As many readers
will recognise, this is a companion of This
is Madness (the pun attracts attention, doesn’t it?), a book published
in 1999 and which followed in the tradition of critical psychiatry and its
perspective on psychiatric practice and services. Like its predecessor, it is a
collection of essays by practitioners, academics and consumers, some
well-known, others not so, which tackle some of the fundamental preconceptions
about mental health as a concept, and mental health services as an institution.
This is not a new debate, and of course, the very nature of mental illness,
true experience and compromised judgement, is at the heart of it.

Like all such
anthologies, it is a curate’s egg. And while some of the essays are tinged a
little too heavily with unsupported, or at least selective, rhetoric, others
are serious, considered and thought-provoking. At their best the essays share
and reveal a common humanity and explore, without blaming, finger-pointing or
anger, the extraordinary situation that those who suffer from a mental illness,
and those who seek to care for them, are in. At their worst they betray what
seems to be an unresolved anger and self-definitional victim status. The
appellation of survivors of the mental health system is something worthy of
deconstruction itself.

The common
humanity is perhaps best shown by Bucknall and Holmes’ chapter on relatives and
carers in which the tensions and dilemmas that living with a severe mental
illness are delicately and sensitively explored. Some others, perhaps like
Peter Breggin’s familiar approach to the drug treatment of children, tend
towards the didactic and selective.

The book is not a
text book. It is not an authoritative account of the territory. It is however,
provocative, deliberately so, and ultimately, in the final chapters, a call for
partnerships and mutuality in mental health. It is not a simple situation and
there are no simplistic answers, as some chapters might suggest. Mental illness
is a terrible thing, it is a real and sometimes devastating experience, and is
not something that can be lightly discounted as the result of social
oppression. The essays rarely give much credit to ordinary practitioners who
are really and truly trying to do their best in the face of tremendous
difficulties and often severe ethical dilemmas. Some of that, however, is
resolved at the end. The mutual respect for different levels of types of knowing
is an important element in the formation of a therapeutic relationship, and
relationships are clearly seen as the essence of psychiatric care.

Wallcroft and Michaelson,
in the final chapter, develop what they call the SPIRAL Model (Systematic
Prevention, Recovery and Learning) and out of these learning may be the
most neglected. It is out of learning from the experience, from extracting some
sense of meaning or understanding, that individuals, be they sufferers, carers,
relatives or professionals can move beyond the stagnation of victimhood. It is
through this that individuals can reform and reconstruct their own sense of
self and place in and to the world. If that one thought comes from this book,
then it is worthwhile, but I suspect that for many readers the strident tone,
and aggressive attack of some of the chapters will make them, like the curate,
discreetly place the less palatable bits in a handkerchief to be disposed of
later.

© 2003
Mark Welch 

Link: Publisher’s
web site.

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: Philosophical, MentalHealth