Mental Health Matters is a collection of forty-five short papers examining mental health issues. Some of the papers are classics that have previously been published elsewhere, others were commissioned especially for the collection. The collection privileges the views of users of psychiatric services, and many of the papers are critical of psychiatric practice. The papers cover an incredibly broad range of issues including debates concerning models of mental distress, the involvement of users in health care provision and the historical and social contexts of mental health care. Although much of the discussion is of broad relevance, some is specifically directed at contemporary issues in British health care. As is usual with collections, the papers are of variable quality. In this review I have chosen to briefly discuss some of the best articles in the collection.

Mental Health Matters includes several excellent papers discussing the involvement of users in mental health services. Peter Campbell’s "The history of the user movement in the United Kingdom" provides a much needed analysis of the reasons for the user movement’s emergence and of its future prospects. The user movement emerged as a force in the U.K. in the 1980s and since then has developed rapidly. Campbell argues that the movement’s emergence can be related to increased community care, a new consumerism in health care and an broader culture of "self-help". He also examines links with the 1970s anti-psychiatry movement and civil rights movements.

Peter Barham and Robert Haywards’ paper "The lives of users" chronicles some of the frustrations felt by chronic psychiatric patients who have been discharged into the community. Particularly moving is the account of these patients’ struggle to find value in their lives. The paper shows how only the peculiarly determined can resist being co-opted into a system of psychiatric care that tends to merely relocate hospital life in the community. On leaving hospital, patients find themselves pressurised into attending sheltered work-places and hospital organised social clubs, and into living in group homes. Rather than being rehabilitated into the community, community psychiatric patients can all to easily end up mixing only with other psychiatric patients. Patients are particularly critical of a psychiatric system that tries hard to ensure that patients have something to "fill their time" and somewhere to live, but neglects to concern itself with whether their employment is useful or with whether they actually want to live in their allocated hostels.

Of the papers examining psychiatric practice Janice Russell’s "Treating anorexia nervosa" stands out. Russell explores a dilemma faced by those who must decide whether to employ coercion in the treatment of anorexia. On the one hand, many anorexics bitterly resent the dehumanising practices of coercive therapy, and claim that it is deeply unhelpful. On the other hand, without being forced to eat some anorexic patients may well die. In addition, the effects of starvation on the brain may be such as to prevent patients from being able to think rationally, thus potentially undermining their claimed wish not to eat. Russell proposes no easy answers, but makes vivid the difficulties facing those involved with anorexic patients.

Other papers discuss issues concerning mental health policy and social inequality. In "Mental health and inequality" Roger Gromm argues that an increased risk of suffering from poor mental health is just one of the many health risks borne by the socially disadvantaged. In "Two notions of risk in mental health debates" David Pilgrim and Anne Rogers argue that mental health policy debates in Britain have too often concentrated on risks posed to the public by patients at the expense of considering potential risks to the patients.

Finally I can’t resist mentioning David Rosenhan’s classic paper "On being sane in insane places" which documents his 1975 investigations into the reliability of psychiatric diagnosis. In Rosenhan’s study normal volunteers presented at the admissions desk of mental hospitals complaining that they heard a voice saying "thud", "empty" and "hollow". All volunteers were promptly admitted into the hospital, all but one being given a diagnosis of schizophrenia. Once admitted, the volunteers began to behave normally. However, despite behaving as they normally would, within the setting of the mental hospital the pseudo-patients’ behaviour was perceived by staff as being abnormal. At no point in their hospitalisation did any mental health professional suspect that the volunteers were not insane (although several patients did). Eventually, after stays varying from seven to fifty-two days the pseudo-patients were discharged, not as sane, however, but with diagnoses of "schizophrenia in remission".

Rosenhan’s study makes fascinating reading, implying as it does that psychiatrists can’t tell the sane from the insane. Its publication, in 1975, was a major blow to organised psychiatry. Since then, however, and in part as a result of studies such as Rosenhan’s, psychiatrists have put a great deal of effort into constructing reliable, operationalised, diagnostic classification systems, such as the DSM-IV and ICD-10. As such, it is questionable how much Rosenhan’s study has to tell us about present diagnostic practices. It is possible that Rosenhan’s study could not be repeated today, perhaps because psychiatric diagnosis has been made more reliable, perhaps because there just aren’t as many psychiatric beds – there are rumours that today it can be harder to get into psychiatric hospitals than to get out of them. Here, as with a few of the other papers, greater editorial comment would have been useful to make it clear how the paper is relevant to contemporary debates.

Mental Health Matters includes some very good papers and covers a wide range of issues. Unfortunately, many of the papers assume rather a lot of background knowledge which renders the collection inaccessible to those without some knowledge of mental illness and psychiatric practice. Still, the collection is an excellent source of challenging critiques of psychiatric practice and will be a valuable resource for those interested in mental health issues.

Rachel Cooper is a lecturer in the Department of Interdisciplinary Human Studies, Bradford University, England. She has research interests in the philosophy of science, especially psychiatry, and in 20th century history of psychiatry.

Categories: MentalHealth, General