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Book review: Stay: A history of suicide and the philosophies against it

disorders. Neurobiology of Mental Illness naturally makes very little mention of hormones, although it does add to the list above by ‘... suggesting that hormonal fluctuations may play a role in either the onset or the exacerbation of OCD symptoms’. Most of the other scattered references in that mighty tome seem to be related to sexual disorders, premenstrual elevated progesterone, eating disorders and childhood developmental disorders. Blaming ‘the glands’ for behavioural disorders was very fashionable in the early years of the 20th century. Possibly the pendulum has now swung too far the other way: psychiatrists have become too unwilling to suggest an endocrine evaluation in cases of otherwise inexplicable mental disorder. One problem pointed out here is that ‘there is no screening tool that has been research-tested for reliability for use by non-medical professionals’. This book does include, as an appendix, a basic clinical assessment checklist which might act as a starting point for developing such a tool. Like Psychiatry and Heart Disease, the Hormone Factor in Mental Health is a collection of short papers by a number of contributors, although in this case written by a world-wide range of authors rather than mainly people from a single institution, and the lone editor has pulled the papers together into a slightly more coherent book. Both of these books qualify for the blurb boast on the latter title, ‘A bold cross-over between the disciplines of medical and mental health’. These four books clearly show that that arrogant senior registrar I referred to at the beginning was wrong. Neurobiology of Mental Illness spells out in intricate detail the current state of our understanding of the organic basis of psychiatric disorders: their molecular biology, genetics, cellular physiology, neuroanatomy and neuropharmacology. Madness and Memory describes the discovery of a new class of disease-producing agents: prions, which are involved in certain uncommon neurological disorders such as Creutzfeldt–Jakob Disease. It also, in its final chapters, brings up the suggestion that prions may be involved in some of the most common neurodegenerative disorders to affect mankind – Alzheimer’s, Parkinson’s and so on, thus, at the very least, opening new avenues of research. Psychiatry and Heart Disease demonstrates a clear directional link between a mental disorder such as depression and a physical disorder such as a heart attack. The Hormone Factor in Mental Health demonstrates the reverse – a clear link between a physical disorder such as a pituitary tumour and psychiatric disorders – and helps bridge the mind– body gap by reminding mental health workers of the importance of the endocrine system. Our arrogant senior registrar must be a few years older now and, perhaps, a little wiser. Out of charity, I sincerely hope that he has not had to bring up an autistic child, or had to go through the dreadful process of caring for a mother with Alzheimer’s disease, or has himself faced the debilitating effects of a major attack of depression. Let us hope, however, that, when faced with patients undergoing these ordeals, he has learned to treat them with the care and compassion they need. With any luck, he might even be joining in the search for therapeutic advances to match and follow on from the scientific advances described here.