José Guimón is a psychiatrist at
the University of Geneva Medical School.  In the Foreword, Otto Kernberg says Guimón
is one of the most prestigious European psychiatrists, so we might have high
expectations of this book, especially considering the fascinating title. Relational
Mental Health: Beyond Evidence-Based Interventions would seem to promise an
investigation of the relational factors that cause mental illness, and an
examination of the limitations of evidence-based approaches. Given the trends
of modern psychiatry to be dominated by neuroscientific and genetic approaches,
restricting treatments to those that have been proven effective by rather crude
scientific measures.  Yet Relational Mental Health is a strange and
unsatisfying book.

The book is divided into 31
chapters over 414 pages, making each chapter about 13 pages on average.  The
first puzzling feature is that there is no introduction explaining what Guimón
aims to accomplish in the book.  Each chapter is quite self-contained, with its
own list of references at its end.  From a theoretical viewpoint, the first ten
chapters are the most important, since they set out the basic approach of the
book, and then the subsequent chapters examine particular disorders and
treatments.  However, even in those first chapters, it is far from clear what is
Guimón’s main thesis, and his argument seems vague and contentious. 

For example, the title of the
second chapter asks "Is Mental Health Founded on Truly Scientific
Conceptions?"  Guimón provides his answer in five pages of text.  He
refers to the distinction between explanation and understanding, and sets out
the growth of evidenced-based psychiatry.  Then, in one page, he asserts that
many psychiatrists have reservations about the approach because of limitations
in its methodology, "such as gaps in interpreting the available evidence
and neglect of individual patient uniqueness in quantitative research through manualised
treatment procedures" (p. 14).  After also referring to some other
problems with the implementation of scientific procedures in mental health, he
refers to some new models of research proposed by researchers such as Margison,
Lutz et al., Barkham, Kendall and Mundt and Backenstrass, all in one
paragraph.  Presumably Guimón endorses these approaches, although he doesn’t
say this explicitly.   Presumably he is not answering the chapter’s question
with a yes or no, but that isn’t clear either. 

Chapter 3 sets out some of standard
approaches to vulnerability to mental illness and concludes that mental health
"is the result of an adequate functioning of the complicated homeostasis
mechanisms described herein" (p. 29).  Yet Guimón says nothing about what
role this view about mental health plays in the overall argument, nor what
views he is opposing.  This leads into Chapter 4, the largest of the book at 24
pages, on "Theories and Ideologies in Mental Health."  Here he sets
out the opposing biological and psychological approaches in psychiatry,
contrasting the medical model with psychodynamic concepts and what he calls the
"social model."  In setting out the social model, he refers to
general systems theory and the antipsychiatric critique of psychiatry.  Then he
sets out what he calls "political-administrative approaches" which he
sees most exemplified in American managed care.  He moves on with some
discussion of how to integrate the different perspectives he has set out, yet
remarkably he does not even mention the biopsychosocial model and he provides
no exhaustive discussion of how to relate the different views.  His concluding
discussion here addresses family therapy, social theories, and general systems
theory, which he seems to provide a way of solving many problems in theoretical
psychiatry, including the mind-body problem, but is remains utterly obscure
exactly how this idea would work out in detail. 

There follow two chapters on
relational aspects of mental health, discussing psychological and social
factors in turn.  First he discusses phenomenology, then Freud and
post-Freudian psychoanalytic theorists, and finishing with Erich Fromm and
Harry Stack Sullivan.  His rapid survey highlights the relational aspects of
those theorists’ approaches.  The next extremely brief chapter mentions some
cultural differences in behavior, with half a page on general systems theory,
and some summary of Ruesch’s views about communication in psychiatry.  The chapter
after this talks about descriptive psychopathology, experimental
psychopathology, and Galileo’s experimental method.  It is quite mysterious
what ideas are meant to hold the chapter together. 

Two chapters on relational
assessment follow, with one on dynamic aspects and the other on social
aspects.  The first is more like a set of notes than a coherent argument,
listing different approaches to patient assessment in psychodynamic theory, and
the second is similar, applied to epidemiology and sociology.  It doesn’t seem
that any general claim is being made here.

The most interesting chapter is the
tenth, on relational diagnosis.  Guimón makes some introductory comments on
psychoanalysis, but they mainly point to the fact that this approach does not
focus much on detailed diagnostic categories.  Then he addresses the question
whether it is possible to apply diagnoses to families and larger groups,
including social networks and health care systems.  Concerning families, Guimón
outlines some ideas of Ackerman, Minuchin, Bowen and Garcia Badaracco.  Guimón
says very little to evaluate or assess the different ideas he mentions, leaving
the reader unclear at to what position he is taking.  He goes through a similar
process in discussing the diagnosis of social networks and institutions. 

Given the limitations of Guimón’s
writing, it is impossible to recommend Relational Mental Health as
anything more than a collection of references to the relevant literature,
especially work by European authors that may be unfamiliar to those trained in
the English-speaking world.  It is hard to understand how the publisher’s
editors allowed such an incoherent book to be published.  There is a real need
for a contemporary book addressing relational issues in mental health, setting
out the available evidence and examining the theoretical issues, trying to see
how important approaches such as systems theory fit with more popular
approaches in biological psychiatry.  At the very least, such a book needs to
set out a main claim and defend it.  Unfortunately, Guimón’s book does not do
this.

© 2005 Christian
Perring. All rights reserved. 

Christian
Perring, Ph.D., is Academic Chair of the Arts & Humanities
Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also
editor of Metapsychology Online Review.  His main research is on
philosophical issues in medicine, psychiatry and psychology.

Categories: MentalHealth, Psychology