Persecutory Delusions: Assessment, Theory and Treatment Edited by Daniel Freeman, Richard Bentall and Philippa Garety. Oxford University Press. 2008. £32.95 (pb). 328pp. ISBN: 9780199206315

Psychopathology has acquired a greater degree of certainty with the application of psychological, biological, sociological, and epidemiological, in addition to the traditional phenomenological understanding of psychiatric symptoms. This publication shows how this particular scientific discipline of psychiatry has developed to the degree that for the first time a whole book can be written on one psychopathological phenomenon, namely persecutory delusions.

The book starts with a narrative account of a psychologist who experienced paranoia at a certain stage of his life. The author manages not only to help the reader to empathise with people who have psychosis, but also to throw a positive light on what is normally seen as a negative and stigmatising experience. This is followed by a chapter covering the assessment of persecutory ideation using the dimensionality of this ideation, and supplemented with several assessment scales that could be helpful in both clinical and research assessment.

The book then moves from the narrative and clinical to epidemiological studies. The first is a survey of psychiatric disorders in the Netherlands, where three factors were found to be significantly associated with lifetime prevalence of persecutory delusions: childhood trauma, perceived discrimination and urban living. The second study considers the prognosis of persecutory delusions in a 20-years follow-up of schizophrenia. There follows a clinically important chapter that assesses the evidence of the relationship of violence with persecutory delusions.

Chapters 7 to 11 look at the psychological processes involved in persecutory delusions, including a cognitive–behavioural approach (CBT), social cognition, theory of mind and neuropsychology. Chapters 12 to 14 cover the biological processes, including the role of dopamine, cannabis and structural brain changes. The treatment of these delusions is discussed in the remaining seven chapters that describe the use of CBT, family therapy and person-based CBT, including case histories.

What is missing from this book is a section on the cultural, religious and political aspects of persecutory delusions. Sims ¹ has outlined criteria to differentiate a belief as a religious delusion. Also, ethnic and cultural factors that colour and modify persecutory delusions ² should have been explored. Finally, the political use of these delusions has been overlooked. Labelling dissidents as ‘paranoid’ is often used by tyrannical and corrupt regimes and institutions to isolate people who oppose them. In spite of these deficits, the book's comprehensive style that ranges from the narrative to the empirical and from the practical to the complex theoretical makes it a useful reference source on the subject for both clinical and academic mental health professionals.