If you have any opinion whatsoever on the subject of schizophrenia,
then this book is to be strongly recommended. Written by a schizophrenic,
I hesitate to use the phrase ‘recovered schizophrenic’, the book
is a powerful and moving contribution to the debate over arguably
the most important psychiatric condition in existence. Like no
other mental health issue, the diagnoses of schizophrenia has
for decades now been subject to fierce and controversial debate.
Modrow’s work is part of precisely such a debate.

The book divides into three sections, the first providing a short
succinct introduction to the position that Modrow takes in the
debate. He has been through the psychiatric process and speaks,
therefore, from the inside, perhaps unsurprisingly coming down
against the dominant model now operative within psychiatric practice,
the ‘medical model’. Modrow operates from within the broad region
of opinion that locates the root of schizophrenia within a schizophrenogenic
environment. This approach is combined with a model derived in
part from Bateson’s account
of the communicative ‘double bind’ as a causal factor within the
pathological processes of schizophrenia. The main difficulty with
the first section of the book is its brevity, which means that
a positive account of schizophrenia is less present that it could
or should have been. This criticism is not particular to Modrow,
however, but is a feature of the debate, whose terms are set,
for the most part, by the psychiatrists and the ‘medical models’
of treatment.

The second section of the book is a personal account of Modrow’s
own history, a case history if you like, given from early childhood
to his psychotic breakdown. As it happens I read this section
last, and the strength of Modrow’s work is in the willingness
he shows within this personal account to be brutally honest. At
times the account seems confused, even contradictory, and inconsistencies
appear in the same way in which inconsistencies appear whenever
someone tells you their life history. These glitches and the odd
veering off onto tangents display a lot of Modrow, perhaps more
than he intended. At times the voice within these passages was
clearly akin to the voice of a schizophrenic. This was both reassuring
and moving but also troubling. A schizophrenic, one ‘identified’
as schizophrenic, is always going to be faced with the situation
whereby their words lose their power because of their diagnoses.
To thus, as Modrow does, clearly self-identify with the term pushes
his account into dangerous but necessary territory. The lingering
worry, perhaps, is whether the obsessive thought patterns of religiosity,
through which Modrow entered his psychosis, are now being structurally
reproduced with the new focus on ‘psychiatry’. It is all too easy
to see how the psychiatrist and the schizophrenic can enter incommensurable
paradigms of argument such that the communication vital to any
doctor-patient relationship is lost. Modrow’s book, in this sense,
is trapped within this communicative disaster that is the debate
on schizophrenia.

Despite such difficulties the book is a valuable contribution
to the debate and its third section provides a clear and strong
reason for the book to be read widely. The third section consists
of a ‘technical survey’ of the medical model, operating over its
fifty pages as a review of the literature. Its’ strength is a
clear, precise and for the most part dispassionate account of
the various theories and research work, presented in a roughly
chronological manner. The ease with which Modrow moves across
the huge field of research material speaks of long hours in the
books and the benefit to anyone reading is in the way Modrow cuts
a path through such a vast literature enabling others to at least
begin exploring the details of the debate. The strength of Modrow’s
book for the debate lies in his having cleared a path through
the forest, enabling us to begin to see the development of the
current practice and relocate ourselves historically and socially.
In my own mind Modrow provides more than reasonable doubt as to
the medical model and given the increasing importance that the
diagnoses of schizophrenia has within the judicial system, such
reasonable doubt has widespread consequences.

Psychiatrists hate the way in which their practice is threatened
with the charge of oppression and violence. Ignoring such charges
as operating within a social agenda that is irrelevant to a scientific
analysis may be justified when such scientific analysis is physical
but medicine increasingly has to face the social issue of ‘health’.
In the struggle to become healthy the issue of schizophrenia must
be resolved. If the anti-psychiatrists are correct then we are
living with a practice abhorrent to all but the most heartless
utilitarians. If the medical model is capable of sustaining itself
it, as a rational scientific model should be, then it is beholden
on psychiatrists to deal with the social implications of that
model and that means finding answers to the questions raised by
schizophrenics such as John Modrow.

Matt Lee,
University Of Sussex (PhD researcher, Philosophy)