Handbook of PTSD Science and Practice Edited By Matthew Friedman, Terence Keane & Patricia Resick. Guilford Press. 2007. 592pp. US$75.00 (hb). ISBN 9781593854737

This book, whose editors are strongly associated with US Veterans Administration post-traumatic stress disorder (PTSD) programmes, sets out to be a comprehensive, state-of-the-art compilation of the work of 60 authors in the field. Part I is a historical overview, Part II covers scientific foundations and theory (including neurobiology and gene–environment interactions), Part III covers clinical practice (including psychosocial treatments and pharmacotherapy) and Part IV is entitled ‘Uncharted territory’ (including PTSD and the law, and the agenda for future research).

A book with ambition, it sets out to ‘document how far we have come during the past 25 years’. The trouble is, nothing is included that might spoil the conclusion that progress has been remarkable. Yet, as Robert Spitzer, one of the original architects of PTSD, wrote recently, ¹ no other DSM diagnosis has generated so much controversy as to its central assumptions, distinction from normality or other categories, clinical utility, and prevalence in various populations and cultures. He proposed a tightening of definitive criteria. Spitzer might well have cited Freuh et al, ² who found that military records did not corroborate the accounts of almost 40% of veterans claiming combat-related PTSD. This supports studies in which clinicians could not distinguish simulation by actors from ‘genuine’ cases of PTSD. Almost 250 000 US veterans still receive financial compensation for PTSD. Indeed there are concerns that issues of secondary gain and malingering have contaminated the PTSD database, and Rosen ³ suggests that journal editors should oblige authors to reveal the litigation status of their subjects.

Similarly, serious questions concerning the role of PTSD in the medicalisation of everyday distress, and whether the dynamics of compensation prolong disability, are brushed aside. Yet most patients given a diagnosis of PTSD do not seem to return to pre-trauma levels of functioning (indeed, when I was psychiatrist to the Metropolitan Police I found that once the diagnosis was applied to an officer he was extremely unlikely ever to return to policing, and that the defining role played by the traumatic stress centre was to support an application for early retirement and medical pension).

I appreciate that the editors might well be unhappy that I, a confirmed critic of PTSD and of the industry it has spawned, have been asked to review their book. In fairness, I would concede that some of the mud I and others have thrown at PTSD would stick to other categories as well (we could start with depression), reflecting a general critique of the construction of psychiatric knowledge and its over-reliance on the biomedical gaze.