When I was a trainee, just beginning psychiatry, I remember when I first discovered that simply because I had no idea what the patient was talking about it did not mean that I was not asking the right questions. Suddenly I realised, this is thought disorder. Any amount of words in the textbook had not been able to convey exactly what it was. Now I understood! Strangely enough, I got more than a little of the same feeling when reading this book, which is rather odd, since it purports to (deep breath here) “ provide information to those multidisciplinary professionals who work in mental health and have little awareness and/or appreciation of the prevalence of various forms of communication breakdown in people with mental illness and therefore the place that the speech and language therapist (SLT) might have in helping to alleviate these problems”. Only the difficulty is that I still have not reached the “Aha, so that's what it is” stage. Maybe it is me. Maybe not.

I am not saying that the book is not scattered with undoubted gems. I should mention here David Newby's concise chapter on communication and formal thought disorder in schizophrenia and a fascinating contribution by Alice Thackery entitled “What can we learn from the deaf patient?” But the problem may be that the editors had two quite different aims: selling the idea of the SLT as a member of the multi-disciplinary team to mental health professionals, and selling the ideas of working in mental health to SLTs and their students. Unfortunately, neither of these laudatory aims is satisfactorily fulfilled.

Psychiatrists working in rehabilitation, who probably have the most to gain from an attached SLT, would have to search quite hard here to discover exactly how an SLT would provide ‘added value’ to their team. SLTs and their students who are new to mental health will not learn a great deal about modern approaches to assessment and treatment from the early chapters of this book, which are curiously quaint in places. There is, for example, no mention of selective serotonin reuptake inhibitors in the chapter on the treatment of depression. Personal construct psychology gets a whole chapter, while cognitive—behavioural therapy is afforded only a passing mention. The declamatory style of writing is best conveyed by the statement “few personality disordered people excel academically”. Those of us who work in universities might disagree here.

I must note, however, that people who specialise in communication can fail to convey ideas clearly — not just those with formal thought disorder.