Since the first publication of this innovative book nearly 30 years ago, the world of psychiatry has changed significantly, as the editors of the current edition acknowledge. There have been major advances in the neurosciences; the pharmaceutical industry now occupies a dominating, not to say domineering, place in clinical practice; and the legitimacy of psychiatry as an agency to alleviate mental suffering has repeatedly been challenged. How do the editors deal with this changing world? They have assembled 25 chapters, mostly rewritten and updated versions from previous editions, and they have commissioned five new chapters on such subjects as neuroethics, trauma, and the relationship between psychiatrists and drug companies. The results are mixed.

On the positive side, there are several thought-provoking contributions. The most penetrating is the chapter on neuroethics by Stephen J. Morse, an American professor of law and psychology, who examines the implications of the rapid developments in the neurosciences. Have such developments undermined our cherished beliefs in what it is to be human, rendering obsolete such notions as free will and autonomy? More sinisterly, do biotechnological advances, with their potential to control and manipulate the mind, pose a threat to humanity? Is a Brave New World just on the horizon? Morse deals with these questions in a balanced and sober fashion. He carefully undermines the more extravagant claims for the biological sciences and observes that brightly coloured brain scans have seduced many into thinking that these mathematically created images explain how the mind works. Morse criticises such reductionism and re-asserts the case for seeing human beings as persons rather than minds and brains.

Stephen A. Green writing on the psychiatrist and the pharmaceutical industry begins unpromisingly with the assertion that this relationship ‘has undoubtedly improved clinical care’. Those of us familiar with David Healy's impassioned polemics against the ever-growing psychopharmacologisation of everyday life will find this a contentious statement. However, Green goes on to examine some of the negative aspects of the industry and quotes research which suggests that, as a result of the influence of drug companies, trainees are less likely to take a comprehensive personal history or pay attention to psychological and social factors.

A new chapter on trauma provides a fair-minded assessment of the arguments as to whether post-traumatic stress disorder is a bona fide psychiatric condition or a completely misguided attempt to medicalise human distress. The authors also consider whether this concept has been applied in an insensitive and inappropriate way to cultures other than the Western culture. In another thoughtful chapter, on the psychiatry of the elderly, Catherine Oppenheimer points out that the majority of the individuals making decisions about older people have not personally experienced old age and as a consequence, there is a danger that the voice of older people is misunderstood or, worse, ignored.

Less convincing is the chapter on the history of psychiatric ethics. It outlines a grand narrative of the progress of psychiatric thinking in which previous ages are chided for lacking the sophistication of our own. It is as if Foucault and other cultural historians whose work has challenged such self-congratulatory accounts had never written on the subject. This chapter tends to echo a feature of the volume, the tendency to privilege the psychiatric establishment's perspective and to give less room to dissenting opinions. For example, Steven Rose, who has criticised what he calls ‘biological imperialism’ and its propensity to explain human beings exclusively in terms of genes and brain function, is mentioned only once in the chapter on genetics. More seriously, what is entirely missing from this volume is the voice of the mentally ill. At a time when much greater attention is being paid to the views of those who experience psychiatric disorder, this is a strange omission. Nevertheless, despite its shortcomings, there are enough interesting chapters to make the book worth reading.