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This book is an edited collection of essays
from authors who have all been involved with the Arbours Crisis Centre (www.arbourscentre.org.uk). The so-called "anti‑psychiatry"
movement associated with RD Laing created various therapeutic communities, the
pioneering venture being Kingsley Hall (1965-70). Others included the Arbours
Crisis Centre, founded by Joseph Berke in 1973 to provide immediate and
intensive psychotherapeutic support for individuals, couples or families
threatened by sudden mental and social breakdown. Three resident therapists
live at the Centre. They are assisted by a resource group of psychiatrists,
psychotherapists, psychologists, nurses, social workers and other
professionals. People who come to live at the Centre are the "guests"
of the resident therapists. The Centre accommodates up to six guests.
The book is divided into sections on
historical and theoretical perspectives, methodology, narratives, and authority
and money. Generally the chapters hang together. However, like several
multi-authored books, I wished at times for a more common thread in the content
and not just the structural connection because of the Arbours Centre. Few of
the chapters, to my mind, were of sufficient merit to stand alone.
In a way, it is remarkable that an
organisation like the Arbours Association has survived so long. The so-called
"anti-psychiatry" movement is supposed to have been a passing phase
in mental health history. I would have liked to have seen more comment on this
aspect of its relationship with mainstream mental health practice. There have
been changes over the years. Initially the Centre was run by a small group of
psychotherapists who offered their services virtually for free. Now it is
registered by the local authorities and funded by social services and health
authorities in the NHS health and social care internal market. As pointed out
in the chapter by Laura Forti, who has been working with the Arbours
Association from the beginning, one of the main functions initially was to
provide an alternative to the traditional psychiatric hospital, seen as
repressive and damaging, whereas now the role is more to provide a specialised
service based on the therapeutic community model enriched by intensive
The aim of the book is to demonstrate that
integrated psychological and social (PsychoSocial) interventions are an
effective means of helping people in psychotic or quasi-psychotic states. Its
emphasis on relationships and community is very welcome in the current
pharmacological dominance of psychiatric treatment. Overall, the book may best
be seen in the context of other books and publications, which may ultimately
have a greater impact, that also stress this point. By itself, this book, in my
opinion, only partially succeeds in showing the validity and humanity of the
PsychoSocial approach. It did not grip me.
I am reminded of RD Laing's conclusion about
Kingsley Hall. When he reflected on it later in life in discussion with Bob
Mullan, he indicated that he failed to provide "a tactical, workable,
pragmatic . . . sort of thing that could work for other people". Providing
a truly therapeutic environment is not easy and may be impossible. The
unsatisfactory sense with which I am left after reading this book may derive
from this fact. Nonetheless, the Arbours Crisis Centre has survived and those
who wish to know more about it may benefit from reading this book.
© 2003 D B Double
Double, Consultant Psychiatrist,
Norfolk Mental Health Care NHS Trust and founding member of Critical Psychiatry
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