Roland Littlewood is already well known for his
contribution to socially contextualised psychiatric literature, and this book
not only reprises some themes, such as its cultural relativity and social
construction, but takes them further by applying an anthropologist’s eye to the
West; this time we (the West) are the exotic, and very peculiar we seem too.

There
are parts of this book that are quite irresistible. He charts a historical
course drawing out the consistent inconsistencies of psychiatric nosology with
a rather amused tone. "Isn’t it all fascinating?" he seems to be saying.
There are great strengths in the ways he blends together insights from other
disciplines to situate psychiatry firmly within the expressions of cultural
values and social mediation that define ourselves to ourselves. From time to
time it might be said that he over-indulges himself, and has an obvious
weakness for a pretty phrase or an obscure word, but that rarely interferes
with the reader’s enjoyment.

He
tackles some particularly significant characteristics of the scope and province of Western psychiatry.
The chapters which deal with incest, and its biological relation, and eating
disorders and body image, and multiple personalities are thought provoking,
well-argued and more than occasionally contentious. His consideration of "genetic
sexual attraction" in incest, particularly apparent in the relations
between birth parents, or sometimes birth siblings, and adopted children
introduces some uncomfortable, but important questions; and some that Western
psychiatry has perhaps sought to avoid. He does not favor psychoanalytic
explanations, and indeed sometimes does not really come to any categorical
conclusions of his own, but he does begin to explore what he terms "a
contingent biological pattern" in such a way that it can neither be denied
nor ignored. His questions always seem to come back to some variant of "Why
should this be like this? What is it about us that makes these things be shown
in these ways?"

His
consideration of eating disorders is less innovative, but he is again
perceptive and quizzical when he addresses the question of multiple
personalities. Is it a fashion? Are they a reworking of an old diagnosis? Why
do they seem so popular in the media? Think of the cinematic representation and
you would believe they are ten a penny. Where lies their attraction to the
public, the patient and the psychiatrist? It may that final point that raises
some of the most pertinent questions. To what extent does psychiatry foster and
encourage such presentations; to what extent are we seeing universals apparent
in every society and how much is it a pathology of the West itself?

He
does not discount that patterns of psychopathology emerge in social contexts,
and that different times and cultures will classify the same behaviors in
different ways. But in the case of multiple personality disorder he does not
examine the treating professionals with quite the same rigor as he does the
profession. He makes clear and persuasive arguments about the cultural shifts
in psychiatric norms and concerns, but it seems he does not really interrogate
the personal kudos of the therapist as much as the social kudos. The
psychiatrist as hero is a phenomenon that can develop a reciprocity between the
exotic and the discoverer. If I am so special that only I can understand this
person or this illness, than I may also shape the behavior, reports,
pathologies of those whose special symptoms only I can understand. Can, or do,
psychiatrists encourage certain sorts of symptom reports from their patients?
Perhaps, if Littlewood had considered this point his analysis would have been
even more penetrating than it is.

It
is an old, but still good, intellectual strategy to ask, "if I was an
anthropologist from Mars, what would I see?" Littlewood does this in an
admirable and engaging way. He would be too modest to be categorical about his
conclusions, and also too grounded to know that this is not just an
intellectual exercise, a good party game and diverting entertainment. As he
says at the end of one chapter, it is "socially compelling because every
now and then a woman dies", and, of course, it could also be said that a
man is devastated or a child suffers. It is a serious subject because it has
crucial, profound, even life-threatening or life-saving consequences. This book
should be recommended for all serious students of psychiatry, and compulsory
for those who are not so serious about their studies.

© 2004
Mark Welch 

Dr
Mark Welch is
currently a Senior Lecturer and Postgraduate Coordinator in The School of
Nursing at the University of Canberra, Australia. His PhD investigated the
representation of madness in popular film, and his other research interests
include the mental health of refugees and victims of torture, and the history
of psychiatric epistemology.

Categories: Psychology