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Related Topics
Psychiatry in SocietyReview - Psychiatry in Society
by Norman Sartorius, Wolfgang Gaebel, Juan Jose Lopez-Ibor and Mario Maj
John Wiley & Sons, 2002
Review by Mark Welch
Jun 30th 2002 (Volume 6, Issue 26)

This book, consisting on eleven chapters each dealing with an aspect of “the interaction between psychiatry and a particular set of social factors”, is based, in part, on presentations delivered at the 11th World Congress of Psychiatry held in Hamburg in August 1999. It is also, as the editors suggest, as much about society in psychiatry as psychiatry in society. Indeed, as Sartorius himself has noted, all psychiatry is social; there is, or rather should be, no need, for a specialist label of social psychiatry.

The editors have brought together a range of international authors who are eminent, experienced and well credentialled in their field. And each one takes on a particularly contentious issue. Thus, this is not a text for those just wishing to learn of the latest advances in clinical trials or pharmacology or neuro-science, but it is one for those who wish to consider deeper and fundamental issues that go to the heart of the place and value of psychiatry in our present world. It places psychiatry, its concepts and practice, firmly within a social, economic, political and ethical context. It considers, especially in areas such as globalization, refugees, mass media and health policy, the ethics, contexts and consequences of our choices of practice in the world.

Benedetto Saraceno, Shekar Saxena and Pallab Maulik from the WHO in Geneva argue that the mental health interventions following conflict are not only becoming more and more pertinent as the world population of refugees and Internally Displaced Persons grows and the affluent countries of the West shut their doors to them, but also because in the past such treatments have been based more on faith than evidence. Glyn Lewis and Ricardo Araya from the University of Wales draw together the growth of globalization and the ever-convincing data that poverty and poor mental health are completely intertwined and so single country initiatives and policies are no longer sufficient. Olga Cuenca from Communications Consultancy, Madrid considers the role of the mass media in the production and support of social constructions of mental illness. She seriously considers the effect of newspaper headlines and representations in movies and shows again that psychiatry and society are completely indivisible.

Some of psychiatry’s cherished nostrums are also challenged, or at least reviewed. Paul Bebbington from University College London laments that although the principle of providing community mental health care through multi-disciplinary teams is “generally accepted ….(still) the best way of doing it remains unclear”. Heinz Katschnig and Monika Krautgartner from the University of Vienna consider the adoption of quality of life measures as the therapeutic imperative, rather than the treatment of symptoms and disorders. Ahmed Okasha from Ain Shams University, Cairo proposes an ethical practice based negotiation rather than monological dominance. For him this means “communal and political activity, in the broadest sense” in a postmodern world shorn of the certainties of the past.

Certainly, some of the contributions are a little polemical, but that is no bad thing. The authors want to put forward an argument and stimulate debate, and there is a clearly a place for this. We do live in a pluralist world and with very few exceptions this is the tone of the text. What is perhaps most refreshing is the relaxed and thoughtful approach to topics of serious concern. The authors have responded to the space and opportunity given to them. These essays intend to generate debate, not conclude it. That is seen not only as a necessity, but also as a responsibility. If we are responsible for what we know, then psychiatry must act on what it knows.

In conclusion it can be said that any mental health worker, from any discipline, who is interested in the fundamental concepts that shape our practice will find much food for thought in this volume. They may not agree with everything that is said, but they find it hard to argue that these are not issues of concern. Everyone, from a clinical or academic background, can benefit from a moment of reflection, and this impressive book provides that space, time and context.

 

© 2002 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.


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