November 2010  << Back  

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Goodwin & Guze’s Psychiatric Diagnosis


University of Iowa, Iowa City, IA, USA

By Carol S. North and Sean H. Yutzy. New York, NY; Oxford University Press; 2010; ISBN 978-0-19514429-1; pp 432; $45 (paperback).

This is the sixth edition of a classic text. I am fortunate to own a copy of the first edition published in 1974, authored by Robert Woodruff, Donald W. Goodwin, and Samuel Guze. The book was pioneering because it presented psychiatry through the lens of the medical model that originated at Washington University in St. Louis, MO. This remarkable department brought together a diverse group of people, many trained in the East, to pursue a new paradigm often referred to as “biologic psychiatry.” As someone trained in this model, the term is a misnomer and still is greatly misinterpreted by its critics. Simply put, the model espoused evidence-based psychiatry before the term was even coined. These men and women included Edwin Gildea, Eli Robins, Samuel Guze, George Winokur, Donald W. Goodwin, Robert Woodruff, Lee Robins, Paula Clayton, Rodrigo Munoz, John Feighner, and many others. Although considered progressive by many, this “atheoretical” approach was a direct challenge to predominant views of the time.

I discovered the second edition when I was a resident and it was love at first sight. The book was clearly written, entertaining, and presented facts about a disorder without the psychiatric jargon I saw in other texts. The book focused on the many syndromes the authors considered valid, as explained in their groundbreaking paper on psychiatric diagnosis, commonly referred to as the “Feighner Criteria.”1 Validity was determined based on clinical description, laboratory studies (as limited as they were), delimitation from other disorders, follow-up, and family studies. These “five phases” are still considered the standard for validating diagnoses. This new approach to diagnosis, in which specific criteria were enumerated, was embraced in DSM-III, published in 1980. The book was not comprehensive and ignored other topics that residents needed, such as interviewing methods. Yet, it endured through subsequent editions until 1996. Its authors passed away, and those who knew of the book assumed that it had disappeared into history.

Imagine my surprise (and delight) when I received a copy of the sixth edition. This was akin to seeing an old friend return after many years, having assumed the person was gone. Carol S. North and Sean H. Yutzy, both trained at Washington University, teamed up to resurrect the book, now renamed Goodwin & Guze’s psychiatric diagnosis, in part to remind its audience of those great men. There are several important changes in the new edition, including new chapters on the evolution of diagnosis, evaluation, posttraumatic stress disorder (PTSD), and borderline personality disorder. Chapters on “anxiety neurosis” and “phobic neurosis” have been renamed and consolidated as “panic disorder and phobia.” The chapter on anorexia nervosa has been changed to “eating disorders.” All chapters present up-to-date material, and tend to follow the same format (ie, history, epidemiology, clinical picture, etc.), followed by references. Recommendations for clinical management reflect the latest information. Few psychiatric writers seem to care about the history of psychiatry, and this book reminds us that little of what we see today is new. For example, in the chapter on PTSD, the authors point to a witness of the Great Fire of London in 1666 who later wrote: “…I cannot sleep at night without great fear of being overcome by fire.”

The book retains its original style—readability combined with a no-nonsense approach that is refreshingly jargon-free. I highly recommend this book.


  1. FeighnerJP, RobinsE, GuzeSB,et al.Diagnostic criteria for use in psychiatric research.Arch Gen Psychiatry.1972;26:5763.