Indian Journal of Palliative Care
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Year : 2007  |  Volume : 13  |  Issue : 1  |  Page : 19-20

The psychiatry of palliative medicine: The dying mind

Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India

Correspondence Address:
Santosh K Chaturvedi
Professor of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore - 560 029
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Chaturvedi SK. The psychiatry of palliative medicine: The dying mind. Indian J Palliat Care 2007;13:19-20

How to cite this URL:
Chaturvedi SK. The psychiatry of palliative medicine: The dying mind. Indian J Palliat Care [serial online] 2007 [cited 2020 Feb 26];13:19-20. Available from:

A. D. (Sandy) Macleod; Radcliffe Publishing, New York, Oxford, 2007. Paperback: US$ 49.95/ 24.95;

This is a rather short book of 14 chapters, 176 pages, written by Dr. A. D. (Sandy) Macleod, who is a Consultant Psychiatrist and Medical Director, Nurse Maude Hospice in Christ Church, New Zealand.

This book provides pragmatic knowledge of psychiatry for those involved in palliative care, including psychiatrists. The foreword is by Emeritus Professor of Palliative Care, Ian Maddocks, who observes that it is strange that psychiatry has not received a similar prominence in palliative care as other specialties.

The chapters on common themes like adjustment and anxiety, depression, delirium, pain and sleep/sedation are well written and quite comprehensive. Each chapter discusses the main signs and symptoms and DSM IV criteria in many places, placed as boxed items for easy reference.

Besides reminding about the ego defence mechanisms, there is an interesting table on personality traits and characteristics of a person, what would be the meaning of illness for a person with such traits, the counter transference response it is likely to evoke, and management of such persons. At some other places in the book, there are dynamic explanations and understandings of issues related to death and dying, stress and coping. This approach is refreshing.

The chapter on "Pain and Psychiatry" is comprehensive, with good explanation of psychology of pain, psychiatry of pain, psychotherapy and pharmacotherapy of cancer pain and on pain in terminal illness. Similarly, depression in palliative care is well discussed and in adequate detail, including the role of grief in depression. The chapter on "Delirium" is yet another comprehensive one with an important box item on bedside indicators of delirium and a table on risk factors in delirium, which could be very handy for palliative care professionals.

The chapter on "Sleep and Sedation" focuses on specific sleep and sedation phenomenon related to advanced disease conditions. Besides disturbances of sleep, the twilight states have been well described. The author draws attention towards such phenomenon like 'lightening before death', which is briefly discussed, 'near-death experiences', about which there is abundant literature and 'speaking the last words'. There is a good account of terminal restlessness, terminal sedation and diagnosing dying. Separate descriptions on brain tumours, cognitive dysfunctions and dementia and terminal neurological disorders are very informative and pragmatic. There is also a brief chapter on chronic mental illness and dying, which may be of more interest for psychiatrists than palliative care professionals; however, interestingly; it has guidelines on use of opioids in terminally ill drug abusing patients.

Although there is no separate chapter on ethical aspects of palliative care, most ethical issues have been discussed in the chapter on "Euthanasia and Psychiatry", including principles of a good death, depression and desire for death and competency. Little more could have been written about certain other issues as staff burnout, complementary and alternative medicine in palliative care, and psychopharmacology in palliative care. The author is well aware of some of these limitations. There had to be a compromise somewhere, as a short, handy, readable book would certainly leave out some details.

Certain novel topics are discussed, including post-traumatic growth and disgust in palliative care on which not much is written about. The author also draws attention towards hardiness as a valuable personality characteristic and a necessary personal attribute.

The book is embellished with numerous quotations from historical sources. Some more can be attributed to the author now - "There is no universal meaning of hope" "Wrong words and poor therapy have negative side-effects", "Dying is difficult, dying crazy [delirious] is more difficult" are some of them. The back cover of the book rightly emphasizes that the author has drawn on his great experience in both consultation-liaison psychiatry and palliative medicine to produce an essential guide for all healthcare professionals involved in palliative care, including consultants and senior nurses as well as psychiatrists, especially consultation-liaison psychiatrists and trainees.

Most participants of the Chennai IAPC Palliative Care Conference 2006 might recall the active participation of this author, Sandy Macleod. This is definitely a must-read book for all professionals involved in palliative care; since it is so readable and enjoyable, it does not seem an effort to read it.


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