Henry's books show the complexity of the task of explaining the manifold phenomena presenting to neurologists and psychiatrists. No simple point-by-point correlation can be expected between cerebral sites and psychopathology. This is not to discount the existence of correlation. These two books are now dated because the empirical data and the potential explanations need continued revision, but as models of boldness and scholarship they are remarkable.

Groundwork for the Metaphysics of Morals

Immanuel Kant's Groundwork for the Metaphysics of Morals (Reference Kant and PatonKant, 1948) is a small book of fewer than 100 pages, but its importance far outweighs its length. Kant sets out his aim clearly: ‘The sole aim of the present Groundwork is to seek out and establish the supreme principle of morality’ (1948: p. 57). His concern is to establish the a priori foundation of morality. For Kant, in order to grasp what is good we necessarily already have a conception of the good. Thus, his aim was to identify the principle determining how to recognise what is good in the moral domain. Kant concludes that

In modern language, Kant's view is that the consequences of our actions cannot be the determinants of their moral value. Thus for Kant, consequentialism, of which utilitarianism is an example, cannot be the basis of our moral judgements. If the consequences, that is the ends, of our actions cannot be the determining factor of the moral worth of our actions, what then can be the principle by which we can discern what is right? Kant answers this question by stating his now famous categorical imperative: ‘Act only on that maxim through which you can at the same time will it should become universal law’ (1948: p. 84). In other words, we should only act in such a way that by our actions we declare a universal principle or law; this is the principle that should guide our conduct. Kant's view is that we cannot know from examples of previous conduct what is good, but by reason alone can we enact a principle to guide our conduct. This supremacy of reason or rationality as the sole determinant of the good is now under assault. There are those who argue that the imperial status of reason following the European Enlightenment should be reviewed. The irony is that these arguments are themselves conducted in the language and systems of logic dependent on reason and reason alone. Kant is clear that moral philosophy is not about accepting reasons for what happens in life, but describing laws of what ought to happen, even if it never does. Kant's second maxim is as follows: ‘Act in such a way that you always treat humanity whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end’ (1948: p. 91). For Kant, persons are not merely subjective ends but objective ends, whose existence is an end such that we cannot put in its place any other and to which they should serve merely as means. Kant further clarifies this point: ‘In the kingdom of ends everything has either a price or a dignity. If it has a price, something else can be put in its place as an equivalent; if it is exalted above all price and so admits of no equivalent, then it has dignity’ (1948: p. 96). In addition, dignity stands for unconditioned and incomparable worth. This description of human life as having dignity, admitting no equivalence, is a secular restatement of the religious notion of the sacredness of life.

It is impossible to do justice to the elegance and richness of Kant's ideas. What is incontestable is that his conceptualisations of autonomy, dignity and freedom are of value to any understanding of the worth of persons and this is particularly so in relation to people with mental illness and disabilities. Thus, his moral philosophy has served me well in clarifying and foregrounding important principles by which to make decisions.

Clinical Psychiatry

My introduction to clinical psychiatry was through this textbook (Reference Mayer-Gross, Slater and RothMayer-Gross et al, 1977). At the completion of house jobs at the University College Hospital Ibadan, I went to Aro, Abeokuta to work for 12 months as a senior house officer at the Neuropsychiatric Hospital built by Adeoye Lambo. At the time there were three consultant psychiatrists and two trainees, including myself. There was no formal teaching, but the wealth of clinical material was exceptional. On average, between us, we saw 80 patients daily, of whom 20 were new cases. Mayer-Gross, Slater & Roth's text consolidated the range and richness of clinical phenomena into a coherent picture for me. Clinical Psychiatry, with its clear introductory manifesto that the foundations of psychiatry have to be laid on the ground of the natural sciences, was attractive to a novice's requirement for clarity. The statement that ‘it seems to us farfetched to claim that sociology or cultural anthropology occupy as basic a position in relation to psychiatry as do the mental and biological sciences’ (1977: p. 3) appealed to my natural inclination. I was already a convert to the idea that psychiatry was definitely a branch of medicine. Mayer-Gross et al's definition of the legitimate territory of psychiatry was attractive. It should not be so wide as to cover all human behaviour or so narrow that it refers solely to the study of interpersonal relationships. For them, ‘psychiatry is that branch of medicine in which psychological phenomena are important as causes, signs and symptoms, or as curative agents’ (1977: p. 6). Here was a book where the authors expressed strong views about the nature of psychiatry, its methods and territory. There was little doubt that the authors intended both to educate and influence me. In both they succeeded. Their goal was to develop a psychiatry infused with the spirit of scientific inquiry, separated from the dogmatism characteristic of some schools of psychiatry, including psychoanalysis. The chapter on schizophrenia is surprisingly still fresh and relevant. Although it does not discuss the dopamine or glutamate hypotheses and there is nothing about the influential findings of Eve Johnstone and colleagues regarding ventricular enlargement in schizophrenia, it is still worth reading. It is in the description of the clinical presentation and picture that it comes into its own. A wealth of case examples, convincing descriptions of psychopathology, make it an exemplary teaching source for trainees whose diet is of sterile descriptions of Schneider's first-rank symptoms. The demise of the asylum also means that the observation and description of the richness and variety of psychopathology is fast becoming a dying art. Average stays of 24 days are not the basis for a ready familiarity with psychopathology. There is a suspicion too that native curiosity about abnormal phenomena and the will to explore these with patients and to listen is no longer nurtured.

Social Origins of Depression

The study of psychiatric disorder in women published in Social Origins of Depression (Reference Brown and HarrisBrown & Harris, 1978) is now unquestionably one of the most significant pieces of social research in psychiatry in the 20th century. The main findings have become part of the common-sense knowledge in psychiatry. Thus, the relationship between severe life events characterised by marked or medium long-term threat and the development of depression is regarded as a matter of fact. The temporal relationship between severe events and the onset of depression within 9 weeks and in the majority of cases by 6 months is well established. The emphasis on loss events and the distinction between triggering and formative effects are part of the folklore of psychiatry. Triggering effects bring onset forward by a short period and perhaps make it more abrupt, while formative effects have a fundamentally aetiological significance. The notion of vulnerability factors and the particular list of these, namely death of mother before 11 years, lack of a confiding relationship with husband, having three or more children at home and being unemployed, are known by practically everyone working with psychiatric patients.

The methodological rigour and the tireless application of critical reasoning to the data in order to test hypotheses, particularly to falsify their own findings, are admirable. For those of us trained in medicine, Brown & Harris's studies made sociology respectable, believable and credible. Their work validated what was already an impression formed from contact with patients in the clinics. Furthermore, it complicated the all too easy conceptual dichotomy between reactive and endogenous depression. Severe events could also accompany depressive episodes characterised on clinical features alone as endogenous in nature. The studies went some way to providing answers to the questions of what the mediating variables are between events and onset of depressive episodes. Thus, a rich conceptualisation was possible.

Individual Psychotherapy and the Science of Psychodynamics

David Malan's simple and clear exposition of the task of psychotherapy in Individual Psychotherapy and the Science of Psychodynamics (Reference MalanMalan, 1979) was a good introduction to psychodynamic psychiatry. I read it within my first 12 months in British psychiatry. Although my clinical experience of the psychoses and major psychiatric disorders in Nigeria was extensive, I had no exposure whatever to psychodynamic psychiatry. Malan's book suited my literary sensibility. It used a case history format, was written with directness and avoided jargon. Very early on in the text he summarises the task of psychotherapy as follows:

This simple stating of what is obvious and his use of the triangle of conflict and of person made the process of understanding and assimilating what was going on in the therapeutic encounter more manageable. Also, Malan's use of case histories, or as he calls them ‘stories’, to illustrate complex theoretical points made it easy to relate to the concepts he was trying to describe. His methodical and careful analysis of these case histories, his effortless and lucid writing combined with his palpable humanity served to make the aims and methods of psychodynamic psychotherapy more user-friendly.

Conclusion

Writing about books and ideas is always a joy. But selecting merely ten titles has been difficult. There are many excluded books, but in the end a choice has to be made. I am aware that I have said little about African literature. Wole Soyinka, Chinua Achebe, Christopher Okigbo, Samuel Johnson and others whose writings and whose intellectual concerns are perhaps less directly relevant to my daily life in Britain have been left out. I have also left out the poets whose writings have very definitely altered my own: Eliot, Auden, Vallejo, Lorca, Brutus, Lowell, Thomas and others. This is not to imply that their influence has been any less significant. It is, I think, a matter of context.