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Related Topics
Liberatory PsychiatryReview - Liberatory Psychiatry
Philosophy, Politics and Mental Health
by Carl I. Cohen and Sami Timimi (Editors)
Cambridge University Press, 2008
Review by Terry Burridge
Dec 23rd 2008 (Volume 12, Issue 52)

This is a series of essays written by a range of contributors from a variety of countries and a variety of settings. There are twenty two contributors and fourteen essays ranging from Carl Cohen arguing for a radicalization of the science of human psychology and behavior through to Charles Tolman writing about German critical psychology as emancipatory psychology. Other essays include Phil Thomas and Pat Bracken on Power, Freedom and Mental Health; Carles Muntaner et al on Class exploitation and psychiatric disorders; Joanna Moncrieff on Neoliberalism and biopsychiatry. The list goes on and it serves no useful purpose to name all the contributors. The topics cited give the flavor of the book which sits firmly in the Critical Psychiatry camp and is very much a left of centre.

Some of the language is opaque at times. Carl Cohen in his paper comments that "From a structural perspective, individuals can be viewed as having no independent ontological status except as nodes of relations or moments of relationship." (p.21) I have a sense of what Cohen is saying but I very much doubt that any of my students would know what he is saying. Or this quote from Tolman "The concrete generality that would be required of a potentially emancipatory psychology can only be achieved by a method that is developmental and historical. Categories and concepts would remain indeterminate unless they can be conclusively deduced or derived from more certain categories."(P.95) In raise the use of language as an issue because I think it obscures what are important matters. I am unclear who is the target audience for this collection of essays? It certainly is not for the "average" psychiatric nurse or for a student nurse. Yet it is precisely these groups who most need to read these papers. (Perhaps that is one of my functions as a lecturer-to predigest some of these papers and then regurgitate them in a palatable form to my students!) Ramotse Saunders et al's paper on Postcolonialism was fascinating with their notion of the "caliban-ization of the colonial subject". She also asks the important question of self identity in relation to one's patients. Speaking of the immigrant physician, she asks "How does she perceive those immigrant populations-i.e. 'her people'.- and others who are immigrants but not 'her people' who are given as her charges to diagnose and treat?" She then hints at the cost of always wanting / needing to ask these kinds of questions. "Is there any alternative but for the migrant/ immigrant physician to constantly ask these questions, and what damage might their repetition wreak upon the self?" (P.212)

Saunders' question could be asked of this collection of papers specifically and of the whole of the critical psychiatry "movement" in general- what damage is wrought on the self by the constant asking of these questions? As one who has worked as a psychiatric nurse for more than twenty years, I am more than aware of the shortcomings within the system. I know about the overrepresentation of young black men in the mental health system; I am aware of the abuses of a diagnosis of Personality Disorder and the way in which it is mis-applied to women; I do know of the shortcomings of the medical model of psychiatry and have spent most of my professional lives trying to challenge the system where possible. And, like Saunders, I am aware of the cost of this perpetual questioning. But… there are wards full of people who need looking after; there are meetings to attend; ward rounds to manage etc. all the business of psychiatric life needs attention. It is then very difficult to balance these conflicting demands. To be a part of the system whilst being at the same time being critically aware of its shortcomings. I recognize the philosophical points made by the contributors as a critique of a system; what I do not recognize is the way in which this critique appears on wards or in community care. The average nurse; doctor or occupational therapist does not spend their time consciously seeking to oppress their patients-although there are dishonorable exceptions to this rule.

So, the question I am left with is twofold. The first part is "Who is this book aimed at?" It is hard reading and often couched in a language shared by academics rather than shared with a more general readership. I cannot imagine too many nurses wanting to read these essays -- which is a shame, because it is so pertinent to nursing.

The second part of the question is "Why was it written?" which perhaps only echoes the first question.

Finally I found myself saddened that this book could still be produced in 2008 and still be relevant, despite all the work that has been done within psychiatry to make changes. It is an excellent series of essays which I enjoyed reading and which I shall pass on to my students. Perhaps when they have been nursing for twenty years and more this book will be seen as an interesting archaeological relic typical of a bygone age of psychiatry. One can hope!

© 2008 Terry Burridge

Terry Burridge is a Senior Lecturer in Mental Health Nursing at Buckinghamshire New University. He has spent most of his professional life as a psychiatric nurse and now spends considerable time and energy trying to inspire future psychiatric nurses to be the best kinds of nurses that they can be! He is very much influenced by psychoanalytic thinking and sees analytic theory as offering a valuable critique to many other areas of human activity. He can be contacted at Terry@dancingbears.co.uk


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