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Contesting PsychiatryReview - Contesting Psychiatry
Social Movements in Mental Health
by Nick Crossley
Routledge, 2006
Review by Elisabetta Sirgiovanni, Ph.D.
Oct 17th 2006 (Volume 10, Issue 42)

The entire history of psychiatry is a one of struggle and contention. Contesting Psychiatry focuses on this aspect and analyses the history of psychiatry as a bottom-up process from society to psychiatry. As a matter of fact, the period of time it analyses (from 1950 to 2000), is a period in which contention between society and psychiatry, centered upon issues of power and control, gave rise to a deep and overt transformation of conceptions, practices and treatments in mental health system. Therefore, the book proposes a roundup of British social movement organizations against psychiatry from a sociological and historical perspective in order to give reasons for that profound shift in psychiatric field in 20th century.

Social movements against the psychiatric orthodox view are presented as expressive of a collective sentiment within some part of society which expresses either demand for change or resistance to change. Their history shows how they constructed their domain (issues, language and assumptions) as a concrete embodiment of thought processes which generated a real esprit de corps among their members. Nevertheless, following Zald and McCarthy (1994)'s model, Nick Crossley, author of this book, does not conceive social movements as agents or actors within society until they are taken up by social movement organizations (SMOs), which are considered economic in inspiration. Furthermore, even though he remarks that political mobilization presupposes a utilization of scarce resources, he does not share rational action theory in the utilitarian terms for social organizations, a theory which tends to ignore cognitive factors.

Crossley enriches Zald and McCarthy's model thanks to the notion of a culturally generative 'field of contention' in order to determine a movement discourse and culture. Then he identifies movement network structures to show the interaction within fields.

In order to explain emergence, survival and decline of fields, SMOs and movements, Crossley chooses a version of the 'value-added model' proposed by Smelser (1962). Movements are analytically explained in each chapter by means of a list of six peculiar elements: structural conduciveness, structural strain, discursive formation and diffusion, trigger events, mobilizing structures and intervention of third parties. This kind of explanation contributes to clarify the endemic dynamism of mental health field, constantly informed by different theoretical impulses and aspirations.

After an introduction that takes the early three chapters and presents the sociological background of the book, the adopted theoretical models and a schematic history of psychiatry, the author offers the history of social movements and their organizations in different eras. Social communities contesting psychiatry, although inspired by different approaches, contribute to that profound transformation in psychiatry from asylum to heterogeneous form of provision, guaranteeing an increase of people receiving help, a shift in the balance of problems and a shift in the social character of patients.

The central chapter is dedicated to the social movement whose influence and effects on all psychiatry was as evident as deep-rooted: the anti-psychiatry movement. Undoubtedly, this chapter is the most interesting. Its centrality in the text (it is the fifth of nine chapters) is a mirror of its undeniable centrality in the history of psychiatric contention. Anti-psychiatry era determined that every social movement in psychiatric field that came next needed to adopt a definite position regarding anti-psychiatric ideas. As a matter of fact, the chain of reaction to which it gave rise is still running.

It emerges from the book is that anti-psychiatry was the first social movement from the patient perspective. The view of mental illness as linked to industrialization and urbanization was a persistent theme from early protests in 1930s. Nevertheless, mental hygiene exponents showed a critical bourgeois attitude against morale decline of working class lifestyle, which was considered the main source of mental disorders.

Anti-psychiatry also influenced the birth of the liberal current in psychiatry, a more politically involved movement on civil right discourse and the emergence of patient unions. Its biggest effect was the Italian Democratic Psychiatry, which developed a Marxist alienation discourse without questioning, as anti-psychiatry did, the existence of mental illness or the use of physical treatments. Democratic Psychiatry had a considerable impact in the UK on disillusioned anti-psychiatrists. Finally, the history of social movements in UK is a history of consolidation and backlash of anti-psychiatry discourse.

In conclusion, the value of this book is in its history of contemporary psychiatry from the perspective offered by the history of British social movement organizations in mental health field, thanks to an analysis which focuses upon processes, interactions and relations among them.

Concentrating on historical and sociological facts, the explanation of theoretical approaches that steered organizations is sometimes brief and excessively schematic. However, as the author himself observes, the limits of the book are most of all empirical and the biggest one is that this book offers only a national level description.

Notwithstanding these general considerations, Contesting Psychiatry is a potted but useful guide to understand the interaction between British society and psychiatry in the previous century.

 

2006 Elisabetta Sirgiovanni

 

Elisabetta Sirgiovanni, Ph.D. in Cognitive Science, University of Siena, Siena, Italy.


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