The entire history of psychiatry is
a one of struggle and contention. Contesting Psychiatry focuses on this
aspect and analyses the history of psychiatry as a bottom-up process from
society to psychiatry. As a matter of fact, the period of time it analyses (from
1950 to 2000), is a period in which contention between society and psychiatry, centered
upon issues of power and control, gave rise to a deep and overt transformation
of conceptions, practices and treatments in mental health system. Therefore,
the book proposes a roundup of British social movement organizations against
psychiatry from a sociological and historical perspective in order to give
reasons for that profound shift in psychiatric field in 20^th
century.

Social movements against the psychiatric
orthodox view are presented as expressive of a collective sentiment within some
part of society which expresses either demand for change or resistance to
change. Their history shows how they constructed their domain (issues, language
and assumptions) as a concrete embodiment of thought processes which generated
a real esprit de corps among their members. Nevertheless,
following Zald and McCarthy (1994)’s model, Nick Crossley, author of this book,
does not conceive social movements as agents or actors within society until
they are taken up by social movement organizations (SMOs), which are considered
economic in inspiration. Furthermore, even though he remarks that political mobilization
presupposes a utilization of scarce resources, he does not share rational
action theory in the utilitarian terms for social organizations, a theory which
tends to ignore cognitive factors.

Crossley enriches Zald and McCarthy’s
model thanks to the notion of a culturally generative ‘field of contention’ in
order to determine a movement discourse and culture. Then he identifies
movement network structures to show the interaction within fields.

In order to explain emergence,
survival and decline of fields, SMOs and movements, Crossley chooses a version
of the ‘value-added model’ proposed by Smelser (1962). Movements are
analytically explained in each chapter by means of a list of six peculiar
elements: structural conduciveness, structural strain, discursive formation and
diffusion, trigger events, mobilizing structures and intervention of third
parties. This kind of explanation contributes to clarify the endemic dynamism
of mental health field, constantly informed by different theoretical impulses
and aspirations.

After an introduction that takes
the early three chapters and presents the sociological background of the book,
the adopted theoretical models and a schematic history of psychiatry, the
author offers the history of social movements and their organizations in
different eras. Social communities contesting psychiatry, although inspired by
different approaches, contribute to that profound transformation in psychiatry
from asylum to heterogeneous form of provision, guaranteeing an increase of
people receiving help, a shift in the balance of problems and a shift in the
social character of patients.

The central chapter is dedicated to
the social movement whose influence and effects on all psychiatry was as
evident as deep-rooted: the anti-psychiatry movement. Undoubtedly, this chapter
is the most interesting. Its centrality in the text (it is the fifth of nine
chapters) is a mirror of its undeniable centrality in the history of
psychiatric contention. Anti-psychiatry era determined that every social
movement in psychiatric field that came next needed to adopt a definite
position regarding anti-psychiatric ideas. As a matter of fact, the chain of
reaction to which it gave rise is still running.

It emerges from the book is that
anti-psychiatry was the first social movement from the patient perspective. The
view of mental illness as linked to industrialization and urbanization was a
persistent theme from early protests in 1930s. Nevertheless, mental hygiene
exponents showed a critical bourgeois attitude against morale decline of
working class lifestyle, which was considered the main source of mental
disorders.

Anti-psychiatry also influenced the
birth of the liberal current in psychiatry, a more politically involved
movement on civil right discourse and the emergence of patient unions. Its
biggest effect was the Italian Democratic Psychiatry, which developed a Marxist
alienation discourse without questioning, as anti-psychiatry did, the existence
of mental illness or the use of physical treatments. Democratic Psychiatry had
a considerable impact in the UK on disillusioned anti-psychiatrists. Finally, the
history of social movements in UK is a history of consolidation and backlash of
anti-psychiatry discourse.

In conclusion, the value of this
book is in its history of contemporary psychiatry from the perspective offered
by the history of British social movement organizations in mental health field,
thanks to an analysis which focuses upon processes, interactions and relations
among them.

Concentrating on historical and
sociological facts, the explanation of theoretical approaches that steered organizations
is sometimes brief and excessively schematic. However, as the author himself
observes, the limits of the book are most of all empirical and the biggest one
is that this book offers only a national level description.

Notwithstanding these general
considerations, Contesting Psychiatry is a potted but useful guide to
understand the interaction between British society and psychiatry in the
previous century.

© 2006 Elisabetta Sirgiovanni

Elisabetta Sirgiovanni, Ph.D. in
Cognitive Science, University of Siena, Siena, Italy.

Categories: Ethics, MentalHealth, Philosophical