Chess Denman's thesis is that sex and sexuality are part of life and so they should routinely contribute to clinical formulation. This is an admirable aim, and she shows us how it is done through vignettes encompassing a wide range of clinical presentations. This is not to say that she has written a textbook, because the book is more than that: it is an extended essay on sexuality built on the literal premise that sex, until proved otherwise, is a good thing. She espouses a non-judgemental attitude to sexuality in most of its incarnations. She emphatically states a ‘sex-positive’ position as well as a preference for taking the best out of the available theory and practice.

It is good to see a psychiatrist as at home with social science and political theory as with psychodynamic theory and sexology, although her impatience shows with those who want their sex and therapeutic endeavours to be only mechanical. She dwells in a number of ways on the symbolic dimensions of sexual practice both for individuals and for subgroups of the population for whom this has special significance. As a result she deals unusually even-handedly with gay and straight sexual preference and incorporates recent feminist and queer theory into her review. This is not therefore a book for those clinicians who will find discussion, in drily humorous tones, of the ‘lesbian sex mafia’ unnerving rather than educational.

The second half of her book is on sexual topics of some sensitivity. She addresses transgressive sex, transgender issues and sex in the consulting room with compassion and discrimination. There is a lot in this book for most of us. Even those whose regular approach to the treatment of schizophrenia avoids consideration of sexuality may find their clinical practice enlivened by this thoughtful and scholarly piece of work.