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Relational Mental HealthReview - Relational Mental Health
Beyond Evidence-Based Interventions
by Jose Guimon
Plenum US, 2004
Review by Christian Perring, Ph.D.
May 28th 2005 (Volume 9, Issue 21)

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.


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